title: Cesarean delivery-related fistulae in the Democratic Republic of Congo.
abstract: OBJECTIVE
  To compare the characteristics of urogenital fistulae after cesarean delivery with those after spontaneous vaginal delivery.
  
  
  METHODS
  A retrospective analysis of hospital records of 597 consecutive patients with a urogenital fistula who received treatment at Panzi Hospital, Bukavu, Democratic Republic of Congo, during 2005-2007.
  
  
  RESULTS
  Of 576 women with an obstetric fistula, 229 (40%) had had a cesarean delivery; 55 (24%) of the 229 fistulae were considered to be iatrogenic. The distribution of risk factors (age, stature, parity, and labor duration) was similar to that among 226 women with a spontaneous vaginal delivery, but the odds ratios for having a ureterovaginal or a vesicouterine fistula were 11.9 (95% confidence interval [CI] 2.8-51.2) and 9.5 (95% CI 2.8-31.9), respectively. Vesicovaginal fistulae with cervical involvement were also significantly more frequent in the cesarean delivery group. The fistulae in this group had less surrounding fibrosis and there was less treatment delay. Stillbirth rates were 87% (cesarean delivery) and 95% (spontaneous vaginal delivery).
  
  
  CONCLUSIONS
  The data indicate that cesarean delivery-related fistulae are a separate clinical entity. Focus on this condition is important for fistula prevention and provision of adequate obstetric care, particularly for training in surgery and alternative delivery methods.
authors.affiliation: Department of Gynecology, Ullevål University Hospital, Oslo, Norway. mathiaso@online.no
authors.forename: Mathias
authors.initials: M
authors.lastname: Onsrud
authors.forename: Solbjørg
authors.initials: S
authors.lastname: Sjøveian
authors.forename: Denis
authors.initials: D
authors.lastname: Mukwege
mesh_terms: D000293:Adolescent; D000328:Adult; D002584:Cervix Uteri / Q000473:pathology; D002585:Cesarean Section / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000379:methods; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D005260:Female; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D001747:Urinary Bladder Fistula / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D014591:Uterine Diseases / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D014719:Vesicovaginal Fistula / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D055815:Young Adult