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Obstetric Fistula : Overview

Obstetric fistula

Obstetric fistula may be a 
medical condition during which a hole develops within the passage as results of childbirth. this will be between the vagina and rectum, ureter, or bladder. It can result in incontinence of urine or feces. Complications may include depression, infertility, and social isolation.

Risk factors include obstructed labor, poor access to medical care, malnutrition, and teenage pregnancy. The underlying mechanism is poor blood flow to the affected area for a prolonged period of time. Diagnosis is usually 
supported symptoms and should be supported by use of methylthionine chloride.


Signs and symptoms

Symptoms of obstetric fistula include:


Ø     Flatulence, urinary incontinence, or fecal incontinence, which may be continual or only happen at night

Ø     Foul-smelling vaginal discharge

Ø     Repeated vaginal or urinary tract infections

Ø     Irritation or pain in the vagina or surrounding areas

Ø     Pain during sexual activity

Other effects of obstetric fistulae include stillborn babies due to prolonged labor, which happens 85% to 100% of the time, severe ulcerations of the vaginal tract, "foot drop", which is the paralysis of the lower limbs caused by nerve damage, making it impossible for women to walk, infection of the fistula forming an abscess, and up to two-thirds of the women become amenorrhoeic.

Obstetric fistulae have far-reaching physical, social, economic, and psychological consequences for the ladies 
affected. According to UNFPA, “Due to the prolonged obstructed labour, the baby almost inevitably dies, and therefore the woman is left with chronic incontinence. Unable to control the flow of urine or faeces, or both, she may be abandoned by her husband and family and ostracized by her community. Without treatment, her prospects for work and family life are virtually nonexistent.”


Risk factors

In less-developed countries, obstetric fistulae usually develop as a result of prolonged labor when a cesarean section cannot be obtained.Over the course of the three to five days of labor, the unborn child presses against the mother's vagina very tightly, isolating 
blood flow to the encompassing tissues between the vagina and therefore the rectum and between the vagina and the bladder, causing the tissues to disintegrate and rot away.

Obstetric fistulae can also be caused by poorly performed abortions,[36] and pelvic fracture, cancer, or radiation therapy targeted at the pelvic area, inflammatory bowel disease (such as Crohn's disease and ulcerative colitis). Other potential causes for the event 
of obstetric fistulae are sexual assault and rape, especially in conflict/postconflict areas, and other trauma, like surgical trauma.

In the developed world, like 
the US, the first explanation for obstetric fistulae, particularly RVF, is that the use of episiotomy and forceps. Primary risk factors include early or closely spaced pregnancies and lack of access to emergency obstetric care. For example, a 1983 study in Nigeria found that 54.8% of the people affected were under 20 years of age, and 64.4% gave birth at home or in poorly equipped local clinics. When available at all, cesarean sections and other medical interventions are usually not performed until after tissue damage has already been done.

Social, political, and economic causes that obliquely cause the event of obstetric fistulae concern problems with poverty, malnutrition, lack of education, early marriage and childbirth, the role and standing of women in developing countries, harmful traditional practices, sexual violence, and lack of excellent quality or accessible maternal and health care



Prevention is the key to ending fistulae. UNFPA states that, “Ensuring skilled birth attendance in the least 
births and providing emergency obstetric look after all women who develop complications during delivery would make fistula as rare in developing countries because it is within the industrialized world.”additionally , access to health services and education – including birth control , gender equality, higher living standards, child marriage, and human rights must be addressed to reduce the marginalization of women and girls. Reducing marginalization in these areas could reduce maternal disability and death by at least 20%.

Prevention comes within the 
sort of access to obstetrical care, support from trained health care professionals throughout pregnancy, providing access to birth control , promoting the practice of spacing between births, supporting women in education, and postponing early marriage. Fistula prevention also involves many strategies to teach local communities about the cultural, social, and physiological factors of that condition and contribute to the danger for fistulae. One of these strategies involves organizing community-level awareness campaigns to educate women about prevention methods such as proper hygiene and care during pregnancy and labor.Prevention of prolonged obstructed labor and fistulae should preferably begin as early as possible in each woman's life.


For example, improved nutrition and outreach programs to raise awareness about the nutritional needs of children to prevent malnutrition, as well as improve the physical maturity of young mothers, are important fistula prevention strategies. It is also important to ensure access to timely and safe delivery during childbirth: measures include availability and provision of emergency obstetric care, as well as quick and safe cesarean sections for women in obstructed labor. Some organizations train local nurses and midwives to perform emergency cesarean sections to avoid vaginal delivery for young mothers who have underdeveloped pelvises. Midwives located in the local communities where obstetric fistulae are prevalent can contribute to promoting health practices that help prevent future development of obstetric fistulae. NGOs also work with local governments, just like the government of Niger, to supply free cesarean sections, further preventing the onset of obstetric fistulae.



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