Treatment-seeking behaviour and social status of women with pelvic organ prolapse, 4th-degree obstetric tears, and obstetric fistula in western Uganda

Krause, Hannah; Natukunda, Harriet; Singasi, Isaac; Hicks, Sylvia S. W.; Goh, Judith

doi:10.1007/s00192-014-2442-6

Cited by 28 publications

(27 citation statements)

References 12 publications

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“…[4][5][6] With women now accessing health care more frequently, the rates of caesarean section in general have increased, and the rates of caesarean section in women suffering OF are high, reaching well over 50%. 7,14 In our study, the group of women suffering OF had a caesarean section rate of 74.4%. Despite these extremely high rates of caesarean section in women with OF, stillbirth remains the most frequent outcome in over 70% of cases 8,14 and OF from pressure necrosis persists.…”

Section: Discussionmentioning

confidence: 53%

“…3 While earlier literature indicates that vaginal delivery is the most common mode of delivery for women who suffer genital tract fistulae from obstructed labour, [4][5][6] more recent surveys demonstrate high rates of caesarean section deliveries for these women who develop fistulae. [7][8][9] Even when delivered by caesarean section, the majority of women with OF experience a stillbirth. 1,8,9 Thus, caesarean section is now commonly performed in women with intra-uterine fetal death with obstructed labour.…”

Section: Introductionmentioning

confidence: 99%

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Pelvic floor ultrasound findings in Ugandan women with obstetric fistula, unrepaired fourth degree obstetric tear, and pelvic organ prolapse

Krause

Wong

et al. 2019

Aust NZ J Obst Gynaeco

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Background: While pelvic floor ultrasound is commonly utilised in high-resource locations, our understanding of pelvic floor characteristics in women suffering with obstetric fistula and unrepaired fourth degree obstetric tears in low-resource areas is limited. Aims: This study aimed to assess the pelvic floor ultrasound characteristics of Ugandan women suffering with obstetric fistula, unrepaired fourth degree obstetric tears and pelvic organ prolapse, and determine whether obstructed labour resulting in obstetric fistula causes more levator muscle defects compared to parous women without a history of obstructed labour. Materials and Methods: This was a prospective study in western Uganda assessing 82 women with obstetric fistula, unrepaired fourth degree obstetric tears and pelvic organ prolapse with a pelvic floor ultrasound scan. Results: Demographic characteristics were significantly different, with women suffering pelvic organ prolapse being older and more parous. Hiatal area on Valsalva was significantly smaller in the obstetric fistula group (mean 21.45 cm 2) compared to non-obstetric fistula group (unrepaired fourth degree obstetric tears and pelvic organ prolapse; mean 30.44 cm 2); a mean difference of 9.0 cm 2 (95% CI: 5.4-12.6 cm 2 , P < 0.001). Overall, levator muscle defects were significantly more common in women with obstetric fistula (66.7%) compared to the non-obstetric fistula group (44.7%) with P = 0.048; however, there were no significant differences in complete levator muscle defects between obstetric fistula (28.6%) and non-obstetric fistula (23.7%). Conclusions: Increased hiatal area on Valsalva was noted in the non-obstetric fistula group compared to women with obstetric fistula; however, there were no differences in proportions of complete levator muscle defects.

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Section: Discussionmentioning

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Pelvic floor ultrasound findings in Ugandan women with obstetric fistula, unrepaired fourth degree obstetric tear, and pelvic organ prolapse

Krause

Wong

et al. 2019

Aust NZ J Obst Gynaeco

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“…Further, there is a shortage of reliable data around social, demographic and clinical factors associated with time to recovery from obstetric Fistula surgical repair that will be valuable for managing health care institution through planning, monitoring and evaluation of quality of care as well as use of human and material resources [29][30][31][32][33][34][35].…”

Section: Significance Of the Studymentioning

confidence: 99%

Predictors of Time to Recovery from a Surgical Repair of Obstetric Fistula at Mekelle Hamlin Fistula Center, Tigray, Ethiopia

