14928 名埃塞俄比亚妇女中的产科瘘。

Obstetric fistula in 14,928 Ethiopian women.

机构信息

Centre for International Health, University of Bergen, Bergen, Norway.

出版信息

Acta Obstet Gynecol Scand. 2010 Jul;89(7):945-51. doi: 10.3109/00016341003801698.

DOI:10.3109/00016341003801698

PMID:20397760

Abstract

OBJECTIVES

Obstetric fistulas are severe sequelae of prolonged obstructed labor, a widespread but incompletely documented problem of low-income countries. Here, we characterize women with obstetric fistula, test the hypothesis that primi- and multipara represent different profiles and that fetal size is an important factor in developing fistula.

DESIGN

Hospital registry statistics and questionnaire.

POPULATION

A total of 14,928 Ethiopian women with obstetric fistula in 1974-2006 and 434 admitted in 2007-8.

METHODS

Self-reported age, marital status, education, distance from home to health facility, parity, duration of labor, neonatal outcome and sex, lag time to treatment; measurement of weight, stature, extent of lesion and clinical assessment of continence before hospital discharge.

OUTCOME MEASURES

Duration of labor, extent of pelvic injury and neonatal survival, cure rate.

RESULTS

Primi- were more common than multiparous cases (56.8 vs. 43.2%). They were of similar age at marriage (17 years) and stature at hospital admission, but shorter than the population average (152.7 vs. 156.5 cm). Primipara had longer labor than multipara (50.5% > 3 days vs. 27%), larger uro-vaginal fistula, more stillbirths (95 vs. 88%), recto-vaginal fistula, vaginal scarring, persistent incontinence after repair and were more commonly divorced. Male fetuses were involved in 76.7% of obstructed deliveries but in only 44.6% of a previous uneventful delivery in multipara. Educational attainment positively influenced outcomes.

CONCLUSIONS

Obstetric fistula is more commonly associated with primiparous than subsequent pregnancies. Primipara have a longer and more damaging labor. A causative role for cephalo-pelvic disproportion is supported by the observation that male fetuses are more commonly involved in obstructed labor.

摘要

目的

产科瘘是长时间梗阻性分娩的严重后遗症，是低收入国家普遍存在但不完全记录的问题。在这里，我们对患有产科瘘的女性进行了特征描述，检验了初产妇和经产妇代表不同特征，以及胎儿大小是导致瘘的一个重要因素的假设。

设计

医院登记统计和问卷调查。

人群

1974 年至 2006 年共有 14928 名埃塞俄比亚产科瘘女性患者，2007 年至 2008 年有 434 名患者入院。

方法

自我报告年龄、婚姻状况、教育程度、离家到医疗机构的距离、产次、分娩持续时间、新生儿结局和性别、治疗的延迟时间；测量体重、身高、损伤范围和出院前的临床评估。

结果

初产妇比经产妇更常见（56.8%比 43.2%）。她们的初婚年龄（17 岁）和入院时的身高相似，但比人口平均水平矮（152.7 厘米比 156.5 厘米）。初产妇的分娩时间比经产妇长（50.5%>3 天比 27%），尿生殖道瘘更大，死产更多（95 例比 88%），直肠阴道瘘、阴道疤痕、修复后持续失禁，离婚的更多。梗阻性分娩中男性胎儿占 76.7%，而经产妇前次无并发症分娩中仅占 44.6%。教育程度对结果有积极影响。