Fistula recurrence, pregnancy, and childbirth following successful closure of female genital fistula in Guinea: a longitudinal study
| Autor: | Thérèse Delvaux, Wei Hong Zhang, Moustapha Diallo, Bienvenu Salim Camara, Bethany Cole, Alexandre Delamou, Kindy Diallo, Patrice Bouedouno, Alain Levêque, Vincent De Brouwere, Abdoul Habib Beavogui, Thierno Hamidou Barry, Lauri Romanzi, Vandana Tripathi, Alison M. El Ayadi, Mandian Camara |
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| Rok vydání: | 2017 |
| Předmět: |
COUNTRIES
Adult medicine.medical_specialty Pregnancy Rate Vaginal fistula Fistula ETHIOPIA Urinary incontinence DETERMINANTS Sciences de l'ingénieur 03 medical and health sciences DELIVERY Young Adult 0302 clinical medicine Pregnancy Recurrence medicine Medicine and Health Sciences VAGINAL FISTULA Childbirth Humans Cumulative incidence 030212 general & internal medicine Longitudinal Studies OUTCOMES 030219 obstetrics & reproductive medicine Obstetrics business.industry Incidence (epidemiology) lcsh:Public aspects of medicine Vaginal Fistula Parturition WOMEN lcsh:RA1-1270 General Medicine Middle Aged medicine.disease SUCCESSFUL REPAIR EXPERIENCES Treatment Outcome Maternal death Female Guinea medicine.symptom business OBSTETRIC FISTULA |
| Zdroj: | The Lancet Global Health, Vol 5, Iss 11, Pp e1152-e1160 (2017) LANCET GLOBAL HEALTH The Lancet Global Health, 5 (11 |
| ISSN: | 2214-109X |
| Popis: | Background Female genital fistula is a devastating maternal complication of delivery in developing countries. We sought to analyse the incidence and proportion of fistula recurrence, residual urinary incontinence, and pregnancy after successful fistula closure in Guinea, and describe the delivery-associated maternal and child health outcomes. Methods We did a longitudinal study in women discharged with a closed fistula from three repair hospitals supported by EngenderHealth in Guinea. We recruited women retrospectively (via medical record review) and prospectively at hospital discharge. We used Kaplan-Meier methods to analyse the cumulative incidence, incidence proportion, and incidence ratio of fistula recurrence, associated outcomes, and pregnancy after successful fistula closure. The primary outcome was recurrence of fistula following discharge from repair hospital in all eligible women who consented to inclusion and could provide follow-up data. Findings 481 women eligible for analysis were identified retrospectively (from Jan 1, 2012, to Dec 31, 2014; 348 women) or prospectively (Jan 1 to June 20, 2015; 133 women), and followed up until June 30, 2016. Median follow-up was 28·0 months (IQR 14·6–36·6). 73 recurrent fistulas occurred, corresponding to a cumulative incidence of 71 per 1000 person-years (95% CI 56·5–89·3) and an incidence proportion of 18·4% (14·8–22·8). In 447 women who were continent at hospital discharge, we recorded 24 cases of post-repair residual urinary incontinence, equivalent to a cumulative incidence of 23·1 per 1000 person-years (14·0–36·2), and corresponding to 10·3% (5·2–19·6). In 305 women at risk of pregnancy, the cumulative incidence of pregnancy was 106·0 per 1000 person-years, corresponding to 28·4% (22·8–35·0) of these women. Of 50 women who had delivered by the time of follow-up, only nine delivered by elective caesarean section. There were 12 stillbirths, seven delivery-related fistula recurrences, and one maternal death. Interpretation Recurrence of female genital fistula and adverse pregnancy-related maternal and child health outcomes were frequent in women after fistula repair in Guinea. Interventions are needed to safeguard the health of women after fistula repair. Funding Belgian Development Cooperation (DGD), Institute of Tropical Medicine of Antwerp (ITM), and Maferinyah Training and Research Center in Rural Health (Guinea). SCOPUS: ar.j info:eu-repo/semantics/published |
| Databáze: | OpenAIRE |
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