The epidemiology of genitourinary fistulae in Kumasi, Ghana, 1977–1992

Danso, Kwabena A.; Martey, J.O.; Wall, L. Lewis; Elkins, Thomas E.

doi:10.1007/bf01894198

Cited by 88 publications

(83 citation statements)

References 15 publications

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“…Vesico vaginal fistula is well known late sequelae of prolonged obstructed labour. 16,17 In present study only 2 patients (0.8%) developed vesicovaginal fistula because of immediate and prolonged bladder catheterization and lesser incidence of destructive operation in our study. six maternal deaths occurred in our study due to extensive uterine rupture causing massive haemorrhage and hypovolemic shock and another 2-maternal death was due to septicemia and hence incidence of maternal mortality in our study was 3.5%.…”

Section: Discussionmentioning

confidence: 43%

Incidence, causes and feto-maternal outcomes of obstructed labour in a tertiary health care centre

Ranjana

Sinha

2017

Int J Reprod Contracept Obstet Gynecol

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Background: Obstructed labour is one of the most common preventable cause of maternal and neonatal morbidity and mortality in developing countries. This study was undertaken to assess the incidence, causes and feto-maternal outcomes of obstructed labour. Methods: This prospective study was carried out in the Department of Obstetrics and Gynaecology at Patna Medical College and Hospital, Patna, Bihar, India over a period of one year from February 2012 to February 2013. The 228 patients diagnosed to have obstructed labour were studied. Results: Out of 2556 deliveries conducted during this period, 228 cases of obstructed labour were found constituting an incidence of 8.9%. Majority of the patients were unbooked (89.47%), between 21-30 years of age (90.35%) and with parity 3 or more. The most common cause of obstructed labour was malposition (45.61%) followed by cephalopelvic disproportion (43.85%) and malpresentation (8.7%). caesarean section was the most common mode of delivery. In 21.92% of cases ruptured uterus was diagnosed pre-operatively among which, 2.63% has scar rupture and in remaining cases rupture was in unscarred uterus due to obstructed labour diagnosed intra-operatively. PPH was seen intra-operatively in 17.54% of cases and bladder trauma in 3.5% of cases. Most common post-operative complications were paralytic ileus (52.6%) followed by severe anaemia (48.2%) and infections (23.68%). Only 0.8% patients developed vesico-vaginal fistula as a late sequela of obstructed labour. The maternal mortality was 3.5% and perinatal mortality was 39%. Conclusions: In present study, the incidence of obstructed labour is very high. Good antenatal care, education of primary health care providers and traditional birth attendants on dangers of obstructed labour and the need for early referral is suggested to reduce the incidence of this condition.

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Section: Discussionmentioning

confidence: 43%

Incidence, causes and feto-maternal outcomes of obstructed labour in a tertiary health care centre

Ranjana

Sinha

2017

Int J Reprod Contracept Obstet Gynecol

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“…[14][15][16] However, the divorce rate of 27% that was found in this work was much lower than the 55% earlier reported by Ibrahim et al [16] Prolonged obstructed labor remains the single most important cause of the fistula (85%) and has been demonstrated consistently in most reports from the West African sub-region. [3,9,14,15,17,18] Gishiri cut (traditional practice of cutting the vagina with sharp instrument) accounted for just two cases (1.5%) in this study when compared to the 13% reported from the Zaria area [5] or the 6.2% found at Maiduguri. [9] It is either because the practice of Gishiri cut is not common in the Sokoto area or that the incidence is falling with increasing awareness of its dangers.…”

Section: Discussionmentioning

confidence: 77%

“…Three out of every 1000 deliveries in West African countries develop VVF and about 200,000 women await surgical repair in Nigeria alone. [1][2][3][4] The prevalence of VVF is often underestimated because knowledge of the number of sufferers is linked to those who come to hospital for treatment. There are patients with the condition who suffer silence and isolation.…”

Section: Introductionmentioning

confidence: 99%

Vesicovaginal fistula: Do the patients know the cause?

