internal exam of uterine scar - Mothering Forums

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#1 of 38 Old 01-21-2007, 06:35 PM - Thread Starter
 
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HI,

My ob (recently switched, long story...) said he'll do an internal exam of the uterine scar to make sure it's intact. I've heard of this before but I haven't been able to find any info on it. I didn't say anything and I plan to refuse but i don't know anything about it and I don't want to be missing something. I realize that if you have a low transverse scar there's not a lot of blood vessels there (this is what he said) so hemorraging will not be the way to find out if i had a rupture.
can anyone shed any light on this? thanks!
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#2 of 38 Old 01-21-2007, 07:03 PM
 
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Heyla...

It's not necessary, and in many cases it's an extremely painful procedure (some OBs will suggest an epi or spinal for the check even if you delivered without pain meds). In addition it leads to an increased risk of uterine infection and certainly gets in the way of bonding with your new babe! Also, it is not uncommon for a c/s scar to thin out and even open as a "window" during labor and delivery...this is not in an of iteself dangerous to the babe or to you. But a small window can be made larger by an OB trying to "feel" the scar.

Also, there's no good reason to check the scar following delivery unless there is an indication of rupture (for example, your blood pressure wont stabilize, your stomach is ditended or atypical to touch, you're in pain after the placenta is delivered, there is a problem with the placental delivery, etc)...and if that is the case, ask them to check with u/s instead of a manual exam.

Check out (and perhaps print out for your care provider) the medical literature. If you're searching a source like PubMed, the terminology is "routine revision of uterine scar after prior cesarean section" or "manual palpation of the uterine scar". A few samples:

"Routine revision of uterine scar after cesarean section : Has it ever been necessary?" in the European journal of obstetrics, gynecology, and reproductive biology:
Quote:
In conclusion, the potential benefit of routine examination of uterine scar after VBAC is doubtful. Transcervical revision should be performed only in symptomatic patients.
"Scarred uterus: is routine exploration of the cesarean scar after vaginal birth always necessary?" (French language, published in the J Gynecol Obstet Biol Reprod):
Quote:
CONCLUSION: These data suggest that transcervical revision of previous cesarean uterine scar should be performed only in symptomatic patients (persistent suprapubic pain, placental retention, excessive bleeding during labor or delivery) or when risk factors are present (prolonged labor, prolonged expulsive efforts, instrumental extraction).
Good luck...and just say no to that exam!

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#3 of 38 Old 01-21-2007, 08:07 PM
 
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When I had my vbac my dr never mentioned checking my scar nor did he check it after my delivery.
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#4 of 38 Old 01-21-2007, 08:31 PM
 
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I just read about this... thanks for the links wombatclay!

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#5 of 38 Old 01-21-2007, 08:35 PM
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I just read about this... thanks for the links wombatclay!
: wombatclay
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#6 of 38 Old 01-21-2007, 08:52 PM
 
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thanks all...I'm a reference librarian and I'm actually at work right now, so I've got the databases at my fingertips. And as a VBAC mama this topic is really something I feel strongly about. The more we know, the stronger we are...and VBAC mamas are STRONG!

And on a totally non-medical, non-academic, level...the thought of having some OB do an internal "spot check" of my uterus is just so unbelievably icky that...well...ugh.

Anyway, despite digging through the medical literature I couldn't find a SINGLE study that supported routine checks after a vbac. So I guess science is on the side of my gut reaction!

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#7 of 38 Old 01-22-2007, 12:22 AM - Thread Starter
 
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thanks for the links! I didn't think to check pubmed.
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#8 of 38 Old 01-22-2007, 12:29 AM
 
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Yes, this has long been a routine after a VBAC delivery. Doctors see it as their business to check for a rupture, but there are clearly other ways to check for a rupture.

I feel it leads to increased infections and misdiagnoses of windows or openings in the muscles as ruptures and further interventions in the birth process.

Check your records to see if this was done and what was found if anything and if anything else was done without your knowledge.

I would think that your consent would have to be given if and when this was done.

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#9 of 38 Old 01-22-2007, 12:51 AM
 
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"Silent Knife" discusses this in length.
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#10 of 38 Old 01-22-2007, 12:59 AM
 
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What is the actual test he is going to do?

I have had 4 sonohystograms. (tests where they inject saline into the uterus, blow it up basically and look and see what the scaring on the inside looks like).

That is 100% non painful. I have had more painful papsmears. It is very definative and a great diagnostic tool. I have no idea, if that is the test your OB is willing to do why anyone in their right mind would have a spinal for that. It truly doesn't hurt and if there is any pain associated with it, it is minor cramping, just like a menstral cycle.

I would highly suggest the sonohystogram and would have no problems saying it is truly a non painful option to feel secure that you are fully healed.
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#11 of 38 Old 01-22-2007, 01:01 AM
 
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There is a serious chance of infection by putting anyone's hands inside you other than yours or your partners. I would never allow it.

