Risk factors for obstetric fistula: a clinical review
- 5.6k Downloads
- 31 Citations
Abstract
Obstetric fistula is the presence of a hole between a woman’s genital tract and either the urinary or the intestinal tract. Better knowledge of the risk factors for obstetric fistula could help in preventing its occurrence. The purpose of this study was to assess the characteristics of obstetric fistula patients. We conducted a search of the literature to identify all relevant articles published during the period from 1987–2008. Among the 19 selected studies, 15 were reports from sub-Saharan Africa and 4 from the Middle East. Among the reported fistula cases, 79.4% to 100% were obstetrical while the remaining cases were from other causes. Rectovaginal fistulae accounted for 1% to 8%, vesicovaginal fistulae for 79% to 100% of cases, and combined vesicovaginal and rectovaginal fistulae were reported in 1% to 23% of cases. Teenagers accounted for 8.9% to 86% of the obstetrical fistulae patients at the time of treatment. Thirty-one to 67% of these women were primiparas. Among the obstetric fistula patients, 57.6% to 94.8% of women labor at home and are secondarily transferred to health facilities. Nine to 84% percent of these women delivered at home. Many of the fistula patients were shorter than 150 cm tall (40–79.4%). The mean duration of labor among the fistula patients ranged from 2.5 to 4 days. Twenty to 95.7% of patients labored for more than 24 h. Operative delivery was eventually performed in 11% to 60% of cases. Obstetric fistula was associated with several risk factors, and they appear to be preventable. This knowledge should be used in strengthening the preventive strategy both at the health facility and at the community level.
Keywords
Risk factors Obstetric Vesicovaginal fistula Rectovaginal fistulaIntroduction
Definition and pathophysiology
Obstetric fistula is the presence of a hole between a woman’s genital tract and urinary tract (i.e., vesicovaginal fistula) or between the genital tract and the intestines (i.e., rectovaginal fistula). The vesicovaginal fistula is characterized by the leakage of the urine through the vagina, and rectovaginal fistula is characterized by the leakage of flatus and stool through the vagina. Both vesicovaginal and rectovaginal fistula are associated with a persistent offensive odor leading to the social stigma and ostracization of these affected women [1, 2]. There are three prominent causes of obstetric fistula. The cause of obstetric fistula is ischemia of the soft tissue between the vagina and the urinary tract or between the vagina and the rectum by compression of the fetal head. The second most common cause of obstetric fistula is the direct tearing of the same soft tissue during precipitous delivery or obstetric maneuvers. The last and least common cause is elective abortion [3, 4]. These causes are not mutually exclusive and may have additive effects. Each of these causes occurs as a complication of delivery or uterine evacuation usually in the absence of skilled medical staff assistance.
Incidence and prevalence
Obstetric fistula is found in all developing countries including South Africa. However, the majority of obstetric fistulae are confined to the “fistula belt” across the northern half of sub-Saharan Africa from Mauritania to Eritrea and in the developing countries of the Middle East Asia.
Several population-based estimates of obstetric fistula have been presented in the obstetrical literature. The most frequently cited estimate is the one introduced by Waaldijk in 1993 when he cited an incidence rate of 1 to 2 per 1,000 deliveries. This incidence rate suggested a worldwide incidence of 50,000 to 100,000 new cases annually; and a worldwide prevalence of 2 million cases of obstetric fistulae [5]. A recent study highlighted the lack of a scientific basis for this incidence and prevalence of fistulae [6]. These authors reported an estimated prevalence of 188 per 100,000 women aged 15 to 49 years in South Saharan Africa and emphasized the need for population-based studies.
Risk factors
Seven primary risk factors for obstetrical fistula commonly reported include the place of birth and presence of a skilled birth attendant, the duration of labor and the use of a partograph, the lack of prenatal care, early marriage and young age at delivery, older age, lack of family planning, and a number of other poorly defined additional factors[3, 4]. Obstetrical fistula is most often the result of prolonged and obstructed labor. Up to 95.5% of 259 cases of obstetrical fistulae reported in Zambia occurred following labor for more than 24 h before the completion of delivery [7]. Ninety-two percent of 201 fistula cases reported in northern Ethiopian women did not have any antenatal care [8]. Eighty-five percent of the 52 fistula patients in a Niger series delivered at home [9].
These underlying characteristics were not found in other low prevalence series [7, 10]. Only 20.0% of 52 cases of fistula reported in Saudia Arabia had a duration of labor lasting for more than 24 h [10]. In Zambia, only 2.5% of 259 patients reported no antenatal care before delivery [7]. Delivery at home was reported by only 9.6% of the 259 patients in the same report [7].
