Original research Characteristics of obstetric fistulas and the need for a prognostic classification system

Abstract

A b s t r a c tIntroduction: To evaluate the need for a prognostic classification system for obstetric fistula (OF) with the data obtained by a voluntarily action for OF repair in a regional hospital and Niger, Africa. Material and methods: Obstetric fistula (OF) characteristics of 51 women with vesicovaginal fistula in a fistula campaign in Maradi Regional Hospital, Niger were evaluated. Initial basic gynecological examination, methylene blue (MBT) test and direct cystoscopy were used to describe the characteristics of the lesions. Demographic and clinical data were compared with the existing literature. Results: In 31 (60 %) cases were the sizes of the fistula greater than 4 cm. The urethra was circumferentially lost in 8 (15.7%) women. In 18 (35.3%) women the trigone was involved. Extensive fibrosis was present in 10 (19.6%) patients. Only in 11 (21.6%) patients without any obliterating scarring, neither the trigone nor urethra were damaged. Five (9.8%) patients had severe infection. Five (9.8%) had multiple lesions. Thirty-four (66.6%) had a history of at least one previous attempt for fistula repair. A significant proportion of women were divorced or abandoned from their husband, and socially isolated. Conclusions: A simple, reproducible and universally accepted scientific classification or staging system for OF dealing with outcomes rather than anatomic landmarks should replace the present proposed classification systems for prognostic and ethical purposes.

Obstetric fistula in Southern Sudan: situational analysis and Key Informant Method to estimate prevalence

“…KIM has been validated for use for other rare conditions including childhood disability and childhood blindness [12,13], but while these are often stigmatizing conditions, it may be that mothers will bring children for assessment but not come themselves. Previous work on women with fistula has emphasised their isolation from family, friends and community [2,20,21]. This could mean that women were “hidden” and unable to be identified.…”

Determinants of Outcomes and Prognosis Score in Obstetric Vesico-Vaginal Fistula Repair

“…The age observed in our series is close to that found by Yeakey and al. [12] in Malawi, Tegbeu [13] in Cameroon (37 years old) and Arshad [14] in Tunisia (35.5 years old). However, this age varies between 25 and 30 years for most authors around the world [4] [6] [9] [15].…”

Obstetric Fistula: The Agony of Unsafe Motherhood. A Review of Nigeria Experience

“…Most of the vesicovaginal fistula patients suffer from psychosocial complications such as loss of self esteem, divorce/separation and depression, because they cannot work or attend social gathering due to of smell of urine [18][19][20][21]. Their husbands, and sometimes their families, desert the patients, accusing them of bringing shame to their families.…”

“…Their husbands, and sometimes their families, desert the patients, accusing them of bringing shame to their families. They are shunned by the society and eventually become social outcast [18,19].…”

“…Women with obstetric fistulae often face difficult conditions as a result of either the fistulae itself or the prolonged obstructed labour, and the most disturbing consequence is incontinence, either urinary, faecal or both [17]. Because of the continuous leakage of urine and faeces, women with fistulae are, usually, ostracized and marginalized, socially [18,19]. Other problems women with fistulae face include: vulva dermatitis [9], high rates of divorce or separation [20,21], absence of sexual intercourse [19,20], loss of fertility and amenorrhea [22,23] and depression [21,24].…”