Risk Factors for Obstetric Fistula : a clinical review
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Risk Factors for Obstetric Fistula : a clinical review
Dr Pierre Marie Tebeu,MD,MPH
Obstetrician Gynecologist,
University Hospital , Yaoundé Cameroon
e.mail: [email protected]
Tel: 77 67 55 33
ISOFS 2010, Dakar , Senegal
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Plan
Introduction
Objective
Methods
Results
Summary
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Physiopathology of obstetric Fistula
Promontory
Pubis
Bladder
Rectum
Vagina
WHO, UNDP, UNICEF, World Bank. IMPAC. 2003
Obstructive labor
Com
pres
sion
VVF
RVF
-Hematoma-Asphyxia-Fetal death
Foot drop
Bladder
Rectum
Obturator nerve
Head
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Objectives
To assess the current state of knowledge regarding the importance of obstetric fistula as a health problem, the patients’ characteristics and the circumstances of occurrence of the disease.
Discuss the contribution of the identified factors in Obstetric fistula prevention strategies
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Data Souce
• Search of the literature
• Identify all relevant articles
• Published between 1987-2008
• Database: Medline (Pubmed, Ovid), Cochrane Trials Register,
Cumulative Index to Nursing and Allied Health.
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Search Strategy
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Term used:• obstetric fistula, • urinary fistula, • vesicovaginal fistula, • vesico vaginal fistula, • vesico-vaginal fistula, • recto-vaginal fistula, • rectovaginal fistula, • recto vaginal fistula
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Variables of Interest
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place of birth; skilled birth attendance; duration of labour; mode of delivery; antenatal care attendance; age at marriage; age at first delivery; age at causal delivery; parity at causal delivery; use of family planning; additional factors
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Results
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Teenager at first delivery
Meyer 2007; Ojanuga 1999; DHS Cameroon 2004; Wall 2004; Muleta 2004; Nafiou 2007; Ramsey 2007; Unfer 19959
• More than 84% of patients got marriage before the age of 20
• Mean age at marriage is between 14 and 16 years old
• Mean age at first delivery: 17 years
• Teenage status at operation: 2.5% -86 %
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6.878.6811.5
15.7716.7719.3521.43
24.0824.8326.51
14.23
05
1015202530
Contribution of teenagers among deliveries in Cameroon %
Teenagers delivery in Cameroon
Tebeu et al. Obstet Gynecol Int 21010
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Illiteracy
Illiteracy among OF patients: 78-96%
Maroua-Cameroon: 76% (Tebeu et al.2009)
Ijaiya 2004; Muleta 2004; Muleta 1997; Jokhio 2006; Meyer 2007; Gessessew 2003; Ramsey 2007; Wall 2004; Rijken 2007; Holme 2007, 11
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Illiteracy in Cameroon
65.3
33.4
3.3
57.7
73.6
7
78.2
11.5 9.4
35.222.3
8
40.5
0102030405060708090
Illeteracy in Cameroon %
DHS 2004
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Lack of Antenatal care
DHS Cameroon 2004; Gessessew 2003; Jokhio 2006; Ramsey 2007; Wall 2004; Home 2007; Ould el Joud 2001
Lack of antenatal care: 72-92% of patients
Maroua-Cameroon: 46%
WHO recommend at least 4 ANC during each pregnancy
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Duration of labor
Holme 2007; Arroswsmith 1994; Nafiou 2007; Muleta 2004; Ijaiya 2004; Hilton 1998; Wall 2004; Ahmad 2005; Ramsey 2007; Roenneburg 2007; Rahman 2003.
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The mean duration of labour among the fistula patients range from 2.5 to 4 days.
Labor > 24 hrs: 73- 95.7 %
OF patients have been in labour for more than 24 hours
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Place of delivery
Home delivery in many studies: 30-44%
Delivery failure at home, then go to facility: 58-91%
DHS Cameroon 2004; Gessessew 20003; Ramsey 1994; Holme 2007;Meyer 2007;Hilton 1998; Ijaiya2004 15
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Home delivery in Cameroon
DHS 2004
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Low Cesarean section rate
Paxton 2006, DHS Cameroon 2004; Nafiou 2007; Muleta 2004; Hilton 1998; Wall 2004; Ramsey 2007; Rijken 2007; Meyer 2007; Holme 2007
By many studies: 20-54%
Some studies: 6-10%Nigeria (Ijaiya2004),
Ethiopia (Gessessew 2003)
Pakistan (Ahmad 2005
(all with labor > 24: >80% for all)
Cesarean section delivery according to the population
36.42.00.4 5.0
15.0
0.010.020.030.040.0
OF patients Far NorthProvince (DHS
2004)
Cameroon(DHS 2004)
UN (Low est) UN (Highest)
PopulationPe
rcent
age
17
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Cesarean delivery in Cameroon
0.6 0.7
5.1
0.80.4
4.7
0.3
3.1
2.22.9
4.4 4.7
2
0
1
2
3
4
5
6
Cesrarean delivery %
DHS 2004
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Association between CS rate and maternal mortality from 118
countries
Cesarean secttion rate
Mat
erna
l mor
talit
y ra
te p
er 1
00,0
00 li
ve b
irths
Adapted from: Althabe 2006
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Grand multiparity
¨ Study from Pakistan : >= 6 deliveries (54.43%) (Ahmad 2005)
¨ 1 of 6 studies from Nigeria (Mean/median Parity at 6(Hilton 1998
Sources: UN 2001; Population Reference Bureau 2002 (use of modern contraception, TFR)
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Total Fertility Rate In Cameroon
4.55.5
3.2
6 6.4
4.3
6
4.7
6
4.63.7
3.2
5
01234567
Total fertility Rate
DHS 2004
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Summary on OF Risk factors
Teenage conditionNulliparity/Grand multiparityHome deliveryLate arrival in the facilityPoor obstetric managementProlonged labor
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END
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WAHA GFMR
University Centre Hospital Yaoundé
LIRASEF