Re: Failed tubal ligations
From: art fougner, md (evsono@pipeline.com)
Sun Feb 11 08:53:45 2007
Why not follow this obviously stable patient with sonograms ( provided
you trust the abilities of your sonographers) until the location of the
pregnancy is confirmed? I have seen at least a dozen cases now of
purported ectopics treated with MTX only to learn the pregnancy was
intrauterine. Is your patient currently symptomatic?
Art
At Sun, 11 Feb 2007, R. Daniel Braun wrote:
>
>Why not do a Menstrual aspiration in the office?????
>Dan
>
>On 2/10/07, Garry E. Siegel, M.D. <garrys@mindspring.com> wrote:
>>
>> You are right--I should have mentioned to let the HCG get higher, maybe
>> 2000, then scan and then, when all points to the diagnosis, go to the
>> OR.
>>
>> I could also accept simply doing a curettage, and if negative for villi,
>> then methotrexate. Many of my patients prefer to go ahead and have a
>> concurrent lapscope since they're already there, though it may be how I
>> present it.
>>
>> Garry
>>
>> At Sat, 10 Feb 2007, Efrain Ramirez wrote:
>> >
>> >Garry - I am not a laparoscopist - don't you think that you can
>> >miss..i.e see "nothing" with a very small ectopic --? Why not to medical
>> >treatment?
>> >Vasectomy would be another alternative if appropriate.. avoiding
>> >surgery, anesthesia.. just my opinion.
>> >
>> >Ef
>> >
>> >>At Sat, 10 Feb 2007, Garry E. Siegel, M.D. wrote:
>> >>
>> >>Andrew:
>> >>
>> >>It is my guess based on what I've heard so far.
>> >>
>> >>In my prior post, I suggested a D and C and Lapscope/TL--you can solve
>> >>it all in one setting.
>> >>
>> >>Garry
>> >>
>> >>At Sat, 10 Feb 2007, Andrew Folley wrote:
>> >>>
>> >>>What is your proof again, that it is an ectopic and not a noviable IUP?
>> >>>
>> >>>>From: garrys@mindspring.com (Garry E. Siegel, M.D.)
>> >>>>Reply-To: ob-gyn-l@obgyn.net
>> >>>>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>> >>>>Subject: Re: Failed tubal ligations
>> >>>>Date: Fri, 9 Feb 2007 12:28:35 -0600
>> >>>>
>> >>>>It's an ectopic!
>> >>>>
>> >>>>Garry
>> >>>>
>> >>>>At Fri, 9 Feb 2007, Elrod, Darryl G Maj 48 MDOS/SGOBO wrote:
>> >>>> >
>> >>>> >Maybe not 100% but the quants are slowly rising, she has passed what
>> >>>> >path called a deciualized cast and she continues to bleed. Based on
>> >>>> >that scenario I would find it hard to suggest that this is a normal
>> >>>> >pregnancy.
>> >>>> >
>> >>>> >As is said here often...but I could be wrong.
>> >>>> >
>> >>>> >Glen
>> >>>> >
>> >>>> >//SIGNED//
>> >>>> >
>> >>>> >D. Glen Elrod, Maj., USAF, MC
>> >>>> >
>> >>>> >Obstetrician/Gynecologist
>> >>>> >
>> >>>> >Chief of Obstetrics
>> >>>> >
>> >>>> >48 MDOS/SGOBO
>> >>>> >
>> >>>> >RAF Lakenheath, England
>> >>>> >
>> >>>> >Telephone DSN: 314-226-8130
>> >>>> >
>> >>>> > Comm: +44 (0) 1638 52 8130
>> >>>> >
>> >>>> >Notice of Confidentiality
>> >>>> >Under the Privacy Act of 1974, you must safeguard all information
>> >>>> >reflected on this e-mail and, if applicable, all attachments.
>> >>>> >Disclosure of information is IAW AFI 33-119, AFI 33-127, AFI 37-131,
>> AFI
>> >>>> >37-132, AFI 33-219, and PL 93-579"
>> >>>> >This e-mail message including any attachments is for the sole use of
>> the
>> >>>> >intended recipient(s) and may contain confidential and privileged
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>> >>>> >prohibited. If you are not the intended recipient, please contact
>> the
>> >>>> >sender by reply e-mail and destroy all copies of the original
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>> >>>> >Any questions pertaining to disclosure should be directed to the
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>> >>>> >officer.
