maternal urogynaecologic conditions.pptx

maternal urogynaecologic conditions

1. Public Burden, Magnitude and Risk factors of Obstetric fistula Nationally and Internationationally Maternal Urogynecologic Conditions 14/05/2024 1

2. Obstetric fistula is an abnormal opening between a woman’s genital tract and her urinary tract or rectum Each year between 50 000 to 100 000 women worldwide are affected by obstetric fistula On a global scale, obstetric fistula (OF) remains a significant obstetrical problem in low-resource countries and found to be one of the most visible indicators of maternal morbidity . 80-90% of fistula cases are in Africa . In developing countries, obstetric fistulas occur at a rate of 2-5 per 1000 deliveries ( where no access to functioning obstetric service ). Obstetric Fistula 14/05/2024 2

3. True Magnitude of Fistula problem world wide is underestimated b/se ignored and outcasted . Countries with high incidence of maternal mortality also have high rates of obstetric fistula I t is estimated that more than 2 million young women live with untreated obstetric fistula, mostly in Asia and sub-Saharan Africa. In Nigeria , estimated number of unrepaired VVF cases are b/n 800,000&1,000,000 by 2001. Cont… 14/05/2024 3

4. Ethiopia had the highest lifetime prevalence of 7.3 per 1000 for women between the ages of 15 and 49. In Ethiopia , among a total burden of 142,387 fistula cases, it is estimated that 9000 new fistula cases per year, but only 1200 are treated Obstetric fistula has serious social and physical health implications for women in Ethiopia Cont……… 14/05/2024 4

5. Obstetric fistula has many consequences: about 93% of women with obstetric fistulas had a stillbirth and 97% develop mental health problems such as depression. Among those who experienced depression, 54% reported suicidal ideation. Further , 68% had no living children, nearly 54% were divorced, 13% were not allowed to eat with family members and 41% did not belong to any community association. Obstetric fistula constitutes a severe threat to the health of adolescent women in particular. Cont….. 14/05/2024 5

6. Obstetric fistula is closely related to prolonged and obstructed labor where emergency obstetrical care is inaccessible and unavailable . A woman with obstructed labor develops a fistula when the presenting fetal part compresses continually the birth canal tissue, bladder base, urethra or sometimes rectum causing ischemia and necrosis of the tissue Obstructed labor injury complex can lead to a host of physical and psychological injuries and who survive develop a life-altering birth injury i.e. obstetric fistula Women who experience obstetric fistula suffer constant incontinence, shame, social segregation and health problems . Cont… 14/05/2024 6

7. P lace of birth and presence of a skilled birth attendant D uration of labor E arly marriage women with no antenatal care and those who delivered at home Poverty, illiteracy, lack of education Harmful traditional practices, (FGM), sexual violence Trauma Infection Causes and Risk Factors for Obstetric Fistula 14/05/2024 7

8. Poverty ( Lack of education, FGM, Malnutrition)  Early marriage  Unprotected intercourse  Unplanned pregnancy  no ANC follow up  Poorly supervised labor  Obstructed labor injuries complex  if untreated premature death will occur. Most common cause of death Chronic renal failure, overwhelming sepsis and sever form of adult malnutrition . P ath ways of fistula formation 14/05/2024 8

9. 1.Vesico-vaginal Fistula -most common obstetric fistula(78% of cases) -classified - juxta -urethral, mid-vaginal, juxta -cervical 2.Urethro-vaginal fistula -Usu. combined with VVF( bladder neck injury) -Complete urethral loss in 5%of fistula patients -Prognosis of continence is uncertain after repair (higher chance of stress incontinence) Classifications 14/05/2024 9

10. 3.Recto-vaginal fistula -less common than VVF -Data from AA fistula hospital .15.2 % of fistula pts have combined VVF& RVF . .6.8% have isolated RVF. - Mechanism-different a) urinary fistula- sloughing due to pressure necrosis b) RVF -low (majority)-due to 3 rd and 4rth degree perineal tear -High RVF-as GUF/pressure necrosis by obst.labor Cont… 14/05/2024 10

11. 4.Uretero-Vaginal Fistula (Ureteric Fistula) -1% of obstetric fistula cases. -ureter can be damaged accidentally during C/S or an emergency hysterectomy for a ruptured Ux. 5.Vesico-cervical / Vesico -uterine fistula - uncommon(1%). -almost always follows a C/S (iatrogenic or pushing for days with an incompletely dilated cervix). Cont… 14/05/2024 11

12. Involuntary loss of urine and/or faeces. Associated medical, Physical Injuries Psychiatrics manifestation. On physical examination all system can be affected ,Thorough P/E Should be conducted with due emphasis on pelvic examination and physical fitness of the patients. Assess the fistula and make classification of pathology to make appropriate decision. Clinical presentations: 14/05/2024 12

13. Primary prevention (social measures ) Health promotion (programmes, policies) Planned pregnancies Birth spacing, Contraception Community awareness (delaying age at 1 st pregnancy, avoiding HTP) Secondary prevention (basic obstetric care) Antenatal care, Skilled health personnel at birth, Use of partograph Identification of signs and symptoms of obstructed labour Immediate referral Bladder care and/or catheterization during labour, if needed Prevention of obstetric Fistula 14/05/2024 13

14. Tertiary prevention (more advanced obstetric care) Access to emergency obstetric and neonatal care (EmONC) by providing A timely , safe, quality Caesarean section by a trained/competent surgeon Use of an indwelling catheter (i.e., a Foley catheter) to close small fresh fistulae Preventing and managing obstetric fistula will contribute to improved maternal health and the achievement of the Sustainable Development Goals (SDGs). Cont…. 14/05/2024 14

15. INCONTINENCE OF URINE AND/OR STOOL Chronic pyelonephritis, hydronephrosis and bladder stone Renal failure Vaginal stenosis (scarring) and dyspareunia ( pain during intercourse ) Pelvic inflammatory disease, amenorrhea and infertility Osteitis pubis (infection in the pubic bone and pubic symphysis ) Complications related to fistula 14/05/2024 15

16. Lumbar plexus and/or peroneal nerve damage resulting in foot drop, loss of control of rectal muscles and numbness/weakness pelvic area and lower extremities. This may lead to contractures of the legs Urea dermatitis - Chronic irritation and excoriation of skin (labia, perineum, groin) from contact with urine and stool Malnutrition – often a result of neglect, depression and poverty Cont…. 14/05/2024 16

17. THANK YOU 14/05/2024 17