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Ngongo CJ, Raassen TJIP, van Roosmalen J, Mahendeka M, Lombard L, Bukusi E. Equivalence between physicians and associate clinicians in the frequency of iatrogenic urogenital fistula following cesarean section in Tanzania and Malawi. HUMAN RESOURCES FOR HEALTH 2024; 22:43. [PMID: 38915096 PMCID: PMC11197166 DOI: 10.1186/s12960-024-00927-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 06/06/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Physicians and associate (non-physician) clinicians conduct cesarean sections in Tanzania and Malawi. Urogenital fistulas may occur as complications of cesarean section. Location and circumstances can indicate iatrogenic origin as opposed to ischemic injury following prolonged, obstructed labor. METHODS This retrospective review assessed the frequency of iatrogenic urogenital fistulas following cesarean sections conducted by either associate clinicians or physicians in Tanzania and Malawi. It focuses on 325 women with iatrogenic fistulas among 1290 women who had fistulas after cesarean birth in Tanzania and Malawi between 1994 and 2017. An equivalence test compared the proportion of iatrogenic fistulas after cesarean sections performed by associate clinicians and physicians (equivalence margin = 0.135). Logistic regression was used to model the occurrence of iatrogenic fistula after cesarean section, controlling for cadre, date, maternal age, previous abdominal surgery and parity. RESULTS Associate clinicians attended 1119/1290 (86.7%) cesarean births leading to fistulas, while physicians attended 171/1290 (13.3%). Iatrogenic fistulas occurred in 275/1119 (24.6%) cesarean births by associate clinicians and in 50/171 (29.2%) cesarean births by physicians. The risk difference and 90% confidence interval were entirely contained within an equivalence margin of 13.5%, supporting a conclusion of equivalence between the two cadres. The odds of iatrogenic fistula after cesarean section were not statistically significantly different between associate clinicians and physicians (aOR 0.90; 95% CI 0.61-1.33). CONCLUSIONS Associate clinicians appear equivalent to physicians performing cesarean sections in terms of iatrogenic fistula risk. Lower iatrogenic proportions for associate clinicians could reflect different caseloads. The occurrence of iatrogenic fistulas illustrates the importance of appropriate labor management and cesarean section decision-making, irrespective of health provider cadre. Given the noninferior performance and lower costs of employing associate clinicians, other countries with insufficient and/or unequally distributed health workforces could consider task-shifting cesarean sections to associate clinicians.
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Affiliation(s)
- Carrie J Ngongo
- RTI International, Global Health Division, Research Triangle Park, United States of America.
| | | | - Jos van Roosmalen
- Leiden University Medical Centre and Athena Institute VU University, Amsterdam, Netherlands
| | | | | | - Elizabeth Bukusi
- Research Care Training Program in the Center for Microbiology Research, KEMRI, Nairobi, Kenya
- Departments of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, United States of America
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
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2
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Pollaczek L, Rajagopal K, Chu J. Patient characteristics, surgery outcomes, presumed aetiology and other characteristics of fistula surgeries and related procedures supported by Fistula Foundation from 2019 to 2021: a multicentre, retrospective observational study. BMJ Open 2024; 14:e078426. [PMID: 38485171 PMCID: PMC10941128 DOI: 10.1136/bmjopen-2023-078426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES Obstetric fistula is a devastating childbirth injury primarily caused by prolonged, obstructed labour. It leaves women incontinent, severely stigmatised and isolated. Fistula repair surgery can restore a woman's health and well-being. Fistula Foundation, a non-profit organisation, works in partnership with local hospitals and community organisations in Africa and Asia to address key barriers to treatment and to increase the number of women receiving surgical care. This paper presents data on fistula and fistula repair surgery across a large global network of hospitals supported by Fistula Foundation. The data were collected between 2019 and 2021. DESIGN Multicentre, retrospective, observational, descriptive study. SETTING AND PARTICIPANTS The study analysed deidentified data from 24 568 surgical repairs supported by Fistula Foundation to treat women with obstetric fistula at 110 hospitals in 27 countries. RESULTS The data highlight patient characteristics and key trends and outcomes from obstetric fistula repair surgeries and related procedures. Of those surgeries, 87% resulted in a successful outcome (fistula dry and closed) at the time of discharge, highlighting the effectiveness of fistula repair in restoring continence and improving quality of life. Over the period studied, the number of supported surgeries increased by 14%, but there remains an urgent need to strengthen local surgical capacity and improve access to treatment. Women suffered an average of 5.7 years before they received surgery and only 4% of women sought care independently. This underscores the importance of enhancing community awareness and strengthening referral networks. CONCLUSIONS This research provides essential insight from a vast, global network of hospitals providing highly effective fistula repair surgery. Further investment is needed to strengthen surgical capacity, increase awareness of fistula and remove financial barriers to treatment if stakeholders are to make significant progress towards the United Nations' ambitious vision of ending fistula by 2030.
