Fertility outcomes following obstetric fistula repair: a prospective cohort study

Abstract

BackgroundObstetric fistula (OF) is a maternal morbidity associated with high rates of stillbirth, amenorrhea, and sexual dysfunction. Limited data exists on the reproductive outcomes of women in the years following a fistula repair. The objective of this study is to describe the fertility outcomes and family planning practices in a population of Malawian women 1–4 years after fistula repair.MethodsWomen who had enrolled into a clinical database of OF patients and undergone OF repair between January 1, 2012 and July 31, 2014 were recruited and enrolled to complete a home-based survey of their demographic and reproductive health data 1–4 years after their repair. Pregnancy, amenorrhea, and sexual function were described using frequency analysis, and we compared antimüllerian hormone (AMH) concentrations between women with menses or pregnancy with women with amenorrhea or no pregnancy using Wilcoxon rank sum tests.ResultsOf 297 women with a prior OF repair, 148 had reproductive potential and were included in this analysis. Overall 30 women of these women (21%) became pregnant since their fistula repair, with most pregnancies ending with cesarean delivery. Of the 32 women who were amenorrheic at the time of repair, 25 (78.1%) had resumption of menses. Only 11 (8.6%) of sexually active women reported dyspareunia, and among women who were not trying to conceive, 53.1% were currently using a method of family planning. No significant differences were found in AMH concentrations between those who were pregnant or had menses versus those without pregnancy or menses, respectively.ConclusionsIn this long-term follow-up study of women after OF repair, many women were able to achieve a pregnancy with a live birth, have normal menses, be sexually active, and access contraception. These achievements will further assist a population of women whose reintegration and restoration of dignity is closely tied to their ability to achieve their reproductive goals.Trial registrationClinicalTrials.gov Identifier: NCT02685878.

Rehabilitation and reintegration programming adjunct to female genital fistula surgery: A systematic scoping review

“…They may require further medical care depending on injury severity and surgical outcomes, and medical support for subsequent pregnancies and births. Longitudinal studies from sub‐Saharan Africa have identified concerning adversity following fistula surgery, including fistula recurrence, persistent fistula‐related symptoms, subsequent fertility challenges, and adverse perinatal outcomes . In Guinea, 16% experienced fistula recurrence by 24 months .…”

“…In Uganda, by 12 months following repair, one‐third had persistent urinary incontinence, 17% weakness, and 9% general pain . In Malawi, only one‐fifth of women with reproductive potential became pregnant in the year following surgery . Experience of persistent physical adversity correlates with substantially lower psychosocial health .…”

Vesicouterine fistula presenting with cyclical haematuria mimicking bladder endometriosis: A case report

“…A surgical approach is contemplated the mainstay and definitive management of the VUF following caesarean section [ 17 ]. Notably, a subset of women was able to resume a normal period after fistula repair [ 14 ], though the data on how frequently this occurs is very limited [ 2 , 10 , 14 ]. Due to the low prevalence of VUF, although hysterectomy is not obligatory, it is not easy to find the most assuring approach to manage VUF.…”

Rehabilitation and reintegration programming adjunct to female genital fistula surgery: a scoping review protocol

“…They may also require further medical care depending on the severity of their injuries and surgical outcomes and require healthcare access for subsequent pregnancies and births. Longitudinal studies from sub-Saharan Africa have identified risks of adverse outcome following fistula surgery, including fistula recurrence, persistent fistula-related symptoms, subsequent fertility challenges and adverse perinatal outcomes 11–13. In Guinea, for example, the cumulative incidence of fistula recurrence was 16% at 24 months13.…”

“…In Uganda, by 12 months postsurgery, one-third of women continued to experience urinary incontinence, 17% reported weakness and 9% reported general pain 14. In Malawi, only one-fifth of women with reproductive potential were able to become pregnant in the year following surgery 12. Furthermore, experience of persistent physical symptoms or adversity is associated with substantially lower psychosocial health 14.…”