Abnormal Pregnancies (HCGs/Progesterones)
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Sat Oct 11 15:39:13 1997
I am interested in how the listmembers handle cases such as this: (From
memory, so my numbers are close, but the concept is the same)
30 YO Para 0010 ( a "chemical pregnancy" per the patient) on clomid 150
mg. for oligoovulation, who has a PCO type hormone picture, has a
positive pregnancy test at home, and her HCG is initially 144, then 2
days late is 150 or so, with an initial Progesterone of less than 5.
Over the weekend, she is spotting a bit, clinically normal, with normal
exam. The next HCG a couple of days later was around 250.
I did not do an ultrasound, believing that it would not alter my
management below.
My diagnosis was an abnormal pregnancy, and I gave her methotrexate 50
mg. per meter squared. She had normal liver tests and a normal CBC
beforehand, and her HCG on initiation was 380 or so, and 5 days later it
is 220 or so. I'm going to follow it weekly down to zero hopefully.
I realize that I did not prove an ectopic by ultrasound or by
endometrial curettage; however, clearly she has an abnormal pregnancy,
and, IMHO, this has saved her an OR trip hopefully.
What do ya'll think?
--
Garry E. Siegel, M.D., FACOG
Private Practice
Roswell, Ga.
