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Re: Mirena and IUP From: aditi desai (draditidesai@yahoo.co.uk) Fri Apr 18 15:59:55 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Charles Bloom: "Re: Would love to have your medical opinions on this" Previous message: DoctorJoe@aol.com: "Re: Earthquake ..." Removal under ultrasound guidance if possible.Retaining it would increase the probability of a miscarriage ,premature labour.Limited evidence regarding the hormonal effects on the baby. Aditi Desai MRCOG UK - >---- Original Message ---- From: Henry Gregor <henrygregor@yahoo.com> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@mail.obgyn.net> Sent: Friday, 18 April, 2008 7:15:55 PM Subject: Re:Mirena and IUP Listers...my apologies for not googling or doing PubMed, etc. Manufacturer's guidance is for removal if IUP present, but in the case just brought to my attention, on sono the gestational sac would seem to be a pretty good bet to be disrupted if the device is pulled. I've seen pregnancies deliver when they weren't recognized for a few months while oral levonorgestrel oc's were being taken into late second trimester.  Patient  desires maintenance of pregnancy. Observrations/experiences?? Thanks. Hank       Frances Wren <fwren@shaw.ca> wrote: I wouldn't be doing weekly or bi-weekly HCG's. frances wren ----- Original Message ----- From: Larry Glazerman To: Multiple recipients of list OB-GYN-L Sent: Wednesday, April 16, 2008 8:06 PM Subject: Re: Would love to have your medical opinions on this 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 ------------------------------------------------------------------------not planning to respond to was this where she's now totally contradicting h= ------------------------------------------------------------------------er own statements:=0A=C2=A0=0AI was not going to reply until I realized tha= ------------------------------------------------------------------------t 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. ----------------------------------------------ice please??? No names will be used but I know she's wrong and I don't see = one doctor that you know. ----------------------------------------------this on the ACOG website to send her.=0A=C2=A0=0AGail.=0A=C2=A0=0A=0A=0A=0A= one doctor that you know. ---------------------------------------------- ________________________________ Need a new ride? Check out the largest site for U.S. used car listings at AOL Autos.=0A=0A=0A___________________= ________________________________ Need a new ride? Check out the larges_____________ No virus found in this incoming message. Checked by AVG. Version: 7.5.524 / Virus Database: 269.23.0/1381 - Release Date: 4/16/20 Next message: Charles Bloom: "Re: Would love to have your medical opinions on this" Previous message: DoctorJoe@aol.com: "Re: Earthquake ..."

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