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Re: Ynt: Correct Placement of IUD's From: Malcolm Griffiths (Malcolm@mgriff22.demon.co.uk) Tue Dec 30 11:33:29 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Malcolm Griffiths: "Re: OB:Prenatal Rituals" Previous message: Malcolm Griffiths: "Re: Earlier menopause with Hyst" In reply to: Bulent Potur: "Ynt: Correct Placement of IUD's" Next in thread: John G. M. Robertson: "Re: Ynt: Correct Placement of IUD's" In message <01bd153d$af7dfda0$LocalHost@bpotur>, Bulent Potur <bpotur@superonline.com> writes > >>As far as listening to the fetal heart at antenatals - haven't done that >>in years! If the woman tells me it has been moving well upto seeing me I >>accept her assessment. If she says otherwise I insist on a computerised >>CTG analysis. The only reason to listen to the FH is to allow the woman >>to hear it - if she needs that reassurance - in which case you need a >>Doppler/Sonicaid so she can hear it to! > >Dear Malcolm, >I suppose you are just kidding. Hell no I wasn't! >There are many reports of normal appearing >FHR tracings of macerated fetuses. (Apparently due to a tachicardiac >maternal heart rate tracing). If you do not see the beating heart of a fetus >on a US screen with your own eyes you can never be certain that the fetus is >alive. I have seen many patients saying the baby was moving while it was >actually dead in utero for days. So what your saying is that unless one actually sees a beating fetal heart on an ultrasound scan at EVERY antenatal visit then one may be dealing with an already macerated fetus! Your (correct) observation that a normal FHR on CTG may be artefact, means that we cannot be totally reassured by any indirect method of picking up FH. Any Doppler or electronic method is liable to artefact. Listening in with a stethoscope is highly subjective and open to error. Whilst I have yet to encounter the macerated stillbirth that exhibits good fetal movements, I have seen dozens of macerated stillbirths where the clinician heard the FH earlier that day (with stethoscope). >Personally I have a US in my office and I routinely perform a US exam for >every obstetric or gyneacologic patient. I do not charge for it. I do not >present a written report of it either. I consider it as a part of my exam. I shan't go into the medicolegal implications of performing an ultrasound scan but not reporting it! In my practice we do not have the resources to perform a scan on every woman attending a hospital antenatal visit. But as 50% of our women have antenatal care by their midwives in the community and the majority of those who receive shared care only have two or three antenatal visits (on average) in hospital - and one of those will be in the first trimester! I can't se how we could even aspire to what you suggest. >Such as an ECG or even a stethescope for a cardiologist. In UK most cardiologist do ECG's *AS INDICATED*. Even the most tunnnel- visioned cardiologist won't use his stethoscope to confirm that the patient is alive! >After IUD insertions I see the patients in one month after the menses. I >routinely check with US if the IUD is placed in uterine fundus. This is where the thread began - there has been no evidence in the discussion to date that this has any value > Because I >also perform US exams before MR or other abortions I have seen cases with >IUD and pregnancy. In most of those cases the gestational sac is in the >uterine fundus while the IUD is in the lower part of the uterine >cavity Of course it USUALLY is. However is it sitting low because it has always been low and that's why the pregnancy has occured? Or is it low because the sac is displacing the IUCD? My money would be on the latter! Equally there are documented cases of placental implantation over the IUCD with the IUCD being found embedded in the placenta at delivery. * I remain highly unconvinced that there is any merit in either routine US after IUCD insertion; or routine fetal heart auscultation. Whilst routine fetal heart ultrasound at every antenatal visit is an unattainable gold standard for my practice, I don't doubt its ability to reliably diagnose fetal demise. However once the fetus is dead, I have no intervention to offer to alter the outcome. My practice remains that is a woman has good fetal movements I don't listen, and if she does I want to see a proper CTG, interpretted by someone who can spot an artefact or by a computer package such as the Sonicaid 8000. >I wish a happy new year for the list. and I congratulate the holy month >ramadan of muslim listmates. Ditto! Malcolm Griffiths MD,MRCOG,MFFP,Cert.Mgmnt Obstetrician & Gynaecologist Luton & Dunstable Hosp.,UK. Tel: 01582-497459 (office) Fax: 01582-497376 01525-222849 (home) email: Malcolm@mgriff22.demon.co.uk http://www.obgyn.net/board/griffith.htm "CLINICAL FREEDOM IS THE LAST REFUGE OF THE CLINICALLY INCOMPETENT!" (Someone [1997]) Next message: Malcolm Griffiths: "Re: OB:Prenatal Rituals" Previous message: Malcolm Griffiths: "Re: Earlier menopause with Hyst" In reply to: Bulent Potur: "Ynt: Correct Placement of IUD's" Next in thread: John G. M. Robertson: "Re: Ynt: Correct Placement of IUD's"

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