Obstetric fistula in a district hospital in DR Congo: Fistula still occur despite access to caesarean section

Loposso, Matthieu Nkumu; Ndundu, Jean Muzembo; Win, Gunter De; Ost, Dieter; Punga, Augustin Maole; Ridder, Dirk De

doi:10.1002/nau.22601

Cited by 16 publications

(12 citation statements)

References 21 publications

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“…In order to get more precise data on whether a fistula is truly iatrogenic Hilton [23] suggested to describe those fistulas as a "true obstetric or ischaemic fistula" where women who experienced obstructed labour, maybe sometimes for days, ultimately delivered a stillborn baby vaginally. He agrees with Raassen [25] as well as referrers to Onsrud [32] and Loposso [28] who describe that women who are delivered by CS of a live baby in a health facility after obstructed labour had been identified and who still develop a VVF "would be reasonably described as having an iatrogenic injury".…”

Section: Discussionsupporting

confidence: 53%

“…In his study the mean duration of labour among the fistula patients ranged from 2.5 to 4 days (60 to 92 h) [5]. In the DRC Loposso found in a collective of 146 women of whom 63.4% were delivered by CS that the mean duration of labour was 30.7 h [28]. 96 women (92.30%) of the 104 women treated at CCBRT for fistula in the investigated time period were delivered in a hospital either by a midwife (20.19%) or a doctor (70.19%).…”

Section: Discussionmentioning

confidence: 92%

“…In comparison: Loposso's overall closure rate after the first surgical treatment was 65%. The continence rate of the patients with a successful closure was 63% [28].…”

Section: Outcomementioning

confidence: 90%

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Aetiology of Vesico Vaginal Fistula (VVF)—Observation in Patients Managed at CCBRT (Comprehensive Community Based Rehabilitation in Tanzania) Hospital, Dar es Salaam, Tanzania. January to March 2016

Majinge¹,

Siebenkotten-Branca²,

Daffeh³

2017

OJOG

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In this manuscript the authors have studied the various causes of vesico-vaginal fistula (VVF) and described etiology, clinical characteristics, and surgical outcome of VVF patients managed at CCBRT. They show that out of 155 patients 104 had surgery for VVF, 25 for stress incontinence (SI), 7 for perineal tears, 6 for recto-vaginal fistula (RVF) and 5 for other reasons, such as urethral strictures and bladder stones. They found a rate of 37 (35.58% out of 104 patients) with definitely iatrogenic fistula and therefore support the observation also made by others that there is a shift in etiology of VVF.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 92%

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Aetiology of Vesico Vaginal Fistula (VVF)—Observation in Patients Managed at CCBRT (Comprehensive Community Based Rehabilitation in Tanzania) Hospital, Dar es Salaam, Tanzania. January to March 2016

Majinge¹,

Siebenkotten-Branca²,

Daffeh³

2017

OJOG

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“…They consider these to be a distinct clinical (iatrogenic) entity and highlighted the training issues discussed above. Loposso et al similarly highlighted the risks of fistula in DRC despite the availability of caesarean section, but attributed this to the duration of obstructed labour prior to hospitalisation, and the delay in achieving caesarean delivery [ 33 ]. The various colleagues with whom the author has discussed this issue (see Acknowledgments), all with much greater experience of working in different low-income and middle-income countries in Africa and Asia, have given a range of views on the point.…”

Section: Post-caesarean Section Fistula: Traumatic or Ischaemic?mentioning

confidence: 99%

Trends in the aetiology of urogenital fistula: a case of ‘retrogressive evolution’?

Hilton

2016

Int Urogynecol J

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It has long been held as conventional wisdom that urogenital fistulae in low-income and middle-income countries are almost exclusively of obstetric aetiology, related to prolonged neglected obstructed labour, whereas those seen in high-income countries are largely iatrogenic in nature. There is, however, a growing perception amongst those working in the field that an increasing proportion of urogenital fistulae in low-income and middle-income countries may be iatrogenic, resulting from caesarean section. Recent studies suggest that adverse patterns of care may also be emerging in high-income countries; an increase in the risk of both vesicovaginal and ureterovaginal fistulae following hysterectomy has been reported, concurrently with the reduction in overall use of the procedure. These apparent secular trends are discussed in the context of evolution of practice, teaching and training in obstetrics and gynaecology.

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“…Low fistulae can also follow a successful cesarean section undertaken to relieve the obstruction, but after tissue necrosis in the lower vagina has occurred. Indeed, in a study of 146 women, Matthieu et al 8 reported that two-thirds of the women with a low obstetric fistula following prolonged labor had a cesarean section.…”

Section: Introductionmentioning

confidence: 99%

The changing face of obstetric fistula surgery in Ethiopia

Wright¹,

Ayenachew²,

Ballard³

2016

IJWH

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ObjectiveTo examine the incidence and type of obstetric fistula presenting to Hamlin Fistula Ethiopia over a 4-year period.Study designThis is a 4-year retrospective survey of obstetric fistula treated at three Hamlin Fistula Hospitals in Ethiopia, where approximately half of all women in the country are treated. The operation logbook was reviewed to identify all new cases of obstetric fistula presenting from 2011 to 2015. New cases of urinary fistula were classified by fistula type (high or low), age, and parity of the woman.ResultsIn total, 2,593 new cases of urinary fistulae were identified in the study period. The number of new cases fell by 20% per year over the 4 years (P<0.001). A total of 1,845 cases (71.1%) were low (ischemic) fistulae, and 804 cases (43.6%) of these had an extreme form of low circumferential fistula. A total of 638 (24.6%) women had a high bladder fistula, which predominantly occurs following surgery, specifically cesarean section or emergency hysterectomy, and 110 (4.2%) women had a ureteric fistula. The incidence of high fistulae increased over the study period from 26.9% to 36.2% (P<0.001). A greater proportion of multiparous women had a high bladder fistula (70.3%) compared with primigravid women (29.7%) (P<0.001). Conversely, a greater proportion of primiparous women experienced a low circumferential fistulae (68.6%) compared with multiparous women (31.4%) (P<0.001).ConclusionThere appears to be a decline in the number of Ethiopian women being treated for new obstetric urinary fistulae. However, the type of fistula being presented for treatment is changing, with a rise in high fistulae that very likely occurred following cesarean section and a decline in the classic low fistulae that arise following obstructed childbirth.

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Obstetric fistula in a district hospital in DR Congo: Fistula still occur despite access to caesarean section

Cited by 16 publications

References 21 publications

Aetiology of Vesico Vaginal Fistula (VVF)—Observation in Patients Managed at CCBRT (Comprehensive Community Based Rehabilitation in Tanzania) Hospital, Dar es Salaam, Tanzania. January to March 2016

Aetiology of Vesico Vaginal Fistula (VVF)—Observation in Patients Managed at CCBRT (Comprehensive Community Based Rehabilitation in Tanzania) Hospital, Dar es Salaam, Tanzania. January to March 2016

Trends in the aetiology of urogenital fistula: a case of ‘retrogressive evolution’?

The changing face of obstetric fistula surgery in Ethiopia

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