The data on risk factors for obstetrical fistula are controversial. Better knowledge of the risk factors for obstetrical fistula is needed to educate the community, healthcare providers, policy makers, and program managers to improve prevention of obstetric fistula at a regional and national level.
Objectives
The purpose of this study is to assess the current state of knowledge regarding the characteristics of obstetric fistula patients. To do so, we compile the international literature on obstetric fistula to identify the relevant information on the demographic, socioeconomic status of the patients, and circumstance of occurrence of the disease.
Methods
Data sources
We conducted a search of the literature to identify all relevant articles published during the period of 1987–2008 in the Medline (PubMed, Ovid), Cochrane Trials Register, and Cumulative Index to Nursing and Allied Health databases. We conducted a variety of searches using a combination of the following medical terms and MeSH headings: obstetric fistula, urinary fistula, vesicovaginal fistula, vesico vaginal fistula, vesico-vaginal fistula, recto-vaginal fistula, rectovaginal fistula, and recto vaginal fistula. In addition, potentially relevant publications were identified from the reference lists of identified articles and from review articles. No attempt was made to identify unpublished studies.
Study selection
Descriptive or analytic studies presenting the characteristics or the outcome of women suffering from genital fistula were initially eligible for inclusion. Data regarding the place of birth, presence of a skilled birth attendant, the duration of labor, mode of delivery, the presence of antenatal care, the age at marriage, the age at first delivery, age at causal delivery, parity at causal delivery, use of family planning, and other additional factors were reviewed. After identification of potentially relevant studies, each of these studies was reviewed in detail, and additional exclusion criteria were applied.
Studies providing complete or partial information on the sociodemographic characteristics of obstetrical fistula patients, access to health care or its consequences were included. Studies were excluded if they reported only the outcome without any presenting sociodemographic characteristics or information about access to emergency health care. Studies were excluded from this analysis if they did not include information on the central tendency or the age of the affected women, proportion of obstetrical causes of fistula, or information about the site(s) of fistulae. Articles were also excluded if they included fewer than 20 cases or if they only reported on selected cases.
Data extraction and analysis
From these articles we extracted the following variables for the review: country of the study, study design, age of the patients, place of causal birth, skilled birth attendance; the duration of labor, mode of delivery, the presence of antenatal care; age at marriage, age at causative delivery, parity at the occurrence of the fistula, and a number of little defined additional factors.
Results
Classification of the selected studies. Studies selected for analysis of obstetrical fistula patients characteristics (Part 1)
| Area of study | Author | Journal | Publication year | Study design | Year of study | Type | Total fistula | Total OF |
|---|---|---|---|---|---|---|---|---|
| South Australia | Rieger et al. [20] | ANZJOG | 2004 | Retrospecti | 1999–2001 | RVpur | 89 | 89 (100%) |
| Saudi Arabia | Rahman et al. [10] | JOG | 2003 | Retrospect | 1986–2001 | RVpur | 52 | 52 (100%) |
