Re: Priority in Post partum retained products?
From: Charlie Chambers (cchamber@gorge.net)
Thu Jan 8 16:19:18 2004
Joanne
At least to me, it's more a question of clinical presentation. If her
bleeding pattern is abnormal for a postpartum patient or she has an
endometritis then she needs a D&C. An ultrasound might be more helpful
if her postpartum bleeding pattern was borderline and without
endometritis. If her postpartum recovery is clearly not normal, then I
would be aggressive regardless of the ultrasound. Ultrasound at this
stage can be misleading, therefore, I wouldn't rely solely on the
ultrasound findings. I hope that helps. Please let us know how she
progresses.
************************************************************************
******
Charlie Chambers
--
Hood River, OR USA
cchamber@alumni.rice.edu
"All good things...come by grace,
and grace comes by art,
and art does not come easy."
Norman Maclean
************************************************************************
*******
On Jan 8, 2004, at 1:52 PM, Joanne Simich wrote:
> Hi Charlie
>
> So, here are some further details on this case. I think I can predict
> how you might respond to it, as I know what I think should happen next!
> My question to you and if others want to respond- how deceptive is the
> vaginal bleeding symptom of slowing down and clearing up? Is that
> enough
> for a doctor to say " No, no D and C."
>
> What is the usual pattern for elimination of post partum retained
> placental tissue? Does it behave like this in that it appears to be
> healing, the bleeding stops and no more clinical measures are taken?
>
> FURTHER CASE DETAILS
>
> This patient below went to get an ultrasound yesterday. This is in
> Australia everyone. The ultrasonographer could definitely see that
> there was still fluid and debris in the uterus. How much she didnt
> say.
> The results from the ultrasound will be delivered to the Dr tomorrow.
>
> The vaginal bleeding has slowed down and is starting
> to look like its clearing up.
>
> So, if anyone else has any input I would appreciate it. Now that a few
> of you have checked out my qualifications, perhaps you might respond.
> :)
>
> Kind regards
>
> Joanne.
>
> At Wed, 7 Jan 2004, Charlie Chambers wrote:
>>
>> --Apple-Mail-7-724992584
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>>
>> Joanne
>> I think that an ultrasound can be helpful. However, if I clinically
>> suspect retained products, then I don't care what the ultrasound
>> shows.
>> I think your instincts are quite correct. Retained products will
>> respond with removal of the tissue. All the abx in the world won't
>> help, if there is a big hunk of placenta still stuck to the fundus.
>>
>> **********************************************************************
>> **
>> *
>>
>> --
>> **********************************************************************
>> **
>> Charlie Chambers
>> Hood River, OR
>> cchamber@alumni.rice.edu
>>
>> "No matter where you go...
>> there you are."
>> Dr. Buckaroo Banzai
>> **********************************************************************
>> **
>> On Jan 7, 2004, at 4:05 PM, Joanne wrote:
>> **********************************************************************
>> **
>>
>>> Hello
>>>
>>> I would like to know what is the criteria for ordering D and C's for
>>> post partum retaining of products. Case history on my patient: Baby
>>> born- Dec 16th 03 , Placental tissue passed Jan 5th 04 . Hospital
>>> that
>>> did the delivery said:" take Antibiotics, because you have an
>>> infection"
>>> So she went to a local General Practitioner (these are M.D's) in
>>> Australia who took a vaginal swab, ordered an Ultrasound, wants her
>>> on
>>> AB's before the results come back, and is talking about possibility
>>> of
>>> D
>>> and C.
>>>
>>> I want to know of how much value you think an U/S is in this
>>> situation,
>>> and are A/B's really called for here? My clinical opinion is get her
>>> in
>>> , do a D and C asap and stop stuffing around with this situation.
>>> That
>>> opinion is based on my own experience. After both my children, it
>>> was
>>> retained products diagnosis. First delivery, I had a family friend
>>> who
>>> was a top Obstets doc in Auckland NZ. As soon as I called him and
>>> told
>>> him, well i passed a 2 " diam piece of something or other" He put me
>>> in
>>> hospital immediately - D and C, done and no problems from that point
>>> on.
>>> The second child, not under the same doctor, - post partum bleeding
>>> for
>>> 6 weeks, then D and C ordered. All of this was without A/Bs
>>>
>>> Also what value do you think an ultrasound is going to be at this
>>> stage?
>>>
>>> So would like to get your opinions please.
>>>
>>> Thanks
>>>
>>> Kind regards
>>> Joanne
>>>
>> --Apple-Mail-7-724992584
>> Content-Transfer-Encoding: 7bit
>> Content-Type: text/enriched;
>> charset=US-ASCII
>>
>> Joanne
>>
>> I think that an ultrasound can be helpful. However, if I clinically
>> suspect retained products, then I don't care what the ultrasound
>> shows. I think your instincts are quite correct. Retained products
>> will respond with removal of the tissue. All the abx in the world
>> won't help, if there is a big hunk of placenta still stuck to the
>> fundus.
>>
>> <bigger>**************************************************************
>> ***********
>>
>> <bigger>**************************************************************
>> ***********
>> Charlie Chambers
>>
>> Hood River, OR
>>
>> cchamber@alumni.rice.edu
>>
>> "No matter where you go...
>>
>> there you are."
>>
>> Dr. Buckaroo Banzai
>>
>> **********************************************************************
>> **</bigger>
>>
>> **********************************************************************
>> **</bigger>
>> On Jan 7, 2004, at 4:05 PM, Joanne wrote:
>>
>> <excerpt>Hello
>>
>> I would like to know what is the criteria for ordering D and C's for
>>
>> post partum retaining of products. Case history on my patient: Baby
>>
>> born- Dec 16th 03 , Placental tissue passed Jan 5th 04 . Hospital
>> that
>>
>> did the delivery said:" take Antibiotics, because you have an
>> infection"
>>
>> So she went to a local General Practitioner (these are M.D's) in
>>
>> Australia who took a vaginal swab, ordered an Ultrasound, wants her on
>>
>> AB's before the results come back, and is talking about possibility
>> of D
>>
>> and C.
>>
>> I want to know of how much value you think an U/S is in this
>> situation,
>>
>> and are A/B's really called for here? My clinical opinion is get her
>> in
>>
>> , do a D and C asap and stop stuffing around with this situation.
>> That
>>
>> opinion is based on my own experience. After both my children, it was
>>
>> retained products diagnosis. First delivery, I had a family friend
>> who
>>
>> was a top Obstets doc in Auckland NZ. As soon as I called him and
>> told
>>
>> him, well i passed a 2 " diam piece of something or other" He put me
>> in
>>
>> hospital immediately - D and C, done and no problems from that point
>> on.
>>
>> The second child, not under the same doctor, - post partum bleeding
>> for
>>
>> 6 weeks, then D and C ordered. All of this was without A/Bs
>>
>> Also what value do you think an ultrasound is going to be at this
>> stage?
>>
>> So would like to get your opinions please.
>>
>> Thanks
>>
>> Kind regards
>>
>> Joanne
>>
>> </excerpt>
>> --Apple-Mail-7-724992584--
>>
>
