Materiały źródłowe

• #1 Vesicovaginal Fistula – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK564389/

  Vesicovaginal fistula is an anomalous communication between the bladder and vagina, resulting in continuous urine leakage through the vagina. This condition occurs most commonly after obstetrical and gynecological injury. […] To avoid significant morbidity, distress, and psychosocial issues associated with vesicovaginal fistula, this condition must be accurately diagnosed and treated in a timely fashion. […] Poor socioeconomic status, malnourishment, low literacy rate, early marriage and childbearing, and inadequate obstetrical care are important risk factors for developing a vesicovaginal fistula in the developing world. […] Despite an optimistic prognosis for patients receiving proper treatment, efforts should be focused on the prevention of vesicovaginal formation. This includes prioritizing womens reproductive health, emergency obstetric services, and properly trained pelvic surgeons in the global medical community. An effort should also be made to educate the general public on the prevalence and prevention of this devastating problem.

• #1 Obstetric fistula – Wikipedia

  https://en.wikipedia.org/wiki/Obstetric_fistula

  Obstetric fistulae are almost entirely preventable with appropriate use of cesarean section. […] Prevention is the key to ending fistulae. UNFPA states that, „Ensuring skilled birth attendance at all births and providing emergency obstetric care for all women who develop complications during delivery would make fistula as rare in developing countries as it is in the industrialized world.” […] Prevention comes in the form of access to obstetrical care, support from trained health care professionals throughout pregnancy, providing access to family planning, promoting the practice of spacing between births, supporting women in education, and postponing early marriage. […] Fistula prevention also involves many strategies to educate local communities about the cultural, social, and physiological factors of that condition and contribute to the risk for fistulae.

• #1 Prevention – Fistula Care Plus

  https://fistulacare.org/what-is-fistula/prevention/

  Many of the approaches that prevent obstetric fistula are the same ones that make motherhood safer in general. […] Family planning allows couples to delay early births, space desired births, and limit family size. Up to one-third of all maternal deaths and injuries could have been prevented if women had access to contraception. Family planning can also help women with a repaired fistula achieve a successful pregnancy, if that is their desire, by helping them delay a future pregnancy until they are fully healed. […] The partograph is designed to act as an early warning system, alerting doctors, midwives, and nurses to the need for action e.g., referral to a higher level facility, labor augmentation, or cesarean section. […] If a woman with obstructed labor arrives at a hospital and is believed to be at risk for obstetric fistula, immediate catheterization can help to prevent the fistula from developing.

• #1 Female Genital Fistula | Article | GLOWM

  https://www.glowm.com/article/heading/vol-7–fistula–female-genital-fistula/id/418273

  The most crucial factor in preventing genital fistula formation is the provision of competent maternal care with improved access to emergency obstetric services. Enhanced surveillance of labor with adequate use of partograms and the development of skilled fistula repair centers at places with higher fistula prevalence can help reduce the burden. […] Universally improving the level of health education amongst young girls and women, increasing awareness of family planning services and improving the social and nutritional status of women, plays a vital role in the prevention. Women need to be educated about the importance of delaying the age of marriage with early births, spacing desired births, and limiting the family size. Incorporating all these factors along with eliminating unsafe abortion practices will avert one-third of maternal and one-quarter of neonatal mortality.

• #1 Vesicovaginal Fistula – Causes, Symptoms, Diagnosis, Treatment & Prevention

  https://www.medindia.net/health/conditions/vesicovaginal-fistula.htm

  Adequate antenatal care should be extended to at risk mothers who are likely to develop obstructed labor. A cesarean section should be planned for those who need it. […] In case of a long-standing obstructed labor, the urinary bladder should be drained continuously for a period of 5-7 days following the delivery of the baby. […] Care must be taken to avoid injury to the urinary bladder during any pelvic surgery.

• #1

  https://www.who.int/news-room/facts-in-pictures/detail/10-facts-on-obstetric-fistula

  Obstetric fistula is preventable; it can largely be avoided by: […] Obstetric fistulae can largely be avoided by delaying the age of first pregnancy, by the cessation of harmful traditional practices and by timely access to quality obstetric care. […] Preventing and managing obstetric fistula will contribute to improved maternal health and the achievement of the Sustainable Development Goals (SDGs).

