Fertility and pregnancy outcomes among women with obstetric fistula, Malawi.

A follow-up assessment of a 2007 study evaluated the fertility and pregnancy experiences of rural Malawian women living with obstetric fistula and following surgical repair of fistula. In 2009, fertility histories were collected via in-depth interviews with 32 women in Mangochi District identified in 2007 as having obstetric fistula, and 26 family members. Six women had unrepaired fistulas, nine incompletely repaired and 17 repaired. 17 women had conceived after developing obstetric fistula, 13 before repair and six after repair (with two conceiving both pre- and post-repair). Complaints of infertility were more frequent and urgent among women who had undergone repair than among those who had not, though caution should be exercised in generalising from these data. Over half (53.8%) who conceived while living with obstetric fistula and all of those who conceived post-repair experienced at least one spontaneous abortion or perinatal death. Nineteen of the 40 pregnancies among women living with obstetric fistula and seven of the ten pregnancies among women post-repair ended in spontaneous abortion or perinatal death. High rates of poor pregnancy outcome among women with unrepaired fistula could be the result of urinary tract infections. Despite undergoing surgical repair, women can continue to experience the effects of obstetric fistula, including infertility, spontaneous abortion, and perinatal mortality, which warrants further attention. (1)

(1.) Wilson AL, Chipeta E, Kalilani-Phiri L, et al. Fertility and pregnancy outcomes among women with obstetric fistula in rural Malawi. International Journal of Gynecology and Obstetrics 2011;113:196-98.

DOI: 10.1016/S0968-8080(11)38593-X