Transmural Vaginal-to-Bladder Injury From an Obstructed Labor Pattern

Allen, Arielle; Lakin, Tracy; Shobeiri, S. Abbās; Nihira, Mikio A.

doi:10.1097/aog.0b013e3181f9b749

Cited by 9 publications

(7 citation statements)

References 4 publications

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“…If a woman in an affluent country develops a serious injury from obstructed labor, the event is remarkable enough to be written up and published as a case report in a medical journal [46,47]. In contrast, there are millions of unrepaired obstetric fistulas in sub-Saharan Africa and south Asia.…”

Section: Discussionmentioning

confidence: 99%

Overcoming phase 1 delays: the critical component of obstetric fistula prevention programs in resource-poor countries

Wall

2012

BMC Pregnancy Childbirth

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BackgroundAn obstetric fistula is a traumatic childbirth injury that occurs when labor is obstructed and delivery is delayed. Prolonged obstructed labor leads to the destruction of the tissues that normally separate the bladder from the vagina and creates a passageway (fistula) through which urine leaks continuously. Women with a fistula become social outcasts. Universal high-quality maternity care has eliminated the obstetric fistula in wealthy countries, but millions of women in resource-poor nations still experience prolonged labor and tens of thousands of new fistula sufferers are added to the millions of pre-existing cases each year. This article discusses fistula prevention in developing countries, focusing on the factors which delay treatment of prolonged labor.DiscussionObstetric fistulas can be prevented through contraception, avoiding obstructed labor, or improving outcomes for women who develop obstructed labor. Contraception is of little use to women who are already pregnant and there is no reliable screening test to predict obstruction in advance of labor. Improving the outcome of obstructed labor depends on prompt diagnosis and timely intervention (usually by cesarean section). Because obstetric fistulas are caused by tissue compression, the time interval from obstruction to delivery is critical. This time interval is often extended by delays in deciding to seek care, delays in arriving at a hospital, and delays in accessing treatment after arrival. Communities can reasonably demand that governments and healthcare institutions improve the second (transportation) and third (treatment) phases of delay. Initial delays in seeking hospital care are caused by failure to recognize that labor is prolonged, confusion concerning what should be done (often the result of competing therapeutic pathways), lack of women’s agency, unfamiliarity with and fear of hospitals and the treatments they offer (especially surgery), and economic constraints on access to care.SummaryWomen in resource-poor countries will use institutional obstetric care when the services provided are valued more than the competing choices offered by a pluralistic medical system. The key to obstetric fistula prevention is competent obstetrical care delivered respectfully, promptly, and at affordable cost. The utilization of these services is driven largely by trust.

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Section: Discussionmentioning

confidence: 99%

Overcoming phase 1 delays: the critical component of obstetric fistula prevention programs in resource-poor countries

Wall

2012

BMC Pregnancy Childbirth

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“…None of these were diagnosed prior to laparotomy. Allen et al 4 reported a case of a patient presenting with obstructed labor. Examination revealed a crowning fetal head, no fetal heart tones, and purulent vaginal discharge.…”

Section: Discussionmentioning

confidence: 99%

Vaginal and Bladder Rupture without Uterine Rupture in Unscarred Uterus

Garg¹,

Singh²,

Yadav³

et al. 2017

JSAFOG

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Introduction: Risk of uterine rupture in obstructed labor in grand multipara in developing countries is well documented; however, rupture of vagina involving bladder is uncommon. Below is described a rare case of 30-year-old grand multipara who suffered vaginal rupture associated with bladder rupture rather than uterine rupture during second stage of labor. This case is an important reminder to obstetricians that vaginal rupture can also occur in unscarred uterus without uterine involvement.

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“…However, this is exceedingly rare in developed world [2]. Even rarer is the occurrence of vaginal rupture.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Rupture of the Anterior Vaginal Wall during the First Stage of Labour

Schultz

Nanda

2012

Case Reports in Obstetrics and Gynecology

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The risk of uterine rupture during attempted trial of labor after caesarean delivery (TOLAC) is well documented. However, vaginal rupture (in the absence of obstructed labour) is exceptionally uncommon. Below is described the rare case of a 37-year-old multiparous woman attempting TOLAC, who suffered a vaginal—rather than uterine—rupture, during the first stage of spontaneous labour. This case is an important reminder to obstetricians that concealed ruptures of both the vagina and uterus do occur and must be considered in clinical situations where another explanation is not apparent.

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Transmural Vaginal-to-Bladder Injury From an Obstructed Labor Pattern

Abstract: These findings may provide evidence of the transmural vaginal-to-bladder damage that can occur from obstructed labor.

Cited by 9 publications

References 4 publications

Overcoming phase 1 delays: the critical component of obstetric fistula prevention programs in resource-poor countries

Overcoming phase 1 delays: the critical component of obstetric fistula prevention programs in resource-poor countries

Vaginal and Bladder Rupture without Uterine Rupture in Unscarred Uterus

Spontaneous Rupture of the Anterior Vaginal Wall during the First Stage of Labour

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