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Figa Z, Temesgen T, Mahamed AA, Bekele E. The effect of maternal undernutrition on adverse obstetric outcomes among women who attend antenatal care in Gedeo zone public hospitals, cohort study design. BMC Nutr 2024; 10:64. [PMID: 38650046 PMCID: PMC11034148 DOI: 10.1186/s40795-024-00870-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 04/15/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Undernutrition refers to an overall deficiency of nutrients due to an inadequate intake of a well-balanced diet. Undernourishment during pregnancy is an important contributor to maternal morbidity and mortality. It remains a persistent problem in developing countries, where women usually fall behind men in having access to food, health care, and education. Despite the high prevalence of maternal undernourishment, its direct impact on obstetric outcomes has not been studied in developing countries, including Ethiopia. OBJECTIVE This study aimed to assess the effect of maternal undernutrition on adverse obstetric outcomes in Gedeo zone public hospitals. METHOD A cohort study design was employed in Gedeo zone public hospitals from June 30, 2022, to February 28, 2023. This study included 721 pregnant women, 237 were exposed group whereas 484 were non-exposed. A systematic random sampling technique was used to select a non-exposed group and the exposed group was selected consecutively. Both groups were followed for 7 months, from 16 weeks of gestation to 24 h of delivery. The pretested interviewer-administered questionnaire and checklist were used. EpiData 4.4.1.2.version was used for data entry and analyzed using Stata version 16 software. A modified Poisson regression model with robust standard errors was used to determine relative risk, and the statistical association was declared at a p-value ≤ 0.05. Finally, the findings were reported in figures, tables, and words. RESULT The incidence of adverse obstetrics outcomes among undernourished and normally nourished mothers was hypertensive disorder during pregnancy (HDDP) (7.49% vs. 3.19%), antepartum haemorrhage (7.49% vs. 3.19%), obstructed labor (1.53% vs. 3.49%), premature rupture of the membrane (2.5% vs. 3.33%), preterm labor (6.52% vs. 6.93%), instrumental vaginal delivery (1.8% vs. 4.3%), postpartum haemorrhage (5.95% vs. 3.88%), and sepsis (3.74% vs. 1.94%). The risk of adverse obstetric outcomes among undernourished women was hypertensive disorder during pregnancy (HDDP) (aRR) = 4.07, 95%CI: 2.53-6.55), antepartum haemorrhage (APH) (aRR = 5.0, 95% CI: 2.08-12.72), preterm labor (aRR = 1.8, 95%CI: 1.23-2.62), operative delivery (aRR = 1.24, 95%C: 0.87-1.78), postpartum haemorrhage (aRR = 3.02, 95%CI: 1.91-4.79), and sepsis/chrioaminitis (aRR = 3.55, 95%CI: 1.83-6.89) times higher than normally nourished women. CONCLUSION The incidence rates of hypertensive disorder during pregnancy (HDDP), antepartum haemorrhage, postpartum haemorrhage, and sepsis were higher among undernourished women than normally nourished women. Undernourished women during pregnancy have an increased risk of adverse obstetrics outcomes including hypertensive disorder during pregnancy, antepartum, preterm labor, operative delivery, postpartum haemorrhage, and sepsis/chorioamnionitis.
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Affiliation(s)
- Zerihun Figa
- Dilla University College of Health and Medical Science Department of Midwifery, Dilla, Ethiopia.
| | - Tesfaye Temesgen
- Dilla University College of Health and Medical Science Department of Midwifery, Dilla, Ethiopia
| | - Abbas Ahmed Mahamed
- Dilla University College of Health and Medical Science Department of Midwifery, Dilla, Ethiopia
| | - Etaferahu Bekele
- Dilla University College of Health and Medical Science Department of Emergency and Critical Care Nursing, Dilla, Ethiopia
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Ba'Abbad L, Turki M, Aldossary G, Elzewawi N, Saleem HA. Uterine prolapse in a term pregnancy: A case report. Case Rep Womens Health 2024; 41:e00578. [PMID: 38192520 PMCID: PMC10772363 DOI: 10.1016/j.crwh.2023.e00578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/10/2024] Open
Abstract
Uterine prolapse is a rare condition in pregnancy that may lead to serious antepartum, intrapartum and postpartum complications for the mother and fetus. This is the case of a 30-year-old woman who presented at 38 weeks of gestation of her third pregnancy with spontaneous rupture of membranes and labor pain. Pelvic examination in dorsal lithotomy position revealed a stage 3 uterine prolapse, with a 3 cm dilated thick edematous cervix and rupture of membranes with clear liquor. Four hours after admission, the cervix became more edematous and there had been no change in cervical dilatation. Therefore, advanced apical prolapse (negatively affecting labor) was diagnosed, and the obstetric team decided on a cesarean delivery because a lack of progression of cervical dilatation. A live female baby weighing 3400 g was delivered and no abnormal findings or complications were reported. The patient had uneventful postoperative course with a significant reduction in uterine prolapse. Six weeks post-delivery, assessment in the urogynecology outpatient clinic revealed spontaneous resolution of the prolapse. The woman was advised to perform pelvic floor muscle exercises and to seek medical advice if the condition recurred. Obstetricians should be aware of this rare condition in pregnancy, as proper early diagnosis is crucial for a safe, uneventful pregnancy.
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Affiliation(s)
- Lina Ba'Abbad
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Princess Nourah Bint Abdulrahman University, Saudi Arabia
| | - Marwa Turki
- Department of Obstetrics and Gynaecology, King Abdullah Bin Abdulaziz University Hospital, Saudi Arabia
| | - Ghada Aldossary
- Department of Obstetrics and Gynaecology, King Abdullah Bin Abdulaziz University Hospital, Saudi Arabia
| | - Nouar Elzewawi
- Department of Obstetrics and Gynaecology, King Abdullah Bin Abdulaziz University Hospital, Saudi Arabia
| | - Heba Abu Saleem
- Department of Obstetrics and Gynaecology, King Abdullah Bin Abdulaziz University Hospital, Saudi Arabia
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El Ayadi AM, Obore S, Kirya F, Miller S, Korn A, Nalubwama H, Neuhaus J, Getahun M, Eyul P, Twine R, Andrew EVW, Barageine JK. Identifying opportunities for prevention of adverse outcomes following female genital fistula repair: protocol for a mixed-methods study in Uganda. Reprod Health 2024; 21:2. [PMID: 38178156 PMCID: PMC10768188 DOI: 10.1186/s12978-023-01732-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 12/28/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Female genital fistula is a traumatic debilitating injury, frequently caused by prolonged obstructed labor, affecting between 500,000-2 million women in lower-resource settings. Vesicovaginal fistula causes urinary incontinence, and other morbidity may occur during fistula development. Women with fistula are stigmatized, limit social and economic engagement, and experience psychiatric morbidity. Improved surgical access has reduced fistula consequences yet post-repair risks impacting quality of life and well-being include fistula repair breakdown or recurrence and ongoing or changing urine leakage or incontinence. Limited evidence on risk factors contributing to adverse outcomes hinders interventions to mitigate adverse events. This study aims to quantify these adverse risks and inform clinical and counseling interventions to optimize women's health and quality of life following fistula repair through: identifying predictors and characteristics of post-repair fistula breakdown and recurrence (Objective 1) and post-repair incontinence (Objective 2), and to identify feasible and acceptable intervention strategies (Objective 3). METHODS This mixed-methods study incorporates a prospective cohort of women with successful vesicovaginal fistula repair at approximately 12 fistula repair centers in Uganda (Objectives 1-2) followed by qualitative inquiry among key stakeholders (Objective 3). Cohort participants will have a baseline visit at the time of surgery followed by data collection at 2 weeks, 6 weeks, 3 months and quarterly thereafter for 3 years. Primary predictors to be evaluated include patient-related factors, fistula-related factors, fistula repair-related factors, and post-repair behaviors and exposures, collected via structured questionnaire at all data collection points. Clinical exams will be conducted at baseline, 2 weeks post-surgery, and for outcome confirmation at symptom development. Primary outcomes are fistula repair breakdown or fistula recurrence and post-repair incontinence. In-depth interviews will be conducted with cohort participants (n ~ 40) and other key stakeholders (~ 40 including family, peers, community members and clinical/social service providers) to inform feasibility and acceptability of recommendations. DISCUSSION Participant recruitment is underway. This study is expected to identify key predictors that can directly improve fistula repair and post-repair programs and women's outcomes, optimizing health and quality of life. Furthermore, our study will create a comprehensive longitudinal dataset capable of supporting broad inquiry into post-fistula repair health. Trial Registration ClinicalTrials.gov Identifier: NCT05437939.
