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Introduction: Obstetric Fistula is defined as direct communication between the vagina and the bladder (vesicovaginal fistula) and/or between the vagina and the rectum (recto-vaginal fistula). Each year 50.000 to 100.000 new cases of obstetric fistula are globally reported. According to World Health Organization, more than 200 million young women live with unrepair obstetric fistula mostly in sub-Saharan Africa and southeast Asia including Afghanistan. Women with obstetric fistula suffer from frequent urinary or fecal incontinence which causes shame, social segregation, and other health problems. Obstructed labor (due to early marriage and inadequately developed pelvic) constitutes the most common cause of obstetric fistula. Therefore, the current study strived to assess teenage pregnancy on obstetric fistula among women in the fistula center of Malalai Maternity Hospital in Kabul, Afghanistan. Methods: A descriptive cross-sectional study was conducted over a period of one year (2019-2020) with 30 cases of obstetric fistula among women attended at Fistula Center of Malalai Maternity Hospital. Result: Among 30 women current aged with obstetric fistula 66.6 % were between20-37years, the mean age was 33.9±10.2 and the median was 30 years, the max and min range was between 20-56y. 66.6 % cases their marriage-age was between 16-20 y, while marriage age(mean) was 18.4±3.2, most women (60%) their ages in first delivery were between 15-19 y old, the height of the 40% women was less than 150 cm, and 46.7% women had 1-4 parity with mean of 5.2±3.1 and extreme (1-14), duration of labor in 90% were more than one day, majority of cases (60%) was Recto vaginal, 33% vesicovaginal and 7% with a compound type of fistula, 80% of cases were from remote and rural areas. Conclusions The teenage pregnancy and early marriage between (16-20 y old) was the vast majority of obstetric fistula formation, rectovaginal fistula, living in a remote area, short stature less than 150cm, and duration of more than one day have been seen. teenage pregnancy and obstetric fistula are preventable conditions. These findings suggest that efforts to reduce obstetrical fistula should target teenagers

Background. Obstructed or prolonged labor is a major cause of maternal deaths. Prolonged and obstructed labor contributed to 13% of global maternal deaths which can be reduced by proper utilization of a partograph during labor. Obstetric caregivers’ use of the partograph during labor has paramount importance in identifying any deviation during labor. Even though partograph use is influenced by different factors as obtained from the literatures, the magnitude of partograph utilization and the factors associated with its use are not well determined in the health facilities of Wolaita Zone. Objective. To assess the magnitude of partograph utilization and factors that affect its utilization among obstetric caregivers in public health facilities of Wolaita Zone, Ethiopia, 2017. Methods. An institution-based cross-sectional study was conducted on obstetric caregivers. A pretested and structured questionnaire was used to collect data. Data was entered to EpiData version 3.01 and exported to SPSS version 23.0 for further analysis. Logistic regression analyses were used to see the association of different variables. Result. A total of 269 obstetric caregivers participated in the study. Among those who were utilizing the partograph, 193 (71.7%) routinely used it for all laboring mothers and 76 (28.3%) of participants reported that they do not routinely utilize it. Greater number of service years (AOR=4.93, 95% CI: 1.53-15.88), on-the-job training (AOR=0.16, 95% CI: 0.06-0.43), good knowledge (AOR=3.35, 95% CI: 1.61-6.97), and favorable attitude towards partograph utilization (AOR=2.99, 95% CI: 1.28-7.03) were significantly associated with partograph utilization. Conclusion and Recommendation. Partograph utilization among obstetric caregivers in the public health facilities was good. Greater years of work experience, in-service training, having good knowledge, and favorable attitude towards partograph utilization among obstetric caregivers independently determined partograph utilization. Provision of on-the-job training to make obstetric caregivers improve knowledge and skill on partograph utilization, maintaining caregivers’ retention to decrease turnover by providing different incentives to more experienced obstetric care providers, and establishing favorable attitude could improve the proper use of the tool.

Aims and Objectives: To compare the maternal and neonatal morbidities and to identify the etiology of obstructed labor and retrospective analyze the pull and push techniques for delivery of impacted head during cesarean section. Method: This observational study was conducted in IPGME and R, SSKM medical college from April 2015 to Feb 2019. The study population included 74 women tackled with the pull method, while the control group comprised 74, age and parity matched who underwent the push method of head delivery. Results: A review of 74 patients revealed the average age of the study population was 25.7±2 years. Patients with anemia (Hb≤8.5 to 10gm/dl) and abnormal BMI (>30and

Objective To determine obstetric fistula knowledge among prenatal attendees and midwives in Mfantsiman municipality, Ghana. Methods An analytical cross‐sectional study was conducted among prenatal clinic attendees and midwives in Mfantsiman municipality from March to April, 2016. Women were selected by systematic sampling and consenting midwives were recruited. Respondents were interviewed using a pretested structured questionnaire. Data were analyzed using the χ2 test and Poisson regression with a robust error variance to generate relative risks (RRs) with 95% confidence intervals (CIs). P, Educating prenatal attendees and organizing regular refresher courses on obstetric fistula for midwives should be a priority in Mfantsiman municipality.

Prolonged first period of labor (uterine opening) is a very unpleasant complication of them, often accompanied by severe consequences; therapy of the named evasion during childbirth is one of the most serious tasks of the obstetrician.

Transverse vaginal septum is a rare Mullerian duct anomaly presenting for the first time in pregnancy and labor. A 24-year-old primigravida presented at 39 weeks gestation. Speculum examination revealed a thick transverse vaginal septum with a pinpoint opening in the upper aspect. Elective cesarean section was done followed by digital perforation and dilatation of the septum. The postoperative period was uneventful. At six week follow up there was no restenosis or scarring of the vagina. To avoid complications like obstructed labor and laceration of vagina prophylactic cesarean section is advocated when the thickness of the septum cannot be ascertained on clinical examination.

