None listed
Conditions
Brief summary
Pelvic floor injury following childbirth is common. In recent years, 4D ultrasound scanning of the pelvic floor has identified injuries within the pelvis not visible on clinical examination. Trauma of the pelvic floor muscles (levator muscles), where these muscles are torn (avulsed) from their insertions to the pelvic bone, can be identified with pelvic floor ultrasound scanning. Levator muscle avulsion may be responsible for the development of pelvic organ prolapse in women. Prolonged neglected obstructed labour (childbirth) is the most common cause of obstetric fistula worldwide. Obstetric fistula refers to a hole between the urinary tract and the vagina, or the bowel and the vagina. This results in the constant leakage of urine or faeces into the vagina. Obstetric fistula and pelvic organ prolapse are common pelvic organ injuries in women following childbirth in Uganda. Pelvic floor ultrasound assessment of these women to assess for levator muscle avulsion and other anatomical features including levator hiatal areas, will identify any correlation between these injuries and whether the patient suffered an obstructed labour with development of fistula. The women with obstetric fistula and pelvic organ prolapse will be assessed and offered surgery as required. The assessment includes: 1. Assessment of pelvic organ prolapse patients undergoing surgery – routine clinical examination, routine history including standardised questionnaire, 4D ultrasound scan examination. 2. Assessment of obstetric fistula patients undergoing surgery – routine clinical examination, routine history including standardised questionnaire, 4D ultrasound scan examination. Pelvic floor muscle avulsion (levator avulsion) has been identified in developed countries with 4D ultrasound scanning in 20% of women following their first delivery. There is no data available regarding these injuries from deliveries in developing countries. There is minimal data available on the incidence of prolapse in developing countries. The study will take place at Kagando hospital, Uganda, where the investigators have been invited as experts to perform surgery on patients with obstetric fistula and pelvic organ prolapse.
Interventions
Women presenting to Kagando hospital, Uganda with obstetric fistula and pelvic organ prolapse - routine history and clinical examination of presenting complaint, routine assessment of women with trans-perineal 4D pelvic floor ultrasound scan.
Each patients undergoes a single episode of assessment which includes history taking and ultrasound assessment - duration approximately 1 hour total for each patient.
The total clinical study period extends from 10/4/2011 - 15/7/2012.
Sponsors
Dr Hannah Krause
Eligibility
Sex/Gender
All
Age
15 Years to No maximum
Healthy volunteers
No
Inclusion criteria
All women attending surgical camps at Kagando hospital in 2011 and 2012 were invited to participate - the women presenting were diagnosed with obstetric fistula and pelvic organ prolapse. All women had previously had a pregnancy resulting in obstetric fistula (with the youngest participant aged 15) or had subsequently developed pelvic organ prolapse.
Exclusion criteria
Women who did not consent
Outcome results
None listed