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Re: Delivery mode in a patient with a previous rectovaginal From: John & Sylvia Robertson (jsrobert@uniserve.com) Fri Aug 29 17:06:33 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Dr. A. Hensenne: "Re: The Missing IUCD" Previous message: Kelly Shanahan: "Re: Wha' do I do now?" I think for both this and the IUCD case the most important thing is informed consent. The IUCD has been there for 20 years and nobody knew about it. Does it have to come out? Will it cause any dammage? I would answer maybe to both. She needs to know that there is a small risk of complications if it is left in, and a small risk of complications with surgery. Then she decides. For the repaired 3rd/4th degree tear I must admit I would lean to a C/S but again I would let the patient decide. Seeing as she has already had a complication of a vaginal delivery she knows what she's in for (granted a repeat repair is more difficult and fraught (sp?) with complications). BTW to me a 3rd degree is tear of some or all of the sphincter without tear of the rectal mucosa and a 4th involves the mucosa. How do others define it? At 08:51 AM 8/29/97 -0500, you wrote: >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 > J.G.M. Robertson MD, 109-9181 Main St. Chilliwack, B.C., Canada, V2P 4M9 (604) 793-9988, Fax 793-9987 e-mail jgmr@unixg.ubc.ca Next message: Dr. A. Hensenne: "Re: The Missing IUCD" Previous message: Kelly Shanahan: "Re: Wha' do I do now?"

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