Re: Priority in Post partum retained products?
From: Joanne Simich (jmsmed58@hotmail.com)
Thu Jan 8 14:50:23 2004
Hi Charlie
So, here are some further details on this case. I think I can predict
how you might respond to it, as I know what I think should happen next!
My question to you and if others want to respond- how deceptive is the
vaginal bleeding symptom of slowing down and clearing up? Is that enough
for a doctor to say " No, no D and C."
What is the usual pattern for elimination of post partum retained
placental tissue? Does it behave like this in that it appears to be
healing, the bleeding stops and no more clinical measures are taken?
FURTHER CASE DETAILS
This patient below went to get an ultrasound yesterday. This is in
Australia everyone. The ultrasonographer could definitely see that
there was still fluid and debris in the uterus. How much she didnt say.
The results from the ultrasound will be delivered to the Dr tomorrow.
The vaginal bleeding has slowed down and is starting
to look like its clearing up.
So, if anyone else has any input I would appreciate it. Now that a few
of you have checked out my qualifications, perhaps you might respond. :)
Kind regards
Joanne.
At Wed, 7 Jan 2004, Charlie Chambers wrote:
>
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>Joanne
>I think that an ultrasound can be helpful. However, if I clinically
>suspect retained products, then I don't care what the ultrasound shows.
>I think your instincts are quite correct. Retained products will
>respond with removal of the tissue. All the abx in the world won't
>help, if there is a big hunk of placenta still stuck to the fundus.
>
>************************************************************************
>*
>
>--
>************************************************************************
>Charlie Chambers
>Hood River, OR
>cchamber@alumni.rice.edu
>
>"No matter where you go...
> there you are."
>Dr. Buckaroo Banzai
>************************************************************************
>On Jan 7, 2004, at 4:05 PM, Joanne wrote:
>************************************************************************
>
>> Hello
>>
>> I would like to know what is the criteria for ordering D and C's for
>> post partum retaining of products. Case history on my patient: Baby
>> born- Dec 16th 03 , Placental tissue passed Jan 5th 04 . Hospital that
>> did the delivery said:" take Antibiotics, because you have an
>> infection"
>> So she went to a local General Practitioner (these are M.D's) in
>> Australia who took a vaginal swab, ordered an Ultrasound, wants her on
>> AB's before the results come back, and is talking about possibility of
>> D
>> and C.
>>
>> I want to know of how much value you think an U/S is in this situation,
>> and are A/B's really called for here? My clinical opinion is get her in
>> , do a D and C asap and stop stuffing around with this situation. That
>> opinion is based on my own experience. After both my children, it was
>> retained products diagnosis. First delivery, I had a family friend who
>> was a top Obstets doc in Auckland NZ. As soon as I called him and told
>> him, well i passed a 2 " diam piece of something or other" He put me in
>> hospital immediately - D and C, done and no problems from that point
>> on.
>> The second child, not under the same doctor, - post partum bleeding for
>> 6 weeks, then D and C ordered. All of this was without A/Bs
>>
>> Also what value do you think an ultrasound is going to be at this
>> stage?
>>
>> So would like to get your opinions please.
>>
>> Thanks
>>
>> Kind regards
>> Joanne
>>
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>Joanne
>
>I think that an ultrasound can be helpful. However, if I clinically
>suspect retained products, then I don't care what the ultrasound
>shows. I think your instincts are quite correct. Retained products
>will respond with removal of the tissue. All the abx in the world
>won't help, if there is a big hunk of placenta still stuck to the
>fundus.
>
><bigger>*************************************************************************
>
><bigger>*************************************************************************
>Charlie Chambers
>
>Hood River, OR
>
>cchamber@alumni.rice.edu
>
>"No matter where you go...
>
> there you are."
>
>Dr. Buckaroo Banzai
>
>************************************************************************</bigger>
>
>************************************************************************</bigger>
>On Jan 7, 2004, at 4:05 PM, Joanne wrote:
>
><excerpt>Hello
>
>I would like to know what is the criteria for ordering D and C's for
>
>post partum retaining of products. Case history on my patient: Baby
>
>born- Dec 16th 03 , Placental tissue passed Jan 5th 04 . Hospital that
>
>did the delivery said:" take Antibiotics, because you have an
>infection"
>
>So she went to a local General Practitioner (these are M.D's) in
>
>Australia who took a vaginal swab, ordered an Ultrasound, wants her on
>
>AB's before the results come back, and is talking about possibility of D
>
>and C.
>
>I want to know of how much value you think an U/S is in this situation,
>
>and are A/B's really called for here? My clinical opinion is get her in
>
>, do a D and C asap and stop stuffing around with this situation. That
>
>opinion is based on my own experience. After both my children, it was
>
>retained products diagnosis. First delivery, I had a family friend who
>
>was a top Obstets doc in Auckland NZ. As soon as I called him and told
>
>him, well i passed a 2 " diam piece of something or other" He put me in
>
>hospital immediately - D and C, done and no problems from that point
>on.
>
>The second child, not under the same doctor, - post partum bleeding for
>
>6 weeks, then D and C ordered. All of this was without A/Bs
>
>Also what value do you think an ultrasound is going to be at this
>stage?
>
>So would like to get your opinions please.
>
>Thanks
>
>Kind regards
>
>Joanne
>
></excerpt>
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>
