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Re: Delivery mode in a patient with a previous rectovaginal fistula From: Dr Eberhard W Lisse (el@linux.lisse.na) Sat Aug 30 20:26:59 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: tradmidwifery@juno.com: "Re: [2]: new case" Previous message: Dr Eberhard W Lisse: "Re: PPROM at 34 wks Follow-up" In reply to: Ronald R Helm: "Re: Delivery mode in a patient with a previous rectovaginal fistula" Next in thread: R.Daniel Braun, MD FACOG: "Re: [2]: new case" Reply: R.Daniel Braun, MD FACOG: "Re: [2]: new case" Ron, > Yet another indication for Cesarean section. I can agree with Cesarean > for a successfully repaired RV fistula, but your rationale for Cesarean > in the presence of an RV fistula (why worsen the fistula/tear) is similar > to doing a Cesarean on anyone who has ever had a third or fourth degree > tear. Condescendingly and annoyingly yours, Ron Indeed that's what you should do in 3rd and 4th degree repaired cases. Call it evidence based medicine or whatever you want, the reason why you are trying to reduce the number of C/S in the US has *NOTHING* to do with evidence, but *ONLY* with payment, or rather lack thereof by the HMOs. I do not think one should try to reduce the rate on such elective indications. I doubt you will achieve much anyway, as a significant percentage of C/S are "emergencies" of which quite a number are unecessary (defensive?). I actually think one should avoid vaginal damage by all means, even more so incontinence. el -- Dr. Eberhard W. Lisse\ / Swakopmund State Hospital <el@lisse.NA> * | Resident Medical Officer Private Bag 5004 \ / +264 81 124 6733 (cell) 64 461005(h) 461004(f) Swakopmund, Namibia ;____/ Domain Coordinator for NA-DOM (el108) Vice-Chairman, Board of Trustees, Namibian Internet Development Foundation, an Association not for Gain. NAMIDEF is the Namibian Internet Service Provider. Next message: tradmidwifery@juno.com: "Re: [2]: new case" Previous message: Dr Eberhard W Lisse: "Re: PPROM at 34 wks Follow-up" In reply to: Ronald R Helm: "Re: Delivery mode in a patient with a previous rectovaginal fistula" Next in thread: R.Daniel Braun, MD FACOG: "Re: [2]: new case" Reply: R.Daniel Braun, MD FACOG: "Re: [2]: new case"

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