Etiology and factors associated with urogenital fistula among women who have undergone cesarean section: a cross-sectional study.

Publisher: BioMed Central Country of Publication: England NLM ID: 100967799 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2393 (Electronic) Linking ISSN: 14712393 NLM ISO Abbreviation: BMC Pregnancy Childbirth Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Vesicovaginal Fistula*/epidemiology ; Vesicovaginal Fistula*/etiology ; Vesicovaginal Fistula*/prevention & control ; Obstetric Labor Complications*/epidemiology ; Dystocia*/etiology; Pregnancy ; Humans ; Female ; Cesarean Section/adverse effects ; Cross-Sectional Studies ; Parity

Background: The prevalence and impact of fistulas are more common in developing countries with limited access to emergency obstetric care. As a result, women in these settings often experience adverse psychosocial factors. The purpose of this study was to describe the characteristics of Congolese women who developed urogenital fistula following Cesarean sections (CS) to determine the characteristics associated with two etiologies: (1) prolonged obstructed labor; and (2) a complication of CS following obstructed labor.
Methods: We performed a cross-sectional study on abstracted data from all patients with urogenital fistula following CS who received care during a surgical campaign in a remote area of the Democratic Republic of the Congo (DRC). Descriptive analyses characterized patients with fistula related to obstructed labor versus CS. Univariate and multivariate logistic regression models identified factors associated with obstetric fistula after cesarean delivery following obstructed labor. Variables were included in the logistic regression models based upon biological plausibility.
Results: Among 125 patients, urogenital fistula etiology was attributed to obstructed labor in 77 (62%) and complications following CS in 48 (38%). Women with a fistula, attributed to obstructed labor, developed the fistula at a younger age (p = .04) and had a lower parity (p = .02). Attempted delivery before arriving at the hospital was associated with an increased risk of obstetric fistula after cesarean delivery following obstructed labor (p < .01).
Conclusion: CS are commonly performed on women who arrive at the hospital following prolonged obstructed labor and fetal demise, and account for almost 40% of urogenital fistula. Obstetric providers should assess maternal status upon arrival to prevent unnecessary CS and identify women at risk of developing a fistula.
(© 2023. The Author(s).)

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Keywords: Cesarean section; Female; Fetal demise; Obstetric fistula; Obstructed labor; The Democratic Republic of the Congo

Date Created: 20230123 Date Completed: 20230125 Latest Revision: 20230202

20250114

PMC9869501

10.1186/s12884-023-05357-3

36690977