Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
摘要：
背景：瘘管的患病率和影响在获得紧急产科护理的机会有限的发展中国家更为普遍。因此,在这些环境中的女性经常经历不良的社会心理因素。这项研究的目的是描述剖腹产（CS）后发生泌尿生殖道瘘的刚果妇女的特征，以确定与两种病因相关的特征：（1）长时间的阻塞分娩；（2）阻塞分娩后CS的并发症。
方法：我们对所有在刚果民主共和国（DRC）偏远地区接受手术治疗的CS后泌尿生殖道瘘患者的提取数据进行了横断面研究。描述性分析描述了与产程梗阻和CS相关的瘘管患者。单变量和多变量逻辑回归模型确定了剖宫产后产科瘘的相关因素。变量包括在基于生物学合理性的逻辑回归模型中。
结果：在125名患者中，泌尿生殖道瘘的病因归因于77例（62％）的难产和48例（38％）的CS并发症。有瘘管病的妇女,归因于阻碍劳动，在较年轻的年龄（p=.04）和较低的奇偶校验（p=.02）发展瘘管。在到达医院之前尝试分娩与剖宫产后的产科瘘风险增加相关（p<0.01）。
结论：CS通常适用于长期难产和胎儿死亡后到达医院的妇女，占泌尿生殖道瘘的近40%。产科提供者应在到达时评估产妇状况，以防止不必要的CS，并确定有患瘘管风险的妇女。
方法：我们对所有在刚果民主共和国（DRC）偏远地区接受手术治疗的CS后泌尿生殖道瘘患者的提取数据进行了横断面研究。描述性分析描述了与产程梗阻和CS相关的瘘管患者。单变量和多变量逻辑回归模型确定了剖宫产后产科瘘的相关因素。变量包括在基于生物学合理性的逻辑回归模型中。
结果：在125名患者中，泌尿生殖道瘘的病因归因于77例（62％）的难产和48例（38％）的CS并发症。有瘘管病的妇女,归因于阻碍劳动，在较年轻的年龄（p=.04）和较低的奇偶校验（p=.02）发展瘘管。在到达医院之前尝试分娩与剖宫产后的产科瘘风险增加相关（p<0.01）。
结论：CS通常适用于长期难产和胎儿死亡后到达医院的妇女，占泌尿生殖道瘘的近40%。产科提供者应在到达时评估产妇状况，以防止不必要的CS，并确定有患瘘管风险的妇女。
