Forceps-Assisted Delivery Could Reduce the Iatrogenic Fistula Crisis: A Clinical Commentary

Area of Science:

• Obstetrics and Gynecology
• Surgical Innovation
• Maternal Health

Background:

• Childbirth-related pelvic floor fistulas are shifting from an ischemic obstetric etiology to iatrogenic causes linked to caesarean sections.
• Increasing caesarean section rates in low- and middle-income countries (LMICs) introduce new maternal complications like ureterovaginal and vesico-uterine fistulae.
• These iatrogenic fistulae often necessitate complex abdominal surgical repair.

Purpose of the Study:

• To address the rising incidence of iatrogenic childbirth-related fistulas.
• To propose strategies for minimizing fistula-related pathologies and surgical complications.
• To advocate for the reintroduction and enhancement of specific obstetric interventions and training.

Main Methods:

• Review of current trends in childbirth-related fistula etiology.
• Analysis of complications associated with caesarean sections in LMICs.
• Evaluation of the potential benefits of instrumental vaginal delivery, specifically forceps, in specific obstetric scenarios.

Main Results:

• Caesarean sections are a growing cause of obstetric fistulas requiring abdominal repair.
• Forceps delivery, when indicated for second-stage arrest, can potentially mitigate this trend.
• Improved surgical training in caesarean sections and comprehensive training in instrumental vaginal deliveries are crucial.

Conclusions:

• A shift in fistula etiology necessitates a re-evaluation of obstetric practices.
• Reintroducing and refining skills in forceps delivery can reduce iatrogenic fistula rates.
• Enhanced obstetric management and surgical training are urgently required to improve maternal healthcare outcomes.