Department of Urogynecology, Panzi General Referral Hospital, Bukavu, Democratic Republic of the Congo.
Faculty of Medicine, Evangelical University in Africa, Bukavu, Democratic Republic of the Congo.
BMC Pregnancy Childbirth. 2023 Jan 23;23(1):54. doi: 10.1186/s12884-023-05357-3.
The prevalence and impact of fistulas are more common in developing countries with limited access to emergency obstetric care. As a result, women in these settings often experience adverse psychosocial factors. The purpose of this study was to describe the characteristics of Congolese women who developed urogenital fistula following Cesarean sections (CS) to determine the characteristics associated with two etiologies: (1) prolonged obstructed labor; and (2) a complication of CS following obstructed labor.
We performed a cross-sectional study on abstracted data from all patients with urogenital fistula following CS who received care during a surgical campaign in a remote area of the Democratic Republic of the Congo (DRC). Descriptive analyses characterized patients with fistula related to obstructed labor versus CS. Univariate and multivariate logistic regression models identified factors associated with obstetric fistula after cesarean delivery following obstructed labor. Variables were included in the logistic regression models based upon biological plausibility.
Among 125 patients, urogenital fistula etiology was attributed to obstructed labor in 77 (62%) and complications following CS in 48 (38%). Women with a fistula, attributed to obstructed labor, developed the fistula at a younger age (p = .04) and had a lower parity (p = .02). Attempted delivery before arriving at the hospital was associated with an increased risk of obstetric fistula after cesarean delivery following obstructed labor (p < .01).
CS are commonly performed on women who arrive at the hospital following prolonged obstructed labor and fetal demise, and account for almost 40% of urogenital fistula. Obstetric providers should assess maternal status upon arrival to prevent unnecessary CS and identify women at risk of developing a fistula.
在获得紧急产科护理机会有限的发展中国家，瘘管的流行率和影响更为常见。因此，这些环境中的妇女经常经历不良的社会心理因素。本研究的目的是描述发生剖宫产术后尿生殖瘘的刚果妇女的特征，以确定与两种病因相关的特征：（1）延长的梗阻性分娩；（2）梗阻性分娩后剖宫产的并发症。
我们对在刚果民主共和国（DRC）偏远地区进行的外科运动中接受剖宫产术后尿生殖瘘治疗的所有患者的摘要数据进行了横断面研究。描述性分析描述了与梗阻性分娩相关的瘘管患者与 CS 的特征。单变量和多变量逻辑回归模型确定了与梗阻性分娩后剖宫产术后产科瘘相关的因素。根据生物学合理性，将变量纳入逻辑回归模型。
在 125 名患者中，77 名（62%）的尿生殖瘘病因归因于梗阻性分娩，48 名（38%）归因于 CS 并发症。由于梗阻性分娩而导致瘘管的妇女年龄较小（p=0.04），且产次较低（p=0.02）。在到达医院之前尝试分娩与梗阻性分娩后剖宫产术后产科瘘的风险增加相关（p<0.01）。
在医院接受长时间梗阻性分娩和胎儿死亡的妇女中，通常会进行 CS，并且占尿生殖瘘的近 40%。产科提供者应在到达时评估产妇的状况，以防止不必要的 CS，并确定有瘘管风险的妇女。
