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Re: 4th degree laceration From: Garry E. Siegel, M.D. (garrys@mindspring.com) Sun Sep 25 16:20:56 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Lynn D. Montgomery, M.D.: "More salary question" Previous message: Robert J. Carpenter, Jr. MD: "Re: Salary question" In reply to: Marie Harkins: "4th degree laceration" Next in thread: Marie Harkins: "Re: 4th degree laceration" Reply: Marie Harkins: "Re: 4th degree laceration" The same thing happened to my wife when my son was born in 1984, except his hand presented through the rectum (really--I saw this myself!). The fine Ob (I was a second year resident) repaired it without creating a "total" 4th degree laceration, i.e. he repaired the rectal mucosa without cutting the sphincter. Garry At Sun, 25 Sep 2005, Marie Harkins wrote: > >I would love some thoughts on this case. > >30 yo, G1P0 at 40 weeks gestation. Hx of Graves disease and >thyroidectomy (2000), on Levoxyl and followed by an endocrinologist. >She is not a smoker, no hx of STDs, monogomous relationship x 9 years. > She is a runner and ran 2 half-marathons during her pregnancy. Total >weight gain during pregnancy was 25 lbs with an initial BMI of 23. She >had an uncomplicated prenatal course. > >She went into spontaneous labor and arrived in L&D 4cm/90%/0station. >Her labor progressed well, she had nothing for pain and no >augmentation. She was fully dilated and pushing 5 hours later. She >pushed well spontaneously and within 20 minutes some head was visible. >As she was at that point where a small portion of the baby's head >became visible with her pushes there was a gush of amniotic fluid and >blood that came from her rectum. The baby delivered 15 minutes later, >3250 gm with a compound presentation of the posterior hand. She had a >1st degree perineal tear, rectal sphincter intact. Behind the >hymanal ring, there was a 3cm tear through the rectal mucosa. The >repair was done in the OR under spinal anesthesia. > >The MDs and other CNMs I work with thought it was unusual for a 4th >degree to happen that far before crowning and birth of the baby. Have >any of you seen this type of laceration? Any thoughts for counseling >with her next pregnancy? > >Thanks. > >-- >Marie Harkins, CNM >Ithaca, NY > -- Garry E. Siegel, M.D. Private Practice Roswell, GA Next message: Lynn D. Montgomery, M.D.: "More salary question" Previous message: Robert J. Carpenter, Jr. MD: "Re: Salary question" In reply to: Marie Harkins: "4th degree laceration" Next in thread: Marie Harkins: "Re: 4th degree laceration" Reply: Marie Harkins: "Re: 4th degree laceration"

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