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Re: Case / question to the list: PLEASE LET ME KNOW YOUR OPNIONSFrom: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. (johnprov@sympatico.ca)Tue Dec 23 05:02:35 2003
Brick I don't fault you for being overly diligent in the medico legal climate we must practice. But if you make it the standard of care that a women with a beta of 2300 and a -ve vag u/s should be treated as an ectopic and followed up within 24-48hrs don't be surprised if you fall victim to it. We get judged with the retroscope the last thing we need is to be setting unrealistic standards. Personally I don't think the use of vaginally U/s has changed the management of ectopics much, and unfortunately it can do some harm, over the last decade I have seen a half dozen cases of ectopics treated with methotrexate elsewhere that end up in my E.R. passing trophoblast vaginally or needing a D&C for bleeding and retained products. Most women who are unsure of their LMP and have infertility for 18 months are anovulatory and I am not sure I would consider that a high grade risk factor for tubal infertility and ectopic.
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Take care, John
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