An estimated 2 million women living in countries with limited resources currently\nhave vesico-vaginal, recto-vaginal, or mixed types of fistulae because of\nthe necrosis that occurs with obstructed labor. We evaluated factors readily\nassessed by the examining practitioner in a consecutive case series of surgical\nrepairs of obstetrical fistulae, for the ability of those factors to stand as a\nprognostic guide, in a clinical score. Objectives: To identify the predictors of\nsurgical repair outcomes and establish a Score combining these different determinants\nto facilitate the care of obstetric fistula. Methods: We conducted a\nmulticentric prospective study between 2011 and 2014 in Democratic Republic\nof the Congo (DRC). Outcomes: We measured 3 months post-surgery in a\nseries of 483 patients with obstetrical fistula repaired by the same surgeon included\nclosure and failure appreciated by dye test. Multivariable generalized\nestimating equation models were used to generate adjusted odd ratios (OR)\nand 95% confidence intervals (CIs). The scores ranging from 3 to 14 were established\nfrom the outcomes determinants identified. Results: In total, 483\nwomen were enrolled, and 390 cases were at their first surgery and were included\nin the obstetric fistula (OF) prognosis score and classification. Their\nmean age was 35 years at the time of the surgery and 25 years at the onset of\nOF. In 28.6%, the fistula patient was primigravida. Mean duration between\nonset of the fistula and surgical treatment was 8 years. In 24%, the fistula patients\nlived separated from their partners. Overall closure rate of the fistulas\nwas 85.7%. Severe vaginal fibrosis (p < 0.01), big fistula size (<0.01), small\ndistance from fistula to external urethral meatus (<0.01) and prior surgery (p\n< 0.48) predicted failed fistula closure. A clinical score ranging from 3 to 14\npoints is a prognostic score with a range of 1 to 4 for the distance between the\nfistula and the external meatus and the size, and a scale of 1 to 6 for fibrosis. Conclusions: This study demonstrated that the marked vaginal scarring; large\nfistula size and distance to urethral meatus are predictors for unsuccessful fistula\nrepair. Due to the lack of a standard classification that is never unanimous\namong the different surgeons, this prognostic score allows the combination\nof the different determinants assessing the chances of success and can\nhelp the practitioners to orient the patients towards the determined skill scale\nto take care of the patients.
Loading....