Quote from OzMW
We will have to disagree SMBEs - my "anecdotal" evidence is the opposite.
Your woman still had the PPH; still needed transfusing- so did the fundal check prevent it from being nasty or did the drugs and the uterine massage do that? To me they are two separate issues; my point is that regular palpation (to check for "bogginess") of the uterine fundus doesn't prevent PPH; some people obviously believe it can add to picking it up earlier, but I think that's debatable. Now massaging a boggy fundus that is bleeding is a different story!!
And i agree it is better to pick something up before it gets too bad - not sure how well fundal checks do that though!
Pardon me, if I was unclear, please....I did not call it evidence
. I called it what it was, anecdotal personal experience
. But I will not stop doing fundal checks, and where indicated, massage on any postpartum patient. In my relatively short career (11 years), I have seen enough terrible pp bleeds not to change my practices any time soon. Also, I discussed this thread at work with my much-more experienced colleagues and the health care practicioners, all of whom agreed it was bad practice NOT to check fundi on post-op patients, as well as vaginally-delivered ones. They could not believe anyone was not doing so as a matter of practice.
Simply put: I cannnot imagine how you know a fundus is boggy if you don't actually palpate it. There is no other way. And I won't chart what I cannot assess, as another member mentioned earlier in the thread.
As I said, I agree to disagree and will not argue with you any more. But I do have one question. Do you have studies you can point me to saying fundal checks on post-op patients are contra-indicated? I really may be missing something here, and would love to learn what I can here.
Anyhow, I wish you good night.