Abstract
BackgroundObstetric fistula (OF) is a serious consequence of prolonged, obstructed labor in settings where emergency obstetric care is limited, but there are few reliable, population-based estimates of the rate of OF. Stillbirth (SB) is another serious consequence of prolonged, obstructed labor, yet the frequency of SB in women with OF is poorly described. Here, we review these data.MethodsWe searched electronic databases and grey literature for articles on OF in low-resource countries published between January 1, 1995, and November 16, 2014, and selected for inclusion 19 articles with original population-based OF incidence or prevalence data and 44 with reports of frequency of SB associated with OF.ResultsOF estimates came from medium- and low-HDI countries in South Asia and Africa, and varied considerably; incidence estimates ranged from 0 to 4.09 OF cases per 1000 deliveries, while prevalence estimates were judged more prone to bias and ranged from 0 to 81.0 OF cases per 1000 women. Reported frequency of SB associated with OF ranged from 32.3 % to 100 %, with estimates from the largest studies around 92 %. Study methods and quality were inconsistent.ConclusionsReliable data on OF and associated SB in low-resource countries are lacking, underscoring the relative invisibility of these issues. Sound numbers are needed to guide policy and funding responses to these neglected conditions of poverty.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-015-0592-2) contains supplementary material, which is available to authorized users.
Highlights
Obstetric fistula (OF) is a serious consequence of prolonged, obstructed labor in settings where emergency obstetric care is limited, but there are few reliable, population-based estimates of the rate of OF
Inclusion and exclusion criteria Published or grey literature articles obtained through ancestry searches or in response to email requests were included if they were published on or after January 1, 1995 and met the following inclusion criteria: 1) they provided original population-based OF incidence and/or prevalence data or frequency of SB associated with OF, 2) data were from high, medium, or low- Human Development Index (HDI) countries and territories as defined by the United Nations Development Programme [18], and 3) the resource was in English, Spanish, French, Chinese, Portuguese, Polish, or German
Nineteen provided population-based obstetric fistula incidence and/or prevalence data (7 from South Asia, 12 from Africa, including 2 reporting on the same study [19, 20]) and 44 provided stillbirth rates associated with the birth that caused an obstetric fistula; one article [21] provided both stillbirth data and population-based obstetric fistula incidence/prevalence data
Summary
Obstetric fistula (OF) is a serious consequence of prolonged, obstructed labor in settings where emergency obstetric care is limited, but there are few reliable, population-based estimates of the rate of OF. Stillbirth (SB) is another serious consequence of prolonged, obstructed labor, yet the frequency of SB in women with OF is poorly described. In countries where emergency obstetric care is available and accessible, OF has been virtually eliminated. It continues to be prevalent and problematic in many less-developed regions of the world despite the fact that it is preventable and treatable [6]. Surgical repair has a success rate of almost 90 %, but can be difficult for women to access or afford [7]
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