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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: pmtebeu@yahoo.fr 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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  1. 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: pmtebeu@yahoo.fr Tel: 77 67 55 33

  2. Plan • Introduction • Objective • Methods • Results • Summary

  3. 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

  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

  5. 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.

  6. SearchStrategy • Term used: • obstetric fistula, • urinary fistula, • vesicovaginal fistula, • vesico vaginal fistula, • vesico-vaginal fistula, • recto-vaginal fistula, • rectovaginal fistula, • recto vaginal fistula

  7. 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

  8. Results

  9. 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

  10. Teenagers delivery in Cameroon Tebeu et al. ObstetGynecolInt 21010

  11. 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

  12. Illiteracy in Cameroon DHS 2004

  13. 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

  14. 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.

  15. 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

  16. Home delivery in Cameroon DHS 2004

  17. 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

  18. Cesarean delivery in Cameroon DHS 2004

  19. Association between CS rate and maternal mortality from 118 countries Maternalmortality rate per 100,000 live births Cesarean secttion rate Adapted from: Althabe 2006

  20. 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)

  21. Total Fertility Rate In Cameroon DHS 2004

  22. Summary on OF Riskfactors Teenage condition Nulliparity/Grand multiparity Home delivery Late arrival in the facility Poor obstetric management Prolonged labor

  23. END University Centre Hospital Yaoundé WAHA GFMR LIRASEF

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