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Re: Tubal Pregnancy--management From: art fougner, md (evsono@pipeline.com) Sat Jan 19 11:20:43 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: AllanHo@aol.com: "Re: Tubal Pregnancy--management" Previous message: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Tubal Pregnancy--management" In reply to: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Tubal Pregnancy--management" Next in thread: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Tubal Pregnancy--management" Reply: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Tubal Pregnancy--management" Reply: Joanne Bulley, MD: "Re: Tubal Pregnancy--management" Reply: Efrain Ramirez: "Re: Tubal Pregnancy--management" Reply: Terrence.Jones@kp.org: "Re: Tubal Pregnancy--management" A word of caution for those who would give MTX in a stable patient simply because their HCG comfort zone has been exceeded - Multiple Pregnancy. Levels of HCG may be significantly elevated prior to first visualization on sonar. Having recently seen this situation, I urge all to keep this in mind, prior to interrupting an early twin intrauterine pregnancy. Of course, that's just my opinion. I could be wrong. Art At Sat, 19 Jan 2008, Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. wrote: > >At Sat, 19 Jan 2008, Garry E. Siegel, M.D. wrote: >> >>20 YO P0, seen in ER and office as follows: >> >>1/13--acute abdominal pain requiring narcotics, got better. Exam per ER >>MD negative, HCG 1300, Hemoglobin 15, ultrasound empty uterus and 3 cm. >>cyst left side. >> >>1/15--asymptomatic except spotting, HCG 1900, Hemoglobin 15, negative >>exam by me. Ultrasound no change. >> >>1/18--HCG now 2800 from 1/17, progesterone 5.4 from 1/17, exam and >>ultrasound unchanged. >> >>Would you have made a dispostion on 1//15? >> >>If so, what? >> >>If not, now it is 1/18 and I made a dispostion. >> >>Would you: >> >>1. D and C, frozen section, and scope if negative? >>2. D and C, await pathology, give methotrexate? >>3. Give methotrexate primarily? >> >>More to discuss once replies come in. . . >> >>Garry > >First I get the feeling this is a very wanted pregnancy, in which case I >would also have done nothing on the 15th.; 1300 -1900 is not good but I >have seen normal pregnancies with similar changes. > >I would have gone with D&C and scope, I don't find frozen section very >helpfull. Having had to take care of about half a dozen MTX disasters >in the the last decade, I don't feel comfortable using it in my practise >setting. > >I recently had a similar case, BHCG 1000-1500 -1700, Q 2daily then 1700 >again, told patient not looking good. brought in for D&C and scope; D&C >looked like mostly deciduia so scoped and saw normal tubes but had a >small fibroid 3cm fibroid on back wall of uterus, I thought it was a >septum on D&C, in view of normal tubes repeated D&C concentrating >suction behind the fiboid and got more tissue. Yes the pregnancy was >stuck behind and to the side of the fibroid. > >-- > Take care, John > -- art fougner, md "May The Wings of Liberty Never Lose a Feather." - Jack Burton Next message: AllanHo@aol.com: "Re: Tubal Pregnancy--management" Previous message: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Tubal Pregnancy--management" In reply to: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Tubal Pregnancy--management" Next in thread: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Tubal Pregnancy--management" Reply: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Tubal Pregnancy--management" Reply: Joanne Bulley, MD: "Re: Tubal Pregnancy--management" Reply: Efrain Ramirez: "Re: Tubal Pregnancy--management" Reply: Terrence.Jones@kp.org: "Re: Tubal Pregnancy--management"

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