Prevention of obstetric urogenital fistulae: some thoughts on a daunting task

Abstract

Significant obstetric-related pelvic floor injury is still all too common in many areas of the world. Vesicovaginal fistula formation typically results from obstructed labor in the setting of limited medical resources for the patient. Many people have dedicated their time and even their lives to repairing these types of pelvic floor injuries, which certainly can impact in a positive way on the quality of life of these suffering women. However, it is time to consistently combine surgical repair initiatives with education, training, and prevention strategies, as well as outcomes research in order to improve on these efforts. It is only through committed initiatives with all of these elements that we may be able to ultimately decrease the prevalence of these types of pelvic floor sequelae.

Obstetric Fistula: A Narrative Review of the Literature on Preventive Interventions in sub-Saharan Africa

“…In considering regional issues around obstructed labour, only one article detailed that obstructed labour is common in African women due to the narrow build of their pelvis 20 . It was noted in eighteen articles that many African girls get married at an early age, which increases their risk for obstructed labour, which if not managed leads to prolonged labour [1][2][3][4]11,12,[14][15][19][20][21][22][23][24][25][26][27][28] .…”

“…In 15 of the articles, a core focus was on the seminal work by Thaddeus and Maine on the Three Phases of Delay [1][2][3][4][5]11,[15][16][19][20][21][23][24][25]28 , which is a conceptual model that identifies obstacles to the provision and timely utilisation of high quality obstetric care 29 . Consideration of the three phases occurred across these 15 articles [1][2][3][4][5]11,[15][16][19][20][21][23][24][25]28 .…”

“…The articles suggested that the factors greatly affecting the decision to seek care were various, including: distance, cost, sociocultural beliefs, and the perceived quality of care [3][4][5]11,[13][14]19,[23][24]28 . Importantly, one article emphasised that research has shown that an increase in the availability of services does not always increase the use of the services, leaving the issue of delay in decision to seek care an important focus for researchers 29 .…”

“…The core focuses of the articles remained on two central factors driving Phase 1 delay: geography and cost. Eight of the articles mention that, more often than not, in rural areas health care facilities are sparse, resulting in people having to travel great distances to access health care [3][4][5]11,15,[24][25][26][27][28] . Such geographical distance not only was connected to travel time (impacting on Phase 2 delay), but connected to the idea of cost.…”

“…Even when the decision is made to seek professional medical care, 14 of the articles highlighted a lack of access to transportation as a core factor in delay [2][3][4]11,15,[19][20][22][23][24][26][27][28] . Five studies pointed out the uncertainty concerning the actual accessibility of facilities, due to the often-uneven distribution of services 11,19,[27][28][29] .…”