Re: PMB on coumadin
From: Atkinson, Samuel M (ATKINSONS@ecu.edu)
Mon Apr 30 07:51:23 2007
I believe you will find that the antibiotic recommendations do not apply
to gyn proc like d&c, cerv bx etc. Of course the last time I pointed it
out to anesthesia they insisted intubation was a risk so my pt got Rxed
for a CKC/D&C. I do not believe Endo bx re quires prophy Rx.
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From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Henry
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Gregor
Sent: Sunday, April 29, 2007 7:12 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: PMB on coumadin
Sam,
Thanks to you and to all othr respondent listers. Endo bx was my minimum
assessment choice, and I guess, without verbalizing it to myself or
others, I was wondering whether a hysto/D&C would be warranted. However,
I've always felt the literature supports endobx as a very correlative
procedure vis a vis hyto/D&C results, so felt - feel - I should go ahead
with the sampling I'd usually do. Can't find anything definitive re the
abx prophylaxis, so I will go ahead with that.
In the last ten years, I've had three ca cases whose presentations were
just the scantes amts of pmb...two were localized and WD'd...one was
poorly diff'd and fairly diffuse within the cavity, but with less than
1/3rd penetration. Years ago, when I was a student, there was a fellow
named Fred Hoffmeister (department head, Univ of Wisconsin, I believe)
whom I heard speak...he was adamant about bx'g all PM women before
initiating HRT. Used to say if bx's weren't done then ca's and atypical
aden's hyperplasias would get erroneously attributed to HRT. Most ot the
attendings I came in contact as a student and a resident would indicate
his view was excessive...however, I bet he didn't miss too many, if any,
abnl endometriums.
Hank
"Atkinson, Samuel M" <ATKINSONS@ecu.edu> wrote:
Hank: I have had two patients sinilar to yours, altho a bit
older that i found endo ca by biopsy. I have taught residents that a bad
lesion bleeds earlier on rat poisin and that they all must be biopsied.
I admit that not all have endo ca hower.. for whiw.
sAm
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From: ob-gyn-l@obgyn.net on behalf of Henry Gregor
Sent: Fri 4/27/2007 11:47 AM
To: Multiple recipients of list OB-GYN-L
Subject: PMB on coumadin
Listers
A 53 yo, LMP 4 years ago, presents with two weeks plus heavy
vaginal bleeding, w/o presyncopal sx's. She is on coumadin secondary to
hx of mitral valve replacement. INR is 2.3, and pt is w/o petechiae,
ecchymoses, or hx of epistaxis or bleeding gums, etc.
PE is unremarkable, and a pap (neg hx abnl past ones) is
pending. Sono with heterogenous endometrial stripe, at 7 mm. I am
planning to do an endometrial pipelle sampling. Comments appreciated.
Thanks
Hank
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=09
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