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Re: 2am roundtable discussions From: Garry E. Siegel, M.D. (garrys@mindspring.com) Sat Nov 17 15:59:33 2007 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: mark decker: "i am looking for services to quit medicine and take up" Previous message: AllanHo@aol.com: "Re: 2am roundtable discussions" In reply to: AllanHo@aol.com: "Re: 2am roundtable discussions" Next in thread: Dr Eberhard Lisse: "Unnecessary Practices" So much of what we do is based on tradition and what we were taught. Because problems are infrequent, and they usually become apparent even if we don't look, it would take a huge number of patients to show a difference between visualizing vs. non-vizualizing the cervix, or cleaning vs. not cleaning the vagina after a section. So. . . I check the cervix I examine the vagina manually after a section and get the clots out I don't pass a ring forceps down Garry At Sat, 17 Nov 2007, AllanHo@aol.com wrote: > >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 -- Garry E. Siegel, M.D. Private Practice Roswell, GA Next message: mark decker: "i am looking for services to quit medicine and take up" Previous message: AllanHo@aol.com: "Re: 2am roundtable discussions" In reply to: AllanHo@aol.com: "Re: 2am roundtable discussions" Next in thread: Dr Eberhard Lisse: "Unnecessary Practices"

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