Re: The pregnancy that wasn't
From: art fougner, md (evsono@pipeline.com)
Wed Jul 31 13:29:36 2002
patient wasn't pregnant - your case illustrates the utility of
ultrasound as the pregnancy test. if nothing on ultrasound - can always
dip urine. recognizable fetal pole yields a measurable crown rump
length and an edc.
just my opinon - i could be wrong.
art
At Wed, 31 Jul 2002, maggiecnm wrote:
>
>I apologize for the length of this post but it's a complicated story.
>Recently had a very strange thing happen and after beating myself black
>and blue I've decided to seek some opinions on this.
>A 42yo G3P1011 came to see my partner for a new OB visit. LMP 3/20, no
>bleeding since. Was 12 weeks by LMP at time of visit. Lady was thin,
>but had a large (2" wide) and thick vertical scar on the abdomen from a
>C/S 24 years ago.
>Hx was sig. for Hep B exposure, drug use, and an HIV+ partner. She had
>tested negative, but did not practice safe sex.
>On exam, my partner thought she heard FHT but it was intermittent at
>best.
>After discussion, we decided this patient was not appropriate for us to
>care for due to the high risk nauture of her pregnancy and that we would
>transfer her to the SCC clinic at the tertiary care center here.
>She came back to see me, and on exam,I felt what appeared to be a S=D
>uterus and an intermittent FHT. Pt agreed to be transferred. Partner
>was very angry with her for having disclosed his HIV status but seemed
>to accept my explanation that it was necessary for her and the baby's
>health to be honest.
>Now here is the kicker. 5 days later she presents at an Urgent care
>center after hurting her back. She tells them she is pregnant....they
>do a scan and no baby. (per the resident only a small "clot" in the
>uterus). No bleeding reported, no nothing. And a neg UPT.
>My partner is convinced that she aborted the baby the next day after I
>saw her but I do not think so....UPT would still be positive. In
>checking her records, it appears that she never had a UPT or HCG in our
>office but simply told the nurse she was pregnant and began prenatal
>care.
>Naturally I feel like a total idiot.....Was I feeling bowel or adhesions
>from the scar? And what did I hear? I have never had this happen before
>( I do early u/s for any questions about dating or not hearing an FH
>when I think I should) and have felt lots of pregnant tummies in my
>time.
>I have not been able to get in touch with the patient (no phone) but am
>very concerned about her- we should find out why she hasn't had a period
>in 4 months and make sure there isn't something else wrong. And I want
>to get to the bottom of this.
>Any thoughts on this? I've already accused myself of everything from
>general stupidity on up so don't worry about hurting my feelings! I do
>believe there was an immaculate conception once but spontaneous
>disappearance?
>
>--
>Maggie, CNM
>
--
art fougner, md
ich bin ein New Yorker
