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Re: Delivery mode in a patient with a previous rectovaginal fistula From: Dr Eberhard W Lisse (el@linux.lisse.na) Fri Aug 29 11:11:31 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Dr Eberhard W Lisse: "ICD-10" Previous message: Dr Eberhard W Lisse: "Re: The Missing IUCD" In reply to: Dr Ron Jewell: "Delivery mode in a patient with a previous rectovaginal fistula" Next in thread: Len2976@aol.com: "Re: Delivery mode in a patient with a previous rectovaginal fistula" > > 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. So he didn't repair the tear :-)-O > 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? No. I'd do an elective C/S whether the baby is small or big. Why risk another tear, incontinence and all sorts of surgery? el -- Dr. Eberhard W. Lisse\ / Swakopmund State Hospital <el@lisse.NA> * | Resident Medical Officer Private Bag 5004 \ / +264 81 124 6733 (cell) 64 461005(h) 461004(f) Swakopmund, Namibia ;____/ Domain Coordinator for NA-DOM (el108) Vice-Chairman, Board of Trustees, Namibian Internet Development Foundation, an Association not for Gain. NAMIDEF is the Namibian Internet Service Provider. Next message: Dr Eberhard W Lisse: "ICD-10" Previous message: Dr Eberhard W Lisse: "Re: The Missing IUCD" In reply to: Dr Ron Jewell: "Delivery mode in a patient with a previous rectovaginal fistula" Next in thread: Len2976@aol.com: "Re: Delivery mode in a patient with a previous rectovaginal fistula"

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