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Roa, Lina, Luke Caddell, Gabriel Ganyaglo, Vandana Tripathi, Nazmul Huda, Lauri Romanzi, and Blake C. Alkire. "Toward a complete estimate of physical and psychosocial morbidity from prolonged obstructed labour: a modelling study based on clinician survey." BMJ Global Health 5, no. 7 (July 2020): e002520. http://dx.doi.org/10.1136/bmjgh-2020-002520.
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IntroductionProlonged obstructed labour often results from lack of access to timely obstetrical care and affects millions of women. Current burden of disease estimates do not include all the physical and psychosocial sequelae from prolonged obstructed labour. This study aimed to estimate the prevalence of the full spectrum of maternal and newborn comorbidities, and create a more comprehensive burden of disease model.MethodsThis is a cross-sectional survey of clinicians and epidemiological modelling of the burden of disease. A survey to estimate prevalence of prolonged obstructed labour comorbidities was developed for prevalence estimates of 27 comorbidities across seven categories associated with prolonged obstructed labour. The survey was electronically distributed to clinicians caring for women who have suffered from prolonged obstructed labour in Asia and Africa. Prevalence estimates of the sequelae were used to calculate years lost to disability for reproductive age women (15 to 49 years) in 54 low- and middle-income countries that report any prevalence of obstetric fistula.ResultsPrevalence estimates were obtained from 132 participants. The median prevalence of reported sequelae within each category were: fistula (6.67% to 23.98%), pelvic floor (6.53% to 8.60%), genitourinary (5.74% to 9.57%), musculoskeletal (6.04% to 11.28%), infectious/inflammatory (5.33% to 9.62%), psychological (7.25% to 24.10%), neonatal (13.63% to 66.41%) and social (38.54% to 59.88%). The expanded methodology calculated a burden of morbidity associated with prolonged obstructed labour among women of reproductive age (15 to 49 years old) in 2017 that is 38% more than the previous estimates.ConclusionsThis analysis provides estimates on the prevalence of physical and psychosocial consequences of prolonged obstructed labour. Our study suggests that the burden of disease resulting from prolonged obstructed labour is currently underestimated. Notably, women who suffer from prolonged obstructed labour have a high prevalence of psychosocial sequelae but these are often not included in burden of disease estimates. In addition to preventative and public health measures, high quality surgical and anaesthesia care are urgently needed to prevent prolonged obstructed labour and its sequelae.
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Shaikh, Shahida, AH Shaikh, SAH Shaikh, and B. Isran. "Frequency of Obstructed Labor in Teenage Pregnancy." Nepal Journal of Obstetrics and Gynaecology 7, no. 1 (October 7, 2013): 37–40. http://dx.doi.org/10.3126/njog.v7i1.8834.
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Aims: Teenage pregnancy has globally recognized as high risk pregnancy. Under grown pelvic bones at delivery pose greater risk of obstructed labour in such young girls resulting in poor feto-maternal outcome. Objective of this study was to determine the frequency of obstructed labor in teenage pregnancy and to know fetomaternal outcome. Methods: This Cross Sectional Observational study was conducted at department of Obstetrics and Gynecology unit I and II, Shaikh Zyed Women Hospital Chandka Medical College, Shaheed Mohtarma Benazir Bhutto Medical University Larkana Sindh Pakistan from 1st January 2010 to 31st December 2010. 468 women admitted with obstructed labour of all age groups, out of these which 257 patients were teenage mothers. Patients selected after fulfilling selection criteria. Obstructed labour in teenage patients wasdiagnosed on the basis of history of prolonged labour and clinical presentation. Demographical characteristics noted. Mode of the delivery and fetomaternal outcome was observed. Statistical analysis was performed using SPSS. 12 version. Results: Total deliveries in both units during study period were 9000. Among them 468(5.2%) patients found to have obstructed labour. Out of these 257(2.85% of total) patients were teenagers.. 82% (210) teengers were non booked and admitted in emergency while only 18 %(47) came through OPD having a single visit. Mean age was 16±2 years and parity was 2±1.5.Mode of delivery was LSCS in 84% (214) ,assisted vaginal delivery in 12% (32) and 4% (11)had spontaneous delivery with episiotomy. Cephalopelvic disproportion remained the commonest reason of obstruction (66%). 1.94% (5) of patients died of septicemia .PPH seen in 41% (105),1.1% (3) had scar dehiscence due to prolonged trial by untrained birth attendant.1.94% (5) patients developed vesicovaginal fistula later on. Perinatal mortality was around 54.6% (142) while 44.75 % (115) babies born alive. Conclusions: Adolescent pregnant women not only face pregnancy related problem but also they are prone to have obstructed labour due to their developing pelvic bones. Obstructed labour is one of the most common and preventable causes of maternal and perinatal deaths and disabilities. Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 1 / Issue 13 / Jan- June, 2012 / 37-40 DOI: http://dx.doi.org/10.3126/njog.v7i1.8834
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Ekanem, E. I., A. Umoiyoho, and A. Inyang-Otu. "Study of Electrolyte Changes in Patients with Prolonged Labour in Ikot Ekpene, a Rural Community in Niger Delta Region of Nigeria." ISRN Obstetrics and Gynecology 2012 (December 17, 2012): 1–6. http://dx.doi.org/10.5402/2012/430265.
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Background. Prolonged obstructed labour is a major cause of maternal and perinatal morbidity and mortality especially in the developing countries of the world, where the incidence is high. These complications are partly attributed to the metabolic and electrolyte derangements that are often associated with this problem. It is, therefore, important to evaluate the metabolic and electrolyte changes of these patients in a rural community in a developing country. Objective. To compare the electrolyte changes, maternal, and perinatal outcomes in patients with prolonged obstructed labour with that of normal labour in General Hospital Ikot Ekpene, Akwa Ibom State, Nigeria. Patients and Methods. This is a prospective cross-sectional case control study conducted in the Labour Ward of the General Hospital Ikot Ekpene to compare the electrolyte levels and perinatal outcome of 95 pregnant women who had prolonged labour with 105 women who had normal labour within the same period. Main Outcome Measures. Electrolyte changes, ketonuria, maternal complications, and perinatal outcome. Results. The majority of women with prolonged labour (91.6%) had major surgical interventions requiring anaesthesia. Perinatal death occurred in 12.6%, and a major life-threatening maternal complications (including two deaths) occurred in 13.7% of those with prolonged labour compared to 2.9% (with no death) in those with normal labour. Significant abnormal electrolyte changes included hyperkalemia, high urea, and creatinine as well as low bicarbonate levels were recorded. Metabolic abnormality was shown by ketonuria in 91.1% of the patients compared to 1.9% in women with normal labour. Conclusion. Women with prolonged labour in Ikot Ekpene have significant electrolyte and metabolic changes which impact adversely on the maternal and perinatal outcomes of the pregnancy. Effort should be made to correct these electrolyte and metabolic abnormalities during resuscitation of the woman in order to reduce the complications associated with such derangements.
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Indra, Usharani N., and Mumtaz Bendigeri. "A study on clinical outcome of obstructed labour." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, no. 2 (January 31, 2017): 439. http://dx.doi.org/10.18203/2320-1770.ijrcog20170027.
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Background: Obstructed labour accounts for 8% of maternal mortality in developing countries. Obstructed labour is the single most important cause of maternal death and is one of the three leading causes of perinatal mortality with the case fatality rate of 87-100%.Methods: The 50 patients with prolonged labour and maternal distress with signs and symptoms of maternal exhaustion, dehydration, keto-acidosis, Bandl’s ring formed the study subjects.Results: Out of the 50 cases studied the still birth rate was 24% (12 cases). This was due to delay in the referring the cases from peripheral centers.Conclusions: Our peripheral hospital need appointment of qualified personnel and well trained staff, who can recognize any deviation from normal labour and recognize malpresentation and malposition at the earliest and refer such cases to higher centers.
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Reshma, Shaik, and Sri Lakshmi Ambarkar. "Paperless partogram: a simple clinical tool in effective labour management." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 10, no. 6 (May 27, 2021): 2308. http://dx.doi.org/10.18203/2320-1770.ijrcog20212167.
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Background: Maternal mortality is unacceptably high, about 830 women die from pregnancy or child birth related complications around the world every-day. Prolonged and obstructed labour is one of the major causes of maternal and perinatal mortality and morbidity worldwide. In developing countries like India, around 5% of total maternal deaths are caused by prolonged and obstructed labour. The purpose of the present study is to evaluate the role of paperless partogram in management of labour, identification of abnormal labour and early intervention to prevent the maternal and perinatal morbidity. The objective of this study was to assess the role of paperless partogram in labour monitoring and decision-making in overburdened Indian labour room setup and to evaluate the outcome of the cases.Methods: A prospective study was conducted at a tertiary care hospital, Kurnool, Andhra Pradesh, between January 2020 to March 2020. A total of 300 pregnant mothers in established labour who fulfilled the inclusion criteria, were included in the study after taking informed consent.Results: In our study, of all the pregnant women 23 crossed the alert ETD but 16 had delivered vaginally and 2 by caesarean section before action ETD and 5 women crossed the action ETD. Among the 5 who crossed action ETD 3 delivered vaginally and 2 had cesarean section. Majority, of the women who crossed the alert and action ETDs were primigravidae.Conclusions: From our study, it is concluded that paperless partogram was effective and user friendly in management of labour and prevention of abnormal or prolonged labour.
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Bansal, Anshul, and Ruchi Kalra. "Feto maternal outcome in obstructed labor: a tertiary centre study." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, no. 6 (May 28, 2019): 2499. http://dx.doi.org/10.18203/2320-1770.ijrcog20192457.
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Background: The number of maternal deaths as a result of obstructed labor is 8% globally but this number varies in developing country, it ranges 4-70% of all maternal deaths and it is also associated to high perinatal mortality rate. Objective of the study was to find out the proportion of obstructed labour cases and their feto-maternal outcome during last 3 years at tertiary level institute.Methods: A cross sectional observation study was done at Department of Obstetrics and Gynecology, People’s College of Medical Sciences and Research Centre Bhopal. All pregnant women presenting with obstructed labor who delivered at our hospital during last 3 years duration (January 2015 to December 2017) were studied for their feto -maternal outcome.Results: 53% cases had duration of trail more than 16 hours. 84% were referred from primary health centers of nearby rural areas. All cases of obstructed labor delivered by cesarean section (100%). 44% were primigravida. 72% of cases had Cephalopelvic disproportion as the cause. 28% of cases had longer stay more than 7 days at hospital. 32% had fever during post operative period 12.5% cases had wound sepsis and 6% of cases required re-suturing of wound during post operative period. 72% baby's birth weight was between 3 to 3.4 kg. 94% of the babies survived where as 6% of babies were still birth. 16% of babies born to obstructed labor mother had APGAR less than 7 at 5 minutes of birth. 6% fetus were IUFD.Conclusions: Cephalopelvic disproportion was the most common cause for obstructed labor. Timely identification of prolonged labor and timely referral and management at place where operation theatre, NICU and blood bank facilities are available can save the life of both baby and mother.
