Women's Health and Education Center (WHEC)

Obstetrical Fistulae

List of Articles

  • Pelvic Fistulae in Women: Diagnostic Tests and Management
    Of all the non-fatal complications of obstetrics and gynecological surgery, fistula is the one we all fear the most. Advancements in both the diagnosis and treatment of vaginal fistulae have been obtained over the past century as surgical interventions have become safer and surgical techniques have improved. The most common cause of fistulae worldwide is obstructed labor in the developing world. In developed countries, fistulae most commonly occur after benign gynecologic surgery, but obstructed labor, malignancy, radiation exposure, and inflammatory bowel disease can also cause fistulae. Fistulae significantly affect quality of life. Surgical correction of pelvic fistulae is still a great challenge and requires a team approach for better results. Such team must be well conversed with surgical anatomy and different procedures on various pelvic organs. In the end remember that vast majority of fistulae are preventable. Prevention of such fistulae, include antenatal education, awareness of women in their reproduction periods, easily available transport facilities and widespread availability of obstetrical facilities even in remote rural areas. Sexual activity and function should be determined before initiating fistula treatment, including a discussion of the presence or absence of dyspareunia before fistula formation. Women reported significant improvement in sexual function after Latzko transvaginal or transabdominal fistula repairs with no statistically significant differences in Female Sexual Function Index scores.

  • Global Efforts to End Obstetric Fistula (Part 1)
    Obstetric fistula is a devastating childbirth injury that leaves women incontinent, often stigmatized, and isolated from their communities. It is a stark outcome of socioeconomic and gender inequalities, human rights denial and poor access to reproductive health services, including maternal and newborn care, and an indication of high levels of maternal death and disability. These reviews outline efforts made at the international, regional and national levels, and by the United Nations system, to end obstetric fistula. It offers recommendations to intensify these efforts, within a human rights-based approach, to end obstetric fistula as a key step towards achieving Millennium Development Goal 5, by improving maternal health, strengthening health systems, reducing health inequities, and increasing the levels and predictability of funding. This review addresses magnitude of the problem and efforts at international, national and regional levels. Nongovernmental organizations (NGOs) and faith-based organizations in Africa are comparable to government-run institutions in terms of infrastructure and capacity to deliver obstetric care. Higher rates of obstetrician attendance and cesarean / instrumental delivery occurred at these institutions, potentially indicating better access to lifesaving intrapartum care. Greater recognition and integration of NGOs and faith-based organizations into strategies to improve maternal and neonatal health are essential for reaching international targets.

  • Global Efforts to End Obstetric Fistula (Part 2)
    The review outlines efforts made by the United Nations system and its Member States and remaining gaps. Commitments and efforts of Women’s Health and Education Center (WHEC) are also included. It offers recommendations to intensify these efforts, within a human rights-based approach, to end obstetric fistula as a key step towards achieving Millennium Development Goal 5, by improving maternal health, strengthening health systems, reducing health inequities, and increasing the levels and predictability of funding. Almost all obstetric fistulae occur in resource-poor areas, as a paucity of resources is the root cause. Where there are no suitable facilities for deliveries and obstetric emergencies, obstruction of labor often results in fetal death and obstetric fistula. Treatment in this setting usually focuses on meeting patients’ immediate needs rather than conducting research and refining techniques and long-term management of the patients. Unified, standardized evidence-base for informing clinical practice is lacking.

  • The Obstetric Fistula in the Developing World
    Worldwide obstructed labor occurs in an estimated 5% of live births and accounts for 8% of maternal deaths. Obstetric fistula are predominately caused by a very long, or obstructed, labor which can last several days or even sometimes, over a week before the women receives obstetric care or dies. Globally, over 300 million women currently suffer from short- or long-term complications arising from pregnancy or childbirth, with around 20 million new cases arising every year. This review provides essential, factual background information along with guiding principles for clinical management and program development. We hope to contribute to the development of more effective services for women under treatment for fistula repair. We hope our efforts advance effective programs for eliminating obstetric fistula. Most of all, however, we hope that the contents will motivate future research that will further enhance the understanding of reproductive health.

