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Prehysterectomy curettage
330 Correspondence
malpositioned second twin is practiced in a controlled setting. 1- 3 It is hoped that with increasing acceptance of vaginal delivery of the second twin, the growing clinical experience will allow us to teach resident physicians these important skills. Last, we respect the expressed concerns about litigation resulting from vaginal breech deliveries with bad outcomes. However, one should be cautioned that if a maternal complication were to result after cesarean section for a second twin in malpresentation, then there might be an attack by members of the legal profession for performing an unnecessary surgical intervention.1-8 It is clear that performance of an abdominal delivery does not confer immunity from prosecution. Rather, conscientious efforts to develop a meaningful physician-patient relationship and the execution of a management plan that best serves the interests of both mother and fetus are advocated as more appropriate prophylactic measures against legal assault. Frank A. Chervenak, M.D. Richard L. Berkowitz, M.D. Department of Obstetrics, Gynecology and Reproductive Science The Mount Sinai Medical Center One Gustave L. Levy Place New York, New York 10029 Robert E. Johnson, M.D. Peter Grannum, M.D. John C. Hobbins, M.D. Department of Obstetrics and Gynecology Yale-New Haven Medical Center 333 Cedar Street New Haven, Connecticut 06510 REFERENCES I. Chervenak FA, Johnson RE, Berkowitz RL, eta!. Is routine cesarean section necessary for vertex-breech and vertextransverse twin gestations? AM J OBSTET GYNECOL 1984; 148:1. 2. Chervenak FA, Johnson RE, Berkowitz RL, eta!. Intrapartum external version of the second twin, Obstet Gynecol 1983;62:160.
October I, 1984 Am J Obstet Gynecol
3. Acker D, Lieberman M, Holbrook M, eta!. Delivery of the second twin. Obstet Gynecol 1982;59:710.
Prehysterectomy curettage To the Editors: Lerner (AM. J. 0BSTET. GYNECOL. 148:1055, 1984) reports on the inadequacy of prehysterectomy curetrages for diagnostic purposes. I disagree with him, as I have been doing endometrial biopsies or diagnostic curettages on every nonemergency hysterectomy for years, approximately 2 to 8 weeks preceding the hysterectomy. My findings, with one exception, have always agreed with the final findings on the hysterectomy. This one miss was in a reported uterus didelphys in which I missed one side at curettage. Therefore I would have to infer that either Lerner's technique or the pathologic interpretation was faulty. King eta!. (AM. J. 0BSTET. GYNECOL. 149:10, 1984) apparently agree with me. Eduard Eichner, M.D. Severance Medical Arts Building 5 Severance Circle Cleveland Heights, Ohio 44118
Reply to Eichner To the Editors: Although I am happy that your endometrial biopsies and diagnostic curettages performed 2 to 8 weeks preceding your hysterectomies have yielded accurate diagnostic results, your letter missed the point of my report. I discussed curettages performed in the operating room immediately preceding a hysterectomy when judgments are made on gross observation of curetted tissue. The experience you described has nothing to do with this. In fact, in the last paragraph of the paper, my recommendation is to do precisely what you do: preoperative curettage or biopsies allowing time for microscopic pathology results to be returned. Henry M. Lerner, M.D. 2000 Washington Street Newton, Massachusetts 02162
malpositioned second twin is practiced in a controlled setting. 1- 3 It is hoped that with increasing acceptance of vaginal delivery of the second twin, the growing clinical experience will allow us to teach resident physicians these important skills. Last, we respect the expressed concerns about litigation resulting from vaginal breech deliveries with bad outcomes. However, one should be cautioned that if a maternal complication were to result after cesarean section for a second twin in malpresentation, then there might be an attack by members of the legal profession for performing an unnecessary surgical intervention.1-8 It is clear that performance of an abdominal delivery does not confer immunity from prosecution. Rather, conscientious efforts to develop a meaningful physician-patient relationship and the execution of a management plan that best serves the interests of both mother and fetus are advocated as more appropriate prophylactic measures against legal assault. Frank A. Chervenak, M.D. Richard L. Berkowitz, M.D. Department of Obstetrics, Gynecology and Reproductive Science The Mount Sinai Medical Center One Gustave L. Levy Place New York, New York 10029 Robert E. Johnson, M.D. Peter Grannum, M.D. John C. Hobbins, M.D. Department of Obstetrics and Gynecology Yale-New Haven Medical Center 333 Cedar Street New Haven, Connecticut 06510 REFERENCES I. Chervenak FA, Johnson RE, Berkowitz RL, eta!. Is routine cesarean section necessary for vertex-breech and vertextransverse twin gestations? AM J OBSTET GYNECOL 1984; 148:1. 2. Chervenak FA, Johnson RE, Berkowitz RL, eta!. Intrapartum external version of the second twin, Obstet Gynecol 1983;62:160.
October I, 1984 Am J Obstet Gynecol
3. Acker D, Lieberman M, Holbrook M, eta!. Delivery of the second twin. Obstet Gynecol 1982;59:710.
Prehysterectomy curettage To the Editors: Lerner (AM. J. 0BSTET. GYNECOL. 148:1055, 1984) reports on the inadequacy of prehysterectomy curetrages for diagnostic purposes. I disagree with him, as I have been doing endometrial biopsies or diagnostic curettages on every nonemergency hysterectomy for years, approximately 2 to 8 weeks preceding the hysterectomy. My findings, with one exception, have always agreed with the final findings on the hysterectomy. This one miss was in a reported uterus didelphys in which I missed one side at curettage. Therefore I would have to infer that either Lerner's technique or the pathologic interpretation was faulty. King eta!. (AM. J. 0BSTET. GYNECOL. 149:10, 1984) apparently agree with me. Eduard Eichner, M.D. Severance Medical Arts Building 5 Severance Circle Cleveland Heights, Ohio 44118
Reply to Eichner To the Editors: Although I am happy that your endometrial biopsies and diagnostic curettages performed 2 to 8 weeks preceding your hysterectomies have yielded accurate diagnostic results, your letter missed the point of my report. I discussed curettages performed in the operating room immediately preceding a hysterectomy when judgments are made on gross observation of curetted tissue. The experience you described has nothing to do with this. In fact, in the last paragraph of the paper, my recommendation is to do precisely what you do: preoperative curettage or biopsies allowing time for microscopic pathology results to be returned. Henry M. Lerner, M.D. 2000 Washington Street Newton, Massachusetts 02162