Introduction Partogram is an important tool to monitor the progress of labor. Existing WHO partogram is too cumbersome for the busy healthcare providers working in labor rooms in developing nations. There is a need to develop a more user-friendly way to measure the progress of labor and thus prevent the unfortunate events during labor. Methods The descriptive study was conducted in the Department of Obstetrics and Gynaecology of a teaching medical institution of India. The participants were patients in labor. Patients were enrolled once they fulfilled eligibility criteria and gave informed consent. Expected time of delivery (ETD) was calculated by application of Friedman's formula of cervical dilatation in “active phase” of labor of 1 cm/hour, which is applicable from 4 cm dilatation onwards. It was written in bold letters on the case sheet. Women were managed as usual, and the progress of labor was monitored. Proportion of women delivered within reasonable time of the ETD was calculated. Results Out of the 110 women included in the study, 73 (66.4%) were nulliparous. The mean (SD) gestational age of them was 38.47 (1.4) weeks. More than half of the women presented at 4 cm cervical dilatation. 11.7% of the women required either 2.5 or 5 U of Syntocinon injection. 75 (68.2%) women delivered on or before time of the calculated ETD. 33 (30%) women delivered within ±60 minutes of the calculated ETD. There was no significant association between the parity status of the woman and the induction of the labor. Similarly, parity status had no association with the time difference between the actual and expected time of delivery. Conclusion Paperless partogram is an important alternative to the conventional partogram. It can be used in resource-constraint settings to save resources and future mothers. How to cite this article Debdas A, Mitra JR, Singh R. Calculating Expected Time of Delivery in Laboring Women Using Paperless Partogram: An Innovation for a Resource-limited Nation. J South Asian Feder Obst Gynae 2020;12(6):363–365.

Obstetric vesico-vaginal fistula is a traumatic complication of prolonged obstructed labor in which pressure necrosis from the impacted fetal head destroys portions of the vesico-vaginal septum, resulting in continuous and uncontrollable urinary incontinence. Ancient evidence suggests that fistula cases have probably been occurring since the development of rotational delivery mechanics in anatomically modern humans hundreds of thousands of years ago. It is likely that attempts to repair such injuries also have a long history. The early history of vesico-vaginal fistula surgery was investigated to determine the earliest credible report of successful cure of this condition. Historical review of vesico-vaginal fistula surgery was undertaken, focusing on the work of Henry Van Roonhuyse, a seventeenth century Dutch surgeon living in Amsterdam. Van Roonhuyse’s clinical treatise entitled Medico-Chirurgical Observations (1676) was reviewed in detail and is described in this article. His technique for vesico-vaginal fistula repair included six essential steps that are still recognizable today: (1) use of the lithotomy position; (2) exposure of the fistula with a speculum; (3) sharp paring of the fistula edge prior to attempted closure; (4) careful approximation of the denuded edges of the fistula; (5) dressing of the wound with absorbent vaginal packing; (6) immobilization of the patient in bed until the repair has healed. Henry Van Roonhuyse is the most credible candidate presently known for having successfully repaired a vesico-vaginal fistula in the pre-modern era.

Genitourinary fistulas (usually arising following prolonged obstructed labor) are particularly devastating for women in low-income counties. Surgical repair is often difficult and delayed. While much attention has been devoted to technical surgical issues, the challenges of returning to normal personal, family, and community life after surgical treatment have received less scrutiny from researchers. We surveyed young Ugandan women recovering from genitourinary fistula surgery to assess their social reintegration needs following surgery.A cross-sectional survey of 61 young women aged 14-24 years was carried out 6 months postoperatively. Interviews were carried out in local languages using a standardized, interviewer-administered, semistructured questionnaire. Data were entered using EpiData and analyzed using SPSS.Ongoing reintegration needs fell into interrelated medical, economic, and psychosocial domains. Although90% of fistulas were closed successfully, more than half of women had medical comorbidities requiring ongoing treatment. Physical limitations, such as foot drop and pelvic muscle dysfunction impacted their ability to work and resume their marital relationships. Anxieties about living arrangements, income, physical strength, future fertility, spouse/partner fidelity and support, and possible economic exploitation were common. Sexual dysfunction after surgery-including dyspareunia, loss of libido, fear of intercourse, and anxieties about the outcome of future pregnancies-negatively impacted women's relationships and self-esteem.Young women recovering from genitourinary fistula surgery require individualized assessment of their social reintegration needs. Postoperative social reintegration services must be strengthened to do this effectively.

Objective: This study analyzes the important role of ultrasonography (IUS) related to the maternal outcomes in women with fetal persistent occiput posterior position (POPP) and asynclitism (A) in l...

Introduction The obstetric conjugate represents the shortest anteroposterior diameter of the birth canal and it reflects the capacity of the pelvic inlet to allow the passage and the engagement of the fetal head. The antepartum evaluation of this parameter may be attempted at digital examination to predict the risk of cephalopelvic disproportion, but the accuracy of clinical pelvimetry is notoriously poor. The aim of our study was to describe the sonographic measurement of the obstetric conjugate at transabdominal 2D-ultrasound and to assess its reproducibility. Material and methods This is a prospective cohort study conducted at a tertiary University hospital. A non-consecutive series of pregnant women with uncomplicated singleton pregnancies attending the antenatal clinic for routine booking from 34 weeks of gestation onward were included. The ultrasound probe was longitudinally placed above the level of the symphysis and the interpubic fibrocartilaginous disk was visualized. Then the promontory was identified as the most prominent segment of the sacral vertebral column. The obstetric conjugate was measured as the distance between the inner edge of the interpubic disk and the promontory. The inter- and intraobserver repeatability of this measurement was calculated using the intraclass correlation coefficient (ICC) and the Bland-Altman method. Results In all, 119 women were considered eligible for the study; of these, 111/119 (93.3%) women were included in the analysis with a median gestational age of 36.0 (35.0-37.0) weeks. The mean obstetric conjugate measurement was 11.4 ± 0.93 mm for the first operator and 11.4 ± 0.91 mm for the second operator. The overall interobserver ICC was 0.95 (95% [confidence interval] CI 0.92-0.96) and the overall intraobserver ICC was 0.97 (95% CI 0.96-0.98). Limits of agreement ranged from -0.84 to 0.80 for interobserver measures and from -0.64 to 0.62 for intraobserver measures. The degree of reliability was also analyzed for women with a body mass index ≥30 and for women with a gestational age ≥37 weeks. The inter- and intraobserver ICCs were respectively 0.97 (95% CI 0.90-0.98) and 0.98 (0.95-0.99) in the former group and 0.96 (95% CI 0.93-0.98) and 0.97 (95% CI 0.95-0.98) in the latter group. Conclusions Our study demonstrated that among pregnant women at term gestation, sonographic measurement of the obstetric conjugate is feasible and reproducible.

