Emergency caesarean operation major reason for increasing VVF cases —Study

Data from Adeoyo Maternity/Fistula Centre, Ibadan, a newly designated fistula care centre in Nigeria, indicate that emergency caesarean operation from prolonged obstructed labour is a major cause of Vesicovaginal fistula (VVF), the leakage of urine through the vagina.

Researchers found that the majority of the women had their caesarean operation at the private hospital and these surgeries were performed by the medical personnel and other cadres of health workers that were not licensed to perform surgery.

The study, which looked at ureterovaginal fistula (UVF)cases managed from January 2012 to December 2017 at UCH and Adeoyo Maternity Hospital found that surgical mishap during caesarean operations accounted for 61.1 per cent of the cases of UVF following the emergency caesarean operation.

These were women whose ages ranged between 28 and 80 years, many of who has had at least three children, and most had been leaking urine for more than six months.

The women were reported to have sustained their injuries at various levels of healthcare.

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Eight (44.4 per cent) patients sustained their injuries in private hospitals, while the remaining sustained injuries at government-owned hospitals (4 {22.2 per cent} at the tertiary hospital and 1{55.6 per cent} at the state hospital), respectively.

The 2019 study published in the journal, Obstetrics and Gynaecology International, involved Olatunji Lawal, Oluwasomidoyin Bello, Imran Morhason-Bello, Rukiyat Abdus-salam and Oladosu Ojengbede.

These caesarean sections performed by the medical personnel and other cadres of health workers that are not licensed to perform surgery also cause other complications such as bleeding, urinary tract infection, wound infection, and injury to the neighbouring structure.

The researchers stated that these indicated that the surgeons might not have properly learnt the art of the caesarean delivery well.

They therefore recommended adequate surgical training of medical officers/surgeons that are involved.

The researchers noted the need to train caregivers on alternative methods of providing vaginal delivery for dead fetuses rather than caesarean delivery may also be essential.

Injury to tubes (ureters) that carry urine from the kidneys to the bladder, which is caused during caesarean delivery  leading to UVF is less common than VVF as a cause of urinary incontinence.

Lately, there has been a surge in the number of UVF cases presenting to University College Hospital (UCH) following caesarean delivery. The urogynaecology unit at UCH is at the forefront of providing surgical repair for women with all forms of VVF.

There are concerns that the caesarean section may contribute more, especially in unreported cases that eventually present in fistula centres.

A recent review by Engender Health reported an increasing incidence of Injury to tubes (ureters) that carry urine from the kidneys to the bladder following the caesarean section, prompting a call to action.