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Re: Delivery mode in a patient with a previous rectovaginal fistulaFrom: Rjwoolley@aol.comFri Aug 29 18:10:52 1997
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. *********** What is LUSCS? Your plan seem sto require the presumption that ML episiotomy is effective in preventing 3rd-degree tears. As you probably know there are a couple of retrospective non-randomized studies (most recently in the Br J OB Gyn earlier this year) which purport to show this, but the conclusion cannot be verified by 4 randomized controlled prospective trials. On what basis do you conclude that the preponderance of the evidence favors a true protective effect, especially in a non-nulliparous patient?
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