-VISIT OUR OTHER FORUMS- OB-GYN-L Ultrasound Ultrasound History Fibroid Forum Physicians-in-Training Tech Talk OBSTET-L (portuguese) OBGIN-L (spanish) Nursing

Re: OB: Ectopics? From: Rafael Haciski, MD (haciski@earthlink.net) Thu May 27 23:58:19 1999 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Deborah J. Wage FNP, CNM: "Re: IUD and PID" Previous message: eugene jursek: "mucosal surface...." Maybe in reply to: Garry E. Siegel, M.D.: "OB: Ectopics?" Next in thread: Bernard Cristalli: "Re: OB: Ectopics?" FIRST CASE....... Why did she present to the ER? How reliable is the ultrasound? If she is in pain, and the sono reliable, then I would scope her, and remove the presumptive ectopic. If pain not a problem (she just got bored, and went out for a walk, stopping by the local ER), then watch the hCG - it may level off and then decline spontaneously with no need for intervention. But if it increases appropriately, and still empty uterus (and still no pain) then I would scope her at that time. SECOND CASE....... This obviously is not going to make it. It's just a matter of how. I would continue observing the hCG and when it goes over 1500, obtain TV sono. If empty, repeat in few days - if still empty, then scope her, as long as the hCG is rising significantly. Otherwise watch it abort on it's own. -- Rafael Haciski, MD FACOG Gynecology & Infertility Assoc. Baltimore MD http://www.ivf-md.com Garry E. Siegel, M.D. wrote: > > 35 YO P0010 presents to the ER with unknown LMP, no contra, history of > infertility with current husband, and RLQ pain. By her history, > negative scope for infertility a couple of years ago (she later told me, > "Oh, yeah, they found endometriosis." I guess when I asked her, "Was > there any endometriosis?," I wasn't specific enough). > > Anyway, benign exam, HCG 2161, empty uterus on vaginal scan, and a > questionable right sided cyst. BTW, she is pregnant from a different > partner, and the husband doesn't know. She does not wish to be pregnant > at this time. > > What would you do? > > Details later. . . > > Second case: > > 28 YO P2022, LMP 4/12/99 at the end of a pill pack, now attempting > pregnancy. > > 1st pregnancy--missed Ab, D and C. > 2nd--left tubal pregnancy, diagnosed by HCGs/scan when being followed > because of the prior loss. Lapscope salpingostomy. > 3rd/4th--term vaginal deliveries > > 5/20--HCG 275, progesterone 17 or so > > 5/24--HCG 825, progesterone 16 (repeated progesterone by error) > > 5/26--HCG 1072, examine benign. > > What would you do? > > Details later. . . > > Garry > > -- > Garry E. Siegel, M.D., FACOG > Private Practice > Roswell, Ga. Next message: Deborah J. Wage FNP, CNM: "Re: IUD and PID" Previous message: eugene jursek: "mucosal surface...." Maybe in reply to: Garry E. Siegel, M.D.: "OB: Ectopics?" Next in thread: Bernard Cristalli: "Re: OB: Ectopics?"

Return to

Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Mon Nov 2 05:31:30 2009

The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.