Background Obstructed labor is a preventable obstetric complication. However, it is an important cause of maternal mortality and morbidity and of adverse outcomes for newborns in resource-limited countries in which undernutrition is common resulting in a small pelvis in which there is no easy access to functioning health facilities with a capacity to carry out operative deliveries. Therefore, this systematic review and meta-analysis aimed to estimate the incidence, causes, and maternofetal outcomes of obstructed labor among mothers who gave birth in Ethiopia. Method for this review, we used the standard PRISMA checklist guideline. Different online databases were used for the review: PubMed, Google Scholar, EMBASE, Cochrane Library, HINARI, AFRO Library Databases, and African Online Journals. Based on the adapted PICO principles, different search terms were applied to achieve and access the essential articles. The search included all published and unpublished observational studies written only in the English language and conducted in Ethiopia. Microsoft Excel 16 was used for data entrance, and Stata version 11.0 (Stata Corporation, College Station, Texas, USA) was used for data analysis. Results I included sixteen (16) primary studies with twenty-eight thousand five hundred ninety-one (28,591) mothers who gave birth in Ethiopia. The pooled incidence of obstructed labor in Ethiopia was 12.93% (95% CI: 10.44–15.42, I2 = 98.0%, p Conclusion This systematic review and meta-analysis showed that the incidence of obstructed labor was high in Ethiopia. Not having antenatal care follow-up, rural residency, and visiting hospitals after 12 h of labor increased the incidence of obstructed labor. The major causes of obstructed labor were cephalo-pelvic disproportion, and malpresentation and malpresentation. Additionally, the commonest complications were sepsis, stillbirth, postpartum hemorrhage, uterine rupture, and maternal death. Thus, promoting antenatal care service utilization, a good referral system, and availing comprehensive obstetric care in nearby health institutions are recommended to prevent the incidence of obstructed labor and its complications.

Background Obstructed labor accounted for 22% of obstetrical complications and 9% of all maternal deaths in low- and middle-income countries. Even though there are separate studies regarding obstructed labor and its complication in Ethiopia, their results are inconsistent. The objectives of this review will be to estimate the pooled the prevalence of obstructed labor and to identify adverse feto-maternal outcomes associated with obstructed labor in Ethiopia. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline will be followed to conduct this systematic review and meta-analysis. The databases we will search will be PubMed, Cochrane Library, Google Scholar, CINAHL, African Journals Online, Dimensions, and Summon per country online databases. To search the relevant literature, we will use the following key search terms: “prevalence,” “adverse outcome,” “obstructed labour,” “maternal near miss,” “neonatal near miss,” “perinatal outcome,” “cesarean section,” “obstetric fistula,” “uterine rupture,” and “Ethiopia.” Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument will be used for evaluating the quality of the studies. Appropriate statistical tests will be conducted to quantify the between studies heterogeneity and for the assessment of publication bias. We will check individual study influence analysis and also do subgroup analysis. The STATA version 15 will be used for statistical analysis. Discussion Our systematic review and meta-analysis will provide the pooled prevalence of obstructed labor and its association with adverse feto-maternal outcomes in Ethiopia. The finding of this study will be helpful to design appropriate preventive and promotive strategies for reducing of obstructed labor-related maternal mortality. Systematic review registration PROSPERO CRD42020196153.

Background Globally over 2.6 million pregnancy ends with stillbirth annually. Despite this fact, only a few sherds of evidence were available about factors associated with stillbirth in Ethiopia. Therefore, the study aimed to spot factors related to stillbirth among women who gave birth at Hawassa University Comprehensive Specialized Hospital Hawassa, Sidama Ethiopia, 2019. Methods Facility-based unmatched case-control study was conducted at Hawassa University Comprehensive Specialized Hospital. Cases were selected using simple random sampling technique and controls were recruited to the study consecutively after every case selection with case to control ratio of 1 to 3. Data were coded and entered into Epi-data version 3.1 and exported to SPSS version 24 for analysis. Results A total of 106 cases and 318 controls were included in the study. Number of antenatal care visit [AOR = 0.38, 95% CI (0.15, 0.95)], lack of partograph utilization [AOR = 4.1 95% CI (2.04, 10.5)], prolonged labor [AOR = 6.5, 95% CI (2.9, 14.4)], obstructed labor [AOR = 3.5, 95% CI (1.5, 9.4)], and congenital defect [AOR = 9.7, 95% CI (4.08, 23.0)] were significantly associated with stillbirth. Conclusion Absence of partograph utilization, prolonged labor, obstructed labor, antepartum hemorrhage and congenital anomaly were found to have positive association with stillbirth.

Background In order to manage a protracted second stage of labor, “eminence-based” birth positions have been suggested by some healthcare professionals. Recent biomechanical studies have promoted the use of an optimized supine birthing position in this setting. However, uncertainty exists regarding the feasibility of this posture, and its acceptability by women. This pilot study primarily aimed to assess these characteristics. Objective and methods In this monocentric prospective study, 20 women with a protracted second stage of labor were asked to maintain a biomechanically-optimized position for at least 20 minutes at full dilatation. This posture is similar to the McRoberts’ maneuver. Maintaining the position for 20 minutes or more was considered clinically relevant and indicative of feasibility and acceptability. Satisfaction with the position was assessed using a Visual Analogue Scale (VAS). A sub-group analysis was performed to assess eventual differences between more and less satisfied patients, according to the median of patients’ satisfaction scores. Results Seventeen patients (85%) maintained the optimized position for at least 20 minutes. The median satisfaction score of these participants was 8 (interquartile range: 1) out of 10. No significant differences were found between the two sub-groups (satisfaction score Conclusion The optimized position is acceptable and feasible for women experiencing a protracted second stage of labor. Further clinical studies are needed to assess the efficiency of such positions when women undergo an obstructed labor.

The pelvis is not only a functional bone but has great importance in obstetrics. Because of bipedal locomotion, the shape and size of the pelvis became more straight. In this situation the only way to delivery large brained fetus is that the fetal head has to perform complex rotation and turning movements (cardinal movements) during the progress in the birth canal. The problem may arise from cephalopelvic disproportion (CPD) that is present when the fetal head is too large to pass through the pelvis. CPD and related obstructed labor is responsible for 2–8% of maternal mortality worldwide and furthermore can cause poor progress of labor and can be indication for operative vaginal delivery (OVD) or primary cesarean section (CS).

