Non-Fistulous Complications of Prolonged Obstructed Labour among Obstetric Fistula Patients in Southern Nigeria

Abstract

Background: Long-term complications of prolonged obstructed labour are multisystemic, obstetric fistula about the most devastating. Efforts at controlling obstetric fistula pay little attention to the non-fistulous injuries which reduce the quality of life of the affected women even after a successful fistula repair. The objectives of this study were to determine the burden of the non-fistulous complications among fistula patients, identify these injuries and the factors associated with them. Methods: This cross-sectional study was conducted at the National Obstetric Fistula Centre, Abakaliki, SouthEast Nigeria from July to December 2016. The hospital has performed over 2600 free fistula repairs. This study was approved by the Research and Ethics Committee of the hospital. The study population comprised of women who developed obstetric fistula following prolonged obstructed labour. Direct questioning, examination findings, operation findings and laboratory results, using a pre-tested, semi-structured and interviewer-administered proforma were used to collect data. Informed consent was obtained from the subjects. Data were analyzed using the Statistical Package for Social Sciences [SPSS] version 21. Frequency and proportions were used to describe categorical variables while means and standard deviation were used to describe continuous variables. Association between categorical variables and direct obstructed labour injuries was tested using chi-square test and predictors of obstructed labour injuries were determined using logistic regression. A P-value < 0.05 was considered statistically significant. Results: One hundred and sixty one (161) women participated in the study. The mean age of the women was 33.4 years while the mean parity was 3.2. Non-fistulous complications of prolonged obstructed labour were found in 96.9% (156) of the women.

Associated Morbidities Seen in Women with Obstetric Fistula

“…It is one of the non-fistulous complications of obstructed labour seen among fistula patients [4] and a morbidity associated with obstetric fistula [13]. In a study in Abakaliki, Nigeria, secondary amenorrhoea was seen in 23.6% of women who developed fistula and it was found to be significantly associated with Caesarean delivery [4]. Majority (65.7%) of the women in this study had secondary infertility.…”

“…It may result from malnutrition, endometritis following prolonged obstructed labour, postpartum haemorrhage or an endocrine response to a traumatic childbirth experience. It is one of the non-fistulous complications of obstructed labour seen among fistula patients [4] and a morbidity associated with obstetric fistula [13]. In a study in Abakaliki, Nigeria, secondary amenorrhoea was seen in 23.6% of women who developed fistula and it was found to be significantly associated with Caesarean delivery [4].…”

“…It an abnormal communication between the genital tract and either the urinary or the intestinal tract, or both, leading to leakage of urine and/or faeces following childbirth [3]. It continues to be a source of misery, inflicting serious morbidities among affected women [4].…”

“…However, poorly-performed Caesarean section is increasingly becoming an important aetiology of fistula in parts of Nigeria [9]. The mainstay of treatment of obstetric fistula is surgery [8].Obstetric fistula has been shown to occur in association with other medical morbidities [4]. These include depression, urinary tract infection, urine dermatitis, obstetric palsy, amenorrhea, infertility, anal sphincter rupture, perineal tear, bladder stone, vaginal stenosis, cervical retraction and cervical stenosis, among others [4,10].…”

“…The mainstay of treatment of obstetric fistula is surgery [8].Obstetric fistula has been shown to occur in association with other medical morbidities [4]. These include depression, urinary tract infection, urine dermatitis, obstetric palsy, amenorrhea, infertility, anal sphincter rupture, perineal tear, bladder stone, vaginal stenosis, cervical retraction and cervical stenosis, among others [4,10]. Attention is usually not paid to these conditions as the immediate concern is to restore continence.…”