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Re: Case / question to the list: PLEASE LET ME KNOW YOUR OPNIONSFrom: Richard D. Kaplan (rkaplan@triad.rr.com)Mon Dec 22 08:12:32 2003
Dear Brick: I would not think that after giving the patient appropriate ectopic precautions (call if you have pain, lightheadedness, etc.) that waiting 72 hours is outside the standard of care in this situation. Certainly it was great for you and the patient to establish an IUP the next day, but what would you have done if you hadn't found an IUP? Richard Kaplan, OB/Gyn Greensboro, NC
> ----- Original Message ----- Listers: I'm looking for any objective opinion for a difference of agreement with another physician / possible lurker on the list: 33 y/o wf G5P2022 with 18mth of unexplained infertility arrives for 1st ob visit 8.5 weeks by dates but unsure LMP. Positive home beta about a week ago per pt. No risk factors for ectopic except unexplained infertility. Pt arrives on a Thursday. Sono by MD on a Medison 530D (a relatively good machine) reveals no IUP; adenexal mass by real time sono reveals adenexal mass that sonographically is a simple cyst with a sono-dense mass which I responded "did that mass have heart beat?". It did not. Quant returns on Friday of 2300. I will say that in my experience, our labs in Atlanta do not match the literature in their discrepancy zone. Thus a quant of 2300 and no gestational sac is not unheard of. In my somewhat sue-happy state. I would like to see the pt the next day (Friday); my associate states he would ideally see the pt 48hrs later, but since that is a Saturday he will wait until Monday. I don't think that is appropriate. Is there anyone out there that can convince me I'm wrong? I have learned a great deal from the list members and I would like some objective insight into a possibly disastrous outcome. Please tell me your opinions; however, I can tell you the outcome. I saw the pt the next day in the office (with a GE 730) and saw an IUP with a gestational sac, and one week later the IUP had FHTs. Thank you all for your insight Brick BIlls MD Alpharetta, GA
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