This document discusses obstetric fistulae, specifically vesico-vaginal fistula (VVF) and recto-vaginal fistula (RVF). VVF is the most common type seen in Tanzania and is usually caused by prolonged obstructed labor. It results in pressure necrosis and tissue sloughing, causing urinary incontinence. RVF occurs due to compression of the rectovaginal septum during labor. Clinical presentation includes a history of difficult labor and subsequent incontinence. Investigations and tests can help diagnose the type of fistula. Surgical repair is usually required along with postoperative care and management. Prevention focuses on nutrition, access to obstetric care, family planning and education
This document discusses obstetric fistulae, specifically vesico-vaginal fistula (VVF) and recto-vaginal fistula (RVF). VVF is the most common type seen in Tanzania and is usually caused by prolonged obstructed labor. It results in pressure necrosis and tissue sloughing, causing urinary incontinence. RVF occurs due to compression of the rectovaginal septum during labor. Clinical presentation includes a history of difficult labor and subsequent incontinence. Investigations and tests can help diagnose the type of fistula. Surgical repair is usually required along with postoperative care and management. Prevention focuses on nutrition, access to obstetric care, family planning and education
This document discusses obstetric fistulae, specifically vesico-vaginal fistula (VVF) and recto-vaginal fistula (RVF). VVF is the most common type seen in Tanzania and is usually caused by prolonged obstructed labor. It results in pressure necrosis and tissue sloughing, causing urinary incontinence. RVF occurs due to compression of the rectovaginal septum during labor. Clinical presentation includes a history of difficult labor and subsequent incontinence. Investigations and tests can help diagnose the type of fistula. Surgical repair is usually required along with postoperative care and management. Prevention focuses on nutrition, access to obstetric care, family planning and education
This document discusses obstetric fistulae, specifically vesico-vaginal fistula (VVF) and recto-vaginal fistula (RVF). VVF is the most common type seen in Tanzania and is usually caused by prolonged obstructed labor. It results in pressure necrosis and tissue sloughing, causing urinary incontinence. RVF occurs due to compression of the rectovaginal septum during labor. Clinical presentation includes a history of difficult labor and subsequent incontinence. Investigations and tests can help diagnose the type of fistula. Surgical repair is usually required along with postoperative care and management. Prevention focuses on nutrition, access to obstetric care, family planning and education
Download as PPT, PDF, TXT or read online from Scribd
Download as ppt, pdf, or txt
You are on page 1/ 24
Obstetric
Fistulae/gynaetresia
Definition A fistula is defined as a pathological communication between two epithelial surfaces. Obstetric fistulae are fistulae developed in the course of pregnancy and childbirth. Common types seen in obstetrics are vesico-vaginal fistula (VVF), rectovaginal fistula (RVF), Ureterovaginal fistula (UVF)
Vesico-Vaginal fistula Commonest type of obstetric fistula in Tanzania. Aetiology-prolonged obstructed labor (CPD), ruptured uterus, caesarean hysterectomy, operative vaginal delivery (forceps, destructive operation), symphysiotomy
Pathology Pressure necrosis Ischaemia-necrosis-sloughing off btw 3 to 10 days-urinary incontinence. RVF- compression of rectovaginal septum btw the fetal skull and sacral promontory.
Low RVF (lower half ) 3rd degree perineal tear. Large (greater than half of post wall
Other clasification
Small fistula less than 2cm
Medium 2-3 cm Large 4-5 cm Extensive greater than 6cm
Clinical presentation Hx of prolonged obstructed labor rsulting in stillbirth/CS/OPVD Total incontinence 3-10 days later There may be associated feacal incontinence (RVF) Weakness in the lower limbs.
Pt is unkempt, smells of urine,
miserable looking. May have cs scar Vulva is wet, vulvar excoriation( ammoniacal dermatitis) May have vaginal stenosis from scarring, so do digital exam before speculum.
Investigations FBC, Hiv screening, E & U, CR, renal uss, cystoscopy, pippette specimen urine for mcs.
3 swab test Use to diferentiate btw UVF, VVF and stress incontinence Place 3 swab in the vagina Instill 100ml methylene blue into bladder Move around for 10-15 min Lower swab wet & blue-SI, upper swab wet & blue-VVF, upper swab wet but not blue-UVF.
Mgt
VVF repair Psychological support Physiotherapy If follow obstructed labor wait for 3 mths to allow slough to separate, inflamation to subside and new tissue plane to form. If due to cs injury, repair immediately. Optimise patient before repair.
Post op mgt
Catheterise for 10-14 days
Monitor urinary output hourly 6 litres of fluid per day. Antibiotics Analgesics All future delivery should be by CS
Complications
Haemorrhage Infection Clot retention Catheter blockage Occlusion of ureters
Prevention Good nutrition for girls Avoid early mariage Adequate ANC/ emergency obstetric care Education of populace Family planning-reduce parity
RVF May coexist with VVF Repair vvf first High fistula-colostomy first
Preoperative mgt Bowel preparation- neomycin 1 g, low residue diet 3 days b4 operation, rectal wash out night before.
Postoperative mgt Low residue diet for 5days Liquid paraffin Deliver subsequent babies by CS
Gynaetresia
Narrowing or occlusion of the vagina
May be congenital or acquired Acquired is more common in the tropics. Incidence 7 per 1000. peak age 20-30 years. Commonest cause here is chemical vaginitis from caustic pessaries May follow vvf/rvf repair, FGM,colporrhaphy, irradition
