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Re: Cervical Pregnancy From: Kleinman, Dr. Gary E. (pg1kle@bpthosp.org) Tue Apr 17 16:38:43 2001 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Geffrey Klein, MD: "Re: Defining Immediately Available" Previous message: Bruce Speyer: "virus on ob-gyn-l?" Maybe in reply to: jafar6: "Cervical Pregnancy" Next in thread: Paul Prior MD: "Re: Cervical Pregnancy" Reply: Paul Prior MD: "Re: Cervical Pregnancy" >Why are you changing course now? -- >Paul Prior MD >Coshocton, OH >Solo Practice >OB/GYN, FACOG Good question. 1. Severe nausea and vomiting after one dose of MTX. 2. Multiple doses of MTX probably necessary for 8 week live gestation with hCG > 50,000 U. 3. Patient autonomy...she thought this (D&C) would be preferable to weeks to months of treatment and follow-up. Patient could not afford much more leave. 4. H&H dropping on current regimen. Patient would probably need several units of blood soon to continue 5. Many articles which describe success with foley bulb tamponade, cervical cerclage, radiographic embolization, pitressin, etc. We had all of this available and ready. 6. We were prepared to remove her uterus if necessary. Bilateral catheters were inserted under angiographic guidance to use in case embolization was necessary. Cervix was injected with pitressin. A cerclage was placed around and not tied. The cervix did not require dilitation. It was wide(large in all dimensions) and very soft. A #8 catheter was inserted and using suction curettage only, the products of conception were aspirated. The cerclage (#1 Dexon) was tied over a uterine sound). Bleeding was less than average for a routine termination of pregnancy. The bilateral femoral catheters will remain in place until tomorrow. Thanks for your help. Gary Kleinman Next message: Geffrey Klein, MD: "Re: Defining Immediately Available" Previous message: Bruce Speyer: "virus on ob-gyn-l?" Maybe in reply to: jafar6: "Cervical Pregnancy" Next in thread: Paul Prior MD: "Re: Cervical Pregnancy" Reply: Paul Prior MD: "Re: Cervical Pregnancy"

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