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Affiliation(s)
- Alison M El Ayadi
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 550 16Th Street, San Francisco, CA, 94158, USA.
| | - Susan Obore
- Department of Urogynecology, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
| | - Fred Kirya
- School of Health Sciences, Soroti University, Soroti, Uganda
| | - Suellen Miller
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 550 16Th Street, San Francisco, CA, 94158, USA
| | - Abner Korn
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 550 16Th Street, San Francisco, CA, 94158, USA
| | - Hadija Nalubwama
- Department of Obstetrics and Gynecology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - John Neuhaus
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Monica Getahun
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Patrick Eyul
- Infectious Disease Research Collaboration, Kampala, Uganda
| | - Robert Twine
- Infectious Disease Research Collaboration, Kampala, Uganda
| | | | - Justus K Barageine
- Department of Urogynecology, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
- Department of Obstetrics and Gynecology, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Obstetrics and Gynaecology, Kampala International University, Kampala, Uganda
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Shimaoka R, Takahashi Y, Ono H, Matsui M, Asai K, Iwagaki S. Magnetic resonance imaging pelvimetric measurements as predictors for emergent cesarean delivery in obstructed labor. Eur J Obstet Gynecol Reprod Biol X 2023; 19:100216. [PMID: 37501741 PMCID: PMC10368825 DOI: 10.1016/j.eurox.2023.100216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
Objective This study aimed to investigate the usefulness of various magnetic resonance imaging (MRI) pelvimetric parameters for predicting emergent cesarean delivery due to obstructed labor. Study design This was a prospective observational study. MRI pelvimetry was performed in cases of a clinically suspected maternal narrow pelvis, maternal short stature, fetal overgrowth, and abnormal placental position. MRI pelvimetry was performed at 34.7 ± 4.2 gestational weeks using a 1.5 T MRI system. The pelvic inlet angle, pelvic inclination, obstetric conjugate, sacral outlet diameter (SOD), and coccygeal pelvic outlet were measured in the sagittal section. The interspinous diameter and intertuberous diameter were measured in coronal sections. Fetal anomalies, cesarean deliveries before the onset of labor, and non-reassuring fetal status were excluded from the analysis. Results MRI pelvimetry was performed in 154 patients. After excluding 76 cases, including 19 cases of absolute cephalopelvic disproportion, 78 cases of trial of labor were included. Of these, 63 were vaginal deliveries and 15 were emergent cesarean deliveries due to obstructed labor. The cut-off value for body mass index (BMI) was 22.2, with an area under the curve (AUC) of 0.69, for predicting obstructed labor. The cut-off value for the SOD was 10.7 cm with an AUC of 0.69. BMI alone had a sensitivity of 80%, specificity of 66%, positive predictive value (PPV) of 36%, and negative predictive value (NPV) of 93%. When BMI and SOD were combined, sensitivity was 53%, specificity was 90%, PPV was 57%, and NPV was 89%. The odds ratio for emergent cesarean delivery was 5.42 (95% confidence interval 1.06-27.6, p = 0.041) if the SOD was less than the cut-off value in the binomial logistic regression analysis in cases with an BMI > 22. Conclusion We confirmed that MRI pelvimetry was a reliable tool for better patient selection for obstructed labor. The SOD was the best predictor of obstructed labor, with a cut-off value of 10.7 cm for women with a low BMI.
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Boujenah J, Fernandez A, Drozd MM, Askenazy F, Carbonne B. Letter to the Editor: Failed labor induction and early-onset schizophrenia: Toward an oxytocin pathway genetic link? Eur J Obstet Gynecol Reprod Biol 2023; 285:204-205. [PMID: 37080893 DOI: 10.1016/j.ejogrb.2023.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023]
Affiliation(s)
- Jeremy Boujenah
- Service de Gynécologie-Obstétrique, Centre Hospitalier Princesse Grace, 1 Avenue Pasteur, 98000 Monaco, Monaco.
| | - Arnaud Fernandez
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice, CHU-Lenval, Nice, France; Université Côte d'Azur, CoBTek, Nice, France; CNRS UMR7275, Université Côte d'Azur, Institut de Pharmacologie Moléculaire et Cellulaire, Valbonne, France
| | - Malgorzata Marta Drozd
- CNRS UMR7275, Université Côte d'Azur, Institut de Pharmacologie Moléculaire et Cellulaire, Valbonne, France
| | - Florence Askenazy
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice, CHU-Lenval, Nice, France; Université Côte d'Azur, CoBTek, Nice, France
| | - Bruno Carbonne
- Service de Gynécologie-Obstétrique, Centre Hospitalier Princesse Grace, 1 Avenue Pasteur, 98000 Monaco, Monaco.
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Maroyi R, Moureau MK, Brown HW, Ajay R, Byabene G, Mukwege DM. Etiology and factors associated with urogenital fistula among women who have undergone cesarean section: a cross-sectional study. BMC Pregnancy Childbirth 2023; 23:54. [PMID: 36690977 PMCID: PMC9869501 DOI: 10.1186/s12884-023-05357-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/06/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The prevalence and impact of fistulas are more common in developing countries with limited access to emergency obstetric care. As a result, women in these settings often experience adverse psychosocial factors. The purpose of this study was to describe the characteristics of Congolese women who developed urogenital fistula following Cesarean sections (CS) to determine the characteristics associated with two etiologies: (1) prolonged obstructed labor; and (2) a complication of CS following obstructed labor. METHODS We performed a cross-sectional study on abstracted data from all patients with urogenital fistula following CS who received care during a surgical campaign in a remote area of the Democratic Republic of the Congo (DRC). Descriptive analyses characterized patients with fistula related to obstructed labor versus CS. Univariate and multivariate logistic regression models identified factors associated with obstetric fistula after cesarean delivery following obstructed labor. Variables were included in the logistic regression models based upon biological plausibility. RESULTS Among 125 patients, urogenital fistula etiology was attributed to obstructed labor in 77 (62%) and complications following CS in 48 (38%). Women with a fistula, attributed to obstructed labor, developed the fistula at a younger age (p = .04) and had a lower parity (p = .02). Attempted delivery before arriving at the hospital was associated with an increased risk of obstetric fistula after cesarean delivery following obstructed labor (p < .01). CONCLUSION CS are commonly performed on women who arrive at the hospital following prolonged obstructed labor and fetal demise, and account for almost 40% of urogenital fistula. Obstetric providers should assess maternal status upon arrival to prevent unnecessary CS and identify women at risk of developing a fistula.
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Affiliation(s)
- Raha Maroyi
- Department of Urogynecology, Panzi General Referral Hospital, Bukavu, Democratic Republic of the Congo ,Faculty of Medicine, Evangelical University in Africa, Bukavu, Democratic Republic of the Congo ,Mushununu, Panzi, Bukavu, Democratic Republic of the Congo
| | - Madeline K. Moureau
- grid.14003.360000 0001 2167 3675Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Heidi W. Brown
- grid.14003.360000 0001 2167 3675Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Rane Ajay
- grid.1011.10000 0004 0474 1797Department of Obstetrics and Gynecology, James Cook University, Townsville, Australia
| | - Gloire Byabene
- Department of General Surgery, Panzi General Referral Hospital, Bukavu, Democratic Republic of the Congo
| | - Denis M. Mukwege
- Faculty of Medicine, Evangelical University in Africa, Bukavu, Democratic Republic of the Congo ,Department of Gynecology and Obstetrics, Panzi General Referral Hospital, Bukavu, Democratic Republic of the Congo
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Chebet I, Izudi J. Patterns and levels of serum electrolyte imbalance among women with obstructed labor in Uganda: A cross-sectional study. Midwifery 2022; 115:103486. [PMID: 36152598 DOI: 10.1016/j.midw.2022.103486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 08/06/2022] [Accepted: 09/08/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To determine the patterns and levels of imbalance in sodium, potassium, and chloride electrolytes, and the factors associated with each electrolyte imbalance among women with obstructed labor. DESIGN In this cross-sectional study, we collected data on personal and obstetric factors using a structured questionnaire. We drew 3 mls of blood from the antecubital vein and analyzed for sodium, potassium, and chloride ions using Cobas Integra 400. Multivariable logistic regression was employed to analyze factors independently associated with each electrolyte imbalance. SETTING Obstetrics and Gynaecology Unit, Mulago National Referral Hospital, Kampala, Uganda. PARTICIPANTS Women with obstructed labor. MEASUREMENTS Imbalance in sodium, potassium, and chloride electrolytes, measured on a binary scale using the normal third-trimester pregnancy electrolyte values: 130-148 mmol/Litre for sodium, 3.3-5.1 mmol/Litre for potassium, and 97-109 mmol/Litre for chloride. Women with electrolyte values outside the respective normal ranges were regarded as having an imbalance. FINDINGS We studied 299 women and found 22/299 (7.4%) had sodium imbalance, 254/299 (84.9%) had potassium imbalance, and 284/299 (95.0%) had chloride imbalance. In multivariable logistic regression analysis, herbal medicine use was associated with sodium imbalance (adjusted odds ratio (aOR), 2.72; 95% confidence interval (CI), 1.11-6.95). KEY CONCLUSIONS Potassium and chloride imbalances were more prevalent among women with obstructed labor relative to sodium imbalance. Herbal medicine use during pregnancy is associated with a higher likelihood of sodium electrolyte imbalance. IMPLICATIONS FOR PRACTICE There is a need to routinely monitor women with obstructed labor for electrolyte imbalance.