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Ahmed, Benazir, Meena Jain, and Hema Bharwani. "Partograph versus no partograph: effect on labour progress and delivery outcome: a comparative study." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, no. 11 (October 28, 2017): 4928. http://dx.doi.org/10.18203/2320-1770.ijrcog20175002.
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Background: Abnormal labour which includes prolonged labour and obstructed labour remain major causes of maternal morbidity. The major reason for neonatal mortality, birth asphyxia and subsequent morbidity is essentially the repercussion which occurs when a complicated labour is not intervened at the right time. A Partograph provides a graphic overview of the progress of labour and records information about maternal and fetal condition during labour. It is considered to be a very effective tool to monitor labour progress and prevent prolonged and obstructed labour.Methods: This prospective randomised comparative study was conducted in the Department of Obstetrics and Gynaecology, JLN Hospital and RC, Bhilai, Chattisgarh, from January 2015 to June 2016. Pregnant women were randomly assigned to two groups, of 200 each, after satisfying the inclusion and exclusion criteria. Women assigned to Group 1 had their active labour modified using modified WHO partograph whereas those assigned to Group 2 were not monitored using the partograph.Results: Use of Partograph (group 1) significantly reduced the duration of active phase of labour (p <0.0001), duration of second stage (p <0.0001) and thus the total duration of labour (active phase plus second stage) (p <0.0001). Requirement of augmentation was also significantly reduced (p <0.05). Group 1 also had significantly more spontaneous vaginal deliveries (p <0.01) with lesser requirement of operative interventions like LSCS or instrumental deliveries like forceps. Use of partograph also significantly improved neonatal outcome with significantly lesser newborns with Apgar <7 (p <0.05). However, there was no significant difference between the two groups with regard to NICU admissions (p>0.05).Conclusions: The use of Partograph, when compared to no Partograph plotting in active labour, is associated with better monitoring of labour progress as well as delivery outcome in the form of a healthy mother and a healthy child.
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Abodunrin, O. N., A. B. C. Daniyan, B. Okusanya, K. C. Ekwedigwe, S. M. Uguru, E. N. Yakubu, and I. Sunday-Adeoye. "Non-Fistulous Complications of Prolonged Obstructed Labour among Obstetric Fistula Patients in Southern Nigeria." Open Journal of Obstetrics and Gynecology 09, no. 10 (2019): 1372–87. http://dx.doi.org/10.4236/ojog.2019.910133.
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Sunday-Adeoye, Ileogben, Patrick Okonta, and Ogbonnaya Lawrence Ulu. "Prevalence, profile and obstetric experience of fistula patients in Abakaliki, Southeast Nigeria." Urogynaecologia 25, no. 1 (December 2, 2011): 6. http://dx.doi.org/10.4081/uij.2011.e6.
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<em>Objective</em>. Fistula has always been thought to be a scourge of the Northern region of Nigeria only. This study was aimed at providing data on the prevalence, profile and obstetric experience of fistula patients in Abakaliki, Southeast Nigeria and to demonstrate that fistula is also a burden in the southern parts of Nigeria. <em>Materials and Methods</em>. This was a prospective descriptive study conducted between 2003 and 2009. Sample size and sampling method. Four hundred and sixty-two fistula patients who were operated at the Fistula Unit of the Teaching Hospital and later at the Southeast Fistula Centre was consecutively recruited and interviewed during the study period. <em>Results</em>. The prevalence of fistula was 4.3%, the mean age was 35±9.5 years and 8.4% was less than 20 years, majority of them had no formal education. A quarter had no occupation and majority had no regular monthly income. Twenty percent were married by the age of 14 years and majority were multiparous. In about 40%, the fistula occurred during the first child birth. About 34% were still sexually active and 30% of the married clients had achieved childbirth after development of fistula. The average height and weight were 1.47m±0.08 and 46.4kg±7.2 respectively. Majority had fistula following prolonged obstructed labour, though 42.6% eventually had caesarean section for prolonged obstructed labour. Majority of the patients were older, had a longer urine leakage and presented latter for corrective surgery than those reported from other parts of Nigeria. <em>Conclusions</em>. There is a high prevalence (43.6/1000 deliveries) of obstetric fistula in this Centre, and majority of the vesico-vaginal fistula (VVF) was due to prolonged obstructed labour. Majority of the patients were older, had a longer urine leakage and presented latter for corrective surgery than those reported from other parts of Nigeria. However, 30% of the married patients achieved a pregnancy and delivered vaginally even in the presence of the fistula.
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Sultana, Sabiha, Kamrun Nahar, Sufia Begum Sompi, and Mst Nazmunnaher Mina. "Fetomaternal Outcome of Emergency Caesarean Section in a Tertiary Level Hospital." Ibrahim Cardiac Medical Journal 7, no. 1-2 (March 4, 2019): 92–98. http://dx.doi.org/10.3329/icmj.v7i1-2.53968.
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Background & objective: Acute threat to the pregnant mother or their foetus may arise during the process of labor or any time after 28 weeks of gestation, when emergency caesarean section (CS) is indicated. But emergency CS is not completely safe to the mother or their foetus. The present study was undertaken to observe the foetomaternal outcome of emergency caesarean section.
Methods: This prospective observational study was conducted between January to June, 2010 in the Department of Obstetrics & Gynaecology, Dhaka Medical College Hospital, Dhaka. All pregnant women undergoing emergency CS admitted at the the above-mentioned Hospital were the study population. The indications for emergency CS were obstructed labour, fetal distress, prolonged labour, cord prolapse, antepartum hemorrhage, antepartum eclampsia with unfavorable cervix labor with malpresentation, history of previous one caesarean section with impending scar rapture, chorioamnionitis, failed forceps/ventous etc. A total of 672 pregnant women based on predefined eligibility criteria were consecutively included in the study and fetomaternal outcome of emergency CS was evaluated.
Result: Age distribution of the patients shows that over 30% were 25-29 years, 26.5% 30-34 years, 23.3% 20-24 years old. About 10% were < 20 years and another 10% were 35 or > 35 years old. Over 20% of the mothers were short-statured (< 140 cm), 60% were nullipara, 16.5% primipara and the rest were multipara. The indications for emergency caesarean sections were previous caesarean section with complications (23.7%) followed by foetal distress (16.2%), antepartum hemorrhage (APH) (8.6), eclampsia (7.8%), obstructed labor (7.4%), severe preeclampsia, breech, prolonged labor, cephalopelvic disproportion, PROM etc. About 25% of the women were preterm, 57% were term and 18% were post-term. A total of 230(34.2%) patients developed complications following caesarean section. Wound infection (14.3%) was the most common complication followed by wound dehiscence, puerperal pyrexia, anaemia, primary PPH, UTI, anesthesic hazarads and vesico-vaginal fistula. Sixteen (2.4%) mother died of complications. Most common causes of death were postpartum haemorrhage (12%), severe preeclampsia & eclampsia (7.1%), puerperal sepsis with septicemia (3.6%) and cardiac arrest. About 94% of fetuses were born alive, 5% were stillborn and 1% born with congenital anomalies. Early perinatal death occurred in 10% cases who were born alive, 5.2% had neonatal jaundice and 3.3% developed septicemia. Finally, 559 (83.1%) were discharged healthy. Of the total 113 perinatal deaths, 68 were early perinatal death.
Conclusion: The findings of the present study suggest that increased perinatal mortality was due to severe birth asphyxia following obstructed labour, placenta praevia, PROM with chorioamnionitis and eclampsia. Proper antenatal care, screening of high-risk pregnancy, timely hospital admission, neonatal resuscitation and establishment of specialized neonatal care unit can significantly reduce perinatal morbidity and mortality
Ibrahim Card Med J 2017; 7 (1&2): 92-98
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Akpan, Ubong, Chinyere Akpanika, Victor Nwagbara, Udeme Asibong, and Saturday Etuk. "Uterine Rupture with Evisceration of Intestines through the Vagina during Labour." Case Reports in Obstetrics and Gynecology 2019 (December 20, 2019): 1–3. http://dx.doi.org/10.1155/2019/5234641.
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Uterine rupture is a life threatening obstetric emergency and is associated with high maternal and perinatal mortality. There are some risk factors associated with uterine rupture which may include: prolonged obstructed labour, previous scarred uterus, grand-multiparity, macrosomic baby, abnormal lie, instrumental delivery, induction of labour, oxytocin stimulation and excessive uterine manipulation. Its modes of presentation have been widely reported. Here, we present a case with an unusual mode of presentation where about two-third of the small intestines protruded through the vagina following some manipulations by an unskilled birth attendant. This highlights the fact that when uterine rupture is suspected, the cord-like structure protruding per vaginum may not always be umbilical cord.
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Jain, Prekshi, Akshay C. Shah, Babulal S. Patel, and Shashwat K. Jani. "Partographic analysis of labour by modified WHO partograph in tertiary care centre." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 10, no. 5 (April 23, 2021): 1920. http://dx.doi.org/10.18203/2320-1770.ijrcog20211512.
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Background: The partograph is a simple, inexpensive tool to provide a continuous pictorial overview of labor. The goal of this study is to use partograph to monitor labor, initiate uterine activity that is sufficient to produce cervical changes, fetal descent while avoiding uterine hyperstimulation, hypostimulation and fetal distress and provide timely surgical intervention where required. Methods: A hospital-based observational study involving prospective review of partographs for births that occurred in 2020 was conducted in 2 hospitals including SVP Hospital and V.S hospital Ahmedabad. A partographic analysis of labour was done in randomly selected 200 patients using modified WHO partogram. The study population was divided into Primigravida (96) and Multigravida (104) term patients. partograph recording were commenced at 4 cm dilatation. close maternal and fetal monitoring was done throughout the labour and partogram was plotted to detect any deviation from normal course.Results: Patients were grouped into primigravida and multigravida and based on partogram finding divided into mode of delivery. 22 of total 96 primigravida underwent caesarean section and 74 delivered vaginally. 8 of total 104 multigravida underwent caesarean section and 96 delivered vaginally. Out of 200 newborn only 11 had Apgar score <7 at 5 minutes.Conclusion: The WHO modified partograph is highly effective in reducing both maternal and neonatal morbidity. It aids in assessing the progress of labour and to identify when intervention is necessary. It is effective in preventing prolonged labour, obstructed labour, reducing operative intervention and improving neonatal outcome.