| Niger | Nafiou et al. [21] | Int J G O | 2007 | Retrospect | 2003–2005 | VVpur | 104 | 104 (100%) |
| Niger | Meyer et al. [22] | Am J O G | 2007 | Retrospect | 2005–2006 | VVpur | 58 | 58 (100%) |
| Nigeria | Ijaiya and Aboyeji [23] | WAJM | 2004 | Retrospect | 1989–1998 | VVpur | 34 | 34 (100%) |
| Nigeria | Melah et. al [4] | J OG | 2007 | Survey | 2001–2003 | VVc | 80 | 75/80 (93.7) |
| Pakistan | Ahmad et. al [24] | Int J G O | 2005 | Retrospect | 1978–2003 | VVc | 1086 | 1,086 (100%) |
| Nigeria | Am J O G | 2004 | Retrospect | 1992–2001 | VVc | 1716 | 1,716 (100%) | |
| Nigeria | Wall et al. [26] | Am J O G | 2004 | Retrospect | 1992–1999 | VVc | 932 | 899/932 (95.5) |
| Mali | Qi Li Ya et al. [27] | Med Afr N | 2000 | Retrospect | 1998–1999 | VVc | 34 | 27/34 (79.4) |
| Nigeria | Hilton and Ward [28] | IUGJPFLD | 1998 | Retrospect | 1989–1995 | VVc | 2389 | (2,202/2,389) 92% |
| Niger | Arrowsmith [29] | J Urol | 1994 | Retrospect | 1990–1993 | VVc | 98 | 93/98 (94.9) |
| Senegal | Gueye et al. [30] | Med Afr N | 1992 | Retrospect | 1986–1992 | VVc | 123 | 118/123 (95.9) |
| Burki, Tchad; Gabon | Falandry [31] | Press Med | 1992 | Retrospect | 1979–1990 | VVc | 230 | 213/230 (93%) |
| Zambia | Holme et al. [7] | Br J O G | 2007 | Retrospect | 2003–2005 | V/R | 259 | 259 (100%) |
| Malawi | Rijken and Chilopora [32] | Int J G O | 2007 | Retrospect | 1997–2005 | V/R | 407 | 379/407 (93.1) |
| Pakistan | Jokhio and Kelly [33] | Int J G O | 2006 | Retrospect | 1999–2005 | V/R | 116 | 116 (100%) |
| Ethiop | Gessessew and Mesfin [8] | Eth M J | 2003 | Retrospect | 1993–2001 | V/R | 193 | 184/193 (95.3) |
| Niger | Harouna et al. [9] | Med Afr N | 2001 | Survey | NP | V/R | 52 | 52 (100.0%) |
Organ related classification of obstetrical fistula included in selected studies
| Author | Journal | Year of publication | Type | Total OF | RVF | VVF | Combined VVF/RVF |
|---|---|---|---|---|---|---|---|
| Rieger et al. [20] | ANZJOG | 2004 | RVpur | 89 (100%) | 89 (100%) | 0 | 0 |
| Rahman et al. [10] | JOG | 2003 | RVpur | 52 (100%) | 52 (100%) | 0 | 0 |
| Nafiou et al. [21] | Int J G O | 2007 | VVpur | 104 (100%) | 0 | 104 (100%) | 0 |
| Meyer et al. [22] | Am J O G | 2007 | VVpur | 58 (100%) | 0 | 58 (100%) | 0 |
| Ijaiya and Aboyeji [23] | WAJM | 2004 | VVpur | 34 (100%) | 0 | 34 (100%) | 0 |
| Melah et. al [4] | J OG | 2007 | VVc | 75/80 (93.7) | 0 | 72/80 (90.0) | 8/80 (10%) |
| Ahmad et. al [24] | Int J G O | 2005 | VVc | 1,086 (100%) | 0 | 950/1,025 (92.7) | 75/1,025 (1.5) |
| Am J O G | 2004 | VVc | 1,716 (100%) | 0 | 1,505 (87.7) | 211 (12.3) | |
| Wall et al. [26] | Am J O G | 2004 | VVc | 899/932 (95.5) | 0 | 800/899 (88.9) | 99 (11%) |
| Qi Li Ya et al. [27] | Med Afr N | 2000 | VVc | 27/34 (79.4) | 0 | 327/34 (79.4%) | 7/34 (2.1) |
| Hilton and Ward [28] | IU J PFD | 1998 | VVc | (2,202/2,389) 92% | 0 | 2,385/2,484 (96.0) | 99/2,484 (4.0%) |
| Arrowsmith [29] | J Urol | 1994 | VVc | 93/98 (94.9) | 0 | 86/98 (92.5) | 7/98 (7.5) |
| Gueye et al. [30] | Med Afr N | 1992 | VVc | 118/123 (95.9) | 0 | 119/123 (96.7) | 4/123 (3.2) |
| Falandry [31] | Press Med | 1992 | VVc | 213/230 (93%) | 0 | 178/230 (77.4) | 52/230 (22.6) |
| Holme et al. [7] | Br J O G | 2007 | V/R | 259 (100%) | 4/297 (1.3) | 247/297 (83.2) | 18/247 (7.3) |
| Rijken and Chilopora [32] | Int J G O | 2007 | V/R | 379/407 (93.1) | 12/408 (2.9) | 396/408 (97.5) | 29/408 (7.1) |
| Jokhio and Kelly [33] | Int J G O | 2006 | V/R | 116 (100%) | 3/116 (2.69) | 103/116 (88.8%) | 5 (4.3) |
