Leaky Issues from Obstetric Fistula

One of the most serious forms of childbirth trauma in developing countries is obstructed labour, which in turn leads to obstetric fistula. Obstructed labour occurs when the mother’s pelvis is too small to permit the foetus to pass through during childbirth.

Prolonged obstructed labour results in severe damage to the soft tissues of the mother’s pelvis. This comes from the unrelenting pressure of the foetal head on the pelvis during labour. An obstetric fistula develops when blood supply to the vagina and bladder (and/ or rectum) tissues is cut off during the prolonged, non-successful labour. This makes the tissues die and a hole forms, through which pee and/or solid waste pass uncontrollably.

The word ‘fistula’ is a medical term for an abnormal connection between two body organs or cavities. Vesicovaginal fistula (VVF) and rectovaginal fistula (RVF) are the most common childbirth injuries that occur after obstructed labour. In VVF, the pressure of the foetal head in the pelvis during obstructed labour interrupts the blood flow to the tissues that are being compressed, causing those tissues to die. When the tissues between the bladder and vagina die, a hole opens up between them, causing pee to leak out as soon as it reaches the bladder.

In RVF, the same process occurs, but in this case, the tissues between the vagina and rectum are destroyed, leading to waste pouring out through the vagina as soon as it enters the rectum.

Other causes
While obstructed labour is the main cause of fistula, there are other factors such as:

• Surgery and FGM
• Coital Injury: One of the outcomes of early marriage
• Rape
• STDs and HIV
• Certain kinds of cancer

Surgical repair
There are several centres in Kenya that specialise in surgical repair of fistula. AMREF, for example, is one of the Non Governmental Organizations with programmes for fistula. Hospitals such as The Kenyatta National Hospital have the personnel and facilities to handle fistula.

Surgery to close a VVF can be successful in the vast majority of cases, but ‘closure’ of the fistula does not necessarily mean that the woman is ‘cured’, About 15 per cent of women whose fistula is closed successfully continued to lose urine due to other problems with the bladder and urethra. Although fistula surgery is quite challenging, it can still be performed with a high degree of success in low- technology settings throughout Africa.

Prevention
Obstetric fistula is unique among the world’s great public health issues in that both the prevention and treatment involves surgery. Preventing obstetric fistula also means preventing obstructed labour.The solution to this problem lies in providing prompt access to emergency obstetric care once labour becomes too prolonged-that is, obstructed.

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