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Abstract：
OBJECTIVE: To evaluate the mode of delivery and stillbirth rates over time among women with obstetric fistula.
METHODS: Retrospective record review.
METHODS: Tanzania, Uganda, Kenya, Malawi, Rwanda, Somalia, South Sudan, Zambia and Ethiopia.
METHODS: A total of 4396 women presenting with obstetric fistulas for repair who delivered previously in facilities between 1990 and 2014.
METHODS: Retrospective review of trends and associations between mode of delivery and stillbirth, focusing on caesarean section (CS), assisted vaginal deliveries and spontaneous vaginal deliveries.
METHODS: Mode of delivery, stillbirth.
RESULTS: Out of 4396 women with fistula, 3695 (84.1%) delivered a stillborn baby. Among mothers with fistula giving birth to a stillborn baby, the CS rate (overall 54.8%, 2027/3695) rose from 45% (162/361) in 1990-94 to 64% (331/514) in 2010-14. This increase occurred at the expense of assisted vaginal delivery (overall 18.3%, 676/3695), which declined from 32% (115/361) to 6% (31/514).
CONCLUSIONS: In Eastern and Central Africa, CS is increasingly performed on women with obstructed labour whose babies have already died in utero. Contrary to international recommendations, alternatives such as vacuum extraction, forceps and destructive delivery are decreasingly used. Unless uterine rupture is suspected, CS should be avoided in obstructed labour with intrauterine fetal death to avoid complications related to CS scars in subsequent pregnancies. Increasingly, women with obstetric fistula add a history of unnecessary CS to their already grim experiences of prolonged, obstructed labour and stillbirth.
UNASSIGNED: Caesarean section is increasingly performed in African women with stillbirth treated for obstetric fistula.
METHODS: Retrospective record review.
METHODS: Tanzania, Uganda, Kenya, Malawi, Rwanda, Somalia, South Sudan, Zambia and Ethiopia.
METHODS: A total of 4396 women presenting with obstetric fistulas for repair who delivered previously in facilities between 1990 and 2014.
METHODS: Retrospective review of trends and associations between mode of delivery and stillbirth, focusing on caesarean section (CS), assisted vaginal deliveries and spontaneous vaginal deliveries.
METHODS: Mode of delivery, stillbirth.
RESULTS: Out of 4396 women with fistula, 3695 (84.1%) delivered a stillborn baby. Among mothers with fistula giving birth to a stillborn baby, the CS rate (overall 54.8%, 2027/3695) rose from 45% (162/361) in 1990-94 to 64% (331/514) in 2010-14. This increase occurred at the expense of assisted vaginal delivery (overall 18.3%, 676/3695), which declined from 32% (115/361) to 6% (31/514).
CONCLUSIONS: In Eastern and Central Africa, CS is increasingly performed on women with obstructed labour whose babies have already died in utero. Contrary to international recommendations, alternatives such as vacuum extraction, forceps and destructive delivery are decreasingly used. Unless uterine rupture is suspected, CS should be avoided in obstructed labour with intrauterine fetal death to avoid complications related to CS scars in subsequent pregnancies. Increasingly, women with obstetric fistula add a history of unnecessary CS to their already grim experiences of prolonged, obstructed labour and stillbirth.
UNASSIGNED: Caesarean section is increasingly performed in African women with stillbirth treated for obstetric fistula.
摘要：
目的：评估产科瘘妇女的分娩方式和死胎率。
方法：回顾性记录回顾。
方法：坦桑尼亚，乌干达，肯尼亚,马拉维,卢旺达,索马里,南苏丹,赞比亚和埃塞俄比亚。
方法：共有4396名接受产科瘘治疗的妇女在1990年至2014年期间曾在医院分娩。
方法：对分娩方式与死产之间的趋势和关联进行回顾性回顾，专注于剖腹产（CS），辅助阴道分娩和自发阴道分娩。
方法：交付方式，死产.
结果：在4396例患瘘管的妇女中，3695（84.1％）分娩了死胎。在产下死胎的瘘管母亲中，CS率(总体为54.8%，2027/3695）从1990-94年的45%（162/361）上升到2010-14年的64%（331/514）。这种增加是以阴道辅助分娩为代价的（总体为18.3％，676/3695),从32%（115/361）下降到6%（31/514）。
结论：在东部和中部非洲，CS越来越多地用于分娩受阻的妇女，其婴儿已经在子宫内死亡。与国际建议相反，替代方案，如真空提取，镊子和破坏性递送的使用越来越少。除非怀疑是子宫破裂,宫内胎儿死亡的难产应避免CS，以避免随后妊娠中与CS疤痕相关的并发症。越来越多,患有产科瘘的妇女在他们已经严峻的长期经历中增加了不必要的CS史，难产和死产。
■在接受产科瘘治疗的死产非洲妇女中越来越多地进行剖腹产。
方法：回顾性记录回顾。
方法：坦桑尼亚，乌干达，肯尼亚,马拉维,卢旺达,索马里,南苏丹,赞比亚和埃塞俄比亚。
方法：共有4396名接受产科瘘治疗的妇女在1990年至2014年期间曾在医院分娩。
方法：对分娩方式与死产之间的趋势和关联进行回顾性回顾，专注于剖腹产（CS），辅助阴道分娩和自发阴道分娩。
方法：交付方式，死产.
结果：在4396例患瘘管的妇女中，3695（84.1％）分娩了死胎。在产下死胎的瘘管母亲中，CS率(总体为54.8%，2027/3695）从1990-94年的45%（162/361）上升到2010-14年的64%（331/514）。这种增加是以阴道辅助分娩为代价的（总体为18.3％，676/3695),从32%（115/361）下降到6%（31/514）。
结论：在东部和中部非洲，CS越来越多地用于分娩受阻的妇女，其婴儿已经在子宫内死亡。与国际建议相反，替代方案，如真空提取，镊子和破坏性递送的使用越来越少。除非怀疑是子宫破裂,宫内胎儿死亡的难产应避免CS，以避免随后妊娠中与CS疤痕相关的并发症。越来越多,患有产科瘘的妇女在他们已经严峻的长期经历中增加了不必要的CS史，难产和死产。
■在接受产科瘘治疗的死产非洲妇女中越来越多地进行剖腹产。
