{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T13:37:44Z","timestamp":1785591464403,"version":"3.56.0"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,1,23]],"date-time":"2023-01-23T00:00:00Z","timestamp":1674432000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,1,23]],"date-time":"2023-01-23T00:00:00Z","timestamp":1674432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pregnancy Childbirth"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The prevalence and impact of fistulas are more common in developing countries with limited access to emergency obstetric care. As a result, women in these settings often experience adverse psychosocial factors. The purpose of this study was to describe the characteristics of Congolese women who developed urogenital fistula following Cesarean sections (CS) to determine the characteristics associated with two etiologies: (1) prolonged obstructed labor; and (2) a complication of CS following obstructed labor.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a cross-sectional study on abstracted data from all patients with urogenital fistula following CS who received care during a surgical campaign in a remote area of the Democratic Republic of the Congo (DRC). Descriptive analyses characterized patients with fistula related to obstructed labor versus CS. Univariate and multivariate logistic regression models identified factors associated with obstetric fistula after cesarean delivery following obstructed labor. Variables were included in the logistic regression models based upon biological plausibility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 125 patients, urogenital fistula etiology was attributed to obstructed labor in 77 (62%) and complications following CS in 48 (38%). Women with a fistula, attributed to obstructed labor, developed the fistula at a younger age (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.04) and had a lower parity (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.02). Attempted delivery before arriving at the hospital was associated with an increased risk of obstetric fistula after cesarean delivery following obstructed labor (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CS are commonly performed on women who arrive at the hospital following prolonged obstructed labor and fetal demise, and account for almost 40% of urogenital fistula. Obstetric providers should assess maternal status upon arrival to prevent unnecessary CS and identify women at risk of developing a fistula.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12884-023-05357-3","type":"journal-article","created":{"date-parts":[[2023,1,23]],"date-time":"2023-01-23T04:03:48Z","timestamp":1674446628000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Etiology and factors associated with urogenital fistula among women who have undergone cesarean section: a cross-sectional study"],"prefix":"10.1186","volume":"23","author":[{"given":"Raha","family":"Maroyi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madeline K.","family":"Moureau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi W.","family":"Brown","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rane","family":"Ajay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloire","family":"Byabene","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denis M.","family":"Mukwege","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,1,23]]},"reference":[{"key":"5357_CR1","unstructured":"FC+. https:\/\/fistulacare.org\/what-is-fistula\/obstetric-fistula\/. Published 2022. Accessed 4 Jan 2022."},{"key":"5357_CR2","unstructured":"WHO. https:\/\/www.who.int\/news-room\/facts-in-pictures\/detail\/10-facts-on-obstetric-fistula. Published 2018. Accessed 4 Jan 2022."},{"key":"5357_CR3","unstructured":"The World Bank. The World Bank in DRC. Overview. https:\/\/www.worldbank.org\/en\/country\/drc\/overview. Accessed 27 Oct 2022."},{"issue":"1","key":"5357_CR4","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1186\/s12905-018-0605-1","volume":"18","author":"DT Bashah","year":"2018","unstructured":"Bashah DT, Worku AG, Mengistu MY. Consequences of obstetric fistula in sub Sahara African countries, from patients\u2019 perspective: a systematic review of qualitative studies. BMC Womens Health. 2018;18(1):106.","journal-title":"BMC Womens Health"},{"key":"5357_CR5","unstructured":"Nations U. https:\/\/www.un.org\/en\/observances\/end-fistula-day. Published 2020. Accessed 4 Jan 2022."