Re: acutely anteflexed uterus
From: Joanne Bulley, MD (islesannie@gmail.com)
Sun Jul 22 10:45:27 2007
Ultimately I did a combination of these suggestions.
Weighted speculum definitely removed
Drop the scope toward the floor
pull like heck on the tenaculum - ripped out of the anterior lip several
times
put the tenaculum on the lateral lip and pulled and that seemed to alter
the angle of the canal and in the scope went. (I didn't consider
putting ant & post tenaculums as Ineeded to be able to drop that scope
posteriorly.
I was doing an essure and depsite taking 15 minutes to get in - the
lining was not yet too edematous from the trials and I passed those
essures into each tube easy as pie.
Then I sutured the cervix.
Has anyone put in any Essures with a flexible scope? (our hospital does
tno have a flexible scope).
So glad this was not one tried in the office!
She wanted the sterilization - and had had a difficult cholecystectomy
in the past with a umbilico=xiphoid incision - I thought avoiding the
abdominal cavity was the best idea.
Joanne
At Fri, 20 Jul 2007, D. Ashley Hill wrote:
>
>I try to place the patient flat on the table (no T-berg), then place the
>rigid hysteroscope into the cervix to the level of the internal os.
>Then, drop your hand and 'scope as low as they will go (you may need to
>remove the speculum if one is in place) and watch as you angle it
>towards the fundus. Alternatively, a flexible scope may work. Good
>luck.
>
>DAH
>
>At Fri, 20 Jul 2007, Joanne Bulley, MD wrote:
>>
>>OK folks - so I split the infinitive - anyone have any suggestions for
>>dealing with the severely anteflexed uterus and successfully place the
>>rigid hysteroscope into the uterus??
>>
>>Joanne
>>
>>At Fri, 20 Jul 2007, Raymond Stephen wrote:
>>>
>>>Well spotted, Gerald! Now I'm wondering how many others didn't notice the reversed order of the "to" and the "not"?
>>>
>>>Steve
>>>
>>>-----Original Message-----
>>>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Gerald P.Rodriguez
>>>Sent: Friday, 20 July 2007 1:19 AM
>>>To: Multiple recipients of list OB-GYN-L
>>>Subject: Re: acutely anteflexed uterus
>>>
>>>I think he was referring to the split infinitive that Joanne used; he was
>>>not claiming it didn't come from the Bard.
>>>
>>>[After 25 years it was really bizarre having to try to guess how to get
>>>into the cavity - while being exceedingly careful to not Perf!]
>>>
>>>Gerald P. Rodríguez, M.D., FACOG
>>>Santa Fe
>>>
>>>>>>>----- Original Message -----
>>>From: "ainsron" <ainsron@sbcglobal.net>
>>>To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net>
>>>Sent: Thursday, July 19, 2007 8:49 AM
>>>Subject: Re: acutely anteflexed uterus
>>>
>>>> If he didn't, who did?? If the quote isn't correct, correct it.
>>>>
>>>> "To be or not to be, --that is the question:--
>>>> Whether 'tis nobler in the mind to suffer
>>>> The slings and arrows of outrageous fortune
>>>> Or to take arms against a sea of troubles,
>>>> And by opposing end them?"
>>>>
>>>> -- From Hamlet (III, i, 56-61)
>>>>
>>>> Ronald E. Ainsworth, MD, FACOG
>>>>
>>>> -----Original Message-----
>>>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Raymond
>>>> Stephen
>>>> Sent: Wednesday, July 18, 2007 8:13 PM
>>>> To: Multiple recipients of list OB-GYN-L
>>>> Subject: RE: acutely anteflexed uterus
>>>>
>>>> Shakespeare did NOT write "to be or to not be"
>>>>
>>>> Steve
>>>>
>>>> -----Original Message-----
>>>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Joanne
>>>> Bulley, MD
>>>> Sent: Thursday, 19 July 2007 1:01 PM
>>>> To: Multiple recipients of list OB-GYN-L
>>>> Subject: acutely anteflexed uterus
>>>>
>>>> Hi Friends,
>>>> "...while being exceedingly careful to not Perf!"
>>>>
>>>> --
>>>> Joanne Bulley, MD, FACOG
>>>> Solo gyn
>>>> Keene, NH USA
>>>>
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>>
>>--
>>Joanne Bulley, MD, FACOG
>>Solo gyn
>>Keene, NH USA
>>
>--
>D. Ashley Hill, MD
>Associate Director
>Department of Obstetrics and Gynecology
>Florida Hospital Family Practice Residency
>Medical Director, Loch Haven Ob/Gyn Group
>Division Director, Dept. of Ob/Gyn, Florida Hospital Orlando
>Orlando, Florida
>
--
Joanne Bulley, MD, FACOG
Solo gyn
Keene, NH USA
