Re: Failed tubal ligations
From: Efrain Ramirez (eramirezt@coqui.net)
Sun Feb 11 09:31:03 2007
That's another very viable, reasonable option.. if the patient
understands what we are talking about..
Ef
>At Sun, 11 Feb 2007, art fougner, md wrote:
>
>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
>>> >>>> >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.
>>> >>>> >
>>> >>>> >-----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
>
--
“ The greatest obstacle to knowledge is not ignorance,
it is the illusion of knowledge.” Daniel J. Boorstin - Historian
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