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Re: Delivery mode in a patient with a previous rectovaginalFrom: Dr. A. Hensenne (cdtg@skynet.be)Fri Aug 29 17:31:09 1997
I have seen a lot of poor women in africa with this pathology. I persist: If the repair is effective don't run the risk. ============================= Dr A.Hensenne cdtg@skynet.be 72 rue verte 4100 Seraing (LIEGE) - Belgium - Gynécologie médicale et chirurgicale
-- ---------- : De : John & Sylvia Robertson <jsrobert@uniserve.com> : A : Multiple recipients of list <ob-gyn-l@talk.obgyn.net> : Objet : Re: Delivery mode in a patient with a previous rectovaginal : Date : samedi 30 août 1997 00:06 : : 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 :
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