Pregnancy and childbirth after repair of obstetric fistula in sub-Saharan Africa: Scoping Review.
OBJECTIVE
To synthesise the evidence on pregnancy and childbirth after repair of obstetric fistula in sub-Saharan Africa and to identify the existing knowledge gaps.


METHODS
A scoping review of studies reporting on pregnancy and childbirth in women who underwent repair for obstetric fistula in sub-Saharan Africa was conducted. We searched relevant articles published between 1 January 1970 and 31 March 2016, without methodological or language restrictions, in electronic databases, general Internet sources and grey literature.


RESULTS
A total of 16 studies were included in the narrative synthesis. The findings indicate that many women in sub-Saharan Africa still desire to become pregnant after the repair of their obstetric fistula. The overall proportion of pregnancies after repair estimated in 11 studies was 17.4% (ranging from 2.5% to 40%). Among the 459 deliveries for which the mode of delivery was reported, 208 women (45.3%) delivered by elective caesarean section (CS), 176 women (38.4%) by emergency CS and 75 women (16.3%) by vaginal delivery. Recurrence of fistula was a common maternal complication in included studies while abortions/miscarriage, stillbirths and neonatal deaths were frequent foetal consequences. Vaginal delivery and emergency C-section were associated with increased risk of stillbirth, recurrence of the fistula or even maternal death.


CONCLUSIONS
Women who get pregnant after repair of obstetric fistula carry a high risk for pregnancy complications. However, the current evidence does not provide precise estimates of the incidence of pregnancy and pregnancy outcomes post-repair. Therefore, studies clearly assessing these outcomes with the appropriate study designs are needed.
Ecole de Santé Publique, Université libre de Bruxelles, Brussels, Belgium. adelamou@gmail.com.|Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forecariah, Guinea. adelamou@gmail.com.|Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. adelamou@gmail.com.
Alexandre
A
Delamou
Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
Bettina
B
Utz
Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
Therese
T
Delvaux
Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forecariah, Guinea.
Abdoul Habib
AH
Beavogui
Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
Asm
A
Shahabuddin
Département Saône et Loire, Association de Dépistage Organisé des Cancers, Charnay-lès-Mâcon, France.
Akoi
A
Koivogui
Ecole de Santé Publique, Université libre de Bruxelles, Brussels, Belgium.
Alain
A
Levêque
Ecole de Santé Publique, Université libre de Bruxelles, Brussels, Belgium.
Wei-Hong
WH
Zhang
Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
Vincent
V
De Brouwere
D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D008428:Maternal Mortality; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D012008:Recurrence; D014624:Vaginal Fistula / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*
Afrique subsaharienne; Embarazo; Fístula obstétrica; Parto; Post-reparación; accouchement; childbirth; fistule obstétrique; grossesse; obstetric fistula; post-repair; post-réparation; pregnancy; sub-Saharan Africa; África subsahariana.