![]() The patient was asked to lie on her side on the exam table, facing away from the examiner with knees bent (see Fig. Sensitivity to patient concerns about embarrassment or body image were acknowledged during pre-procedure counseling. All exams and testing were performed during one clinic visit.Īs most patients had not been examined in positions other than dorsal lithotomy, the examiner explained the reasoning for exam in lateral decubitus position as well the details of how the exam is conducted. From until, all records of patients meeting these criteria in the author’s clinical practice were reviewed after obtaining Mayo Clinic Institutional Review Board approval. Unsuccessful cervical visualization was defined as the inability to see the cervical os despite use of a vaginal speculum in dorsal lithotomy positon. The objective of this case series was to describe use of the lateral decubitus position to improve visualization of the cervix in women with severe obesity.Īll patients with obesity in the gynecologic practice of the author with prior unsuccessful cervical visualization in dorsal lithotomy position were examined in the lateral decubitus position. Īs more minimally invasive procedures move to the office setting, development of techniques to facilitate ambulatory surgical practice are needed. ![]() Marion Sims in the 1800s for surgical procedures, and reportedly provides better visualization of the cervix than the dorsal lithotomy position. The Sims position was originally described by J. Little information is available on the comparative efficacy and patient's satisfaction with the various positions. Other positions for examination have been described including knee chest position, lateral decubitus (Sims) position, M position, V position and diamond position. Traditionally pelvic examination has been performed in the dorsal lithotomy position to facilitate access to the perineum and to adduct the thighs for bimanual examination. In general, intra-abdominal pressure and vaginal pressure are closely correlated. Intra-abdominal pressure is as much as 12 cmH 20 higher in patients with morbid obesity compared to patients of normal weight. Intra-abdominal pressure is markedly increased in patients with morbidly obesity. The abdominal pannus may also increase the vaginal pressure making speculum examination more difficult. Furthermore, the abdominal pannus limits the ability to palpate the uterus and ovaries. Pelvic examination may be more difficult due to adiposity in the perineum and labia, increasing the distance between the vulva and cervix. Patients with elevated BMI pose a number of challenges for the gynecologist. From 2007 to 2016, the obesity rate in women increased from 35.4 to 41.1%, while the rate of severe obesity (BMI ≥ 40) increased to 9.7%. ![]() Obesity has become epidemic in the United States. Consideration should be given to use of the lateral decubitus position when the cervix cannot be visualized in the dorsal lithotomy position. In this case series, the use of the lateral decubitus position appears to improve visualization of the cervix in the outpatient setting among women with severe obesity. In all but one case the cervix was successfully visualized in the lateral decubitus position and all intended intrauterine procedures were successfully performed. ResultsĮleven patients with severe obesity in the gynecologic practice of the author with prior unsuccessful cervical visualization in dorsal lithotomy position were examined in the lateral decubitus position. The speculum was opened gently as would be done with examination in dorsal lithotomy position until the cervix was visualized. A vaginal speculum was then placed in the vagina with the posterior blade toward the anus. ![]() An assistant elevated the upper bent leg 45 degrees from horizontal, exposing the perineum. For the lateral decubitus position, the patient was asked to lie on her side on the exam table, facing away from the examiner with knees bent. From until, all records of patients with obesity and unsuccessful cervical visualization during pelvic exam in the dorsal lithotomy position in the author’s clinical practice were reviewed after obtaining Mayo Clinic Institutional Review Board approval. The objective of the current work was to describe use of the lateral decubitus position to improve visualization of the cervix in women with severe obesity.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |