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Re: Where's the os? From: Braun, R. Daniel (rbraun@iupui.edu) Fri Mar 10 11:13:18 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: ainsron@msn.com: "Re: vacuum extraction criteria" Previous message: Efrain Ramirez: "Re: Where's the os?" Maybe in reply to: Braun, R. Daniel: "Where's the os?" Next in thread: Robert J. Woolley: "Re: Where's the os?" R. Daniel Braun, MD FACOG Clinical Professor Department of Obstetrics and Gynecology Indiana U. School of Medicine Indianapolis, IN 46202 OBGYN.net International Representative for United States Certified AllExperts Expert Check out my bio/ratings page! http://www.allexperts.com/displayExpert.asp?Expert=1236 -----Original Message----- From: Lynn Montgomery [mailto:lmontgomery@communitymed.org] Sent: Friday, March 10, 2000 12:27 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Where's the os? Dan, Don't know if any of this will help but I'll offer a couple of suggestions that I have used in similar situations. First, with your description of infolding of the vaginal apex, I have had this problem visualizing a similar cervix and placed a condom over the speculum with a small defect in the end. That doesn't seem to be the problem. The infolding starts at about where I think the os is located and goes down with the vagina adhered to the cervix. She appears to be highly estrogenized, she is 38 and menstruating. Dan This allows visualization without non-cervical tissue falling in the way. Second, I have placed patients like this on estrogen cream vaginally for a couple of weeks and sometimes it makes the os more readily apparent. Then use a lacrimal duct probe to gently explore possibilities. Lynn -- Lynn D. Montgomery, M.D. Director, Maternal-Fetal Medicine Rocky Mountain Perinatal Center 2825 Fort Missoula Road, Suite 130 Missoula, Montana, 59804 406-327-4094 fax 406-327-4154 e-mail: lmontgomery@communitymed.org website: http://www.communitymed.org/rmpc/ -----Original Message----- From: Braun, R. Daniel <rbraun@iupui.edu> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@forum.obgyn.net> Date: Friday, March 10, 2000 8:53 AM Subject: Where's the os? >A 38 y/o patient had a conization in 1982. About 7 days later, she developed >post cone bleeding and had another operation. Do not know either the >Pathology or the nature of the second operation. In 1990, she had a Pap >smear reported as HGSIL. Because of her previous experience with conization, >she refused colposcopy because it could lead to conization. Since then, she >has had 6 Pap smears, All revealed NPC and all but 1 were reported as >Inadequate due to lack of endocervical or metaplastic cells. The one >exception makes no comment at all about adequacy. >On speculum exam, there are many infoldings in the vagina at the apex and >nothing that looks like a cervical os. (She has monthly periods, fairly >regular and assoc. with moderate cramping) On bimaual exam there is what >feels like a normal cervix and a normal uterine exam. TVS reveals normal >uterus and ovaries. Repeat Pap by me reported as inadequate, no endocervical >or metaplastic cells noted. >I had her come in during a menses. She has blood in the vagina. I am unable >to find the opening through which it is coming. No real tract visualized. >Suggestions??? Conization is unacceptable to the patient. > >Dan >R. Daniel Braun, MD FACOG >Clinical Professor >Department of Obstetrics and Gynecology >Indiana U. School of Medicine >Indianapolis, IN 46202 > >OBGYN.net >International Representative for United States > >Certified AllExperts Expert >Check out my bio/ratings page! >http://www.allexperts.com/displayExpert.asp?Expert=1236 > Next message: ainsron@msn.com: "Re: vacuum extraction criteria" Previous message: Efrain Ramirez: "Re: Where's the os?" Maybe in reply to: Braun, R. Daniel: "Where's the os?" Next in thread: Robert J. Woolley: "Re: Where's the os?"

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