Quality care for rectovaginal fistula

Abstract

Objective: To describe the circumstances of occurrence, identify potential risk factors and the surgical outcome of rectovaginal obstetric fistula in Northern Cameroon.

Methods: This case series study included 6 rectovaginal obstetric fistula patients seeking services at the Regional Hospital of Maroua, Cameroon between May 2005 and August 2007. Structured interviews of patients were conducted prior to surgical intervention and the surgical outcome was recorded. We conducted a literature search to identify relevant studies on recto-vaginal fistulas.

Results: Patients were found to suffer an average of 12 years with fistula, with four of them living with fistula for more than 10 years at the time of surgery. Four patients were teenagers (less than 19 years old) in their first delivery. Patients had a parity ranging from 1-9 with the mean of 5. Regarding the pregnancy and delivery preceding the occurrence of the fistula, all the 6 women reported to have received antenatal care and 5 of them gave birth in the health facility. Four patients delivered within the 24 hours of onset of labour. All the 3 patients with combined fistulas delivered a stillborn baby. Six months after transperineal repair surgery, closure and continence were observed in all 6 cases. In the literature the overall closure of recto-vaginal fistula was found to range between 79-100% with the overall closure with continence between 56-100%

Conclusion: Obstetric recto-vaginal fistula patients in Far North Cameroon had a high parity, delivered in a facility usually within 24 hours of labour, lost their foetus if they had a combination of fistulas, had been suffering of fistula for the average of 12 years, and were more likely to have had a prior unsuccessful operation (this part is not in the main paper). The technique by transperineal repair used in our practice provides complete closure and continence.