WOMENS-HEALTH Messages for March, 1997: Re: 4th Degree Tear

Re: 4th Degree Tear

From: Harvey S. Marchbein, M.D. (anonymous@obgyn.net)
Thu, 27 Mar 1997 23:34:21 -0600 (CST)

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At Thu, 27 Mar 1997, Mrs. wrote: >
>I gave birth vaginally 8 months ago and experienced a 4th degree tear. I
>now have a rectovaginal fistula (as explained by the colo-rectal
>specialist I went to see), which is getting smaller, but which still
>allows communication of bowel movements into my vagina on occasion. The
>rectal specialist recommends that I repair the fistula and opt for a
>c-section for my next delivery.

I agree. Get the r-v fistula repaired and have a primaray c/s for the next delivery.

>My ob-gyn feels I should deliver
>vaginally again and then repair the tears after my childbearing years.
>I am thinking of having another baby and would like to hear about
>similar cases. Is it wiser to opt for the c-section to avoid possible
>worse tearing or would a vaginal birth still be the norm in such a
>situation? What is the chance that the tearing would be even greater
>with another child and could it be repairable after?

R-V fistulae are not something to be accepted as a long term conditon because bacteria from the colon are not meant to co-exist with normal vaginal flora (bacteria normal to the vagina). A fourth degree laceration is a very thin area leading to a lack of tissue at one spot. It is likely that this will occur again and a further disruption of the perineal anatomy (muscles and related tissue between the vagina and the rectum) will ensue.

-- Harvey S. Marchbein, M.D. FACOG, FACS OBGYN.net U.S. Representative, New York Great Neck, New York

*Note: Opinions expressed here are for educational purpose only. This information is not intended to supplant the need for you to consult with your physician prior to choosing therapeutic options.

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