Delivery mode in a patient with a previous rectovaginal fistula
From: Dr Ron Jewell (rjewell@medeserv.com.au)
Fri Aug 29 08:51:04 1997
This 27 year old G2P1 had her first delivery in a small rural hospital
and had an undiagnosed third degree(4th for our American colleagues)
tear. Her GP repaired the tear but 1 week later she started passing
faeces per vaginum.
The fistula was repaired at 4 weeks post partum by a general surgeon.
She is now 30 weeks gestation in the second pregnancy and has been
referred to me for delivery.
I have advised LUSCS if she appears to have a larger baby - the first
was about 3.5kgs. Otherwise I would have thought vaginal delivery with
close supervision and an early large mediolateral episiotomy reasonable.
Is this advice reasonable?
--
Ron Jewell FRACOG
PO Box 507
Bunbury
Western Australia