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Patel, Archana, Yamini Vinod Pusdekar, Amber Abhijeet Prakash, Elizabeth Simmons, Manjushree Waikar, Sowmya R. Rao, and Patricia L. Hibberd. "Trends and determinants of increasing caesarean sections from 2010 to 2013 in a prospective population-based registry in eastern rural Maharashtra, India." BMJ Open 9, no. 8 (August 2019): e024654. http://dx.doi.org/10.1136/bmjopen-2018-024654.
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ObjectiveOur objective was to describe trends in caesarean section (CS) rates, characteristics of women delivering by CS, reasons for CS and impact of CS on perinatal mortality, in a rural Indian population.DesignSecondary data analysis using a prospective population-based registry.SettingFour districts in Eastern Maharashtra, India, 2010 to 2013.Participants39 026 pregnant women undergoing labour and delivery.Main outcomesCS, single most likely reason, perinatal mortality.ResultsOverall, 20% of the women delivered by CS. Rates increased from 17.4% in 2010 to 22.7% in 2013 (p<0.001) with an absolute risk increase from 1% to 5% during this time-period. Women aged 25+ years old, being nulliparous, having at least a secondary school education, a body mass index 25+ and a multiple gestation pregnancy were more likely to deliver by CS. Perinatal mortality was higher among babies delivered vaginally than those delivered by CS (4.5% vs 2.7%, p<0.001). Prolonged and obstructed labour as the reported reason for CS increased over time for both nulliparous and multiparous women (p<0.001), and 6% to 10% women had no clear reason for CS. Perinatal mortality was higher among babies born vaginally than those delivered by CS (adjusted OR: 0.65, 95% CI 0.56 to 0.76, p<0.001).ConclusionRates of CS increased over time in rural Maharashtra, exceeding WHO recommendations. Characteristics associated with CS and outcomes of CS were similar to previous reports. Further studies are needed to ensure accuracy of reported reasons for CS, why obstructed and prolonged labour leading to CS is increasing in this population and what leads to CS without a clear indication. Such information may be helpful for implementing the Indian Government mandate that no CS be performed without strict medical indications, while ensuring that the overall CS rates are appropriate.Trial registration numberNCT01073475.
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Thiagarajan, Senthil Kumar. "Vesico-Salpingo Fistula Masquerading as Hydrosalpinx with Neurogenic Bladder - An Interesting Case Report." Journal of Evolution of Medical and Dental Sciences 10, no. 34 (August 23, 2021): 2942–44. http://dx.doi.org/10.14260/jemds/2021/600.
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A fistula is an abnormal connection between two luminal structures of different epithelium. The majority of urological fistulas in developed countries are consequences of iatrogenic injury most commonly laparoscopic hysterectomies, or from radiotherapy in the treatment of pelvic cancers.1 Contrary to this, most obstetric fistulas in developing countries result from obstructed labour during childbirth.2 Common factors that contribute to obstructed labour in developing countries are delayed presentation after trial labour at home, cephalopelvic disproportion and poor nutrition. Due to prolonged compression by head on the pelvic tissues there happens ischemic necrosis of vagina, bladder neck, and urethra3 called obstructed labour complex. Necrosis and fibrotic healing lead to fistula formation with adjacent structures. The vesicovaginal fistula was the most frequent one (78 %) and the common site involved was trigone (51 %) and based on the level it could be a high or low fistula. Others are vesicouterine fistula, vesicourethral fistula, vesicoureteral fistula and rarely vesico-salpingo fistula. During the acute phase of fistula, tissue oedema, hypovascularity, infection, and nonviable tissue hinder proper tissue healing and hence delayed repair is done after 3 months. Recent literature advises early repair for simple fistulas to reduce patient morbidity and delayed repair of complex fistula, multiple fistulas, infected fistulas, post-radiotherapy, fistula due to foreign bodies, immunocompromised patients, hypoproteinaemia patients, urosepsis patients. 4 Fistula repair is preceded by contrast evaluation of ureter and bladder by CT –IVU and cystogram or MRI followed by cystoscopy or retrograde pyelography. Apart from fistula closure, bilateral ureteric implantation may be needed if ureters are close to the fistula. 5 Abdominal hysterectomy is done in uterovesical fistulas. Huge fistulas close to the bladder neck cannot be repaired without compromising continence hence bladder neck closure is done with the Mitrofanoff procedure. 6 A vesico-salpingo fistula is an abnormal epithelial-lined communication between the urinary bladder and the fallopian tube. This rare type of urogenital fistula has only 7 previously published cases in the literature.
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Sultana, Rifat, Mahmuda Khatun, Dewan Shahida Banu, Mst Nurunnahar Aktar, Rumana Ashraf, Afrin Billah, and Shahana Nazneen. "Indications of Emergency Caesarean Section at a Tertiary Care Hospital in Dhaka City." Journal of Science Foundation 15, no. 2 (August 28, 2018): 36–40. http://dx.doi.org/10.3329/jsf.v15i2.37780.
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Background: Caesarean Section is now a common surgical practice during child birth.Objective: The purpose of the present study was to see the indication of emergency caesarean section.Methodology: This descriptive type of cross sectional study was conducted in the Department of Gynaecology & Obstetrics at Dhaka Medical College Hospital during the period from July 2006 to December 2006 for a period of 6 months. The pregnant women who were selected for emergency caesarean section during the mentioned period of study were included as study population. The details of the indication of the caesarean section were recorded.Result: A total number of 100 cases were recruited in this study. Among the all indications of emergency caesarean section history of previous caesarean section was the most common which was found in 25(25.0%) cases. Foetal distress was the second common indication of emergency caesarean section which was 18(18.0%) cases. Obstructed labour was also reported in 11(11.0%) cases. Antepartum haemorrhage (8.0%) was another indication of emergency caesarean section. Considering the hypertensive disorder preeclamptic toxaemia (7.0%), eclampsia (5.0%) and pregnancy induced hypertension (1.0%) were the reported as the indications of emergency caesarean section. Some other indications of emergency caesarean section were recorded which were mal-presentation (7.0%), prolonged labour (6.0%), cephalopelvic disproportion (4.0%) and failed trial labour (4.0%).Conclusion: In conclusion history of previous caesarean section is the most common indication for emergency caesarean section obstructed labour, antepartum haemorrhage as well as foetal distress, malpresentation and cephalopelvic disproportion.Journal of Science Foundation 2017;15(2):36-40
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Jain, Shuchi, Pramod Kumar, Manish Jain, Megha Bathla, Shiv Joshi, Sushil Srivastava, Mahtab Singh, Ajit Sudke, Vikram Datta, and Poonam Shivkumar. "Increasing adherence to plotting e-partograph: a quality improvement project in a rural maternity hospital in India." BMJ Open Quality 10, Suppl 1 (July 2021): e001404. http://dx.doi.org/10.1136/bmjoq-2021-001404.
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Abnormal prolonged labour and its effects are important contributors to maternal and perinatal mortality and morbidity worldwide. E-partograph is a modern tool for real-time computerised recording of labour data which improves maternal and neonatal outcome. The aim was to improve the rates of e-partograph plotting in all eligible women in the labour room from existing 30% to achieve 90% in 6 months through a quality improvement (QI) process.A team of nurses, obstetricians, postgraduates and a data entry operator did a root cause analysis to identify the possible reasons for the drop in e-partograph plotting to 30%. The team used process flow mapping and fish bone analysis. Various change ideas were tested through sequential Plan-Do-Study-Act (PDSA) cycles to address the issues identified.The interventions included training labour room staff, identification of eligible women and providing an additional computer and internet facility for plotting and assigning responsibility of plotting e-partographs. We implemented these interventions in five PDSA cycles and observed outcomes by using control charts. A set of process, output and outcome indicators were used to track if the changes made were leading to improvement.The rate of e-partograph plotting increased from 30% to 93% over the study period of 6 months from August 2018 to January 2019. The result has been sustained since the last PDSA cycle. The maternal outcome included a decrease in obstructed and prolonged labour with its associated complications from 6.2% to 2.4%. The neonatal outcomes included a decrease in admissions in the neonatal intensive care unit for birth asphyxia from 8% to 3.4%. It can thus be concluded that a QI approach can help in improving adherence to e-partography plotting resulting in improved maternal health services in a rural maternity hospital in India.
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Rajoriya, Mohini, and Ruchi Kalra. "Comparative feasibility of two World Health Organization partographs to predict prolonged labour: a randomized control trial." International Journal of Clinical Trials 6, no. 4 (October 19, 2019): 167. http://dx.doi.org/10.18203/2349-3259.ijct20193674.
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<p class="abstract"><strong>Background:</strong> One of the major causes of maternal mortality is obstructed labor. Identification of abnormal labor at earliest and timely management can prevent prolonged labor and significantly reduce its sequel. Partograph is a useful tool in hands of labor care givers to monitor labor course. The study was done to compare feasibility of two WHO partographs a composite partograph including the latent phase with a simplified one without the latent phase to predict prolonged labor in randomized control trial.</p><p class="abstract"><strong>Methods:</strong> A randomized controlled trial, with parallel arm design was conducted. Sample size was calculated as 404 pregnant women .They were randomly categorized in two groups, each group having 202 participants.</p><p class="abstract"><strong>Results:</strong> labor had crossed the alert line in 108 (53.4%) cases monitored by composite partograph and 38(18.8%) cases monitored with simplified partograph. The calculated P value was <0.0001. The odds ratio calculate was 4.95 and 95% confidence interval was 3.16 to 7.76. Labor crossing the action line was found in 16 (7.9%) in composite partograph whereas in simplified partograph, labor had crossed the action line in 18 cases in simplified group. Calculated P value was 0.72 (>0.05). The odds ratio was 0.8793 and 95% confidence interval 0.43 to 1.77 which was not significant statistically .Most participants (70%) experienced difficulty with the composite partograph, but no participant reported difficulty while plotting the simplified partograph.</p><p class="abstract"><strong>Conclusions: </strong>WHO simplified partograph was found to be as good as WHO composite partograph in identifying maternal and perinatal outcomes and was more user friendly.</p>
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AKHTAR, YASMEEN. "RUPTURED UTERUS." Professional Medical Journal 17, no. 02 (June 10, 2010): 314–17. http://dx.doi.org/10.29309/tpmj/2010.17.02.2439.
