Question

The most common cause of vesico-vaginal fistula in India is:

• A. Gynae surgery
• B. Irradiation
• C. Obstructed labour
• D. Trauma

Hint:

In India, delayed access to obstetric care makes obstructed labour, not surgery, the leading cause of VVF.

Answer 1

The Correct Option is C

Step 1: Understanding the Question:
A vesico-vaginal fistula (VVF) is an abnormal connection between the bladder and vagina that causes constant leaking of urine. The question asks for its leading cause in India specifically.

Step 2: Key Formula or Approach:
The cause of VVF differs sharply by setting. In well resourced countries with good access to hospitals, gynaecological surgery, mainly hysterectomy, is the top cause. In India and other low resource settings, poor access to timely obstetric care means many women labour for days at home before reaching a hospital.

Step 3: Detailed Explanation:
Obstructed labour: when labour is prolonged and the baby's head is stuck against the pelvic bones for a long stretch, the soft tissue of the bladder and vaginal wall gets crushed between the fetal head and the bone. This cuts off blood flow, the tissue dies, and days later a hole forms between bladder and vagina. This mechanism is common wherever access to timely caesarean section is limited, which fits India's rural and semi-urban reality.
Gynae surgery: hysterectomy can injure the bladder and cause a fistula, but this is the leading cause mainly in developed countries with high surgical rates, not the leading cause in India.
Irradiation: pelvic radiotherapy for cervical cancer can cause a delayed fistula, but this affects a much smaller number of women overall.
Trauma: direct injury (accidents, assault) causes some fistulas but is far less common than obstetric causes.

Step 4: Final Answer:
In India, prolonged obstructed labour without timely intervention remains the single biggest cause of VVF.
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