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Determinants and management outcomes of pelvic organ prolapse in a low resource setting
Gu Eleje1, Oi Udegbunam1, Cj Ofojebe1
1Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria.
Insights
Pelvic organ prolapse affects 6.5% of women in this Nigerian study, with menopause, advanced age, and multiparity as key risk factors. Early presentation is crucial for effective conservative management.
Area of Science:
- Gynecology
- Public Health
- Epidemiology
Background:
- Significant advancements in understanding pelvic organ prolapse (POP) pathophysiology and management have occurred.
- A review of POP management in low-resource settings is essential.
- This study addresses the need for context-specific POP management strategies.
Purpose of the Study:
- To determine the incidence of pelvic organ prolapse.
- To identify risk factors associated with pelvic organ prolapse.
- To evaluate management modalities for pelvic organ prolapse in a low-resource setting.
Main Methods:
- A 5-year cross-sectional study with retrospective data collection was conducted.
- Data were collected from women diagnosed with pelvic organ prolapse at a Nigerian teaching hospital.
- Epi-info software was utilized for data analysis.
Main Results:
- The incidence of pelvic organ prolapse was 6.5% (199/3082).
- Leading risk factors identified include menopause, advanced age, multiparity, and increased intra-abdominal pressure.
- Urinary tract infection and recurrence rates were both 13.5%; many patients were lost to follow-up.
Conclusions:
- Pelvic organ prolapse incidence is 6.5%, with multiparity, menopause, increased intra-abdominal pressure, and advanced age as primary determinants.
- Conservative management was offered to a smaller proportion of patients, highlighting the need for early presentation.
- Improved follow-up strategies and timely intervention are crucial for better outcomes in pelvic organ prolapse management.
Background:
The last decade has seen significant progress in understanding of the pathophysiology, anatomy and management modalities of pelvic organ prolapse. A review of the way we manage this entity in a low resource setting has become necessary.
Aim:
The aim of the study is to determine the incidence, risk factors and management modalities of pelvic organ prolapse.
Materials And Methods:
A 5-year cross-sectional study with retrospective data collection of women who attended the gynecologic clinic in Nnamdi Azikiwe University Teaching Hospital, Nnewi, south-east Nigeria and were diagnosed of pelvic organ prolapse was made. Proforma was initially used for data collection before transfer to Epi-info 2008 (v 3.5.1; Epi Info, Centers for Disease Control and Prevention, Atlanta, GA) software.
Results:
There were 199 cases of pelvic organ prolapse, out of a total gynecologic clinic attendance of 3082, thus giving an incidence of 6.5%. The mean age was 55.5 (15.9) years with a significant association between prolapse and advanced age (P < 0.001). The age range was 22-80 years. The leading determinants were menopause, advanced age, multiparity, chronic increase in intra-abdominal pressure (IAP) and prolonged labor. Out of the 147 patients with uterine prolapse, majority, 60.5% (89/147) had third degree prolapse. Vaginal hysterectomy with pelvic floor repair was the most common surgery performed. The average duration of hospital stay following surgery was 6.8 (2.9) days and the most common complication was urinary tract infection, 13.5% (27/199). The recurrence rate was 13.5% (27/199). Most of the patients who presented initially with pelvic organ prolapse were lost to follow-up.
Conclusion:
The incidence of pelvic organ prolapse in this study was 6.5% and the leading determinants of pelvic organ prolapse were - multiparity, menopause, chronic increase in IAP and advanced age. Most were lost to follow-up and a lesser proportion was offered conservative management. Early presentation of women is necessary so that conservative management could be offered if feasible.
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