A 25-year-old primigravida developed a large vesicovaginal fistula following 3 days of obstructed labour. She presents now, 5 weeks postpartum, with continuous urinary leakage and excoriation of the vulva. The fistula margins are inflamed and edematous. Optimal management is:

• A Immediate fistula repair
• B Continuous bladder drainage for 6 weeks followed by reassessment, then repair regardless of tissue state
• C Permanent urinary diversion
• D Repair after 3 months once tissues become healthy and slough separates ✓

Explanation

For post-obstetric fistulas, the standard practice is to delay repair until about 3 months after delivery, allowing separation of necrotic slough, resolution of inflammation and infection, and return of healthy vascular tissue, all of which markedly improve success rates. Immediate repair is appropriate mainly for small fresh surgical fistulas recognized intraoperatively. Continuous catheter drainage can heal very small fistulas but will not close a large obstetric fistula with unhealthy margins, and diversion is a last resort.

Reference: Dutta's Textbook of Obstetrics and Gynecology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.