The author of a Review in this week's issue of The Lancet is calling for a devastating complication of pregnancy - obstetric fistula - to be moved up the list of international health care priorities.

Obstetric vesicovaginal fistula is a preventable injury, in which an abnormal opening is formed connecting the vagina and bladder, resulting in continuous urinary incontinence in women. The injury is a common complication of obstructed labour in developing countries, despite having been virtually eradicated in developed countries thanks to universal access to basic obstetric care.

The paper suggests that the condition is becoming increasingly commonplace; estimating that over 3 million women in poor countries have unrepaired vesicovaginal fistulas and that as many as 130,000 new cases develop in African nations annually. The author highlights an urgent need for specialised fistula repair centres to be developed in countries with a high prevalence of sufferers.

Author, Lewis Wall (Washington University School of Medicine, St Louis, USA) suggests that the increased prevalence in developing countries is due to a fundamental lack of adequate obstetric services, in addition to a complex combination of other biological, social and economic factors.

The Review also highlights how "the psychosocial circumstances in which these women find themselves as the result of having sustained an obstetric fistula can be even more devastating than the physical injuries themselves."

Dr Wall states: "Obstetric vesicovaginal fistula continues to ruin the lives of tens if not hundreds of thousands of young women every year. This situation is a mark of shame on the world medical community and demands urgent and sustained action."

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Contact: Joe Santangelo
j.santangelo@elsevier.com
212-633-3810
Lancet
28-Sep-2006