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Re: 4th degree tear/reconstruction From: Joanne Bulley, MD (jbulley@cheshire.net) Sat Jun 17 15:49:40 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Joanne Bulley, MD: "Re: Making sure PAPs get followed up; Femtrack, etc." Previous message: Paul Prior MD: "Making sure PAPs get followed up; Femtrack, etc." In reply to: freda seddon: "4th degree tear/reconstruction" Next in thread: Garry E. Siegel: "Re: 4th degree tear/reconstruction" Reply: Garry E. Siegel: "Re: 4th degree tear/reconstruction" Freda I think you are asking for a good, sturdy posterior colporrhaphy and perineorrhaphy. Is the sphincter shot or intact? If it is intact then any good vaginal surgeon can do the procedure. Who is your favorite gyn surgeon in your area? If the sphincter is not intact, then ask your favorite vaginal surgeon who is recommended. It was my opinion while in residency (and still is) (and the opinion of one arrogant supervising resident - we did not agree on much else) - that when repairing the vagina, rectovaginal septum and perineum after delivery - the repair should be done with great care as a colporrhaphy and perineorrhaphy. It should not be done as 'let's throw in some stitches quick to get out of the delivery room fast'. I just saw for a post op check, a woman whose bottom was not repaired correctly after a vaginal delivery of an LGA infant. It gaped open and made sex totally unenjoyable and resulted in air passing from the vagina because of the flappy walls - (not from a fistula). She had a hard time convincing anyone she had a medical problem and not just a plastic/cosmetic/sexual problem. She is delighted with the results. Pre-op it just gaped and now it has normal size, shape, direction and distendibility. Please - no male doc/female doc or doc/CNM issues here. The patient's delivery and 'repair' was by a woman doc. This is not a gender or CNM/Doc issue. I think (and I could be wrong....) that there are many folks at delivery who do a 'quick let's finish job' in the delivery room. my $0.02 Joanne At Fri, 16 Jun 2000, freda seddon wrote: > >I have a client who had a fourth degree tear last year. This was following >the vaginal birth of a 10 lb 12 oz, presenting posterior brow, by vacuum. >She has asked me what would be involved in recovering from a procedure to >re-repair her rectum and a perineal flap. Would anyone know of a ob/gyn in >the Toronto area with good results. > >thanks, > >Freda > >-- >Freda Seddon, RN, RM >Community Midwife >Midwifery Care Scarborough >2680 Lawrence Ave. East, Suite 211 >Toronto, Ontario M1P 4Y4 >(416) 757-4848 fax 757-1562 > -- Joanne Bulley, MD Keene, NH, USA Next message: Joanne Bulley, MD: "Re: Making sure PAPs get followed up; Femtrack, etc." Previous message: Paul Prior MD: "Making sure PAPs get followed up; Femtrack, etc." In reply to: freda seddon: "4th degree tear/reconstruction" Next in thread: Garry E. Siegel: "Re: 4th degree tear/reconstruction" Reply: Garry E. Siegel: "Re: 4th degree tear/reconstruction"

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