Purpose: Direct obstetric causes have a significant contribution for severe maternal morbidities and mortalities, although the effect of grand multiparity on adverse obstetric outcomes remains controversial across studies. This study aimed to compare obstetric outcomes in grand multiparous and low multiparous women in two hospitals of southern Ethiopia.Materials and methods: A comparative cross-sectional study was conducted in one general and one comprehensive specialized hospitals in 2018. Four hundred and sixty-one mothers were included in the study. Data were collected by structured questionnaire and extraction sheets from clinical documents, and were analyzed using STATA version 14 (StataCorp, College Station, TX, USA).Results: About 39% of the included mothers had at least one adverse obstetric outcome. Hypertensive disorders of pregnancy, antepartum hemorrhage, and premature rupture of membrane and were higher in the grand multiparous mothers. However, obstructed labor and risk of cesarean delivery were higher in low multiparous women. History of medical illnesses, previous cesarean delivery, and high birth weight were independent predictors of adverse maternal outcomes regardless of parity. However, parity did not show statistically significant difference in obstetric outcomes.Conclusion: Parity did not show statistically significant difference in experiencing adverse obstetric outcomes in women. Early identification and treatment of high-risk mothers is recommended regardless of parity.

Aims To discuss the role of physiotherapy in the management of women who have suffered an obstetric fistula, referring to research findings when appropriate and available, and the experiences of clinical specialists in the field. Methods The experiences of physiotherapists who have worked in countries where obstetric fistula is prevalent, and the limited literature available, were considered in producing this consensus document on behalf of the ICS Physiotherapy Committee. Results The role of physiotherapy both pre- and post-fistula repair was identified, and is multi-faceted. Women may have general rehabilitation needs based on the obstructed labor itself and subsequent care. All affected women may benefit from pelvic floor muscle assessment, education and exercises to optimize the outcome of their surgery; further pelvic floor physiotherapy may be indicated for those who experience persistent genitourinary dysfunction following closure of the fistula. Conclusions Further robust research is required to confirm the effectiveness of physiotherapy in the management of women who have suffered an obstetric fistula and the optimum development of such services. Based on the available literature and the experience of physiotherapists in the field, there was consensus within the ICS Physiotherapy Committee that patient outcomes can be improved if physiotherapy is provided as part of the multidisciplinary team. Physiotherapy should not be overlooked when fistula services are being developed.

Obstetric fistula is a devastating childbirth injury caused by unrelieved obstructed labor. Obstetric fistula leads to chronic incontinence and, in most cases, significant physical and emotional suffering. The condition continues to blight the lives of 1-2 million women in low-resource settings, with 50 000-100 000 new cases each year adding to the backlog. A trained, skilled fistula surgeon is essential to repair an obstetric fistula; however, owing to a global shortage of these surgeons, few women are able to receive life-restoring treatment. In 2011, to address the treatment gap, FIGO and partners released the Global Competency-Based Fistula Surgery Training Manual, the first standardized curriculum to train fistula surgeons. To increase the number of fistula surgeons, the FIGO Fistula Surgery Training Initiative was launched in 2012, and FIGO Fellows started to enter the program to train as fistula surgeons. Following a funding boost in 2014, the initiative has grown considerably. With 52 fellows involved and a new Expert Advisory Group in place, the program is achieving major milestones, with a record-breaking number of fistula repairs performed by FIGO Fellows in 2017, bringing the total number of repairs since the start of the project to more than 6000.

Fetal malpositions and cephalic malpresentations are well-recognized causes of failure to progress in labor. They frequently require operative delivery, and are associated with an increased probability of fetal and maternal complications. Traditional obstetrics emphasizes the role of digital examinations, but recent studies demonstrated that this approach is inaccurate and intrapartum ultrasound is far more precise. The objective of this review is to summarize the current body of literature and provide recommendations to identify malpositions and cephalic malpresentations with ultrasound. We propose a systematic approach consisting of a combination of transabdominal and transperineal scans and describe the findings that allow an accurate diagnosis of normal and abnormal position, flexion, and synclitism of the fetal head. The management of malpositions and cephalic malpresentation is currently a matter of debate, and individualized depending on the general clinical picture and expertise of the provider. Intrapartum sonography allows a precise diagnosis and therefore offers the best opportunity to design prospective studies with the aim of establishing evidence-based treatment. The article is accompanied by a video that demonstrates the sonographic technique and findings.

Significance The cliff-edge model explains the evolutionary persistence of relatively high incidences of fetopelvic disproportion (FPD), the mismatch of fetal and maternal dimensions during human childbirth. It also predicts that FPD rates have increased evolutionarily since the regular use of Caesarean sections. Here we show that the model also explains why women born by Caesarean because of FPD are about twice as likely to develop FPD in their own childbirth compared with women born vaginally. This theoretical prediction of a complex epidemiological pattern lends support to the cliff-edge model and its underlying assumptions., Recently, we presented the cliff-edge model to explain the evolutionary persistence of relatively high incidences of fetopelvic disproportion (FPD) in human childbirth. According to this model, the regular application of Caesarean sections since the mid-20th century has triggered an evolutionary increase of fetal size relative to the dimensions of the maternal birth canal, which, in turn, has inflated incidences of FPD. While this prediction is difficult to test in epidemiological data on Caesarean sections, the model also implies that women born by Caesarean because of FPD are more likely to develop FPD in their own childbirth compared with women born vaginally. Multigenerational epidemiological studies indeed evidence such an intergenerational predisposition to surgical delivery. When confined to anatomical indications, these studies report risks for Caesarean up to twice as high for women born by Caesarean compared with women born vaginally. These findings provide independent support for our model, which we show here predicts that the risk of FPD for mothers born by Caesarean because of FPD is 2.8 times the risk for mothers born vaginally. The congruence between these data and our prediction lends support to the cliff-edge model of obstetric selection and its underlying assumptions, despite the genetic and anatomical idealizations involved.

