Magali Robert1, A Jane Govan2, Uma Lohani3, Aruna Uprety3. 1. Department of Obstetrics and Gynecology, Section of Urogrynecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. 2. Independent Consultant, Calgary, AB, Canada. 3. Rural Health and Education Service Trust, Kathmandu, Nepal.
Abstract
OBJECTIVE: To evaluate the acceptability, feasibility, and outcomes of pessary fitting in rural Nepali communities. METHODS: A 1-year prospective cohort study was conducted in the Ramechhap district of Nepal in January 2013-January 2014 among women attending a free gynecology health camp. All women with symptomatic pelvic organ prolapse (POP) were offered ring pessaries. Demographic information was collected and questionnaires on POP were completed. A urogynecologic examination was performed. At the 1-year follow-up, women were questioned on pessary use and underwent an examination. Logistic regression was used to identify associations. RESULTS: In total, 411 women attended the health camps, of whom 142 presented with symptomatic POP. Initial fitting was accomplished for 134 (94.4%) of the women. At the 1-year follow-up, 130 (97.0%) women in the cohort were evaluated, and 72 (55.4%) were still using the pessary. The primary reason for discontinuation was the pessary falling out (35/58, 60.3%). The most common complication was vaginal erosion (18/130, 13.8%), observed exclusively among postmenopausal women. Postmenopausal status was a predictor of continued use (odds ratio 3.12, 95% confidence interval 1.45-6.72; P=0.004). CONCLUSION: Pessaries were found to be an acceptable and feasible option with minimal complications for treating POP in rural Nepal.
OBJECTIVE: To evaluate the acceptability, feasibility, and outcomes of pessary fitting in rural Nepali communities. METHODS: A 1-year prospective cohort study was conducted in the Ramechhap district of Nepal in January 2013-January 2014 among women attending a free gynecology health camp. All women with symptomatic pelvic organ prolapse (POP) were offered ring pessaries. Demographic information was collected and questionnaires on POP were completed. A urogynecologic examination was performed. At the 1-year follow-up, women were questioned on pessary use and underwent an examination. Logistic regression was used to identify associations. RESULTS: In total, 411 women attended the health camps, of whom 142 presented with symptomatic POP. Initial fitting was accomplished for 134 (94.4%) of the women. At the 1-year follow-up, 130 (97.0%) women in the cohort were evaluated, and 72 (55.4%) were still using the pessary. The primary reason for discontinuation was the pessary falling out (35/58, 60.3%). The most common complication was vaginal erosion (18/130, 13.8%), observed exclusively among postmenopausal women. Postmenopausal status was a predictor of continued use (odds ratio 3.12, 95% confidence interval 1.45-6.72; P=0.004). CONCLUSION: Pessaries were found to be an acceptable and feasible option with minimal complications for treating POP in rural Nepal.
Authors: Suelene Albuquerque Coelho; Luiz Gustavo O Brito; Camila Carvalho de Araújo; Luiza Borges Aguiar; Jorge M Haddad; Paulo C Giraldo; Cássia R T Juliato Journal: Clinics (Sao Paulo) Date: 2019-09-09 Impact factor: 2.365