Evaluatie van Gynokamp in Nepal : Analyse van factoren die invloed hebben op ernst van genitale prolaps en hun invloed op keuze en effectiviteit van de ingezette behandeling

Pelvic organ prolapse has a high prevalence in Nepal, because of that it is a common medical health condition of the Nepalese woman. Factors which are likely to contribute to pelvic organ prolapse have been partly investigated. These factors are known to be specific for Nepal and possibly also for other underdeveloped countries. Heavy, physical labour during pregnancy and also after delivery, inadequate medical support during delivery, multiparity and malnutrition seem to play a role in the high prevalence. However, these factors do not complete the whole list of possible risk factors. It is unknown for example in what way genetic predisposition contributes to the existence of pelvic organ prolapse in Nepal. The Dutch NGO Woman for Woman organize since 2003 biannually gynecological health camps in the rural parts of Nepal. A condition which is treated by them is pelvic organ prolaps. Women are treated by placement of a pessary, operation and or counseling. Evaluation of their former applied therapy has taken place. The aim of our study was to determine the influence of possible risk factors on the severity of pelvic organ prolapse in Nepal and also to determine their influence on the efficacy of the applied treatment. The following factors were specifically analyzed: age, age at first pregnancy, number of pregnancies, number of deliveries, post – menopausal status, being educated and the nature of help during delivery. Similar research did not take place before. A total of 529 patients with pelvic organ prolaps were included. These women were treated in gynecological health camps in november 2008 and 2009. Analyze was partly done by investigation of a cohort, partly cross – sectional. The period of follow – up was 1 year. All patients were interviewed and examined gynaecologically, by use of the POP-Q method. The results of our study show that a higher level of POP – Q is associated with older age, older age of first pregnancy and an increased number of pregnancies and deliveries. The choice of treatment for pelvic organ prolapse is influenced by the severity of the pelvic organ prolaps. Patients who were operated were diagnosed with a higher stage of POP-Q in comparison to the patients who were treated with a pessary. A possible trend is seen in the fact that patients who got an operation were older of age than the patients who were treated with a pessary. Not being educated led more often to a pessary as choice of treatment. The biggest amount of our population developed pelvic organ prolapsed before the menopause (59.9%), POP – Q stage 4 was mostly seen with woman who were post – menopause (68.8%). The influence of the factors and the severity of pelvic organ prolapse on the efficacy of the treatment (pessary placement and operation) could not be adequately investigated in this research because of the low follow – up percentage. A tendency torward a decrease in the severity of POP – Q after treatment (pessary placement and operation) is most likely. Although not the complete list of possible risk factors for pelvic organ prolapse in Nepal have been investigated, further research after that is necessary, we can use these results to make up better intervention and prevention methods to reduce pelvic organ prolaps as a widespread problem in Nepal.