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Fistula recurrence, pregnancy, and childbirth following successful closure of female genital fistula in Guinea : a longitudinal study

(2017) LANCET GLOBAL HEALTH. 5(11). p.E1152-E1160
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Organization
Abstract
Background: Female genital fistula is a devastating maternal complication of delivery in developing countries. We sought to analyse the incidence and proportion of fistula recurrence, residual urinary incontinence, and pregnancy after successful fistula closure in Guinea, and describe the delivery-associated maternal and child health outcomes. Methods: We did a longitudinal study in women discharged with a closed fistula from three repair hospitals supported by Engender Health in Guinea. We recruited women retrospectively (via medical record review) and prospectively at hospital discharge. We used Kaplan-Meier methods to analyse the cumulative incidence, incidence proportion, and incidence ratio of fistula recurrence, associated outcomes, and pregnancy after successful fistula closure. The primary outcome was recurrence of fistula following discharge from repair hospital in all eligible women who consented to inclusion and could provide follow-up data. Findings: 481 women eligible for analysis were identified retrospectively (from Jan 1, 2012, to Dec 31, 2014; 348 women) or prospectively (Jan 1 to June 20, 2015; 133 women), and followed up until June 30, 2016. Median follow-up was 28.0 months (IQR 14.6-36.6). 73 recurrent fistulas occurred, corresponding to a cumulative incidence of 71 per 1000 person-years (95% CI 56.5-89.3) and an incidence proportion of 18.4% (14.8-22.8). In 447 women who were continent at hospital discharge, we recorded 24 cases of post-repair residual urinary incontinence, equivalent to a cumulative incidence of 23.1 per 1000 person-years (14.0-36.2), and corresponding to 10.3% (5.2-19.6). In 305 women at risk of pregnancy, the cumulative incidence of pregnancy was 106.0 per 1000 person-years, corresponding to 28.4% (22.8-35.0) of these women. Of 50 women who had delivered by the time of follow-up, only nine delivered by elective caesarean section. There were 12 stillbirths, seven delivery-related fistula recurrences, and one maternal death. Interpretation: Recurrence of female genital fistula and adverse pregnancy-related maternal and child health outcomes were frequent in women after fistula repair in Guinea. Interventions are needed to safeguard the health of women after fistula repair.
Keywords
OBSTETRIC FISTULA, SUCCESSFUL REPAIR, VAGINAL FISTULA, WOMEN, OUTCOMES, DETERMINANTS, EXPERIENCES, COUNTRIES, DELIVERY, ETHIOPIA

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Please use this url to cite or link to this publication:

Chicago
Delamou, Alexandre, Therese Delvaux, Alison M El Ayadi, Vandana Tripathi, Bienvenu S Camara, Abdoul H Beavogui, Lauri Romanzi, et al. 2017. “Fistula Recurrence, Pregnancy, and Childbirth Following Successful Closure of Female Genital Fistula in Guinea : a Longitudinal Study.” Lancet Global Health 5 (11): E1152–E1160.
APA
Delamou, A., Delvaux, T., El Ayadi, A. M., Tripathi, V., Camara, B. S., Beavogui, A. H., Romanzi, L., et al. (2017). Fistula recurrence, pregnancy, and childbirth following successful closure of female genital fistula in Guinea : a longitudinal study. LANCET GLOBAL HEALTH, 5(11), E1152–E1160.
Vancouver
1.
Delamou A, Delvaux T, El Ayadi AM, Tripathi V, Camara BS, Beavogui AH, et al. Fistula recurrence, pregnancy, and childbirth following successful closure of female genital fistula in Guinea : a longitudinal study. LANCET GLOBAL HEALTH. 2017;5(11):E1152–E1160.
MLA
Delamou, Alexandre, Therese Delvaux, Alison M El Ayadi, et al. “Fistula Recurrence, Pregnancy, and Childbirth Following Successful Closure of Female Genital Fistula in Guinea : a Longitudinal Study.” LANCET GLOBAL HEALTH 5.11 (2017): E1152–E1160. Print.
@article{8555454,
  abstract     = {Background: Female genital fistula is a devastating maternal complication of delivery in developing countries. We sought to analyse the incidence and proportion of fistula recurrence, residual urinary incontinence, and pregnancy after successful fistula closure in Guinea, and describe the delivery-associated maternal and child health outcomes. 
Methods: We did a longitudinal study in women discharged with a closed fistula from three repair hospitals supported by Engender Health in Guinea. We recruited women retrospectively (via medical record review) and prospectively at hospital discharge. We used Kaplan-Meier methods to analyse the cumulative incidence, incidence proportion, and incidence ratio of fistula recurrence, associated outcomes, and pregnancy after successful fistula closure. The primary outcome was recurrence of fistula following discharge from repair hospital in all eligible women who consented to inclusion and could provide follow-up data. 
Findings: 481 women eligible for analysis were identified retrospectively (from Jan 1, 2012, to Dec 31, 2014; 348 women) or prospectively (Jan 1 to June 20, 2015; 133 women), and followed up until June 30, 2016. Median follow-up was 28.0 months (IQR 14.6-36.6). 73 recurrent fistulas occurred, corresponding to a cumulative incidence of 71 per 1000 person-years (95\% CI 56.5-89.3) and an incidence proportion of 18.4\% (14.8-22.8). In 447 women who were continent at hospital discharge, we recorded 24 cases of post-repair residual urinary incontinence, equivalent to a cumulative incidence of 23.1 per 1000 person-years (14.0-36.2), and corresponding to 10.3\% (5.2-19.6). In 305 women at risk of pregnancy, the cumulative incidence of pregnancy was 106.0 per 1000 person-years, corresponding to 28.4\% (22.8-35.0) of these women. Of 50 women who had delivered by the time of follow-up, only nine delivered by elective caesarean section. There were 12 stillbirths, seven delivery-related fistula recurrences, and one maternal death. 
Interpretation: Recurrence of female genital fistula and adverse pregnancy-related maternal and child health outcomes were frequent in women after fistula repair in Guinea. Interventions are needed to safeguard the health of women after fistula repair.},
  author       = {Delamou, Alexandre and Delvaux, Therese and El Ayadi, Alison M and Tripathi, Vandana and Camara, Bienvenu S and Beavogui, Abdoul H and Romanzi, Lauri and Cole, Bethany and Bouedouno, Patrice and Diallo, Moustapha and Barry, Thierno H and Camara, Mandian and Diallo, Kindy and Leveque, Alain and Zhang, Wei Hong and De Brouwere, Vincent},
  issn         = {2214-109X},
  journal      = {LANCET GLOBAL HEALTH},
  keyword      = {OBSTETRIC FISTULA,SUCCESSFUL REPAIR,VAGINAL FISTULA,WOMEN,OUTCOMES,DETERMINANTS,EXPERIENCES,COUNTRIES,DELIVERY,ETHIOPIA},
  language     = {eng},
  number       = {11},
  pages        = {E1152--E1160},
  title        = {Fistula recurrence, pregnancy, and childbirth following successful closure of female genital fistula in Guinea : a longitudinal study},
  url          = {http://dx.doi.org/10.1016/S2214-109X(17)30366-2},
  volume       = {5},
  year         = {2017},
}

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