Re: Post Partum D and C's for retained placenta- ultrasound result
From: Dr. Fazeel (fazeel@abt.wol.net.pk)
Fri Jan 9 12:58:26 2004
Yes Ted Lyons's point is very important. one should also be aware of
trophoblastic disease (h.mole or invasive mole or choriocarcinoma) which
also can present as post D&C bleed recurrence................so you got to
follow the case with serial scans, doppler, beta hcg and histology of what
comes out or is taken out.
fazeel
-------Original Message-------
From: ultrasound@obgyn.net
Date: 1/9/2004 4:24:05 PM
To: Multiple recipients of list ULTRASOUND
Subject: Re: Post Partum D and C's for retained placenta- ultrasound result
What has not been mentioned is the value of color doppler with the endovag
study. I rely on it MORE than the 2D image. If there is local increased
vascularity it is significant and needs to be followed of to go for D&C.
Non-vascularized RPOC may pass on their own, I think!
--
Ted Lyons
>----- Original Message -----
From: "Joanne Simich" <jmsmed58@hotmail.com>
To: "Multiple recipients of list ULTRASOUND" <ultrasound@dns.obgyn.net>
Sent: Thursday, January 08, 2004 3:40 PM
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
>
.
