AI Article Synopsis
- The study compares urogenital fistula characteristics arising from cesarean deliveries versus spontaneous vaginal deliveries among 597 patients treated at Panzi Hospital in the Democratic Republic of Congo from 2005 to 2007.
- Out of 576 women with obstetric fistula, 40% had cesarean deliveries, with a notable percentage being iatrogenic, and higher odds for specific types of fistulae were found in the cesarean group.
- The findings suggest that cesarean delivery-related fistulae have distinct clinical features, indicating the need for targeted prevention strategies and better training in surgical techniques to improve obstetric care.
Article Abstract
Objective: To compare the characteristics of urogenital fistulae after cesarean delivery with those after spontaneous vaginal delivery.
Methods: A retrospective analysis of hospital records of 597 consecutive patients with a urogenital fistula who received treatment at Panzi Hospital, Bukavu, Democratic Republic of Congo, during 2005-2007.
Results: Of 576 women with an obstetric fistula, 229 (40%) had had a cesarean delivery; 55 (24%) of the 229 fistulae were considered to be iatrogenic. The distribution of risk factors (age, stature, parity, and labor duration) was similar to that among 226 women with a spontaneous vaginal delivery, but the odds ratios for having a ureterovaginal or a vesicouterine fistula were 11.9 (95% confidence interval [CI] 2.8-51.2) and 9.5 (95% CI 2.8-31.9), respectively. Vesicovaginal fistulae with cervical involvement were also significantly more frequent in the cesarean delivery group. The fistulae in this group had less surrounding fibrosis and there was less treatment delay. Stillbirth rates were 87% (cesarean delivery) and 95% (spontaneous vaginal delivery).
Conclusion: The data indicate that cesarean delivery-related fistulae are a separate clinical entity. Focus on this condition is important for fistula prevention and provision of adequate obstetric care, particularly for training in surgery and alternative delivery methods.
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| http://dx.doi.org/10.1016/j.ijgo.2011.01.018 | DOI Listing |
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