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Re: Cytotec and hypotonic uterus From: DoctorJoe@aol.com Fri Apr 14 07:12:45 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: DoctorJoe@aol.com: "Fwd: ACS NewsScope" Previous message: Efrain Ramirez: "On Doctors and Nurses" Maybe in reply to: Diane Petersen: "Cytotec and hypotonic uterus" In a message dated 4/13/00 7:48:08 PM, garrys@mindspring.com writes: > I did not >>want to open too many new tissue spaces with the DIC and, therefore, >>decided to not do a hypogastric ligation. >> >You know, we were all raised to do this, and perhaps practiced the >simulated technique at radical gyn surgery when residents. And, of >course, these spaces shouldn't be bloody. However, in practical terms, >each of us "regular Ob/Gyns" will rarely encounter this situation. >Furthermore, isolating the hypogastrics with a just pregnant uterus >nearby, through a small transverse incision isn't too easy. > >My academic side says you should have ligated the hypogastrics; my >practical side applauds your management. In fact, I was criticized on one of my oral board exams for doing a hysterectomy (in a woman who had a tubal ligation already, before the case turned exciting) before attempting to ligate the hypogastric arteries. At that time, I believe I had already written a monograph and done a paper on cesarean hysterectomy (and of course, done a number of cases myself), so I was more expert than the examiner. But I was told that was wrong, because hysterectomies are so technically difficult, they bleed too much, and blah, blah, blah. So there is definitely an academic bias which is at odds with an "in the trenches" appreciation of cesarean/postpartal hysterectomy. Joe P. Next message: DoctorJoe@aol.com: "Fwd: ACS NewsScope" Previous message: Efrain Ramirez: "On Doctors and Nurses" Maybe in reply to: Diane Petersen: "Cytotec and hypotonic uterus"

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