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Re: VBAC uterus not palpable on bimanual exam.From: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. (johnprov@sympatico.ca)Thu May 17 05:38:41 2007
At Wed, 16 May 2007, Joanne Bulley, MD wrote: > >I saw a new patient with the following OB history > >First pregnancy (late 30's) PhD Psychologist - IN THE HOSPITAL at majore >center in Boston - abrupted and even with stat CS had a stillbirth. >Second pregnancy - hopsitalized for multitude of related issues: >spontaneous ruptured uterus at CS scar without labor - another STAT CS - >this with live baby. Uterus repaired rather than hyst. > >So that S**T can hit the rotating blades with disastrous results or very >lucky saves in a place with all the ducks ready to fly into action. > >Her uterus is totally unassessable by exam - I assume from adhesions: >nearly impossible to see the cervix and absolutely unable to feel it - I >assume it is bound way up high out of the true pelvis! I am getting an >US. The Boston docs did US on her for years after the second CS. They >finally stopped soing them because "the findings were too boring" (My >guess was they coudln't feel it either - even when she was a bit >thinnner) - they also told her to never let anyone do a TV US as nothing >can be seen with TV US! > >She had a ruptured appy after the second CS - and the surgeon said she >had some of the worst adhesions he had ever dealt with. > >She reports other general gyns have done horribly painful exams mashing >all over trying to find her uterus with a bimanual. When I could not >find anything I decided it was going to be not at all meaningful to put >her through an overly aggressive exam. She also reports that she had an >IUD - a doc said lets take it out (at menopause) - the strings broke off >and the doc said lets operate to get it and that might require a hyst. >She said "just leave it there" I agreed with that as long as no signs of >uterine infection. > >Since it was my fist visit with her ... I said - lets do another US (it >has been a number of years). Since a pelvic exam truly means nothing >here - how many of you would decide to never bother at all with a >bimanual? Should she have a yearly US??? More often - less often??? (I >will see what this one shows and let you know) > >>-- >Joanne Bulley, MD, FACOG >Solo gyn >Keene, NH USA > Is she still menstrating? the few times I have not felt the uterus was in obese post menapausal women with multiple surgeries, previous cones or large leeps are often involved. I hope she never had cervical dsyplasia. I would not be surprsied if the uterus is stuck to her abdominal incision, midline verticle?
--
Take care, John
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