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Obstetric fistulas & Bartholin's cysts
Transcript of Obstetric fistulas & Bartholin's cysts
-Cancer or radiation treatment
-Deep perineal tears or infected episiotomies
-Violent rape Diagnosis -Review of history
-Physical examination & visual inspection
-Sometimes radio-opaque dyes & x-rays
-Can include blood tests and urinalysis to check for infection Obstetric Fistulas (efeMENA, Fistula) (Moon, Vesicovaginal fistula) Bladder Vagina Vesicovaginal
fistula Bartholin's Glands -Located bilaterally at the base of the labia minora near the entrance to the vagina
-Produce small amounts of mucous thought to lubricate the vagina during sexual intercourse
-Not palpable except if disease or infection present
-Glands prone to obstruction from oedema & friction Symptoms Can be asymptomatic
Can be uncomfortable and painful
Seek treatment when it's not improving, becomes painful or shows sign of infection Bartholin's Cysts (Hutchon, Bartholin's gland) (Routada, Bartholin Cyst) A fistula that has formed in the vaginal wall
= Vaginal fistula / Obstetric fistula Vesicovaginal Fistula (OperationOf, Vesicovaginal fistula) -Vaginal fistula that opens into the urinary tract -Often the result of obstetric trauma & prolonged & obstructed labour in third world countries or gynaecologic surgery in developed countries -Main symptoms are urinary incontinence, pain and irritation of the vulva & vagina (Haferkamp et al., 2005) Rectovaginal Fistula (OperationOf, Rectovaginal fistula) -Vaginal fistula that opens into the rectum -Main symptoms are passage of gas or stool from the vagina, foul vaginal discharge irritation of vulva, vagina & perineum -Obstetric trauma which occurs in 0.1% vaginal deliveries causes up to 88% of these (Bradley & Champagne, 2010) (Bradley & Champagne, 2010;
Cook, Dickens & Syed, 2004) (Demianczuk, Candu) Treatments -Conservative management; cateterisation to allow fistula to close
-Surgical repair transvaginally, transabdominally or laparoscopically (Garthwaite & Harris, 2010) (Bradley & Champagne, RVF with probe placed through the tract) -ADHB surgical repair, IDC for at least 24 hours, antibiotics for 7 days, laxatives, specialist input for future pregnancies, physiotherapy. Treatment is covered under ACC (ADHB, 2011) Note that upto 30% of 3rd & 4th degree tears are not picked up at delivery (ADHB, 2011) The presence of a pre-existing gynecological disorder such as a fistula or Barholin's cyst warrants a CONSULTATION with another health practitioner such as an obstetrician under S88. As pregnancy, labour, birth & the post-natal period my be affected by the condition & situation. (Workplace Possibilities, Productivity) (Ministry of Health, 2007; Australian College of Midwives, 2003) It is reasonable to anticipate that a woman who has undergone repair of a vaginal fistula will have an elective c-section for subsequent births Midwives are crucial in primary prevention, re-occurrence & treatment of fistulas
(Australian College of Midwives, 2003) References Worldwide Fistula Occurrence (Drugs Information Online, Bartholin's gland) Bartholin's cyst = fluid filled, swollen sac-like structure
resulting from the blockage of one of
the ducts of the gland (Bora & Condous, 2009; Patil, Sultan & Thakar, 2007) Usually affects women of reproductive age
Affects 2% women (Bora & Condous, 2009; Patil, Sultan & Thakar, 2007) (Owen, Porcine model) (Gyn pictures, Bartholin Cyst) (NHS, 2011) Treatments Conservative Invasive Several types of bacteria can cause an infection that blocks the duct Diagnosis through physical examination -Best to leave alone if asymptomatic
-Have a warm bath or soak with a warm compress
-Paracetamol or ibuprofen may be recommended
-Soaking area with antibiotics (NHS, 2011; Patil, Sultan & Thakar, 2007) -Fine needle aspiration & drain fluid with a catheter
-Excision of the gland
-Lasering with carbon dioxide to create a new opening
-Ablation with silver nitrate (Wechter, Wu, Marzano & Haefner, 2009; NHS, 2011) Reoccurrence rate of up to 38% depending on treatment (Wechter et al., 2009) In pregnancy... (Adams, The Telegraph) Usually left untreated in pregnancy if not causing any problems as increased blood flow to vaginal area increases risk of bleeding.
