|
|
 |
 |
 |
|
|
|||
|
||||
|
||||
Re: 2am roundtable discussionsFrom: AllanHo@aol.comMon Nov 19 23:05:24 2007
In a message dated 11/19/2007 5:04:53 AM Eastern Standard Time, el@lisse.NA writes: Allan, With all due respect, before Semmelweis all our colleagues were enjoying their good results too... Is there some evidence that a vaginal digital manipulation post C/S is safe? And, while we are at it, is there evidence that we should express clots from the uterus at all? el You will not believe me if I told you how extremely low my infection rate is for Cesarean sections. So lets just assume that my infection rate is better or no worse than my peers, otherwise someone at my hospital would be on my case. And I would be too ashamed to tell everyone what I do. Evidence of safety? Besides anecdotal, perhaps from reasoning or extension of experience after vaginal deliveries? I am sure everyone has done this before - the nurse called shortly after an eventfull birth... the patient was bleeding from the vagina and she passed a blood clot. You went back, did a vaginal exam and cleared more blood clots from the vagina. The uterine fundus was kind of high. You pushed down the fundus and yet more clots came out. Then the uterus became firm. And no more bleeding after that. The patient was happy, the nurse was happy, you were happy! You saved her life from bleeding to death by pushing the blood clots out of her uterus! I always do a bimanually exam after a vaginal birth to make sure the uterus is well contracted. I think it makes sense to do the same after a C/S. If there was a sizable blood clot in the uterus and you managed to express it out of the uterus, you may have saved yourself a trip back to the recovery room later and a few hundred cc of blood for the patient. If anyone is interested in doing a research project to clarify this question, I would be happy to collaborate. My hypothesis would be "a digital vaginal exam after a C/S reduces the rates of endometritis and post op uterine atony". Thanks for the reference to Semmelweis - people who are about to loose his or her mind may have a good idea once in a while. Allan
|
|
Return to
|
Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Wed Jul 2 04:48:03 2008 |
The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.