| Gessessew and Mesfin [8] | Eth M J | 2003 | V/R | 184/193 (95.3) | 9/193 (4.7) | 166/193 (86%) | 16/193 (8.3) |
| Harouna et al. [9] | Med Afr N | 2001 | V/R | 52 (100.0%) | 4/52 (7.7) | 45/52 (86.5%) | 3/52 (5.8) |
Risk factors of obstetrical fistula and illiteracy status of the patients (Part 2)
| Author | Journal | Year | Illiteracy |
|---|---|---|---|
| Meyer et al. [22] | Am J O G | 2007 | 49/58(84.5%) |
| Ijaiya and Aboyeji [23] | WAJM | 2004 | 32/34(94.1%) |
| Melah et. al [4] | J OG | 2007 | 77/80(96.3) |
| Wall et al. [26] | Am J O G | 2004 | 700/898(77.9) |
| Holme et al. [7] | Br J O G | 2007 | 42/213(19.7) |
| Rijken and Chilopora [32] | Int J G O | 2007 | 154/407(37.8) |
| Jokhio and Kelly [33] | Int J G O | 2006 | 105/116(90.5) |
| Gessessew and Mesfin [8] | Eth M J | 2003 | 156/193(80.8)% |
Teenage status of the patients
| Author | Journal | Year | <20 years at management |
|---|---|---|---|
| Nafiou et al. [21] | Int J G O | 2007 | 13/52 (25%) |
| Ijaiya and Aboyeji [23] | WAJM | 2004 | 9/34( 26.5) |
| Ahmad et. al [24] | Int J G O | 2005 | 26/1,025 (2.5%)a |
| Am J O G | 2004 | 728/1,716 (42.4%)a | |
| Qi Li Ya et al. [27] | Med Afr N | 2000 | 6/34 (17.6%)b |
| Rijken and Chilopora [32] | Int J G O | 2007 | 134/407 (32.9) |
| Jokhio and Kelly [33] | Int J G O | 2006 | 10/112 (8.9) |
| Gessessew and Mesfin [8] | Eth M J | 2003 | 74/184 (40.3) |
| Harouna et al. [9] | Med Afr N | 2001 | 45/52 (86.5) |
Parity of the patients
| Author | Journal | Year | First parity at operation | First parity at occurrence |
|---|---|---|---|---|
| Rieger et al. [20] | ANZJOG | 2004 | 34/51 (66.7) | 34/51 (66.7%) |
| Rahman et al. [10] | JOG | 2003 | 28 (80.0%) | – |
| Nafiou et al. [21] | Int J G O | 2007 | 48/111 (43.2) | 57/111 (51.3) |
| Meyer et al. [22] | Am J O G | 2007 | 26/58 (26.0) | 26/58 (44.9) |
| Ijaiya and Aboyeji [23] | WAJM | 2004 | 17 (50.0%) | – |
| Melah et. al [4] | J OG | 2007 | – | 75/80 (94.0) |
| Ahmad et. al [24] | Int J G O | 2005 | 143/1,025 (13.9) | – |
| Am J O G | 2004 | 937/1,716 (54.6) | 937/1,716 (54.6) | |
| Wall et al. [26] | Am J O G | 2004 | – | 412/889 (46.3) |
| Qi Li Ya et al. [27] | Med Afr N | 2000 | – | 16/34 (47.1) |
| Hilton and Ward [28] | IUJPFD | 1998 | 190/605 (31.4) | 190/605 (31.4%) |
| Arrowsmith [29] | J Urol | 1994 | – | – |
| Gueye et al. [30] | Med Afr N | 1992 | 57/123 (46.3%) | – |
| Falandry [31] | Press Med | 1992 | 162 (70%) | – |
| Holme et al. [7] | Br J O G | 2007 | – | 117/239 (49.0) |
| Rijken and Chilopora [32] | Int J G O | 2007 | 100/379 (49.6) | |
| Jokhio and Kelly [33] | Int J G O | 2006 | – | 44/112 (39.3) |
| Gessessew and Mesfin [8] | Eth M J | 2003 | 87 (47.3%) | |
| Harouna et al. [9] | Med Afr N | 2001 | 35/52 (67.3) | – |
Antenatal care and place of delivery
| Author | Journal | Year of publication | ANC None | Home/TH attempt | Delivery at home/on the way | Delivery at the hospital |
|---|---|---|---|---|---|---|
| Rieger et al. [20] | ANZJOG | 2004 | – | – | – | – |
| Rahman et al. [10] | JOG | 2003 | – | – | – | – |
| Nafiou et al. [21] | Int J G O | 2007 | – | – | 45/111 (40.5) | 66 (59.5) |
| Meyer et al. [22] | Am J O G | 2007 | – | 55/58 (94.8) | – | 53/58 (91.4) |
| Ijaiya and Aboyeji [23] | WAJM | 2004 | – | 31/34 (91.1) | – | – |
| Melah et. al [4] | J OG | 2007 | 72/80 (90.0%) | – | – | 61/80 (76.3) |
| Ahmad et. al [24] | Int J G O | 2005 | – | – | – | |
| Am J O G | 2004 | – | – | – | – | |
| Wall et al. [26] | Am J O G | 2004 | 647/889 (72.0%) | – | – | – |
| Qi Li Ya et al. [27] | Med Afr N | 2000 | – | – | 214/34 (41.2) | 20/34 (58.8) |
