Obstetric fistula: current practicalities and future concerns

Excerpt

Wubenesh is a typical young woman in Ethiopia. She was married at 10 and became pregnant soon after menarche. She actually had three normal deliveries and three live children before she turned 20. However, on her fourth delivery she developed an obstructed labour and remained in labour for 4 days. She eventually delivered a stillborn child but by this time she was unconscious from exhaustion. Three days after her delivery she started to leak uncontrollably from her bladder and bowel due to vesico-vaginal and recto-vaginal fistulae forming by ischaemic injuries from the impacted presenting part. Her family looked after her for 2 weeks, but it was obvious that she was not getting better, and, still unconscious, she was carried for 2 days to the Barhirdar Hamlin Fistula Centre in northern Ethiopia. On arrival she was in a critical state, unresponsive, in respiratory distress, no blood pressure, low heart rate, she had ascites, full-body oedema, paralysed from the waste down, blind from corneal ulcerations from having her eyes open during that period, retained products, and fistulas from her vagina to both her bladder and rectum. …