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

Alexandre Delamou, Therese Delvaux, Alison M El Ayadi, Vandana Tripathi, Bienvenu S Camara, Abdoul H Beavogui, Lauri Romanzi, Bethany Cole, Patrice Bouedouno, Moustapha Diallo, Thierno H Barry, Mandian Camara, Kindy Diallo, Alain Leveque, Wei-Hong Zhang, Vincent De Brouwere, Alexandre Delamou, Therese Delvaux, Alison M El Ayadi, Vandana Tripathi, Bienvenu S Camara, Abdoul H Beavogui, Lauri Romanzi, Bethany Cole, Patrice Bouedouno, Moustapha Diallo, Thierno H Barry, Mandian Camara, Kindy Diallo, Alain Leveque, Wei-Hong Zhang, Vincent De Brouwere

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 EngenderHealth 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.

Funding: Belgian Development Cooperation (DGD), Institute of Tropical Medicine of Antwerp (ITM), and Maferinyah Training and Research Center in Rural Health (Guinea).

Conflict of interest statement

Declaration of interests

We declare no competing interests.

Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Figures

Figure 1
Figure 1
Study profile
Figure 2. Kaplan-Meier curves for overall recurrence-free…
Figure 2. Kaplan-Meier curves for overall recurrence-free survival (A) and first post-repair pregnancy-free survival (B)
Shaded regions are 95% CIs.
Figure 3
Figure 3
Incidence of fistula recurrence (n=73), first post-repair pregnancy (n=67), and residual urinary incontinence (n=24) over time in study participants
Figure 4
Figure 4
Post-repair pregnancy and delivery outcomes among sexually active study participants of reproductive age

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Source: PubMed

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