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Affiliation(s)
- Irene Chebet
- Gynecology and Obstetrics Unit, Soroti Regional Referral Hospital, Soroti City, Uganda. Box 289, Soroti City, Uganda.
| | - Jonathan Izudi
- Department of Community Health, Mbarara University of Science and Technology, Mbarara City, Uganda. Box 1410, Mbarara City, Uganda.
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Maggiulli O, Rufo F, Johns SE, Wells JC. Food taboos during pregnancy: meta-analysis on cross cultural differences suggests specific, diet-related pressures on childbirth among agriculturalists. PeerJ 2022; 10:e13633. [PMID: 35846875 PMCID: PMC9281602 DOI: 10.7717/peerj.13633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/03/2022] [Indexed: 01/17/2023] Open
Abstract
Pregnancy is the most delicate stage of human life history as well as a common target of food taboos across cultures. Despite puzzling evidence that many pregnant women across the world reduce their intake of nutritious foods to accomplish cultural norms, no study has provided statistical analysis of cross-cultural variation in food taboos during pregnancy. Moreover, antenatal practices among forager and agriculturalists have never been compared, despite subsistence mode being known to affect staple foods and lifestyle directly. This gap hinders to us from understanding the overall threats attributed to pregnancy, and their perceived nutritional causes around the world. The present study constitutes the first cross-cultural meta-analysis on food taboos during pregnancy. We examined thirty-two articles on dietary antenatal restrictions among agricultural and non-agricultural societies, in order to: (i) identify cross-culturally targeted animal, plant and miscellaneous foods; (ii) define major clusters of taboo focus; (iii) test the hypothesis that food types and clusters of focus distribute differently between agricultural and non-agricultural taboos; and (iv) test the hypothesis that food types distribute differently across the clusters of taboo focus. All data were analysed in SPSS and RStudio using chi-squared tests and Fisher's exact tests. We detected a gradient in taboo focus that ranged from no direct physiological interest to the fear of varied physiological complications to a very specific concern over increased birth weight and difficult delivery. Non-agricultural taboos were more likely to target non-domesticated animal foods and to be justified by concerns not directly linked to the physiological sphere, whereas agricultural taboos tended to targed more cultivated and processed products and showed a stronger association with concerns over increased birth weight. Despite some methodological discrepancies in the existing literature on food taboos during pregnancy, our results illustrate that such cultural traits are useful for detecting perception of biological pressures on reproduction across cultures. Indeed, the widespread concern over birth weight and carbohydrate rich foods overlaps with clinical evidence that obstructed labor is a major threat to maternal life in Africa, Asia and Eurasia. Furthermore, asymmetry in the frequency of such concern across subsistence modes aligns with the evolutionary perspective that agriculture may have exacerbated delivery complications. This study highlights the need for the improved understanding of dietary behaviors during pregnancy across the world, addressing the role of obstructed labor as a key point of convergence between clinical, evolutionary and cultural issues in human behavior.
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Affiliation(s)
| | | | | | - Jonathan C.K. Wells
- University College London Great Ormond Street Institute of Child Health, London, United Kingdom
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Pollaczek L, El Ayadi AM, Mohamed HC. Building a country-wide Fistula Treatment Network in Kenya: results from the first six years (2014-2020). BMC Health Serv Res 2022; 22:280. [PMID: 35232440 PMCID: PMC8889651 DOI: 10.1186/s12913-021-07351-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022] Open
Abstract
It is estimated that one million women worldwide live with untreated fistula, a devastating injury primarily caused by prolonged obstructed labor when women do not have access to timely emergency obstetric care. Women with fistula are incontinent of urine and/or feces and often suffer severe social and psychological consequences, such as profound stigma and depression. Obstetric fistula affects economically vulnerable women and garners little attention on the global health stage. Exact figures on fistula incidence and prevalence are not known. In Kenya, results from a 2014 population-based survey suggest that 1% of reproductive-aged women have experienced fistula-like symptoms. In collaboration with key stakeholders, Fistula Foundation launched the Fistula Treatment Network (initially known as Action on Fistula) in 2014 to increase access to timely, quality fistula treatment and comprehensive post-operative care for women with fistula in Kenya. The integrated model built linkages between the community and the health system to support women through all parts of their treatment journey and to build capacity of healthcare providers and community leaders who care for these women. Fistula Foundation and its donors provided the program’s funding. Seed funding, representing about 30% of the program budget, was provided by Astellas Pharma EMEA. Over the six-year period from 2014 to 2020, the network supported 6,223 surgeries at seven hospitals, established a fistula training center, trained eleven surgeons and 424 Community Health Volunteers, conducted extensive community outreach, and contributed to the National Strategic Framework to End Female Genital Fistula. At 12 months post fistula repair, 96% of women in a community setting reported that they were not experiencing any incontinence and the proportion of women reporting normal functioning increased from 18% at baseline to 85% at twelve-months. The Fistula Treatment Network facilitated collaboration across hospital and community actors to enhance long-term outcomes for women living with fistula. This model improved awareness and reduced stigma, increased access to surgery, strengthened the fistula workforce, and facilitated post-operative follow-up and reintegration support for women. This integrated approach is an effective and replicable model for building capacity to deliver comprehensive fistula care services in other countries where the burden of fistula is high.
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Affiliation(s)
| | - Alison M El Ayadi
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
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Getachew A, Wakgari N, Gishille T. Feto-Maternal Outcomes of Obstructed Labor and Associated Factors among Mothers Who Gave Birth in Public Hospitals of West Shoa Zone, Central Ethiopia: Cross-Sectional Study. Ethiop J Health Sci 2021; 31:467-474. [PMID: 34483603 PMCID: PMC8365494 DOI: 10.4314/ejhs.v31i3.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/16/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Obstructed labor the major cause of adverse feto-maternal outcomes. Hence, the study assessed adverse fetomaternal outcomes of obstructed labor and associated factors among women who gave birth in public Hospitals of West Shoa Zone. METHODS Cross-sectional study design was conducted among 277 respondents. The required data were extracted from the mothers' chart by using a systematic random sampling method. Checklists were used to collect data. Bivariable and multivariable logistic regression was used to identify factors associated with feto-maternal outcomes. The odds ratio with 95%CI and p-value were used to identify the significant variables. RESULTS In this study, 145(52.3%) and 157(56.7%) of the respondents had adverse maternal and fetal outcomes respectively. Mothers who were referred from the health center (AOR: 3.96, 95%CI: 1.61-9.8) and who had a trial of labor at the health center and home had a more likelihood of adverse maternal outcomes than those who were referred and had trial of labor at hospital respectively. In addition, mothers who were not followed by partograph and in labor for >24hrs had also a more likelihood of adverse maternal outcomes than their counterparts. Likewise, newborns whom their mothers were not followed by partograph and mothers in labor for >24 hrs had also a more likelihood of adverse fetal outcomes than their counterparts. Hence, health professionals should give special attention to early diagnosis and referral of obstructed labor to higher facilities.
