title: Obstetric fistula in 14,928 Ethiopian women.
abstract: OBJECTIVE
  Obstetric fistulas are severe sequelae of prolonged obstructed labor, a widespread but incompletely documented problem of low-income countries. Here, we characterize women with obstetric fistula, test the hypothesis that primi- and multipara represent different profiles and that fetal size is an important factor in developing fistula.
  
  
  METHODS
  Hospital registry statistics and questionnaire.
  
  
  METHODS
  A total of 14,928 Ethiopian women with obstetric fistula in 1974-2006 and 434 admitted in 2007-8.
  
  
  METHODS
  Self-reported age, marital status, education, distance from home to health facility, parity, duration of labor, neonatal outcome and sex, lag time to treatment; measurement of weight, stature, extent of lesion and clinical assessment of continence before hospital discharge.
  
  
  METHODS
  Duration of labor, extent of pelvic injury and neonatal survival, cure rate.
  
  
  RESULTS
  Primi- were more common than multiparous cases (56.8 vs. 43.2%). They were of similar age at marriage (17 years) and stature at hospital admission, but shorter than the population average (152.7 vs. 156.5 cm). Primipara had longer labor than multipara (50.5% > 3 days vs. 27%), larger uro-vaginal fistula, more stillbirths (95 vs. 88%), recto-vaginal fistula, vaginal scarring, persistent incontinence after repair and were more commonly divorced. Male fetuses were involved in 76.7% of obstructed deliveries but in only 44.6% of a previous uneventful delivery in multipara. Educational attainment positively influenced outcomes.
  
  
  CONCLUSIONS
  Obstetric fistula is more commonly associated with primiparous than subsequent pregnancies. Primipara have a longer and more damaging labor. A causative role for cephalo-pelvic disproportion is supported by the observation that male fetuses are more commonly involved in obstructed labor.
authors.affiliation: Centre for International Health, University of Bergen, Bergen, Norway.
authors.forename: Mulu
authors.initials: M
authors.lastname: Muleta
authors.forename: Svein
authors.initials: S
authors.lastname: Rasmussen
authors.forename: Torvid
authors.initials: T
authors.lastname: Kiserud
mesh_terms: D000328:Adult; D017677:Age Distribution; D016001:Confidence Intervals; D003906:Developing Countries; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008427:Maternal Health Services / Q000706:statistics & numerical data; D008428:Maternal Mortality / Q000639:trends*; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D010298:Parity; D011247:Pregnancy; D011336:Probability; D011788:Quality of Life; D012006:Rectovaginal Fistula / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014719:Vesicovaginal Fistula / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D055815:Young Adult