2006-11-09Staff Report 2 "By Wezi Tjaronda WINDHOEK The hearing into the circumstances in which a medical doctor performed a dilation and curettage (D&C) on a pregnant woman, who presented vaginal bleeding symptoms, continued yesterday with a specialist insisting that the procedure should not have been done as long as the baby was alive and the cervix was closed. Obstetrician and gynaecologist, Dr Michael Roberts, said the performance of the D&C at 12 weeks of pregnancy was contra-indicated as long at the cervix was closed and the baby was alive. Curettage of the uterus is the scraping of the lining of the uterus. The procedure is commonly known as dilation and curettage or D&C. A gynaecological D&C is part of the investigation of a woman who is experiencing heavy period or vaginal bleeding after menopause while an evacuation D&C is performed in a recently pregnant woman to remove tissue remaining in the womb. ""If bleeding was so much, one needed to assess the situation. If the cervix was open, one would evacuate the uterus and not open the cervix, putting instruments and removing a foetus of 15 weeks in size,"" said Roberts, adding: ""My experience is that even though one may lose blood, it is far less risky than dilating the cervix and doing a D&C."" The issue concerns 29-year-old Catherine Fidalgo, who at the age of 27 years was pregnant while having an intrauterine device (IUD) in situ. The issue is before a Professional Conduct Committee that started an inquiry into the matter on Tuesday in Windhoek. She started bleeding and saw two doctors who advised conservative treatment after which she consulted Dr Franz Stellmacher from Rehoboth. Stellmacher, having diagnosed placenta praevia (when the placenta lies between the foetus, and the birth canal covers the cervix) performed an evacuation on the patient. Roberts did not agree with his fellow doctor's diagnosis because the diagnosis could not be made before 28 weeks of pregnancy. ""The ultra-sound scan did not show that the placenta was covering the cervix. I do not agree with the diagnosis of placenta praevia,"" Roberts added. He said as long as the baby was alive and the cervix closed, one was dealing with threatened miscarriage pregnancy and one could have observed the patient for much longer. Figaldo is said to have consented to the evacuation because the pregnancy could have turned out to be a threat to her life. Although there was a possibility that the bleeding could have continued, Roberts said the situation could also have turned out for the better and the patient could have delivered a premature baby or the baby could have been born with the IUD implanted in the placenta. The two doctors traded arguments as to the source of the bleeding. Roberts said the source could have been between the lining of the placenta and the uterus and once the bleeding increased and the cervix opened, it could have led to an inevitable abortion. The medical report indicates that Stellmacher arrived at the diagnosis without using an ultra-sound. Even with the diagnosis, Roberts said a D&C was still contra-indicated. ""In the past, suspected placenta praevia was diagnosed after fresh and painless vaginal bleeding and not accidental hemorrhage with the foetus lying in a breach position or in a transverse position,"" said Roberts when asked by Stellmacher how the diagnosis could be arrived at in the absence of an ultra-sound scan. Since bleeding in pregnancy is a symptom and not a diagnosis, there was need for full observation before the procedure was performed, said Roberts. After the procedure, Figaldo is said to have continued bleeding until September when she returned to hospital and this time was admitted to the Katutura State Hospital for another evacuation after examination showed that she had had an incomplete abortion. It was suspected that she still had products of conception in her uterus because of a piece of bone that came out as she passed urine. Another witness said it was possible to find products of conception four months after an evacuation if it was an incomplete evacuation. The ultra-sound scan that was done did not however confirm the presence of any remnants. Dr Willem de Klerk, who was the first doctor Figaldo consulted, said this was a special case of a woman who was bleeding and the intervention would have been to terminate the pregnancy and other causes of bleeding. The committee is made up of a group of peers from different specialties in the health field who discipline others. It also includes a lawyer, Willie Rousseau, who is a proformer complainant and a member of the public. The committee can caution or reprimand, acquit, fine, suspend or remove a practitioner from the register or recommend that the practitioner be tried if criminal charges are involved. ""D&C would have been inevitable regardless of who is doing it,"" De Klerk said. The inquiry continues tomorrow at 08h30." 2006-11-09Staff Report 2