Hassan

Ekele

2009

Ann Afr Med

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Background: So much has been written on vesicovaginal fi stula (VVF) but there is little on the patients' perspective of the condition. The objectives of this study were to determine the knowledge of patients who have developed VVF on the causes of the fi stula and their attitude toward measures that would prevent future occurrence. Methods: The questionnaire-based survey was conducted on VVF patients on admission from June to August 2003 at Maryam Abacha Women and Children Welfare Hospital, Sokoto, Nigeria. The case notes of the patients were reviewed after the interview to match the responses from the patients with those documented in the folders. Focus group discussions were held with the maternity staff to ascertain the content and quality of existing counseling. Results: One hundred and thirty patients were studied out of which 121 (93%) had no formal education. Teenagers constituted 37%, while 57% were primiparae. Thirty-fi ve (27%) patients were divorced or separated because of the VVF. There were seven cases of recurrence after a previous successful repair. Prolonged obstructed labor was the cause of the VVF in 110 (85%) patients and 77 (70%) correctly attributed their problem to the prolonged labor. The 33 patients who could not identify the prolonged obstructed labor as the cause either attributed their condition to God/destiny or to the operation that was done to relief the obstruction and therefore would not have hospital delivery in their subsequent pregnancies. From the focus group discussions, it was confi rmed that pre and post-operative counseling were inadequate. Conclusion: Even though majority (70%) of the patients knew the cause of their fi stula from the health talks, some (32%) would still not change from risky obstetric behavior. Mandatory provision of accurate and appropriate information and education to all VVF patients and their relatives or spouses by trained counselors should be ensured. Such information and education should emphasize the etiology and management of obstetric fi stula in order to prevent a recurrence.

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“…This may reflect differing aetiology as previous studies have included women with fistulae secondary to gynaecological surgery and radiotherapy rather than purely obstetric causes 14 . Faecal incontinence has been reported in association with repair of a vesico-vaginal fistula but the frequency of this problem is unclear 3,8,9,13 . We have identified altered faecal continence in 21 women (38%) following repair of obstetric fistula, including women with frank faecal incontinence ( Table 2).…”

Section: Discussionmentioning

confidence: 99%

Urinary and faecal incontinence following delayed primary repair of obstetric genital fistula

Murray¹

2002

BJOG: An International Journal of Obstetrics and Gynaecology

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Objective To evaluate: (1) the factors associated with the development of obstetric genitourinary fistula, (2) the incidence of urinary and faecal incontinence following closure of the fistula and (3) the urodynamic findings in women with persistent urinary incontinence. Design An observational clinical study.Setting A specialised fistula unit in a developing country.Population Women following successful anatomical closure of obstetric genitourinary fistula.Methods Fifty-five women were enrolled from the Fistula Hospital in Ethiopia, following obstetric fistula repair. Their case records were reviewed and details regarding (1) antecedent obstetric factors, (2) the site, size and type of fistula and (3) pre-operative bladder neck mobility and vaginal scarring were recorded. All women were questioned regarding symptoms of faecal and urinary incontinence. Women reporting urinary incontinence following fistula repair underwent urodynamic investigations. Main outcome measures Clinical and urodynamic assessment.Results The mean age of the women was 23 years (range 16 -45 years). The fistula in 38 women (69%) followed the first delivery and in 17 women (31%) following a subsequent delivery. The mean duration of labour was four days (range 1-9 days). Forty-four women (80%) had an isolated vesico-vaginal fistula and 11 (20%) had a combined vesico-vaginal and recto-vaginal fistula. The mean diameter of the fistula was 2.9 cm (0.5 -6 cm). Successful repair occurred in all women. Thirty women (55%) reported persistent urinary incontinence and 21 (38%) altered faecal continence at follow up. In the former group, urodynamic investigations identified genuine stress incontinence in 17 women (31%), detrusor instability in two (4%) and mixed incontinence in 11 (20%). Conclusion This study demonstrates the high rate of successful closure of the fistula in a specialised fistula unit, but highlights the problem of persistent urinary incontinence following closure.

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The epidemiology of genitourinary fistulae in Kumasi, Ghana, 1977–1992

Cited by 88 publications

References 15 publications

Incidence, causes and feto-maternal outcomes of obstructed labour in a tertiary health care centre

Incidence, causes and feto-maternal outcomes of obstructed labour in a tertiary health care centre

Vesicovaginal fistula: Do the patients know the cause?

Urinary and faecal incontinence following delayed primary repair of obstetric genital fistula

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