Predisposing Factors of Obstetric Fistula & its Surgical Outcomes, among Al-Sabeen maternal Hospital attendances, Sana`a –Yemen

Abstract

Background : Obstetric fistula, one of the most
devastating consequences of prolonged obstructed
labour, is a historical issue in the developed world.
However, it is still prevalent in developing country
like Yemen. Obstetric fistula is still a persisting
scourge in the developing countries, including Yemen in which >5000 new cases of obstetric fistula were estimated yearly. It occurs in areas where
access to care at childbirth is limited, or of poor
quality and where few hospitals offer the necessary corrective surgery.
Objectives : To study the Predisposing Factors
(social, demographic, cultural and maternal) of
Obstetric Fistula & its Surgical Outcomes, among
Al-Sabeen maternal Hospital attendances, Sana`a
–Yemen.
Materials and methods: A hospital-based
cross-sectional descriptive study was carried out
for 86 medical files of obstetric fistula patients
admitted to gynecological department in Al-Sabeen maternal hospital in Sana’a city during study
during October 2011 to October 2015. Using
available data technique and closed ended questionnaire were used to collect the study data from
medical files available in the hospital. Study data
were analyzed by SPSS software(version 21).
Results : Most of obstetric fistula patient were
in age groupe15-35yrs (76.8%) early age of marriage(82%) illiterate (69.8%) and still married despite having fistula (83.7%) with no antenatal care
attendance in the causative pregnancy (53.5%) and
have history of previous once and more caesarian
section (20.0%,16.3%) most of participants delivered vaginally(53.5%) with prolonged delivery >
2 days (81.4%) most of result with p-value <0.05
statistically significant. With (80.5%) obstructed prolonged labour is leading cause to obstetric
fistula still the iatrogenic cause with high percent
(5.9%).
Most of obstetric fistula (90.7%) with genitourinary type,(25%) with rectovaginal type and
(16.27%) have complex fistula With p-value0.00.
Majority of obstetric fistula patient conducted trans-vaginal approach(65.1%) in one stage
(75.3%) and most of them (79.1%) stay in hospital>3weeks with highly success surgical repair
(97.7%) all result with p-value <0.05 which statistically significant.
Conclusion : The predisposing factors of obstetric
fistula are illiteracy, early age of marriage, early
age get pregnancy <25yrs, no or inadequate antenatal care, obstructed prolonged vaginal delivery,
the iatrogenic cause during cesarean section and
previous once or more caesarian section. Genitourinary fistula is the most predominant Obstetric
fistula type among study patients and the other
types are Rectovaginal and complex fistula. The
most significantly surgical approach are Trans vaginal, one stage of repair, the duration of post-operative stay was significantly more 3 weeks in most
of them and finally there is a significantly success
repair after surgery in the vast majority of study
patients.
Recommendations: The study findings emphasize the obstetric fistula is important problem faced
community and major problem leading to increase
maternal morbidity, significance of both treatment
and prevention activities against obstetric fistula which highly preventable health condition of
women in Yemen. Also needed are interventions
that focus on improving access to maternal health
care, emergency obstetric care, and increased rates
of cesarean delivery when indicated.