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10.1007/s00192-017-3375-7

http://scihub22266oqcxt.onion/10.1007/s00192-017-3375-7
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C5847061!5847061!28600757
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suck abstract from ncbi


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pmid28600757      Int+Urogynecol+J 2018 ; 29 (3): 345-51
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  • Obstetric fistula in Niger: 6-month postoperative follow-up of 384 patients from the Danja Fistula Center #MMPMID28600757
  • Ouedraogo I; Payne C; Nardos R; Adelman AJ; Wall LL
  • Int Urogynecol J 2018[]; 29 (3): 345-51 PMID28600757show ga
  • Introduction and hypothesis: The impoverished West African country of Niger has high rates of obstetric fistula. We report a 6-month postoperative follow-up of 384 patients from the Danja Fistula Center and assess factors associated with operative success or failure. Methods: The medical records of 384 women who had completed a 6-month follow-up after fistula surgery were reviewed. Cases were categorized as ?easy,? ?of intermediate complexity,? or ?difficult? based on a preoperative points system. Data were analyzed using simple chi-squared statistics and logistic regression. Results: The patients were predominantly of Hausa ethnicity (73%), married young (average 15.9 years), had teenage first pregnancies (average first delivery 16.9 years), and experienced prolonged labor (average 2.3 days) with poor outcomes (89% stillbirth rate). The average parity was four. Patients commonly developed their fistula during their first delivery (43.5%), but over half sustained a fistula during a subsequent delivery (56.5%). Prior fistula surgery elsewhere (average 1.75 operations) was common. The overall surgical success (?closed and dry?) was 54%. When the 134 primary operations were analyzed separately, the overall success rate was 80%. Increasing success was seen with decreasing surgical difficulty: 92% success for ?easy? cases, 68% for ?intermediate? cases, and 57% success for ?difficult? cases. Success decreased with increasing numbers of previous attempts at surgical repair. Conclusions: These data provide further evidence that clinical outcomes are better when primary fistula repair is performed by expert surgeons in specialist centers with the support of trained fistula nurses.
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