• #1

  https://westafricafistulafoundation.org/fistula-2/prevention-methods/

  We want to treat every lady that has a fistula, but must realize Prevention Is The Key. […] If we are able to provide early C-Section capabilities for women, obstetrical VVFs would become extinct. […] Our long term goal is Provide modern obstetrical services Rid the world of OBSTETRICAL FISTULAS. […] Now that the basis for most fistulas have been laid out in the above format we can now base that if we are going to change the VVF from taking place, that educational programs and teaching procedures, must change the way that the social behavior has established, the thinking of both men and women. […] In short summary: Treat the existing fistulas, Provide pre and post operative care for fistula patients, Educate and school either by vocational or enterprise methods, Add more doctors and nurses qualified to medically treat these patients from all over their country.

• #1 Female Genital Fistula | Article | GLOWM

  https://www.glowm.com/article/heading/vol-7–fistula–female-genital-fistula/id/418273

  To prevent fistula formation in case of prolonged or obstructed labor: Insert a urethral catheter for free drainage of urine and keep the catheter in place for at least 2 weeks (with no apparent damage) or 4-6 weeks in case of a small fistula. […] The above approach can prevent fistula formation in 20% of cases. […] According to the WHO, preventing and managing obstetric fistula will contribute to improved maternal health and the achievement of the Sustainable Development Goals (SDG-3). […] Higher rates of bladder and ureteric injuries are noted during the learning curve of surgeons. Hence step-wise training in trainees is one point to consider worldwide. […] Prophylactic stenting is a debatable topic. Some experts believe it prevents injury, on the contrary, some believe it increases the chances of injury as it limits mobility and reduces the pliability.

• #1 Vesicovaginal Fistulas: Prevalence, Impact, and Management Challenges

  https://www.mdpi.com/1648-9144/59/11/1947

  The estimated incidence of bladder injury associated with gynecologic surgery is 3.2% to 4.8%. Good surgical techniques and early bladder injury detection are the keys to VVF prevention. Good surgical techniques to avoid bladder injury include the identification, dissection, and reflection of all contiguous lower urinary tract structures during gynecologic surgery. If bladder injury occurs despite these efforts, the surgeon should strive for intraoperative recognition and repair. Routine intraoperative cystoscopy after all major gynecologic operations may facilitate the recognition of a real or potential injury, allowing intraoperative repair. Immediate repair is easier, more successful, and less morbid for the patient. […] For obstetric fistulas, the quality of intrapartum care is crucial. Improved access to standard obstetric care, avoidance of prolonged labor, avoidance of unnecessary vaginal obstetric procedures, and drainage of the bladder during labor are useful preventive factors.

• #1

  https://journals.lww.com/greenjournal/abstract/1970/06000/prevention_of_vesicovaginal_fistulas.15.aspx

  Five practical methods for the prevention of a vesicovaginal fistula are presented. They include a simple method for early detection of a vesical injury, a technic to attain water-tight bladder closure, a practical method of draining the retrovesical space to the skin, an alternative operative plan in which the vagina is not opened (making the formation of a vesicovaginal fistula almost impossible), and prolonged postoperative bladder drainage.

• #1 Rectovaginal fistula after low anterior resection: Prevention and management

  https://www.wjgnet.com/1948-9366/full/v13/i8/764.htm

  Rectovaginal fistula after low anterior resection for rectal malignancy is one of the most challenging postoperative complications because it is difficult to treat and may complicate plans of adjuvant therapy. […] This article presents a comprehensive overview of the incidence, risk factors, management and outcome of RVF after low anterior resection. Preventive strategies and a management algorithm are also discussed. […] Strategies to prevent rectovaginal fistula formation after rectal cancer surgery are also discussed. […] Because RVF after low anterior resection is usually caused by inadvertent incorporation of the posterior wall of the vagina into a colorectal anastomosis, the adequate dissection of the rectum from the vagina and direct vision of the dissected posterior vaginal wall from a rectal transection line and a colorectal anastomosis as well as digital examination of the vagina before firing a circular staple are essential steps before the creation of the anastomosis. […] Notably, in a stapled colorectal anastomosis, it is advisable that a stapler pin should pass through the rectal stump posterior to the rectal transection line, thereby allowing more space between the vagina and the colorectal anastomosis.