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Objective: To analyze the risk factors for uterine rupture and to share the 5 years experience of ruptured uterus with other colleagues of the specialty. Study design: Case series descriptive study. Settings: Gynae /Obstetrics Unit -I Lady Willingdon Hospital Lahore. Study Duration: Five years i.e Ist May 2004 to 30th April 2009. Material and Methods: Obstetric patients who presented with ruptured uteri. Results: Results showed that risk factor for ruptured uteri include cesarean sections (61.11%), grand multiparty (16.6%), Instrumentaldeliveries (4.44%) and undetected perforation (1.11%). Conclusion: Ruptured uterus is a high risk category of patients. The patients with previous scar, grand multiparas, obstructed prolonged labour must be managed by proper trained personnel and in tertiary care centers in order to avoid the morbidity or mortality due to ruptured uterus.
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Ngongo, CJ, TJIP Raassen, L. Lombard, J. Roosmalen, S. Weyers, and M. Temmerman. "Delivery mode for prolonged, obstructed labour resulting in obstetric fistula: a retrospective review of 4396 women in East and Central Africa." BJOG: An International Journal of Obstetrics & Gynaecology 127, no. 6 (January 2, 2020): 702–7. http://dx.doi.org/10.1111/1471-0528.16047.
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Bello, Oluwasomidoyin O., and Olatunji O. Lawal. "A case series of masquerade postpartum haemorrhage." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, no. 12 (November 26, 2018): 5165. http://dx.doi.org/10.18203/2320-1770.ijrcog20184986.
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Postpartum hemorrhage (PPH) is an obstetric emergency with different causes. Management is directed towards the cause and can be medical or surgical. This is a case series report of four patients who presented to University College Hospital; Ibadan, Nigeria with PPH following emergency caesarean section (EMCS) with three performed for prolonged obstructed labour. All the cases had severe PPH, hemodynamic instability and presented 14 to 84 days post caesarean section. Surgical exploration revealed extension of caesarean incision into the uterine vessel with slipped ligature in two of them and bleeding vessel without ligature in the other two. Two had haemostasis secured with uterine artery ligation, one had repair of uterine incision extension while the 4th had hysterectomy. The length of hospital stay was 5 to 13 days. All recovered fully post-operatively and were discharge home in good clinical condition.
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Sharmin, S., M. Rashid, SC Hazra, and L. Khondker. "Implementation of Partograph and Its Effect on Outcome of Spontaneous Labour at Term." Bangladesh Medical Journal 41, no. 1 (May 4, 2014): 42–44. http://dx.doi.org/10.3329/bmj.v41i1.18781.
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A cross sectional study was carried out in the department of Obstetrics and Gynae of Dhaka Medical College Hospital (DMCH). Two hundred thirty two cases who fulfilled the inclusion criteria were studied. This study aimed to assess the outcome of implementation of WHO modified partograph in labour management with special interest to evaluate the fetomaternal outcome. Among the 232 cases, engaged fetal head had more vaginal delivery, 78.8% than unengaged head. The rate of caesarean section was 26.9% in women with unengaged head vs 11.5% in women with engaged head in this study. This study showed that there was no LUCS when cases remained within alert line and outside the action line in partograph all were delivered by caesarean section. The rate of spontaneous delivery was more 58.6% who did not require any augmentation. On the other hand 80 percent cases of LUCS needed augmentation. In this study, 84.1 percent babies cried spontaneously, 12.9 percent cried after resuscitation and only 3 percent needed admission to neonatal care unit. The frequency of neonatal resuscitation was higher for the group who crossed the alert line (27.8%) or action line (23.1%), than the group which remained within alert line (8.6%) in partograph. Thus with proper monitoring and maintenance of partograph in labour prolonged labour or obstructed labour and their sequelae can be avoided, operative interventions will be reduced and thus fetomaternal outcome will be improved. DOI: http://dx.doi.org/10.3329/bmj.v41i1.18781 Bangladesh Medical Journal 2012 Vol. 41 No. 1; 42-44
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Wright, Jeremy, and Fekade Ayenachew Aklilu. "Re: Delivery mode for prolonged obstructed labour resulting in obstetric fistula: a retrospective review of 4396 women in Central and East Africa." BJOG: An International Journal of Obstetrics & Gynaecology 127, no. 7 (March 25, 2020): 907–8. http://dx.doi.org/10.1111/1471-0528.16188.
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Moray, Arun P., Urmila A. Moray, Vaishali M. Patil, and Grishma A. Moray. "Changing trends in the indications of obstetric hysterectomies in teaching rural hospital." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, no. 8 (July 26, 2018): 3184. http://dx.doi.org/10.18203/2320-1770.ijrcog20183314.
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Background: Obstetric hysterectomy (OH) still remains lifesaving procedure. OH still poses a major obstetrical morbidity in the developing world due to lack of human, infrastructural and monetary resources. Irrespective of attempts like good antenatal care and delivery planning in modern obstetrics to prevent major obstetric complications; unfortunately, OH needs to be performed at times even today. The aim of present study was to determine the changes in the indications of obstetric hysterectomy.Methods: A retrospective review based on hospital data of all the patients’ records subjected to OH from January 1994 to September 2001 (Gr. A) and from January 2006 to December 2015 (Gr. B) was done and analyzed for incidence and changing trends in the indications.Results: The incidence of OH during two periods from January 1994 to September 2001 (Group A) and from January 2006 to December 2015 (Group B) in the Department of Obstetrics and Gynecology at Shri. Bhausaheb Hire Govt. Medical College, Dhule was 3.27/1000 and 0.97/1000 deliveries. Incidence is reduced by more than three folds. In both groups maximum patients were below 30 yrs of age and multipara. The commonest indications for OH in both groups were uterine rupture, uncontrolled Atonic PPH and placental causes. The incidence of uterine rupture as a cause for OH was reduced from 78.16% to 43.24%, while that of Atonic PPH has increased from 16.09% to 28.37% and placental causes has increased from 4.59% to 9.45%. Among the risk factors for OH, the incidence of prolonged or obstructed labour has reduced from 66.66% to 21.62% and that of malpresentations has reduced from 27.58 to 5.4%.Conclusions: There is definite reduction in the incidence of OH, frequency of uterine rupture, obstructed labor and malpresentations in Gr. B due to timely referral, improved infrastructure and transportation facilities.
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Ngongo, Carrie J., Thomas JIP Raassen, Ladeisha Lombard, Jos Roosmalen, Steven Weyers, and Marleen Temmerman. "Authors' reply re: Delivery mode for prolonged obstructed labour resulting in obstetric fistula: a retrospective review of 4396 women in Central and East Africa." BJOG: An International Journal of Obstetrics & Gynaecology 127, no. 7 (March 29, 2020): 908–9. http://dx.doi.org/10.1111/1471-0528.16190.
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Mustafa Adelaja, Lamina, and Oladapo Olufemi Taiwo. "Maternal and Fetal Outcome of Obstetric Emergencies in a Tertiary Health Institution in South-Western Nigeria." ISRN Obstetrics and Gynecology 2011 (June 16, 2011): 1–4. http://dx.doi.org/10.5402/2011/160932.
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Objective. This study was carried out to determine the pattern of obstetric emergencies and its influence on maternal and perinatal outcome of obstetric emergencies at the Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, Nigeria. Method. A retrospective study of obstetric emergencies managed over a three-year period at Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, Nigeria was conducted. Results. There were 262 obstetric emergencies accounting for 18.5% of the 1420 total deliveries during the period. Unbooked patients formed the bulk of the cases (60.3%). The most common emergencies were prolonged/obstructed labour, postpartum haemorrhage, fetal distress, severe pregnancy-induced hypertension/eclampsia, and antepartum haemorrhage. Obstetric emergencies were responsible for 70.6% of the maternal mortality and 86% of the perinatal mortality within the period. Conclusion. Prevention/effective management of obstetric emergencies will help to reduce maternal and perinatal mortality in our environment. This can be achieved through the utilization of antenatal care services, making budget for pregnancies and childbirth at family level (pending the time every family participates in National Health Insurance Scheme), adequate funding of social welfare services to assist indigent patients, liberal blood donation, and regular training of doctors and nurses on this subject.
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Johnson, Avita Rose, Sobin Sunny, Ramola Nikitha, Sulekha Thimmaiah, and Suman P. N. Rao. "A Case-Control Study on the Predictors of Neonatal Near-Miss: Implications for Public Health Policy and Practice." Neonatal Medicine 28, no. 3 (August 31, 2021): 124–32. http://dx.doi.org/10.5385/nm.2021.28.3.124.
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Purpose: Neonatal near miss (NNM) allows for the detection of risk factors associated with serious newborn complications and death, the prevention of which could reduce neonatal mortality. This study was conducted with the objective of identifying predictors for NNM in a tertiary hospital in Bangalore city.Methods: This was an unmatched case-control study involving 120 NNM cases and 120 controls. NNM was determined using Pileggi-Castro’s pragmatic and management criteria. Data was collected from in-patient hospital records and interviews of postpartum mothers. Multiple logistic regression of exposure variables was performed to calculate adjusted odds ratio (AOR) with 95% confidence interval (CI).Results: Significant predictors were maternal age ≥30 years (AOR, 5.32; 95% CI, 1.12 to 9.29; P=0.041), inadequate antenatal care (ANC) (AOR, 8.35; 95% CI, 1.98 to 51.12; P=0.032), <3 ultrasound scans during pregnancy (AOR, 12.5; 95% CI, 1.60 to 97.27; P=0.016), maternal anaemia (AOR, 18.96; 95% CI, 3.10 to 116.02; P=0.001), and any one obstetric complication (hypertensive disorder in pregnancy, diabetes in pregnancy, preterm premature rupture of membranes, prolonged labour, obstructed labour, malpresentation) (AOR, 4.34; 95% CI, 1.26 to 14.95; P=0.02).Conclusion: The predictors of NNM identified has important implications for public health policy and practice whose modifications can improve NNM. These include expanding essential ANC package to include ultrasound scans, ensuring World Health Organization recommendations of eight ANC visits, capacity building at all levels of health care to strengthen routine ANC and obstetric care for effective screening, referral and management of obstetric complications.
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Akhter, Shamima, Mst Mahbuba, Nusrat Ara Yusuf, Munirunnessa, and Nasrin Rosy. "Surgical Outcome of Hundred Vesico Vaginal Fistula Patients in National Fistula Centre." Bangladesh Medical Journal 48, no. 1 (October 23, 2019): 39–43. http://dx.doi.org/10.3329/bmj.v48i1.50190.