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Affiliation(s)
- Alem Getachew
- Dire Incini Health Center, West Shoa Zone, Oromia Region, Central Ethiopia
| | - Negash Wakgari
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Tolosa Gishille
- Department of Obstetrics and Gynecology, Ambo University Referral Hospitals, Ambo, Ethiopia
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Ayenew AA. Incidence, causes, and maternofetal outcomes of obstructed labor in Ethiopia: systematic review and meta-analysis. Reprod Health 2021; 18:61. [PMID: 33691736 PMCID: PMC7944638 DOI: 10.1186/s12978-021-01103-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/09/2021] [Indexed: 11/18/2022] Open
Abstract
Background Obstructed labor is a preventable obstetric complication. However, it is an important cause of maternal mortality and morbidity and of adverse outcomes for newborns in resource-limited countries in which undernutrition is common resulting in a small pelvis in which there is no easy access to functioning health facilities with a capacity to carry out operative deliveries. Therefore, this systematic review and meta-analysis aimed to estimate the incidence, causes, and maternofetal outcomes of obstructed labor among mothers who gave birth in Ethiopia. Method for this review, we used the standard PRISMA checklist guideline. Different online databases were used for the review: PubMed, Google Scholar, EMBASE, Cochrane Library, HINARI, AFRO Library Databases, and African Online Journals. Based on the adapted PICO principles, different search terms were applied to achieve and access the essential articles. The search included all published and unpublished observational studies written only in the English language and conducted in Ethiopia. Microsoft Excel 16 was used for data entrance, and Stata version 11.0 (Stata Corporation, College Station, Texas, USA) was used for data analysis. Results I included sixteen (16) primary studies with twenty-eight thousand five hundred ninety-one (28,591) mothers who gave birth in Ethiopia. The pooled incidence of obstructed labor in Ethiopia was 12.93% (95% CI: 10.44–15.42, I2 = 98.0%, p < 0.001). Out of these, 67.3% (95% CI: 33.32–101.28) did not have antenatal care follow-up, 77.86% (95% CI: 63.07–92.66) were from the rural area, and 58.52% (95% CI: 35.73– 82.31) were referred from health centers and visited hospitals after 12 h of labor. The major causes of obstructed labor were cephalo-pelvic disproportion 64.65% (95% CI: 57.15– 72.14), and malpresentation and malposition in 27.24% (95% CI: 22.05–32.42) of the cases. The commonest complications were sepsis in 38.59% (95% CI: 25.49–51.68), stillbirth in 38.08% (95% CI: 29.55–46.61), postpartum hemorrhage in 33.54% (95% CI:12.06– 55.02), uterine rupture in 29.84% (95% CI: 21.09–38.58), and maternal death in 17.27% (95% CI: 13.47–48.02) of mothers who gave birth in Ethiopia. Conclusion This systematic review and meta-analysis showed that the incidence of obstructed labor was high in Ethiopia. Not having antenatal care follow-up, rural residency, and visiting hospitals after 12 h of labor increased the incidence of obstructed labor. The major causes of obstructed labor were cephalo-pelvic disproportion, and malpresentation and malpresentation. Additionally, the commonest complications were sepsis, stillbirth, postpartum hemorrhage, uterine rupture, and maternal death. Thus, promoting antenatal care service utilization, a good referral system, and availing comprehensive obstetric care in nearby health institutions are recommended to prevent the incidence of obstructed labor and its complications. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01103-0.
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Affiliation(s)
- Asteray Assmie Ayenew
- Midwifery Department, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
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12
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Yeshitila YG, Desta M, Kebede A. Obstructed labor and its association with adverse feto-maternal outcome in Ethiopia: a protocol for a systematic review and meta-analysis. Syst Rev 2021; 10:57. [PMID: 33593436 PMCID: PMC7887789 DOI: 10.1186/s13643-021-01611-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/09/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Obstructed labor accounted for 22% of obstetrical complications and 9% of all maternal deaths in low- and middle-income countries. Even though there are separate studies regarding obstructed labor and its complication in Ethiopia, their results are inconsistent. The objectives of this review will be to estimate the pooled the prevalence of obstructed labor and to identify adverse feto-maternal outcomes associated with obstructed labor in Ethiopia. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline will be followed to conduct this systematic review and meta-analysis. The databases we will search will be PubMed, Cochrane Library, Google Scholar, CINAHL, African Journals Online, Dimensions, and Summon per country online databases. To search the relevant literature, we will use the following key search terms: "prevalence," "adverse outcome," "obstructed labour," "maternal near miss," "neonatal near miss," "perinatal outcome," "cesarean section," "obstetric fistula," "uterine rupture," and "Ethiopia." Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument will be used for evaluating the quality of the studies. Appropriate statistical tests will be conducted to quantify the between studies heterogeneity and for the assessment of publication bias. We will check individual study influence analysis and also do subgroup analysis. The STATA version 15 will be used for statistical analysis. DISCUSSION Our systematic review and meta-analysis will provide the pooled prevalence of obstructed labor and its association with adverse feto-maternal outcomes in Ethiopia. The finding of this study will be helpful to design appropriate preventive and promotive strategies for reducing of obstructed labor-related maternal mortality. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020196153 .
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Affiliation(s)
| | - Melaku Desta
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
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13
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Addisu D, Mekie M, Melkie A, Yeshambel A. Burden of obstructed labor in ethiopia: A systematic review and meta-analysis. Midwifery 2021; 95:102930. [PMID: 33581417 DOI: 10.1016/j.midw.2021.102930] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/10/2020] [Accepted: 01/15/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Obstructed labor is a major cause of maternal and neonatal morbidity and mortality mainly in low-income countries, particularly in Ethiopia. In Ethiopia, the prevalence and determinant factors of obstructed labor described by different studies were highly inconsistent. Therefore, this study aimed to determine the pooled prevalence and determinants of obstructed labor in Ethiopia. METHODS International databases (PubMed, Hinari, Google scholar, Cochrane library, and web of science) and Ethiopian universities' digital libraries were used to search relevant articles. Both cross-sectional and case control studies were included. A total of 15 studies were included in this study. All the necessary data were extracted by two authors independently using Microsoft excel and exported to STATA Version 11 for analysis. Heterogeneity of the studies was assessed by using I2 test. The funnel plot and Egger's test were used to assess publication bias between the studies. The pooled prevalence of obstructed labor was estimated using random effects model. Furthermore, the associations between determinant factors and obstructed labor were examined using both random and fixed effect models. RESULTS A total of 15 studies with 34632 study participants were involved in this meta-analysis. The overall prevalence of obstructed labor was 11.79% with 95% CI (9.78, 13.80). In this study, maternal age between 15-19 years [OR=8.03, 95% CI=4.21, 15.30], malpresentation [OR=7.73, 95% CI=3.78, 15.83], lack of Ante Natal Care follow-up [OR=4.37, 95%CI=1.51, 12.67] and fetal weight ≥4kg [OR=5.83, 95% CI=2.74, 12.41] were associated with obstructed labor. CONCLUSION The overall prevalence of obstructed labor was high in Ethiopia. Maternal age between 15-19 years, malpresentation, lack of Ante Natal Care follow-up and fetal Wight ≥4kg were determinants of obstructed labor. Hence, this study implies the need to develop plans and policies to improve Ante Natal Care follow and labor and delivery management at each level of the health system. Besides to this, fetal malpresentation and macrosomia should be recognized and intervene early during labor and delivery.
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Azanu WK, Dassah ET, Agbeno EK, Ofori AA, Opare-Addo HS. Knowledge of obstetric fistula among prenatal clinic attendees and midwives in Mfantsiman municipality, Ghana. Int J Gynaecol Obstet 2020; 148 Suppl 1:16-21. [PMID: 31943183 PMCID: PMC7004089 DOI: 10.1002/ijgo.13034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective To determine obstetric fistula knowledge among prenatal attendees and midwives in Mfantsiman municipality, Ghana. Methods An analytical cross‐sectional study was conducted among prenatal clinic attendees and midwives in Mfantsiman municipality from March to April, 2016. Women were selected by systematic sampling and consenting midwives were recruited. Respondents were interviewed using a pretested structured questionnaire. Data were analyzed using the χ2 test and Poisson regression with a robust error variance to generate relative risks (RRs) with 95% confidence intervals (CIs). P<0.05 was considered statistically significant. Results Altogether, 393 prenatal attendees and 45 midwives were studied. Mean age of attendees was 28.1 ± 7.1 years. About 29% of prenatal attendees knew of, 37.2% had poor knowledge of, and 56.6% had some misconceptions about obstetric fistula. Women who had attained some level of education (P trend=0.001), were employed (adjusted RR 4.92; 95% CI, 1.98–12.21), or had given birth before (P trend=0.01) were more likely to have heard of obstetric fistula. All midwives knew of obstetric fistula and its preventive measures; however, up to 73.3% had some misconceptions about it. Conclusion Educating prenatal attendees and organizing regular refresher courses on obstetric fistula for midwives should be a priority in the municipality. Educating prenatal attendees and organizing regular refresher courses on obstetric fistula for midwives should be a priority in Mfantsiman municipality.
