WOMENS-HEALTH Messages for August, 2000: Re: Question for Harvey Marchbein please

Re: Question for Harvey Marchbein please

From: Harvey S. Marchbein, M.D. (anonymous@obgyn.net)
Mon, 7 Aug 2000 18:53:57 -0500 (CDT)

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In reply to: Jane: "Re: Question for Harvey Marchbein please"

At Mon, 7 Aug 2000, Jane wrote: >
>Hi, thanks for your comments.
>
>What I meant by the last question is, which seems to give better
>results: intra-muscular metho or when injected directly into the
>pregnancy?

No difference I'm aware of. The one possibility might be (I don't know this to be true, just conjecture) is intratubal injection may be better for ectopics that are larger or with a heartbeat.

>Are there any Net sites you'd recommend I read for options for
>terminating this nightmare?

None that I've visited. As you can see, I'm rather busy at our site. Try any search engine and see what comes up. Also understand that this is an evolving therapy and newer recommendations are coming out all the time.

HSM

>Regards
>
>Jane
>
>At Sun, 6 Aug 2000, Harvey S. Marchbein, M.D. wrote:
>>
>>At Sun, 6 Aug 2000, Jane wrote:
>>>
>>>After weeks of confusion over diagnosis, I travelled 3 hours to see a
>>>top London gyny who confirmed that I do have an ectopic pregnancy in my
>>>right tube, close to the ovary at the fimbral end.
>>>
>>>Apparently, after having measured it he thought that it was fairly safe
>>>to wait for one more blood result to see if the HCG level starts to come
>>>down.
>>>
>>>He has said he would be happy to treat me with either methotrexate
>>>(either intra-muscularly or directly into the pregnacy via ultrasound)
>>>or I can have a laparoscopy. I can choose to have the lap in my home to
>>>me if I can't get to him.
>>>
>>>My dilemma is that I don't know which option to choose and which one is
>>>likely to be most successful for preserving my tube. My current HCG
>>>level is 410 and still rising by about 8% per day and the ectopic mass
>>>is 13mm x 10mm x 8mm.
>>
>>Recent studies indicate both would be equally effective given your test
>>results.
>>
>>>My questions are:
>>>
>>>How difficult (ie more or same as ususal) is it to remove a pregnancy
>>>from the fimbral end of the tube, rather than in the middle - does the
>>>clinician need to be more technically skilled?
>>
>>Fimbria is much easier (usually) and fimbrial pregnancies may abort,
>>something one hopes for to eliminate all other therapy.
>>
>>>How does the different treatment methods of methotrexate have a bearing
>>>on how effective it is/side effects and has anyone out there got a large
>>>amount of experience in using methotrexate for terminating ectopic
>>>pregnancies (no-one seems to have a great deal of experience in this
>>>country as it isn't used very much at all).
>>
>>It's 75 mg/m2 (milligrams per meter squated of body surface area).
>>Usually that means 150mg intramuscular. If no major drop in HCG by day
>>4, repeat treatment. Hope that helps. (Not sure I understood the
>>question from the last paragraph).
>>
>>>I would really appreciate an experienced clinician's view.
>>>
>>>Thank you
>>
>>--
>>Harvey S. Marchbein, M.D. FACOG, FACS
>>Great Neck, New York
>>
>>**Note: Opinions expressed here are for educational purposes only
>>and, as such, do not constitute a physician-patient relationship.
>>This information is not intended to supplant the need for you to
>>consult with your physician prior to choosing therapeutic options
>>and/or interventions.
>>
>>**Private emails cannot be entertained due to time constraints,
>>consequently no private emails will receive a response.
>>
>>**Thank you for your understanding ;-)
>>
>>Please be aware that all e-mail on this forum is archived and can be viewed at
>>http://forums.obgyn.net/womens-health,
>>http://forums.obgyn.net/pregnancy-birth or
>>http://forums.obgyn.net/young-women
>>and is accessible to anybody on the
>>internet including internet search engines. This should be taken into
>>consideration before sending postings of a personal or confidential nature.
>>

--
Harvey S. Marchbein, M.D. FACOG, FACS
Great Neck, New York

**Note:  Opinions expressed here are for educational purposes only
and, as such, do not constitute a physician-patient relationship.
This information is not intended to supplant the need for you to
consult with your physician prior to choosing therapeutic options
and/or interventions.

**Private emails cannot be entertained due to time constraints,
consequently no private emails will receive a response.

**Thank you for your understanding ;-)

Please be aware that all e-mail on this forum is archived and can be viewed at
http://forums.obgyn.net/womens-health,
http://forums.obgyn.net/pregnancy-birth or
http://forums.obgyn.net/young-women
and is accessible to anybody on the
internet including internet search engines.  This should be taken into
consideration before sending postings of a personal or confidential nature.

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In reply to: Jane: "Re: Question for Harvey Marchbein please"

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