Obstetric fistula: a paradigm shift is needed in research and prevention

Letchworth, P.; MacLaren, Edward; Duffy, Shane

doi:10.1111/1471-0528.15110

Cited by 7 publications

(8 citation statements)

References 14 publications

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“…Also, though prevention is key, treating those that already have fistula remains of great importance especially considering the enormous impact of OF on the affected women. Fortunately, after the launch of the global campaign to end fistula in 2003, much progress has been made in improving the treatment of OF patients, but the best strategy for OF prevention still remains a difficult topic [66][67][68][69].…”

Section: Discussionmentioning

confidence: 99%

Obstetric fistulas in Uganda: scoping review using a determinant of health approach to provide a framework for health policy improvement

Hollander

Janszen

2020

BMC Pregnancy Childbirth

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Background The uneven global and national distribution of obstetric fistulas suggests a complex network of determinants contributing to fistula development. This study aims to create an understanding of the determinants of obstetric fistula in Uganda and to give a framework for health policy improvement. Methods A scoping review of existing literature was performed, searching the PubMed/MEDLINE database, Ugandan Demographic and Health Surveys, and official sources of Ugandan statistics. Data was analysed using the model for the determinants of health by Dahlgren and Whitehead. Results Obstetric fistulas are associated with different personal lifestyle factors, certain social and community networks, as well as poor working and living conditions. Malnutrition, early childbearing, limited female empowerment, lack of awareness of childbearing risks, low socioeconomic status, and long distances to emergency obstetric care play a part. Certain regions of Uganda are in particular associated with obstetric fistula, where an accumulation of determinants is notable. Conclusion Analysis using the model of Dahlgren and Whitehead shows that obstetric fistulas are associated with determinants at different levels of society. Poverty and low education link these in a web that is disproportionately hard to escape from for the poorest women. This inequity asks for co-operation between ministries to dismantle the environment for obstetric fistula.

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Section: Discussionmentioning

confidence: 99%

Obstetric fistulas in Uganda: scoping review using a determinant of health approach to provide a framework for health policy improvement

Hollander

Janszen

2020

BMC Pregnancy Childbirth

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“…Among patients who have undergone IPAA for UC, we found that bowel obstructions could develop after CS, and fecal incontinence and an increased stool frequency could develop, even after CS, according to this analysis. In the VD group, we found one case of vaginal fistula after delivery, although the association between VD and fistulizing is unclear because injuries of the soft parturient canal can commonly develop during delivery [26,27]. The remaining three patients with VD had no problems after delivery.…”

Section: Discussionmentioning

confidence: 78%

Delivery Mode after Ileal Pouch-Anal Anastomosis among Pregnant Women with Ulcerative Colitis

Goto

Uchino

Horio

et al. 2021

J Anus Rectum Colon

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Objectives:The appropriate and recommended delivery mode after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) has not been sufficiently evaluated. This study was designed to compare the delivery outcomes associated with cesarean section (CS) and vaginal delivery (VD) after IPAA. Methods: We conducted a questionnaire-based survey of female patients who underwent IPAA for UC between July 1987 and May 2018. Additionally, we reviewed clinical data and collected information regarding pouch function and postpartum complications. Results: In total, 45 patients had 68 deliveries, including 64 CS deliveries and four VDs. Fecal incontinence worsened in seven patients, including six CS patients and one VD patient. The Wexner scores of these patients before and after delivery were 5.4 ± 0.4 and 14.8 ± 1.0, respectively (p = 0.005). Four patients in the CS group and one in the VD group (p = 0.32) had increased stool frequency. Bowel obstructions developed during 11/64 (17.2%) deliveries, and one patient required surgical intervention. One patient with four VDs (three before IPAA and one after IPAA) developed vaginal fistula 5 months after the final VD. Information on episiotomies could not be obtained. Conclusions: Pouch function can decline even after CS. Notably, bowel obstruction can develop after CS. However, we cannot recommend a particular delivery method after IPAA. Further analyses to elucidate the relationship between CS and postoperative complications or vaginal fistula and episiotomy in VDs should be conducted.

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“… 10 , 11 Despite such efforts, obstetric fistula still compromises the well-being of affected women in all dimensions of their health. 12 , 13 …”

Section: Introductionmentioning

confidence: 99%

“…10,11 Despite such efforts, obstetric fistula still compromises the well-being of affected women in all dimensions of their health. 12,13 Many women with obstetric fistulas experience varying degrees of social stigma that can prevent them from seeking care early. 5 In addition, lack of sexual and reproductive health knowledge, or cultural inhibitions to discuss these topics, lead a woman to accept these conditions as normal postpartum healing rather than seeking care.…”

Section: Introductionmentioning

confidence: 99%

The Predictors of Intent to Prevent Obstetric Fistula Recurrence Among Women with Fistula in Ethiopia: A Facility-Based Cross-Sectional Study

Hurissa¹,

Koricha²,

Dadi³

2022

IJWH

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Background Obstetric fistula recurrence predisposes to a decreasing success rate of fistula repair and accounts for the continued incidence of obstetric fistulas in low-income countries. Evidence has revealed that there are women’s intent gaps in the prevention of obstetric fistula recurrence. Assessments of predictors of intent to prevent obstetric fistula recurrence among women with fistula are scarce. Objective This study assessed the intent to prevent obstetric fistula recurrence and its predictive factors among women with obstetric fistula in Ethiopia. Methods Facility-based cross-sectional study was conducted from April 01, 2019, to August 01, 2019, with consecutively selected 478 women with fistulas in five fistula treatment centers in Addis Ababa and Oromia regions. Data were collected using an interviewer-administered structured questionnaire and analyzed using SPSS 23 software. Simple and multiple linear regression models were fitted for data analysis. Results Mean score of intent to prevent obstetric fistula recurrence among women with obstetric fistula was 27.72 ± 5.06. Living in a rural setting (β =−2.27; 95% CI: −3.62, −0.93), being married (β =1.71, 95% CI: 0.56, 2.85), having one previous repair (β =2.14, 95% CI: 0.19, 4.08), high self-esteem (β =1.42, 95% CI: 0.09, 2.74), psychological health (β =0.05, 95% CI: 0.26, 3.79), living with fistula ≥5 years (β =1.82, 95% CI: 0.44, 3.21), high knowledge of risk factors (β =3.12, 95% CI: 1.99, 4.25), and a positive attitude (β =2.33, 95% CI: 1.12, 3.54) were significant predictors of the intent to prevent obstetric fistula recurrence. Conclusion Intent to prevent obstetric fistula recurrence among women with obstetric fistula was low. This indicates an urgent need to create awareness among women with an obstetric fistula on the risk factors of obstetric fistula recurrence, attitudinal changes towards prevention of obstetric fistula recurrence, and the availability of prevention measures.

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Obstetric fistula: a paradigm shift is needed in research and prevention

Abstract: Please cite this paper as: Letchworth P, MacLaren E, Duffy S. Obstetric fistula: a paradigm shift is needed in research and prevention. BJOG 2018;125:925-928.

Cited by 7 publications

References 14 publications

Obstetric fistulas in Uganda: scoping review using a determinant of health approach to provide a framework for health policy improvement

Obstetric fistulas in Uganda: scoping review using a determinant of health approach to provide a framework for health policy improvement

Delivery Mode after Ileal Pouch-Anal Anastomosis among Pregnant Women with Ulcerative Colitis

The Predictors of Intent to Prevent Obstetric Fistula Recurrence Among Women with Fistula in Ethiopia: A Facility-Based Cross-Sectional Study

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