• #1 A Problematic Peril of Pessaries: The Rare Case of Rectovaginal Fistulas Resulting From Pessary Use | Gordon | Journal of Clinical Gynecology and Obstetrics

  https://jcgo.org/index.php/jcgo/article/view/308/172

  Pelvic organ prolapse (POP) is a condition of herniation of the pelvic organs into the vagina or past the introitus. Management options include pessary use. A very rare complication of pessary usage is erosion resulting in a vesicovaginal or rectovaginal fistula. […] For optimal outcomes with pessary use, we recommend that patients be actively managed with individualized periodic evaluations. Estrogen cream may be considered for prevention and treatment of eroded vaginal epithelium. […] The risk for major complication such as fistula formation from pessaries is believed to be low, but this may be due to under reporting in the literature. […] We also believe that estrogen cream may augment the healing process. The benefit of a colostomy for treatment of rectovaginal fistulas caused by pessary use is the diversion of stool away from the healing vaginal fistula, allowing the optimum opportunity for spontaneous resolution of the fistula and application of local estrogen therapy if desired.

• #1 Vaginal Fistula: Types, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22079-vaginal-fistula

  Developing a vaginal fistula is usually something you cant prevent. But you can be aware of the things that cause fistulas and try to modify those things. For example, you can: […] Manage chronic conditions like Crohns disease or ulcerative colitis. […] Treat pelvic infections right away and follow your providers exact treatment plan. […] Get regular prenatal care so that your provider can detect complications that may prolong your labor and delivery. […] Choose a provider who has extensive experience with surgeries like hysterectomies to minimize your risk for complications that lead to fistulas.

• #1 Vaginal gas: Common causes and prevention

  https://www.medicalnewstoday.com/articles/319558

  In many cases, there is no real way to prevent vaginal gas, but there is also no need to. […] If vaginal gas is problematic, a person can avoid the sexual activities and physical exercises that cause it. Avoiding internal menstrual products, such as tampons, may also help reduce the risk. […] Kegel exercises are a type of pelvic floor exercise known to improve the strength of these muscles. By strengthening the pelvic floor muscles, a person may also reduce the likelihood of vaginal gas. […] A fistula between the vagina and another abdominopelvic organ is a condition associated with vaginal gas requiring medical attention.

• #1 A randomised controlled trial of antibiotic prophylaxis for vesico-vaginal fistula repair – PubMed

  https://pubmed.ncbi.nlm.nih.gov/9609264/

  Objective: To test the hypothesis that intravenous antibiotics given intra-operatively reduce the failure rate of vesico-vaginal fistula repair. […] Prophylactic antibiotics should not be used in vesico-vaginal fistulae repair in the developing world outside randomised controlled trials.

• #1 Current practices in treatment of female genital fistula: a cross sectional study | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-10-73

  The study found that antibiotics are usually available to fistula surgeons. Just over two-thirds said they use their hospital pharmacy formulary. […] Overall, the majority of respondents reported that their patients receive prophylactic antibiotics. However, there was little agreement as to what type of antibiotic and regimen to use. […] Many respondents said that their routine use of antibiotics is based on either the medical literature or their clinical training in fistula surgery. […] The group also identified six research needs: 1) Assessing the burden of disease attributable to fistula; 2) Identifying community-level prevention measures such as delaying early childbearing and raising awareness about the need for skilled attendance at birth; 3) Developing a standard classification system; 4) Identifying evidenced-based practices for successful management of fistula; 5) Assessing low-cost treatment methods for resource-poor settings; 6) Identifying barriers to emergency obstetric care at the community, facility, provider, and patient levels. […] In addition, the authors encourage the fistula care community to do the following: 1) Emphasize training in the use of antibiotics (what is prophylactic antibiotic use, what is empiric therapy), the problem of multi-drug resistant organisms, and the need for „rescue” antibiotic therapy.

• #1

  https://www.ics.org/committees/developingworld/publicawareness/obstetricfistulaanintroduction

  Obstetric fistula is a wholly preventable condition, provided that appropriate medical and obstetric facilities including emergency caesarean section are available. […] The immense number of obstetric fistulas occurring in developing countries is of great concern, particularly since they are preventable if the right facilities are in place. […] Prevention means tackling the many different factors which contribute to their widespread occurrence. These factors include: access to skilled maternity healthcare close to the community, such as maternity waiting homes; easy access to emergency caesarean section for women in obstructed labour; better training of locally based nurses, midwives, doctors and surgeons; national and regional policy on maternity care; ensuring that healthcare and transportation to healthcare facilities are affordable, with financial support schemes for those needing treatment for fistula; ensuring that the necessary infrastructure is in place to facilitate access to medical centres; providing girls and women with formal education, including health education concerning family planning, pregnancy and childbirth; involvement of the whole local community, including men, in promoting fistula awareness; training traditional birth attendants so that they understand the risks of obstructed labour and know what action must be taken; raising the legal age of marriage to prevent child pregnancy; combating poverty in the developing world.

