|
|
 |
 |
 |
|
|
|||
|
||||
|
||||
Re: Would love to have your medical opinions on thisFrom: Frances Wren (fwren@shaw.ca)Thu Apr 17 11:48:50 2008
I wouldn't be doing weekly or bi-weekly HCG's. frances wren
> ----- Original Message ----- I've never routinely done an hCG after D&C/D&E for any pregnancy loss, UNLESS there's some reason - persistent bleeding after the procedure, concern for choriocarcinoma, etc, or if she had a mole. Larry R. Glazerman, MD, FACOG St. Luke's Center for Advanced Gynecologic Care 250 Cetronia Road Suite 305 Allentown PA 18104 484-223-3279 484-223-2830 FAX glazerl@slhn.org On Apr 16, 2008, at 10:55 PM, GIN11153@aol.com wrote: it's a little long but I really would like to know the standards of care around the US and world for my learning experience: This was posted on a list for nurses in response to someone's question about a patient-my replies to an OB/GYN friend of mine are in parenthesis : "In the case you posted, the patient had a Missed Abortion. If a fetal heart beat was not detected on an ultrasound, and the fetus measured 6 weeks smaller than her dates, it sounds like it definitely was a missed abortion. The fetus has died and there is no need to do an ultrasound in the outpatient setting before the D & C. Even after a D & C, the Beta HCG levels can take up to 4 weeks to drop down to pre-pregnancy levels. Most women can expect their levels to return to a non-pregnant range about 4 weeks after the D & C. It also depends on how high the levels were when the loss occurred. At 13 weeks, the Beta HCG level could have been as high as 250,000 mlU/ml. The doctor should have had her levels checked after the D & C weekly or bi- weekly until the level returned to at or below 5." (I don't agree with her last sentence-I personally have had 2 D&Cs for a miscarriage and I have never heard in 34 years of working in OB of a doctor drawing weekly or biweekly HCG levels after a D&C for a missed AB. ) My OB/GYN friend emailed this reply to me: It is not standard of care to check B-HCG levels after a miscarriage. Certainly not after an operative procedure. I sent that to this gal and she send this absurd reply, as if to say that this 'association' is 'authorative": Gail, Thanks for your email, but I respectfully disagree. I live in CT and I have worked in OB/GYN for 21 of my 24 years as a nurse. My most recent job was as Nursing Supervisor at a large 8 physician OB/GYN practice (one of the largest in the state). Our physicians always followed a miscarriage with at least one Beta HCG to be sure that the levels were back to 5 or below. We actually had a patient who had had a D &C and was found to still be pregnant. The paragraph below is from the American Pregnancy Association What can I expect of my hCG levels after a pregnancy loss? Most women can expect their levels to return to a non-pregnant range about 4 - 6 weeks after a pregnancy loss has occurred. This can differentiate by how the loss occurred (spontaneous miscarriage, D & C procedure, abortion, natural delivery) and how high the levels were at the time of the loss. Health care providers usually will continue to test hCG levels after a pregnancy loss to ensure they return back to <5.0 I emailed her back to say that no blood test can differentiate an abortion at 8 weeks vs a spontaneous loss at 8 weeks, etc. I also asked my OB friend if it was possible and he said: The short answer is no. Typically, I will do an Ultrasound after the miscarriage to verify that the uterus is empty, but there is no need to draw a B-HCG unless you gave methotrexate, or the patient has persistent bleeding more than a month after the procedure. PS. I have never heard of the American Pregnancy Association Her final reply tonight that I am not planning to respond to was this where she's now totally contradicting her own statements: I was not going to reply until I realized that you misunderstood what the website said. The sentence that you quoted "this can differentiate by how the loss occurred...." is NOT stating that the blood test can determine how the loss occurred. If you read closely what it says, it is saying that the blood RESULTS can differentiate BY how the loss occurred. Obviously a blood test cannot tell how a pregnancy loss occurred. That's absurd. It is saying that the HCG levels can differentiate depending on how the loss occurred. I know that the doctors that I worked for order follow up HCG tests. I posted my answer according to my experience, not according to that website. I just happened to find that website so I attached a quote from it. I regret that part of my email to you. Can you show me where there is proof of the standard of care in this instance, except from your expert MD. I consider the 8 OB/GYN's that I worked for experts also. I am willing to admit if I am wrong. But please show me where to confirm the standard of care in this situation, other than one doctor that you know. *sigh* Advice please??? No names will be used but I know she's wrong and I don't see this on the ACOG website to send her. Gail.
|
|
Return to
|
Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Tue Dec 2 04:56:05 2008 |
The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.