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Affiliation(s)
| | | | - Jesse Chu
- Fistula Foundation, San Jose, California, USA
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3
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Lim WH, Lamaro VP, Livingstone S. Pre-operative ureteric catherisation for major endoscopic gynaecological surgery. Surg Endosc 2023; 37:8335-8339. [PMID: 37697117 DOI: 10.1007/s00464-023-10359-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/30/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Several strategies have been implemented to better identify the course of the ureters intra-operatively due of the morbidity associated with ureteric injuries especially during gynaecological surgery. We described our experience with pre-operative ureteric catherisation in women who underwent major endoscopic gynaecological surgery. METHODS A case-controlled study of 862 women who underwent major endoscopic gynaecological surgery sourced from two health institutions were conducted. Two groups were compared: those who had pre-operative prophylactic ureteric catherisation (study group) and those who had routine cystoscopy performed immediately post surgery (control group). RESULTS There were no intra-operative ureteric injuries or associated complications noted in the study group. When compared to the control group, length of hospital stay (2 days vs 5 days; p < 0.05) and overall mean time for cystoscopy (11 min vs 35 min; p < 0.05) was significantly shorter in the study group. There was no long-term morbidity recorded in the study group. CONCLUSION Our experiences with prophylactic pre-operative bilateral ureteric catheterisation for major endoscopic gynaecological surgeries were favourable and are associated with low complication rates. Routine or adjunct use before major gynaecological and pelvic surgery combined with meticulous surgical technique can help reduce iatrogenic and unintentional ureteric injuries.
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Affiliation(s)
- Wei How Lim
- Department of Gynaecology, St Vincent's Hospital Sydney, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia.
- Graduate School of Medicine, The University of Wollongong, Wollongong, NSW, 2500, Australia.
| | - Vincent P Lamaro
- Department of Gynaecology, St Vincent's Hospital Sydney, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
| | - Sarah Livingstone
- Department of Gynaecology, St Vincent's Hospital Sydney, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
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4
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Ahmed F, Al-Wageeh S, Badheeb M, Altam A, Alsharif A. Iatrogenic Ureteral and Colonic Injuries During Emergency Cesarean Section: A Lesson Learned from a Surgical Catastrophe - A Case Report. Int Med Case Rep J 2023; 16:251-256. [PMID: 37143965 PMCID: PMC10153445 DOI: 10.2147/imcrj.s407241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/27/2023] [Indexed: 05/06/2023] Open
Abstract
Introduction Iatrogenic concomitant ureteral and colonic injury in emergency cesarean section (C-section) is an exceedingly rare, yet, catastrophic complication and has not been reported to our knowledge. Case Report A 30-year-old woman presented with decreased urination for 2 days after a C-section. Ultrasonography showed severe left hydronephrosis and moderate abdominal free fluid. A ureteroscopy revealed a total occlusion of the left ureter, and subsequently, a ureteroneocystostomy was performed. Two days later, the patient was complicated with abdominal distension that necessitated re-exploration. The exploration revealed colonic injury (rectosigmoid), peritonitis, endometritis, and ureteral anastomosis disruption. A colostomy, repair of colonic injury, hysterectomy, and ureterocutaneous diversion were performed. The patient's hospital stay was complicated, with stomal retraction requiring operative revision and wound dehiscence, which was treated conservatively. After 6 months, the colostomy was closed, and the ureter was anastomosed via the Boari-flap procedure. Conclusion Injuries to the urinary and gastrointestinal tracts are serious complications of a cesarean section; concurrent involvement is exceedingly rare; however, delayed recognition and intervention can worsen the prognosis.
