TREND IN OBSTETRIC FISTULA
ADMISSIONS AT THE KORLE-BU
TEACHING HOSPITAL, ACCRA, GHANA
BY
G. O. KLUFIO• AND A. T. LASSEY#
DEPARTMENTS OF SURGERY•
&
OBSTETRICS AND GYNAECOLOGY#
UNIVERSITY OF GHANA MEDICAL SCHOOL AND
THE KORLE-BU TEACHING HOSPITAL,
ACCRA, GHANA
1
BRINGING GHANA TO AMERICA
25
1
GHANA : REGIONS
• Population : 18.9million
• Urban / Rural: 34.9% / 65.1%
• Land Area:
238,533 sq. km
(92,098 sq. miles)
• Doctor Population ratio: 1: 17,615
• Nurse Population ratio: 1: 1513
(GSS, 2002 ; GHS, 2004)
NB: Specialist outreach services
33
ACCRA : CAPITAL CITY
• Population:
3million
• Hospitals:
6
• Numerous Public /
Private Clinics
NB: Doctor population ratio
1 : 5000
44
2
KORLEKORLE-BU TEACHING HOSPITAL
SURGICAL DEPARTMENT
• National reference hospital
• Bed compliment : 1,738
5
STUDY DESIGN / METHODOLOGY
z Retrospective
study
z 10-year
(1995 - 2004) admissions record
of obstetric fistulae from admission
registers
z Examination
of case notes of eligible
patients seen from 2000 to 2004
6
3
TREND IN OBSTETRIC FISTULA ADMISSIONS AT THE
KORLEKORLE-BU TEACHING HOSPITAL
35
30
NUMBER OF CASES
30
25
20
18
16
15
13
10
12
11
10
11
10
7
5
20
04
20
03
20
02
20
01
20
00
19
99
19
98
19
97
19
96
19
95
0
YEAR
7
AGE DISTRIBUTION OF PATIENTS
12
11
10
8
6
6
6
4
4
2
2
1
41
-4
5
36
-4
0
31
-3
5
26
-3
0
21
-2
5
16
-2
0
O
R
<
0
15
NUMBER
10
AGE GROUPS
8
4
PATIENT PARITY
PARITY
No. (%)
Primigravid
15
(37.5)
1
8
(20)
2
4
(10)
3
4
(10)
4
6
(15)
5
1
(2.5)
6
1
(2.5)
7
1
(2.5)
9
AETIOLOGY OF THE FISTULAE
z Obstructed
labour
- Directly
- Hysterectomy
- Caesarian section
(20 PPH)
z Perineal tears (30)
z Hysterectomy
*
35 (87.5%)
2
2
1
3*
Associated with VVFs
10
5
TYPES OF FISTULAE
TYPE
No.
Vesico-vaginal (VVF)
• Juxta-uretheral 8
31 (77.5%)
• Mid-vaginal 14
• Juxta-cervical 8
• Vault 1
VVF + Recto-vaginal
3 (7.5%)
Urethro-vaginal
1
Vesico-uterine
1
Vesico-cervico-vaginal
2
Uretero-vaginal
2
11
PATHOLOGICAL FINDINGS
ASSOCIATED WITH VVFs
Pathology
No. of Patients
Double Fistula
4
Vesical Stones
2
Vaginal Fibrosis
4
Bilateral Foot drop
1
Blocked Urethra
3
12
6
OPERATIVE TECHNIQUES / APPROACHES
z VVFs / Related fistulae
a) Transvaginal repair (± Martius flap)
b) Transabdominal repair(± Omental interposition)
c) Urinary diversion (Uretero-sigmoidostomy)
31
2
1
z Uretero-vaginal: Ureteroneocystostomy
2
z Recto-vaginal: Layered closure
3
13
RESULTS OF OPERATIONS
No. of Patients(n=35)
VVFs / Related fistulae
• Cured
32
• Awaiting 2nd attempt
1
Uretero-vaginal fistulae : cured
2
*Recto-vaginal fistulae : cured
3
Urinary Diversion
1
*
Associated with VVFs
14
7
K
N
A
H
T
U
O
Y
15
8