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Affiliation(s)
- Wisdom K Azanu
- School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Edward T Dassah
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Department of Obstetrics and Gynecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Evans K Agbeno
- School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Anthony A Ofori
- School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Henry S Opare-Addo
- Department of Obstetrics and Gynecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Wonde TE, Mihretie A. Maternofetal outcomes of obstructed labor among women who gave birth at general hospital in Ethiopia. BMC Res Notes 2019; 12:128. [PMID: 30867028 PMCID: PMC6416895 DOI: 10.1186/s13104-019-4165-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/06/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Obstructed labor had different maternal outcomes such as uterine rupture, postpartum hemorrhage, puerperal sepsis, Vesico-Vaginal fistula (VVF), recto-vaginal fistula can leads to death. Besides fetal outcomes including birth asphyxia, still birth, neonatal jaundice and umbilical sepsis can occur. Identifying maternal and fetal outcomes of obstructed labor among women who gave birth at Suhul general Hospital, Shirie town, Tigray, Ethiopia has been done using a retrospective review of delivery charts and registration book. RESULTS Majority of mothers 69 (75.8%) came from rural areas and 74.7% were married. Cephalo pelvic disproportion occurs in 59 (64.8%) and mal-presentation in 28 (30.8%) of obstructed labor. Fetal congenital anomaly (hydrocephalus) occurs in 3 (3.3%) of cases and pelvic mass constituted 1 (1.1%) of cause of obstructed labor. Above half of mothers delivered with obstructed labor had sepsis 23 (25.3%), post-partum hemorrhage 10 (11%), Vesico Vaginal Fistula 5 (5.5%) and anemia 15 (16.5%). From the well-known causes of obstructed labor; mal-presentation, Cephalo pelvic disproportion, fetal congenital anomaly, and pelvic mass were found to the common outcomes of obstructed labor in our study area. Besides Still birth, birth asphyxia, and birth injury were the others.
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Affiliation(s)
- Tewodros Eshete Wonde
- Department of Public Health, College of Medicine and Health Sciences (CMHS), Debre Markos University (DMU), Debre Markos, Ethiopia.
| | - Abebe Mihretie
- Department of Midwifery, College of Medicine and Health Sciences (CMHS), Debre Brhan University, Debrebrhan, Ethiopia
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Mgaya AH, Kidanto HL, Nyström L, Essén B. Use of a criteria-based audit to optimize uptake of cesarean delivery in a low-resource setting. Int J Gynaecol Obstet 2018; 144:199-209. [PMID: 30499099 DOI: 10.1002/ijgo.12726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/04/2018] [Accepted: 11/28/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the impact of a criteria-based audit (CBA) of obstructed labor and fetal distress on cesarean delivery and perinatal outcomes. METHODS A cross-sectional study was performed at a tertiary referral hospital in Tanzania. Data were collected before and after CBA (January 2013-November 2013 and July 2015-June 2016). Outcomes of fetal distress (baseline CBA, n=248; re-audit, n=251) and obstructed labor (baseline CBA, n=260; re-audit n=250) were assessed using a checklist. Additionally, 27 960 parturients were assessed using the Robson classification. RESULTS Perinatal morbidity and mortality decreased from 42 of 260 (16.2%) to 22 of 250 (8.8%) among patients with obstructed labor after CBA (P=0.012). Cesarean delivery rate decreased for referred term multiparas with induced labor or prelabor cesarean delivery (odds ratio [OR] 0.28, 95% confidence interval [CI] 0.09-0.82). Cesarean delivery rate for preterm pregnancies increased among both referred (OR 1.28, 95% CI 1.02-1.63) and non-referred (OR 2.78, 95% CI 1.98-3.90) groups. Neonatal distress rate decreased for referred term multiparas (OR 0.72, 95% CI 0.56-0.92), referred preterm pregnancies (OR 0.32, 95% CI 0.25-0.39), and non-referred preterm pregnancies (OR 0.26, 95% CI 0.18-0.36). CONCLUSION Use of CBA reduced poor perinatal outcomes of obstructed labor and increased uptake of cesarean delivery.
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Affiliation(s)
- Andrew H Mgaya
- Department of Obstetrics and Gynaecology, Muhimbili National Hospital, Dar es Salaam, Tanzania.,Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Hussein L Kidanto
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden.,Reproductive and Child Health, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Lennarth Nyström
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit, Umeå University, Umeå, Sweden
| | - Birgitta Essén
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
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Pinder LF, Natsuhara KH, Burke TF, Lozo S, Oguttu M, Miller L, Nelson BD, Eckardt MJ. Nurse-midwives' ability to diagnose acute third- and fourth-degree obstetric lacerations in western Kenya. BMC Pregnancy Childbirth 2017; 17:308. [PMID: 28923011 DOI: 10.1186/s12884-017-1484-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 09/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obstetric fistula devastates the lives of women and is found most commonly among the poor in resource-limited settings. Unrepaired third- and fourth-degree perineal lacerations have been shown to be the source of approximately one-third of the fistula burden in fistula camps in Kenya. In this study, we assessed potential barriers to accurate identification by Kenyan nurse-midwives of these complex perineal lacerations in postpartum women. METHODS Nurse-midwife trainers from each of the seven sub-counties of Siaya County, Kenya were assessed in their ability to accurately identify obstetric lacerations and anatomical structures of the perineum, using a pictorial assessment tool. Referral pathways, follow-up mechanisms, and barriers to assessing obstetric lacerations were evaluated. RESULTS Twenty-two nurse-midwife trainers were assessed. Four of the 22 (18.2%) reported ever receiving formal training on evaluating third- and fourth-degree obstetric lacerations, and 20 of 22 (91%) reported health-system challenges to adequately completing their examination of the perineum at delivery. Twenty-one percent of third- and fourth-degree obstetric lacerations in the pictorial assessment were incorrectly identified as first- or second-degree lacerations. CONCLUSION County nurse-midwife trainers in Siaya, Kenya, experience inadequate training, equipment, staffing, time, and knowledge as barriers to adequate diagnosis and repair of third- and fourth-degree perineal tears.
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El Ayadi A, Nalubwama H, Barageine J, Neilands TB, Obore S, Byamugisha J, Kakaire O, Mwanje H, Korn A, Lester F, Miller S. Development and preliminary validation of a post-fistula repair reintegration instrument among Ugandan women. Reprod Health 2017; 14:109. [PMID: 28865473 PMCID: PMC5581461 DOI: 10.1186/s12978-017-0372-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 08/23/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Obstetric fistula is a debilitating and traumatic birth injury affecting 2-3 million women globally, mostly in sub-Saharan Africa and Asia. Affected women suffer physically, psychologically and socioeconomically. International efforts have increased access to surgical treatment, yet attention to a holistic outcome of post-surgical rehabilitation is nascent. We sought to develop and pilot test a measurement instrument to assess post-surgical family and community reintegration. METHODS We conducted an exploratory sequential mixed-methods study, beginning with 16 in-depth interviews and four focus group discussions with 17 women who underwent fistula surgery within two previous years to inform measure development. The draft instrument was validated in a longitudinal cohort of 60 women recovering from fistula surgery. Qualitative data were analyzed through thematic analysis. Socio-demographic characteristics were described using one-way frequency tables. We used exploratory factor analysis to determine the latent structure of the scale, then tested the fit of a single higher-order latent factor. We evaluated internal consistency and temporal stability reliability through Raykov's ρ and Pearson's correlation coefficient, respectively. We estimated a series of linear regression models to explore associations between the standardized reintegration measure and validated scales representing theoretically related constructs. RESULTS Themes central to women's experiences following surgery included resuming mobility, increasing social interaction, improved self-esteem, reduction of internalized stigma, resuming work, meeting their own needs and the needs of dependents, meeting other expected and desired roles, and negotiating larger life issues. We expanded the Return to Normal Living Index to reflect these themes. Exploratory factor analysis suggested a four-factor structure, titled 'Mobility and social engagement', 'Meeting family needs', 'Comfort with relationships', and 'General life satisfaction', and goodness of fit statistics supported a higher-order latent variable of 'Reintegration.' Reintegration score correlated significantly with quality of life, depression, self-esteem, stigma, and social support in theoretically expected directions. CONCLUSION As more women undergo surgical treatment for obstetric fistula, attention to the post-repair period is imperative. This preliminary validation of a reintegration instrument represents a first step toward improving measurement of post-surgical reintegration and has important implications for the evidence base of post-surgical reintegration epidemiology and the development and evaluation of fistula programming.