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Vesico-vaginal fistula (VVF) is still a major global health problem.This study was performed to detect the surgical outcome of 100 VVF patients in National Fistula Centre. A descriptive cross sectional study was carried out among 100 VVF patients fulfilling the inclusion criteria admitted in the National Fistula Centre under the department of Obstetrics and Gynaecology during the study period of April, 2017 to September, 2017. During the period, 100 patients presented for surgical repair at a mean age of 28.7 years (SD7.1). Majority of them (49%) had a parity of one and 57% were less than 20 years old at the time of their first pregnancy. About 83% of women developed VVF following prolonged obstructed labour. Most of the fistula (95%) repaired through vaginal route by flap splitting technique and 73% repaired at 1st time. Recovery of most of the patient (75%) was uneventful. Inadequate post-operative care (26.9%) was the major causes of unsuccessful repair. Obstetric fistula is one of the tragedies of third world countries and it would be better solved by providing surgical procedure and easy access of all women to competent obstetrical care, irrespective of their social and economic status during pregnancy and delivery.
Bangladesh Med J. 2019 Jan; 48 (1): 39-43
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Patra, Kajal Kumar, Apurba Mandal, Shibram Chattopadhyay, Arunava Biswas, and Siddhartha Majumder. "A retrospective case series of rupture uterus during five years period at a rural medical college in West Bengal, India." Asian Journal of Medical Sciences 12, no. 2 (February 1, 2021): 91–94. http://dx.doi.org/10.3126/ajms.v12i2.31019.
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Background: Rupture of the uterus carries major risk of maternal and perinatal morbidity and mortality especially in the developing world.
Aims and Objectives: This study aims to identify retrospectively the risk factors leading to uterine rupture through case series and to determine the feto-maternal outcome of such serious clinical condition.
Material and Methods: A retrospective study was done at Bankura Sammilani Medical College, Bankura, West Bengal, India from January 2014 to December 2018 to observe the incidence, aetiology, management and complications with maternal and foetal mortality and morbidity associated with rupture of the uterus in pregnant women at different gestational periods. The data were obtained from the case record section of the hospital. All rupture uterus cases were included excluding the dehiscence of scarred uterus.
Results: Twenty-one cases of Rupture Uterus were documented out of total delivery of 43,323 mothers in five years. There was a single maternal death and 15 (71.42 %) unbooked cases. Previous mode of delivery was found to be vaginal in 5 cases (23.8%). Most of the incidences of rupture uterus were scarred uterus (previous caesarean section and repaired uterus) 16 cases (76.19%), prolonged / obstructed labour 4 cases (19%), inductionof labour 1 (4.76%) and spontaneous rupture 1 (4.76%). Most cases were multiparous; site of rupture was in lower uterine segment in 18 cases (85.7%), fundal rupture 2 cases (9.52%) and left lateral 3 cases (14.2%). Bladder injury was in 1 case (4.76 %). Total abdominal hysterectomy was performed in 2 cases (9.52%) andsubtotal hysterectomy were done in 15 cases (71.4%); repair of the ruptured uterus wasperformed in 4 cases (19%). Fever and wound infections were present in 5 cases (23. 8%). Maternal death 1(4.76%) and 3 babies survived with perinatal mortality 18 (85.7%).
Conclusion: Mandatory antenatal care, prompt diagnosis and safe instrumental delivery may change the rupture uterus incidences.
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Aftab, Fahad, Imran Ahmed, Salahuddin Ahmed, Said Mohammed Ali, Seeba Amenga-Etego, Shabina Ariff, Rajiv Bahl, et al. "Direct maternal morbidity and the risk of pregnancy-related deaths, stillbirths, and neonatal deaths in South Asia and sub-Saharan Africa: A population-based prospective cohort study in 8 countries." PLOS Medicine 18, no. 6 (June 28, 2021): e1003644. http://dx.doi.org/10.1371/journal.pmed.1003644.
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Background Maternal morbidity occurs several times more frequently than mortality, yet data on morbidity burden and its effect on maternal, foetal, and newborn outcomes are limited in low- and middle-income countries. We aimed to generate prospective, reliable population-based data on the burden of major direct maternal morbidities in the antenatal, intrapartum, and postnatal periods and its association with maternal, foetal, and neonatal death in South Asia and sub-Saharan Africa. Methods and findings This is a prospective cohort study, conducted in 9 research sites in 8 countries of South Asia and sub-Saharan Africa. We conducted population-based surveillance of women of reproductive age (15 to 49 years) to identify pregnancies. Pregnant women who gave consent were include in the study and followed up to birth and 42 days postpartum from 2012 to 2015. We used standard operating procedures, data collection tools, and training to harmonise study implementation across sites. Three home visits during pregnancy and 2 home visits after birth were conducted to collect maternal morbidity information and maternal, foetal, and newborn outcomes. We measured blood pressure and proteinuria to define hypertensive disorders of pregnancy and woman’s self-report to identify obstetric haemorrhage, pregnancy-related infection, and prolonged or obstructed labour. Enrolled women whose pregnancy lasted at least 28 weeks or those who died during pregnancy were included in the analysis. We used meta-analysis to combine site-specific estimates of burden, and regression analysis combining all data from all sites to examine associations between the maternal morbidities and adverse outcomes. Among approximately 735,000 women of reproductive age in the study population, and 133,238 pregnancies during the study period, only 1.6% refused consent. Of these, 114,927 pregnancies had morbidity data collected at least once in both antenatal and in postnatal period, and 114,050 of them were included in the analysis. Overall, 32.7% of included pregnancies had at least one major direct maternal morbidity; South Asia had almost double the burden compared to sub-Saharan Africa (43.9%, 95% CI 27.8% to 60.0% in South Asia; 23.7%, 95% CI 19.8% to 27.6% in sub-Saharan Africa). Antepartum haemorrhage was reported in 2.2% (95% CI 1.5% to 2.9%) pregnancies and severe postpartum in 1.7% (95% CI 1.2% to 2.2%) pregnancies. Preeclampsia or eclampsia was reported in 1.4% (95% CI 0.9% to 2.0%) pregnancies, and gestational hypertension alone was reported in 7.4% (95% CI 4.6% to 10.1%) pregnancies. Prolonged or obstructed labour was reported in about 11.1% (95% CI 5.4% to 16.8%) pregnancies. Clinical features of late third trimester antepartum infection were present in 9.1% (95% CI 5.6% to 12.6%) pregnancies and those of postpartum infection in 8.6% (95% CI 4.4% to 12.8%) pregnancies. There were 187 pregnancy-related deaths per 100,000 births, 27 stillbirths per 1,000 births, and 28 neonatal deaths per 1,000 live births with variation by country and region. Direct maternal morbidities were associated with each of these outcomes. Conclusions Our findings imply that health programmes in sub-Saharan Africa and South Asia must intensify their efforts to identify and treat maternal morbidities, which affected about one-third of all pregnancies and to prevent associated maternal and neonatal deaths and stillbirths. Trial registration The study is not a clinical trial.
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Agwu, Ngwobia P., Abdullahi A. Ahmed, Abubakar S. Muhammad, Ismaila A. Mungadi, Emmanuel U. Oyibo, and Mairo Hassan. "Management of complex genital fistula: experience in a tertiary sub-Saharan hospital." International Surgery Journal 7, no. 4 (March 26, 2020): 998. http://dx.doi.org/10.18203/2349-2902.isj20201379.
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Background: Management of complex genital fistulae is challenging due to the cost and technical skill required. This study reports our experience in the management of patients with complex genital fistulae and to highlight the crucial role of the reconstructive urologists.Methods: This was a retrospective review of female patients managed at a tertiary hospital in Nigeria from 2006 to 2017 for complex urinary fistulae. Data were extracted from patient case notes and the data analysed using the SPSS software.Results: Twenty-four female patients mean age 28.9±11.1 years. Fistulae resulted from prolonged obstructed labour 10 (41.6%), caesarean hysterectomy 7 (29.2%), caesarean section and abdominal hysterectomy 2 (8.4%) respectively. The fistulae were vesicovaginal 16 (66.7%), ureterovaginal 3 (12.5%). Others were vesicocutaneous, urethrovaginal and rectovaginal. Prior attempts at repair were done in 7 (29.2%) and the number of attempts ranged from 1 to 4. Surgical procedures included direct closure in 9 (37.5%), closure and uretero-neocystostomy 7 (29.2%), uretero-neocystostomy only 3 (12.5%) closure and abdominal hysterectomy 2 (8.3%), closure and continent catheterizable neo-bladder 2 (8.3%) and 1 (4.2%) closure, abdominal hysterectomy and uretero-neocystostomy. Post-operative complications were noted in 2 (8.3%) and consisted of gynaeatresia and recurrent RVF. Repair was successful in 70.8% of patients while failed repair was recorded in 16.7% and while stress incontinence was present in 12.5%.Conclusions: Complex genital fistulae in our practice are of obstetric origin involving the bladder, ureters and rectum. The reconstructive urologist has a crucial role the management for a favourable outcome.
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Lawal, Olatunji, Oluwasomidoyin Bello, Imran Morhason-Bello, Rukiyat Abdus-salam, and Oladosu Ojengbede. "Our Experience with Iatrogenic Ureteric Injuries among Women Presenting to University College Hospital, Ibadan: A Call to Action on Trigger Factors." Obstetrics and Gynecology International 2019 (February 10, 2019): 1–6. http://dx.doi.org/10.1155/2019/6456141.
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Background. Ureteric injuries leading to ureterovaginal fistula (UVF) is less common than vesicovaginal fistula, as a cause of urinary incontinence. Recently, there is a surge in the number of UVF cases presenting to University College Hospital (UCH) following a caesarean delivery. The urogynaecology unit at UCH is at the forefront of providing surgical repair for women with all forms of genitourinary fistulas. We describe our experience with managing UVF arising from ureteric injury. Methods. A retrospective data collection of UVF cases managed from January 2012–December 2017 at UCH is presented. Information on sociodemographic and obstetric characteristics, presenting complaints, antecedent surgery, treatment received, findings at surgery, and postoperative complications were obtained with a structured proforma. Results. Eighteen cases of UVFs due to iatrogenic ureteric injury were managed. Majority (N=11; 61.1%) of the women suffered the injury following the emergency caesarean section (EMCS). Abdominal hysterectomy operation accounted for four (22.2%) cases, and one case each (5.6%) was due to vaginal hysterectomy and destructive operations. Prolonged obstructed labour (POL) (81.8%) was the most common indication for the EMCS, while 18.2% had surgery on account of lower uterine segment fibroid. Most of the ureteric injuries were on the left side. Postoperative complications documented were haemorrhage, urinary tract infection, wound infection, and injury to the neighbouring structure. Conclusion. Caesarean section being one of the most performed surgical operations in Nigeria was surprisingly found to be the most common cause of ureteric injury ahead of hysterectomy. It is a pointer that the surgeons might not have properly learnt the art of the caesarean delivery well. We recommend adequate surgical training of medical officers/surgeons that are involved.
