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Obese Woman age 43 3rd pregnancy healthy baby extensive

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Obese Woman age 43...
Obese Woman age 43 3rd pregnancy healthy baby extensive bleeding high risk for hysterectomy advice? please please please
Submitted: 8 years ago.Category: OB GYN
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Answered in 4 minutes by:
6/29/2010
OB GYN Doctor: khagihara, OB/GYN (Doctor) replied 8 years ago
khagihara
khagihara, OB/GYN (Doctor)
Category: OB GYN
Satisfied Customers: 6,591
Experience: Trained in OB & GYN for many years.
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Can you tell me more about your situation?
What is your diagnosis?
Do you still need more babies?
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Customer reply replied 8 years ago

Female baby delivered March 3rd 2110 vaginal delivery genetic history of heavy menstrual bleeding also heavy clotting gyn says if hysterectomy would have to be mid- abdomen... too much detritus vaginally... concerned for care of baby & 9 yr old child

Customer reply replied 8 years ago

Female baby delivered March 3rd 2110 vaginal delivery genetic history of heavy menstrual bleeding also heavy clotting gyn says if hysterectomy would have to be mid- abdomen... too much detritus vaginally... concerned for care of baby & 9 yr old child

also lack of confidence in present ob/gyn

Customer reply replied 8 years ago
no more children am not financially in a position to do so. This child is welcome however was not planned for. OB/GYN is concerned somewhat unwilling due to amount of abdominal fat & high risk of infection to perform hysterectomy.... presently waiting to see if estrogen will control bleeding..... iron levels still acceptable but hemogloben borderline.
OB GYN Doctor: khagihara, OB/GYN (Doctor) replied 8 years ago
How long have you had the bleeding? How much? Is it getting worse?
Did you have a pelvic exam and ultrasound to see if there is the remaining of the pregnancy in the uterus or fibroids or ovarian tumor?
How tall are you? How much do you weigh? Any weight change? If so, over what period of time?
Do you have problem adjusting to hot temperature? Tremor? Hair loss? Bowel problem? Sleep problem? Palpitations?
Do you have excessive facial or body hair? Do you have thinning hair on the skull? Do you have acne increased? Do you have irregular periods? Tell me more about your periods.
Do you feel you are always thirsty and drink a lot of liquid? Do you go to the bathroom frequently? Is your appetite increased? Do you crave sweets?
Do you have any other problems associated with the problem?
Do you bruise easily? Do you have problem stopping bleeding?
Are you aware of anything which might have brought this on?
Do you have any medical problems?
Did you have any problem with the pregnancy and baby delivery? Tell me more about the D&C progesterone & estrogen needle, on estrogen pills.
Any surgeries?
Are you taking any medications including OTC pills and herbs?
Any family medical history? Like bleeding diseases?
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OB GYN Doctor: khagihara, OB/GYN (Doctor) replied 8 years ago
My previous questions may not be appropriate when your bleeding can't stop.
Your doctor is worrying about the infection due to the abdominal fat when you have an abdominal hysterectomy. I suggest you have a vaginal hysterectomy if your uterus is not big and your uterus is approachable from the vagina.
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Customer reply replied 8 years ago
The Ob/Gyn is reluctant to perform a vaginal hysterectomy because the D&C showed very poor visibility & she felt it would be too difficult todo a vaginal procedure..... any other suggestions or ideas to try? Thanks for your help
OB GYN Doctor: khagihara, OB/GYN (Doctor) replied 8 years ago
Other methods are as follows:
  • Danazol: It induces endometrial atrophy resulting in reduced menstrual loss. Side effects include musculoskeletal pain, breast atrophy, hirsutism, weight gain, oily skin, and acne. Because of the significant androgenic side effects, this drug is usually reserved as a second-line treatment for short-term use prior to surgery.
  • Gonadotropin-releasing hormone agonists: It may be helpful for short-term use in inducing amenorrhea and allowing women to rebuild their red blood cell mass. They produce a profound hypoestrogenic state similar to menopause. Side effects include menopausal symptoms and bone loss with long-term use.
  • Tranexamic acid: It is an antifibrinolytic drug that exerts its effects by reversibly inhibiting plasminogen. It diminishes fibrinolytic activity within endometrial vessels to prevent bleeding. It has been shown effective in reducing bleeding in up to half of women with dysfunctional uterine bleeding. Tranexamic acid is not approved for the treatment of dysfunctional uterine bleeding in the United States.
  • Endometrial ablation: It is a procedure that uses a lighted viewing instrument and other instruments to destroy (ablate) the uterine lining. Endometrial ablation can be done by: Laser beam, heat, electricity, freezing, or microwave. The endometrium heals by scarring, which usually reduces or prevents uterine bleeding. Most women will have reduced menstrual flow following endometrial ablation, and up to half will stop having periods. Younger women are less likely than older women to respond to endometrial ablation. After an endometrial ablation, younger women are more likely to continue to have periods and need a repeat procedure. Young women may be treated with either gonadotropin-releasing hormone analogues 1 to 3 months before the procedure. This will decrease their production of estrogen and help thin the lining of the uterus.
While the bleeding stops, you should lose weight. Ask your doctor to refer a dietitian who can help plan out a diet and exercise program with you.
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