Is a patient who underwent colpoperineorrhaphy (surgical repair of the perineum and vagina) on March 26, 2022, and is now experiencing a normal pregnancy without obstetric complications, a candidate for Normal Vaginal Delivery (NVD) or Cesarean Section (CS)?

From the Guidelines

The patient who underwent colpoperineorrhaphy surgery in March 2022 and is now experiencing a normal pregnancy without obstetric complications should attempt a normal vaginal delivery (NVD) if individual assessment by her obstetrician confirms adequate healing and no significant scarring of the vaginal tissues. When considering the mode of delivery for this patient, several factors must be taken into account, including the extent of the original surgery, the degree of healing, and the current condition of the vaginal tissues 1. Given that it has been more than a year since the surgery, the tissues have likely healed adequately to withstand the stretching during vaginal delivery. However, the risk of wound complications, such as infection and dehiscence, particularly after anal sphincter injury, as highlighted in the study on repair of episiotomy and obstetrical perineal lacerations 1, necessitates a thorough examination by her obstetrician in the third trimester. Some key points to consider in the decision-making process include:

• The severity and morbidity experienced after perineal injury, which is dependent on the extent of perineal damage, the technique and materials used for repair, and the skill and knowledge of the birth attendant 1.
• The overall incidence of wound complications after perineal trauma, including infection rates and dehiscence rates 1.
• The importance of the birth attendant being well-versed in identifying and repairing different types of perineal trauma to optimize short- and long-term outcomes 1. The patient should discuss her delivery options with her healthcare provider, considering both the surgical history and current pregnancy status, to make an informed decision that prioritizes both maternal and fetal well-being, focusing on minimizing the risk of morbidity and mortality while optimizing quality of life 1.

From the Research

Patient's Situation

The patient had a colpoperineorrhaphy surgery on 26/3/2022 and is now pregnant with a normal pregnancy and no obstetric complications. The question is whether she is a candidate for a Normal Vaginal Delivery (NVD) or a Cesarean Section (CS).

Risk Factors for Perineal Trauma

• The patient's history of colpoperineorrhaphy surgery may increase the risk of perineal trauma during vaginal birth 2.
• Risk factors for perineal trauma include increased fetal birthweight, operative vaginal birth, prolonged second stage of labor, maternal birth position, and advanced maternal age 2.
• The patient's previous surgery may also increase the risk of wound complications, such as infection and dehiscence 3.

Considerations for Vaginal Birth After Cesarean (VBAC)

• The patient's history of colpoperineorrhaphy surgery may not be directly related to VBAC, but it's essential to consider the risks of perineal trauma and wound complications 4.
• Women undergoing VBAC are at increased risk of severe perineal trauma, irrespective of the indication and timing of primary cesarean delivery 4.

Decision for NVD or CS

• The decision for NVD or CS should be based on individual assessment of the patient's risk factors and medical history 2, 4, 3.
• The patient's healthcare provider should discuss the risks and benefits of each option and make a decision based on the patient's unique situation.

Key Points to Consider

• The patient's history of colpoperineorrhaphy surgery and potential risks of perineal trauma and wound complications.
• The importance of individual assessment and discussion of risks and benefits for NVD and CS.
• The need for careful monitoring and management of the patient's pregnancy and delivery to minimize the risk of complications.