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Pelvic floor ultrasound findings in Ugandan women with obstetric fistula, unrepaired fourth degree obstetric tear, and pelvic organ prolapse
Author(s) -
Krause Hannah G.,
Wong Vivien,
Ng ShuKay,
Tan Gaik Imm,
Goh Judith T.W.
Publication year - 2019
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/ajo.12990
Subject(s) - medicine , fistula , tears , pelvic floor , pelvic floor dysfunction , obstetrics , surgery
Background While pelvic floor ultrasound is commonly utilised in high‐resource locations, our understanding of pelvic floor characteristics in women suffering with obstetric fistula and unrepaired fourth degree obstetric tears in low‐resource areas is limited. Aims This study aimed to assess the pelvic floor ultrasound characteristics of Ugandan women suffering with obstetric fistula, unrepaired fourth degree obstetric tears and pelvic organ prolapse, and determine whether obstructed labour resulting in obstetric fistula causes more levator muscle defects compared to parous women without a history of obstructed labour. Materials and Methods This was a prospective study in western Uganda assessing 82 women with obstetric fistula, unrepaired fourth degree obstetric tears and pelvic organ prolapse with a pelvic floor ultrasound scan. Results Demographic characteristics were significantly different, with women suffering pelvic organ prolapse being older and more parous. Hiatal area on Valsalva was significantly smaller in the obstetric fistula group (mean 21.45 cm 2 ) compared to non‐obstetric fistula group (unrepaired fourth degree obstetric tears and pelvic organ prolapse; mean 30.44 cm 2 ); a mean difference of 9.0 cm 2 (95% CI : 5.4–12.6 cm 2 , P < 0.001). Overall, levator muscle defects were significantly more common in women with obstetric fistula (66.7%) compared to the non‐obstetric fistula group (44.7%) with P = 0.048; however, there were no significant differences in complete levator muscle defects between obstetric fistula (28.6%) and non‐obstetric fistula (23.7%). Conclusions Increased hiatal area on Valsalva was noted in the non‐obstetric fistula group compared to women with obstetric fistula; however, there were no differences in proportions of complete levator muscle defects.