Re: New question-fistula and delivery route
From: Dr. Ainsworth (ainsron@sbcglobal.net)
Thu Nov 13 14:13:03 2003
While eating lunch today, I was reading the latest ACOG clinical review.
They abstracted an article from the Eur J Obstet Gynecol Reprod Biol
2003;109:149-52, "Anal Sphincter disruption at vaginal delivery: Is
recurrence predictable?"
The authors advised considering cesarean delivery for women who are
anally incontinent during pregnancy after having had a third degree tear
in a previous delivery. I know that doesn't completely address your
question, but I think it is reasonable to extrapolate from it that C/S
after rectal complications is appropriate and defensible.
>My recommendation has always been to deliver abdominally after repair or
>spontaneous closure of a fistula. My wife had one with our first child
>and four C/S afterwards, we never regreted the C/S and wished the OB had
>not been so aggressive with spinal and forceps with our first - I didn't
>know much then, just a lowly first year medical student.
>
>>A patient has a rectal fistula repair (etiology of the fistula not childbirth or inflammatory bowel disease related) and is now, a few years later, pregnant. She asks what the recommended route of delivery should be. I'm looking for references or articles to help her. In my training we would have recommended primary C/S but I want to know if there is different thinking now.
>>All thoughts and references appreciated.
>>
>>Jay
>>
>>--
>>Jay M. Kulkin MD MBA FACOG
>>Women's Institute For Health PC
>>975 Johnson Ferry Road
>>Suite 460
>>Atlanta, GA. 30342
>>ph: 404-832-0300
>>fax: 404-832-0070
>>http://www.wifh.com
>>
>>This email may contain confidential or proprietary information which may be legally privileged. If you are not the named recipient, you should immediately delete it from your computer system.
>>
>>>>> ----- Original Message -----
>> From: Terrence.Jones@kp.org
>> To: Multiple recipients of list OB-GYN-L
>> Sent: Wednesday, November 12, 2003 5:58 PM
>> Subject: Re: FRI Spam Alert: RE: Amazing case!
>>
>> A ticket You've earned for writing with an expired poetic lisense. Mont Ana, Lucy Anna, where will it all end? tj
>>
>> DoctorJoe@aol.com
>> Sent by: ob-gyn-l@obgyn.net
>> 11/12/2003 01:31 PM
>> Please respond to ob-gyn-l
>>
>> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>> cc:
>> Subject: Re: FRI Spam Alert: RE: Amazing case!
>>
>> In a message dated 11/12/03 15:26:45, Terrence.Jones@kp.org writes:
>>
>> Just curious - when was the last time You renewed that poetic license? Think Ben D would've agreed with sentiment embodied in Lucy Anna -- Liberal Govt is much the same as Conservative, just without the organization. So chads are left hanging about, uncounted. Tho paternalistic, He cared about the worker. tj
>>
>> Yes.... Workers of the world unite! You have nothing to lose but your... your... your JOBS!!!
>>
>> Yeah, that's the ticket!
>>
>> Joe P.
>>
