maternal urogynaecologic conditions

1. Public Burden, Magnitude and Risk factors
of
Obstetric fistula Nationally and
Internationationally
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2.  Obstetric fistula is an abnormal opening between a woman’s genital
tract and her urinary tract or rectum
 Each year between 50 000 to 100 000 women worldwide are affected
by obstetric fistula
 On a global scale, obstetric fistula (OF) remains a significant
obstetrical problem in low-resource countries and found to be one of
the most visible indicators of maternal morbidity.
 80-90% of fistula cases are in Africa.
 In developing countries, obstetric fistulas occur at a rate of 2-5 per
1000 deliveries ( where no access to functioning obstetric service).
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3.  True Magnitude of Fistula problem world wide is underestimated
b/se ignored and outcasted.
 Countries with high incidence of maternal mortality also have
high rates of obstetric fistula
 It is estimated that more than 2 million young women live with
untreated obstetric fistula, mostly in Asia and sub-Saharan
Africa.
 In Nigeria, estimated number of unrepaired VVF cases are b/n
800,000&1,000,000 by 2001.
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4.  Ethiopia had the highest lifetime prevalence of 7.3 per 1000
for women between the ages of 15 and 49.
 In Ethiopia, among a total burden of 142,387 fistula cases, it is
estimated that 9000 new fistula cases per year, but only 1200
are treated
 Obstetric fistula has serious social and physical health
implications for women in Ethiopia
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5.  Obstetric fistula has many consequences: about 93% of women
with obstetric fistulas had a stillbirth and 97% develop mental
health problems such as depression.
 Among those who experienced depression, 54% reported
suicidal ideation.
 Further, 68% had no living children, nearly 54% were divorced,
13% were not allowed to eat with family members and 41% did
not belong to any community association.
 Obstetric fistula constitutes a severe threat to the health of
adolescent women in particular.
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6.  Obstetric fistula is closely related to prolonged and obstructed labor
where emergency obstetrical care is inaccessible and unavailable.
 A woman with obstructed labor develops a fistula when the presenting
fetal part compresses continually the birth canal tissue, bladder base,
urethra or sometimes rectum causing ischemia and necrosis of the
tissue
 Obstructed labor injury complex can lead to a host of physical and
psychological injuries and who survive develop a life-altering birth
injury i.e. obstetric fistula
 Women who experience obstetric fistula suffer constant incontinence,
shame, social segregation and health problems.
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7.  Place of birth and presence of a skilled birth attendant
 Duration of labor
 Early marriage
 women with no antenatal care and those who delivered at home
 Poverty, illiteracy, lack of education
 Harmful traditional practices, (FGM), sexual violence
 Trauma
 Infection
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8.  Poverty (Lack of education, FGM, Malnutrition)  Early
marriage  Unprotected intercourse  Unplanned
pregnancy  no ANC follow up  Poorly supervised labor
 Obstructed labor injuries complex  if untreated
premature death will occur.
 Most common cause of death Chronic renal failure,
overwhelming sepsis and sever form of adult malnutrition.
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9. 1.Vesico-vaginal Fistula
-most common obstetric fistula(78% of cases)
-classified -juxta-urethral, mid-vaginal, juxta-cervical
2.Urethro-vaginal fistula
-Usu. combined with VVF( bladder neck injury)
-Complete urethral loss in 5%of fistula patients
-Prognosis of continence is uncertain after repair (higher
chance of stress incontinence)
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10. 3.Recto-vaginal fistula
-less common than VVF
-Data from AA fistula hospital
.15.2% of fistula pts have combined VVF& RVF.
.6.8% have isolated RVF.
-Mechanism-different
a) urinary fistula- sloughing due to pressure necrosis
b) RVF
-low (majority)-due to 3rd and 4rth degree perineal tear
-High RVF-as GUF/pressure necrosis by obst.labor
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11. 4.Uretero-Vaginal Fistula (Ureteric Fistula)
-1% of obstetric fistula cases.
-ureter can be damaged accidentally during C/S or an
emergency hysterectomy for a ruptured Ux.
5.Vesico-cervical/ Vesico-uterine fistula
- uncommon(1%).
-almost always follows a C/S (iatrogenic or pushing for days
with an incompletely dilated cervix).
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12.  Involuntary loss of urine and/or faeces.
 Associated medical, Physical Injuries Psychiatrics manifestation.
 On physical examination all system can be affected ,Thorough
P/E Should be conducted with due emphasis on pelvic
examination and physical fitness of the patients.
 Assess the fistula and make classification of pathology to make
appropriate decision.
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13. Primary prevention (social measures)
 Health promotion (programmes, policies)
 Planned pregnancies
 Birth spacing, Contraception
 Community awareness (delaying age at 1st pregnancy, avoiding HTP)
Secondary prevention (basic obstetric care)
 Antenatal care, Skilled health personnel at birth, Use of partograph
 Identification of signs and symptoms of obstructed labour
 Immediate referral
 Bladder care and/or catheterization during labour, if needed
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14. Tertiary prevention (more advanced obstetric care)
 Access to emergency obstetric and neonatal care (EmONC) by
providing
 A timely, safe, quality Caesarean section by a trained/competent
surgeon
 Use of an indwelling catheter (i.e., a Foley catheter) to close
small fresh fistulae
 Preventing and managing obstetric fistula will contribute to
improved maternal health and the achievement of the
Sustainable Development Goals (SDGs).
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15.  INCONTINENCE OF URINE AND/OR STOOL
 Chronic pyelonephritis, hydronephrosis and bladder stone
 Renal failure
 Vaginal stenosis (scarring) and dyspareunia (pain during
intercourse)
 Pelvic inflammatory disease, amenorrhea and infertility
 Osteitis pubis (infection in the pubic bone and pubic
symphysis)
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16.  Lumbar plexus and/or peroneal nerve damage resulting in foot
drop, loss of control of rectal muscles and numbness/weakness
pelvic area and lower extremities.
 This may lead to contractures of the legs
 Urea dermatitis - Chronic irritation and excoriation of skin
(labia, perineum, groin) from contact with urine and stool
 Malnutrition – often a result of neglect, depression and poverty
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17. THANK YOU
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