On that vein, why do people persist in calling an "evacuation of uterus"
a "D&C"? The two procedures may have some similarities, but the
evacuation is not preceded by a dilatation (so no D) and the curettage
these days should be done with a suction cannula, so it is not the same
process and is being done for a different reason.
--
________________________________
Daniel Braun
Sent: Monday, 31 December 2007 7:54 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: secondary post partum hemorrhage
Sounds like this may have been "Subinvolution of the placental site". In
which case treatment with methylergonovine is indicated instead of a D &
C. This should always be considered in cases of Delayed PPH. It usually
should be suspected if the patient has gone at least one 24 hour period
with no lochia. If there has been no such 24 hour period then retained
products is more likely. Doing a D&C in a patient with subinvolution is
one of the more common causes of Asherman's Syndrome.
Dan
On Dec 29, 2007 6:45 PM, tirupati seshasai <drseshasai@yahoo.co.in>
wrote:
A 31 years aged primi gravida at 40 weeks delivered with vacuum
extraction indication persistant occipito posterior. the neonate and
mother were healthy and discharged. on 7Th postnatal day at 3.00am she
was brought with bleeding vaginally. On examination the episiotomy
sight is healthy and the uterus is around 8 to 10 weeks size and
bleeding from the cervical os seen continuously and clots were evacuted.
suspecting fragments of placental products a gentle D&C done. but no
products seen. The haematological exam is normal.She was appearing pal
our so blood transfused. with in 10 minutes the bleeding stopped. the
usg of pelvis shown as normal study,
on 14Th day of post natal day again she reported with heavy bleeding. on
examination the bleeding is from the cervical canal profusely bleeding.
the haematological exam is with in normal limits,
she was transfused with 2 paints of B Positive freshly collected blood
and the bleeding stopped with in 30 minutes.
in this case I found DISSEMINATED INTRAVASCULAR COAGULATION OR SUB ACUTE
INFECTION which made to struggle to save the mother.
Hope she won't report on 21st post natal day with hemorrhage.
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--
R. Daniel Braun, MD FACOG(L) CMT
Professor Emeritus
Dept. of Obstetrics and Gynecology
Indiana U. School of Medicine
R. Daniel Braun
"Science without Religion is LAME; Religion without Science is
BLIND"
Einstein 1941
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