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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

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


Risk factors for obstetric fistula a clinical review

Plan

  • Introduction

  • Objective

  • Methods

  • Results

  • Summary


Physiopathology of obstetric fistula

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

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

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.


Search strategy

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

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


Risk factors for obstetric fistula a clinical review

Results


Teenager at first delivery

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


Risk factors for obstetric fistula a clinical review

Teenagers delivery in Cameroon

Tebeu et al. ObstetGynecolInt 21010


Illiteracy

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

Illiteracy in Cameroon

DHS 2004


Lack of antenatal care

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

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

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

Home delivery in Cameroon

DHS 2004


Low cesarean section rate

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

Cesarean delivery in Cameroon

DHS 2004


Association between cs rate and maternal mortality from 118 countries

Association between CS rate and maternal mortality from 118 countries

Maternalmortality rate per 100,000 live births

Cesarean secttion rate

Adapted from: Althabe 2006


Risk factors for obstetric fistula a clinical review

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

Total Fertility Rate In Cameroon

DHS 2004


Summary on of risk factors

Summary on OF Riskfactors

Teenage condition

Nulliparity/Grand multiparity

Home delivery

Late arrival in the facility

Poor obstetric management

Prolonged labor


Risk factors for obstetric fistula a clinical review

END

University Centre Hospital Yaoundé

WAHA

GFMR

LIRASEF


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