Predictors of Obstetric Fistula Repair Outcomes in Lubango, Angola.

Authors:
Laurence Bernard
Laurence Bernard
University School of Medical Sciences & Regional Medical Center for Mother and Child
Poland
Andrew Giles
Andrew Giles
Queen's University
Canada
Mark G Shrime
Mark G Shrime
Harvard Medical School
Boston | United States
Sarah Feldman, Medical Resident, MSc, MSPH
Sarah Feldman, Medical Resident, MSc, MSPH
Pierre and Marie Curie University - Paris 6
Public health resident
Public health resident, MSc in biology with subspecialty in physiology-physiopathology, MSc in public health with subspeciality in statistics and methodology in biomedical research
Paris | France

J Obstet Gynaecol Can 2019 Apr 12. Epub 2019 Apr 12.

Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Center for Surgery and Public Health,(,) Brigham and Women's Hospital, Harvard Medical School, Boston, MA.

Objective: Obstetric fistulas have a significant physical and social impact on many women in Angola. The majority of the population of this sub-Saharan African nation does not have access to high-quality obstetric care, and this is associated with a risk of prolonged labour and formation of obstetric fistulas. Fistulas are challenging to correct surgically and may require repeated operations. The objective of the study was to determine predictors of successful obstetric fistula repair.

Methods: In this retrospective study, data from all recorded cases of fistula repairs performed between July 2011 and December 2016 at the Centro Evangélico de Medicina do Lubango (CEML) hospital located in Lubango, Angola, were reviewed. Analysis of the data was carried out to determine factors affecting the success of fistula repair; parametric and non-parametric tests were used for group comparisons and logistic regression for outcome prediction (Canadian Task Force classification II-2).

Results: A total of 407 operations were performed on 243 women. Of these, 224 women were diagnosed with a vesicovaginal fistula and 19 with a combined vesicovaginal and rectovaginal fistula. The success rate for the attempted repairs was 42%. On multivariate analysis, the success of first surgery was negatively affected by the difficulty of repair (odds ratio 0.28; P < 0.01). For patients requiring repeat surgery, the odds of success were increased with each subsequent operation (odds ratio 5.32; P < 0.01).

Conclusion: Although fistulas rated as difficult to repair had a higher likelihood of initial failure, successive attempts at repair increased the likelihood of a successful outcome.

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Source
https://linkinghub.elsevier.com/retrieve/pii/S17012163193008
Publisher Site
http://dx.doi.org/10.1016/j.jogc.2019.01.025DOI Listing
April 2019
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