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    189915
    Peer Reviewed

    Obstetric fistula: the international response.

    Donnay F; Weil L

    Lancet. 2003 Dec 31; 363(9402):71-72.

    The advent of modern obstetric care has led to the eradication of obstetric fistula in nearly every industrialized country. However, in the developing world obstetric fistula continues to cause untold pain and suffering in millions of women. The very existence of this condition is the result of gross societal and institutional neglect of women that is, by any standard, an issue of rights and equity. In the developing world, obstetric fistula is almost always the result of obstructed labour. During prolonged obstructed labour the soft tissues of the pelvis are compressed between the descending baby’s head and the mother’s pelvic bone. The lack of blood flow to these tissues leads to necrosis and ultimately a hole forming between the mother’s vagina and bladder (vesicovaginal) or vagina and rectum (rectovaginal), or both, that leaves her with urinary or faecal incontinence, or both. Early intervention to relieve obstructed labour will restore perfusion to these tissues and, in most cases, will prevent fistula. The results of fistula are devastating. In nearly every case the baby is stillborn. Women and girls with fistula are unable to stay dry. They smell of urine or faeces and are shunned by the community and, at times, even by their own husbands and families. They remain hidden, shamed, and forgotten. (excerpt)
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