Obstetric Fistula in the Developing World: An Agonising Tragedy

Dangal, Ganesh; Thapa, Kusum; Yangzom, Kundu; Karki, Aruna

doi:10.3126/njog.v8i2.9759

Cited by 12 publications

(17 citation statements)

References 25 publications

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“…Not only those, but also there are congenital malformation, cancer especially cervical cancer with or without radiotherapy which influence to the occurrence of this fistula. 9 In this study, among the 34 subjects, there were no subjects with the history of infection as well as cancer.…”

Section: Discussionmentioning

confidence: 85%

Characteristics of Patients with Obstetric and Gynecologic Fistula in Jakarta

Djusad

Ambalagen

Natanael

2017

Indones J Obstet Gynecol

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Objective: To know the characteristics of patients with obstetrics and gynecologic fistula in Dr. Cipto Mangunkusumo Hospital, Jakarta. Method: This study was a descriptive design using secondary data from medical records and patient database during 2011-2016. Result: There were 68 subjects with fistula. From 2011-2016, there were 5 cases (7.4%), 19 cases (27.9%), 16 cases (23.5%), 11 cases (16.2%), 8 cases (11.8%), and 9 cases (13.2%) of fistula; respectively. The average age of subjects was 38 years old and only 34 subjects have complete data. Gynecologic and obstetric fistula were 17 cases each. As total 28% of fistula cases were vesicovagina fistula, 12% were rectovaginal fistula, 9% were anovagina fistula, and the other types of fistula were 2%. Among 34 subjects, there were 21% of vesicovagina fistula and 3% of rectovagina fistula, which were caused by iatrogenic. There were 7% of vesicovagina and rectovagina fistula each and 9% of anovagina fistula were caused by obstetric problems. The iatrogenic procedures found from this study were total abdominal hysterectomy (16%), vaginal hysterectomy (3%), and neovagina (3%). Conclusion: The trend of cases is decreasing during the present years (2011-2016). Gynecologic fistula cases caused by iatrogenic are the major problems, but the obstetrics fistula cases decreasing following the labor monitoring is much better nowadays. [Indones J Obstet Gynecol 2016; 4-4: 212-217] Keywords: gynecologic fistula, iatrogenic, obstetric fistula

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Section: Discussionmentioning

confidence: 85%

Characteristics of Patients with Obstetric and Gynecologic Fistula in Jakarta

Djusad

Ambalagen

Natanael

2017

Indones J Obstet Gynecol

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“…Beside these, the patients have to wait for weeks to repair as there are few trained surgeons in this Þ eld, and there is inadequate numbers of supplies and equipment in our part of the world. [15][16][17]…”

Section: Discussionmentioning

confidence: 99%

Profile of Obstetric and Iatrogenic Fistula Surgeries at Kathmandu Model Hospital

Shrestha¹,

Karki²,

Dangal³

et al. 2018

Nepal J Obstet Gynaecol

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Aims: Vesico-vaginal Þ stula (VVF) is an abnormal Þ stulous communication between the bladder and/or urethra and the vagina that allows continuous involuntary discharge of urine into the vaginal vault affecting patients' medical, physical, mental, social and sexual life. The aim of this study was to review and deliver a proÞ le, their demography and outcome in the early phase of Þ stula surgery performed in our institute.Methods: This was a retrospective study of 222 patients who underwent Þ stula surgery during the period of January 2012 to March 2018 in Kathmandu Model Hospital. The Þ stula were classiÞ ed according to Goh`s system. Patients' demography, obstetric characteristics and Þ stula repair outcomes were reviewed. The primary outcome was in terms of urinary continence.Results: A total of 222 women aged between 10 to 65 years with a mean age of 31.4 were included. Majority of the patients had Þ stula due to obstetrical cause, contributing 58% (n=127) and in 42 % (n=95) of patients had Þ stula of gynecological etiology. Most of the patients had Þ stula of type 1a, contributing 38% (n=84) and only 0.01% (n=3) of type 3c and 4b according to Goh's classiÞ cation. Among 127 Þ stulas repaired of obstetric etiology100 (78.7%) patients and 85 (89.4%) out of 95 Þ stula patients of gynecological cause were continent and dry.Conclusions: Our study showed obstructed and prolonged labor was the major cause of obstetric Þ stula, however iatrogenic Þ stula was also becoming common. Majority of our cases had successful outcome with some degree of stress in some patients.

