Pregnancy and childbirth after repair of obstetric fistula in sub‐Saharan Africa: Scoping Review

Abstract

Abstractobjective To synthesise the evidence on pregnancy and childbirth after repair of obstetric fistula in sub-Saharan Africa and to identify the existing knowledge gaps.methods A scoping review of studies reporting on pregnancy and childbirth in women who underwent repair for obstetric fistula in sub-Saharan Africa was conducted. We searched relevant articles published between 1 January 1970 and 31 March 2016, without methodological or language restrictions, in electronic databases, general Internet sources and grey literature.results A total of 16 studies were included in the narrative synthesis. The findings indicate that many women in sub-Saharan Africa still desire to become pregnant after the repair of their obstetric fistula. The overall proportion of pregnancies after repair estimated in 11 studies was 17.4% (ranging from 2.5% to 40%). Among the 459 deliveries for which the mode of delivery was reported, 208 women (45.3%) delivered by elective caesarean section (CS), 176 women (38.4%) by emergency CS and 75 women (16.3%) by vaginal delivery. Recurrence of fistula was a common maternal complication in included studies while abortions/miscarriage, stillbirths and neonatal deaths were frequent foetal consequences. Vaginal delivery and emergency C-section were associated with increased risk of stillbirth, recurrence of the fistula or even maternal death.conclusion Women who get pregnant after repair of obstetric fistula carry a high risk for pregnancy complications. However, the current evidence does not provide precise estimates of the incidence of pregnancy and pregnancy outcomes post-repair. Therefore, studies clearly assessing these outcomes with the appropriate study designs are needed.

Fertility outcomes following obstetric fistula repair: a prospective cohort study

“…Compared to reports of OF patients in other settings, women in our study who became pregnant after repair had a slightly lower proportion of stillbirth. The previously-mentioned review found that 7.6% of pregnancies ended in stillbirth, whereas our proportion was 4.5%, which is still slightly higher than the 3.4% reported among all pregnancies in Malawi [ 17 , 19 ]. However, 16.1% of our pregnancies resulted in spontaneous abortion, which is higher than the 5.4% calculated from the review and the 4.7% reported overall in Malawi [ 20 ].…”

“…Only four of 22 women in our study reported urinary incontinence after delivery, and two already had urinary incontinence prior to delivery. Our maximum proportion of 9.1% for fistula recurrence is slightly higher than the 5.0% reported in the review [ 17 ] but lower than the 12–33% women reported in other studies [ 6 , 22 , 23 ]. In one of these studies, fistula recurrence was associated with delivery outside the hospital where the repair took place, at home, or after 2 or more days of obstructed labor [ 22 ].…”

“…A recent review of 11 studies (including one from our study population [ 4 ]) found that 212 (17.4%) of 1218 women followed after OF repair became pregnant, with a range of 2.5–40% [ 17 ]. Our proportion of 20.2% is well within this range.…”

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 .…”

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.…”