Preterm vaginal birth in the background of an unrepaired vesicovaginal fistula: A case report

Abstract

Obstetric fistula accounts for most genital tract fistulae seen in the developing countries and poses significant psychosocial stress on the woman. It is a cause of marital disharmony, stigmatization, and infertility. Thus, women with unrepaired vesicovaginal fistula (VVF) rarely present with coexisting pregnancy. We present a rare case of a 29‑year‑old unbooked G3P2 (1A) with unrepaired VVF who presented with an advanced second stage of labor of a preterm fetus at 32 weeks of gestation. She was referred from a primary health center in labor. She had ruptured her fetal membranes about 3 days before presentation. She had been experiencing continuous involuntary leakage of urine about 2 weeks after vaginal delivery of a macerated male stillbirth following prolonged labor at a traditional birth home about 13 months earlier. She had not sought any specialized care for her condition due to financial challenges. She had regular unprotected coitus despite urinary soiling; her menstrual cycle was regular and she achieved conception. At presentation, she was in intermittent painful distress with bearing down efforts and had ammoniacal fetor. Fundal height was 34 cm and a singleton fetus was palpated in longitudinal lie and cephalic presentation with a normal fetal heart rate. The fetal head was visible at the introitus without parting the labia, and amnii liquor was foul smelling with ammoniacal dermatitis of the vulva and upper thigh. She delivered a live male baby with poor APGAR scores and birth weight of 1.96 kg. A 4 cm × 4 cm mid‑vaginal defect was noticed on the anterior vaginal wall accommodating an inflated balloon of urethral catheter. She subsequently had VVF repair and rehabilitation. Financial challenge is an impediment to adequate care of VVF. This report establishes the possibility of regular coitus leading to conception and a live birth despite ongoing urinary soilage. Enhancement of social support services is advocated.

Keywords: Infertility; vesicovaginal fistula; VVF repair