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Episiotomy and obstetric outcomes among women living with type 3 female genital mutilation: a secondary analysis

Reprod Health. 2016 Oct 10;13(1):131.FREE

Episiotomy and obstetric outcomes among women living with type 3 female genital mutilation: a secondary analysis.

Rodriguez MI, Seuc A, Say L, Hindin MJ

BACKGROUND: To investigate the association between type of episiotomy and obstetric outcomes among 6,187 women with type 3 Female Genital Mutilation (FGM).

METHODS: We conducted a secondary analysis of women presenting in labor to 28 obstetric centres in Burkina Faso, Ghana, Kenya, Nigeria, Senegal and Sudan between November 2001 and March 2003. Data were analysed using cross tabulations and multivariable logistic regression to determine if type of episiotomy by FGM classification had a significant impact on key maternal outcomes. Our main outcome measures were anal sphincter tears, intrapartum blood loss requiring an intervention, and postpartum haemorrhage.

RESULTS: Type of episiotomy performed varied significantly by FGM status. Among women without FGM, the most common type of episiotomy performed was posterior lateral (25.4 %). The prevalence of the most extensive type of episiotomy, anterior and posterior lateral episiotomy increased with type of FGM. Among women without FGM, 0.4 % had this type of episiotomy. This increased to 0.6 % for women with FGM Types 1, 2 or 4 and to 54.6 % of all women delivering vaginally with FGM Type 3. After adjustment, women with an anterior episiotomy, (AOR = 0.15 95 %; CI 0.06-0.40); posterior lateral episiotomy (AOR = 0.68 95 %; CI 0.50-0.94) or both anterior and posterior lateral episiotomies performed concurrently (AOR = 0.21 95 % CI 0.12-0.36) were all significantly less likely to have anal sphincter tears compared to women without episiotomies. Women with anterior episiotomy (AOR = 0.08; 95%CI 0.02-0.24), posterior lateral episiotomy (AOR = 0.17 95 %; CI 0.05-0.52) and the combination of the two (AOR = 0.04 95 % CI 0.01-0.11) were significantly less likely to have postpartum haemorrhage compared with women who had no episiotomy.

CONCLUSIONS: Among women living with FGM Type 3, episiotomies were protective against anal sphincter tears and postpartum haemorrhage. Further clinical and research is needed to guide clinical practice of when episiotomies should be performed.

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[Maternal and foetal prognostic in excised women delivery]

J Gynecol Obstet Biol Reprod (Paris). 2007 Jun;36(4):393-8. Epub 2007 Apr 6.FREE

[Maternal and foetal prognostic in excised women delivery]. [Article in French]

Millogo-Traore F, Kaba ST, Thieba B, Akotionga M, Lankoande J. fmillogo_traore@caramail.com

ABSTRACT

INTRODUCTION: The female circumcision constitutes by their frequency and complications a real problem of public health.

MATERIAL AND METHOD: Our study aims at comparing the maternal land fetal complications of the spontaneous vaginal delivery in the excised women and non-excised. We led a comparative survey case witness implying 227 excised pregnant women at the maternity in CHU YO of Ouagadougou.

RESULTS: The prevalence of the excision from January 1st to July 31, 2006 was 72.86%. The distribution of female genital mutilations in this population is the following: type I=27.75%, type II=69.61%, type III=2.64%. The middle age was 25 years and 79.30% of women were aged less than 30 years. Islam appeared like a factor of exposure to the practice of the excision with 67.40% of women excised that practise it against 41.90% at the non-excised group (P<0,0001). The maternal complications were dominated by the duration of fetal expulsion prolonged and perineal tears. The duration of fetal expulsion was superior to 30 minutes for 34.56% of excised woman childbirths 9 times more frequently than women non-excised (P=0.001). The frequency of perineal tears was 10.13% in the group of women excised against 5.73% in the group of the non-excised (P=0.008). These perineal lesions were more frequent with the primiparae and women excised at the 2nd and 3rd degree. The neobirth asphyxia affected 4.4% of newborns from mother excised against 0.2% in the non-excised group (RR=5.18; P=0.006). In the group of excised them the rate of mortinatality was 22.03 for 1000 births, against 8.81 for 1000 births in the group of the non-excised (P=0.22).

CONCLUSION: The prevention of these complications with the excised woman rests on the episiotomy and the instrumental extraction in the FGM of type III.

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[Nurses’ roles in female sexual mutilation]

Soins Pediatr Pueric. 2008 Dec;(245):39-41.

[Nurses’ roles in female sexual mutilation]. [Article in French]

Gignon M, Manaouil C, Decourcelle M, Jarde O.

Service de médecine légale et sociale, CHU d’Amiens-Picardie, Amiens.

There is no ABSTRACT available for this article.

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Correspondence: Episiotomy: a form of genital mutilation

Lancet. 1999 June;353(9168):1977 – 1978

Correspondence: Episiotomy: a form of genital mutilation

Marsden Wagner

Preview

In his ‘Sketches from The Lancet’ (April 24, p 1453) Peter Kandela describes how over 130 years ago The Lancet played a part in turning support away from one form of female genital mutilation in the UK—clitoridectomy. Hopefully, you can play a part in turning support away from another form of female genital mutilation which is widespread in the UK today—episiotomy.

After their review of scientific evidence, Thacker and Banta concluded that an episiotomy rate over 20% cannot be justified. On the basis of this and other evidence, WHO published the recommendation: “The systematic use of episiotomy is not justified. The protection of the perineum through alternative methods should be evaluated and adopted”. More recent research presents further evidence against frequent use of episiotomy…

This article can be accessed in this LINK