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“…Which implies, there could be a delay in decision making to visit health institution during the onset of labor or a delay while transportation or a delay in making intervention after reaching health institution. Eventually, the unrelieved prolonged labor badly damages soft tissues of the pelvic organs and results in complex Fistula that make patients incontinent even after surgical therapy [45].…”

Section: Discussionmentioning

confidence: 99%

Predictors of Time to Recovery from a Surgical Repair of Obstetric Fistula at Mekelle Hamlin Fistula Center, Tigray, Ethiopia

Hailu¹

2018

J Preg Child Health

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Background: Ethiopia is one of the high fistula burdened countries in the world with an annual occurrence of 3,500 new and existence of 37,500 untreated obstetric fistula cases. Studies conducted in this area focus on determinants of obstetric fistula before surgical repair and researches addressing the associated factors are limited.Objective: To estimate time to recovery from a surgical repair of obstetric fistula and its associated factors among patients treated at Mekelle Hamlin Fistula Center. Results: The patients were followed for 6657 person days at risk, the median recovery time was 20 days. The overall recovery rate was 2.5 cases per 100 person days. Multivariable Cox proportional hazard model result showed labor duration of two or more days (AHR=0.73, 95% CI=0.53, 0.99) and post-operative bladder catheterization longer than 14 or more days (AHR=0.45, 95% CI=0.32, 0.62) were factors negatively associated with recovery time from obstetric fistula surgery. Methods Conclusion and recommendations:women who experienced labor of two or more days and post-operative bladder drainage for more than two or more weeks took longer time to recover after the repair. Therefore, Decision makers, Health care professionals, Stakeholders and Researchers should give emphasis on activities that reduce delays' in decision making, delays' in giving urgent intervention and delays' in reaching health institutions that contributes in reducing complications of prolonged labor ultimately obstetric fistula.Harmful traditional practices such as early marriage and home delivery are other potential factors for the development of obstetric fistula [8][9][10]. Globally, nine to 84% of obstetric fistula patients gave birth at home and more than 2 million women are currently living with this problem. Additional 50,000 to 100,000 new cases are estimated to occur each year and majority of which are from Africa and Asia [9][10][11][12][13].Incidence rates of obstetric fistula in countries with high maternal mortality is as high as two to three cases per 1000 women [14]. Estimated incidence and prevalence of untreated obstetric fistula in Ethiopia during the year 2010 was 3,500 and 37,500, respectively [9,15]. Introduction BackgroundObstetric fistula is an injury that occurs during prolonged or obstructed labor causing tissue damage to organs inside the pelvis and resulting in incontinence of urine, feces or both. The dead tissues due to prolonged pressure fall away and a hole will be formed between the vagina and bladder called Vesico-vaginal Fistula (VVF) or between the vagina and rectum called Recto Vaginal Fistula (RVF) [1][2][3].Obstetric fistula is the worst child birth related complication that contributes for 2.5% of the Global daily death of mothers associated with child birth related complications [4].The main causes of obstetric fistula in the developed world are radiation therapy and surgery whereas in developing countries, "the three delays" are responsible, the delay in seeking skilled emergency obstetric care, the del...

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Obstetric Fistula in the Developing World: An Agonising Tragedy

Cited by 12 publications

References 25 publications

Characteristics of Patients with Obstetric and Gynecologic Fistula in Jakarta

Characteristics of Patients with Obstetric and Gynecologic Fistula in Jakarta

Profile of Obstetric and Iatrogenic Fistula Surgeries at Kathmandu Model Hospital

Predictors of Time to Recovery from a Surgical Repair of Obstetric Fistula at Mekelle Hamlin Fistula Center, Tigray, Ethiopia

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