Presentation on theme: "1 Risk Factors for Obstetric Fistula : a clinical review Dr Pierre Marie Tebeu,MD,MPH Obstetrician Gynecologist, University Hospital, Yaoundé Cameroon."— Presentation transcript:
1 Risk Factors for Obstetric Fistula : a clinical review Dr Pierre Marie Tebeu,MD,MPH Obstetrician Gynecologist, University Hospital, Yaoundé Cameroon e.mail: firstname.lastname@example.org@yahoo.fr Tel: 77 67 55 33 ISOFS 2010, Dakar, Senegal
3 Physiopathology of obstetric Fistula Promontory Pubis Bladder Rectum Vagina WHO, UNDP, UNICEF, World Bank. IMPAC. 2003 Obstructive labor Compression VVF RVF - Hematoma -Asphyxia -Fetal death Foot drop Bladder Rectum Obturator nerve Head
4 Objectives To assess the current state of knowledge regarding the importance of obstetric fistula as a health problem, the patients’ characteristics and the circumstances of occurrence of the disease. Discuss the contribution of the identified factors in Obstetric fistula prevention strategies
5 Data Souce Search of the literature Identify all relevant articles Published between 1987-2008 Database: Medline (Pubmed, Ovid), Cochrane Trials Register, Cumulative Index to Nursing and Allied Health.
Variables of Interest 7 place of birth; skilled birth attendance; duration of labour; mode of delivery; antenatal care attendance; age at marriage; age at first delivery; age at causal delivery; parity at causal delivery; use of family planning; additional factors
Teenager at first delivery Meyer 2007; Ojanuga 1999; DHS Cameroon 2004; Wall 2004; Muleta 2004; Nafiou 2007; Ramsey 2007; Unfer 1995 9 More than 84% of patients got marriage before the age of 20 Mean age at marriage is between 14 and 16 years old Mean age at first delivery: 17 years Teenage status at operation: 2.5% -86 %
Teenagers delivery in Cameroon Tebeu et al. Obstet Gynecol Int 21010
Lack of Antenatal care DHS Cameroon 2004; Gessessew 2003; Jokhio 2006; Ramsey 2007; Wall 2004; Home 2007; Ould el Joud 2001 Lack of antenatal care: 72-92% of patients Maroua-Cameroon: 46% WHO recommend at least 4 ANC during each pregnancy 13
Duration of labor Holme 2007; Arroswsmith 1994; Nafiou 2007; Muleta 2004; Ijaiya 2004; Hilton 1998; Wall 2004; Ahmad 2005; Ramsey 2007; Roenneburg 2007; Rahman 2003. 14 The mean duration of labour among the fistula patients range from 2.5 to 4 days. Labor > 24 hrs: 73- 95.7 % OF patients have been in labour for more than 24 hours
Place of delivery Home delivery in many studies: 30-44% Delivery failure at home, then go to facility: 58-91% DHS Cameroon 2004; Gessessew 20003; Ramsey 1994; Holme 2007;Meyer 2007;Hilton 1998; Ijaiya2004 15
Association between CS rate and maternal mortality from 118 countries Cesarean secttion rate Maternal mortality rate per 100,000 live births Adapted from: Althabe 2006
Grand multiparity Study from Pakistan : >= 6 deliveries (54.43%) (Ahmad 2005) 1 of 6 studies from Nigeria (Mean/median Parity at 6(Hilton 1998 Sources: UN 2001; Population Reference Bureau 2002 (use of modern contraception, TFR)
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