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Re: 2am roundtable discussionsFrom: AllanHo@aol.comSat Nov 17 13:58:21 2007
When I started my residency over ten years ago, I was taught to check the cervix after every vaginal delivery. Then during one of the weekly conferences, the subject of whether it should be routine to check the cervices came up. The conclusion after the discussion was that it was not necessary to check the cervix when there is no significant bleeding after the delivery. From that point on, the newer residents were no longer taught to rountinely check the cervices. As the previous listers have pointed out, the yield of a routine exam is extremely low. In addition, a laceration should be able to heal by secondary intention. Checking the cervices can be very uncomfortable to the patient. And once the baby has come out, a patient is not going to be very tolerant with a painful exam. The patient will now remember that the pain is caused by you - not by the baby anymore. Some may even say "my last doctor did not hurt me like that after I gave birth last time". So why bother? This reminds me of another related clincal practice. During the early part of my resdiency, we used to check the uterine scar from the vagina after a VBAC. We also stopped doing that rountinely if there was no abnormal bleeding afterwards. Lastly, I want to share a clinical practice that I do (without being taught). After a cesarean section, I always do a vaginal exam after closing up the patient. I do that because I want to make sure the cervix is open and that no blood clot is left inside the uterus. During residency, I was taught to push a pair ring forceps from above through the cervix to make sure the cervix is open. But I didn't like it as I feel more contamination may be brought up from the vagina. Doing a vaginal exam myself may take another minute or two, but it reduces the chance of being called back later for a problem. Allan
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