In developing countries including India, what is the most common cause of vesico-vaginal fistula?

• A Abdominal hysterectomy
• B Radiotherapy for carcinoma cervix
• C Prolonged obstructed labour ✓
• D Anterior colporrhaphy

Explanation

In developing countries, neglected obstructed labour is the leading cause of vesico-vaginal fistula: the fetal head compresses the bladder base and urethra against the symphysis pubis, producing ischaemic sloughing that manifests as a fistula several days after delivery. In industrialised countries, gynaecological surgery, particularly hysterectomy, is the commonest cause, which makes option A the classic distractor for students who learn Western statistics.

Reference: DC Dutta's Textbook of Obstetrics, 10th ed.

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