BackgroundObstetric fistula is a preventable and treatable condition predominately affecting women in low-income countries. Understanding the social context of obstetric fistula may lead to improved prevention and treatment.ObjectivesThis study investigated social experiences of women with obstetric fistula seeking treatment at Mulago Hospital in Kampala, Uganda.MethodsA descriptive study was conducted among women seeking treatment for obstetric fistula during a surgical camp in July 2011 using a structured questionnaire. Descriptive statistics were computed regarding sociodemographics, obstetric history, and social experience.FindingsFifty-three women participated; 39 (73.58%) leaked urine only. Median age was 29 years (range: 17-58), and most were married or separated. About half (28, 47.9%) experienced a change in their relationship since acquiring obstetric fistula. More than half (27, 50.94%) acquired obstetric fistula during their first delivery, despite almost everyone (50, 94.3%) receiving antenatal care. The median years suffering from obstetric fistula was 1.25. Nearly every participant's social participation changed in at least one setting (51, 96.23%). Most women thought that a baby being too big or having kicked their bladder was the cause of obstetric fistula. Other participants thought health care providers caused the fistula (15, 32.61%; n = 46), with 8 specifying that the bladder was cut during the operation (cesarean section). Knowing someone with obstetric fistula was influential in pursuing treatment. The majority of participants planned to return to family (40, 78.43%; n = 51) and get pregnant after repair (35, 66.04%; n = 53).ConclusionStudy participants experienced substantial changes in their social lives as a result of obstetric fistula, and there were a variety of beliefs regarding the cause. The complex social context is an important component to understanding how to prevent and treat obstetric fistula. Further elucidation of these factors may bolster current efforts in prevention and holistic treatment.

Ethiopia is one of the countries with the highest maternal mortality rates, obstructed labor and its complications being the leading causes of maternal deaths in the country. This study was aimed at assessing feto-maternal outcomes in obstructed labor in Suhul General Hospital, North Ethiopia. Institution based cross-sectional study was carried out from May 1 to August 31, 2014 in Suhul General Hospital. All mothers who had given birth in the hospital during the study period were included in the study. Data were collected by using a pre tested structured questionnaire and checklists, entered into Epi Info version 7.1.2.0 and finally transported in to SPSS version 20 software package for analysis. A total of 660 mothers had given birth in the hospital during the study period out of which 44(6.7%) were diagnosed as obstructed labor cases. More than 89% of the mothers with obstructed labor and about 93% of the babies born to them had developed at least one complication. Eighteen (40.9%) of the babies were stillbirths or had died immediately after delivery. Postpartum hemorrhaged and puerperal sepsis 25(56.8%) each and uterine rupture 11(25%) were the main maternal complications among the mothers with obstructed labor. Cesarean birth (68%), hysterectomy (20%), destructive delivery (7%) and repair of the ruptured uterus with bilateral tubal ligation in 5% were interventions done for the mothers with obstructed labor. Inaccessibility of vehicle road and time the women stayed at health centers before they were referred to the hospital have shown association with poor maternal outcomes in Fisher’s Exact test. Prevalence of obstructed labor in Suhul general hospital is high with high rate of maternal and fetal complications. Improving vehicle road accessibility and giving training for health centers delivery case teams on when to refer laboring mother to the hospitals is needed in order to decease proportion of Obstructed labor and it sequels. Key words: Obstructed labor, Ethiopia, low income country, maternal mortality.

Introduction and hypothesis The impoverished West African country of Niger has high rates of obstetric fistula. We report a 6-month postoperative follow-up of 384 patients from the Danja Fistula Center and assess factors associated with operative success or failure. Methods The medical records of 384 women who had completed a 6-month follow-up after fistula surgery were reviewed. Cases were categorized as “easy,” “of intermediate complexity,” or “difficult” based on a preoperative points system. Data were analyzed using simple chi-squared statistics and logistic regression. Results The patients were predominantly of Hausa ethnicity (73%), married young (average 15.9 years), had teenage first pregnancies (average first delivery 16.9 years), and experienced prolonged labor (average 2.3 days) with poor outcomes (89% stillbirth rate). The average parity was four. Patients commonly developed their fistula during their first delivery (43.5%), but over half sustained a fistula during a subsequent delivery (56.5%). Prior fistula surgery elsewhere (average 1.75 operations) was common. The overall surgical success (“closed and dry”) was 54%. When the 134 primary operations were analyzed separately, the overall success rate was 80%. Increasing success was seen with decreasing surgical difficulty: 92% success for “easy” cases, 68% for “intermediate” cases, and 57% success for “difficult” cases. Success decreased with increasing numbers of previous attempts at surgical repair. Conclusions These data provide further evidence that clinical outcomes are better when primary fistula repair is performed by expert surgeons in specialist centers with the support of trained fistula nurses.

Objective Urinary fistula is a distressing complication after difficult vaginal deliveries, obstetric, and gynecologic surgeries. The present study describes a single center's experience in the management of urinary fistula at a tertiary care hospital. It was performed to analyze the etiology of genitourinary fistula, to assess the outcome after surgical repair, and to determine the changing trends in the etiology and management of urinary fistula. Material and methods This retrospective study was conducted over 5 years in the department of obstetrics and gynecology, All India Institute of Medical Sciences, New Delhi. Twenty patients who underwent surgical repair of urinary fistula were included in the study and analyzed for their etiology, presentation, site, size, previous failed repair, approach of surgical repair, and outcome. The findings of the present study were compared with a previous study at our center to determine the changing trends of urinary fistula. Results The mean age of the study population was 37.05±8.08 years. The majority (65%) of the fistulae occurred following gynecologic surgeries, whereas 25% were due to obstructed labor, and 10% after cesarean section for other indications. The vaginal approach was used in all except one case of uterovesical fistula, which was repaired abdominally. The outcome was successful in 85% of cases. The success rate was similar in primary versus previous failed repair (p=0.270). Conclusion The most common cause of urinary fistula in the present study was gynecologic surgery. The vaginal approach can be used even in cases with previous failed repairs with a high success rate.

Сephalohematoma – one of the forms of birth trauma, which occurs in 1 % to 4 % according to different authors. It’s believed that cephalohematoma arises not only in obstructed labor, but in physiological childbirth too. Analysis of occurrence of cephalohematoma was held among 60 newborns. To decrease this pathology appointment of drugs, that affect blood clotting, must be more careful, and correction of complications of pregnancy and childbirth, must be in timely manner.

Typical etiologies of vesicovaginal fistula (VVF) include obstructed labor, iatrogenic surgical injury, pelvic irradiation and cancer invasion. VVF caused by cystocele are very rare. To date, there are no documented cases in Japanese literature.A 74-year-old woman presented with near total incontinence. On physical examination, she was found to have severe cystocele and pressure necrosis of anterior vaginal wall, which caused partial breakdown of vaginal mucosa and VVF. She underwent vesicovaginal fistula repair using transvaginal and transabdominal approaches. Catheter drainage was performed for 10 days and postoperative cystogram showed no sign of leakage. She is currently symptom-free at 55 months.

