Lewis Wall L, Belay Shewaye, Haregot Tesfahun, Dukes Jonathan, Berhan Eyoel, Abreha Melaku
Department of Obstetrics and Gynecology, Ayder Referral Hospital, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO, USA.
Int Urogynecol J. 2017 Dec;28(12):1817-1824. doi: 10.1007/s00192-017-3368-6. Epub 2017 May 26.
We tested the null hypothesis that there were no differences between patients with obstetric fistula and parous controls without fistula.
A unmatched case-control study was carried out comparing 75 women with a history of obstetric fistula with 150 parous controls with no history of fistula. Height and weight were measured for each participant, along with basic socio-demographic and obstetric information. Descriptive statistics were calculated and differences between the groups were analyzed using Student's t test, Mann-Whitney U test where appropriate, and Chi-squared or Fisher's exact test, along with backward stepwise logistic regression analyses to detect predictors of obstetric fistula. Associations with a p value <0.05 were considered significant.
Patients with fistulas married earlier and delivered their first pregnancies earlier than controls. They had significantly less education, a higher prevalence of divorce/separation, and lived in more impoverished circumstances than controls. Fistula patients had worse reproductive histories, with greater numbers of stillbirths/abortions and higher rates of assisted vaginal delivery and cesarean section. The final logistic regression model found four significant risk factors for developing an obstetric fistula: age at marriage (OR 1.23), history of assisted vaginal delivery (OR 3.44), lack of adequate antenatal care (OR 4.43), and a labor lasting longer than 1 day (OR 14.84).
Our data indicate that obstetric fistula results from the lack of access to effective obstetrical services when labor is prolonged. Rural poverty and lack of adequate transportation infrastructure are probably important co-factors in inhibiting access to needed care.
我们检验了零假设，即产科瘘患者与无瘘经产妇对照组之间不存在差异。
开展了一项非匹配病例对照研究，比较75例有产科瘘病史的女性与150例无瘘病史的经产妇对照组。测量了每位参与者的身高和体重，以及基本的社会人口统计学和产科信息。计算了描述性统计量，并使用学生t检验、适当情况下的曼-惠特尼U检验、卡方检验或费舍尔精确检验分析了组间差异，同时进行了向后逐步逻辑回归分析以检测产科瘘的预测因素。p值<0.05的关联被认为具有显著性。
瘘管患者结婚更早，首次怀孕分娩也早于对照组。她们受教育程度显著更低，离婚/分居的患病率更高，且生活环境比对照组更贫困。瘘管患者的生育史更差，死产/流产数量更多，辅助阴道分娩和剖宫产率更高。最终的逻辑回归模型发现了四个导致产科瘘的显著风险因素：结婚年龄（比值比1.23）、辅助阴道分娩史（比值比3.44）、缺乏充分的产前护理（比值比4.43）以及产程持续超过1天（比值比14.84）。
我们的数据表明，产程延长时缺乏有效的产科服务会导致产科瘘。农村贫困和缺乏足够的交通基础设施可能是阻碍获得所需护理的重要共同因素。
