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Re: Delivery mode in a patient with a previous rectovaginal fistula From: Ronald R Helm (rrhelm@juno.com) Sat Aug 30 12:18:46 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Kenneth Moise, MD: "Low molecular weight heparin in pregnancy" Previous message: Kenneth Moise, MD: "Vaginal triplets" Maybe in reply to: Dr Ron Jewell: "Delivery mode in a patient with a previous rectovaginal fistula" Next in thread: Bernard Cristalli: "Re: Delivery mode in a patient with a previous rectovaginal fistula" On at least three occasions, while delivering a colleague's patient, I have discovered a rectovaginal fistula at the time of delivery. On all three occasions, I cut a fourth degree into the rectovaginal fistula, excised the edges of the fistula, and did a layered closure of the fourth as usual. This highly vascular area, especially immediately postpartum, heals remarkably well and all fistulae were closed successfully. In all three I added topical estrogen for three weeks, because they were nursing, and I empirically think that the vaginal atrophy in the nursing mother is detrimental to normal healing of the repair. Ron Non-academic, trench warfare. Unimpaired by scientific evidence. On Sat, 30 Aug 1997 11:48:31 -0500 Philip Rosenow <philip@netpath.net> writes: >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 > Next message: Kenneth Moise, MD: "Low molecular weight heparin in pregnancy" Previous message: Kenneth Moise, MD: "Vaginal triplets" Maybe in reply to: Dr Ron Jewell: "Delivery mode in a patient with a previous rectovaginal fistula" Next in thread: Bernard Cristalli: "Re: Delivery mode in a patient with a previous rectovaginal fistula"

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