Hailu¹

2018

J Preg Child Health

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Background: Ethiopia is one of the high fistula burdened countries in the world with an annual occurrence of 3,500 new and existence of 37,500 untreated obstetric fistula cases. Studies conducted in this area focus on determinants of obstetric fistula before surgical repair and researches addressing the associated factors are limited.Objective: To estimate time to recovery from a surgical repair of obstetric fistula and its associated factors among patients treated at Mekelle Hamlin Fistula Center. Results: The patients were followed for 6657 person days at risk, the median recovery time was 20 days. The overall recovery rate was 2.5 cases per 100 person days. Multivariable Cox proportional hazard model result showed labor duration of two or more days (AHR=0.73, 95% CI=0.53, 0.99) and post-operative bladder catheterization longer than 14 or more days (AHR=0.45, 95% CI=0.32, 0.62) were factors negatively associated with recovery time from obstetric fistula surgery. Methods Conclusion and recommendations:women who experienced labor of two or more days and post-operative bladder drainage for more than two or more weeks took longer time to recover after the repair. Therefore, Decision makers, Health care professionals, Stakeholders and Researchers should give emphasis on activities that reduce delays' in decision making, delays' in giving urgent intervention and delays' in reaching health institutions that contributes in reducing complications of prolonged labor ultimately obstetric fistula.Harmful traditional practices such as early marriage and home delivery are other potential factors for the development of obstetric fistula [8][9][10]. Globally, nine to 84% of obstetric fistula patients gave birth at home and more than 2 million women are currently living with this problem. Additional 50,000 to 100,000 new cases are estimated to occur each year and majority of which are from Africa and Asia [9][10][11][12][13].Incidence rates of obstetric fistula in countries with high maternal mortality is as high as two to three cases per 1000 women [14]. Estimated incidence and prevalence of untreated obstetric fistula in Ethiopia during the year 2010 was 3,500 and 37,500, respectively [9,15]. Introduction BackgroundObstetric fistula is an injury that occurs during prolonged or obstructed labor causing tissue damage to organs inside the pelvis and resulting in incontinence of urine, feces or both. The dead tissues due to prolonged pressure fall away and a hole will be formed between the vagina and bladder called Vesico-vaginal Fistula (VVF) or between the vagina and rectum called Recto Vaginal Fistula (RVF) [1][2][3].Obstetric fistula is the worst child birth related complication that contributes for 2.5% of the Global daily death of mothers associated with child birth related complications [4].The main causes of obstetric fistula in the developed world are radiation therapy and surgery whereas in developing countries, "the three delays" are responsible, the delay in seeking skilled emergency obstetric care, the del...

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“…Women with pelvic floor dysfunction (PFD)—including obstetric fistula, unrepaired obstetric anal sphincter injuries (OASIS), or severe pelvic organ prolapse (POP; defined as stage 3 or 4)—can experience high levels of social stigma and social isolation . This observation suggested that PFD might be a risk factor for IPV.…”

Section: Introductionmentioning

confidence: 99%

Incidence of intimate partner violence among Ugandan women with pelvic floor dysfunction

Krause

Singasi

et al. 2019

Intl J Gynecology & Obste

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Objective To assess the occurrence of intimate partner violence (IPV) among women seeking surgery for pelvic floor dysfunction (PFD) in a rural African community. Methods A prospective questionnaire‐based study was conducted among women with obstetric fistula, unrepaired obstetric anal sphincter injuries (OASIS), or severe (stage 3 or 4) pelvic organ prolapse (POP) who attended surgical camps at Kagando Hospital in western Uganda between July 15, 2016, and September 14, 2017. The control group comprised women without PFD. Participants completed the Hurt, Insult, Threaten, and Scream (HITS) tool and the Woman Abuse Screening Tool (WAST) to screen for IPV. Results 117 of the 312 women interviewed reported current IPV: 73/214 (34.1%) in the PFD group and 44/98 (44.9%) in the control group. The PFD group comprised unrepaired OASIS (n=85, 39.7%), obstetric fistula (n=75, 35.1%), and severe POP (n=54, 25.2%). All groups experienced high levels of IPV. The frequency of positive screening results for IPV with WAST (score ≥13.0) and/or HITS (score ≥10.5) were: severe POP (n=17, 31.5%), obstetric fistula (n=28, 37.3%), unrepaired OASIS (n=30, 35.3%), and control group (n=44, 44.9%). Conclusion Women in western Uganda experienced high rates of IPV, regardless of whether or not they had PFD. ANZCTR number: ACTRN12617001073392.

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Treatment-seeking behaviour and social status of women with pelvic organ prolapse, 4th-degree obstetric tears, and obstetric fistula in western Uganda

Cited by 28 publications

References 12 publications

Pelvic floor ultrasound findings in Ugandan women with obstetric fistula, unrepaired fourth degree obstetric tear, and pelvic organ prolapse

Pelvic floor ultrasound findings in Ugandan women with obstetric fistula, unrepaired fourth degree obstetric tear, and pelvic organ prolapse

Predictors of Time to Recovery from a Surgical Repair of Obstetric Fistula at Mekelle Hamlin Fistula Center, Tigray, Ethiopia

Incidence of intimate partner violence among Ugandan women with pelvic floor dysfunction

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