title: Demographic and delivery characteristics associated with obstetric fistula in Kigali, Rwanda.
abstract: OBJECTIVE
  To assess the characteristics of Rwandan women undergoing surgical correction of obstetric fistula.
  
  
  METHODS
  A retrospective, cross-sectional study was conducted of women undergoing surgery to repair obstetric fistula as part of a program run by the International Organization for Women and Development in Kigali, Rwanda, between April 1, 2010, and February 28, 2011. Data were collected from medical records, including demographics, obstetric history, and results of the physical examination.
  
  
  RESULTS
  A total of 65 women underwent fistula surgery in the study period. Among 59 women for whom relevant data were available, 43 (73%) reported that the fetus did not survive the pregnancy during which the fistula developed. Delivery had occurred in a healthcare facility for 49 (82%) of 60 women. Delivery was by cesarean in 31 (48%) women included in the analyses. Cervicovesical or uterovesical fistula occurred more frequently among women who underwent cesarean delivery (9 [29%]) than among those who underwent vaginal delivery (3 [9%] of 34; P=0.04). There was no difference in the number of fetal or neonatal deaths between the two groups (P=0.2).
  
  
  CONCLUSIONS
  Approximately half of the women in the sample delivered by cesarean, and these women were more likely to have a fistula involving the uterus or cervix.
authors.affiliation: Section of Gynecology, Virginia Mason Medical Center, Seattle, WA, USA. Electronic address: blair.washington@vmmc.org.
authors.forename: Blair B
authors.initials: BB
authors.lastname: Washington
authors.affiliation: Division of Research, Women and Infants' Hospital of Rhode Island, Providence, RI, USA.
authors.forename: Christina A
authors.initials: CA
authors.lastname: Raker
authors.affiliation: Department of Obstetrics and Gynecology, National University of Rwanda, Kigali, Rwanda.
authors.forename: George A
authors.initials: GA
authors.lastname: Kabeja
authors.affiliation: Warren Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Kay
authors.affiliation: Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, Women and Infants' Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: Brittany S
authors.initials: BS
authors.lastname: Hampton
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D005402:Fistula / Q000209:etiology / Q000601:surgery*; D006801:Humans; D017533:Marital Status; D008875:Middle Aged; D007744:Obstetric Labor Complications; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012432:Rwanda; D014591:Uterine Diseases / Q000209:etiology / Q000601:surgery*; D014624:Vaginal Fistula / Q000601:surgery*
keywords: Cesarean delivery; Fistula; Obstetric fistula; Obstructed labor; Rwanda