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Affiliation(s)
- Faisal Ahmed
- Department of Urology, School of Medicine, Ibb University of Medical Sciences, Ibb, Yemen
- Correspondence: Faisal Ahmed, Department of Urology, School of Medicine, Ibb University of Medical Sciences, Ibb, Yemen, Tel/Fax +967 4428950, Email
| | - Saleh Al-Wageeh
- Department of General Surgery, School of Medicine, Ibb University of Medical Sciences, Ibb, Yemen
| | - Mohamed Badheeb
- Department of Internal Medicine, Faculty of Medicine, Hadhramout University, Hadhramout, Yemen
| | - Abdulfattah Altam
- Department of General Surgery, School of Medicine, 21 September University, Sana’a, Yemen
| | - Afaf Alsharif
- Department of Gynecology, School of Medicine, Jeblah University for Medical and Health Sciences, Ibb, Yemen
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5
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Ngongo CJ, Raassen TJIP, Mahendeka M, Lombard L, van Roosmalen J, Temmerman M. A retrospective review of genital fistula occurrence in nine African countries. BMC Pregnancy Childbirth 2022; 22:744. [PMID: 36195839 PMCID: PMC9531465 DOI: 10.1186/s12884-022-05051-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 09/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background Female genital fistulas are abnormal communications that lead to urinary and/or fecal incontinence. This analysis compares the characteristics of women with fistulas to understand how countries differ from one another in the circumstances of genital fistula development. Methods This retrospective records review evaluated demographics and circumstances of fistula development for 6,787 women who sought fistula treatment between 1994 and 2017 in Tanzania, Uganda, Kenya, Malawi, Rwanda, Somalia, South Sudan, Zambia, and Ethiopia. Results Most women developed fistula during childbirth, whether vaginal (3,234/6,787, 47.6%) or by cesarean section (3,262/6,787, 48.1%). Others had fistulas attributable to gynecological surgery (215/6,787, 3.2%) or rare causes (76/6,787, 1.1%). Somalia, South Sudan, and Ethiopia had comparatively high proportions following vaginal birth and birth at home, where access to care was extremely difficult. Fistulas with live births were most common in Kenya, Malawi, Rwanda, Uganda, Tanzania, and Zambia, indicating more easily accessible care. Conclusions Characteristics of women who develop genital fistula point to geographic differences in obstetric care. Access to care remains a clear challenge in South Sudan, Somalia, and Ethiopia. Higher proportions of fistula after cesarean birth and gynecological surgery in Kenya, Malawi, Rwanda, Uganda, Tanzania, and Zambia signal potential progress in obstetric fistula prevention while compelling attention to surgical safety and quality of care.
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Affiliation(s)
- Carrie J Ngongo
- Global Health Division, RTI International, Research Triangle Park, USA.
| | | | | | | | - Jos van Roosmalen
- Leiden University Medical Centre and Athena Institute VU University, Amsterdam, Netherlands
| | - Marleen Temmerman
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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6
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Bahuguna G, Panwar VK, Mittal A, Talwar HS, Mandal AK, Bhadoria AS, Chapple C. Management strategies and outcome of ureterovaginal fistulae: A systematic review and meta-analysis. Neurourol Urodyn 2022; 41:562-572. [PMID: 35032348 DOI: 10.1002/nau.24874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 12/30/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Genitourinary fistula is a distressful condition involving mental, social, marital, and financial repercussions. OBJECTIVE The objective of this study is to systematically evaluate etiology, clinical presentation, diagnosis, the timing of repair, and perform a meta-analysis evaluating the success rate of various treatment modalities with respect to time taken to seek treatment. SEARCH STRATEGY We performed a critical review of PubMed/Medline, Embase, and the Cochrane Library in April 2020 according to the PRISMA statement. Seventeen studies were included in the final analysis and all were retrospective in design. SELECTION CRITERIA Each article was rated by the evidence-based medicine levels of evidence scale and the Methodological Index for Nonrandomized Studies scale for assessment of bias among nonrandomized studies. MAIN RESULTS Of the 799 fistulae reported in 17 studies, endoscopic management was done in 35.6% (12 studies), whereas surgical management was preferred in 85.6% fistulae (15 studies). The pooled success of endoscopic stenting was 32% (95% confidence interval [CI]: 7-64) and 100% (95% CI: 98-100) in operated patients. Patients who underwent stenting within 2 weeks (20%), 2-6 weeks (21%), and >6 weeks (40%) had pooled success rates of 95% (95% CI: 87-100), 46% (95% CI: 0-100), and 20% (95% CI: 1-49), respectively. Patients who underwent surgical management <6 weeks (15.9%) and >6 weeks (22%) of diagnosis had pooled success rates of 100% (95% CI: 99-100) and 100% (95% CI: 99-100), respectively. CONCLUSIONS Stent placement as early as <6 weeks (preferably < 2 weeks) had better outcomes as compared to >6 weeks. Proceeding to surgery regardless of timing in cases of stent failure seems to be a feasible option.
