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Re: A case of cervical pregnancyFrom: Robert J. Carpenter, Jr. MD (zygote@ICSI.Net)Sun Apr 27 21:08:29 1997
Date: Sat, 26 Apr 1997 22:00:15 -0500 Subject: A case of cervical pregnancy Questions: Was this the appropriate initial management? What were the alternatives? What is the next step you recommend from here? Given a prior reply which asked why the IUP was not detected, I will nt elaborate on that. However the administration of mtx may give you a malformation which you will be unable to detect by scan. Therefroe the information of serious cognitive deficits from mtx Rx must be explained to pt. Similar events have happended with servere collagen vascular diseae and unrecognized preg. A second method for the termination of a cervical pregnancy is direct fetal injection with KCl as soon as recognized. It works and with death of placenta then removal is possible or aleternaticely in a single case, MTX was then given to hasten placental loss. Neither of those cases resulted in adverse outcomes. The most critical issue is early recognition and disruption of the cervical ectopic. If a concomitant IUP is recognized, then the significant potential for maternal injury and loss of uterus must be put up front. In that situation, mu own judgement would be to consider the entire pregnancy lost and proceed accordingly. It will be interesting to others who have had such experience. R.J.CARPENTER, JR MD 6624 fANNIN #2720 HOUSTON 77030
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