Obstetric Fistula

Obstetric fistula (OF) is a condition that remains prevalent in non-industrialized nations, mainly in sub-Saharan Africa and Southeast Asia where proper and timely obstetrical care is inaccessible, unavailable, or inadequate. The reasons for the delay vary from country to country where poverty remains a common thread, and understanding the many factors leading to the development of OF is critical in preventing this scourge that has been all but eliminated in industrialized nations. Preventive measures can be effective when developed in conjunction with local resources and expertise and should include patient education and empowerment in addition to educating and equipping healthcare providers. In the absence of such measures, patients develop an « obstructed labor injury complex » involving the genital, urinary, and gastrointestinal tracts. Many troublesome health consequences arise from this complex, including skin lesions from the caustic effects of urine, endocrine abnormalities such as amenorrhea and infertility, neuropsychological consequences such as depression and suicide, and musculoskeletal impairments such as foot drop and contractures. Globally, evidence-based interventions are needed to address the debilitating and persistent medical, psychological, and social effects of this condition on its sufferers. While surgery offers the amelioration of symptoms, many patients may not have access to such care due to lack of funds, knowledge of surgical options, or availability of surgical facility. Even after successful repair of the fistula, patients may still suffer from persistent incontinence, stigma, and socio-economic hardship requiring special programs for support, rehabilitation, and reintegration. Additionally, the patients who are deemed inoperable require special counseling and care. Consensus is needed on standardizing care and outcome measures to improve the quality of care and to evaluate programs directed toward prevention that will render this condition obsolete.