Profiles of women presenting with obstetric fistulae at Universitas Academic Hospital, Free State province, South Africa
Loading...
Date
2019-07
Authors
Marokane, Masekhokho M. P.
Journal Title
Journal ISSN
Volume Title
Publisher
University of the Free State
Abstract
Background: Obstetric fistula is a serious consequence of prolonged and obstructed labour, common in low income countries were accessibility to emergency obstetric care may be limited. Most common cause is ischemia and necrosis of the soft tissues of the birth canal caused by the compression of the foetal presenting part against the bony pelvis. This results in abnormal communication between the vagina, bladder and/or rectum with resultant leakage of stools or/and urine through the vagina. Other causes may be tearing of those tissues or iatrogenic injury during abortions. Objectives: Primary objective To determine the prevalence of obstetric fistula at Universitas Academic Hospital urogynaecology clinic Secondary objective To determine the demographic characteristics of the women presenting with obstetric fistulae. Study design and methods: Retrospective descriptive-analytical study. Medical records and demographic characteristics of all patients referred to Universitas Academic Hospital's urogynaecology clinic with obstetric fistulae from 01 January 2013 to 31 December 2017. A 21- item data sheet was used to collect data and the latter was analysed on the Microsoft excel spreadsheet. Limitations: Small sample size, only 46 patients met the inclusion criteria over the 5 year study period. Results: The prevalence of obstetric fistula at UAH urogynaecology clinic was found to be 1% which correlates with the global estimates in the literature. The most common type of fistula was found to be rectovaginal fistula (63.04%) and mostly they developed as a result of soft tissue lacerations not necessarily ischemia and necrosis. Only 5(10.87%) patients in our population group delivered before the age of 20 though it is reported globally that this condition is the most in teenagers. Fifty percent of the study population were not married and only 2(4.35%) of the married ones were divorced. 63.04% of the study population had high school level education and only 8.7% of them were employed. Out of 46 participants only 2 (4.35%} did not seek antenatal care, the median number of follow-up in this group was 4 antenatal visits. Almost all of them {91.3%) delivered normally and only 4 had episiotomies. The perineal (71.74%) tears were common in this study group and some remained not sutured. Most of them delivered at a level 2 health care facility. Conclusion: The prevalence of obstetric fistula in our setting although shown to be low, like in the rest of the world, more attention should be paid to maternal health services as this complication of child birth is the indicator of poor/inadequate health service. Although the level 2 facilities are regarded as well equipped to deal with obstetric emergencies authorities are urged to pay more attention to skill development of the personnel rendering the maternity care as most of these cases were not appropriately managed during the intrapartum period, use of partogram during labour during be encouraged so that those patients who will end up with obstructed labour can be identified timeously.
Description
Keywords
Dissertation (M.Med. (Obstetrics and Gynaecology))--University of the Free State, 2019, Obstetric fistula, Generative organs, Female, Fistula, Vesico-vaginal