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Re: Amenorrhoea four years after a caesarean section From: Alex M. Pirie (Alexander.Pirie@cityhospbham.wmids.nhs.uk) Wed Jul 4 11:44:18 2001 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Paul Prior MD: "Re: Medem, etc." Previous message: Larry Glazerman: "Re: Medem, etc." In reply to: Steve & Eryl Raymond: "Re: Amenorrhoea four years after a caesarean section" Next in thread: Efrain Ramirez: "Re: Amenorrhoea four years after a caesarean section" Reply: Efrain Ramirez: "Re: Amenorrhoea four years after a caesarean section" Thank you for the varied and very useful advice, I'll let you know what we find. I think old notes, followed by hysteroscopy with or without laparoscopy will be plan. If we re-open the cavity, interested in your thoughts about estrogen and progestagen as for Ashermanns. What about leaving a stent. If so, then what? eg an IUCD for 3 months? What about a progestagen IUCD? Alex At Tue, 03 Jul 2001, Steve & Eryl Raymond wrote: > >I have seen this almost happen more than once (suturing the lower edge of the >anterior incision either to the posterior wall of the uterus or indeed to the >posterior lip of cervix). On each occasion it was discovered because the >resident doing the repair of uterus was unable to achieve haemostasis and called >me. For this reason, I doubt that it could be missed and left to become a >problem later in the way that your patient is affected. > >My hunch is that you will find, on probing the cervical canal carefully, that >there is in fact a passage, albeit a very stenosed one, which you will be able to >dilate, and, as has already been so elegantly expressed, "you will find melted >chocolate". The hysteroscope will be the best instrument to use, but I think it >could be done with a dilator blind. >stray > >DoctorJoe@aol.com wrote: > >> In a message dated 7/2/01 15:27:31, Alexander.Pirie@cityhospbham.wmids.nhs.uk >> writes: >> >> << ... 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. >> >> >> Or perhaps it was SUTURED that way. I've seen cases where there were >> separated layers front and back, such that if you were not very careful or >> observant, you COULD HAVE stitched the anterior incision to the posterior >> wall... No lie! >> >> Joe P. > >-- > >Dr.S.H. Raymond >Head of Department of O & G >Empangeni Hospital >South Africa 3880 >Phone: (+27) 35-7721111 >Fax: (+27) 35-7922596 > -- Alexander M. Pirie MRCP(UK) MRCOG Consultant & Hon Senior Lecturer in Obstetrics & Gynaecology City Hospital, Birmingham, UK Next message: Paul Prior MD: "Re: Medem, etc." Previous message: Larry Glazerman: "Re: Medem, etc." In reply to: Steve & Eryl Raymond: "Re: Amenorrhoea four years after a caesarean section" Next in thread: Efrain Ramirez: "Re: Amenorrhoea four years after a caesarean section" Reply: Efrain Ramirez: "Re: Amenorrhoea four years after a caesarean section"

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