Treated if causing pain or is large that it may cause problems in labour (Patil, Sultan & Thakar, 2007) (Omole, Marsupialization) (Haferkamp, Wagener, Buse, Reitz, Pfitzenmaier, Hallscheidt & Hohenfellner, 2005; Garthwaite & Harris, 2010) (Garthwaite & Harris, 2010;
Bradley & Champagne, 2010) -Affects at least 2 million women worldwide
-At least 100,000 new cases a year Figures grossly underestimate as they are based on number of women who seek treatment -In developing countries with high maternal mortality fistulas can occur at a rate of 2-3 per 1000 births (UNFPA, Campaign to end fistula) -Very rare in Western countries through improved obstetric care (UNFPA, 2013) Adams, B. (Photographer). The Telegraph [Web Photo]. Retrieved from http://www.telegraph.co.uk/health/healthnews/9503860/Eating-nuts-in-pregnancy-reduces-chance-of-childhood-allergy.htmlAuckland District Health Board (ADHB). (2011). Perineal Tears – Third and Fourth Degree Recommended Best Practice. Auckland, New Zealand: ADHB.Australian College of Midwives (2003). National midwifery guidelines for consultation and referral. Canberra, Australia: Australian College of Midwives Incorporated.Bora, S., & Condous, G. (2009). Bartholin's, vulval and perineal abscesses, Best Practice and Research Clinical Obstetrics and Gynaecology, 23, 661-666. doi: 10.1016/j.bpobgyn.2009.05.002Bradley, J., & Champagne, M. D. (2010). Rectovaginal fistula. Surgical Clinics of North America, 90(1), 69-82. doi: 10.1016/j.suc.2009.09.003Cook, R. J., Dickens , B. M., & Syed, S. (2004). Obstetric fistula: the challenge to human rights. International Journal of Gynecology & Obstetrics, 87(1), 72-77. doi: 10.1016/j.ijgo.2004.07.005,Demianczuk, D. (Photographer). (2013). Candu [Web Photo]. Retrieved from http://www.candubusinesssystems.com/blog/Drugs Information Online. (Artist). (2013). Bartholin's gland [Web Graphic]. Retrieved from http://drugline.org/medic/term/bartholins-glands/efeMENA. (Photographer). (2010). Fistula [Web Graphic]. Retrieved from http://efemenaoreoluwa.blogspot.co.nz/2010/05/vesico-vaginal-fistula.htmlGarthwaite, M., & Harris, N. (2010). Vesicovaginal fistula. Indian Journal of Urology, 26(2), 253-256. doi: 10.4103/0970-1591.65400Gyn pictures. (Photographer). Bartholin Cyst [Web Photo]. Retrieved from http://sinoemedicalassociation.org/obgyn/gynpictures/id24.htmHaferkamp, A., Wagener, N., Buse, S., Reitz, A., Pfitzenmaier, J., Hallscheidt, P., & Hohenfellner, M. (2005). Vesikovaginale fisteln. Der Urologe,44(3), 270-276. doi: 10.1007/s00120-005-0766-zHutchon, D. (Artist). (2006). Bartholin's gland [Web Graphic]. Retrieved from http://www.privatehealth.co.uk/private-operations/gynaecology/bartholins-cyst-/Ministry of Health (2007). Guidelines for the consultation with obstetric and related specialist medical services; referral guidelines. Wellington, New Zealand: Ministry of Health.Moon, S. G. (Photographer). (2001). Vesicovaginal fistula [Web Photo]. Retrieved from http://openi.nlm.nih.gov/detailedresult.php?img=2718108_kjr-2-97-g002&req=4National Health Service, (NHS). (2011). Bartholin's Cyst Treatment. Retrieved from http://www.nhs.uk/Conditions/Bartholins-cyst/Pages/Treatments.aspxOmole, F. (Artist). Marsupialization [Web Graphic]. Retrieved from http://www.aafp.org/afp/2003/0701/p135.htmlOperationOf. (Artist). Rectovaginal fistula [Web Graphic]. Retrieved from http://www.operationof.org/fistula/obstetric-fistula/rectovaginal-fistula-rvf/OperationOf. (Artist). Vesicovaginal fistula [Web Graphic]. Retrieved from http://www.operationof.org/fistula/obstetric-fistula/vesicovaginal-fistula-vvf/Owen, J. W. (Photographer). Porcine model [Web Photo]. Retrieved from http://www.sciencedirect.com/science/article/pii/S0002937805003091Patil, S., Sultan, A. H., & Thakar, R. (2007). Bartholin's cysts and abcesses. Journal of Obstetrics and Gynaecology, 27(3), 241-245. doi: 10.1080/01443610701194762Routada. (Photographer). (2011). Bartholin Cyst [Print Photo]. Retrieved from de.routada.com/pictures/2011/05/bartholin-cyst-picture-imageSeyoum, B. (2011). I carry life not shame!. Retrieved from http://africanfeminism.com/2011/03/20/i-carry-life-not-shame/UNFPA. (2013). End fistula. Retrieved from http://www.endfistula.org/UNFPA. (Designer). Campaign to end fistula [Web Graphic]. Retrieved from http://www.unfpa.org/public/Wechter, M., Wu, J., Marzano, D., & Haefner, H. (2009). Management of Bartholin duct cysts and abscesses, Obstetrical and Gynecology Survey, 64(6), 395-404.Workplace Possibilities. (Photographer). (2013). Productivity [Web Photo]. Retrieved from http://workplacepossibilities.com/author/mklachefsky/