  • Rectovaginal Fistula and Fecal Incontinence
    Childbirth is increasingly being recognized as commonly injuring the mother's anal sphincter complex. Fecal incontinence also appears to be associated with urinary incontinence and pelvic organ prolapse. Anal continence does not completely depend on intact sphincters; also important are intact neuromuscular function, including a functioning puborectalis muscle and pudendal nerve. This is supported by the fact that some women with sphincter lacerations remain continent. Anatomical knowledge of the anorectal canal is essential. Complications of anal sphincter laceration include anal incontinence, fecal urgency, perineal pain, and sexual dysfunction. Diagnostic studies, non-invasive therapies, and surgical management have all evolved in recent years. This has resulted in an improving outlook for women with this stigmatizing condition.

  • Surgical Management of Lower Urinary Tract Fistulas
    Obstructed labor remains the most important cause of vesicovaginal fistulas in developing countries. Absent or untrained birth attendants, reduced pelvic dimensions (caused by early childbearing, chronic disease, malnutrition, and rickets), uncorrected inefficient uterine action, malpresentation, hydrocephalus, and introital stenosis secondary to tribal circumcision all contribute to obstructed labor. The purpose of this document is to explore various surgical techniques for surgical repairs of lower urinary tract fistulas. Obstetric fistulas are characterized by considerable necrosis, sloughing, tissue loss, and cicatrisation. Vesicovaginal fistulas commonly occur in the setting of wide range of other immediate problems, such as stillbirth, ruptured uterus, third- or fourth-degree perineal lacerations with resultant rectovaginal fistulas and anal incontinence, and pelvic infection. In modern obstetrics, most of these conditions do not exist. Generalists should be trained to repair simple fistulas, with referral of complex cases to specialized fistula hospitals.

  • An Overview & Forums On Obstetrical Fistulae
    Obstetrical fistulae are the most devastating healthcare problem for women globally. In modern obstetrics its existence is negligible, yet each year over half a million women die of complications of pregnancy, childbirth or unsafe abortion. The vast majority of these deaths are in developing countries. For every woman who dies in childbirth, 30 to 50 women suffer injury, infection or disease. About 1 million women in the world suffer from obstetrical fistulae. Pregnancy related complications are among the leading causes of death and disability for women age 15-49 in developing countries. This is not a problem of developing countries only; it is about human beings in distress and pain. THE BEST TREATMENT & MANAGEMENT OF OBSTETRICAL FISTULAE IS PREVENTION.

  • Obstetrical Fistulae & Efforts Of The United Nations
    The United Nations is an organization of sovereign States and not a world government. It is an international organization comprising 192 Member States. As the "town hall of global affairs", its work affects our life every day. Clearly no single organization can solve crisis of maternal mortality and morbidity worldwide. Its causes are incredibly complex, and its solution requires more than good obstetrical care alone. The United Nations is irreplaceable as a forum for international dialogue. Global issues require global action and global initiatives involving both from industrialized and developing countries. Building strategic and coordinated responses to this tragedy is the way forward. The need to take a fresh look at development aid is vital. This manual is intended to be a practical guide to be read and used at many different levels by many different people, especially health-care professionals and planners, policy-makers and community leaders.

  • Managing Vesico-vaginal Fistula
    Of the various uro-genital fistulas previously described, the vesico-vaginal fistula (VVF) is the most common due to its relationship to various obstetric and gynecologic risk factors. However, presentation and prognosis can be variable depending on the location, size, and coexisting factors associated with fistula formation. Fortunately, the diagnosis and surgical management of vesico-vaginal fistulas is associated with high cure rates if performed by trained gynecologic surgeons.

  • Psychosocial Impact of Incontinence
    Loss of control of urine, gas and stool can have a significant impact on the social well-being of affected women. It is a social and hygienic problem and leads to social distress. Urinary and fecal incontinence and related psychosocial distress constitute a spectrum related to the actual severity of the loss of control and to the woman's perception of her disability. Great stigma and shame is associated with urinary and fecal incontinence. The purpose of this document is to provide a better understanding of this devastating situation and provide management. Forums and management guidelines hope to provide the incentive for social and psychological programs to help women who are unfortunate victims of the situation.

  • Vesico-Vaginal Fistula: The Need for Safe Motherhood Practices in India
    The social consequences of ostracism take an enormous toll on affected women; divorce is common, and depression and suicide may follow. Many women are unaware that the condition is treatable, and are prevented from learning about appropriate care by severe social isolation as a result of their incontinence. In the first half of the twentieth century, obstetricians in India considered Vesico-Vaginal Fistula (VVF) as a hopeless condition.

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