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Obstetrics and Gynecology International
Volume 2018, Article ID 7409131, 6 pages
Research Article

Pelvic Ultrasound Findings in Women with Obstetric Fistula: A Cross-Sectional Study of Cases and Controls

1Baylor College of Medicine, Department of Obstetrics and Gynecology, Global Women’s Health, Baylor Plaza, Houston, TX 77030, USA
2University of North Carolina, Department of Epidemiology, 401 Rosenau Hall, Chapel Hill, NC 27599-7455, USA
3Freedom from Fistula Foundation, Fistula Care Centre, Lilongwe, Malawi
4Department of Obstetrics and Gynecology, Malawi College of Medicine, Blantyre, Malawi
5Malawi Ministry of Health, Bwaila Maternity Hospital, Lilongwe, Malawi
6University of North Carolina, Department of Obstetrics and Gynecology, 101 Manning Drive, Chapel Hill, NC 27599-7570, USA

Correspondence should be addressed to Jeffrey P. Wilkinson; ude.mcb@nosnikliw.yerffej

Received 1 June 2017; Accepted 19 September 2017; Published 10 January 2018

Academic Editor: Peter E. Schwartz

Copyright © 2018 Jeffrey P. Wilkinson et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective. Obstetric fistula (OF) is a morbid condition caused by prolonged obstructed labor. Women with OF experience profound injury and have high rates of infertility and poor obstetric outcomes. We examined endovaginal ultrasound parameters in women with and without OF. Design/Setting/Sample/Methods. This cross-sectional study enrolled women evaluated at the Fistula Care Centre in Lilongwe, Malawi. Eligibility criteria included age 18–45, prior pregnancy, and a uterus on ultrasound. Participants underwent endovaginal ultrasound with measurement of cervical dimensions. Comparisons were done using t-tests and Fisher's exact test. Among women with OF, linear regression was used to assess whether fistula stage was associated with cervical length. Results. We enrolled 98 cases and 12 controls. Women with OF had shorter cervical lengths (18.8 mm versus 27.3 mm, p < 0.01), as well as shorter anterior (7.0 mm versus 9.3 mm, p < 0.01) and posterior (9.5 mm versus 11.0 mm, p < 0.04) cervical stroma, compared to controls. Conclusion. Women with OF have shorter cervical lengths and anterior and posterior cervical stroma, when compared to women without OF. This may offer a partial explanation for subfertility and poor obstetric outcomes in OF patients. Additional studies to clarify the role of ultrasound in OF patients and prediction of future fertility are warranted.