• #1 Obstetric fistula

  https://www.unfpa.org/obstetric-fistula

  Obstetric fistula is one of the most serious and tragic childbirth injuries. […] Yet fistula is almost entirely preventable. […] UNFPA also strengthens sexual and reproductive health care including timely and quality emergency obstetric services to prevent obstetric fistula from occurring in the first place. […] Prevention is the key to ending fistula. Fistula is an indicator of poor quality of care. Ensuring skilled birth care at all births and providing timely and high quality emergency obstetric care for all women and girls who develop complications during delivery would make this tragic condition as rare in developing countries as it is in the industrialized world. […] Additionally, providing family planning to those who want it could significantly reduce maternal disability and death.

• #2

  https://www.who.int/news-room/facts-in-pictures/detail/10-facts-on-obstetric-fistula

  Obstetric fistula is preventable; it can largely be avoided by: […] Obstetric fistulae can largely be avoided by delaying the age of first pregnancy, by the cessation of harmful traditional practices and by timely access to quality obstetric care. […] Preventing and managing obstetric fistula will contribute to improved maternal health and the achievement of the Sustainable Development Goals (SDGs).

• #2

  https://induspublishers.com/IJBR/article/view/630

  Postpartum VVFs are strongly associated with obstructed labor, prolonged delivery, and inadequate antenatal care. […] Early intervention and skilled birth attendance are crucial for preventing VVFs.

• #2 Vaginal Fistula: Types, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22079-vaginal-fistula

  Developing a vaginal fistula is usually something you cant prevent. But you can be aware of the things that cause fistulas and try to modify those things. For example, you can: […] Manage chronic conditions like Crohns disease or ulcerative colitis. […] Treat pelvic infections right away and follow your providers exact treatment plan. […] Get regular prenatal care so that your provider can detect complications that may prolong your labor and delivery. […] Choose a provider who has extensive experience with surgeries like hysterectomies to minimize your risk for complications that lead to fistulas.

• #2 Prevention – Fistula Care Plus

  https://fistulacare.org/what-is-fistula/prevention/

  Many of the approaches that prevent obstetric fistula are the same ones that make motherhood safer in general. […] Family planning allows couples to delay early births, space desired births, and limit family size. Up to one-third of all maternal deaths and injuries could have been prevented if women had access to contraception. Family planning can also help women with a repaired fistula achieve a successful pregnancy, if that is their desire, by helping them delay a future pregnancy until they are fully healed. […] The partograph is designed to act as an early warning system, alerting doctors, midwives, and nurses to the need for action e.g., referral to a higher level facility, labor augmentation, or cesarean section. […] If a woman with obstructed labor arrives at a hospital and is believed to be at risk for obstetric fistula, immediate catheterization can help to prevent the fistula from developing.

• #2 Female Genital Fistula | Article | GLOWM

  https://www.glowm.com/article/heading/vol-7–fistula–female-genital-fistula/id/418273

  The most crucial factor in preventing genital fistula formation is the provision of competent maternal care with improved access to emergency obstetric services. Enhanced surveillance of labor with adequate use of partograms and the development of skilled fistula repair centers at places with higher fistula prevalence can help reduce the burden. […] Universally improving the level of health education amongst young girls and women, increasing awareness of family planning services and improving the social and nutritional status of women, plays a vital role in the prevention. Women need to be educated about the importance of delaying the age of marriage with early births, spacing desired births, and limiting the family size. Incorporating all these factors along with eliminating unsafe abortion practices will avert one-third of maternal and one-quarter of neonatal mortality.

• #2 Obstetric fistula – Wikipedia

  https://en.wikipedia.org/wiki/Obstetric_fistula

  It is also important to ensure access to timely and safe delivery during childbirth: measures include availability and provision of emergency obstetric care, as well as quick and safe cesarean sections for women in obstructed labor. […] NGOs also work with local governments, like the government of Niger, to offer free cesarean sections, further preventing the onset of obstetric fistulae.

• #2 Vesicovaginal Fistula – Causes, Symptoms, Diagnosis, Treatment & Prevention

  https://www.medindia.net/health/conditions/vesicovaginal-fistula.htm

  Adequate antenatal care should be extended to at risk mothers who are likely to develop obstructed labor. A cesarean section should be planned for those who need it. […] In case of a long-standing obstructed labor, the urinary bladder should be drained continuously for a period of 5-7 days following the delivery of the baby. […] Care must be taken to avoid injury to the urinary bladder during any pelvic surgery.

