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Amenorrhoea four years after a caesarean sectionFrom: Alex M. Pirie (Alexander.Pirie@cityhospbham.wmids.nhs.uk)Mon Jul 2 14:33:20 2001
A 32 year old woman has had no periods since her 'uncomplicated' caesarean section four years ago in another country. She does have monthly discomfort and would now like to have another child. Her pituitary, ovarian and thyroid hormone profiles are normal, but transvaginal ultrasound shows that the uterine cavity appears to end anteriorly at the uterine scar. The cervical canal appears to be blind. It appears that the caesarean has ended up with the anterior uterine wall being adherent to the posterior wall above the level of the internal os. Would you: -attempt a hysterosalpingogram to confirm the diagnosis, or is this a waste of time -attempt to create a false cervical canal under anaesthesia with either ultrasound guidance or with a laparoscope in situ to see you dont perforate the cavity -do a laparotomy, and attempt to refashion the uterine closure -or what?? Very interested to hear suggestions, and how often anyone has seen this sort of thing. Alex Alex
-- Alexander M. Pirie MRCP(UK) MRCOG Consultant & Hon Senior Lecturer in Obstetrics & Gynaecology City Hospital, Birmingham, UK
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