Obstetric fistulae: a practical review

Obstetric fistulae: a study of women managed at the Monze Mission Hospital, Zambia

“…Given the impact of fistula on the women’s lives, treatment and prevention are critical public health issues 35 . Prevention strategies must focus on factors predisposing to prolonged obstructed labour, including access to obstetric care, early childbearing, malnutrition, and female genital mutilation 36 . Indirect risk factors include poor education, poverty, lack of antenatal care or skilled birth attendance, and low status of women, which may limit access to services that could prevent the onset of such conditions 2 .…”

“…This reveals the need to inform all maternity care providers on managing women with obstetric fistula. For example, women can be catheterised for 4–5 weeks as small fistulas may heal spontaneously this way, 36 or if this is unsuccessful, referred to a designated fistula repair centre. The fact that first repairs had a lower failure rate emphasises the importance of sufficient expertise, since multiple operations increase the risk of failure in subsequent surgery due to increased scar tissue.…”

“…35 Prevention strategies must focus on factors predisposing to prolonged obstructed labour, including access to obstetric care, early childbearing, malnutrition, and female genital mutilation. 36 Indirect risk factors include poor education, poverty, lack of antenatal care or skilled birth attendance, and low status of women, which may limit access to services that could prevent the onset of such conditions. 2 This study suggests that in dealing with obstetric fistula in Zambia, it is essential to address the transport problem and ensure all pregnant women have timely access to EmOC.…”

Application of Small Intestinal Submucosa Graft for Repair of Complicated Vesicovaginal Fistula: A Pilot Study

“…These problems are evident when dealing with large fistulas requiring much mobilization of the fistulous edges or for which previous primary repair failed. 10 In a review of 100 surgeries the success rate of VVF closure was inversely related to the number of repair trials, that is 85% for trial 1, 50% for trial 2 and 33% for trial 3. 11,12 Since there is no internationally accepted VVF classification system, we adopted the definition of complex fistulas as those 1.5 cm or larger in diameter, or those with failed previous repair trials.…”

“…Thus, most surgeons prefer to interpose vascularized grafts or flaps between the bladder and vagina at surgical correction. 10 According to Cron, the benefits of grafting are better coverage of minor defects in the suture line and maintaining the healing of the bladder and vaginal wall apart, which limits the opportunity for communication during the healing process. 13 Eilber et al reported 10-year experience with the treatment of VVF with peritoneal, omental or Martius flap interposition with a 95% to 97% success rate.…”