• #2

  https://www.ijrcog.org/index.php/ijrcog/article/view/169

  Complications are possible in all type of surgeries including hysterectomy irrespective of the route of surgery, experience of the operating surgeon or the associated risk factors present. […] If the surgeon is careful from the beginning of the surgery and follows all the preventive measures complications like urinary tract injuries and vesico-vaginal fistula formation following hysterectomy can be avoided. […] Here we are presenting a case of vesico-vaginal fistula formed following total laparoscopic hysterectomy (TLH) and reviewed literature regarding incidence, preventive measures for this complication. […] Prevention of vesicovaginal fistulas after laparoscopic hysterectomy with electrosurgical cystotomy in female mongrel dogs Am J Obstet Gynecol.2004 Mar;190(3):628-33.

• #2

  https://journals.lww.com/greenjournal/abstract/1970/06000/prevention_of_vesicovaginal_fistulas.15.aspx

  Five practical methods for the prevention of a vesicovaginal fistula are presented. They include a simple method for early detection of a vesical injury, a technic to attain water-tight bladder closure, a practical method of draining the retrovesical space to the skin, an alternative operative plan in which the vagina is not opened (making the formation of a vesicovaginal fistula almost impossible), and prolonged postoperative bladder drainage.

• #2 Rectovaginal Fistula Treatment – Dr. Diego MarinesVisit our FacebookVisit our InstagramVisit our TwitterVisit our YouTube channelplay-circle-ochevron-downyoutube-playpause-circle-ophone-handsetlocationchevron-downmenu-circlecross-circlelinkedinfacebookpin

  https://drdiegomarines.com/anorectal-diseases-2/rectovaginal-fistula/

  Prevention of rectovaginal fistulas involves proper management of underlying medical conditions such as Crohn’s disease or cancer. Minimizing trauma during childbirth through proper prenatal care and delivery management can also help prevent this condition.

• #2 Vaginal gas: Common causes and prevention

  https://www.medicalnewstoday.com/articles/319558

  In many cases, there is no real way to prevent vaginal gas, but there is also no need to. […] If vaginal gas is problematic, a person can avoid the sexual activities and physical exercises that cause it. Avoiding internal menstrual products, such as tampons, may also help reduce the risk. […] Kegel exercises are a type of pelvic floor exercise known to improve the strength of these muscles. By strengthening the pelvic floor muscles, a person may also reduce the likelihood of vaginal gas. […] A fistula between the vagina and another abdominopelvic organ is a condition associated with vaginal gas requiring medical attention.

• #2 Current practices in treatment of female genital fistula: a cross sectional study | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-10-73

  The study found that antibiotics are usually available to fistula surgeons. Just over two-thirds said they use their hospital pharmacy formulary. […] Overall, the majority of respondents reported that their patients receive prophylactic antibiotics. However, there was little agreement as to what type of antibiotic and regimen to use. […] Many respondents said that their routine use of antibiotics is based on either the medical literature or their clinical training in fistula surgery. […] The group also identified six research needs: 1) Assessing the burden of disease attributable to fistula; 2) Identifying community-level prevention measures such as delaying early childbearing and raising awareness about the need for skilled attendance at birth; 3) Developing a standard classification system; 4) Identifying evidenced-based practices for successful management of fistula; 5) Assessing low-cost treatment methods for resource-poor settings; 6) Identifying barriers to emergency obstetric care at the community, facility, provider, and patient levels. […] In addition, the authors encourage the fistula care community to do the following: 1) Emphasize training in the use of antibiotics (what is prophylactic antibiotic use, what is empiric therapy), the problem of multi-drug resistant organisms, and the need for „rescue” antibiotic therapy.

• #2

  https://link.springer.com/article/10.1007/s00192-011-1622-x

  Obstetric fistula is associated with several risk factors, and they appear to be preventable. […] This knowledge should be used in strengthening the preventive strategy both at the health facility and at the community level. […] Better knowledge of the risk factors for obstetric fistula is needed to educate the community, healthcare providers, policy makers, and program managers to improve prevention of obstetric fistula at a regional and national level. […] Knowledge of the leading risk factors for obstetrical fistula in a given population is of paramount importance and should be studied. […] These observations suggest that emergency obstetrical care should be a cornerstone of any obstetrical fistula prevention program.

