Obstetric Vesicovaginal Fistula as an International Public-Health Problem

Department of Obstetrics-Gynecology, Washington University School of Medicine, St Louis, MO 63110, USA.
The Lancet (Impact Factor: 45.22). 10/2006; 368(9542):1201-9. DOI: 10.1016/S0140-6736(06)69476-2
Source: PubMed


Vesicovaginal fistula is a devastating injury in which an abnormal opening forms between a woman's bladder and vagina, resulting in urinary incontinence. This condition is rare in developed countries, but in developing countries it is a common complication of childbirth resulting from prolonged obstructed labour. Estimates suggest that at least 3 million women in poor countries have unrepaired vesicovaginal fistulas, and that 30 000-130 000 new cases develop each year in Africa alone. The general public and the world medical community remain largely unaware of this problem. In this article I review the pathophysiology of vesicovaginal fistula in obstructed labour and describe the effect of this condition on the lives of women in developing countries. Policy recommendations to combat this problem include enhancing public awareness, raising the priority of women's reproductive health for developing countries and aid agencies, expanding access to emergency obstetric services, and creation of fistula repair centres.

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Available from: Lewis Wall, Apr 06, 2014
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    • "The overriding principle of fistula repair is that the first attempt offers the best chance of successful closure[1]. The basic principles of surgical repair are: 1) achieving adequate exposure, 2) mobilizing the fistula from surrounding scar tissue, so that 3) a tension-free closure can be performed that is water-tight[1,4]. "

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    • "From a surgeon's perspective, success might mean the closure of the hole. A woman would probably not consider herself to be cured, however, if her fistula is closed but she is still leaking [17]. While practitioners and decision-makers working on obstetric fistula services recognize the need for standardizing indicators, there are no consensus global indicators. "
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    ABSTRACT: The field of obstetric fistula has historically lacked common definitions for measuring needs and outcomes. This paper recounts the process of developing, refining, and using standardized monitoring indicators as part of a fistula prevention and repair project in fourteen countries—Bangladesh, Benin, Democratic Republic of the Congo, Ethiopia, Ghana, Guinea, Liberia, Mali, Niger, Nigeria, Rwanda, Sierra Leone, Togo, and Uganda. The process included collaborative indicator development, introducing standardized data collection at health facilities, and promoting the integration of fistula indicators into national health management information systems (HMIS) to enable continued measurement and support for fistula treatment services. As monitoring of obstetric fistula continues to become more standardized and routine, the multi-country scope of the project has enabled a wide-ranging effort through which indicators for an emerging maternal health content were introduced and applied.
    Full-text · Article · Mar 2015
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    • "Obstetric fistula is one of the most debilitating maternal health morbidities associated with poor obstetric practice, imposing an enormous medical and psychological burden on affected women. Most cases of obstetric fistula result from prolonged obstructed labor and leave women incontinent, ashamed, depressed, stigmatized, and isolated from their communities [1] [2] [3] [4] [5] [6] [7]. Its true prevalence and incidence are difficult to determine , but it is estimated that between 100 000 and 1 000 000 women are living with untreated fistula in Nigeria [1] [2] [8]. "
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    ABSTRACT: To determine the contraceptive practices of women after surgical repair of obstetric fistula and to assess determinants of uptake and the pregnancy rate in the first year. A prospective cohort study enrolled women who had a successful surgical repair of obstetric fistula at a center in Nigeria between 2011 and 2013. Patients were followed up for 1year. Data were obtained through record review and completion of a semi-structured questionnaire. Among 188 participants, 180 (95.7%) were aware of contraception, but only 70 (37.2%) used contraceptive methods after surgery. The most commonly used methods were the male condom (50 [71.4%] of 70) and hormonal injections (14 [20.0%]). The main reasons for non-use were fear of adverse effects (48 [40.7%] of 118 women), future desire for more children (35 [29.7%]), religious prohibition (26 [22.0%]), cultural beliefs (29 [24.6%]), and partner disapproval (42 [35.6%]). The risk of unplanned pregnancy in the first year was significantly lower among women who used contraceptives than among those who did not (relative risk 0.14, 95% confidence interval 0.02-1.06; P=0.03). Contraceptive uptake for birth control after fistula repair surgery was low because of socioeconomic reasons, religious and cultural beliefs, and myths, resulting in unplanned pregnancies. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
    Full-text · Article · Feb 2015 · International Journal of Gynecology & Obstetrics
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