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Re: caesarean myomectomy From: Kenneth A. Thomas, M.D. (KTHOMAS719@HOTMAIL.COM) Sat Oct 16 19:59:46 2004 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Robert J. Carpenter, Jr. MD: "Re: caesarean myomectomy" Previous message: Dr Eberhard W Lisse: "Re: physician pager response times" In reply to: DoctorJoe@aol.com: "Re: caesarean myomectomy" Next in thread: Robert J. Carpenter, Jr. MD: "Re: caesarean myomectomy" Reply: Robert J. Carpenter, Jr. MD: "Re: caesarean myomectomy" I also had one like this a number of years ago in a patient who needed a C/S for reasons unrelated to the fibroid. The fibroid was right in the middle of the anterior lower segment. I made the incision immediately inferior to the fibroid and got the baby out without any problems. But it was impossible to suture the lower segment to the upper segment with the fibroid in the way. I used the scalpel to split the upper segment into anterior and posterior halves just enough to expose the fibroid which was then easily shelled out. Several running mattress sutures closed the defect, and the uterus was then closed routinely. There was no excessive blood loss and no postop complications. I would never do an elective cesarean myomectomy, but if you are forced into it because a fibroid is in your way, then this method should hopefully prove useful. KT *********************************** At Fri, 15 Oct 2004, DoctorJoe@aol.com wrote: > >In a message dated 10/15/04 16:03:52, hsheld@anv.net writes: > >> Had a case similar to this some years ago in a primigravida. Left the myoma >> alone at C/S. The patient began to abort it about a week after delivery, >> presenting this huge necrotic mass the size of a fetus' head at the introitus. >> Ended up doing a hysterectomy. I would leave it alone and monitor for this >> kind of complication. >> >Had a patient with a very lower uterine segment fibroid that aggravated the >pregnancy for 37 weeks (was on terbutaline, Mg++, etc.). Ultrasound showed from >early pregnancy blood trickling down from the fibroid. Finally she had a >primary elective C/S. > >About a month postpartum, she had a crampy slimy bloody D/C and the fibroid >magically all but disappeared. Obviously, it infarcted and mostly resorbed. > >The next pregnancy went much smoother, although she had PTL and was treated >(by another doc) with a Ca++ channel blocker (which she incidentally said made >her feel TERRIBLE, contrary to how she felt on the t-pump). > >Joe P. -- Kenneth A. Thomas, M.D. FACOG Stratford, CT Next message: Robert J. Carpenter, Jr. MD: "Re: caesarean myomectomy" Previous message: Dr Eberhard W Lisse: "Re: physician pager response times" In reply to: DoctorJoe@aol.com: "Re: caesarean myomectomy" Next in thread: Robert J. Carpenter, Jr. MD: "Re: caesarean myomectomy" Reply: Robert J. Carpenter, Jr. MD: "Re: caesarean myomectomy"

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