Your Gyno and Your Weatherlady Have The Same Average With This Prediction: 50/50: Is it a Tubal Pregnancy? Is it Rain?!

In our office we joke about the accuracy of rain prediction: I usually say it is correct about 50% of the time, what's your take? In medicine we have improved the diagnosis of tubal pregnancy greatly, but unfortunately the initial diagnosis of ectopic pregnancy may be incorrect up to 40 percent of the time! Ectopic pregnancies are actually not a rare thing, but occur once in 50 pregnancies. In a new study that looked at the medical consequences of missing the diagnosis of normal and interpreting the pregnancy as doomed they caution the treatments can be harmful. This study discusses the medications used to treat tubal pregnancy, in the cases that can be treated with medicine, can be very harmful to a pregnancy that is actually developing in the uterus and may go on to term. So that if a woman has a wanted pregnancy, she and her gyno may have to wait for the diagnosis to be clear. Waiting is potentially dangerous because some tubal pregnancies can bleed internally, but for most cases, watchful waiting (being watched closely!) is not harmful. They also have cautioned that several tests over a period of days are needed to confirm the diagnosis of a tubal (ectopic) pregnancy, and that women need to understand that patience is often important. Pregnancies develop at different paces in different women and the levels of hormone and when and how rapidly the different structures are visualized on ultrasound can also vary.In a study reported by Dr. Andrew Kaunitz in the February 2012 issue of OBG Management he said that you should be able to see a pregnancy in the uterus about the serum beta-HCG level is in the 1000-2000 mIU/ml range. And that if you see no pregnancy one day, and look with the ultrasound to try to see a pregnancy...the VERY NEXT DAY... about 80% of the time it was because that level was below the 1000 mIU/ml value for that pregnancy HCG blood test, but about 10% of the time the value was 1500 or even higher! These numbers won't mean anything to the average patient, but the point is we have to interpret these values very carefully. Your blood test value cannot be paired with the ultrasound and have a simple straight forward diagnosis, the blood pregnancy test value and the ultrasound almost have to be interpreted in isolation, not an 'either/or' or a firm yes/no  really will get rain from that blob of cloud top on the radar, they have to look at a lot more to get a diagnosis. IN fact here is where it now looks like interpreting whether yWhen the ectopic (misplaced pregnancy) is not in the fallopian tube: for instance when it is implanted in the ovary, the final diagnosis is so confusing on ultrasound Dr. Donald Fylstra,  in his large review of these condition in the July 2011 issue of the American Journal of Obstetrics and Gynecology, says the diagnosis can only be made after a pathologist examines the tissue after a surgical removal, sort of like, no matter how many types of maps a weather girl makes, sometimes we just have to stick our hand out of the window to accurately know, are we getting rain!

Comments

Popular posts from this blog

Passing Your Uterine Lining, Menstrual Period Norms

Mirena IUD and Your Sex Drive

Post-Endometrial Ablation Syndrome