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Affiliation(s)
- Gunjan Bahuguna
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Vikas K Panwar
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ankur Mittal
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Harkirat S Talwar
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Arup K Mandal
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ajeet S Bhadoria
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Christopher Chapple
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England, UK
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7
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Chen X, Chen J, Maria Cananzi FC, Li W, Quagliuolo V, Luo C, Yang Y. Prophylactic Ureteral Catheter Placement Appears to Reduce Intraoperative Ureteric Injury During Resection of Primary Retroperitoneal Liposarcoma. Technol Cancer Res Treat 2022; 21:15330338221087831. [PMID: 35440255 PMCID: PMC9047802 DOI: 10.1177/15330338221087831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Prophylactic ureteral catheters placement (PUCP) was advocated as an effective strategy for decreasing ureteral morbidities in colorectal surgeries. However, whether it should be routinely used prior to primary retroperitoneal liposarcoma (PRLS) surgeries remains unknown. Methods: It was a retrospective study, conducted at a tertiary sarcoma center. Medical records of patients with PRLS undergoing surgeries from January 2015 through December 2018 were reviewed. Primary endpoint was the rate of ureteral morbidities during and after retroperitoneal liposarcoma resection procedures. Univariate and multivariate analyses determined risk factors associated with ureteral injury (UI) in patients undergoing surgeries. Results: A total of 55 patients of PRLS were included. Fourteen (25.5%) patients underwent PUCP, with 1 UI (7.1%) identified. In 41 patients with no PUCP, 15 (36.6%) exhibited UIs during and post surgeries. There were significant improvements of UIs in group PUCP, compared with patients without PUCP (P < .05). Resection surgeries combined with colectomy and tumor-ureter relationship were 2 risk factors significantly associated to UIs (P < .01). Conclusions: PUCP might be an effective way of preventing UIs in patients with PRLS. It could be suggested especially in patients with ureter encased by tumor or anticipated colectomy during the surgical process.
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Affiliation(s)
- Xiaobing Chen
- 26447Peking University First Hospital, Beijing, China.,594822Peking University International Hospital, Beijing, China
| | - Jun Chen
- 594822Peking University International Hospital, Beijing, China
| | - Ferdinando Carlo Maria Cananzi
- 437807Humanitas University, Pieve Emanuele-Milan, Italy.,Sarcoma, Melanoma and Rare Tumors Surgery Unit, 9268IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Wenjie Li
- 594822Peking University International Hospital, Beijing, China
| | - Vittorio Quagliuolo
- Sarcoma, Melanoma and Rare Tumors Surgery Unit, 9268IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Chenghua Luo
- 594822Peking University International Hospital, Beijing, China
| | - Yinmo Yang
- 26447Peking University First Hospital, Beijing, China
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Application of Nonvascular Interventional Radiology Procedures in the Treatment of Iatrogenic Ureteral Injuries. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2021. [DOI: 10.2478/sjecr-2019-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction. He most common ureteral injuries are iatrogenic injuries. Diagnosis of ureteral lesions includes ultrasound, computer tomography, intravenous urography, anterograde and retrograde ureterography. For a definitive diagnosis it is necessary to determine the existence of the extralumination of contrast media from the ureter. Minor ureteral injuries can be treated with nonvascular interventional radiology procedures.
Case presentation. We have presented two patients with iatrogenic ureteral injuries. Injury in the first patient occurred at the sigmoid colon resection and partial resection of the bladder, whereas in the second patient the lesion was formed as a result of cesarean section. In both patients, there was a history of previously conducted interventions, clinical picture included fever and pain, a diagnosis was made by intravenous and anterograde urography. Patients were treated with interventional radiology procedures and they have been definitely cured.
Conclusion. Methods of nonvascular interventional radiology can be successfully applied in the treatment of minor iatrogenic ureteral injuries.
