Re: Abnormal implantation location!
From: Dr. Rupak Ranjan Roy (rupakroy@vsnl.com)
Mon Apr 9 21:50:02 2001
Deviating from the actual question - why did she have a scan so early particularly if she was asymptomatic? Was it to reassure the patient to rule out another miscarriage?
It did turn out to be extremely helpful in this case - but is this your routine practice?
--
Rupak Ranjan Roy
MRCOG
>----- Original Message -----
From: "Garry Siegel" <garrys@mindspring.com>
To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@mail.medispecialty.com>
Sent: 10 April 2001 03:16
Subject: Ob: Abnormal implantation location!
> 30 YO P0010 is now 7 weeks pregnant.
>
> In her first pregnancy, she had spotting that led to a diagnosis of a
> missed Ab at 8 weeks, terminated by uncomplicated D and C in 4/99.
>
> In 10/2000, she had a LEEP for CIN 3 with clear margins.
>
> She is now 7 weeks pregnant, and was brought in prior to her first Ob
> visit with me for an ultrasound to assess viability at 6.5 weeks. The
> sonographer suggested that it represented a possible cornual pregnancy,
> and sent her to the MFM for a scan (I was in surgery and couldn't review
> at the time). The MFM scan concurred, raising the questions as to
> whether this was a cornual versus a right horn pregnancy in a bicornuate
> uterus. The MFM was quite concerned with the lack of thick myometrium
> surrounding the gestational sac, and after discussion, she had an MRI.
>
> The MRI clearly shows a right horn pregnancy (the original
radiologist's
> report says the same, as do several that I reviewed the pictures with
> today on site), with 5 mm of myometrium surrounding the gestation.
>
> PS--I've not yet seen this woman, and she is coming in tomorrow. For
> the sake of discussion, let's call her asymptomatic and desirous of the
> pregnancy (she is!).
>
> MFM number one is fearful of uterine rupture, and suggests D and C soon
> (scheduled in a couple of days), with ultrasound guidance. MFM number
> two, who has reviewed the scan and the MRI report, says just peek with a
> lapscope, and if it looks bad, D and C if you can with lapscope
> guidance.
>
> My plan was to D and C with ultrasound and lapscope guidance (the
> ultrasound to make sure the uterus is empty, and the laparoscope to
> watch from above). We also kicked around methrotrexate and misoprostol
> (didn't kick around RU 486), and were a bit worried about "blowing out"
> the uterus with uterotonics.
>
> This is a tough one; no one wants to terminate a "good" pregnancy, but
> no one wants here to present at 18 weeks with a rupture uterus in shock
> requiring a laparotomy, either. Furthermore, to follow her with serial
> scans/MRIs might make a potential easy solution (D and C now) a
> difficult one.
>
> Any thoughts welcome; it is Monday 1700 Eastern time, and she's coming
> in Tuesday AM 1130.
>
> Garry
>
> --
> Garry E. Siegel, M.D., F.A.C.O.G.
> Roswell, GA
> Private Practice
>
