Gynaecologists link high maternal, child mortality to traditional delivery methods

Worried by increase in number of women coming down with fistula health condition in the country, gynaecologists have called for abolition of traditional birth attendance. Rather, pregnant women are urged to attend antenatal care in primary healthcare and other recognised hospitals, as this would help to reduce cases of prolonged obstructed labours, which are the major cause of obstetric fistula.

The gynaecologists made this call at a media roundtable discussion on fistula intervention titled: Fistula and The Media-‘How Well Have I Played Part’ organised by Engender Health, the Fistula Care Plus Project funded by United State Agency for International Development (USAID) held in Ikeja, Lagos.

Prof. Oladosu Ojengbede, Master trainer of fistula surgeons, and Consultant gynaecologist at University Teaching Hospital (UCH) Ibadan, explained that prolonged obstetric labour is the major cause of maternal mortality and morbidity in the country, while most developing countries account for 13 per cent of direct causes of maternal death.

He said: “For every woman that suffers mortality from prolonged obstetric labour, there are more than 20 near misses with serious morbidities. Commonest known is the obstetric fistula.

Entrapment of urethra, bladder, rectum, cervix between the pubic bone and foetal head will lead to tissue damage, due to blood supply cut off, known as chaemia, with subsequent tissue death, necrosis and sloughing. This causes partial or complete destruction of the urethra and bladder neck, cervix and rectum, leading to urinary and fecal incontinence and other symptoms.

“Prolonged obstructed labour causes maternal injury, morbidities and death mortality, foetal morbidities and mortality, short-term morbidities, including long-term morbidities.

“Injuries resulting from prolonged obstructed labour include a syndrome that involves multiple organ systems with constellation of injuries. Other parts of the body affected by prolonged obstructed labour include, urinary system, genital and reproductive system, gastrointestinal system, musculoskeletal system, neurologic system, dermatology, mental health and psychosocial issues.”

Ojengbede said the dangers and effect of obstructed labour are certainly more far-reaching than may be thought. So, a more holistic obstetrics care is required for the devastating consequences on quality of life of afflicted women. But more importantly is the need to prevent these dangers and effects.

He listed signs and symptoms of urinary disorder to include urinary tract infection, bladder weakness, atony, obstetric fistula, bladder stone, calculi, small bladder syndrome, stress incontinence, leaking urine, when there is increased pressure on bladder, for instance coughing, sneezing and laughing, among others.

Other symptoms include, vulva oedema, uterine rupture, disruption of the perineal body, vaginal scarring, cervical scarring and stenosis, pelvic inflammatory disease, secondary amenorrhea, secondary infertility, sepsis, postpartum and haemorrhage.

He said: “Paralytic ileus following sepsis acquired rectal atresia from excessive scarring rectal prolapse, anal sphincter incompetence with flatus and or faecal incontinence. Other symptoms include rectovaginal fistula, musculoskeletal system, osteitis pubis, rectal atresia, foot drop, neurologic system, mental health, psychosocial and sexuality issues, family disruption anxiety disorder, stress disorder, depression, prolonged hospital stay, low self-esteem, dyspareunia, impaired routine daily functions nerve palsy with foot drop, pituitary and hypothalamic dysfunction.”