Obstructed Labor Injury Complex

Abstract

Prolonged obstructed labor may produce injuries to multiple organ systems. The best known, and most common, of these injuries is obstetric fistula formation. When obstructed labor is unrelieved, the presenting fetal part is impacted against the soft tissues of the pelvis and a widespread ischemic vascular injury develops that results in tissue necrosis and subsequent fistula formation. Unlike the postsurgical vesicovaginal fistula, however, which is usually the result of focal trauma to otherwise healthy tissues, the obstetric fistula is the result of a "field injury" to a broad area. The field injury that is produced by prolonged obstructed labor may result in multiple birth-related injuries in addition to (or instead of) a vesicovaginal fistula. Focusing simply on the "hole" between the bladder and the vagina ignores the multifaceted nature of the injury that many of these patients have sustained. These injuries may include total urethral loss, stress incontinence, hydroureteronephrosis, renal failure, rectovaginal fistula formation, rectal atresia, anal sphincter incompetence, cervical destruction, amenorrhea, pelvic inflammatory disease, secondary infertility, vaginal stenosis, osteitis pubis, and foot-drop. In addition to their physical injuries, women who have experienced prolonged obstructed labor often develop serious social problems, including divorce, exclusion from religious activities, separation from their families, worsening poverty, malnutrition, and almost unendurable suffering. Isolated almost exclusively to the developing world, particularly Africa, this problem has not received the international attention that it deserves, from either a medical or a social standpoint.

Musculoskeletal sequelae in patients with obstetric fistula – a case–control study

“…Foot drop was found in three (4.2%) cases, which is lower than that reported by Arrowsmith et al [2] (20%), Waaldijk and Elkins [5] (26%) and Williams [6] (30%). An explanation for the high number of women with foot drop found by Arrowsmith et al [2] and Williams [6] could be a selection effect, the more severe cases being referred to their centre while the less extensive cases were operated locally.…”

“…An explanation for the high number of women with foot drop found by Arrowsmith et al [2] and Williams [6] could be a selection effect, the more severe cases being referred to their centre while the less extensive cases were operated locally. Secondly, the register had been based on informal surveys.…”

“…Studies report on foot drop in 20-30% of these women [2,5,6]. Walking difficulties have been reported in 1.5% of primiparous (95%CI: 1.47, 1.53) and 0.8% in multiparous fistula patients (95%CI: 0.6, 1.0) [7].…”

Obstetric Fistula in Ilorin, Nigeria

“…Bladder stones can occur, as women affected by fistula often drink less to try and pass less urine and the concentrated urine can form calculi. The obstetric injury has been termed a ‘field injury’, as the pathology is broad rather than isolated [9]. The resulting range of injuries can be daunting for health professionals who are working with limited resources.…”

Etude des connaissances, attitudes et pratiques en matière de réintégration sociale des femmes victimes de fistule obstétricale: région de l’Extrême-nord, Cameroun

“…Littéralement il s'agit d'un orifice entre le vagin et la vessie ou le rectum, voire les deux, qui provoque une incontinence urinaire et/ou fécale chronique ayant des effets nocifs sur la vie sociale et l’état de santé de la femme [4–6]. Selon l'Organisation Mondiale de la Santé (OMS), environ 800 femmes meurent chaque jour dans le monde du fait de complications liées à la grossesse ou à l'accouchement [7].…”