Precipitate birth3/21/2023 She was counseled regarding practicing abstinence for 3 months. She had no complaints of incontinence in post-operative period. Antibiotics (Ampicillin and metronidazole) were given for a week. Pereneal care, Sitz bath and Stool softners were provided. The patient was kept nil per orally for first 48 hours in post-operative period and thereafter allowed liquid diet, semi-solid and normal diet sequentially. Digital rectal examination was done to evaluate the integrity of anal sphincter which was found to be intact. The rectal mucosa, rectovaginal fascia and then the vaginal mucosa was stitched using 3-0 vicryl. Patient was shifted to operation theatre at once for primary repair of the recto-vaginal fistula under spinal anaesthesia. A digital rectal examination was done and it was found that there was a communication between the vaginal tear and the rectum 3 cm above the anal verge just at the junction of rectum with anal canal. There was a small 2 cm tear in the posterior vaginal wall 3 cm above the introitus. Exploration of vagina and perineum after delivery wasperformed and a small 1 cm second degree perineal tear was found at the muco-cutaneous junction. Placenta delivered completely and there was no post partum hemorrhage. The duration of second stage was 15 minutes. She delivered a female baby of 3020 grams whose Apgar score at 1, 5 and 10 minutes was 9. She delivered vaginally in 3 hours and 40 minutes after instillation ofprostaglandin E2 gel. There was no evidence of any uterine hyperstimulation or fetal distress. Her Bishops score was 4 and a prostaglandin E2 gel was instilled for induction. Patient was not in labor and was admitted for induction of labor in view of postdatism after pelvic assessment for vaginal delivery. No records of previous pregnancy were available. She had a history of severe fetal growth restriction in first pregnancy with a birth weight of 900 grams. Her previous delivery was uneventful but the baby expired after three months due to prematurity complications. The strong index of suspicion necessary for any delivery personnel, to diagnose this condition in cases of posterior small tears, lead us to report this case.Ī 24 years old lady, G 2P 1L 0,who had a previous preterm vaginal delivery, presented to the antenatal OPD of a tertiary care hospital at 40 weeks and 5 days for antenatal check-up. Precipitate labor is another risk factor as seen in this case. Lack of skilled attendance at birth, lack of emergency obstetric care, and lack of transportation to maternity facilities contribute to the high rates of prolonged and obstructed labor and resultant fistula in developing countries. Risk factors include infant weighing more than 4 kg, instrumental delivery, prolonged second stage of labor, midline episiotomy, occipito-posterior position and failure of detection of sub optimal repair of sphincter injury. Rectovaginal fistula, following infection and episiotomy dehiscence,present low in the rectovaginal septum but may extend higher especially if birth trauma leads to extension of tear. This is usually evident by third or fourth day of delivery. Although majority of perineal injuries are repaired following delivery, dehiscence can occur due to infection or otherwise and lead to formation of fistula or sphincter dysfunction. In developing countries, obstructed labor is the most common cause of recto-vaginal fistula (RVF). Midline episiotomies resulting in third or fourth degree perineal tear is the greatest risk factor for development of a rectovaginal fistula. Rectovaginal fistulas occur far less frequently, comprising 10% of obstetric fistulas which itself is not so common in modern obstetrics these days. Recto-vaginal fistula Precipitate labor RVF Repair Obstetric RVF An index of suspicion and digital rectal examination in cases of posterior vaginal tears should be done to rule out recto-vaginal fistula. Diagnosis and successful management was done due to strict vigilance.Ĭonclusion: Rectovaginal fistulas are usually preceded by difficult, prolonged and obstructed labor but may also occur after precipitate labor. These are usually preceded by prolonged and difficult labor.Ĭase: This case report illustrates formation of a rectovaginal fistula after precipitate labor.There was no associated third or fourth degree perineal tear. Such injuries include perineal tears extending to rectum, episiotomy site infection or extension of an episiotomy. Background:Obstetric injuries are the most common cause of rectovaginal fistulas.
0 Comments
Leave a Reply.AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |