“Webinar on Cesarean Section Safety and Quality in Low-Resource Settings: Highlights from a Global Technical Consultation”- November 9, 2017. Cesarean section provision has expanded rapidly in low- and middle-income countries (LMICs). While this includes needed growth in emergency obstetric and newborn care, evidence indicates that many cesarean sections are performed in settings where minimum standards for care quality and surgical safety cannot be met. Iatrogenic fistula resulting from cesarean section now accounts for a substantial proportion of fistula incidence in LMICs.
The Fistula Care Plus project and the Maternal Health Task Force recently convened a consultation to understand the causes of and potential solutions to this challenge. Participants included clinicians and researchers in LMICs, at global institutions, and in the United States. Following presentations of global cesarean section trends, participants discussed flashpoints in safety and quality (e.g., workforce density, task shifting, clinical decision making, and client rights). The proceedings showcased evidence of severe gaps (e.g., staffing, infrastructure, protocols) undermining cesarean section care quality and surgical safety and public health impacts of cesarean section underuse and overuse. Participants identified a consensus agenda to respond to these challenges through action across the maternal, newborn, and safe surgery communities. Implementation of this agenda is essential for realizing the potential impacts of universal access to essential obstetric surgery.
“Obstructed labor does not end at delivery: Strengthening postpartum care following prolonged/obstructed labor” – June 20, 2017. The USAID-funded Fistula Care Plus project of EngenderHealth convened a breakfast panel discussion cosponsored by Bard Medical on postpartum care following prolonged/obstructed labor (P/OL) at the 31st International Confederation of Midwives (ICM) Triennial Congress in Toronto, Canada. The panel was moderated by Dr. Lauri Romanzi, FC+ Director, and involved the following panelists: 1) Vandana Tripathi, FC+ Deputy Director; 2) Pandora Hardtman, International Midwifery Consultant; 3) Ekpoanwan Esienumoh, Senior Lecturer and Professor of Midwifery at University of Calabar, Nigeria; and 4) Jeffrey M. Smith, Vice President, Jhpiego. Panelists discussed gaps in guidelines for intrapartum and postpartum care, and highlighted practices to prevent and manage morbidity, focusing on bladder care and urinary catheterization, as well as sepsis prevention, recognition, and treatment.
“After Fistula Repair: Understanding Women’s Needs” – April 10, 2017.
The USAID-funded Fistula Care Plus project of EngenderHealth hosted a webinar discussion on understanding women’s needs after fistula repair in Uganda on Monday, April 10, 2017. Genital fistula, whether obstetric, iatrogenic, or from other causes, is a devastating condition with profound health and psychosocial impacts. Surgical repair can restore continence to women who have been living with fistula.
However, most fistula programs are unable to follow women after they are discharged from care; consequently, clients’ success in reintegration and their mental and physical health trajectories are not well understood. In order to better understand the long-term outcomes of fistula repair, Makerere University in Uganda and the University of California, San Francisco recently conducted a one year longitudinal study to develop a measure of postsurgical reintegration success and document physical and mental health changes among repaired clients. During the webinar, presenter Alison El Ayadi reviewed the results from this study, while commentators Moustapha Diallo and Rose Mukisa discussed the implications of these findings for the Fistula Care Plus project. Bethany Cole moderated a discussion with questions from webinar attendants.
To read more about the UCSF and Makerere research, including answers to questions raised during the webinar, visit the FC+ blog.
“Obstetric Fistula and Gender-Based Violence: Examining the Linkages” –Feb 22, 2017.
Reproductive outcomes, including maternal morbidities, have a direct impact on a woman’s vulnerability to intimate partner and sexual violence. A new multi-country analysis of data from the Demographic and Health Surveys (DHS) has found that women reporting symptoms of gynecological fistula are also more likely to report experience of physical and sexual violence. These findings raise important questions about the temporal and causal relationships between fistula and gender-based violence (GBV) and about how programs can better serve women throughout their experiences of seeking health services. During the webinar, moderator Lauri Romanzi and presenters Lindsay Mallick and Vandana Tripathi reviewed the literature on fistula and GBV, presented results from the DHS data analysis, and discussed the research and program implications of these findings.
“Surgical Safety Toolkit Webinar”– February 8, 2017.
EngenderHealth’s Fistula Care Plus (FC+) project has published an important new resource, the FC+ Surgical Safety Toolkit (SST), which will advance safe surgical practices and improve health outcomes for women affected by fistula. The SST consists of an adaptable system of quality assurance tools and safety checklists that aim to standardize surgical care. The toolkit is the first resource available to offer checklists designed for women with fistula, prolapse, and incontinence. The checklists are universal, so they can also be used for any type of surgery offered by health facilities. Available in both French and English, the SST will help surgeons and health care providers improve safety and quality of care around fistula surgery—from admission to care long after discharge from the health facility—to ensure the best possible health outcomes for women. Lauri Romanzi, Project Director of FC+ moderates a webinar to showcase the SST and how to use it.
“A Call to Action to End Iatrogenic Fistula”– Aug 17, 2016.
Evidence is emerging that iatrogenic causes contribute significantly to the burden of genital fistula in low-income countries. Given the preventability and severity of fistula, data on iatrogenic fistula indicate the urgency of improving surgical training, supervision, and facility capacity, particularly amid increasing rates of cesarean section and gynecologic surgery in low-income countries. While data indicate the need for a consistent definition of iatrogenic fistula, people working on these issues have yet to reach a consensus on definitions or a minimum acceptable standard of surgical care in low-income countries. During the webinar, moderator Bethany Cole and presenters Dr. Lauri Romanzi and Dr. Vandana Tripathi aimed to further the global effort to address these important issues.