title: Incidence of obstetric fistula in Norway: a population-based prospective cohort study.
abstract: BACKGROUND
  Obstetric fistula is a serious complication of childbirth prevalent in developing societies. Less is known about its occurrence in industrialized countries. We aimed to determine incidence and outcome of obstetric fistulas in Norway.
  
  
  METHODS
  This was a population-based prospective cohort study. Patient characteristics were registered for all treated at the National Treatment Center for Gynecologic Fistulas, Haukeland University Hospital, Bergen. Women with obstetric fistula after delivering in Hordaland County were included when calculating the incidence based on number of deliveries in that county during 1995-2014.
  
  
  RESULTS
  Of 280 fistulas, 40 were related to obstetrics (four urogenital and 36 enterogenital), 19 women were from Hordaland County. During this period, 116 389 deliveries were registered, giving an incidence of obstetric fistula of 16.3/100,000 deliveries (95% confidence interval 10.2-25.7/100,000). The urinary fistulas were due to cesarean section, cerclage, and uterine rupture, and all were repaired surgically. The 36 enteral fistulas were all related to vaginal deliveries; nine (25%) were instrumental and 19 (53%) had experienced a perineal tear of grade 3-4. These fistulas were small, with a median diameter of 2 mm. Four healed spontaneously or after enterostomy, and 30 were repaired transvaginally. In all, 37 of 40 obstetric fistulas were confirmed healed at follow up. Two women refrained from surgery, and one was lost to follow up.
  
  
  CONCLUSIONS
  Obstetric fistula does occur in industrialized societies but with a low incidence; fistulas are due to obstetric trauma or surgery rather than prolonged obstructed labor. The outcome of treatment is excellent when women are treated at a competent center.
authors.affiliation: Department of Obstetrics & Gynecology, National Center for Gynecological Fistulas, Haukeland University Hospital, Bergen, Norway.|Department of Clinical Science, University of Bergen, Bergen, Norway.
authors.forename: Jone
authors.identifier: http://orcid.org/0000-0002-3808-6407
authors.initials: J
authors.lastname: Trovik
authors.affiliation: Department of Obstetrics & Gynecology, National Center for Gynecological Fistulas, Haukeland University Hospital, Bergen, Norway.
authors.forename: Heidi F
authors.identifier: http://orcid.org/0000-0003-4256-8027
authors.initials: HF
authors.lastname: Thornhill
authors.affiliation: Department of Obstetrics & Gynecology, National Center for Gynecological Fistulas, Haukeland University Hospital, Bergen, Norway.|Department of Clinical Science, University of Bergen, Bergen, Norway.
authors.forename: Torvid
authors.identifier: http://orcid.org/0000-0003-1825-1660
authors.initials: T
authors.lastname: Kiserud
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015994:Incidence; D009664:Norway / Q000453:epidemiology; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D011247:Pregnancy; D011446:Prospective Studies; D012006:Rectovaginal Fistula / Q000453:epidemiology*
keywords: Obstetric fistula; delivery complication; etiology; outcome; surgical treatment