Management Of Obstetric Urogenital Fistula
Linda Cardozo, Staskin David in Textbook of Female Urology and Urogynecology - Two-Volume Set, 2017
The mAjority of deliveries Are stillborn. The womAn is weAk And shocked postdelivery And on AverAge, it tAkes 26.1 dAys before she is strong enough to be Able to wAlk unAided [4]. The immediAte course of the injury is thAt 3–10 dAys postdelivery, A necrotic slough is extruded through the vAginA, And the vesicovAginAl fistulA is exposed rendering her completely incontinent of urine, leAking every minute of the dAy And night (Figure 109.1). rArely, if the fistulA is very smAll, she cAn describe symptoms more like stress Urinary incontinence, but leAking from the vAginA rAther thAn the urethrA. If she hAs sustAined similAr injuries to the posterior compArtment, she is Also rendered incontinent of feces And flAtus per vAginA. It is eAsy to think of the obstetric fistulA As merely just A hole in the vAginA to the blAdder And perhAps the rectum.
Obstetrics and Gynecology
Akshaya Neil Arya in Preparing for International Health Experiences, 2017
Women with gynecological conditions such as pelvic inflammatory disease and malignancy often present late in their clinical course, and their treatment options are limited in resource poor settings. For example, cervical cancer is the number one malignancy of women in many sub-Saharan African countries; 84% of cervical cancer cases occur in resource-limited countries, and 85% of deaths from this disease which is mostly preventable in developed nations (WHO, 2016). Many of these healthcare settings do not have equitable access to intensive care and oncologic services. Obstetric fistula is another condition rarely experienced in resource-rich settings but prevalent in the poorest parts of the world (Tunçalp et al., 2015). It should be noted that in the past 25 years, with the push from the WHO MDGs from 1990 to 2015 and now the transition to the Sustainable Development Goals (SDGs) to address the most significant health conditions and prerequisites around the globe, significant progress has been made in reducing the burden of maternal and neonatal mortality. As with so many conditions, the least change has been made in the poorest of settings (Wang et al. 2016).
Gynaecological Considerations and Urogenital Fistulas
Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams in Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Comparing the outcomes of treatment between different reports and different methods is made difficult by the inconsistent outcome measures used. Most studies report anatomical closure (based on inspection or dye testing), anatomical closure with residual incontinence (based on patient-reported symptoms at the time of discharge from hospital) or failure of repair. Others have the more specific but less sensitive outcome of the need for a repeat repair procedure. Follow-up in obstetric fistula patients is inevitably difficult in many low-resourced countries, but even amongst surgical or radiotherapy cases in well-resourced countries, relatively few reports describe examination findings or symptoms at later post-operative review. Long-term outcomes and quality of life measures have only rarely been reported.42,43
Budgeting for comprehensive sexual and reproductive health and rights under universal health coverage
Published in Sexual and Reproductive Health Matters, 2020
Naomi Lince-Deroche, Elizabeth A Sully, Lauren Firestein, Taylor Riley
Finally, we turn to the third example, which focuses on providing quality, in-facility childbirth services, including essential care for women and their newborns, and providing treatment for a select group of delivery-related complications. We estimate that there are 127.4 million live births in LMICs annually and that 96.6 million women and newborns have in-facility deliveries with the required essential care (Table 3). At current service levels, many women need but do not receive care for obstetric fistula repair, maternal sepsis case management, and postpartum haemorrhage treatment. Likewise, many newborns who need care for infections or sepsis do not receive it. The total cost for managing all complications in this cluster under current conditions is US$1.36 billion annually. For the all-needs-met scenario, all women and newborns receive safe childbirth services as recommended. As a result, all cases of obstetric fistula are eliminated due to women receiving appropriate care for obstructed labour (Table 3). Other maternal and newborn complications are greatly reduced. However, in the all-needs-met scenario all complications also receive treatment, and the overall costs increase by 3% to US$1.41 billion annually. Again, it is important to remember that these increased investments likely avert other, longer-term negative health and financial impacts.
Feasibility and acceptability of mobile phone data collection for longitudinal follow-up among patients treated for obstetric fistula in Uganda
Published in Health Care for Women International, 2022
Alison M. El Ayadi, Hadija Nalubwama, Justus K. Barageine, Suellen Miller, Susan Obore, Othman Kakaire, Abner Korn, Felicia Lester, Nadia G. Diamond-Smith, Haruna Mwanje, Josaphat Byamugisha
Obstetric fistula, a debilitating maternal birth trauma mainly due to prolonged obstructed labor, is an important maternal morbidity largely affecting women in sub-Saharan Africa and Asia. Prevalence and incidence data are poor, yet estimates suggest that two million women globally may be living with obstetric fistula, with annual incident cases ranging as high as 100,000 (Wall, 2006; WHO, 2006). Women living with obstetric fistula experience severe physical, psychological, and social sequelae (Ahmed & Holtz, 2007; Browning & Menber, 2008; Roush, 2009; Siddle et al., 2013; Turan et al., 2007) and are a paradigm of a marginalized population. Delays in treatment are common due to costs of surgery, sparse transport, and lodging; and poor geographic access to medical services (Bellows et al., 2014; Kabayambi et al., 2014; Phillips et al., 2016; UNFPA and Ministry of Health, Uganda, 2003; UNFPA & Family Care International, 2007; Woldeamanuel, 2012). Obstetric fistula occurs most frequently in remote geographies (Direct Relief, 2016), largely correlating to availability of emergency obstetric care; thus, affected women are often geographically dispersed. Furthermore, risk of fistula follows a social gradient consistent with socioeconomic patterns of health care inequity (Maheu-Giroux et al., 2015, 2016), further complicating patient access to care and follow-up due to marginalization of this population. Treatment facilities, on the contrary, are typically highly specialized referral centers located in major cities, which can be difficult to access for the surgery itself, placing a further significant travel burden on study participants for in-person longitudinal research participation.
After obstetric fistula repair; willingness of women in Northern Nigeria to use family planning
Published in Journal of Obstetrics and Gynaecology, 2019
Obioma Uchendu, Hadizah Adeoti, Oluwapelumi Adeyera, Olayide Olabumuyi
Obstetric fistula (OF) is a life-changing morbidity associated with childbirth (Wall et al. 2005). It occurs after a prolonged obstructed labour especially in the developing countries (Neilson et al. 2003; Miller et al. 2005). Most fistulae occur as an indirect result of cultural factors which aid early marriage, a poor family planning and poor obstetric practices among the women of the reproductive age group (Adedokun et al. 2012). OF usually comes with the psychological trauma of loss of the baby (Briggs 2009). Also, the smell of stool and urine in leads to the ostracising and rejection of fistula patients by their spouses, families and friends (Pope et al. 2011).
Related Knowledge Centers
- Childbirth
- Fecal Incontinence
- Infertility
- Mood Disorder
- Urinary Incontinence
- Vesicovaginal Fistula
- Ureter
- Vagina
- Fistula
- Rectovaginal Fistula