Association between parity and fistula location in women with obstetric fistula: a multivariate regression analysis

Abstract

Objective To compare primiparous and multiparous women who develop obstetric fistula (OF) and to assess predictors of fistula location Design Cross-sectional study Setting Fistula Care Center at Bwaila Hospital, Lilongwe, Malawi Population Women with OF who presented between September 2011 and July 2014 with a complete obstetric history were eligible for the study. Methods Women with OF were surveyed for their obstetric history. Women were classified as multiparous if prior vaginal or cesarean delivery was reported. Location of fistula was determined at operation. OF involving the urethra, bladder neck, and midvagina were classified as low; OF involving the vaginal apex, cervix, uterus, and ureters were classified as high. Main Outcome Measures Demographic information was compared between primiparous and multiparous women using Chi-squared and Mann-Whitney U tests. Multivariate logistic regression models were implemented to assess the relationship between variables of interest and fistula location. Results During the study period, 533 women presented for repair, of which 452 (84.8%) were included in the analysis. The majority (56.6%) were multiparous when the fistula formed. Multiparous women were more likely to have labored less than a day (62.4% vs 44.5%, p<0.001), delivered a live-born infant (26.8% vs 17.9%, p=0.026), and have a high fistula location (37.5% vs 11.2%, p<0.001). Multiparity (aOR=4.55, 95% CI 2.27–9.12) and history of cesarean delivery (aOR=4.11, 95% CI 2.45–6.89) were associated with development of a high fistula. Conclusions Multiparity was common in our cohort, and these women were more likely to have a high fistula. Additional research is needed to understand the etiology of high fistula including potential iatrogenic causes.

Characteristics and Surgical Repair Outcomes of Obstetric Fistula Patients Managed at a Teaching Hospital in Zambia: A Retrospective Cross Sectional Study

“…rds Over 2/3 of the women were multiparous, and had experienced prolonged labour of varying degree (Table 1). Similar findings were noted in other 22,34 settings.…”

Iatrogenic Female Genitourinary Fistula in Uganda: Etiology, Twelve-year trends, and Risk factors among women delivered by cesarean section

“…In our study, grandmultiparity, repeat CS, CS performed by an intern doctor and CS done at a lower health facility (Health Centre IV) were risk factors for iatrogenic stula from cesarean section. Our nding of high parity is in correlation with other studies where the odds of iatrogenic stula increased with rising parity [15,24]. This may be because multiparous women have a thinner lower segment which is more likely to get tears extending to the urinary bladder during cesarean delivery and if unnoticed results into stula (14).…”

Determinants of obstetric fistula in Afghanistan: An analysis of the Demographic and Health Survey 2015

“…Previous studies from other countries have found primiparity, as well as five or more births as a risk factor for obstetric fistula development. 2, 13 The pregnancy in which the obstetric fistula occurred cannot be ascertained in this study but the association of multiparity could be explained by change in pelvic structure due to nutritional factors, trauma, deformity, malpresentations, and increase in birth weight with each pregnancy. 2 In our study several socio-economic factors were associated with obstetric fistula including wealth index, a woman and her husband's education level, healthcare decision making role, and a woman's employment status.…”

“…Our study found that multiparous women were more likely to report suffering from obstetric fistula than nulliparous or primiparous women, and the prevalence increased with increasing number of pregnancies. Previous studies from other countries have found primiparity, as well as five or more births as a risk factor for obstetric fistula development 2,13 2 …”