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Re: Abnormal Pregnancies (HCGs/Progesterones)From: R.Daniel Braun, MD FACOG (rbraun@netdirect.net)Sun Oct 12 13:44:07 1997
At Sat, 11 Oct 1997, Garry E. Siegel, M.D. wrote: > >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. > Let me see if I got this straight. The 1st HCG was 144, then 2 days later 150, then 2days later 380. Is that right? If so how are you so sure this was na abnormal pregnancy?? It seems to me that if you throw out the first value, it looks pretty normal to me. I would strongly consider the lab goofed on the first value. That has happened many times. Also possible they got the sample mixed up. Happens very frequently. This is why I make the residents have a repeat HCG before giving MTX.
-- R.Daniel Braun, MD
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