Delivery mode for prolonged, obstructed labour resulting in obstetric fistula: a retrospective review of 4396 women in East and Central Africa

C. J. Ngongo*, T. J.I.P. Raassen, L. Lombard, J. van Roosmalen, S. Weyers, M. Temmerman

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Objective: To evaluate the mode of delivery and stillbirth rates over time among women with obstetric fistula. Design: Retrospective record review. Setting: Tanzania, Uganda, Kenya, Malawi, Rwanda, Somalia, South Sudan, Zambia and Ethiopia. Population: A total of 4396 women presenting with obstetric fistulas for repair who delivered previously in facilities between 1990 and 2014. Methods: Retrospective review of trends and associations between mode of delivery and stillbirth, focusing on caesarean section (CS), assisted vaginal deliveries and spontaneous vaginal deliveries. Main outcome measures: Mode of delivery, stillbirth. Results: Out of 4396 women with fistula, 3695 (84.1%) delivered a stillborn baby. Among mothers with fistula giving birth to a stillborn baby, the CS rate (overall 54.8%, 2027/3695) rose from 45% (162/361) in 1990–94 to 64% (331/514) in 2010–14. This increase occurred at the expense of assisted vaginal delivery (overall 18.3%, 676/3695), which declined from 32% (115/361) to 6% (31/514). Conclusions: In Eastern and Central Africa, CS is increasingly performed on women with obstructed labour whose babies have already died in utero. Contrary to international recommendations, alternatives such as vacuum extraction, forceps and destructive delivery are decreasingly used. Unless uterine rupture is suspected, CS should be avoided in obstructed labour with intrauterine fetal death to avoid complications related to CS scars in subsequent pregnancies. Increasingly, women with obstetric fistula add a history of unnecessary CS to their already grim experiences of prolonged, obstructed labour and stillbirth. Tweetable abstract: Caesarean section is increasingly performed in African women with stillbirth treated for obstetric fistula.

Original languageEnglish
Pages (from-to)702-707
Number of pages6
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume127
Issue number6
DOIs
Publication statusPublished - 1 May 2020

Funding

We sincerely thank Dr Marietta Mahendeka for her collaboration repairing fistulas and collecting data. We thank the African Medical and Research Foundation (AMREF), EngenderHealth, the Fistula Foundation, the Freedom from Fistula Foundation, Gesellschaft für Technische Zusammenarbeit (GTZ; now GIZ), Johnson & Johnson, the Royal Netherlands Embassy of Tanzania, SOS East Africa, United Nations Population Fund (UNFPA), and Women and Health Alliance International (WAHA) for supporting the second author in travelling to the many hospitals. We thank Millicent Oundo for entering some of the data through the support of the United States Agency for International Development through EngenderHealth's Fistula Care project. We are grateful to the Fistula Foundation and the International Federation of Gynecology and Obstetrics (FIGO) for paying the BJOG open access fee. We thank the specialists and staff in the hospitals, who operated on the women and managed them during their hospital stays. Finally, we thank the women whose unforgettable experiences inform our conclusions.

FundersFunder number
African Medical and Research Foundation
FIGO
Gesellschaft für Technische Zusammenarbeit
International Federation of Gynecology and Obstetrics
Women and Health Alliance International
United States Agency for International Development
Fistula Foundation
Johnson and Johnson
United Nations Population Fund

    Keywords

    • Assisted vaginal delivery
    • caesarean section
    • destructive delivery
    • obstetric fistula
    • stillbirth
    • vacuum extraction

    Fingerprint

    Dive into the research topics of 'Delivery mode for prolonged, obstructed labour resulting in obstetric fistula: a retrospective review of 4396 women in East and Central Africa'. Together they form a unique fingerprint.

    Cite this