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Re: Post Partum D and C's for retained placentaFrom: Serge Guichard (sguich@transnethaiti.com)Fri Jan 9 07:26:26 2004
Desolé Mireille: "Il s'agit d'un forum international et la langue generalement utilisée est bien l'anglais." Dear Joanne: About that patient with retained placental products 2wks PP, it's very common.If we could do an ultrasound for every patient in the postpartum we would found many cases like this.What the french authors call : "petit retour de couches" (small bleeding couple of weeks PP) is probably due to some retained debris. The classical attitude is: -Observation with no intervention if the bleeding is not important.Most of the time the get eliminated throught the natural shredding of the endometrium -If the bleeding increases ,an ultrasound is of course mandatory to know what's inside of the uterus. -If there is some debris you can still be conservative and give antibio,prostaglandines,bed rest and follow-up by ultrasound and Bhcg. The decision for a D&c will be guided on the persistance of the bleeding and placental debris,the raise of the Bhcg . The D&C will prevent the risk of placental polyp and possible choriocarcinoma in the future. It's wise to perform another US 2 months later when normal menstrual period resumed. The D&C can be done under peridural but the anesthesiologists prefers the anesthesia with mask using Diprivan that offers a quick wake up so the patient can go home couple of hours after the procedure.
-- Serge Guichard M.D, OBGYN sguich@transnethaiti.com
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