Mom of a 7 yr old, 4 yr old, and 1 yr old. Wow. How did that happen?
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#12 of 38 Old 01-22-2007, 02:02 AM
 
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Originally Posted by phrogger View Post
sonohystogram
...also carries with it an infection rate. Odd. It is a test to see if your tubes are blocked, yet it can cause an infection that will block your tubes later.

Did your doctor warn you about this possiblilty?

The Opening Poster is talking about a manual exploration of the uterus after the birthing of the placenta and before the repair of any tears or episiotomy.

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#13 of 38 Old 01-22-2007, 02:48 AM
 
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you are thinking of a HSG hystosonogram, two different procedures. One injects dye and checks for blockages, the one I had ONLY looks into the uterus.

The chance of infection is extremely minimal not to mention it is a requirement for me to even consider becoming pregnant. (I am a surrogate) with that said, I have been in this "business" and have dealt with and worked with numerous REs, OB and potential surrogates and clients. I have never had a single woman contract an infection from this procedure not to mention have any complications or even pain.

With that said, I have had two die in childbirth.

So basically, from my personal and "professional" standpoint, it is a safe procedure and if the OB feels it is a good option to consider, it is worth considering.

By the way, that is why I asked what the test was, I unfortuantly assumed she was talking about prior to getting pg. As there was someone who asked about it before and I did suggest the sonohystogram.
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#14 of 38 Old 01-22-2007, 03:34 AM
 
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No way...I would never allow this. There are so many other signs of rupture.

Sticking his hand up there would be not only horribly painful but could cause damage and infection. The risks to me would FAR out weigh any benefit.
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#15 of 38 Old 01-22-2007, 10:55 AM
 
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No way...I would never allow this. There are so many other signs of rupture.

Sticking his hand up there would be not only horribly painful but could cause damage and infection. The risks to me would FAR out weigh any benefit.
This! I asked my OB if he did routine manual exploration of the uterus after a vbac, and he said he didn't do that and didn't think anyone would do that in this day and age (he's such an innocent!) I would be very wary of an OB who is ignorant enough to suggest this. If you are going to continue with this guy, you should make it clear that you are not going to allow this.

As Wombatclay said, this procedure can cause damage to the uterus. I've read that the OB could poke his finger through a thinned out area of the uterus, *causing* a rupture.
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#16 of 38 Old 01-22-2007, 05:01 PM
 
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Quote:
Originally Posted by phrogger View Post
What is the actual test he is going to do?

I have had 4 sonohystograms. (tests where they inject saline into the uterus, blow it up basically and look and see what the scaring on the inside looks like).

That is 100% non painful. I have had more painful papsmears. It is very definative and a great diagnostic tool. I have no idea, if that is the test your OB is willing to do why anyone in their right mind would have a spinal for that. It truly doesn't hurt and if there is any pain associated with it, it is minor cramping, just like a menstral cycle.
Heyla phrogger!

The "test" mentioned by the OP is far less "scientific" and much more "hands on"...once the placenta is delivered the doctor does a manual exploration of the uterus. One hand on the stomach to provide downward pressure and the other hand all the way INSIDE the uterus to see if a scar can be felt, and if so, whether the scar has opened.

There is a high risk of infection, possible risk of causing a rupture (for example, if the doctor presses too hard against a thinned out section of the scar and perforates the uterus), and, at least according to the medical literature, no good reason to do the exam.

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#17 of 38 Old 01-22-2007, 11:11 PM - Thread Starter
 
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I did mean after delivering the placenta and not before getting pg. As soon as he mentioned that I think my uterus clamped down in protest. At the time I was thinking noone will be sticking anything in there to check because of the ick factor, I didn't even think about infection or actually causing other damage. It just seemed wrong on a much more basic level.
I can potentially switch obs, again, but i'm 37 weeks and have already switched 2x in the last month. I plan to stay at home as long as possible and to have a birth plan and a doula (and hubby of course) for lots of support.
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#18 of 38 Old 01-22-2007, 11:20 PM
 
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It sounds like you are well prepared. Do you feel comfortable to tell him beforehand that you will be declining the internal exam?
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#19 of 38 Old 01-22-2007, 11:41 PM
 
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Quote:
The "test" mentioned by the OP is far less "scientific" and much more "hands on"...once the placenta is delivered the doctor does a manual exploration of the uterus. One hand on the stomach to provide downward pressure and the other hand all the way INSIDE the uterus to see if a scar can be felt, and if so, whether the scar has opened.

ugh, that seriously just made my stomach turn over!

