Monday, September 12, 2011 have it or not??

I follow RCOG (london) Guidelines to the core in my day to day practice.And it works well for me and my patients.But there is one area where I personally am not convinced about the guidelines due to the clinical experiences.
It is recommended not to give a routine episiotomy.In UK as well, I was called by the midwives to repair big bad tears which I always believed a timely episiotomy could have saved.
Now ,In India  as ladies are googling a lot and read these Biritish and American books on Pregnancy,they also wish the 'cut' to be minimized or avoided.I try to do so,but recently it ended in fourth degree tear of one of my patients.The dreaded Complete perineal tear.I feel really sorry for the lady.There wasn't any high risk factor.A very easy 'lift off' ventouse delivery for foetal bradycardia in 2nd stage.The lady is obese but that doesn't increase the risk of CPT.
Took her to OT for the anorectal repair and the perineal muscle repair and the repair of anal spincter.This is day 3 of the delivery.She is doing Ok.But with CPT one expects problems only later.......a fistula or anal incontinence.I have done a satisfactory job as the surgeon and I hope with little bit of luck  she won't have these complications.Atleast that is my sincere wish.
But again I am debating whether it is a good practice to give routine cut in all the first time pregnant ladies.May be that is what i will do in future.

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