Obstetric Fistula

Final Quiz

Results
Score for this question group: 53%
1. A vesicovaginal fistula:
Is a hole between rectum and vagina.
Is a hole between urinary bladder and vagina. Your answer
Leads to faecal incontinence.
Is a hole between ureter and vagina.
Is a hole between urethra and vagina.
2. Where do most women with obstetric fistula live?
Sub-Saharan Africa and Asia Your answer
South and Central America
North America and Europe
Only Asia
All of the above
3. How does obstetric fistula impact women?
It causes incontinence
It causes social isolation
It causes abandonment by family and community
Inability to work
All of the above Your answer
4. The following are known causes of rectovaginal fistulas except:
Obstructed labour
Sexual assault
Crohn’s disease Your answer
Radiation therapy
Skillfully-performed Caesarean section
5. Which of the following is not an iatrogenic cause of VVF/RVF ?
Hysterectomy
Radiation therapy
Cancer of the cervix Your answer
Caesarean section
Repair of raptured uterus following obstructed labour
6. Which of the following is not true about obstetric fistula?
It is often highly stigmatizing
Majority of cases occur in developing countries
It is rarely associated with depression Your answer
In developed countries, majority of causes are iatrogenic
It is an indicator of health system failure
7. The following factors make it difficult to estimate incidence and prevalence of obstetric
fistula except:
Most cases occur in remote settings
It is not costly to estimate
It is associated with ostracization
It is a rare condition
It is underappreciated as a major cause of maternal morbidity Your answer
8. Which of the following gives the most accurate estimates about incidence and prevalence
of obstetric fistula?
Population-based studies
 Hospital-based studies
Self-reports by fistula surgeons Your answer
Studies employing mixed methods
None of the above
9. Which of the following is not true about population-based studies in estimating the obstetric
fistula burden?
They are able to capture cases within the community
They often cannot find women who are institutionalized in repair centers or those that
have been ostracized Your answer
They do not suffer from self-reporting
They can be incorporated into existing survey tools such as demographic health
surveys
They give better estimates than hospital-based studies
10. Which of the following is an epidemiologic indicator in monitoring prevention of obstetric
fistula?
The estimated number of women living with obstetric fistulas
The estimated number of new cases of obstetric fistulas per year
Estimated rate of obstetric fistulas per 1000 deliveries Your answer
The unmet need for fistula surgery
All of the above
11. According to the WHO classification system, the following are considered complicated
fistulas except:
Multiple fistulas
Recto-vaginal fistula
No previous attempt at repair Your answer
Presence of scarred vaginal tissue
Involvement of urethra
12. Which of the following are not urological injuries resulting from obstructed labour?
Vesico-vaginal fistula Your answer
Secondary hydroureteronephrosis
Urolithiasis
Stress incontinence
Vaginal stenosis
13. The following are risk factors for obstetric fistula:
Child marriages
Malnutrition
Long distances to health facilities
Lack of education
All of the above Your answer
14. Which of the following is described as Main’s third delay that contributes to bad obstetric
outcome ?
The decision to seek care.
Delay due to the lack skilled staff.
Long distance from the hospital.
Restriction imposed by husband and community. Your answer
15. Which of the following is not part of the obstructed labour complex?
Maternal death
Uterine loss
Amenorrhea Your answer
Obstructed labour
Fetal loss
16. Which of the following is not a strategy in reducing obstetric fistula resulting from third
delays?
Proper use of the partograph in monitoring labour
Programs aimed at eradicating bad cultural practices such as infibulation Your answer
Provision of comprehensive emergency obstetric care
Employment of more skilled midwives
 Provision of surgical equipment and supplies
17. In facilities without specialist fistula surgeons, which of the following is not part of the
diagnostic criteria?
The client must complain of the constant leakage of urine throughout the day Your
answer
Onset of this incontinence must have occurred directly after labor and delivery, or
immediately after pelvic trauma (for example, from surgery).
Examination reveals urine draining from the vagina
Observation or palpation of a defect in the anterior vagina leading to the bladder or
observation of urine passing from the cervical os.
History of obstructed labor
18. The following are modalities used in conservative management of obstetric fistula except?
Fibrin glue
Bladder catheterization
Interposition flap
Electrocoagulation Your answer
None of the above
19. In which of the following cases would conservative management using bladder
catheterization be beneficial?
Fistula resulting from lymphogranulomavenereum
Isolated rectovaginal fistula
A small VVF measuring less than 3 mm in diameter Your answer
An established ureterovaginal fistula
Recurred fistula
20. For fistula patients on conservative management with bladder catheterization, follow-up
after 1 week is done to ensure the following except
Catheter is in the bladder and not the vagina
The catheter is actively draining
Any concerns the patient might have
The patient is compliant with instructions to be active and drink 5 litres of water a day
The fistula is closed Your answer
21. Which of the following is not a principle of successful VVF/RVF repair?
The site should be un-infected
The repair should be tension free
The repair is achieved using multiple non-overlapping sutures
The repair should be watertight
The repair should be performed within one month of occurrence Your answer
22. The following are principles applicable to RVF repair only except?
Use of multiple, non-overlapping suture lines Your answer
More thorough preoperative bowel preparation than for VVF alone.
A temporary colostomy may be required
Care should be taken not to cause an inadvertent stricture of the rectum
An RVF repair that has not required a colostomy, should remain on a fluids-only diet
for the first two days
23. Advantages of the vaginal approach include the following except?
Less complications
Less postoperative pain
It is cosmetic
Shorter hospital stay
Improved surgeon satisfaction Your answer
24. The transabdominal route of fistula repair is preferred under the following circumstances
except?
When the fistula site cannot be visualized or easily accessed per vagina
Simple VVF
Significant vaginal fibrosis
When initial vaginal repair has to be converted to an abdominal approach Your answer
Large tracts close to the ureteral orifice
25. Which of the following is not true about obstetric rectovaginal fistula?
They occur less commonly than isolated VVF cases
The patient may report passage of air vaginally
They are generally more difficult to manage than VVF
Plugs and advancement flaps are best suited for low fistulas than high ones Your
answer
Transabdominal ligation procedures and mesh repairs are best suited for low fistulas
than high ones
26. Which of the following is a mechanism of ureteric injury following VVF repair?
Crushing from misapplication of a clamp
Ligation with a suture
Transsection (partial or complete)
Angulation of the ureter with secondary obstruction
All of the above Your answer
27. Which of the following is not good immediate post-operative care for a fistula patient?
Encourage vigorous activity Your answer
Bladder catheterization
Adequate analgesia
Monitoring any bleeding
Monitoring of vital signs
28. The following are complications of fistula repair except
Gynatresia Your answer
Urinary tract infection
Contracted and over-reactive bladder
Dyspareunia
None of the above
29. Which of the following is a socio-economic component of reintegration after fistula repair?
Timely surgery for fistula patients
Vocational skills training
Provision of enough funds for treatment
Psychological treatment Your answer
Early detection
30. Women who have had fistula repair are important in the following ways except?
Serve as an example of bad choices in delaying to seek care for obstructed labor Your
answer
Can serve as peer educators
Are ambassadors of social change
Being economically productive
Provide a link between the community and the health system