I have had 4 VBAC's. (3 different hospitals, 3 different states, 3 different OB's) and this is NOT A TYPICAL procedure!
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#20 of 38 Old 01-23-2007, 12:23 PM
 
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Just wanted to re-iterate this procedure is totally unecessary. Ugh, sorry, he (OB) must be living in the dark ages........
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#21 of 38 Old 01-23-2007, 04:51 PM - Thread Starter
 
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I'll have to clarify with him again if this is something that he would do or if other OBs in his practice are known to do - maybe he was giving me a heads up. Heck i'm saying no to it! I have been known to misunderstand or misinterpret stuff lately, but this was pretty clear. It was mentioned in the same paragraph as continuous monitoring and a uterine catheter to monitor contractions because i'm vbac. I will be refusing all this stuff. It was very surprising because this same doc does a lot of vbacs and seems pretty crunchy. I even heard he is supportive of homebirths for non-vbacs. Something doesn't add up. It could be others in his practice and they also just recently joined practices with another bigger group of OBs to cut down on insurance cost and to have coverage for births. It's kind of a sad state of affairs here in CT for OBs. A lot are leaving because they can't afford the insurance and they don't like what has been happening to the practice. But that's a whole other issue.
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#22 of 38 Old 01-23-2007, 06:08 PM
 
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If I had an epidural that hadn't completely worn off yet, how would I know if the dr did this exam while I was distracted with my new baby and not metioned it to me? Would it possibly be mentioned in the hospital records? I ask because I did look down at the dr at one point (maybe 10 minutes) after my baby was born and he was feeling around on my abdomen with what seemed to be the other hand in my vagina (I'm not sure if it was his entire hand or not). At the time, I assumed he was seeing if the placenta had detached yet, but now I'm wondering. Since I was still partially numb, he could have done it and I just not have known about it. I were not still numb, he probably couldn't have done it without me knowing, but this is sort of bothering me now.

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#23 of 38 Old 01-23-2007, 06:24 PM
 
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It should be in your complete hospital record.

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#24 of 38 Old 01-24-2007, 12:21 AM
 
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I'm wondering now if my doc plans on this. I'm writing it down to ask him tomorrow at my appt. The last thing i want to be saying after my vbac is, "where's your hand?!?....hubby where's his hand?!?....is it in there?!?....why's it in there?!?.......Doctor, get your hands where i can see 'em!!!":

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#25 of 38 Old 02-25-2007, 12:32 AM
 
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I know this is an older thread, but I have to comment. I just watched my vbac birth of my daughter and was amazed at how much I had forgotten! For one thing, my midwife commented after she did the internal exam (after baby was born and placenta was out), that she had done an internal exam of the incision and that it was intact. I did not realize that this was NOT standard. Kind of irks me off now. : I didn't realize she was doing it because at the time, I thought she was evaluating my cervix since I had a superficial tear. It's sad what they think is the right thing to do sometimes.
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#26 of 38 Old 02-26-2007, 02:22 PM
 
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Ouch, no way. Sick and barbaric (sp?). I did not think any doc's still did this!
Why would you NEED to ever do that? So you got baby out, placenta's lookin good... What would it even matter if there is a scar seperation? it will heal....
icky

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#27 of 38 Old 02-26-2007, 07:03 PM
 
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sorry replying so late, but i did ask my ob about this. He said it's something they routinely did in the 80's and really don't do anymore because the finger's prodding around in there can actually cause the separation.

As for asking the doc to "show me their hands". Well, my doc wasn't there for the delivery, it was his associate (equally good) and yes, i did at one point after ds birth ask her (kind of louldly) where her hands were. She was just checking for tears but she was very nice to explain to me everything she was doing after that.

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#28 of 38 Old 08-02-2007, 04:01 PM
 
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Hello,

I am planning a VBAC in Oct and also have a doctor who considers a manual interuterine exam "routine" after delivery. On my next visit I'm going to print some articles and try discussing my feelings about the procedure with her. However, no matter what she says during my OB visits I WILL be REFUSING the exam at the time of delivery. Here are the articles I've found so far:

http://www.asjog.org/Journal/Issue%2...views-VBAC.pdf
PDF - requires adobe acrobat *very last paragraph of article*

http://www.vbac.com/chapter38.html#53
section 5.3

http://www.aimsusa.org/CareInNormalBirth.htm
section 6.2 #15

http://www.childbirthconnection.org/...oad=gecpc3ch38
PDF *website requires registration -- free* section 5.3

I hope these help, good luck!

-Susan
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#29 of 38 Old 08-02-2007, 04:17 PM
 
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I have a look of absolute horror on my face at the thought of anyone's hand in my uterus ...
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#30 of 38 Old 08-03-2007, 12:33 AM
 
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I VBAC'ed last week (yay!) and my ob checked my scar. I had an epidural and 4 bags of penicillin during labor due to my GBS results not being in. I don't think she would have checked me w/o anaesthesia or meds. I also bled very little at delivery.
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