ArticleBMC pregnancy and childbirth2022
Iatrogenic genito-urinary fistula following cesarean birth in nine sub-Saharan African countries: a retrospective review.
Article in BMC pregnancy and childbirth, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
15 citing papers in PubMed, 18 citations in OpenAlex.
- Spatial disparities and determinants of obstetric fistula among childbearing women in sub-Saharan Africa: A geospatial regression approach.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026Article
- Twelve Years of Managing Female Urogenital Fistula in Uganda: Characteristics, Repair Outcomes, and Predictors for Success in a Multicentre Cohort Study.International urogynecology journal · 2026Article
- Forceps-Assisted Delivery Could Reduce the Iatrogenic Fistula Crisis: A Clinical Commentary.International urogynecology journal · 2026Article
- How many women in East Africa suffer from iatrogenic fistula after caesarean birth?BMJ global health · 2026Article
- Reducing Iatrogenic Female Genitourinary Fistula: Impact of Short-Term Obstetric Training for Lower Cadre Surgeons in Uganda.International journal of women's health · 2026Article
- Research and Learning Priorities for a Surgical Obstetrics and Family Planning Project Implementing in Low- and Middle-Income Countries: Results of an Expert Consultation.Global health, science and practice · 2025Article
- Global, regional and national estimates of obstetric fistula prevalence.BMJ global health · 2025Article
- Pregnancy outcomes following surgical repair of female genital fistula in Uganda.AJOG global reports · 2025Article
- Surgical Systems Strengthening in Urogynecology.International urogynecology journal · 2024Article
- Equivalence between physicians and associate clinicians in the frequency of iatrogenic urogenital fistula following cesarean section in Tanzania and Malawi.Human resources for health · 2024Article
- Iatrogenic Female Genitourinary Fistula in Uganda: Etiology, Twelve-Year Trends, and Risk Factors for Development Following Cesarean Section.International journal of women's health · 2024Article
- A research agenda to improve incidence and outcomes of assisted vaginal birth.Bulletin of the World Health Organization · 2023Article
- The feasibility and outcome of laparoscopic vesicovaginal fistula repair as a minimally invasive technique: a retrospective descriptive monocentric study.The Pan African medical journal · 2023Article
- Rare causes of genital fistula in nine African countries: a retrospective review.BMC women's health · 2022Article
- A retrospective review of genital fistula occurrence in nine African countries.BMC pregnancy and childbirth · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 5 institutions in 5 countries.
Funding
Abstract
backgroundGenito-urinary fistulas may occur as complications of obstetric surgery. Location and circumstances can indicate iatrogenic origin as opposed to pressure necrosis following prolonged, obstructed labor.
methodsThis retrospective review focuses on 787 women with iatrogenic genito-urinary fistulas among 2942 women who developed fistulas after cesarean birth between 1994 and 2017. They are a subset of 5469 women who sought obstetric fistula repair between 1994 and 2017 in Tanzania, Uganda, Kenya, Malawi, Rwanda, Somalia, South Sudan, Zambia, and Ethiopia. We compared genito-urinary fistula classifications following vaginal birth to classifications following cesarean birth. We assessed whether and how the proportion of iatrogenic genito-urinary fistula was changing over time among women with fistula, comparing women with iatrogenic fistulas to women with fistulas attributable to pressure necrosis. We used mixed effects logistic regression to model the rise in iatrogenic fistula among births resulting in fistula and specifically among cesarean births resulting in fistula.
resultsOver one-quarter of women with fistula following cesarean birth (26.8%, 787/2942) had an injury caused by surgery rather than pressure necrosis due to prolonged, obstructed labor. Controlling for age, parity, and previous abdominal surgery, the odds of iatrogenic origin nearly doubled over time among all births resulting in fistula (aOR 1.94; 95% CI 1.48-2.54) and rose by 37% among cesarean births resulting in fistula (aOR 1.37; 95% CI 1.02-1.83). In Kenya and Rwanda the rise of iatrogenic injury outpaced the increasing frequency of cesarean birth.
conclusionsDespite the strong association between obstetric fistula and prolonged, obstructed labor, more than a quarter of women with fistula after cesarean birth had injuries due to surgical complications rather than pressure necrosis. Risks of iatrogenic fistula during cesarean birth reinforce the importance of appropriate labor management and cesarean decision-making. Rising numbers of iatrogenic fistulas signal a quality crisis in emergency obstetric care. Unaddressed, the impact of this problem will grow as cesarean births become more common.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.