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Re: Following an Ectopic and...From: David A. Nagey, M.D., Ph.D., FACOG (dnagey@welchlink.welch.jhu.edu)Wed Jul 31 23:04:32 1996
Geffrey H Klein, MD wrote: > > 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 wait a few days and repeat the hCG's - in these days of managed care, I wouldn't trust the lab as much as I did 15 years ago.... David
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