Most women in sub-Saharan Africa and South Asia who develop genital fistula and have fistula repair surgery are of reproductive age. Fistulas occur the most in countries with high fertility rates, where cultures place a high value on childbearing. To help women have the best possible health outcomes following fistula and surgical repair, we must understand the risks to their future pregnancies and how to mitigate them. This will enable women to have the size of family they want without additional health problems.

New research led by Abner Korn and Alison El Ayadi of UCSF and Justus Barageine of Makerere University, Uganda, looks at the rates of pregnancy loss and stillbirth after fistula repair and what risk factors are associated with those outcomes.

The researchers found that among women who became pregnant within 10 years of fistula repair surgery, the miscarriage rate was 14%, and 5% had stillbirths. The stillbirth rate found among study participants was significantly higher than among similar Ugandan women without a history of fistula.   

Factors that increased the risk of miscarriage include fistula type, food insecurity, vaginal bleeding during pregnancy, ongoing urine leakage, and education level. Assisted vaginal birth and emergency cesarean birth were both associated with 17-fold increased odds of stillbirth when compared to elective cesarean birth. Stillbirth risk was also associated with ongoing urine leakage.

This study shows that greater attention to high-quality, comprehensive pregnancy care and birth planning is critical for improving outcomes among women who’ve had fistula repair surgery. This includes helping people have planned cesarean sections, which is recommended for post-repair births. We also need greater investments to strengthen women’s health access and knowledge to support their post-fistula repair reproductive goals.