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Affiliation(s)
- Alison El Ayadi
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
| | - Hadija Nalubwama
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Justus Barageine
- Urogynecology Division, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Torsten B. Neilands
- Center for AIDS Prevention Studies, Division of Prevention Sciences, Department of Medicine, University of California, San Francisco, USA
| | - Susan Obore
- Urogynecology Division, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
- Urogynecology Division, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Othman Kakaire
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Haruna Mwanje
- Urogynecology Division, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Abner Korn
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
| | - Felicia Lester
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
| | - Suellen Miller
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
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Meurice M, Genadry R, Heimer C, Ruffer G, Kafunjo BJ. Social Experiences of Women with Obstetric Fistula Seeking Treatment in Kampala, Uganda. Ann Glob Health 2017; 83:541-549. [PMID: 29221527 DOI: 10.1016/j.aogh.2017.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Obstetric fistula is a preventable and treatable condition predominately affecting women in low-income countries. Understanding the social context of obstetric fistula may lead to improved prevention and treatment. OBJECTIVES This study investigated social experiences of women with obstetric fistula seeking treatment at Mulago Hospital in Kampala, Uganda. METHODS A descriptive study was conducted among women seeking treatment for obstetric fistula during a surgical camp in July 2011 using a structured questionnaire. Descriptive statistics were computed regarding sociodemographics, obstetric history, and social experience. FINDINGS Fifty-three women participated; 39 (73.58%) leaked urine only. Median age was 29 years (range: 17-58), and most were married or separated. About half (28, 47.9%) experienced a change in their relationship since acquiring obstetric fistula. More than half (27, 50.94%) acquired obstetric fistula during their first delivery, despite almost everyone (50, 94.3%) receiving antenatal care. The median years suffering from obstetric fistula was 1.25. Nearly every participant's social participation changed in at least one setting (51, 96.23%). Most women thought that a baby being too big or having kicked their bladder was the cause of obstetric fistula. Other participants thought health care providers caused the fistula (15, 32.61%; n = 46), with 8 specifying that the bladder was cut during the operation (cesarean section). Knowing someone with obstetric fistula was influential in pursuing treatment. The majority of participants planned to return to family (40, 78.43%; n = 51) and get pregnant after repair (35, 66.04%; n = 53). CONCLUSION Study participants experienced substantial changes in their social lives as a result of obstetric fistula, and there were a variety of beliefs regarding the cause. The complex social context is an important component to understanding how to prevent and treat obstetric fistula. Further elucidation of these factors may bolster current efforts in prevention and holistic treatment.
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Affiliation(s)
| | - Rene Genadry
- Department of OB/GYN, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Carol Heimer
- Department of Sociology, Northwestern University, Evanston, IL
| | - Galya Ruffer
- Department of Political Science, Northwestern University, Evanston, IL
| | - Barageine Justus Kafunjo
- Department of OB/GYN, Makerere University/Mulago National Referral and Teaching Hospital, Kampala, Uganda; Department of Women's Health-Save the Mothers, Uganda Christian University, Mukono, Uganda
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Ouedraogo I, Payne C, Nardos R, Adelman AJ, Wall LL. Obstetric fistula in Niger: 6-month postoperative follow-up of 384 patients from the Danja Fistula Center. Int Urogynecol J 2017; 29:345-351. [PMID: 28600757 PMCID: PMC5847061 DOI: 10.1007/s00192-017-3375-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/28/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The impoverished West African country of Niger has high rates of obstetric fistula. We report a 6-month postoperative follow-up of 384 patients from the Danja Fistula Center and assess factors associated with operative success or failure. METHODS The medical records of 384 women who had completed a 6-month follow-up after fistula surgery were reviewed. Cases were categorized as "easy," "of intermediate complexity," or "difficult" based on a preoperative points system. Data were analyzed using simple chi-squared statistics and logistic regression. RESULTS The patients were predominantly of Hausa ethnicity (73%), married young (average 15.9 years), had teenage first pregnancies (average first delivery 16.9 years), and experienced prolonged labor (average 2.3 days) with poor outcomes (89% stillbirth rate). The average parity was four. Patients commonly developed their fistula during their first delivery (43.5%), but over half sustained a fistula during a subsequent delivery (56.5%). Prior fistula surgery elsewhere (average 1.75 operations) was common. The overall surgical success ("closed and dry") was 54%. When the 134 primary operations were analyzed separately, the overall success rate was 80%. Increasing success was seen with decreasing surgical difficulty: 92% success for "easy" cases, 68% for "intermediate" cases, and 57% success for "difficult" cases. Success decreased with increasing numbers of previous attempts at surgical repair. CONCLUSIONS These data provide further evidence that clinical outcomes are better when primary fistula repair is performed by expert surgeons in specialist centers with the support of trained fistula nurses.
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Affiliation(s)
- Itengre Ouedraogo
- The Danja Fistula Center, Danja, Niger
- The Worldwide Fistula Fund, Chicago, IL, USA
| | | | - Rahel Nardos
- The Worldwide Fistula Fund, Chicago, IL, USA
- Department of Obstetrics and Gynecology, Oregon Health and Sciences University, Portland, OR, USA
| | - Avril J Adelman
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - L Lewis Wall
- The Worldwide Fistula Fund, Chicago, IL, USA.
- Department of Anthropology, Washington University in St. Louis, Campus Box 1114, One Brookings Drive, St. Louis, MO, 63110, USA.
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA.
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Lewis Wall L, Belay S, Haregot T, Dukes J, Berhan E, Abreha M. A case-control study of the risk factors for obstetric fistula in Tigray, Ethiopia. Int Urogynecol J 2017; 28:1817-1824. [PMID: 28550462 DOI: 10.1007/s00192-017-3368-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 05/06/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We tested the null hypothesis that there were no differences between patients with obstetric fistula and parous controls without fistula. METHODS A unmatched case-control study was carried out comparing 75 women with a history of obstetric fistula with 150 parous controls with no history of fistula. Height and weight were measured for each participant, along with basic socio-demographic and obstetric information. Descriptive statistics were calculated and differences between the groups were analyzed using Student's t test, Mann-Whitney U test where appropriate, and Chi-squared or Fisher's exact test, along with backward stepwise logistic regression analyses to detect predictors of obstetric fistula. Associations with a p value <0.05 were considered significant. RESULTS Patients with fistulas married earlier and delivered their first pregnancies earlier than controls. They had significantly less education, a higher prevalence of divorce/separation, and lived in more impoverished circumstances than controls. Fistula patients had worse reproductive histories, with greater numbers of stillbirths/abortions and higher rates of assisted vaginal delivery and cesarean section. The final logistic regression model found four significant risk factors for developing an obstetric fistula: age at marriage (OR 1.23), history of assisted vaginal delivery (OR 3.44), lack of adequate antenatal care (OR 4.43), and a labor lasting longer than 1 day (OR 14.84). CONCLUSIONS Our data indicate that obstetric fistula results from the lack of access to effective obstetrical services when labor is prolonged. Rural poverty and lack of adequate transportation infrastructure are probably important co-factors in inhibiting access to needed care.
