Prospective results after first-time surgery for obstetric fistulas in East African women

Raassen, Tom; Verdaasdonk, Emiel G. G.; Vierhout, Mark E.

doi:10.1007/s00192-007-0389-6

Cited by 80 publications

(78 citation statements)

References 15 publications

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“…This rate varies between 2.2% and 4% according to authors throughout the world [5] [7] [11]. The average age at the time of surgery is 35 years (16 -76 years) in our series.…”

Section: Discussionmentioning

confidence: 71%

“…This age depends on the availability of surgeons in the area. The average age at onset of fistula was 25 years and the average length of time our patients had fistula was 8 years (4 months to 61 years) due to lack of availability of surgeons, 2 to 4 years for most authors around the world [5] [7] [9] [16] except Tegbeu who found 8.5 years in Cameroon. The duration of the index delivery labor that resulted in the formation of the obstetric fistula was 3 days as most authors have also noted in their series [9] [16] [17].…”

Section: Discussionmentioning

confidence: 99%

“…The obstetric FVV is due to uncorrected obstructed labor in time [5] [6]. The direct consequences of this situation include urinary and/or fecal incontinence in cases where the rectum is involved.…”

Section: Introductionmentioning

confidence: 99%

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

Mubikayi¹,

Matson²,

Lokomba³

et al. 2017

OJOG

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An estimated 2 million women living in countries with limited resources currently have vesico-vaginal, recto-vaginal, or mixed types of fistulae because of the necrosis that occurs with obstructed labor. We evaluated factors readily assessed by the examining practitioner in a consecutive case series of surgical repairs of obstetrical fistulae, for the ability of those factors to stand as a prognostic guide, in a clinical score. Objectives: To identify the predictors of surgical repair outcomes and establish a Score combining these different determinants to facilitate the care of obstetric fistula. Methods: We conducted a multicentric prospective study between 2011 and 2014 in Democratic Republic of the Congo (DRC). Outcomes: We measured 3 months post-surgery in a series of 483 patients with obstetrical fistula repaired by the same surgeon included closure and failure appreciated by dye test. Multivariable generalized estimating equation models were used to generate adjusted odd ratios (OR) and 95% confidence intervals (CIs). The scores ranging from 3 to 14 were established from the outcomes determinants identified. Results: In total, 483 women were enrolled, and 390 cases were at their first surgery and were included in the obstetric fistula (OF) prognosis score and classification. Their mean age was 35 years at the time of the surgery and 25 years at the onset of OF. In 28.6%, the fistula patient was primigravida. Mean duration between onset of the fistula and surgical treatment was 8 years. In 24%, the fistula patients lived separated from their partners. Overall closure rate of the fistulas was 85.7%. Severe vaginal fibrosis (p < 0.01), big fistula size (<0.01), small distance from fistula to external urethral meatus (<0.01) and prior surgery (p < 0.48) predicted failed fistula closure. A clinical score ranging from 3 to 14 points is a prognostic score with a range of 1 to 4 for the distance between the fistula and the external meatus and the size, and a scale of 1 to 6 for fibrosis. 768Conclusions: This study demonstrated that the marked vaginal scarring; large fistula size and distance to urethral meatus are predictors for unsuccessful fistula repair. Due to the lack of a standard classification that is never unanimous among the different surgeons, this prognostic score allows the combination of the different determinants assessing the chances of success and can help the practitioners to orient the patients towards the determined skill scale to take care of the patients.

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“…This rate varies between 2.2% and 4% according to authors throughout the world [5] [7] [11]. The average age at the time of surgery is 35 years (16 -76 years) in our series.…”

Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Mubikayi¹,

Matson²,

Lokomba³

et al. 2017

OJOG

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“…Further, there is a shortage of reliable data around social, demographic and clinical factors associated with time to recovery from obstetric Fistula surgical repair that will be valuable for managing health care institution through planning, monitoring and evaluation of quality of care as well as use of human and material resources [29][30][31][32][33][34][35].…”

Section: Significance Of the Studymentioning

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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“…40,41 However, in the developing countries, obstetric fistulae are common. 42 Estimates indicate that 2-3 millions women live with obstetric fistulae worldwide, the majority of whom are in Africa and Asia. [43][44][45] Fistulas are preventable and treatable, however, many women are still unaware of the availability of treatment and 80% of them never seek treatment due to lack of knowledge.…”

Section: Fistulae In the Developing Worldmentioning

confidence: 99%

Female urinary incontinence: a systematic overview and non-surgical treatment

Ngarambe

Peng

2015

Int J Reprod Contracept Obstet Gynecol

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Prospective results after first-time surgery for obstetric fistulas in East African women

Cited by 80 publications

References 15 publications

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

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

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

Female urinary incontinence: a systematic overview and non-surgical treatment

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