},{"key":"5357_CR6","unstructured":"Wall LL. https:\/\/www.uptodate.com\/contents\/obstetric-fistulas-in-resource-limited-settings?sectionName=EPIDEMIOLOGY&topicRef=8071&anchor=H1345392&source=see_link#H1345392. Published 2020. Accessed 4 Jan 2022."},{"key":"5357_CR7","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1186\/s12884-015-0592-2","volume":"15","author":"KD Cowgill","year":"2015","unstructured":"Cowgill KD, Bishop J, Norgaard AK, Rubens CE, Gravett MG. Obstetric fistula in low-resource countries: an under-valued and under-studied problem\u2013systematic review of its incidence, prevalence, and association with stillbirth. BMC Pregnancy Childbirth. 2015;15:193.","journal-title":"BMC Pregnancy Childbirth"},{"issue":"2","key":"5357_CR8","doi-asserted-by":"publisher","first-page":"e80","DOI":"10.1016\/S2214-109X(15)00290-9","volume":"4","author":"S Ahmed","year":"2016","unstructured":"Ahmed S, Anastasi E, Laski L. Double burden of tragedy: stillbirth and obstetric fistula. Lancet Glob Health. 2016;4(2):e80-82.","journal-title":"Lancet Glob Health"},{"issue":"6","key":"5357_CR9","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1111\/1471-0528.16047","volume":"127","author":"CJ Ngongo","year":"2020","unstructured":"Ngongo CJ, Raassen T, Lombard L, van Roosmalen J, Weyers S, Temmerman M. Delivery mode for prolonged, obstructed labour resulting in obstetric fistula: a retrospective review of 4396 women in East and Central Africa. BJOG. 2020;127(6):702\u20137.","journal-title":"BJOG"},{"key":"5357_CR10","doi-asserted-by":"publisher","first-page":"243","DOI":"10.2147\/IJWH.S106645","volume":"8","author":"J Wright","year":"2016","unstructured":"Wright J, Ayenachew F, Ballard KD. The changing face of obstetric fistula surgery in Ethiopia. Int J Womens Health. 2016;8:243\u20138.","journal-title":"Int J Womens Health"},{"issue":"Suppl 1","key":"5357_CR11","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1002\/ijgo.13036","volume":"148","author":"R Maroyi","year":"2020","unstructured":"Maroyi R, Keyser L, Hosterman L, Notia A, Mukwege D. The mobile surgical outreach program for management of patients with genital fistula in the Democratic Republic of Congo. Int J Gynaecol Obstet. 2020;148(Suppl 1):27\u201332.","journal-title":"Int J Gynaecol Obstet"},{"issue":"2","key":"5357_CR12","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1016\/j.ijgo.2012.08.014","volume":"120","author":"L Hawkins","year":"2013","unstructured":"Hawkins L, Spitzer RF, Christoffersen-Deb A, Leah J, Mabeya H. Characteristics and surgical success of patients presenting for repair of obstetric fistula in western Kenya. 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Int Urogynecol J. 2021;32(9):2505\u201310.","journal-title":"Int Urogynecol J"},{"issue":"8","key":"5357_CR17","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1080\/01443610701709825","volume":"27","author":"GS Melah","year":"2007","unstructured":"Melah GS, Massa AA, Yahaya UR, Bukar M, Kizaya DD, El-Nafaty AU. Risk factors for obstetric fistulae in north-eastern Nigeria. J Obstet Gynaecol. 2007;27(8):819\u201323.","journal-title":"J Obstet Gynaecol"},{"issue":"2","key":"5357_CR18","doi-asserted-by":"publisher","DOI":"10.4081\/jphia.2011.e26","volume":"2","author":"ML Sagna","year":"2011","unstructured":"Sagna ML, Hoque N, Sunil T. Are some women more at risk of obstetric fistula in Uganda? Evidence from the Uganda Demographic and Health Survey. J Public Health Afr. 2011;2(2): e26.","journal-title":"J Public Health Afr"},{"issue":"4","key":"5357_CR19","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1007\/s00192-011-1622-x","volume":"23","author":"PM Tebeu","year":"2012","unstructured":"Tebeu PM, Fomulu JN, Khaddaj S, de Bernis L, Delvaux T, Rochat CH. Risk factors for obstetric fistula: a clinical review. Int Urogynecol J. 2012;23(4):387\u201394.","journal-title":"Int Urogynecol J"},{"issue":"1","key":"5357_CR20","doi-asserted-by":"publisher","first-page":"1136","DOI":"10.1186\/s12913-020-05997-7","volume":"20","author":"KM Bourret","year":"2020","unstructured":"Bourret KM, Larocque S, Hien A, Hogue C, Muray K, Lukusa AT, et al. Midwives\u2019 integration of post abortion manual vacuum aspiration in the Democratic Republic of Congo: a mixed methods case study & positive deviance assessment. 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All study procedures adhered with institutional ethical standards and the Declaration of Helsinki and its later amendments. Upon enrollment in this study, informed consent was obtained from participants.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"54"}}