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Ekanem, Etim I., Mabel I. Ekott, John E. Ekabua, Thomas U. Agan, and Atta Inyang-Otu. "Outcome of management of obstetric genito-urinary fistulae in the general hospital, Ikot Ekpene, Akwa Ibom state, Nigeria." Urogynaecologia 24, no. 2-3 (December 20, 2010): 1. http://dx.doi.org/10.4081/uij.2010.e1.
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<strong>Background</strong>: Obstetric fistula with urinary incontinence is one of the most distressing maternal morbidities. It is associated with physical and social deprivation such as wife abandonment and violent reactions against the victims, particularly in the developing countries of the world. This study was carried out to assess the demographic and reproductive profiles as well as outcome of management of patients with obstetric genito-urinary fistulae in the General Hospital Ikot Ekpene, Akwa Ibom State, Nigeria. <strong>Design and Methods</strong>: A five-year cross sectional observational study of medical records of 37 patients managed in maternity section of General Hospital Ikot Ekpene, Akwa Ibom State, Nigeria was conducted. <strong>Results</strong>: One delivery every 122 ones during the study period was complicated by urinary fistula. Eleven (29.7%) were teenagers. Most patients were married (54.1%), primiparous (59.4%) from low socioeconomic class (72.9%) who did not utilize modern obstetric facilities effectively. Many cases were the consequence of prolonged obstructed labour (51.4%) and majority presented with total incontinence of urine (70.2%). Eighteen (48.7%) patients presented within 6 months of delivery. They were mainly vesico-vaginal (34.4%) or complex (10.8%) fistulae that were managed conservatively (21.6%) or with bladder repairs. About a third was referred for further treatment management due to unsatisfactory outcome. <strong>Conclusion</strong>: This age-long obstetric morbidity is common among young married women in Ikot Ekpene, Akwa Ibom, mainly due to poor utilization of modern obstetric care facilities. Results of treatment are largely unsatisfactory in a third of these patients; therefore resources should be channeled towards effective and comprehensive preventive programs especially among this vulnerable group of women.
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Bayo, Pontius, Imose Itua, Suzie Paul Francis, Kofi Boateng, Elijo Omoro Tahir, and Abdulmumini Usman. "Estimating the met need for emergency obstetric care (EmOC) services in three payams of Torit County, South Sudan: a facility-based, retrospective cross-sectional study." BMJ Open 8, no. 2 (February 2018): e018739. http://dx.doi.org/10.1136/bmjopen-2017-018739.
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ObjectiveTo determine the met need for emergency obstetric care (EmOC) services in three Payams of Torit County, South Sudan in 2015 and to determine the frequency of each major obstetric complication.DesignThis was a retrospective cross-sectional study.SettingFour primary healthcare centres (PHCCs) and one state hospital in three payams (administrative areas that form a county) in Torit County, South Sudan.ParticipantsAll admissions in the obstetrics and gynaecology wards (a total of 2466 patient admission files) in 2015 in all the facilities designated to conduct deliveries in the study area were reviewed to identify obstetric complications.Primary and secondary outcome measuresThe primary outcome was met need for EmOC, which was defined as the proportion of all women with direct major obstetric complications in 2015 treated in health facilities providing EmOC services. The frequency of each complication and the interventions for treatment were the secondary outcomes.ResultsTwo hundred and fifty four major obstetric complications were admitted in 2015 out of 390 expected from 2602 pregnancies, representing 65.13% met need. The met need was highest (88%) for Nyong Payam, an urban area, compared with the other two rural payams, and 98.8% of the complications were treated from the hospital, while no complications were treated from three PHCCs. The most common obstetric complications were abortions (45.7%), prolonged obstructed labour (23.2%) and haemorrhage (16.5%). Evacuation of the uterus for retained products (42.5%), caesarean sections (32.7%) and administration of oxytocin for treatment of postpartum haemorrhage (13.3%) were the most common interventions.ConclusionThe met need for EmOC in Torit County is low, with 35% of women with major obstetric complications not accessing care, and there is disparity with Nyong Payam having a higher met need. We suggest more support supervision to the PHCCs to increase access for the rural population.
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Chimamise, Chipo, Stephen Peter Munjanja, Mazvita Machinga, and Iris Shiripinda. "Impact of Covid-19 pandemic on obstetric fistula repair program in Zimbabwe." PLOS ONE 16, no. 4 (April 1, 2021): e0249398. http://dx.doi.org/10.1371/journal.pone.0249398.
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The advent of Covid-19 pandemic adversely affected many programs worldwide, public health, including programming for obstetric fistula were not spared. Obstetric fistula is an abnormal connection between the vagina and the bladder or the rectum resulting from obstetric causes, mainly prolonged obstructed labour. Zimbabwe has two obstetric fistula repair centers. Because the program uses specialist surgeons from outside the country, the repairs are organized in quarterly camps with a target to repair 90 women per quarter. This study aimed at assessing the impact of restrictions on movement and gathering of people brought about by the Cocid-19 pandemic and to characterize participants of the camp which was held in the midst of the Covid-19 pandemic at Mashoko Hospital. Specifically it looked at how Covid-19 pandemic affected programming for obstetric fistula repair and characterized participants of the fistula camp held in November to December 2020 at one of the repair centers. A review of the dataset and surgical log sheets for the camp and national obstetric fistula dataset was conducted. Variables of interest were extracted onto an excel spreadsheet and analyzed for frequencies and proportions. Data were presented in charts, tables and narratives. The study noted that Covid-19 pandemic negatively affected performance of fistula repairs greatly with only 25 women repaired in 2020 as compared to 313 in 2019. Ninety women were called to come for repairs but 52 did not manage to attend due to reasons related to the restriction of the Covid-19 pandemic lockdown. Two thirds of those women suffered from urinary incontinence while the other third had fecal incontinence. The successful repair rate was 92%. This study concluded that the pandemic greatly affected programming of fistula repair in the country and recommended the Ministry of Health and Child Care to institute measures to resume programming as soon as the situation allows.
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Das, Suchanda, Rokeya Begum, and Bidhan Roy Chowdhury. "Obstetric Fistula and Common Peroneal Nerve Palsy in a Rural Based Women: A Case Report." Chattagram Maa-O-Shishu Hospital Medical College Journal 14, no. 1 (April 5, 2015): 71–73. http://dx.doi.org/10.3329/cmoshmcj.v14i1.22891.
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Neglected obstructed labor is a major cause of both maternal and newborn morbidity and mortality. By far the most severe and distressing long term morbidity following obstructed labor is obstetric fistula i.e. Vesicovaginal fistula. In developing countries fistula is commonly the result of prolonged obstructed labor. A18 year old primi gravida was admitted in the labor ward with the involuntary passage of stool and urine and unable to walk after 15 days of her home delivery. Temporary colostomy was done. Patient was on regular physiotherapy for prolonged time and she was responded slowly. There was a plan for repair of Vesicovaginal and Rectovaginal fistula. Obstructed labor complex is completely preventable if high quality basic and comprehensive health services are available to all. DOI: http://dx.doi.org/10.3329/cmoshmcj.v14i1.22891 Chatt Maa Shi Hosp Med Coll J; Vol.14 (1); Jan 2015; Page 71-73
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Mohamed, Adam A., Abiodun O. Ilesanmi, and M. David Dairo. "The Experience of Women with Obstetric Fistula following Corrective Surgery: A Qualitative Study in Benadir and Mudug Regions, Somalia." Obstetrics and Gynecology International 2018 (September 27, 2018): 1–10. http://dx.doi.org/10.1155/2018/5250843.
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Obstetric fistula is a severe maternal morbidity which can have devastating consequences for a woman’s life and is generally associated with poor obstetric services leading to prolonged obstructed labour. The predisposing factors and consequences of obstetric fistula differ from country to country and from community to community. The World Health Organization estimated that more than 2 million women in sub-Saharan Africa, Asia, the Arab region, Latin America, and the Caribbean are living with the fistula, and some 50,000 to 100,000 new cases develop annually with 30,000–90,000 new cases developing each year in Africa alone. This study aimed at describing and exploring the experiences of women living with obstetric fistulas following corrective surgery in Benadir and Mudug regions, Somalia. Women living with obstetric fistula who had surgical repairs at Daynile and GMC fistula centers and key informants were identified purposively. Twenty-one individual in-depth interviews among women with obstetric fistula and eight key informant interviews were conducted. Thematic analyses were used. Codes were identified, and those codes with similar connections were organized together as to form themes. Detailed reading and rereading of the transcribed interviews were employed in order to achieve and identify themes and categories. Themes, categories, and subcategories illustrating the experiences of women living with obstetric fistula emerged from the thematic analysis of individual in-depth and key informant interviews. These were challenges of living with OBF which include “wounds around genitalia, bad odour, incontinences of urine and feces, stigma, isolation, divorce, powerlessness, dependency, financial constraints, and loss of healthy years” and coping mechanisms which include “withdrawal from the community and improved personal hygiene.” Women with obstetric fistula experience serious health and social consequences which prevents them fulfill social, family, and personal responsibilities. We recommend expansion of BEmONC services to underserved areas, capacity building for local OBF surgeons, and improved media campaign and birth preparedness at community levels.
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Nahar, Begum Sharifun, Syeda Afroza, and Zakia Naher. "Risk Factors Analysis in Asphyxiated Newborn and Their Neurological Outcome in Relation to Hypoxic-Ischaemic Encephalopathy." Journal of Paediatric Surgeons of Bangladesh 4, no. 2 (June 30, 2015): 54–57. http://dx.doi.org/10.3329/jpsb.v4i2.23939.