>> >>>> >
>> >>>> >-----Original Message-----
>> >>>> >From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
>> art
>> >>>> >fougner, md
>> >>>> >Sent: Friday, February 09, 2007 1:37 PM
>> >>>> >To: Multiple recipients of list OB-GYN-L
>> >>>> >Subject: Re: Failed tubal ligations
>> >>>> >
>> >>>> >Are you certain this patient has an ectopic?
>> >>>> >
>> >>>> >Art
>> >>>> >
>> >>>> >At Fri, 9 Feb 2007, Elrod, Darryl G Maj 48 MDOS/SGOBO wrote:
>> >>>> >>
>> >>>> >>I have a gal that I did a c-section tubal on 8 months ago (with
>> path
>> >>>> >>specimens showing tubal segments) that now has a positive home
>> >>>> >pregnancy
>> >>>> >>test.
>> >>>> >>
>> >>>> >>Repeat quants have been 191, 282, and 390 at 48 hr intervals. Pt
>> is
>> >>>> >>without symptoms.
>> >>>> >>
>> >>>> >>My presumption is that this is an ectopic based on the history and
>> the
>> >>>> >>abnormally rising quants.
>> >>>> >>
>> >>>> >>My plan would be to give her methotrexate now to treat the ectopic.
>> >>>> >>
>> >>>> >>When you any of you consider doing l/s to repeat the
>> tubal? Now? 6
>> >>>> >>weeks?
>> >>>> >>
>> >>>> >>Thanks,
>> >>>> >>
>> >>>> >>Glen
>> >>>> >>
>> >>>> >>//SIGNED//
>> >>>> >>
>> >>>> >>D. Glen Elrod, Maj., USAF, MC
>> >>>> >>
>> >>>> >>Obstetrician/Gynecologist
>> >>>> >>
>> >>>> >>Chief of Obstetrics
>> >>>> >>
>> >>>> >>48 MDOS/SGOBO
>> >>>> >>
>> >>>> >>RAF Lakenheath, England
>> >>>> >>
>> >>>> >>Telephone DSN: 314-226-8130
>> >>>> >>
>> >>>> >> Comm: +44 (0) 1638 52 8130
>> >>>> >>
>> >>>> >>Notice of Confidentiality
>> >>>> >>Under the Privacy Act of 1974, you must safeguard all information
>> >>>> >>reflected on this e-mail and, if applicable, all attachments.
>> >>>> >>Disclosure of information is IAW AFI 33-119, AFI 33-127, AFI
>> 37-131,
>> >>>> >AFI
>> >>>> >>37-132, AFI 33-219, and PL 93-579"
>> >>>> >>This e-mail message including any attachments is for the sole use
>> of
>> >>>> >the
>> >>>> >>intended recipient(s) and may contain confidential and privileged
>> >>>> >>information. Any unauthorized review, use, disclosure or
>> distribution
>> >>>> >is
>> >>>> >>prohibited. If you are not the intended recipient, please contact
>> the
>> >>>> >>sender by reply e-mail and destroy all copies of the original
>> message.
>> >>>> >>Any questions pertaining to disclosure should be directed to the
>> >>>> >privacy
>> >>>> >>officer.
>> >>>> >
>> >>>> >--
>> >>>> >art fougner, md
>> >>>> >"May The Wings of Liberty Never Lose a Feather." - Jack Burton
>> >>>> >
>> >>>>
>> >>>>--
>> >>>>Garry E. Siegel, M.D.
>> >>>>Private Practice
>> >>>>Roswell, GA
>> >>
>> >>--
>> >>Garry E. Siegel, M.D.
>> >>Private Practice
>> >>Roswell, GA
>> >>
>> >--
>> >" The greatest obstacle to knowledge is not ignorance,
>> >it is the illusion of knowledge." Daniel J. Boorstin - Historian
>> >
>>
>> --
>> Garry E. Siegel, M.D.
>> Private Practice
>> Roswell, GA
>>
>--
>R. Daniel Braun, MD FACOG(L) CMT
>Professor Emeritus
>Dept. of Obstetrics and Gynecology
>Indiana U. School of Medicine
>
>R. Daniel Braun
>
> "The way to health is an aromatic bath and scented massage everyday".
> Hippocrates
>
--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
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