Dejene Tadesse Mamo, Belachew Asrat Kassaw, Amera Tizazu Michael, Yesuf Sadat Mohammed
Department of Public Health, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia.
Front Glob Womens Health. 2024 Nov 21;5:1460227. doi: 10.3389/fgwh.2024.1460227. eCollection 2024.
Obstetric Fistula leads to fecal and urine incontinence in women and girls. Surgical repair is the cornerstone of care. Failure to repair an obstetric fistula exposes women not only to repeated surgery but also to ongoing incontinence and its sequela, depression, and social exclusion. Which impacts the nation's health intervention programs and socioeconomic burden.
To determine factors associated with failed fistula closure in women who underwent Fistula Closure at the Hamlin Fistula Center in Addis Ababa, central Ethiopia, between February 10, 2018, and December 28, 2020.
Women who underwent Fistula Closure between February 10, 2018, and December 28, 2020 were included in a case-control study that was conducted between May and June 2021. In total, 417 study participants (139 cases and 280 controls) were selected using a systematic random sampling technique. Two professional midwife data collectors and one BSC nurse for the supervisory assessment of women's medical cards utilized a structured questionnaire to collect data. SPSS version 25 was used to enter, clean, and analyze the data. During data analysis, bivariate and multivariate regression models were used. A -value of less than 0.05 indicates a significant correlation.
Forty-nine patients (35.3%) and 133 controls (47.8%) who were older than 26 years were at repair while they were (14-19 years old). The factors that contributed to failure of fistula closure included age at repair (14-19 years old) [AOR = 2.1, 95% CI (0.94-4.89)], prior fistula attempts (9.6, rural residence [AOR = 2.69, 95% CI (1.36-5.35)], height <150 cm [AOR = 1.80, 95% CI (0.99-3.59)], labor duration longer than 2 days [AOR = 1.89, 95% CI (0.99-3.59)], delivery by cesarean section [AOR = 1.88, 95% CI (1.04-3.89)], damaged urethra [AOR = 2.02, 95% CI (1.04-3.89)], diameter of fistula >3 cm, mild vaginal scar [AOR = 3.20, 95% CI (1.24-8.29)], moderate and severe vaginal scar [AOR = 5.49, 95% CI (1.92-15.75)], and completion of ANC [AOR = 0.20 (0.11, 0.38)].
Age at the time of repair, Residence, Height, duration of labor, mode of delivery, completion of ANC, damaged urethra, fistula diameter >3 cm, previous fistula attempts, and vaginal scar are factors related to failure of fistula closure. By focusing on these areas, we can significantly improve the outcomes for patients undergoing fistula repair and lower the likelihood of failed closures in the future. Community-based health education regarding obstetric fistula and the importance of seeing a doctor as soon as possible during labor to lower the risk of obstructed delivery, boost antenatal care completion, and shorten the length of labor are all necessary to prevent failed fistula closure in comparable patients in the future.
产科瘘导致妇女和女童大小便失禁。手术修复是治疗的基石。未能修复产科瘘不仅使妇女面临再次手术，还面临持续失禁及其后遗症、抑郁和社会排斥。这会影响国家的卫生干预计划和社会经济负担。
确定2018年2月10日至2020年12月28日期间在埃塞俄比亚中部亚的斯亚贝巴哈姆林瘘管中心接受瘘管闭合手术的妇女中与瘘管闭合失败相关的因素。
2018年2月10日至2020年12月28日期间接受瘘管闭合手术的妇女纳入了2021年5月至6月进行的病例对照研究。总共使用系统随机抽样技术选取了417名研究参与者（139例病例和280名对照）。两名专业助产士数据收集员和一名负责监督评估妇女医疗卡的理学学士护士使用结构化问卷收集数据。使用SPSS 25版输入、清理和分析数据。在数据分析过程中，使用了二元和多元回归模型。P值小于0.05表示存在显著相关性。
49名患者（35.3%）和133名对照（47.8%）在14至19岁时接受修复手术，而她们实际年龄超过26岁。导致瘘管闭合失败的因素包括修复时年龄（14至19岁）[调整后比值比（AOR）=2.1，95%置信区间（CI）（0.94至4.89）]、既往瘘管修复尝试（9.6）、农村居住[AOR=2.69，95%CI（1.36至5.35）]、身高<150厘米[AOR=1.80，95%CI（0.99至3.59）]、产程超过2天[AOR=1.89，95%CI（0.99至3.59）]、剖宫产分娩[AOR=1.88，95%CI（1.04至3.89）]、尿道受损[AOR=2.02，95%CI（1.04至3.89）]、瘘管直径>3厘米、轻度阴道瘢痕[AOR=3.20，95%CI（1.24至8.29）]、中度和重度阴道瘢痕[AOR=5.49，95%CI（1.92至15.75）]以及产前检查完成情况[AOR=0.20（0.11，0.38）]。
修复时年龄、居住地点、身高、产程、分娩方式、产前检查完成情况、尿道受损、瘘管直径>3厘米、既往瘘管修复尝试以及阴道瘢痕是与瘘管闭合失败相关的因素。通过关注这些方面，我们可以显著改善接受瘘管修复患者的治疗效果，并降低未来闭合失败的可能性。开展关于产科瘘的社区健康教育以及分娩时尽早就医以降低梗阻性分娩风险、提高产前检查完成率和缩短产程的重要性，对于预防未来类似患者的瘘管闭合失败都是必要的。
