Re: Post Partum D and C's for retained placenta- ultrasound resul t
From: art fougner, md (evsono@pipeline.com)
Fri Jan 9 06:20:40 2004
One zebra to keep in mind is trophoblastic disease which can present as
persistent post partum bleeding ... once saw a patient with GTN
following a cervical pregnancy treated with methotrexate who presented
with persistent vaginal bleeding and a cervical mass. A BHCG is a
simple test but you need to think of it.
art
At Fri, 09 Jan 2004, Tom Kavic Direcpc wrote:
>
>I would not only treat the patient as per clinical findings but would not
>hesitate to get pelvic sonar at some point so that no surprises may be
>overlooked in a patient with
>possible retained products of conception.
>
>T. Kavic , M.D., RVT, RDCS, RDMS
>
>>>----- Original Message -----
>From: "Greg Kesby" <greg.kesby@sufw.com.au>
>To: "Multiple recipients of list ULTRASOUND" <ultrasound@dns.obgyn.net>
>Sent: Thursday, January 08, 2004 6:07 PM
>Subject: Re: Post Partum D and C's for retained placenta- ultrasound resul t
>
>> Treat the patient not the scan. At now (3-4 weeks) postpartum, if she is
>> fine and happy with life and the trend is for things to be improving, I
>> would leave her alone in the absence of a definite clump or RPOC
>>
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>> -----Original Message-----
>> From: jmsmed58@hotmail.com [SMTP:jmsmed58@hotmail.com]
>> Sent: Friday, 9 January 2004 8:42:AM
>> To: Multiple recipients of list ULTRASOUND
>> Subject: Re: Post Partum D and C's for retained placenta-
>> ultrasound result
>>
>> Hi Greg.
>>
>> This patient below went to get an ultrasound. The ultrasonographer
>> could definitely see that there was still fluid and debris in the
>> uterus.... How much she didnt say. The results from the ultrasound
>> will be delivered to the Dr tomorrow.
>>
>> The per vaginal bleeding has really slowed down and is starting
>> to look like its clearing up.
>>
>> So Greg, what would be your advice in this situation? Would you
>> still go
>> the conservative way?
>>
>> Interested to know what you think
>>
>> Regards
>>
>> Joanne
>>
>> At Wed, 7 Jan 2004, Greg Kesby wrote:
>> >
>> >As an Aussie sonologist and MFM, what you describe is pretty
>> standard (and
>> >in my view good) practice. We are a little more conservative with
>> regard the
>> >use of curettage.
>> >
>> >While aware of the limited utility of sonography in the setting of
>> RPOC 2
>> >weeks postpartum, we use it to ensure that there is not a large
>> amount of
>> >RPOC.
>> >
>> > Then, in the setting of a confirmed small volume or none
>> >sonographically evident, antibiotics and "let nature take its
>> course" is a
>> >very common practise.
>> >
>> > Her management sounds excellent.....avoided a GA and curette
>> with
>> >its possible associated morbidity and just had to put up with
>> passing a
>> >small amount of placenta 2 weeks post partum.
>> >
>> > Cheers
>> >
>> >Greg
>> >
>> >CONFIDENTIALITY NOTICE:
>> >This information in this e-mail is intended for the named
>> recipients only.
>> >It may contain privileged or confidential information. If you are
>> not an
>> >intended recipient, you must not copy, distribute, or disclose any
>> details
>> >to any person, firm or corporation.
>> >If you have received this e-mail in error please contact
>> smee@sufw.com.au
>> ><mailto:administration@sufw.com.au> immediately.
>> >
>> > -----Original Message-----
>> > From: jmsmed58@hotmail.com [SMTP:jmsmed58@hotmail.com]
>> > Sent: Wednesday, 7 January 2004 8:54:AM
>> > To: Multiple recipients of list ULTRASOUND
>> > Subject: Post Partum D and C's for retained placenta
>> >
>> > Hi
>> >
>> > I would like to know pracitioners opinion on the value of
>> doing an
>> > ultrasound if a patient has passed Is the ultrasound
>> examination
>> >going to pick up small
>> > amounts of retained products?
>> > If it isnt then why not just do a D and C.
>> >
>> > This particular patient had some retained placenta. A small
>> amt
>> > discharged 2 weeks post partum. She called the hospital who
>> did the
>> > delivery and they said get some antibiotics. Not being
>> happy with
>> >that
>> > she went to a local GP (In Australia they are M.D's) and the
>> >following
>> > was done: vaginal swab, an ultrasound was ordered and
>> antibiotics
>> >were
>> > prescribed to be taken before the results of ultrasound came
>> >through. A
>> > possiblity of a D and C was mentioned at the time of
>> appointment.
>> >So,
>> > having said what this person's history is, how valuable is
>> the
>> > ultrasound going to be? Shouldnt this doctor just go ahead
>> and order
>> >a D
>> > and C without further ado?
>> >
>> > Looking forward to your replies
>> >
>> > Regards
>> >
>> > Joanne
--
art fougner, md
ich bin ein New Yorker