Obstetric vescicovaginal (VVF) fistulas, most of all as consequences of prolonged neglected obstructed labor, occurs mainly in low-income countries. Considering the limited resources, both of trained specialists and equipments, fistulas have a devastating impact on affected women and their families from physical, social and economic point of view. However, also in low-income settings, fistulas prevalence and consequences could be reduced with focused interventions addressed to pregnant women during antenatal visits and to surgeons which face of these particular diseases. We report a case of obstetric VVF, related to a prolonged labor, treated by surgery and managed with satisfying results in a low-income setting.

Background: Abdominal operations account for a majority of surgical volume in low-income countries, yet population-level prevalence data on surgically treatable abdominal conditions are scarce. Objective: In this study, our objective was to quantify the burden of surgically treatable abdominal conditions in Uganda. Methods: In 2014, we administered a two-stage cluster-randomized Surgeons OverSeas Assessment of Surgical Need survey to 4,248 individuals in 105 randomly selected clusters (representing the national population of Uganda). Findings: Of the 4,248 respondents, 185 reported at least one surgically treatable abdominal condition in their lifetime, giving an estimated lifetime prevalence of 3.7% (95% CI: 3.0 to 4.6%). Of those 185 respondents, 76 reported an untreated condition, giving an untreated prevalence of 1.7% (95% CI: 1.3 to 2.3%). Obstructed labor (52.9%) accounted for most of the 238 abdominal conditions reported and was untreated in only 5.6% of reported conditions. In contrast, 73.3% of reported abdominal masses were untreated. Conclusions: Individuals in Uganda with nonobstetric abdominal surgical conditions are disproportionately undertreated. Major health system investments in obstetric surgical capacity have been beneficial, but our data suggest that further investments should aim at matching overall surgical care capacity with surgical need, rather than focusing on a single operation for obstructed labor.

INTRODUCTION AND OBJECTIVES:Vesicovaginal fistulae represent the most common fistula of the genitourinary tract. In developing nations, this is most frequently caused by obstructed labor, while in ...

Objective Obstructed labor had different maternal outcomes such as uterine rupture, postpartum hemorrhage, puerperal sepsis, Vesico-Vaginal fistula (VVF), recto-vaginal fistula can leads to death. Besides fetal outcomes including birth asphyxia, still birth, neonatal jaundice and umbilical sepsis can occur. Identifying maternal and fetal outcomes of obstructed labor among women who gave birth at Suhul general Hospital, Shirie town, Tigray, Ethiopia has been done using a retrospective review of delivery charts and registration book. Results Majority of mothers 69 (75.8%) came from rural areas and 74.7% were married. Cephalo pelvic disproportion occurs in 59 (64.8%) and mal-presentation in 28 (30.8%) of obstructed labor. Fetal congenital anomaly (hydrocephalus) occurs in 3 (3.3%) of cases and pelvic mass constituted 1 (1.1%) of cause of obstructed labor. Above half of mothers delivered with obstructed labor had sepsis 23 (25.3%), post-partum hemorrhage 10 (11%), Vesico Vaginal Fistula 5 (5.5%) and anemia 15 (16.5%). From the well-known causes of obstructed labor; mal-presentation, Cephalo pelvic disproportion, fetal congenital anomaly, and pelvic mass were found to the common outcomes of obstructed labor in our study area. Besides Still birth, birth asphyxia, and birth injury were the others.

Background: Obstructed labor is still major cause of maternal morbidity and mortality, and adverse birth out comes in low income countries. The issue of obstructed labor is unsolved problem in Ethiopia so far.Objective: This study aimed to assess magnitude and factors associated with obstruct labor among women delivered at Halaba Kulito Primary Hospital, Halaba Special District, Southern Ethiopia.Methods: A hospital based cross-sectional study was employed from March 1-21, 2015 at Halaba Kulito Primary Hospital. Systematic sampling technique was used to select 344 deliveries from delivery registration book. A pretested checklist was used to retrieve data from delivery card of the women. Data were entered Epi data version-3.1 and analyzed using SPSS version-21 software. To identify independent factors, bivariate and multiple binary logistic regressions were undertaken. A p-value

Rationale: Vesicovaginal fistula (VVF) most commonly occurs due to iatrogenic injury during surgery or obstructed labor. We report a rare case of a patient with severe pelvic organ prolapse who developed VVF even though pessary had not been used.

Background: The global prevalence of female genital mutilation (FGM) ranges from 0.6% up to 98%. It has many health psychological impacts including abnormalities of female sexual function. Objectives: To study female genital mutilation and its effect on female sexual function, Alexandria, Egypt 2013. Methods: A case–control study was conducted on a convenient sample of 272 circumcised women with their 272 control from 4 randomly selected primary health care centers. Specially designed format (including data about socio-demographic characters, gynecological obstetric histories, and FGM act) and female sexual function index (a 19-item self-reported questionnaire for assessing the key dimensions of female sexual function) were used. Bivariate analysis was conducted to test significant differences between cases and control. Results: 73.9% of cases experienced dysmenorrhea (OR= 3.750), 43.4% had obstructed labor (OR= 1.745) and 27.6% got postpartum hemorrhage (OR= 2.855). 48.9% of FGM was performed by dayas or midwives, 91.2% performed at home, 49.6% of type I, and 87.9% experienced complications. Cases had lower mean sexual function. 52.6% of cases were convinced with FGM. Conclusion: FGM was a risk factor for dysmenorrhea, obstructed labor and postpartum hemorrhage. Cases had lower mean sexual function; moreover, half of them convinced with FGM practice and with its continuation. Keywords: Female genital mutilation; Female sexual function; Circumcision

Despite global efforts to reduce the maternal mortality ratio (MMR) through the World Health Organization's (WHO) Millennium Development Goal 5 (MDG5), MMR remains unacceptably high in low-income countries (LICs). Maternal death and disability from hemorrhage, infection, and obstructed labor may be averted by timely cesarean section (CS). Most LICs have CS rates less than that recommended by the WHO. Without access to timely CS, it is unlikely that MMR in LICs will be further reduced. Our purpose was to measure the MMR gap between the current MMR in LICs and the MMR if LICs were to raise their CS rates to the WHO recommended levels (10-15 %).This model makes the assumption that increasing the CS rates to the recommended rates of 10-15 % will similarly decrease the MMR in these LICs. WHO health statistics were used to generate estimated MMRs for countries with CS rates between 10 and 15 % (N = 14). A weighted MMR average was determined for these countries. This MMR was subtracted from the MMR of each LIC to determine the MMR gap. The percent decrease in MMR due to increasing CS rate was calculated and averaged across the LICs.We found an average 62.75 %, 95 %CI [56.38, 69.11 %] reduction in MMR when LICs increase their CS rates to WHO recommended levels (10-15 %).Maternal mortality is unacceptably high in LICs. Increasing CS rates to WHO recommended rates will decrease the maternal mortality in these countries, significantly decreasing the mortality ratio toward the projected MDG5.

