Obstetrics Fistulae Following Caesarean Section For Neglected Obstructed Labour In Northern Nigeria

ABSTRACT

Background: Prolonged obstructed labour remains a major cause of obstetrics fistula in Northern Nigeria, and in places with high prevalence of vesico-vaginal fistula. This study aimed to determine the characteristics and risk factors of obstetrics fistulae following caesarean section for neglected obstructed labour in Northern Nigeria. Methods: A prospective cross-sectional study was conducted in 4 fistula hospitals in Northern Nigeria from January to December 2015. All the patients who developed fistula following delivery by caesarean section (due to prolonged obstructed labour) were considered eligible for the study. A proforma was used to collect data on the research variables. Data were analyzed using IBM SPSS version 22 computer statistical software package. Results: About a quarter of the study subjects (24.3%) have had a previous caesarean delivery, and about a third of them (37.8%) have had a previous unsuccessful fistula repair. Most of the study subjects (73.0%) were offered prompt emergency caesarean section at presentation, and majority of them (59.5%) were delivered of still births. The most common reason for delay at home was that they did not anticipate a difficult delivery (41.4%). The most common type of fistula seen was intra-cervical (52.3%). There was a moderate association between development of fistula and delay in the hospital, with the most common reasons being absence of doctors (25.2%) and financial constraints (22.5%). Conclusion: The large proportions of subjects with intra-cervical, ureteric and vault fistulae in this study suggest iatrogenic origin. Emergency obstetric care should be made available at the grass root level.