- مبلغ: ۸۶,۰۰۰ تومان
- مبلغ: ۹۱,۰۰۰ تومان
Objective. Obstetric 0stula (OF) is a morbid condition caused by prolonged obstructed labor. Women with OF experience profound injury and have high rates of infertility and poor obstetric outcomes. We examined endovaginal ultrasound parameters in women with and without OF. Design/Setting/Sample/Methods. ,is cross-sectional study enrolled women evaluated at the Fistula Care Centre in Lilongwe, Malawi. Eligibility criteria included age 18–45, prior pregnancy, and a uterus on ultrasound. Participants underwent endovaginal ultrasound with measurement of cervical dimensions. Comparisons were done using t-tests and Fisher’s exact test. Among women with OF, linear regression was used to assess whether 0stula stage was associated with cervical length. Results. We enrolled 98 cases and 12 controls. Women with OF had shorter cervical lengths (18.8 mm versus 27.3 mm, p < 0.01), as well as shorter anterior (7.0 mm versus 9.3 mm, p < 0.01) and posterior (9.5 mm versus 11.0 mm, p < 0.04) cervical stroma, compared to controls. Conclusion. Women with OF have shorter cervical lengths and anterior and posterior cervical stroma, when compared to women without OF. ,is may oer a partial explanation for subfertility and poor obstetric outcomes in OF patients. Additional studies to clarify the role of ultrasound in OF patients and prediction of future fertility are warranted.
The implications for the 0ndings of this study are numerous. Up to 70% of women who experience OF will never have a living child . Determining the role of cervical destruction in the etiology of subsequent infertility, subfertility, or pregnancy loss is an important area of future exploration. ,ere may be opportunities to study the impact of surgical revision of the cervix at the time of OF surgery. Also, OF patients who are found to have a shortened cervix may bene0t from cerclage, pessary, hormonal therapy, or other modalities to prevent preterm delivery or early pregnancy loss; however, this would have to be validated with an appropriate prospective study before implementation.
In the rush to cure women and girls with OF from their debilitating urinary incontinence, we have largely neglected other important aspects of women’s health care in this vulnerable population. Fecundity and the ability to carry a pregnancy to viability are often as important to our patients as achieving continence. Understanding the role of compromised pelvic anatomy infertility in this population is a critical step to helping these patients realize their reproductive goals.