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9
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Beamer LJ, Neary S, McCormack T, Ankers D. Transient ureteric obstruction following pelvic floor reconstruction. BMJ Case Rep 2021; 14:14/5/e238669. [PMID: 33986003 PMCID: PMC8126275 DOI: 10.1136/bcr-2020-238669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We describe the first reported case of transient distal ureteric obstruction attributed to post-surgical oedema in a patient with a solitary kidney. This occurred following combined pelvic floor repair and sacrospinous fixation for recurrent pelvic organ prolapse and manifested clinically as anuria, radiological hydroureter and acute kidney injury in the postoperative period. The transient nature of this obstruction, which was managed by a temporary percutaneous nephrostomy, indicates that it was caused by ureteric compression secondary to soft tissue oedema following surgery. We highlight the importance of this potential complication in females with a history of nephrectomy, unilateral renal tract anomalies or severely diminished renal reserve.
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Affiliation(s)
- Liam Joseph Beamer
- Obstetrics & Gynaecology, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, Cheshire, UK
| | - Sarah Neary
- Obstetrics & Gynaecology, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, Cheshire, UK
| | - Thomas McCormack
- Obstetrics & Gynaecology, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, Cheshire, UK
| | - David Ankers
- Obstetrics & Gynaecology, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, Cheshire, UK
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10
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Cesarean delivery in low- and middle-income countries: A review of quality of care metrics and targets for improvement. Semin Fetal Neonatal Med 2021; 26:101199. [PMID: 33546999 PMCID: PMC8026747 DOI: 10.1016/j.siny.2021.101199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Improving quality of care in low-and middle-income countries (LMICs) is a global priority, specifically around maternal and newborn care, where mortality and morbidity remain unacceptably high. Cesarean delivery is the most common procedure in women, thus evaluating quality around the provision of this intervention provides insight into overall quality of care around childbirth. In this review we provide an overview on the quality of care around cesarean delivery using the six domains of quality proposed by the Institute of Medicine: equity, effectiveness, efficiency, safety, timeliness and patient-centered care. We review evidence of potential quality gaps in each of these domains around cesarean delivery in LMICs, discuss opportunities for improvement and provide suggestions on metrics for tracking quality in each of these domains. As cesarean delivery rates increase globally, efforts to ensure quality will be essential to drive continued and sustained improvements in global maternal and newborn outcomes.
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11
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Gupta R, Mahajan A, Mahajan M, Anand A, Masood S. Management of Genitourinary Fistulas Following Benign Gynecological and Obstetric Procedures: A Single Surgeon Experience. J Midlife Health 2021; 11:156-160. [PMID: 33384539 PMCID: PMC7718932 DOI: 10.4103/jmh.jmh_70_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 04/28/2020] [Accepted: 05/05/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Genitourinary fistula results in lot of anxiety in the suffering females. Scant literature regarding the comprehensive management of genitourinary fistula i.e. VVF and UVF is available. Objective: The aim of the study was to review a single surgeon experience in dealing with these complex situations. Material and Methods: We conducted a retrospective, institutional review board approved chart review of patients who underwent genitourinary fistula repair from Jan 2014 till Dec 2019. Of all the fistulas VVF accounted for 18 and UVF for 12 cases. Pre-operative diagnosis in these patients was based predominantly on the history, local examination and cystoscopy. Of the 18 VVF 12 were managed laparoscopically and 6 by open O'Connor's repair. Of the 12 UVF, 8 were managed laparoscopically and 4 by open ureteric reimplants. All were followed up for three months post operatively. Results: A total of 30 patients were treated since 2014 till December 2019. Average age for the VVF was 54.72 ≤ 10.9 years and that for UVF repair was 59.9 ≤ 7.6 years. Hysterectomies for benign diseases accounted for 66.66% of VVF and 91.6% of UVF. Of the VVF patients one required a ureteric reimplantation, remaining were managed with O'Connors' repair. We had one failure which was successfully repaired after 6 weeks. None of our patients with UVF repairs had a failure at three months follow-up. Conclusion: Genitourinary fistulas are a debilitating problem in females but a comprehensive approach regarding diagnosis and treatment can cure these patients.
