Re: Abnormal implantation location!
From: art fougner, md (evsono@pipeline.com)
Tue Apr 10 11:55:59 2001
Garry -
is the gestational sac at all contiguous with the endometrial echo or
cavity? if so, start with D&C under sonar guidance. If not - Scope!
agree that Now is the time, given the facts presented. if possible are
any of the images available for the ultrasound section?
just my opinion - i could be wrong.
art
At Mon, 9 Apr 2001, Braun, R. Daniel wrote:
>
>5 mm of myometrium???? Are we sure this is a horn and not a tube???? Only
>5 mm around the pregnancy says something needs to be done. Maybe start with
>D&C with US. If it is emptied nicely wait til no longer pregnant and do
>Laparoscopy then to get idea of what is there and plan definitive corrective
>surgery later.
>
>Dan
>
>-----Original Message-----
>From: garrys@mindspring.com [mailto:garrys@mindspring.com]
>Sent: Monday, April 09, 2001 4:46 PM
>To: Multiple recipients of list OB-GYN-L
>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
>
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