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Background: Perinatal mortality rate in the developing world is still significantly higher than what obtained in the individualized nation1. Perinatal asphyxia has been established as one of the major causes of these deaths. Perinatal asphyxia is a serious clinical problem world wide. There are various reasons of failure to initiate and sustain breathing immediately after birth. Neurological complication like hypoxic ischaemic encephalopathy (HIE) following damage to the brain is very frequent and commonly seen in asphyxiated newborn .Objective: To find out the risk factors and the hospital outcome with special emphasis on HIE following perinatal asphyxia.Methods: It was a retrospective study on 92 (ninety two) consecutive cases of perinatal asphyxia admitted in the neonatal care unit of Sir Salimullah Medical College and Mitford Hospital during the period of January and February 2011.Results: The results revealed that during the study period the number of perinatal asphyxia in admitted in neonatal care unit was 92 out of 193 i.e. 47.6%. Out of 92 asphyxiated newborn 86% were admitted in first 24 hours of life. Among them 71% were inborn and of male sex. Most of them (69%) were of normal birth weight. Regarding gestational age 56% were term. Fifty one percent were delivered per vaginally. Majority of mothers (79%) received antenatal care. Intrapartum risk factors included premature rupture of membrane (PROM) 19%, prolonged labour 15%, pregnancy induced hypertension 13%, antepartum haemorrhage 13%, preeclampsia and eclampsia 10%, obstructed labour 10%, malpresentation 8%, multiple gestation 8%. 60% mothers had multiparity. Presenting complaints were respiratory distress characterized by tachypnea /chest indrawing (30%), grunting (25%), convulsion (21%), irritability or excessive crying (9%), poor feeding or sucking (8.6%). About neurological complications 45% developed hypoxic ischaemic encephalopathy. Out of 42 HIE cases 60% had grade II encephalopathy. Grade I HIE was found in 26% of cases and 14% cases had grade III or severe encephalopathy. About hospital outcome 58% had hospital stay for minimum 5 days and 63% were discharged after improvement Thirteen percent were discharged on risk bond. 22 cases died during hospitalizationConclusion & Recommendation: The rate of hospital admission of Perinatal asphyxia as well as Neurological complication like hypoxic ischemic encephalopathy (HIE) was very high though majority of mother received antenatal care and affected newborns were inborn. So proper attention and timely intervention as well as resuscitation of newborn delivered in the hospital is essential to prevent the unwanted neurological complication of Perinatal asphyxia like HIE as well as other morbidity and fatality.J. Paediatr. Surg. Bangladesh 4(2): 54-57, 2013 (July)
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Kyei-Aboagye, K., O. Vragovic, G. Kaufman, and P. Stubblefield. "Prolonged obstructed labor as a major cause of postpartum hemorrhage." International Journal of Gynecology & Obstetrics 70 (2000): A19—A20. http://dx.doi.org/10.1016/s0020-7292(00)82005-6.
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Selukar, Dhananjay, Amit Narayan Pothare, Kunal Meshram, Nikhilesh Jibhkate, Vinay Rahangdale, and Shrikant Perka. "A case series of urogenital fistulas." International Surgery Journal 4, no. 5 (April 22, 2017): 1731. http://dx.doi.org/10.18203/2349-2902.isj20171630.
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Background: Urogenital fistula is an abnormal fistulous communication that occurs between the bladder and cervix or uterus; between the ureter and vagina, uterus, or cervix; and between the urethra and vagina. Most cases in developing countries are of obstetric etiology, resulting from prolonged neglected obstructed labour, and around 1–2 per 1000 deliveries may be affected. The majority of UGFs in developed countries are a consequence of gynecological surgery, mainly hysterectomies. Present study focuses on the various presentations and the different modalities of surgeries done for cases of urogenital fistulas at our institute.Methods: A total 19 cases of urogenital fistula were studied in detail as per proforma. Two patients were operated on emergency basis because of early presentation in postoperative period. For others a pre-operative waiting period of 3-6 months was followed after development of fistula. During this period initially bilateral DJ stenting was tried in all patients, in hope of spontaneous closure of fistulas. Two patients whose fistulas closed spontaneously are not subjected to surgery. Rest all cases were managed surgically by standard surgical procedures.Results: Study was conducted between, February 2015 to February 2017. A total 19 patients studied. In 2 patients, fistula healed spontaneously while in 17 patients, surgery was needed. Most common age group affected is 2nd decade of life about 47.36%. In our study gynecological surgeries predominate with 57.89% followed by obstetric cases in 26.31%. Most of patients presented with continues dribbling of urine through vagina with normal voiding pattern in about 78.94% of cases. Overall transabdominal procedures had nearly 100% success rate, mainly because of better dissection, visualization and use of vascularized graft which prevents recurrence. 1 recurrence was seen in transvesical extraperitoneal approach because of undiagnosed another fistulous tract. Ureteric reimplantation was 100% successful in ureterogenital fistulas. Vaginal approach with use of Mortius flap had 75% success rate with 1 recurrence because of flap necrosis. Mean duration of surgery was 120 minutes and mean hospital stay was 8 days..Conclusions: Urogenital fistulas are the most distressing complications of obstetric and gynecological surgeries. Obstetric causes predominate in developing countries while gynecological surgeries predominate in developed countries. Despite the good results of surgical repair, attempt should be focused on the prevention of VVF.
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Workie, Amare, Yemmiamrew Getachew, Kibir Temesgen, and Prem Kumar. "Determinants of uterine rupture in Dessie Referral Hospital, North East Ethiopia, 2016: case control design." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, no. 5 (April 28, 2018): 1712. http://dx.doi.org/10.18203/2320-1770.ijrcog20181900.
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Background: Uterine rupture remains a major obstetric problem particularly in less developed countries. The aim of this study was to identify determinants of uterine rupture among mothers getting delivery services in Dessie Referral Hospital from January 2016 to June 2016, North East Ethiopia.Methods: A prospective unmatched case control study was conducted recruiting 42 mothers with uterine rupture as case group and 168 for control group. Pretested, structured questionnaire was used to collect data.Results: Descriptive statistics and Logistic regression models were utilized considering 95% confidence interval and p-value of 0.05 to determine the presence and strength of association between dependent and independent variables. Majority (94.2%) of cases came from rural areas, 76.2% had obstructed labor and 55% had prolonged labor. Of 85.7% of cases have reported number of pregnancies ≥ 5. Mothers who encountered obstructed labor and previous Caesarean section scar were at higher risk of uterine rupture (AOR=22.2, 95% CI=2.8-4.1 and AOR=13.6, 95% CI=2.16-17.84 respectively). Mothers living in urban area, having Antenatal Care follow-up, shorter labor stay and primi-parity were found to have lower risk of uterine rupture.Conclusions: This study revealed that living in rural areas, absence of Antenatal Care follow-up, prolonged labor, obstructed labor, grand multiparity and previous Caesarean section scar were determinants of uterine rupture. Viable strategies have to be designed and implemented to tackle these determinants of uterine rupture.
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Chhetry, Manisha, Basudeb Banerjee, Shanti Subedi, Narayan Bahadur Gharti Chhetri, and Yogendra Gupta. "Challenges in the Caesarean Section of a Severely Kyphotic Parturient." Case Reports in Obstetrics and Gynecology 2016 (2016): 1–4. http://dx.doi.org/10.1155/2016/8405052.
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Caesarean section in a severely kyphotic patient presents with unique challenges. We report a case of obstructed labor in case of a pregnant lady with severe kyphosis of spine that was managed by caesarean section. Lateral recumbent position with adequate assistance and paramedian or vertical skin incision was used and found to provide good exposure. Baby was delivered by lower segment uterine incision by reverse breech extraction. Postpartum hemorrhage was managed with uterotonics and bilateral uterine artery ligation. Tubal ligation though advised was refused by the patient. Prolonged catheterization was done in view of obstructed labor. Postoperative period was uneventful.
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Marie Bereka, Tefera, Amlaku Mulat Aweke, and Tewodrose Eshetie Wondie. "Associated Factors and Outcome of Uterine Rupture at Suhul General Hospital, Shire Town, North West Tigray, Ethiopia 2016: A Case-Control Study." Obstetrics and Gynecology International 2017 (2017): 1–7. http://dx.doi.org/10.1155/2017/8272786.
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Background. Uterine rupture is tearing of the uterine wall during pregnancy or delivery. It may extend to partial or whole thickness of the uterine wall. It is usually a case where obstetric care is poor. In extensive damage, death of the baby and sometimes even maternal death are evident.Objective. This study assesses associated factors and outcome of uterine rupture at Suhul General Hospital, Tigray Region, Ethiopia, 2016.Methodology. A case-control study was conducted by review of data from September 2012 to August 2016. A total of 336 samples were studied after calculating by EPI-INFO using proportion of multiparity (53%) and ratio of 1 : 2 for cases and controls, respectively. Analysis was done using SPSS version 20. Bivariate and multivariate logistic regression was applied withp<0.05.Result. ANC, grand multiparity, malpresentation, and obstructed labor had association, but previous cesarean delivery was not significant. Perinatal mortality was 105 (93%) versus 13 (5.8%) in cases and controls, respectively. Anemia was highest for both groups (53.7% versus 32.1%).Conclusion. Majority of uterine rupture is attributed to prolonged or obstructed labor. Cases of uterine rupture had prompt management preventing maternal mortality, but burden of perinatal death is still high.
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Markos, Mesfin, Aseb Arba, and Kebreab Paulos. "Partograph Utilization and Associated Factors among Obstetric Care Providers Working in Public Health Facilities of Wolaita Zone, 2017." Journal of Pregnancy 2020 (July 1, 2020): 1–8. http://dx.doi.org/10.1155/2020/3631808.
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Background. Obstructed or prolonged labor is a major cause of maternal deaths. Prolonged and obstructed labor contributed to 13% of global maternal deaths which can be reduced by proper utilization of a partograph during labor. Obstetric caregivers’ use of the partograph during labor has paramount importance in identifying any deviation during labor. Even though partograph use is influenced by different factors as obtained from the literatures, the magnitude of partograph utilization and the factors associated with its use are not well determined in the health facilities of Wolaita Zone. Objective. To assess the magnitude of partograph utilization and factors that affect its utilization among obstetric caregivers in public health facilities of Wolaita Zone, Ethiopia, 2017. Methods. An institution-based cross-sectional study was conducted on obstetric caregivers. A pretested and structured questionnaire was used to collect data. Data was entered to EpiData version 3.01 and exported to SPSS version 23.0 for further analysis. Logistic regression analyses were used to see the association of different variables. Result. A total of 269 obstetric caregivers participated in the study. Among those who were utilizing the partograph, 193 (71.7%) routinely used it for all laboring mothers and 76 (28.3%) of participants reported that they do not routinely utilize it. Greater number of service years (AOR=4.93, 95% CI: 1.53-15.88), on-the-job training (AOR=0.16, 95% CI: 0.06-0.43), good knowledge (AOR=3.35, 95% CI: 1.61-6.97), and favorable attitude towards partograph utilization (AOR=2.99, 95% CI: 1.28-7.03) were significantly associated with partograph utilization. Conclusion and Recommendation. Partograph utilization among obstetric caregivers in the public health facilities was good. Greater years of work experience, in-service training, having good knowledge, and favorable attitude towards partograph utilization among obstetric caregivers independently determined partograph utilization. Provision of on-the-job training to make obstetric caregivers improve knowledge and skill on partograph utilization, maintaining caregivers’ retention to decrease turnover by providing different incentives to more experienced obstetric care providers, and establishing favorable attitude could improve the proper use of the tool.
