Obstetrical fistulae

Obstetrical Fistulae
Specialty	Obstetrics

Obstetrical fistulae are medical conditions characterized by an abnormal opening between the vagina and the bladder or rectum, caused by prolonged obstructed labor without timely medical intervention. The most common types are vesicovaginal fistula (VVF) and rectovaginal fistula (RVF). These conditions are a significant cause of morbidity among women in developing countries, particularly in regions with limited access to obstetric care.

Causes

Obstetrical fistulae typically occur when a prolonged labor presses the unborn baby so tightly in the birth canal that blood flow is cut off to the surrounding tissues, causing tissue necrosis. This can result in a fistula, or hole, forming between the mother’s vagina and her bladder or rectum. Factors contributing to the risk of developing an obstetrical fistula include young age at pregnancy, small stature, malnutrition, and lack of access to Cesarean section or other medical interventions.

Symptoms

The primary symptom of an obstetrical fistula is the continuous and involuntary discharge of urine or feces through the vagina, leading to significant physical discomfort and social isolation. Other symptoms may include infection, foul odor, and pain.

Diagnosis

Diagnosis of obstetrical fistulae is primarily clinical, often involving a physical examination and medical history. In some cases, dye tests or imaging studies like ultrasound may be used to confirm the diagnosis and assess the extent of the damage.

Treatment

Treatment for obstetrical fistulae typically involves surgery to close the fistula. Success rates for surgical repair are high, especially with experienced surgeons. Postoperative care is crucial and may include antibiotics, catheterization, and proper hygiene management to prevent infection and aid healing. In addition to physical treatment, psychological and social support is also important due to the stigma and isolation often experienced by affected women.

Prevention

Prevention of obstetrical fistulae involves improving access to quality obstetric care, including timely and skilled intervention during childbirth. Education on reproductive health and the availability of family planning services are also critical in preventing these conditions.

Epidemiology

Obstetrical fistulae are most prevalent in sub-Saharan Africa and parts of Asia, where access to obstetric care is limited. The World Health Organization estimates that more than 2 million young women live with untreated obstetrical fistula in developing countries.

See also

• Maternal health
• Childbirth
• Women's health