|
|
 |
 |
 |
|
|
|||
|
||||
|
||||
Daily bleeding, fibroidsFrom: Caitlin Cusack MD (caitlincusack@yahoo.com)Wed Feb 28 14:49:56 2001
Yesterday I inherited a patient who is extremely attached to her uterus. She is a 50 y/o who had a myomectomy about 7 years ago. She came in for a 'routine annual' and tells me she has bled everyday since her myomectomy-approximately once a month she will bleed very heavily with clots, and then returns to her baseline of daily bleeding, heavy enough to need a pad. In reviewing her chart someone did a CA-125 a year ago that was 40. (ordered because a grandmother died of ovarian cancer-just explaining, not defending...). It was repeated 2 more times and was above 35 each time. She had an u/s which showed a large uterus and bilateral small simple cysts, the largest being 1.5 cm, endometrial lining of 10mm. She was referred to a gyn oncologist who recommended a hysterectomy-she did not follow up after this until she showed up on my schedule. On exam she indeed has a bloody discharge in her vault. She has a 16 week size uterus. The cervix is deflected up behind her symphasis, her posterior cul-de-sac is filled with fiboid. In order to do a pap I got a tenaculum on the underside of her cervix to bring the cervix down enough to do a pap-a huge struggle (I think I was standing on my head by the time I finally got it). Her virginal introitus did not help. I wanted to do an endo. bx but could not manipulate the pipelle to the angle needed to get into the uterus. I'm very uneasy with this patient. I've ordered an FSH to see if this might be post-menopausal bleeding, a repeat u/s to re-evaluate her ovaries and her endometrium. She feels this is all too much-that she has bled every day for 7 years and 'this is normal for me and is due to my myomectomy'. Of course the right thing to do is a hyst-but she adamently refuses. Any suggestions? Has anyone ever had a patient that bled secondary to a myomectomy? Should I put her on progesterone and see if I can at least cycle her (assuming her FSH shows she is still pre-menopausal)? Should I insist on taking her to the OR to try and do a D&C? Not sure this will be possible even if cut her hymen given the sharp angle of her cervix. Very frustrating to be taking care of a patient who really doesn't want us to take care of her.
-- C. Cusack MD
|
|
Return to
|
Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Mon Nov 2 04:47:31 2009 |
The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.