| Hilton and Ward [28] | IUJPFD | 1998 | – | 552/605 (91.2%) | – | 442/605 (73.1) |
| Arrowsmith [29] | J Urol | 1994 | – | (14/93) 15% | 79/93 (85.0) | |
| Gueye et al. [30] | Med Afr N | 1992 | – | – | – | – |
| Falandry [31] | Press Med | 1992 | – | – | – | – |
| Holme et al. [7] | Br J O G | 2007 | 6/239 (2.5) | – | 23/239 (9.6) | – |
| Rijken and Chilopora [32] | Int J G O | 2007 | – | – | – | – |
| Jokhio and Kelly [33] | Int J G O | 2006 | 92/112 (81.8) | – | – | – |
| Gessessew and Mesfin [8] | Eth M J | 2003 | 169/184 (92%) | 106/184 (57.6%) | – | 78/184 (42.4) |
| Harouna et al. [9] | Med Afr N | 2001 | 40/52 (77.0%) | – | 44/52 (84.5) | 8/52 (15.4) |
Height of the patients
Duration of labor and mode of delivery
| Author | Journal | Year of publication | Labor, mean (days) | Labor > = 24 h | Instrumental | Operative delivery | CS |
|---|---|---|---|---|---|---|---|
| Rieger et al. [20] | ANZJOG | 2004 | – | – | 24/51 (47.0%) | – | – |
| Rahman et al. [10] | JOG | 2003 | 7/35 (20.0) | – | – | – | |
| Nafiou et al. [21] | Int J G O | 2007 | 3a | 103/111 (93.0) | – | – | 23/111 (20.2) |
| Meyer et al. [22] | Am J O G | 2007 | 2.61 | – | – | 21/58 (36.2%) | 13/58 (22.4%) |
| Ijaiya and Aboyeji [23] | WAJM | 2004 | 28/34 (82.4) | 1/34 (2.9%) | 4/34 (11.8%) | 2/34 (5.9%) | |
| Melah et al. [4] | J OG | 2007 | 3.6 | 75/80 (93.7) | – | – | – |
| Ahmad et al. [24] | Int J G O | 2005 | – | 790/1,086 (72.5) | – | 202/1,086 (18.6) | 79/1,086 (7.3) |
| Wall et al. [26] | Am J O G | 2004 | – | 272/898 (30.2) | – | 452/898 (50.5) | 363/898 (40.4) |
| Qi Li Ya et al. [27] | Med Afr N | 2000 | – | 34 (100.0) | 6/34 (17.6) | 4/34 (11.8) | |
| Hilton and Ward [28] | IUJPFD | 1998 | 2.5 | (1,918/2,389) 80.3% | (36/605) 6.0 | (224/605) 37.0 | (206/605) 34.0% |
| Arrowsmith [29] | J Urol | 1994 | 2.52 | (88/93) 94.9 | (9/93) 10% | – | (35/93) 38% |
| Holme et al. [7] | Br J O G | 2007 | – | 223/233 (95.7) | – | 144/239 (60.3) | 119/239 (50.2) |
| Rijken and Chilopora [32] | Int J G O | 2007 | – | – | 34/379 (9.0) | 209/379 (55.1) | 138/379 (36.4) |
| Gessessew and Mesfin [8] | Eth M J | 2003 | 3.6 | – | 52/184 (28.3%) | – | 19/184 (10.3%) |
| Harouna et al. [9] | Med Afr N | 2001 | 4.0 |
Stillbirth status of the patients
| Author | Journal | Year of publication | Stillbirth | |
|---|---|---|---|---|
| Niger | Arrowsmith [29] | J Urol | 1994 | 89/93 (96%) |
| Nigeria | Wall et al. [26] | Am J O G | 2004 | 824/898 (91.7%) |
| Niger | Meyer et al. [22] | Am J O G | 2007 | 53/58 (91.4%) |
| Nigeria | Hilton and Ward [28] | IUJPFD | 1998 | 543/605 (89.7%) |
| Ethiopia | Gessessew and Mesfin [8] | Eth M J | 2003 | 167/193 (86.6%) |
| Malawi | Rijken and Chilopora [32] | Int J G O | 2007 | 305/379 (80.5) |
| Zambia | Holme et al. [7] | Br J O G | 2007 | 185/239 (78.1%) |
Discussion
We found that 8.9% to 86% of obstetrical fistula patients are teenagers at the time of management (Table 4), and 31% to 66.7% were primiparous at the moment of occurrence. (Table 5). Previous studies found a higher rate of obstetrical complications in teenagers; Unfer et al. reported a higher rate of cesarean section in teenagers compared to women in their twenties. Unfer et al. also reported a higher incidence of low birth weight infants and acute intrapartum distress in adolescent mothers [34]. The increased obstetrical risk in teenagers can partially be explained by anatomic immaturity. Teenage pregnancies account for a higher proportion of all pregnancies (7–30%) in developing countries [35, 36]. These findings suggest that efforts to reduce obstetrical fistula should target teenagers.
