WOMENS-HEALTH Messages for March, 1997: Re: 4th Degree Tear

Re: 4th Degree Tear

From: R.Daniel (anonymous@obgyn.net)
Thu, 27 Mar 1997 23:34:54 -0600 (CST)

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At Thu, 27 Mar 1997, Mrs. wrote: >
>I gave birth vaginally 8 months ago and experienced a 4th degree tear. I
>now have a rectovaginal fistula (as explained by the colo-rectal
>specialist I went to see), which is getting smaller, but which still
>allows communication of bowel movements into my vagina on occasion. The
>rectal specialist recommends that I repair the fistula and opt for a
>c-section for my next delivery. My ob-gyn feels I should deliver
>vaginally again and then repair the tears after my childbearing years.
>I am thinking of having another baby and would like to hear about
>similar cases. Is it wiser to opt for the c-section to avoid possible
>worse tearing or would a vaginal birth still be the norm in such a
>situation? What is the chance that the tearing would be even greater
>with another child and could it be repairable after?
>
>--
>Sanja Pozar
>

How soon are you planning to get pregnant? If it is real soon, I would get pregnant, deliver vaginally and see what happens. If the fistula persists or gets bigger then get it repaired after that delivery.(at least 3 months and preferably6months after the delivery) If you plan to wait another 1-3 years, I would recommend waiting another 6-8 months hoping the fistula will continue to close on its own. Many of them will. If it doesn't, then have it repaired, get pregnant and either have a Cesarean or vaginal delivery depending on how you feel about the risk of having a recurrence. The risk is fairly small (around 10% I think) but if that is too high then have a cesarean. As you can see, there is no simple straight forward across the board answer to your question. If either of your physicians recommends a course of action, ask them why and what are the alternatives and risks and benefits. If they won't discuss it with you, get a physician who will.

-- R.Daniel Braun, MD

"Heisenberg might have slept here" Unknown or possibly Indecisve

Next message: Roberta: "Re: cervical cancer follow up DON'T ABUSE THE DOCTORS!!!"
Previous message: Harvey S. Marchbein, M.D.: "Re: 4th Degree Tear"
In reply to: Mrs.: "4th Degree Tear"
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