Unnecessary Practices
From: Dr Eberhard Lisse (el@lisse.NA)
Sun Nov 18 00:30:15 2007
Checking Cervix when it is not bleeding? What for?
Palpating Uterine Scar? What for?
Vaginal exam after a C/S, routinely? What *ON* *EARTH* for? Other than
contamination...
el
on 11/17/07 10:58 PM AllanHo@aol.com said the following:
> 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