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Abubakar, B. M., A. Abdulkadir, A. A. Atterwahmie, A. A. Atterwahmie, A. A. Panti, and A. I. Maina. "Prolonged Obstructed Labor Is an Uncommon Presentation of a Giant Bladder Calculus: A Case Report and Literature Review." Open Journal of Urology 09, no. 04 (2019): 77–83. http://dx.doi.org/10.4236/oju.2019.94009.
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Ginzburg, M. "Dr. J. C. Edgar. Prolonged, non obstructed Labor in the first stage; its Management. - (New-Iork medic. Journal, 12 / v 94, p. 582-585). - Carrying out a prolonged first period of labor without mechanical obstacles." Journal of obstetrics and women's diseases 9, no. 3 (September 22, 2020): 271–73. http://dx.doi.org/10.17816/jowd93271-273.
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Prolonged first period of labor (uterine opening) is a very unpleasant complication of them, often accompanied by severe consequences; therapy of the named evasion during childbirth is one of the most serious tasks of the obstetrician.
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Fatema, Muckti Kaniz, Eti Saha, Fouzia Begum, Shamsun Nahar Lucky, and Farzana Rahman. "Causal factors and treatment outcome of genitourinary fistula in a teaching hospital." Bangladesh Medical Journal Khulna 50, no. 1-2 (March 1, 2018): 18–21. http://dx.doi.org/10.3329/bmjk.v50i1-2.35837.
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Background: Urogenital fistula, majority of which is vesicovaginal fistula is a public health problem especially of developing countries. It is commonly caused by prolonged and obstructed labor. With the advancement of health care delivery system etiology of urogenital fistula is changing in our country.Objective: This study was done to find out the causal factors and to determine the success rate of operative procedure for treatment of urogenital fistula.Method: This was an observational type of cross sectional study, carried out in Department of Obs and Gynae in Khulna Medical College Hospital from January 2013 to June 2014 among 30 women at different ages suffering from urogenital fistula due to gynaecological or obstetrical causes or malignancy.Result: Majority of the patients were young primipara, short stature and malnourished, coming from lower socioeconomic condition of rural areas. Prolonged labor 12 (40%) was the most common cause of urogenital fistula, followed by gynaecological surgeries mainly hysterectomies 9 (30%) and malignancy 2 (6.6%) rare cause. The success rate of repair following first and second attempt was 92% and 8% respectively. Overall success rate was 24 (96%) and functionally failed with a failure in 1 (4%) cases. This study showed main cause for developing fistula showing prolonged labor and majority of patient were treated pervaginally. Most of the cases (96%) had successful repair which is very encouraging and correlates well with recently published series.Conclusion: Fistula can be totally preventable by proper antenatal care, identification of high risk cases, timely referral, proper intranatal, postnatal care, and proper training. So improvement of health care services and dedication will prevent this type of morbidity. The best results are obtained when repair of urogenital. fistulae is carried out under optimal conditions.Bang Med J (Khulna) 2017; 50 : 18-21
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Shrestha, Ranjana, Kenusha Devi Tiwari, Ganesh Dangal, Aruna Karki, Hema Pradhan, Kabin Bhattachan, Rekha Poudel, Nishma Bajracharya, and Sonu Bharati. "Pregnancy after Obstetric Fistula: Should It Be Encouraged?" Nepal Journal of Obstetrics and Gynaecology 13, no. 3 (December 31, 2018): 56–58. http://dx.doi.org/10.3126/njog.v13i3.23447.
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Obstetric fistula (OF) is a life-changing morbidity associated with childbirth. It occurs especially after a prolonged obstructed labor and is a major public health problem in the developing countries. The smell of stool and urine leads to the ostracization and rejection of fistula patients by their spouses, families, friends and society in whole. Surgical treatment of fistula is possible. However, this successful outcome of fistula repair surgery is dependent on pre-operative care and the post-operative care such as delaying the commencement of sexual intercourse and delaying conception. Family planning can aid to this. Pregnancy is advised after minimum of 12 months’ post-repair and mode of delivery should be elective cesarean section. Here, we present a case of 23 years’ female, who suffered from obstetric fistula who underwent obstetric fistula repair twice, re-married and conceived after a year with successful elective cesarean delivery.
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Akl, Ahmed Ibrahim, Gunnar Tellnes, and Tor Bjerkedal. "ASSESSMENT OF TYPE AND CLINICAL FEATURES IN FEMALES WITH OBSTETRIC FISTULA – A CLINICAL STUDY." Journal Of Healthcare In Developing Countries 1, no. 1 (April 21, 2021): 01–02. http://dx.doi.org/10.26480/jhcdc.01.2021.01.02.
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Obstetric fistula is an injury that occurs during prolonged and obstructed labor causing tissue damage to organs inside the pelvis and resulting in urine and fecal incontinence or both. The present study was conducted to record type and clinical features in females with Obstetric fistula. 60 patients with Female genital fistula were involved. A thorough clinical examination along with types and clinical features were recorded. Age group 10-20 years had 14 patients, 20-30 years had 26, 30-40 years had 12 and >40 years had 8 patients. The difference was significant (P< 0.05). Type of fistula was VVF in 48, RVF in 7 and RVVF in 5 cases. Clinical features comprised of urine incontinence in 38, fecal incontinence in 20 and both urine and fecal incontinence in 2 cases. The difference was significant (P< 0.05). Most common cause was VVF and RVVF. Clinical features comprised of urine and fecal incontinence
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Sowunmi, C. O., A. O. Olajide, O. Olorunfemi, O. M. Iwaola, and O. F. Adeyemo. "Enhancing Knowledge of Traditional Birth Attendants for the Identification of Selected Labor Emergencies." African Journal of Health, Nursing and Midwifery 4, no. 3 (May 27, 2021): 1–14. http://dx.doi.org/10.52589/ajhnm-hl0bdmzj.
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Objectives: In Nigeria, the number of professional midwives available for care of pregnant women and their babies is inadequate; hence, most pregnant women are attended to by Traditional Birth Attendants (TBAs). Studies show that TBAs have poor knowledge of how to identify obstetrics complications. Aim: To determine the effectiveness of a training program on enhancing the knowledge of TBAs in the identification of some selected labor emergencies. Materials and Methods: An experimental research design was conducted with probability sampling to select sample size (n = 111 TBAs). A modified, structured questionnaire from TBAs knowledge on identification of labor emergencies (TBAs-TPKI) was used for data collection. Data collected were analyzed using Statistical Packages for the Social Science (SPSS) software. Descriptive statistics were used to provide answers to the six research questions of the study while inferential statistics of paired t-test was used to test the hypothesis of the study at 0.05 level of significance. Results: The results show that the mean score on knowledge identification on prolonged labor increased from 4.88±2.54 to 11.56±1.48; obstructed labor from 4.18±2.18 to 5.73±1.26, cord presentation from 2.44 ±1.27 to 5.78 ± 0.74, cord prolapse from 2.79±1.45 to 6.60±0.84, placenta abruptio from3.83±1.99 to 9.08±1.16 and postpartum hemorrhage from 3.48±1.82 to 8.26±1.05. The overall mean score of TBAs on knowledge of identification increased from 21.59 ± 11.26 to 51.19 ± 6.54 post-intervention. There was a significant difference between pre- and post-intervention mean scores of knowledge of TBAs on the identification of all the selected labor emergencies (t = 32.208, p = 0.00). Conclusions: The Ministry of Health in each state should organize regular training for TBAs to target early identification of obstetrics emergencies in order to reduce maternal mortality in Nigeria.
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Bedada, Kefena Etita, Tufa Kolola Huluka, Gizachew Abdissa Bulto, and EphremYohannesRoga. "Low Utilization of Partograph and Its Associated Factors among Obstetric Care Providers in Governmental Health Facilities at West Shoa Zone, Central Ethiopia." International Journal of Reproductive Medicine 2020 (July 18, 2020): 1–9. http://dx.doi.org/10.1155/2020/3738673.
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Background. Globally, prolonged and obstructed labors were among the common causes of maternal morbidity and mortality in low- and middle-income countries including Ethiopia. The World Health Organization (WHO) recommends the routine use of partograph as a key intervention to avoid prolonged and obstructed labor. Despite the recommendation, studies indicated that the partograph utilization among obstetric care providers (OCPs) is still low. Therefore, this study is aimed at assessing the level of utilization of partograph and associated factors among obstetric care providers working at health facilities in the West Shoa Zone, Central Ethiopia 2019. Methods. Facility-based cross-sectional study was conducted from February 1st to 22nd March 2019. A computer-generated simple random sampling technique was used to select 325 study subjects. Data were collected using a self-administered structured questionnaire and using an observational checklist. Additionally, 200 partograph charts were reviewed. Both bivariate and multivariable logistic regression analyses were used to determine the association. Results. A total of 322 obstetric care providers were included in the study, giving a response rate of 99.1%. The level of partograph utilization in the study area was revealed to be 31.1% (95% CI: 25.97-36.13). Only 3% of the reviewed partograph was recorded according to the recommended standard. In this study attending training (AOR=3.94, 95% CI: 1.99-7.78), availability of partograph (AOR=5.23, 95% CI: 1.69-16.22), perceived as not time-consuming task (AOR=3.61, 95% CI: 1.19-10.96), adequate number of OCPs available (AOR=2.92, 95% CI: 1.16-7.33), presence of supervision (AOR=4.35, 95% CI: 2.11-8.97), having a positive attitude (AOR=2.48, 95% CI: 1.23-5.02), availability of standard protocol in a health facility (AOR=4.71, 95% CI: 2.31-9.60), and lack of commitment (AOR=0.32, 95% CI: 0.16-0.63) were factors significantly associated with partograph utilization. Conclusion and Recommendation. Partograph utilization in the study area was found to be low. Almost all reviewed partograph charts were not recorded as to the recommended standard. Attending training, availability of partograph, perceived as it is not time-consuming, the available number of OCPs, presence of supervision, having a positive attitude, available standard protocol, and commitment were factors associated with partograph utilization. Therefore, all concerned stakeholders should emphatically consider those identified factors for intervention.