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Re: Placenta accreta/increta & recalcitrant endomyometritis From: art fougner, md (evsono@pipeline.com) Sun Mar 8 10:47:22 1998 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: R.Daniel Braun, MD FACOG: "Re: shortening cervix" Previous message: R.Daniel Braun, MD FACOG: "Re: shortening cervix" In reply to: Kelly Shanahan, MD: "Placenta accreta/increta & recalcitrant endomyometritis" Next in thread: R.Daniel Braun, MD FACOG: "Re: Placenta accreta/increta & recalcitrant endomyometritis" not feeling so esteemed but if your patient continues to be febrile, and her exam is anything BUT benign, then it is time to perform a hysterectomy. three yrs ago in our neck of the woods, a similar patient died of complications related to pelvic sepsis. good luck and let us know how things turn out. art At Sat, 7 Mar 1998, Kelly Shanahan, MD wrote: > >Oh esteemed colleagues, I need your input on a case: > >20ish G2, now P2, 10 days s/p c-section (breech, ROM x 16 hrs prior to >presentation to hospital). At C/S, placenta accreta/increta noted, >requiring uterine curretage and bilateral uterine artery ligation. >Transfused 2 units secondary to hgb of 6 and symptomatic on POD 2. >Intraop received erythromycin (pcn allergic) and postop immediately >begun on gentamycin as well. IV Flagyl added on POD 4 d/t continued >temps >101 and h/o gardnerella in December. Wound seroma/hematoma noted >on POD 5 and wound opened, without any sign of infection. Blood, urine, >vaginal and wound cultures negative thus far. >Continues to spike temps, usually at night, up to 102. Pelvic US on POD >8 showed retained placental tissue (no surprise there) but nothing else. >Antibiotics changed from erythro to vancomycin to better cover possible >enterococcus. POD 9 pt taken to OR for repeat uterine curretage; >necrotic placental fragments removed, cultures pending. Antibiotics >changed again on pharmacists recommendation -- current abx are >levaquine, gentamycin and flagyl. Pelvic CT today (POD 10) shows no >evidence of pelvic vein thrombosis. >Pt has > 10 year h/o IVDA of methamphetamine, clean x 6 months, negative >HIV during this pregnancy, negative blood culture. > >What would you do if she continues to spike? Empiric heparin despite (-) >CT? Different antibiotics, even if cultures (-)? Hysterectomy? > >Your opinions would be most welcome. > >-- >Kelly Shanahan, MD, FACOG >S. Lake Tahoe, CA > >note: Opinions here are for educational purposes only. This information is not intended to supplant the need for you to consult with your own physician. It cannot take the place of a face to face consultation and examination. >Sorry, but private e-mails will not be answered. > -- art fougner, md SonoScan/Genetic Sciences forest hills, ny evsono@pipeline.com Next message: R.Daniel Braun, MD FACOG: "Re: shortening cervix" Previous message: R.Daniel Braun, MD FACOG: "Re: shortening cervix" In reply to: Kelly Shanahan, MD: "Placenta accreta/increta & recalcitrant endomyometritis" Next in thread: R.Daniel Braun, MD FACOG: "Re: Placenta accreta/increta & recalcitrant endomyometritis"

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