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Affiliation(s)
- L Lewis Wall
- Department of Obstetrics and Gynecology, Ayder Referral Hospital, College of Health Sciences, Mekelle University, Mekelle, Ethiopia. .,Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO, USA. .,Department of Anthropology, Washington University, Campus Box 1114, One Brookings Drive, St Louis, MO, 63130-8159, USA.
| | - Shewaye Belay
- Department of Microbiology, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | | | - Jonathan Dukes
- Performance Solution, Data Engineering and Analytics, Mercy Health, Chesterfield, MO, USA
| | - Eyoel Berhan
- St Paul's Millennium Medical School, Addis Ababa, Ethiopia
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Tinelli A, Di Renzo GC, Malvasi A. The intrapartum ultrasonographic detection of the Bandl ring as a marker of dystocia. Int J Gynaecol Obstet 2015; 131:310-1. [PMID: 26384791 DOI: 10.1016/j.ijgo.2015.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 06/04/2015] [Accepted: 08/24/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Andrea Tinelli
- Department of Obstetrics and Gynecology, Division of Experimental Endoscopic Surgery, Imaging, Technology, and Minimally Invasive Therapy, Vito Fazzi Hospital, Lecce, Italy; The International Translational Medicine and Biomodelling Research Group, Department of Applied Mathematics, Moscow Institute of Physics and Technology (State University), Moscow, Russia.
| | - Gian Carlo Di Renzo
- Department of Obstetrics and Gynecology, and Centre for Perinatal and Reproductive Medicine, Santa Maria della Misericordia University Hospital, University of Perugia, Perugia, Italy
| | - Antonio Malvasi
- The International Translational Medicine and Biomodelling Research Group, Department of Applied Mathematics, Moscow Institute of Physics and Technology (State University), Moscow, Russia; Department of Obstetrics and Gynecology, Santa Maria Hospital, Bari, Italy
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Abstract
INTRODUCTION Uterine rupture is a catastrophic obstetrical emergency associated with a significant feto-maternal morbidity and mortality. Many risk factors for uterine rupture, as well as a wide range of clinical presentations, have been identified. OBJECTIVES To analyze the frequency, predisposing factors, and maternal and fetal outcomes of uterine rupture. METHODS A retrospective analysis of cases of unscarred uterine rupture was conducted at the Department of Obstetrics and Gynecology, RIMS, Imphal from June 1, 2010 to June 30, 2012. RESULTS Our analysis comprised 13 cases. Of these, 30.8 % were booked cases. Most of the cases (46.2 %) were Para 2. Uterine rupture occurred at term in 10 cases. The rupture occurred due to mismanaged labor (30.8 %), the use of oxytocin (23 %), instrumental delivery (15.4 %), obstructed labor (15.4 %), induction by prostaglandin gel (7.7 %), and placenta percreta (7.7 %). Maternal deaths and perinatal deaths were 30.8 and 53.8 %, respectively. Sub-total hysterectomy was done in 8 cases and in 1 patient laparotomy with repair was performed. CONCLUSION Ruptured uterus causes a high risk in patients. An unscarred uterus can undergo rupture even without etiological or risk factors. The patients with mismanaged labor, grand multiparas, and obstructed prolonged labor must be managed by properly trained personnel at a tertiary care center in order to avoid the morbidity or mortality.
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Affiliation(s)
- Manisha Vernekar
- Department of Obstetrics & Gynaecology, ESI-PGIMSR, ESIC & MC, Joka, Kolkata, India ; c/o Dr Rajib Roy, Plot No 34/1, Pailan Park Housing Project, Pailan, Mouza Daulatpur, P.S-Bishnupur, Kolkata, 700104 India
| | - Roy Rajib
- Department of Obstetrics & Gynaecology, ESI-PGIMSR, ESIC & MC, Joka, Kolkata, India
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Berhe Y, Gidey H, Wall LL. Uterine rupture in Mekelle, northern Ethiopia, between 2009 and 2013. Int J Gynaecol Obstet 2015; 130:153-6. [PMID: 25935473 DOI: 10.1016/j.ijgo.2015.02.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 02/01/2015] [Accepted: 04/09/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To review cases of uterine rupture at a center in northern Ethiopia. METHODS In a retrospective chart review, data were assessed for cases of symptomatic uterine rupture treated at Ayder Referral Hospital in Mekelle between January 1, 2009, and December 31, 2013. RESULTS In the 5-year study period, there were 5185 deliveries and 47 cases of uterine rupture, giving a rate of one case per 110 deliveries. All patients underwent laparotomy for suspected uterine rupture. Mean parity was 3.6 (range 0-8). The most common predisposing factors were cephalopelvic disproportion (35 [74%] patients), previous cesarean delivery (5 [11%)], and fetal malpresentation (4 [9%]). Hysterectomy was undertaken for 35 (74%) patients; the other 12 (26%) were treated conservatively by simple repair of the rupture. There were 44 (95%) stillbirths and 1 (2%) maternal death. CONCLUSION Uterine rupture remains an important clinical problem in northern Ethiopia. Changes in the cultural preference for home delivery, better transport and referral systems, and improved obstetric training and hospital management of laboring women are needed.
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Affiliation(s)
- Yibrah Berhe
- Department of Obstetrics and Gynecology, Ayder Referral Hospital, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Hagos Gidey
- Department of Obstetrics and Gynecology, Ayder Referral Hospital, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - L Lewis Wall
- Department of Obstetrics and Gynecology, Ayder Referral Hospital, College of Health Sciences, Mekelle University, Mekelle, Ethiopia; Department of Obstetrics and Gynecology, School of Medicine, Washington University in St Louis, St Louis, MO, USA; Department of Anthropology, College of Arts and Sciences, Washington University in St Louis, St Louis, MO, USA.
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Lawani LO, Iyoke CA, Ezeonu PO. Contraceptive practice after surgical repair of obstetric fistula in southeast Nigeria. Int J Gynaecol Obstet 2015; 129:256-9. [PMID: 25728480 DOI: 10.1016/j.ijgo.2014.11.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 11/23/2014] [Accepted: 02/03/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the contraceptive practices of women after surgical repair of obstetric fistula and to assess determinants of uptake and the pregnancy rate in the first year. METHODS A prospective cohort study enrolled women who had a successful surgical repair of obstetric fistula at a center in Nigeria between 2011 and 2013. Patients were followed up for 1year. Data were obtained through record review and completion of a semi-structured questionnaire. RESULTS Among 188 participants, 180 (95.7%) were aware of contraception, but only 70 (37.2%) used contraceptive methods after surgery. The most commonly used methods were the male condom (50 [71.4%] of 70) and hormonal injections (14 [20.0%]). The main reasons for non-use were fear of adverse effects (48 [40.7%] of 118 women), future desire for more children (35 [29.7%]), religious prohibition (26 [22.0%]), cultural beliefs (29 [24.6%]), and partner disapproval (42 [35.6%]). The risk of unplanned pregnancy in the first year was significantly lower among women who used contraceptives than among those who did not (relative risk 0.14, 95% confidence interval 0.02-1.06; P=0.03). CONCLUSION Contraceptive uptake for birth control after fistula repair surgery was low because of socioeconomic reasons, religious and cultural beliefs, and myths, resulting in unplanned pregnancies.
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Affiliation(s)
- Lucky O Lawani
- School of Post Graduate Studies, Department of Community Medicine, University of Nigeria, Enugu, Nigeria.
| | - Chukwuemeka A Iyoke
- Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Paul O Ezeonu
- Department of Obstetrics and Gynecology, Federal Teaching Hospital Abakaliki, Abakaliki, Nigeria
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Seim AR, Alassoum Z, Bronzan RN, Mainassara AA, Jacobsen JL, Gali YA. Pilot community-mobilization program reduces maternal and perinatal mortality and prevents obstetric fistula in Niger. Int J Gynaecol Obstet 2014; 127:269-74. [PMID: 25128929 DOI: 10.1016/j.ijgo.2014.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 06/06/2014] [Accepted: 07/23/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the impact of a pilot community-mobilization program on maternal and perinatal mortality and obstetric fistula in Niger. METHODS In the program, village volunteers identify and evacuate women with protracted labor, provide education, and collect data on pregnancies, births, and deaths. These data were used to calculate the reduction in maternal mortality, perinatal mortality, and obstetric fistula in the program area from July 2008 to June 2011. RESULTS The birth-related maternal mortality fell by 73.0% between years 1 and 3 (P<0.001), from 630 (95% confidence interval [CI] 448-861) to 170 (95% CI 85-305) deaths per 100 000 births. Early perinatal mortality fell by 61.5% (P<0.001), from 35 (95% CI 31-40) to 13 (95% CI 10-16) deaths per 1000 births. No deaths due to obstructed labor were reported after the lead-in period (February to June 2008). Seven cases of community-acquired fistula were reported between February 2008 and July 2009; from August 2009 to June 2011 (23 months; 12 254 births), no cases were recorded. CONCLUSION Community mobilization helped to prevent obstetric fistula and birth-related deaths of women and infants in a large, remote, resource-poor area.
