Etiology and factors associated with urogenital fistula among women who have undergone cesarean section: a cross-sectional study

BMC Pregnancy and Childbirth

Research

Gloire Byabene¹  Rane Ajay²  Madeline K. Moureau³  Heidi W. Brown³  Raha Maroyi⁴  Denis M. Mukwege⁵ 

[1]Department of General Surgery, Panzi General Referral Hospital, Bukavu, Democratic Republic of the Congo

[2]Department of Obstetrics and Gynecology, James Cook University, Townsville, Australia

[3]Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, USA

[4]Department of Urogynecology, Panzi General Referral Hospital, Bukavu, Democratic Republic of the Congo

[5]Faculty of Medicine, Evangelical University in Africa, Bukavu, Democratic Republic of the Congo

[6]Mushununu, Panzi, Bukavu, Democratic Republic of the Congo

[7]Faculty of Medicine, Evangelical University in Africa, Bukavu, Democratic Republic of the Congo

[8]Department of Gynecology and Obstetrics, Panzi General Referral Hospital, Bukavu, Democratic Republic of the Congo

关键词: Female;    Obstetric fistula;    Cesarean section;    Obstructed labor;    Fetal demise;    The Democratic Republic of the Congo;   

DOI  :  10.1186/s12884-023-05357-3

 received in 2022-07-18, accepted in 2023-01-06,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe prevalence and impact of fistulas are more common in developing countries with limited access to emergency obstetric care. As a result, women in these settings often experience adverse psychosocial factors. The purpose of this study was to describe the characteristics of Congolese women who developed urogenital fistula following Cesarean sections (CS) to determine the characteristics associated with two etiologies: (1) prolonged obstructed labor; and (2) a complication of CS following obstructed labor.MethodsWe performed a cross-sectional study on abstracted data from all patients with urogenital fistula following CS who received care during a surgical campaign in a remote area of the Democratic Republic of the Congo (DRC). Descriptive analyses characterized patients with fistula related to obstructed labor versus CS. Univariate and multivariate logistic regression models identified factors associated with obstetric fistula after cesarean delivery following obstructed labor. Variables were included in the logistic regression models based upon biological plausibility.ResultsAmong 125 patients, urogenital fistula etiology was attributed to obstructed labor in 77 (62%) and complications following CS in 48 (38%). Women with a fistula, attributed to obstructed labor, developed the fistula at a younger age (p = .04) and had a lower parity (p = .02). Attempted delivery before arriving at the hospital was associated with an increased risk of obstetric fistula after cesarean delivery following obstructed labor (p < .01).ConclusionCS are commonly performed on women who arrive at the hospital following prolonged obstructed labor and fetal demise, and account for almost 40% of urogenital fistula. Obstetric providers should assess maternal status upon arrival to prevent unnecessary CS and identify women at risk of developing a fistula.

【 授权许可】

CC BY   
© The Author(s) 2023