RESUMO
OBJECTIVE: To assess the fertility and pregnancy experiences of rural Malawian women living with obstetric fistula and following surgical repair of fistula. METHODS: Fertility histories were collected via in-depth interviews with women identified in 2007 as having obstetric fistula and with their family members. RESULTS: Of the 32 affected women interviewed, 17 (53.1%) conceived after developing obstetric fistula: 13 before repair and 6 after repair (with 2 conceiving both pre- and post-repair). Complaints of infertility were more frequent and urgent among women who had undergone repair than among those who had not. Over half (53.8%) of the women who conceived while living with obstetric fistula and all of those who conceived post-repair experienced at least 1 spontaneous abortion or perinatal death. Nineteen (47.5%) of the 40 pregnancies among women living with obstetric fistula and 7 (70.0%) of the 10 pregnancies among women post-repair ended in spontaneous abortion or perinatal death. CONCLUSION: Even 2 years after undergoing surgical repair, women can continue to experience the effects of obstetric fistula, which include infertility, spontaneous abortion, and perinatal mortality. The factors responsible for extensive infertility and poor pregnancy outcome in women post-repair warrant further investigation.
Assuntos
Aborto Espontâneo/etiologia , Infertilidade Feminina/etiologia , Mortalidade Perinatal , Fístula Vaginal/complicações , Aborto Espontâneo/epidemiologia , Adulto , Estudos de Coortes , Feminino , Seguimentos , Humanos , Infertilidade Feminina/epidemiologia , Malaui/epidemiologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Gravidez , Fístula Vaginal/cirurgiaRESUMO
Twenty-five cats exhibiting at least four episodes of vertical urine marking per week were assessed. Following a medical workup, a 4-week clomipramine trial was instituted, using a mean dose of 0.54 mg/kg per os q 24 hours. No concurrent behavioral or environmental modifications were applied. There was a statistically significant (P<0.0001) decrease in urine spraying when the cats were on clomipramine, with 20 of 25 cats having a > or =75% reduction in spraying within 4 weeks. Side effects were mild. Twenty cats were followed for an additional 5 months. Fifteen cats required medication to control the spraying, often at a reduced dose.