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Affiliation(s)
- Anders R Seim
- Health and Development International, Fjellstrand, Norway.
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Kay A, Idrissa A, Hampton BS. Epidemiologic profile of women presenting to the National Hospital of Niamey, Niger for vaginal fistula repair. Int J Gynaecol Obstet 2014; 126:136-9. [PMID: 24856734 DOI: 10.1016/j.ijgo.2014.03.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 03/04/2014] [Accepted: 04/24/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To describe the epidemiologic profile of women with vaginal fistulas presenting to the surgical mission trips of the International Organization for Women and Development (IOWD) at the National Hospital of Niamey, Niger. METHODS In a cross-sectional retrospective study, data were assessed from a database of women who attended the IOWD at the National Hospital of Niamey, Niger, from October 2003 to April 2009. The database was compiled from the history and physical examination forms for each patient visit. RESULTS During the study period, there were 1323 data entries and 896 initial patient visits. Overall, 580 women presented with obstetric fistulas. The median age was 29 years; the mean age at marriage was 16 years; 73.7% were married. The median age at first delivery was 18 years; the mean number of past full-term pregnancies was 3; the mean parity was 4. Vaginal (66.3%) or cesarean (27.7%) delivery was a common predisposing factor for developing an obstetric fistula. Overall, 97.4% of women labored for 24 hours or more; 75.4% delivered in hospital; 82.9% had a stillbirth. CONCLUSION Women presenting to the IOWD for fistula repair have specific epidemiologic characteristics. Better understanding of these characteristics might help to formulate future public health programs for fistula prevention.
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Affiliation(s)
- Allison Kay
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Abdoulaye Idrissa
- Clinique Universitaire d'Urologie-Andrologie du CNHU (Centre National Hospitalier Universitaire) Hubert Maga Koutoukou de Cotonou, Cotonou, Benin
| | - Brittany S Hampton
- Division of Urogynecology and Reconstructive Pelvic Surgery, Women and Infants Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, RI, USA
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28
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Abstract
A 22-years-old lady presented with obstructed labor with a probable preoperative diagnosis of bladder/urethral injury. When a laparotomy was performed there was a complete urethral disruption at the vesicourethral junction with a big anterior forniceal tear in the vagina with intact uterus and cervix. The fetus had pushed itself through the upper vagina and bladder neck into the extraperitoneal space leading to complete urethrovesical disruption as a result of prolonged pressure on the vesicourethral junction against pubic symphysis for which an end to end anastomosis was performed. Although trauma has been mentioned as a cause of such urethral disruption in the literature, no such case has been reported so far following obstructed labor. A brief discussion of various surgical options for such cases is discussed.
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Affiliation(s)
- S Arora
- Department of Obstetrics, Gynecology, Government Medical College and Hospital, Chandigarh, Punjab, India
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Abstract
Background Obstructed labor is one of the common preventable causes of maternal and perinatal morbidity and mortality in developing countries. Africa has the highest maternal mortality in the world, estimated at an average of about 1,000 deaths per 100,000 live births. This study was conducted to assess the incidence, causes and outcome of obstructed labor in Jimma University Specialized Hospital. Methods Hospital-based, cross-sectional study was conducted on all mothers who were admitted and delivered in the labor ward of Jimma University Specialized Hospital from November 1, 2008 to April 30, 2009. Data was collected using structured questionnaire and checklist, and then analyzed using SPSS for windows version 16.0. Results The incidence of obstructed labor was 12.2%. Out of these 61.5% did not have antenatal care follow-up. Most of the cases, accounting for 145(81.0%), 160 (89.4%) and 170 (93.9%) were referred from health centers, visited the hospital after at least 12 hours of labor and came from a distance of more than 10 kilometers, respectively. The causes of obstructed labor were cephalo-pelvic disproportion in 121(67.6%) and malpresentation in 50 (27.9%) of the cases. The commonest maternal complications observed were uterine rupture in 55 (45.1%) and sepsis in 48 (39.3%) of the cases with complications. Forty-five point eight percent of fetuses were born alive and all had low first minute APGAR score. Conclusion The incidence of obstructed labor was high with high rate of complications. The antenatal care follow-up practice was also found to be low. Improved antenatal care coverage, good referral system, and availing comprehensive obstetric care in nearby health institution are recommended to prevent obstructed labor and its complications.
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Affiliation(s)
- Shimelis Fantu
- Department of Obstetrics and Gynecology, Jimma University, Jimma, Ethiopia
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Mathur R, Joshi N, Aggarwal G, Raikwar R, Shrivastava V, Mathur P, Raikwar P, Joshi R. Urogenital fistulae: A prospective study of 50 cases at a tertiary care hospital. Urol Ann 2011; 2:67-70. [PMID: 20882157 PMCID: PMC2943683 DOI: 10.4103/0974-7796.65114] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2009] [Accepted: 02/22/2010] [Indexed: 12/02/2022] Open
Abstract
Introduction: The misfortunate incident of formation of a urogenital fistula remains a major challenge for surgical urologists worldwide. Such fistulae may not be a life-threatening problem, but surely the women face demoralization, social boycott and even divorce and separation. The fistula may be vaginal, recto-vaginal or a combination of the two. The World Health Organization (WHO) has estimated that in the developing nations, nearly 5 million women annually suffer severe morbidity with obstetric fistulae being the foremost on the list. The objective of our study was to enunciate the patient demography, patient profile, incidence, type of surgery, as well as the long-term outcomes encountered in the management of all types of genital fistulae at a tertiary care centre. Materials and Methods: 50 consecutive patients, attending the outpatient department with urogenital fistulae, were studied during the period of 5 years from July 2005 to July 2009. All female patients with complaints of urinary incontinence and fecal incontinence and dribbling, patients having a history of obstructed labor, radiotherapy, instrumental delivery, foreign body or trauma and with a history of hysterectomy (abdominal/ vaginal) and lower segment caesarean section (LSCS) were included. A thorough urological examination included a dye study using methylene blue, Renal function tests, X-ray KUB and intravenous urography (IVU). Cystoscopy along with examination under anaesthesia (EUA) were done to assess the actual extent of injury. All patients were subjected to appropriate surgical interventions via the same combination of surgeons . Post operatively, prophylactic antibiotics were administered to all patients and patients were managed till discharge and followed thereafter via regular outpatient visits for a period of 3 years. Results: Age of patients ranged from 21 to 40 years. 64% patients hailed from rural areas, 76% were from the lower socio-economic strata, 40% illiterate and 69% were short Statured. Vesico vaginal fistulae (VVF) was seen in 64% cases of which 50% were due to obstructed labor, 19% cases post LSCS and 31% cases post total abdominal hysterectomy (TAH). 68% of urogenital fistulae were between 1 to 3 cms. We obtained a 75% cure rate in UVF, 87.5% cure rate in RVF while a 93.75% cure rate was observed in patients with VVF. 76% of all patients were cured while 8% had a recurrence, probably due to the large size of fistula. Conclusion: Genital fistula is preventable, yet it remains a significant cause of morbidity among females of reproductive age group. Despite facilities available, certain conditions like physical, social, economic, illiteracy, and a very casual attitude towards maternal health and children birth practices limit utilization of services for women. It is important that the modern health care providers should be aware of these aspects, so that they can recognize services that are appropriate and acceptable to the people. Thus, one must agree that in cases of urogenital fistulae, "prevention is better than cure".
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Affiliation(s)
- Rajkumar Mathur
- Department of Surgery, M.G.M Medical College and M.Y.H Group of Hospitals, Indore, Madhya Pradesh - 452 001, India
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Semere L, Nour NM. Obstetric fistula: living with incontinence and shame. Rev Obstet Gynecol 2008; 1:193-197. [PMID: 19173024 PMCID: PMC2621054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Over 2 million women worldwide have an obstetric fistula, with the majority of cases occurring in resource-poor countries. Afflicted women tend to be young, primiparous, impoverished, and have little or no access to medical care. Incontinent of urine and/or stool, these women become ostracized and shunned by their community. Most obstetric fistulas are surgically correctible, although surgical outcomes have been poorly studied. Programs that improve nutrition, delay the age of marriage, improve family planning, and increase access to maternal and obstetric care are necessary to prevent obstetric fistula.
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