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Re: Post Partum BTL From: D. Ashley Hill (dahmd@cfl.rr.com) Tue Feb 27 20:51:32 2007 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: DoctorJoe@aol.com: "Re: Ob:  Advanced dilatation/footling" Previous message: Garry E. Siegel, M.D.: "Ob: Advanced dilatation/footling" Next in thread: Henry Gregor: "My partners think I'm a woos (?sp?)" Reply: Henry Gregor: "My partners think I'm a woos (?sp?)" In residency I was called to help with a 500# patient on the table (actually, 2 tables) for a postpartum BTL. Despite a lot of effort we could not get deep enough with the retractors and a large umbilical incision to find the tubes. Finally I took a sterile scalp pH "megaphone," lubed it up, and inserted it into the umbilical incision. I used 0-plain endoloops and laparoscopic instruments through the scalp pH device to tie the tubes sucessfully. I thought about writing it up but I felt like it was a "cowboy" move, although given the circumstances it was all I could think of. Now I would counsel for an IUD or interval Essure, or even a vaginal BTL, rather than try to find the tubes in a patient like you described. Ashley At Tue, 27 Feb 2007, Richard Kaplan wrote: > >About 6 months ago I had to abandon a post partum BTL on an obese patient >who was close to 36 hours post delivery because her fundus had involuted to >the point where I could not palpate it or find the tubes through my >subumbilical minilap incision. This morning I cancelled a BTL on another >obese patient 24 hours post partum when her fundus palpated well below the >umbilicus (14-16 wks.) and I was afraid that I would have the same problem. >She was happy to schedule a laparscopic procedure in 5 weeks. My partners >think I'm a woos. Have any of you had similar experiences? > >-- >Richard Kaplan > -- D. Ashley Hill, MD Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Medical Director, Loch Haven Ob/Gyn Group Division Director, Dept. of Ob/Gyn, Florida Hospital Orlando Orlando, Florida Next message: DoctorJoe@aol.com: "Re: Ob:  Advanced dilatation/footling" Previous message: Garry E. Siegel, M.D.: "Ob: Advanced dilatation/footling" Next in thread: Henry Gregor: "My partners think I'm a woos (?sp?)" Reply: Henry Gregor: "My partners think I'm a woos (?sp?)"

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