BACKGROUND: Vesicovaginal fistula is a preventable calamity, which has been an age-long menace in developing countries. OBJECTIVE: To review the causes, complications, and outcome of vesicovaginal fistula in Nigeria. METHODS: Studies on vesicovaginal fistula were searched on the internet. Information was obtained on Pubmed (medline), WHO website, Bioline Innternational, African Journal on Line, Google scholar, Yahoo, Medscape and e Medicine. RESULTS: Many Nigerian women are living with vesicovaginal fistula. The annual obstetric fistula incidence is estimated at 2.11 per 1000 births. It is more prevalent in northern Nigeria than southern Nigeria. Obstetric fistula accounts for 84.1%-100% of the vesicovaginal fistula and prolonged obstructed labour is consistently the most common cause (65.9%-96.5%) in all the series. Other common causes include caesarean section, advanced cervical cancer, uterine rupture, and Gishiri cut. The identified predisposing factors were early marriage and pregnancy, which were rampant in northern Nigeria, while unskilled birth attendance and late presentation to the health facilities was common nationwide. Among the significant contributory factors to high rate of unskilled birth attendance were poverty, illiteracy, ignorance, restriction of women's movement, non-permission from husband, and transportation. All but one Nigerian studies revealed that primiparous women were the most vulnerable group. Pregnancy outcome was dismal in most cases related to delivery with still birth rate of 87%-91.7%. Stigmatization, divorce and social exclusion were common complications. Overall fistula repair success rate was between 75% and 92% in a few centres that offer such services. CONCLUSION: Vesicovaginal fistula is prevalent in Nigeria and obstetric factors are mostly implicated. It is a public health issue of concern.

BackgroundSnake bite in the third trimester of pregnancy with late presentation, systemic envenomation; disseminated intravascular coagulopathy and delivery of a live neonate is uncommon in a low resource setting.CaseWe present a 22 year old unbooked Gravida 3 Para 1+ 1 1alive lentiviral positive woman at 32 weeks gestation with snake bite, leg swelling, vaginal bleeding and labour pains. At presentation, there were anemia, tachycardia, hypotension; a gravid uterus with a single fetus in longitudinal lie, cephalic presentation, regular fetal heart rate and cervical dilatation of 3 cm. Preterm labour with antepartum hemorrhage due to venomous snake bite was diagnosed. Multidisciplinary management instituted led to the survival of both mother and baby.ConclusionIn resource constrained setting, disseminated intravascular coagulopathy arising from systemic envenomation due to snake bite in pregnancy could be challenging. Obstetric outcome depends on the degree of envenomation, gestational age at presentation, timing, duration and quality of treatment.

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Objectives: This study aimed to determine the rate and predictive factors for successful vaginal birth after cesarean delivery, and measure maternal and neonatal outcomes of VBAC following one previous cesarean delivery. Methods: In this hospital-based prospective study, sixty women with one previous CD (subjects) who attempted VBAC and another sixty without previous CD (controls) carrying singleton cephalic fetuses matched for maternal age, parity, and gestational age were compared. The primary outcome measures were successful vaginal delivery and its predictors. Data were analyzed using SPSS (version 22.0), and p<0.05 was significant. Results: Out of 1768 deliveries, 105 (5.9%) had one previous CD; 57.1% (60/105) attempted while 61.7% (37/60) had successful VBAC; 23 (38.3%) had failed VBAC and repeat CD, while 14 (23.3%) of the control group had CD. The significant predictors of successful VBAC were cervical dilatation ≥4cm on admission (p=0.003), maternal age >35 years (p=0.019); and augmentation of labor (p=0.020); while previous vaginal delivery (p=0.108), parity (p=0.706), BMI (0.240), and inter-delivery interval (p=0.265) were not statistically significant. The maternal and neonatal outcomes were not statistically different among women who had successful VBAC after one CD compared to women without previous CD. Important morbidities following VBAC included uterine rupture (3.3%) and primary postpartum hemorrhage (6.7%). There was no peripartum hysterectomy or maternal death; the perinatal mortality rate was 16.7/1,000 live births for women who attempted VBAC while no perinatal death was recorded among the controls. Conclusion: VBAC is safe, and its outcome is comparable to women without previous CD.

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