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

Re: 4th Degree Tear

From: Dr (anonymous@obgyn.net)
Sat, 29 Mar 1997 01:09:13 -0600 (CST)

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In reply to: Mrs.: "4th Degree Tear"

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. 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?
>
>--
>Sanja Pozar
>

-- Dear Sanja,

If you plan to be pregnant soon you can wait till the delivery which can be quite normal. The healing of the fistula will come later. For an old (more than months) fistula the repair must not be done immediatly after the delivery because the risk of recurrence is high. If you want a baby in "some years" and if the fistula is bothering (and tou are the only one to tell if it's enough bothering), then get the fistula repaired. If the result is good then I won't take the chance of a vaginal birth.

--
Bernard Cristalli MD CNGOF
Paris - France
http://www.obgyn.net/corresp/cristalli.htm

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