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ISOFS 2010, Dakar , Senegal. 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. Plan. Introduction Objective Methods Results Summary.

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Risk Factors for Obstetric Fistula : a clinical review

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ISOFS 2010, Dakar , Senegal

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


Plan

  • Introduction

  • Objective

  • Methods

  • Results

  • Summary


Physiopathology of obstetric Fistula

Pubis

VVF

Bladder

RVF

Rectum

Bladder

Obstructive

labor

Compression

Obturator

nerve

Foot drop

Vagina

-Hematoma

-Asphyxia

-Fetal death

Head

Promontory

Rectum

WHO, UNDP, UNICEF, World Bank. IMPAC. 2003


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


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.


SearchStrategy

  • Term used:

    • obstetric fistula,

    • urinary fistula,

    • vesicovaginal fistula,

    • vesico vaginal fistula,

    • vesico-vaginal fistula,

    • recto-vaginal fistula,

    • rectovaginal fistula,

    • recto vaginal fistula


Variables of Interest

  • 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


Results


Teenager at first delivery

  • 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 %

9

Meyer 2007; Ojanuga 1999; DHS Cameroon 2004; Wall 2004; Muleta 2004; Nafiou 2007; Ramsey 2007; Unfer 1995


Teenagers delivery in Cameroon

Tebeu et al. ObstetGynecolInt 21010


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


Illiteracy in Cameroon

DHS 2004


Lack of Antenatal care

  • Lack of antenatal care: 72-92% of patients

  • Maroua-Cameroon: 46%

  • WHO recommend at least 4 ANC during each pregnancy

13

DHS Cameroon 2004; Gessessew 2003; Jokhio 2006; Ramsey 2007; Wall 2004; Home 2007; Ould el Joud 2001


Duration of labor

  • 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

14

Holme 2007; Arroswsmith 1994; Nafiou 2007; Muleta 2004; Ijaiya 2004; Hilton 1998; Wall 2004; Ahmad 2005; Ramsey 2007; Roenneburg 2007; Rahman 2003.


Place of delivery

  • Home delivery in many studies: 30-44%

  • Delivery failure at home, then go to facility: 58-91%

15

DHS Cameroon 2004; Gessessew 20003; Ramsey 1994; Holme 2007;Meyer 2007;Hilton 1998; Ijaiya2004


Home delivery in Cameroon

DHS 2004


Low Cesarean section rate

  • By many studies: 20-54%

  • Some studies: 6-10%

    • Nigeria (Ijaiya2004),

    • Ethiopia (Gessessew 2003)

    • Pakistan (Ahmad 2005

  • (all with labor > 24: >80% for all)

17

Paxton 2006, DHS Cameroon 2004; Nafiou 2007; Muleta 2004; Hilton 1998; Wall 2004; Ramsey 2007; Rijken 2007; Meyer 2007; Holme 2007


Cesarean delivery in Cameroon

DHS 2004


Association between CS rate and maternal mortality from 118 countries

Maternalmortality rate per 100,000 live births

Cesarean secttion rate

Adapted from: Althabe 2006


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)


Total Fertility Rate In Cameroon

DHS 2004


Summary on OF Riskfactors

Teenage condition

Nulliparity/Grand multiparity

Home delivery

Late arrival in the facility

Poor obstetric management

Prolonged labor


END

University Centre Hospital Yaoundé

WAHA

GFMR

LIRASEF


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