Objective: To identify the obstetric risk factors, incidence, and causes of uterine rupture, management modalities, and the associated maternal and perinatal morbidity and mortality in one of the largest tertiary level women care hospital in Delhi. Materials and Methods: A 7-year retrospective analysis of 47 cases of uterine rupture was done. The charts of these patients were analyzed and the data regarding demographic characteristics, clinical presentation, risk factors, management, operative findings, maternal and fetal outcomes, and postoperative complications was studied. Results: The incidence of rupture was one in 1,633 deliveries (0.061%). The vast majority of patients had prior low transverse cesarean section (84.8%). The clinical presentation of the patients with rupture of the unscarred uterus was more dramatic with extensive tears compared to rupture with scarred uterus. The estimated blood loss ranged from 1,200 to 1,500 cc. Hemoperitoneum was identified in 95.7% of the patient and 83% of the patient underwent repair of rent with or without simultaneous tubal ligation. Subtotal hysterectomy was performed in five cases. There were no maternal deaths in our series. However, there were 32 cases of intrauterine fetal demise and five cases of stillbirths. Conclusions: Uterine rupture is a major contributor to maternal morbidity and neonatal mortality. Four major easily identifiable risk factors including history of prior cesarean section, grand multiparity, obstructed labor, and fetal malpresentations constitute 90% of cases of uterine rupture. Identification of these high risk women, prompt diagnosis, immediate transfer, and optimal management needs to be overemphasized to avoid adverse fetomaternal complications.

Objectives: maternal and neonatal mortality in Ethiopia is a major reproductive health problem. Obstructed labor is one of the leading causes of maternal, fetal, and neonatal morbidity in developing countries. The evidence regarding its determinants at the tertiary level of care is sparse. Therefore, this study aimed to study the determinants of obstructed labor among women attending intrapartum care in Amhara region referral hospitals. Methods: A Hospital-based unmatched case-control study was conducted from March 1stto August 30, 2017. Cases were women whose labor was obstructed (n = 270), and controls were women whose labor was not obstructed (n = 540). Both cases and controls were selected randomly, and a proportional to size allocation was made to the referral hospitals selected for the study. A binary and a multivariable logistic regression model was computed to identify the determinant factors at 95% CI. Results: The mean age of the study participants was 27.66 years (27.4 ± 5.44 for cases and 28.15 ± 6.16 for controls), ranging between 16 and 45 years. Relatively, higher proportions of cases than controls were unable to read and write (58.5%) and were urban residents (53.7%). Distance from hospital, distance from health center, mothers inability to read and write, mothers primary level of education, more than 28 weeks of gestation at the first visit of antenatal care, 37 to 42 weeks at admission, above 42 weeks at admission, women of a merchant spouse, and history of pregnancy-related complications were the positive determinants of obstructed labor. However, mothers whose gestational age was 16 to 28 weeks at the first antenatal care visit were 62% less likely to be exposed to obstructed labor. Conclusions: Obstetric, service-related, and system factors were predictors of obstructed labor. Improving women’s literacy status, health service access, and utilization will help reduce obstructed labor.

Aims: To describe how a community clinic in Bangladesh playing role in prevention of female genital fistula in remote villages in Bangladesh.Methods: Fistula service related program data and records of a community clinic during January 2018 to September 2018 have been used to prepare this report.Results: Mobilizing the Community Clinic Group and Community Clinic Support Groups, a community clinic centered plan of action for prevention and care of fistula was prepared. Universal coverage of obstructed labor was achieved during this period through mobilizing the community clinic support groups. There was no case of early marriage in the coverage area during this time. Debipur community clinic facilitated the “School Girls for Fistula Free Bangladesh program” in the villages.Conclusions: Community Clinics in Bangladesh may play a major role in prevention of early marriage, promotion of safe motherhood and prevention of female genital fistula in villages. Community clinic centered social mobilization engaging school girls would help in ending fistula in remote communities.Keywords: community clinic, genital fistula, prevention

Aims: To understand intrapartum and postpartum clinical practices among skilled birth attendants in low- and middle-income countries (LMICs).Methods: This survey, based on clinical guidelines and curricula, was administered online in French and English, from May-Oct, 2017. Summaries of respondent characteristics, knowledge, and practices were generated. Chi-square tests investigated significant disparities by region, facility type, and geography. Data were analyzed using Stata v12.Results: Respondents (222) were primarily midwives (61%) and OB-GYNs (15%); 56% in Africa and 39% in South-East Asia. A majority practice many recommended practices related to intrapartum/postpartum bladder care and P/OL management. Most reported using partograph to monitor labor (99%), monitoring voiding frequency for postpartum patients (95%), and utilizing UC after P/OL (94%). Findings revealed a lack ofprotocols on bladder care and P/OL management, variation in practice by region, and less access to in-service training and supplies in Africa and public facilities.Conclusions: Findings reveal a strong foundation for standardization in intrapartum/postpartum bladder care and P/OL management. UC after P/OL appears feasible and acceptable, meaning its systematic practice can be scaled up to prevent obstetric fistula and other sequelae of P/OL in low-resource settings. However, SBAs need protocols, in-service training, and consistent supplies, especially in Africa and public facilities. Key words: bladder care, maternal morbidity, obstetric fistula, prolonged/obstructed labor,urinary catheterization

Aims: To share the experience of using community radio networks for female genital fistula communication in Bangladesh.Methods: We selected 11 community radio stations from remote areas in Bangladesh. Four hours orientation training was provided to manager and fistula focal person per radio station. We provided pre-recorded education and advocacy materials for fistula prevention and communication. Station staffs were provided with a manual for fistula communication.Results: 32 key staff members of community radios were trained. At least 33 episodes were broad casted focusing on prevention of early marriage, care of obstructed labor, treatment and rehabilitation of fistula. Information about fistula prevention, case identification, repair center and rehabilitation were provided to an estimated number 660,000 people living in hard to reach places through community radio stations. They incorporated fistula messages song, dramas and talk shows on fistula throughout the year.Conclusions: Community radio is a low cost, effective media for fistula communication in hard to reach areas. It is capable of linking a range of stakeholders and can be a strong force for facilitation of social movement for fistula free communities.Keywords: communication, community radio, fistula

The arguments presented in this chapter are not only interested in the bio-medical aspects of vaginal fistulas, but also their socio-cultural and political implications.

