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Thin uterus at C/Section, prev. IUFDFrom: Garry E. Siegel (garrys@atl.mindspring.com)Mon Sep 30 15:06:58 1996
A 37 YO Para 2021 recently underwent an elective Section at 37.5 weeks (patient choice after mature amnio), and when I went to manually remove her placenta with the uterus still in the abdomen, I noted an extremely thin uterus overlying it, and thus exteriorized the uterus for visualization during manual removal. Indeed, the uterine wall overlying the attachment was millimeters thick, in the left cornual area. The placenta was grossly normal, and detached easily, and, stupidly, I didn't sent it for pathology. Her first 2 pregnancies were elective terminations with an IUD in place; her more recent pregnancy resulted in a 40 week, 3 day IUFD, subsequently delivered by induction, with an extensive negative workup. That placenta delivered normally, and was pathologically normal. The autopsy noted marked twisting of the umbilical cord, and the delivering physician noted a thin, twisted cord with no blood in it. The best guess for a cause was a cord accident, and it was only a best guess. This physician assisted at the C Section. This patient has a long history of infertility, and has a laser scope for endometriosis elsewhere in 1994; this op note has been requested. During her recent, successful pregnancy, she underwent careful surveillance and multiple level 2 scans by the good guys in town, and nothing was ever seen as abnormal in terms of the uterine wall and/or placentation. Incidently, her IUFD was a Clomid/intrauterine insemination, and her successful recent pregnancy was spontaneous. She now is quite concerned about her prognosis, since she overheard the discussion about her uterus between me and the assistant (love those awake C/Sections sometimes!). My initial feeling is that this likely was a placenta accreta, and that all will be normal next time. However, I wonder if abnormal placentation could have accounted for her first IUFD. Furthermore, will an HSG at 3 months be helpful to prognosticate, followed (if the HSG is abnormal) by laparoscopy/hysteroscopy? Sorry that I went over 2 paragraphs. I would appreciate any thoughts by direct e mail or posted to the list.
-- Garry E. Siegel, M.D. garrys@mindspring.com
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