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Following an Ectopic and...From: Geffrey H Klein, MD (gklein@bcm.tmc.edu)Wed Jul 31 22:48:59 1996
Hi all.... Need some help with a case. As you may know, I have finished residency and I am now in private practice. What a change.. Anyway.. Please advise: I have a patient who presented to the ER complaining of classical symptoms of ruptured ectopic. She is a 25 y/o G4P1A3 (all spontaneous Abs) who was hemodynamically unstable and underwent emergent exploratory laparotomy. She desired to preserve fertility if possible. At that time she had a 750 cc hemoperitoneum and a ruptured right ampullary ectopic. The contralateral side was grossly normal as was the distal portion of the affected side. I resected the ruptured portion (salpingostomy would have been impossible) with the idea that if she got a contralateral ectopic, the right side could be re-anastamosed. (In retrospect, I am not sure if I should have done that). In any event.. The pre-op quant was 6000. Postop the patient did well and went home. The path returned as trophoblastic hyperplasia in the specimen with a recommendation to follow betas as if it were a molar pregnancy. She was started on contraception, but at the office admitted that she had had unprotected intercourse. Betas as follows: 7/15 167 7/17 103 7/24 111 Now she complains of some vague abdominal discomfort and spotting. I took the slides for review by a gyn onc pathologist who concurs that the specimen contains trophoblastic hyperplasia. Any suggestions on how to proceed? Methotrexate? Scope? Follow betas some more? help!!! Geffrey H. Klein, MD listowner: OB-GYN-L gklein@bcm.tmc.edu gklein@icsi.net http://www.bcm.tmc.edu/obgyn/obgyn-ce/geff.html
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