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Re: Vag hyst after C/S ... was Positive margins. From: R. Daniel Braun (rd.braun@gmail.com) Wed Oct 31 18:08:01 2007 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Joanne Bulley, MD: "Re: Vag hyst after C/S ... was Positive margins." Previous message: Dean Huffman .: "Legal Malpractice Suit Against Personal Injury Lawyers Permitted to Go Forward" In reply to: Garry E. Siegel, M.D.: "Re: Vag hyst after C/S ... was Positive margins." Next in thread: Douglas Krell: "Re: Vag hyst after C/S ... was Positive margins." Reply: Douglas Krell: "Re: Vag hyst after C/S ... was Positive margins." The pubic arch is the limiting factor in suitability for Vag. Hyst. Not uterine size, not parity, not previous surgery. My comment about 6 prior C/S was with the idea that there aren't very many women out there who have had 6. I personally have never done a vag. hyst on a uterus greater than 28 (twenty-eight) weeks size (22050 gm). It took a while to do, but she went home the next morning. When the residents wanted to staff a TAH or LVH, I would always ask them: "Why can't it be done vaginally?" Dan On 10/31/07, Garry E. Siegel, M.D. <garrys@mindspring.com> wrote: > > I would also factor in the pelvic architecture, i.e. how narrow is her > arch (did she have the first C/S for "CPD" and has a narrow arch that > makes vaginal access a struggle). > > Garry > > At Wed, 31 Oct 2007, Douglas Krell wrote: > > > >Is one enough...six too many? > > > >No. If the patient has prev C/S, I wouldn't hesitate to do a vag hyst > based > >on the number of C/S alone, but rather on the patient's exam, degree of > >uterovaginal prolapse, apparent severity of scarring, size of uterus > >etc...Haven't we all seen those women who've had 5 or 6 C/S and it looks > >like they've barely been to surgery? Then there was the woman last > week... > >2nd C/s and I couldn't even exteriorize the uterus to do the tubal. > > > >-- > >Douglas Krell MD > > > >>So a question for Y'All : any rule-of-thumb on VH - at how many C/S > >>would you be hesitant to do a VH? > >> > >>JB > >> > > -- > Garry E. Siegel, M.D. > Private Practice > Roswell, GA > -- R. Daniel Braun, MD FACOG(L) CMT Professor Emeritus Dept. of Obstetrics and Gynecology Indiana U. School of Medicine R. Daniel Braun "Science without Religion is LAME; Religion without Science is BLIND" Einstein 1941 Next message: Joanne Bulley, MD: "Re: Vag hyst after C/S ... was Positive margins." Previous message: Dean Huffman .: "Legal Malpractice Suit Against Personal Injury Lawyers Permitted to Go Forward" In reply to: Garry E. Siegel, M.D.: "Re: Vag hyst after C/S ... was Positive margins." Next in thread: Douglas Krell: "Re: Vag hyst after C/S ... was Positive margins." Reply: Douglas Krell: "Re: Vag hyst after C/S ... was Positive margins."

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