We found that 57.6% to 94.8% of obstetrical fistula patients tried to labor at home but were later transferred to health facilities and 9% to 84% of the patients delivered at home (Table 6).
The WHO recommends that labor should be monitored with a partograph (an instrument on which the labor events are recorded) and interpreted for decision making during labor and delivery. This is impossible if women choose to labor at home [37, 38]. When women try to labor at home unsuccessfully, they are more likely to come to the hospital at a late stage. This may be further delayed by the absence of transportation, poor roads, heavy rains, and great distances to the health facility. In many developing countries, patients have to use their own money to pay for health care, and this may further delay treatment.
The mean duration of labor in fistula patients ranged from 2.5 to 4 days. Twenty to 95.7% of these women had labored for more than 24 h, and operative delivery was performed in 11% to 60% of the indexed deliveries leading to fistula formation (Table 8). Cephalopelvic disproportion (CPD) was the most common indication for cesarean delivery in sub-Saharan Africa [39, 40, 41]. Previous studies have found CPD as the primary indication in 30%, 33%, and 34% of cesarean deliveries in Senegal, Cameroon, and Namibia, respectively.
Delay in intervention increases the time of compression of the mother’s soft pelvic organs (i.e., bladder and rectum) between the fetal presentating part (i.e., the fetal head) and the mother’s pelvic bones, leading to uterine rupture, obstetric fistula, and fetal death. These observations suggest that emergency obstetrical care should be a cornerstone of any obstetrical fistula prevention program. We found that more than 78% of fistula patients did not have a live baby. Our findings strongly emphasize on the association between obstetric fistula (OF) and stillbirth. This suggests that the OF patients will not suffer only from their physical condition but will also suffer from psychological setbacks due to the loss of the pregnancy [7, 8, 22, 26, 28, 29, 32].
Conclusion
Obstetric fistula is associated with several risk factors, and they appear to be preventable. This disease is associated with teenage status at delivery, primiparity, prolonged labor, home delivery, and short status at delivery. Knowledge of the leading risk factors for obstetrical fistula in a given population is of paramount importance and should be studied. This knowledge should be used in strengthening preventive strategies both at the health facility and at the community level.
Notes
Acknowledgments
The authors would like to thank Ms. Mamma Danna for her secretarial assistance and the personnel of the Department of Obstetrics and Gynaecology in Regional Hospital Maroua for their interest on the assessment of the day practice
Conflicts of interest
None.
Open Access
This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.
