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Re: Vag hyst after C/S ... was Positive margins. From: Joanne Bulley, MD (islesannie@gmail.com) Wed Oct 31 21:11:26 2007 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Joanne Bulley, MD: "Re: Gyn: MRI OK with Mirena" Previous message: R. Daniel Braun: "Re: Vag hyst after C/S ... was Positive margins." In reply to: Garry E. Siegel, M.D.: "Re: Vag hyst after C/S ... was Positive margins." Next in thread: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Gyn: Positive margins on a LEEP" thanks folks. Patient A: For the woman with the LEEP (and prior C/S) I am going to do an abd hyst -- her arch is narrow and I could barely access the cervix for the LEEP. Patient B: But I have another patient who had 2 prior C/S who seems to have good access and will start / plan for a VH knowing we could switch. Patient A also had PMB - and when I did her LEEP (planning to do fractional D&C as well) - but she had 100% cervical stenosis. So she had a post op US with no evidence for abnormal endometrial stripe. But her first Pap after LEEP (with clean margins) is still LSIL. I say times up and that uterus has to go. Joanne At Wed, 31 Oct 2007, Garry E. Siegel, M.D. 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 > -- Joanne Bulley, MD, FACOG Solo gyn Keene, NH USA Next message: Joanne Bulley, MD: "Re: Gyn: MRI OK with Mirena" Previous message: R. Daniel Braun: "Re: Vag hyst after C/S ... was Positive margins." In reply to: Garry E. Siegel, M.D.: "Re: Vag hyst after C/S ... was Positive margins." Next in thread: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Gyn: Positive margins on a LEEP"

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