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Obstetric fistula: Guiding principles for clinical management and programme development, a new WHO guideline.
International Journal of Gynecology and Obstetrics. 2007 Nov; 99 Suppl 1:S117-S121.It is estimated that more than 2 million women are living with obstetric fistulas (OFs) worldwide, particularly in Africa and Asia, and yet this severe morbidity remains hidden. As a contribution to the global Campaign to End Fistula, the World Health Organization (WHO) published Obstetric fistula: Guiding principles for clinical management and programme development, a manual intended as a practical working document. Its 3 main objectives are to draw attention to the urgency of the OF issue and serve as an advocacy document for prompt action; provide policy makers and health professionals with brief, factual information and principles that will guide them at the national and regional levels as they develop strategies and programs to prevent and treat OFs; and assist health care professionals as they acquire better skills and develop more effective services to care for women treated for fistula repair. (author's)
Lancet. 1989 Jun 10; 1(8650):1316-7.Vesicovaginal fistula (VVF), commonly caused by prolonged obstructed labor, is one of the worst complications of childbirth. Afflicted women continuously leak urine and sometimes feces, excoriating their mutilated vulvas and vaginas and often becoming social outcasts. Until the early part of this century, VVF was common in the United States and European countries, but today it is rarely encountered in developed countries. It is still, however, a major problem in many developing countries, where it is generally caused by neglect and mismanagement in labor. As many as 300 women suffering from VVF come to gynecology clinics for treatment every month in some areas of northern Nigeria. But many doctors do not wish to deal with VVF and their Western training does not equip them to perform needed surgery. The major thrust of research and development of services must be in prevention of VVF. But much can be learned about the disorder through treatment of its victims, and their suffering in and of itself demands a major treatment effort. This will require establishment of specialized centers, including hostel accommodations. International and national teams of medical experts would go periodically to needy areas to train local surgeons, advise on difficult cases, and help reduce patient backlogs. Such a program can only be set in motion through funds provided by international organizations. A WHO working group on VVF recently recommended urgent measures to prevent the disorder and to clear the backlog of patients waiting for operations. And an organization known as the VVF Initiative has been established in Nigeria and is in need of practical and financial assistance.