References
- 1.Bangser M (2006) Obstetric fistula and stigma. Lancet 367(9509):535–536PubMedCrossRefGoogle Scholar
- 2.Cook RJ, Dickens BM, Syed S (2004) Obstetric fistula: the challenge to human rights. Int J Gynaecol Obstet 87(1):72–77PubMedCrossRefGoogle Scholar
- 3.Tebeu PM, de Bernis L, Doh AS, Rochat CH, Delvaux T (2009) Risk factors for obstetric fistula in the Far North Province of Cameroon. Int J Gynaecol Obstet 107(1):12–15PubMedCrossRefGoogle Scholar
- 4.Melah GS, Massa AA, Yahaya UR, Bukar M, Kizaya DD, El Nafaty AU (2007) Risk factors for obstetric fistulae in north-eastern Nigeria. J Obstet Gynaecol 27(8):819–823PubMedCrossRefGoogle Scholar
- 5.Waaldijk K (1994) The immediate surgical management of fresh obstetric fistulas with catheter and/or early closure. Int J Gynaecol Obstet 45(1):11–16PubMedCrossRefGoogle Scholar
- 6.Stanton C, Holtz SA, Ahmed S (2007) Challenges in measuring obstetric fistula. Int J Gynaecol Obstet 99(Suppl 1):S4–S9PubMedCrossRefGoogle Scholar
- 7.Holme A, Breen M, MacArthur C (2007) Obstetric fistulae: a study of women managed at the Monze Mission Hospital, Zambia. BJOG 114(8):1010–1017PubMedCrossRefGoogle Scholar
- 8.Gessessew A, Mesfin M (2003) Genitourinary and rectovaginal fistulae in Adigrat Zonal Hospital, Tigray, north Ethiopia. Ethiop Med J 41(2):123–130PubMedGoogle Scholar
- 9.Harouna YD, Seidou A, Maikano S, Djabeidou J, Sangare A, Bilane SS et al (2001) La fistule vesico-vaginale de cause obstetricale:enquete aupres de 52 femmes admises au village des fistuleuses. Med Afr N 48(2):55–59Google Scholar
- 10.Rahman MS, Al Suleiman SA, El Yahia AR, Rahman J (2003) Surgical treatment of rectovaginal fistula of obstetric origin: a review of 15 years’ experience in a teaching hospital. J Obstet Gynaecol 23(6):607–610PubMedCrossRefGoogle Scholar
- 11.Sefrioui O, Aboulfalah A, Taarji HB, Matar N, el Mansouri A (2001) [Current profile of obstetrical vesicovaginal fistulas at the maternity unit of the University of Casablanca]. Ann Urol (Paris) 35(5):276–279Google Scholar
- 12.Sefrioui O, Benabbes TH, Azyez M, Aboulfalah A, el Karroumi M, Matar N et al (2002) [Vesico-uterine fistula of obstetrical origin. Report of 3 cases]. Ann Urol (Paris) 36(6):376–380Google Scholar
- 13.Chew SS, Rieger NA (2004) Transperineal repair of obstetric-related anovaginal fistula. Aust N Z J Obstet Gynaecol 44(1):68–71PubMedCrossRefGoogle Scholar
- 14.Hosseini SY, Roshan YM, Safarinejad MR (1998) Ureterovaginal fistula after vaginal delivery. J Urol 160(3 Pt 1):829PubMedGoogle Scholar
- 15.Ramsey K, Iliyasu Z, Idoko L (2007) Fistula Fortnight: innovative partnership brings mass treatment and public awareness towards ending obstetric fistula. Int J Gynaecol Obstet 99(Suppl 1):S130–S136PubMedCrossRefGoogle Scholar
- 16.Danso KA, Opare-Addo HS, Turpin CA (2007) Obstetric fistula admissions at Komfo Anokye Teaching Hospital, Kumasi, Ghana. Int J Gynaecol Obstet 99(Suppl 1):S69–S70PubMedCrossRefGoogle Scholar
- 17.Muleta M (2004) Socio-demographic profile and obstetric experience of fistula patients managed at the Addis Ababa Fistula Hospital. Ethiop Med J 42(1):9–16PubMedGoogle Scholar
- 18.Browning A (2007) The circumferential obstetric fistula: characteristics, management and outcomes. BJOG 114(9):1172–1176PubMedCrossRefGoogle Scholar
- 19.Husain A, Johnson K, Glowacki CA, Osias J, Wheeless CR Jr, Asrat K et al (2005) Surgical management of complex obstetric fistula in Eritrea. J Womens Health (Larchmt) 14(9):839–844CrossRefGoogle Scholar
- 20.Rieger N, Perera S, Stephens J, Coates D, Po D (2004) Anal sphincter function and integrity after primary repair of third-degree tear: uncontrolled prospective analysis. ANZ J Surg 74(3):122–124PubMedCrossRefGoogle Scholar
