Table 1

Scenarios described in variables of interest questions

ScenarioCase description
1An 18-year-old female patient had obstructed labour and delivery of a stillbirth 1 month ago. She has a large vesicovaginal fistula that obliterated the anterior vaginal wall, resulting in total loss of the urethra. On examination, she has involvement of both ureters, with partial obstruction of one. The main long-term complications are the constant leakage of urine (urinary incontinence) and functional loss of a kidney
2A 22-year-old female patient presents with urinary incontinence after having a stillbirth. She has a small fistula but bilateral foot drop. Long-term disability includes urinary incontinence with severe hip and leg pain, difficulty in mobility and atrophy of the lower extremities
3A 27-year-old female patient presents after labouring for 3 days in her village during her 3rd pregnancy. She undergoes an emergency caesarean delivery of a stillbirth. Possible long-term outcomes include: loss of her uterus leading to infertility, and damage to the bladder and/or ureters due to the difficult nature of the surgery
4A 17-year-old female patient presents in labour with obstruction for the last 24 h. She delivers a live infant who has some transient respiratory depression, but otherwise appears well. She develops a rectovaginal fistula on post partum day 1. Potential long-term disability includes severe faecal incontinence, imposed isolation from her family and depression (For this scenario, we asked experts about both rates of long-term disability and death)
5A 30-year-old woman underwent an emergency caesarean delivery after presenting to a hospital with severe antepartum haemorrhage at term. Her recovery is complicated by the constant leakage of urine during her postoperative course, despite placement of a Foley catheter for drainage. She is diagnosed with a right-sided ureterovaginal fistula. Potential long-term disability is severe urinary incontinence, depression, isolation and the possible loss of kidney function
  • Questions asked about the rate of long-term disability and, for scenario 3, the rate of death per 1000 cases treated at different facility types or untreated.