Obstetrical Fistula

Clinical Description

Abnormal opening or communication between the vagina and the bladder and rectum.

Obstructed labour is the most common cause of urogenital fistula in Malawi. Other aetiologies include pelvic surgery, radiation therapy and trauma or instrumental vaginal delivery.

Signs and Symptoms

• Draining urine or stools through the vagina

Investigations

• Speculum examination plus or minus dye test.

Non-pharmacological

Discourage early pregnancies.

• Encourage all pregnant women to attend antenatal care.
• Encourage health workers to use and interpret of partograph for laboring women
• Encourage all women to deliver at health facility
• Avoid delay in performing C/S

Pharmacological

• Catheterize patient with prolonged Labor for 5 days and give Amoxicillin 500mg 8 hourly and Metronidazole 400mg 8 hourly for 5 days.

At Health Centre

• Insert Foley’s catheter and refer all patients with draining urine and/or stools to the District Hospital

At District Hospital

• Reassess the patient to confirm the diagnosis with physical examination and dye test
• Insert urinary catheter and bring patient back for repair after 3 months.

Complications and Referral Criteria

• Refer all complicated fistulae to the Central Hospital, such as: VVF of more than 2cm, rectal vaginal fistulae, ureteral vaginal and urethral vaginal fistulae