Obstetric vesico-vaginal fistula is preventable by timely recognition of prolonged labour and identification and management of post-partum urinary retention

Abstract

Obstetric vesico-vaginal fistula is still prevalent in developing countries at an incidence of about 150,000 cases annually. This is mainly the result of a poorly developed health care delivery system where a majority of women labour away from the care of trained birth attendants. When ineffective uterine contractions occur and  it is not corrected, prolonged labour results in the fetal head impacting deeply in the pelvis causing field injury due to pressure ischaemia-necrosis. Bladder care is least attended to in the settings where obstetric fistula is prevalent and this is likely to result in post-partum urinary retention. Overt or covert urinary retention when not corrected in a timely manner causes the ischaemic tissues not to heal resulting in fistula formation. Prevention of obstetric fistula should include universal access to maternity care, recognition and timely correction of abnormal progress of labour and punctilious attention to bladder care to avoid post-partum urinary retention.

Key words: Obstetric fistula, Risk factors, Pathophysiology, Post-partum urinary retention