Risk factors for obstetric fistula: a clinical review

Abstract

Obstetric fistula is the presence of a hole between a woman’s genital tract and either the urinary or the intestinal tract. Better knowledge of the risk factors for obstetric fistula could help in preventing its occurrence. The purpose of this study was to assess the characteristics of obstetric fistula patients. We conducted a search of the literature to identify all relevant articles published during the period from 1987–2008. Among the 19 selected studies, 15 were reports from sub-Saharan Africa and 4 from the Middle East. Among the reported fistula cases, 79.4% to 100% were obstetrical while the remaining cases were from other causes. Rectovaginal fistulae accounted for 1% to 8%, vesicovaginal fistulae for 79% to 100% of cases, and combined vesicovaginal and rectovaginal fistulae were reported in 1% to 23% of cases. Teenagers accounted for 8.9% to 86% of the obstetrical fistulae patients at the time of treatment. Thirty-one to 67% of these women were primiparas. Among the obstetric fistula patients, 57.6% to 94.8% of women labor at home and are secondarily transferred to health facilities. Nine to 84% percent of these women delivered at home. Many of the fistula patients were shorter than 150 cm tall (40–79.4%). The mean duration of labor among the fistula patients ranged from 2.5 to 4 days. Twenty to 95.7% of patients labored for more than 24 h. Operative delivery was eventually performed in 11% to 60% of cases. Obstetric fistula was associated with several risk factors, and they appear to be preventable. This knowledge should be used in strengthening the preventive strategy both at the health facility and at the community level.

Urogenital Fistula in Cote d’Ivoire: Epidemiological, Clinical and Therapeutical Aspects

“…In the series of Aristide Kaboré et al [1], these rates are respectively of 4.1% and 5.9% contrary to the series of Said Moudoumi [10], where rates of uretro-vaginal fistulas were high and reached 39.9%. Concerning shapes (vesicle or urtero-vaginal and rectovaginal) which were part of type III injuries, represented 2.2% of cases, those were in accordance with literature where these rates vary between 1% and 23% [14].…”

“…According to the works of Tebeu, PM et al [14], average duration of labor was superior to 24 hours in 20% to 95.7% of cases with averages varying between 2.5 and 4 days according to the series and 57.6% to 94.8% for patients monitoring their labor at home and were secondarily transferred to hospital to ease the delivery. Once the decision to consult a doctor is taken, difficulty of access to a health center or to the nearest recommended medical center is an essential element in the risk factors of the obstetrical fistulas.…”

Vesicovaginal fistulas: a gynecological experience in 41 cases at a German pelvic floor center

“…Ischemia of the soft tissue between the vagina and the urinary tract due to compression of the fetal head or direct tearing of the same soft tissue during precipitous deliveries are responsible for the obstetrical vesicovaginal fistulas [17]. This seems to be the reason for the VVF in our patient after forceps delivery, especially following an elective cesarean section.…”

S3-Leitlinie: Rektovaginale Fisteln (ohne M. Crohn)

“…Insgesamt [297] beschreiben eine Inzidenz von bis zu 3% und zusätzlich das Risiko einer Kloakenbildung bei bis zu 6% der Gebä-renden. Umfangreiche Reviews wurden aktuell von Arrowsmith et al [16], Sjoeian et al [269] sowie Tebeu et al [282] vorgestellt. In einer aktuellen amerikanischen Studie konnte eine Abnahme der Häufig-keit von geburtstraumatischen Fisteln beobachtet werden [36].…”