Lessons From the Developing World: Obstructed Labor and the Vesico-Vaginal Fistula

Julia Cron, MD

In This Article


Perhaps one of the most famous accounts of obstructed labor is the case of Princess Charlotte of England. In 1817, Princess Charlotte, daughter of George IV, was the only eligible heir to the British throne in her generation. Her grandfather, George III, had 7 sons and 5 daughters, but Charlotte was the only legitimate grandchild. Thus, when the newspapers announced her pregnancy in early July 1817, the entire country was closely following this most important event in British history. On November 3, 1817, 42 weeks after her last menstrual period, Princess Charlotte went into labor. Fifty hours later -- after 24 hours of being in the second stage of labor and 6 hours of perineal pressure -- Charlotte delivered a 9-pound stillborn. Five and one half hours after delivery, the Princess died, presumably from hypovolemic shock after a postpartum hemorrhage from uterine atony, likely a direct result of her obstructed labor. Three months later, Sir Richard Crofts, Princess Charlotte's obstetrician, committed suicide, unable to bear the burden of responsibility for the death of the heir. As this event resulted in the death of the infant, the patient, and the physician, it has historically been referred to as the "Triple Obstetric Tragedy." Nonetheless, some will question how tragic this truly was for the country, as after Charlotte's death, her uncle married Princess Mary Louisa Victoria, who went on to give birth to the famous heir, Queen Victoria.[1]

This story serves to illustrate the consequences of obstructed labor. Fortunately, advances in obstetric care have made the serious consequences of obstructed labor nearly obsolete in the developed world. However, in the developing world, obstructed labor continues to be a common, serious medical problem, with thousands of women suffering significant morbidity each year. This review discusses the morbidity associated with pregnancy in the developing world. In particular, the morbidity of obstructed labor will be emphasized, with a specific focus on the vesico-vaginal fistula.


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