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Affiliation(s)
- Rahul Gupta
- Department of Urology, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Arti Mahajan
- Department of Anesthesia and, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Manik Mahajan
- Department of Radiology, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Ajay Anand
- Department of Urology, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Suhail Masood
- Department of Urology, Government Medical College, Jammu, Jammu and Kashmir, India
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12
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Chang OH, Stokes MJ, Chalamanda C, Wilkinson J, Pope RJ. Baseline renal function and renal ultrasound findings in patients with obstetric fistulas (RENFRU): a prospective cohort study. BJOG 2020; 127:897-904. [PMID: 31961472 DOI: 10.1111/1471-0528.16106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe and compare baseline renal anatomy and renal function in patients with obstetric fistulas, and to evaluate whether preoperative renal testing and imaging may aid with operative decision making. DESIGN A prospective cohort study. SETTING Fistula Care Centre in Malawi. POPULATION Women with an obstetric fistula. METHODS Baseline creatinine testing and renal ultrasounds were performed. Surgeons completed a short questionnaire on the usefulness of creatinine and renal ultrasound on operative decision making. MAIN OUTCOME MEASURES Baseline creatinine and renal ultrasound findings. RESULTS Four surgeons performed operations on 85 patients. The mean creatinine in patients with vesicovaginal fistulas (VVF) was 0.60 ng/ml versus patients with uretero-vaginal fistulas (UVF) (0.79 ng/ml, P = 0.012). When a grade 3 or more hydronephrosis is absent on renal ultrasound, the negative predictive value of the presence of UVF is 93.3% (95% confidence interval [CI] 88.6-96.2) with a specificity of 97.2% (95% CI 90.3-99.6). In cases of UVF, surgeons found the renal ultrasound results useful or very useful 87.5% of the time, and the creatinine useful or very useful 75% of the time. CONCLUSION In this pilot study, most patients with obstetric fistulas presented with a normal creatinine. In the absence of a grade 3 hydronephrosis or above on renal ultrasound, the probability of not having a UVF is 93.3%. Surgeons should consider performing preoperative renal ultrasound testing in all patients with an obstetric fistula, particularly in women with a prior laparotomy, as this population has risk factors for ureterovaginal fistula. TWEETABLE ABSTRACT Most patients with obstetric fistulas have normal renal function. Preoperative renal ultrasounds should be performed.
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Affiliation(s)
- O H Chang
- Department of Global Women's Health, Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - M J Stokes
- Department of Global Women's Health, Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | | | - J Wilkinson
- Department of Global Women's Health, Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - R J Pope
- Freedom from Fistula, Lilongwe, Malawi
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13
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Wen L, Liu Q, Xu J, Liu X, Shi C, Yang Z, Zhang Y, Xu H, Liu J, Yang H, Huang H, Qiao J, Tang F, Chen ZJ. Recent advances in mammalian reproductive biology. SCIENCE CHINA. LIFE SCIENCES 2020; 63:18-58. [PMID: 31813094 DOI: 10.1007/s11427-019-1572-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/22/2019] [Indexed: 01/05/2023]
Abstract
Reproductive biology is a uniquely important topic since it is about germ cells, which are central for transmitting genetic information from generation to generation. In this review, we discuss recent advances in mammalian germ cell development, including preimplantation development, fetal germ cell development and postnatal development of oocytes and sperm. We also discuss the etiologies of female and male infertility and describe the emerging technologies for studying reproductive biology such as gene editing and single-cell technologies.
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Affiliation(s)
- Lu Wen
- Beijing Advanced Innovation Center for Genomics, Department of Obstetrics and Gynecology Third Hospital, College of Life Sciences, Peking University, Beijing, 100871, China
| | - Qiang Liu
- Beijing Advanced Innovation Center for Genomics, Department of Obstetrics and Gynecology Third Hospital, College of Life Sciences, Peking University, Beijing, 100871, China
| | - Jingjing Xu
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
| | - Xixi Liu
- Beijing Advanced Innovation Center for Genomics, Department of Obstetrics and Gynecology Third Hospital, College of Life Sciences, Peking University, Beijing, 100871, China
| | - Chaoyi Shi
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
| | - Zuwei Yang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
| | - Yili Zhang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
| | - Hong Xu
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
| | - Jiang Liu
- CAS Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, 100101, China.
| | - Hui Yang
- Institute of Neuroscience, State Key Laboratory of Neuroscience, Key Laboratory of Primate Neurobiology, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Research Center for Brain Science and Brain-Inspired Intelligence, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, 200031, China.
| | - Hefeng Huang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China.
| | - Jie Qiao
- Beijing Advanced Innovation Center for Genomics, Department of Obstetrics and Gynecology Third Hospital, College of Life Sciences, Peking University, Beijing, 100871, China.
| | - Fuchou Tang
- Beijing Advanced Innovation Center for Genomics, Department of Obstetrics and Gynecology Third Hospital, College of Life Sciences, Peking University, Beijing, 100871, China.
| | - Zi-Jiang Chen
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, 250021, China.
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