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: pmtebeu@yahoo.fr

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

4

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.

Search Strategy

6

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

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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

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 %

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

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

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

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

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

Home delivery in Cameroon

DHS 2004

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

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

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

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

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

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