Authors' reply re: Delivery mode for prolonged obstructed labour resulting in obstetric fistula

Abstract

We welcome the reflections on the rise of iatrogenic obstetric fistulas in sub‐Saharan Africa.1 Our article did not address iatrogenic fistulas but documented a 25‐year rise in caesarean section (CS) among women with fistula and stillbirth in nine East and Central African countries.2 CS in such circumstances exposes women to a uterine scar without the benefit of a live baby. Rising CS for prolonged, obstructed labour increases the risk for all CS complications, including iatrogenic fistula. In an earlier article we proposed an algorithm to determine the likelihood that a fistula is of iatrogenic origin, because alignment on clear definitions will allow long‐term measurement and appropriate responses.3 A next step will be to evaluate iatrogenic fistulas by causative operation, so that we can document which injuries follow gynecological as compared with obstetric surgeries. This will ensure that concern regarding iatrogenic fistulas broadens beyond fistula surgeons to the diverse community engaged in improving emergency obstetric care and surgical safety.