WOMENS-HEALTH Messages for April, 2000: Re: How to regain trust in an OB

Re: How to regain trust in an OB

From: D. Ashley Hill, MD (anonymous@obgyn.net)
Wed, 5 Apr 2000 12:08:57 -0500 (CDT)

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At Wed, 5 Apr 2000, anonymous wrote:

>Certainly there must be some risks involved with doing this procedure
>(infection, possibly causing a problem with the scar by feeling it -
>where a problem may not have existed otherwise). What would be done, if
>anything, if a separation (in the absence of abnormal bleeding or other
>symptoms) was found? Do the risks outweigh the benefits? Shouldn't the
>patient have a say in whether this is done?

All excellent questions. I have always suspected that palpating the uterine scar would slightly increase the infection rate, but I have not seen this studied. If there is a separation that is not bleeding heavily, most ob doctors would simply observe the patient closely, and follow serial abdominal exams and blood counts. If the blood count dropped a lot, then it's off to the OR for a bikini cut and some stitches in the uterus. If it did not drop, then the patient can usually go home in a few days. I can't comment on whether the risks outweigh the benefits, because I don't think this has been adequately studied. However, I don't routinely examine the uterus, because I feel that unless there is active bleeding, then observation is indicated, not further surgery. Some might disagree.

Patients always have a say about medical procedures (unless they are in a coma, etc). Palpating the uterine scar should be done right after delivering the placenta, to take advantage of the dilated cervix. There might not be enough time for a discussion at that moment, so this is something to talk about before the delivery, or perhaps even in the office.

Take care,

--
David Ashley Hill, MD
Associate Director
Department of Obstetrics and Gynecology
Florida Hospital Family Practice Residency
http://home.mpinet.net/dahmd

My apologies, but due to time constraints I am unable to answer private e-mails.

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