Gestational diabetes mellitus (GDM), known as glucose intolerance, diagnosed for the first time in pregnancy usually occurs between 24 and 28 weeks of gestation [1,2]. The international diabetes federation (IDF) asserts that, globally, one in 7 births was diagnosed of GDM in 2017 [3]. GDM can results in several pregnancy complications such as increased blood pressure, large birth weight babies and obstructed labor.

This article has no abstract. The first 100 words appear below: An outborn, 2 hours old male newborn was admitted at the neonatal intensive care unit due to delayed cry after birth and respiratory distress soon after birth. The baby was born at 39 weeks of gestation at another hospital to a 30 year old primi mother by lower uterine caesarian section due to the obstructed labor. Although the mother was not in regular antenatal checkup. Her pregnancy period was uncomplicated. The baby was limp and blue immediately after birth and was managed accordingly by the attending physician and was referred to the Neonatal Intensive Care Unit of Bangabandhu Sheikh Mujib Medical University for better management.

This chapter presents nine cases of skeletal trauma in children following accidental deaths resulting from motor vehicle incidents, falling objects, and obstructed labor. An additional nine cases of non-accidental sharp- and blunt-force trauma to the head and body of children are also provided.

The women of developing countries are at risk of pregnancy-relatedcomplications including pre-eclampsia/ eclampsia, obstructed labor, sepsis etc. Obstructedlabor results due to three delays while woman is full term & is in labor. If detected and managedearly and correctly, the pregnancies can be made safe and may result in birth of healthybabies. Objectives: (1) To assess frequency of obstructed labor among pregnant women. (2)To determine socio-demographic risk factors associated with obstructed labor among studypopulation. (3)To determine outcomes of obstructed labor among pregnant women. StudyDesign: It was a hospital based descriptive cross sectional study. Period: Two months. Setting:Department of Gynaecology and Obstetrics units I, II and III of Liaquat University Hospital(LUH) Hyderabad. Methods: To estimate the frequency, risk factors & outcomes of obstructedlabor as of third trimester adverse pregnancy outcomes & to seek association of this adversepregnancy outcome with the socio-demographic characteristics of the pregnant women i.e.their age, residence, parity, level of education & socio economic class. Results: Out of total sixhundred & nine women enrolled in the study, only 22 (3.61%) were in obstructed labor. 63.64%of them were of age > 30 years. More than 60% women in obstructed labor had reported fromrural areas; and more than eighty percent of them were illiterate & belonged to lower socioeconomicclass. Only 4.55% of the women in obstructed labor were the booked cases. All thecases of obstructed labor were at full term. Cesarean section was done on 90.90% women. Nota single maternal mortality was reported among women enrolled in the study as obstructedlabor. Conclusion: Neglected obstructed labor is a major public health issue. It can be avoidedby addressing various socio-demographic determinants of pregnant women.

Background Obstetric fistula devastates the lives of women and is found most commonly among the poor in resource-limited settings. Unrepaired third- and fourth-degree perineal lacerations have been shown to be the source of approximately one-third of the fistula burden in fistula camps in Kenya. In this study, we assessed potential barriers to accurate identification by Kenyan nurse-midwives of these complex perineal lacerations in postpartum women. Methods Nurse-midwife trainers from each of the seven sub-counties of Siaya County, Kenya were assessed in their ability to accurately identify obstetric lacerations and anatomical structures of the perineum, using a pictorial assessment tool. Referral pathways, follow-up mechanisms, and barriers to assessing obstetric lacerations were evaluated. Results Twenty-two nurse-midwife trainers were assessed. Four of the 22 (18.2%) reported ever receiving formal training on evaluating third- and fourth-degree obstetric lacerations, and 20 of 22 (91%) reported health-system challenges to adequately completing their examination of the perineum at delivery. Twenty-one percent of third- and fourth-degree obstetric lacerations in the pictorial assessment were incorrectly identified as first- or second-degree lacerations. Conclusion County nurse-midwife trainers in Siaya, Kenya, experience inadequate training, equipment, staffing, time, and knowledge as barriers to adequate diagnosis and repair of third- and fourth-degree perineal tears.

Background Obstetric fistula is a debilitating and traumatic birth injury affecting 2–3 million women globally, mostly in sub-Saharan Africa and Asia. Affected women suffer physically, psychologically and socioeconomically. International efforts have increased access to surgical treatment, yet attention to a holistic outcome of post-surgical rehabilitation is nascent. We sought to develop and pilot test a measurement instrument to assess post-surgical family and community reintegration. Methods We conducted an exploratory sequential mixed-methods study, beginning with 16 in-depth interviews and four focus group discussions with 17 women who underwent fistula surgery within two previous years to inform measure development. The draft instrument was validated in a longitudinal cohort of 60 women recovering from fistula surgery. Qualitative data were analyzed through thematic analysis. Socio-demographic characteristics were described using one-way frequency tables. We used exploratory factor analysis to determine the latent structure of the scale, then tested the fit of a single higher-order latent factor. We evaluated internal consistency and temporal stability reliability through Raykov’s ρ and Pearson’s correlation coefficient, respectively. We estimated a series of linear regression models to explore associations between the standardized reintegration measure and validated scales representing theoretically related constructs. Results Themes central to women’s experiences following surgery included resuming mobility, increasing social interaction, improved self-esteem, reduction of internalized stigma, resuming work, meeting their own needs and the needs of dependents, meeting other expected and desired roles, and negotiating larger life issues. We expanded the Return to Normal Living Index to reflect these themes. Exploratory factor analysis suggested a four-factor structure, titled ‘Mobility and social engagement’, ‘Meeting family needs’, ‘Comfort with relationships’, and ‘General life satisfaction’, and goodness of fit statistics supported a higher-order latent variable of ‘Reintegration.’ Reintegration score correlated significantly with quality of life, depression, self-esteem, stigma, and social support in theoretically expected directions. Conclusion As more women undergo surgical treatment for obstetric fistula, attention to the post-repair period is imperative. This preliminary validation of a reintegration instrument represents a first step toward improving measurement of post-surgical reintegration and has important implications for the evidence base of post-surgical reintegration epidemiology and the development and evaluation of fistula programming.