• #2 Obstetric fistula | EBSCO Research Starters

  https://www.ebsco.com/research-starters/anatomy-and-physiology/obstetric-fistula

  Obstetric fistula can be prevented in a number of ways. The primary way is to delay the age of a woman’s first pregnancy. In sub-Saharan Africa, girls commonly get married between the ages of nine and fifteen. At this age, the body has had little time to develop into maturity, leading to difficulties during childbirth. Postponing pregnancy allows the female’s body to grow and make the necessary room for conceiving a baby. Other prevention methods suggest eliminating traditions such as home births and early marriages all together. Obstetric fistula is also preventable with timely access to obstetric care and treatment. […] An estimated 80 to 95 percent of vaginal fistulas can be repaired with surgery, but due to high costs and unavailability of nearby medical centers, many women in developing countries do not get the treatment needed to heal. The United Nations and the World Health Organization have initiated efforts to bring awareness to the prevalence of obstetric fistulas in developing countries and have taken measures to help prevent this problem. Since 2003, the United Nations Population Fund has financed thousands of surgical fistula treatments and continued these efforts through a number of partner agencies.

• #3

  https://induspublishers.com/IJBR/article/view/630

  Postpartum VVFs are strongly associated with obstructed labor, prolonged delivery, and inadequate antenatal care. […] Early intervention and skilled birth attendance are crucial for preventing VVFs.

• #3 Obstetric fistula

  https://www.unfpa.org/obstetric-fistula

  Obstetric fistula is one of the most serious and tragic childbirth injuries. […] Yet fistula is almost entirely preventable. […] UNFPA also strengthens sexual and reproductive health care including timely and quality emergency obstetric services to prevent obstetric fistula from occurring in the first place. […] Prevention is the key to ending fistula. Fistula is an indicator of poor quality of care. Ensuring skilled birth care at all births and providing timely and high quality emergency obstetric care for all women and girls who develop complications during delivery would make this tragic condition as rare in developing countries as it is in the industrialized world. […] Additionally, providing family planning to those who want it could significantly reduce maternal disability and death.

• #3 Overcoming phase 1 delays: the critical component of obstetric fistula prevention programs in resource-poor countries | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-12-68

  Obstetric fistulas can be prevented through contraception, avoiding obstructed labor, or improving outcomes for women who develop obstructed labor. […] Improving the outcome for women who develop complications is the rationale for enhancing rapid access to emergency obstetric services. This has emerged as the cornerstone of current efforts to reduce maternal mortality and morbidity in developing nations. […] The key to obstetric fistula prevention is prompt diagnosis and treatment of obstructed labor. […] The key to obstetric fistula prevention is competent obstetrical care delivered respectfully, promptly, and at affordable cost. […] Intensive community education about obstructed labor combined with an efficient, welcoming system of prenatal care and competent, accessible emergency obstetric services is fundamental to reducing the burden of obstetric fistulas.

• #3 Female Genital Fistula | Article | GLOWM

  https://www.glowm.com/article/heading/vol-7–fistula–female-genital-fistula/id/418273

  To prevent fistula formation in case of prolonged or obstructed labor: Insert a urethral catheter for free drainage of urine and keep the catheter in place for at least 2 weeks (with no apparent damage) or 4-6 weeks in case of a small fistula. […] The above approach can prevent fistula formation in 20% of cases. […] According to the WHO, preventing and managing obstetric fistula will contribute to improved maternal health and the achievement of the Sustainable Development Goals (SDG-3). […] Higher rates of bladder and ureteric injuries are noted during the learning curve of surgeons. Hence step-wise training in trainees is one point to consider worldwide. […] Prophylactic stenting is a debatable topic. Some experts believe it prevents injury, on the contrary, some believe it increases the chances of injury as it limits mobility and reduces the pliability.

• #3 Obstetric Fistula – Causes, Symptoms, Diagnosis, Treatment, Prevention, Health Tips

  https://www.medindia.net/health/conditions/obstetric-fistula.htm

  Obstetric fistula is a preventable tragedy. It affects millions of women and girls, more so in Sub-Saharan Africa and South Asia. Maternal medical care and expertise and adequate infrastructure can largely contribute towards prevention of obstetric fistula. […] The United Nations Population Fund has launched a global campaign against obstetric fistula. The campaign aims at preventing and treating fistulas, as well as rehabilitating survivors. […] Skilled medical care providers can identify women and girls at risk for obstetric fistula and educate them about the prevention and action to be taken. Effective surgical repair, to be done at low cost or free of cost, has to be made available to the areas where the prevalence of obstetric fistula is high.

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