Re: Incarcerated uterus
From: Efrain Ramirez (eramirez@icepr.com)
Fri Jun 30 22:16:40 2000
Looks like a good idea --
At Fri, 30 Jun 2000, Joanne Bulley, MD wrote:
>
>The best treatment - from my series of about a half dozen - is to put
>the cath in for 3-7 days. The uterus resolves itself while the cath is
>in. I have never had to cath a second time. My 2 cents is that the
>growth of the uterus pushes itself out of the pelvis as long as the
>bladder is drained for a few days to a week. How did we decide when to
>take the cath out - Luck, I guess.
>
>None of those other maneuvers worked - whether for me or my older
>partners.
>
>Joanne
>
>At Fri, 30 Jun 2000, Jane Helwig, MD wrote:
>>
>>G3P2 at 11 weeks presents with urinary retention. She says this
>>happened in each of her previous pregnancies and both times her OB
>>pushed on her uterus from below to resolve the problem. On exam, the
>>uterus is so retroflexed as to be almost horizontal, with the cervix
>>under the symphysis. Foley was inserted for 24 hours and urinary
>>retention has resolved.
>>
>>I tried to push the uterus up vaginally while the patient was in
>>lithotomy position and again while she was in knee-chest position, but
>>didn't feel any change in its position.
>>
>>Questions for those who have successfully pushed the uterus up, with or
>>without anesthesia: could you tell from movement of the uterus that you
>>had succeeded? Did you monitor with ultrasound? How did you know it
>>worked?
>>
>>Since she's now asymptomatic, do I need to do anything more? If urinary
>>retention or pain returns, I have Plans B, C, D: pushing from below
>>rectally, pushing from below under spinal anesthesia, colonoscopy a la
>>recent article. Don't have any elemental mercury on hand for Plan E.
>>
>>Any comments?
>>
>>--
>>Jane Helwig, MD, FACOG
>>Private practice
>>Nassawadox, VA
>>
>--
>Joanne Bulley, MD
>Keene, NH, USA
>
--
"Do not take life too seriously. You will never get out of it alive."
Marianne Williamson
|
|
