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Re: palpation of the uterine scarFrom: dahmd@gate.netSun May 12 19:52:26 1996
During my early residency I was taught by a number of upper-level residents to both palpate uterine scars in VBAC patients, and to manually remove all placentas (allegedly because they "can get stuck in which case the patient will need a D and C"). Ronald Chez came along one day and pointedly asked us during rounds why we were doing painful procedures on asymptomatic patients, and from that time forward I have neither palpated uteri after VBAC's, nor manually removed placentas, unless I find unaccounted- for pai, vaginal bleeding, or a prolonged 3rd stage. Even if I palpated a "window" or even a ruptured scar, I doubt I would do anything, anyway, in an asymptomatic patient. It seems that clinical findings such as profuse bleeding should guide management in this situation. It really must be extremely painful to have either of the above procedures done. Ashley Hill D. Ashley Hill, M.D. dahmd@gate.net Orlando, Fl
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