- 21.Nafiou I, Idrissa A, Ghaichatou AK, Roenneburg ML, Wheeless CR, Genadry RR (2007) Obstetric vesico-vaginal fistulas at the National Hospital of Niamey, Niger. Int J Gynaecol Obstet 99(Suppl 1):S71–S74PubMedCrossRefGoogle Scholar
- 22.Meyer L, Ascher-Walsh CJ, Norman R, Idrissa A, Herbert H, Kimso O et al (2007) Commonalities among women who experienced vesicovaginal fistulae as a result of obstetric trauma in Niger: results from a survey given at the National Hospital Fistula Center, Niamey, Niger. Am J Obstet Gynecol 197(1):90–94PubMedCrossRefGoogle Scholar
- 23.Ijaiya MA, Aboyeji PA (2004) Obstetric urogenital fistula: the Ilorin experience, Nigeria. West Afr J Med 23(1):7–9PubMedGoogle Scholar
- 24.Ahmad S, Nishtar A, Hafeez GA, Khan Z (2005) Management of vesico-vaginal fistulas in women. Int J Gynaecol Obstet 88(1):71–75PubMedCrossRefGoogle Scholar
- 25.Waaldijk K (2004) The immediate management of fresh obstetric fistulas. Am J Obstet Gynecol 191(3):795–799PubMedCrossRefGoogle Scholar
- 26.Wall LL, Karshima JA, Kirschner C, Arrowsmith SD (2004) The obstetric vesicovaginal fistula: characteristics of 899 patients from Jos, Nigeria. Am J Obstet Gynecol 190(4):1011–1019PubMedCrossRefGoogle Scholar
- 27.Ya QL, Ouattara Z, Ouottara K (2000) Traitement des fistules vesico-vaginales a l,hopital de Kati, apropos de 34 cas. Med Afr N 47(3):167–169Google Scholar
- 28.Hilton P, Ward A (1998) Epidemiological and surgical aspects of urogenital fistulae: a review of 25 years’ experience in southeast Nigeria. Int Urogynecol J Pelvic Floor Dysfunct 9(4):189–194PubMedCrossRefGoogle Scholar
- 29.Arrowsmith SD (1994) Genitourinary reconstruction in obstetric fistulas. J Urol 152(2 Pt 1):403–406PubMedGoogle Scholar
- 30.Gueye SM, Diagne BA, Mensah A (2008) Les fistules vesico-vaginales, aspects etio-pathogeniques et therapeutiques au Senegal. Med Afr N 39(8/9):559–563Google Scholar
- 31.Falandry L (1992) Vesicovaginal fistula in Africa. 230 cases. Presse Med 21(6):241–245PubMedGoogle Scholar
- 32.Rijken Y, Chilopora GC (2007) Urogenital and recto-vaginal fistulas in southern Malawi: a report on 407 patients. Int J Gynaecol Obstet 99(Suppl 1):S85–S89PubMedCrossRefGoogle Scholar
- 33.Jokhio AH, Kelly J (2006) Obstetric fistulas in rural Pakistan. Int J Gynaecol Obstet 95(3):288–289PubMedCrossRefGoogle Scholar
- 34.Unfer V, Piazze GJ, Di Benedetto MR, Costabile L, Gallo G, Anceschi MM (1995) Pregnancy in adolescents. A case–control study. Clin Exp Obstet Gynecol 22(2):161–164PubMedGoogle Scholar
- 35.Chang SC, O’Brien KO, Nathanson MS, Mancini J, Witter FR (2003) Characteristics and risk factors for adverse birth outcomes in pregnant black adolescents. J Pediatr 143(2):250–257PubMedCrossRefGoogle Scholar
- 36.Tebeu PM, Tantchou J, Obama Abena MT, Mevoula OD, Leke RJ (2006) [Delivery outcome of adolescents in Far North Cameroon]. Rev Med Liege 61(2):124–127PubMedGoogle Scholar
- 37.Beazley JM, Kurjak A (1972) Influence of a partograph on the active management of labour. Lancet 2(7773):348–351PubMedCrossRefGoogle Scholar
- 38.WHO (1994) World Health Organization partograph in management of labour. World Health Organization Maternal Health and Safe Motherhood Programme. Lancet 343(8910):1399–1404Google Scholar
- 39.Cisse CT, Faye EO, de Bernis L, Dujardin B, Diadhiou F (1998) Cesarean sections in Senegal: coverage of needs and quality of services. Sante 8(5):369–377PubMedGoogle Scholar
- 40.van Dillen J, Stekelenburg J, Schutte J, Walraven G, van Roosmalen J (2007) The use of audit to identify maternal mortality in different settings: is it just a difference between the rich and the poor? Healthc Q 10(4):133–138PubMedGoogle Scholar
- 41.Tebeu PM, Ngassa P, Mboudou E, Kongnyuy E, Binam F, Abena MT (2008) Neonatal survival following cesarean delivery in northern Cameroon. Int J Gynaecol Obstet 103(3):259–260PubMedCrossRefGoogle Scholar