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Re: Delivery mode in a patient with a previous rectovaginal fistulaFrom: Philip Rosenow (philip@netpath.net)Sat Aug 30 11:46:22 1997
Dr Ron Jewell wrote: > > 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. > This is almost too much of a coincidence. I saw a patient last week who was delivered by another colleague in town. She developed a RV fistula several weeks later. By her history, she was told that she could get it repaired then or after another delivery. This was about 2 years ago.(she is able to describe, in detail, the joys of being married and passing flatus/stool per vagina but is a very compliant patient) She presented to me, now pregnant! I did a MEDLINE search and there is nothing in the literature about delivery in a patient with an ACTIVE RV fistula. My partners and I decided that the best course was probably to allow her to labor and have a repair attemtped removed from the postpartum period unless a vaginal laceration occurs. Any other ideas? Thanks
-- Philip J. Rosenow, M.D. private practice, Burlington, NC
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