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Deinfibulation for preventing or treating complications in women living with type III female genital mutilation: A systematic review and meta-analysis.

FREEInt J Gynaecol Obstet. 2017 Feb;136 Suppl 1:13-20. doi: 10.1002/ijgo.12056.

Deinfibulation for preventing or treating complications in women living with type III female genital mutilation: A systematic review and meta-analysis.

Okusanya BO, Oduwole O, Nwachuku N, Meremikwu MM.

ABSTRACT

BACKGROUND: Deinfibulation is a surgical procedure carried out to re-open the vaginal introitus of women living with type III female genital mutilation (FGM). OBJECTIVES: To assess the impact of deinfibulation on gynecologic or obstetric outcomes by comparing women who were deinfibulated with women with type III FGM or women without FGM. SEARCH STRATEGY: Major databases including CENTRAL, MEDLINE, and Scopus were searched until August 2015. SELECTION CRITERIA: We included nonrandomized studies that compared obstetric outcomes of women with deinfibulation, type III FGM (not deinfibulated during labor), and no FGM. DATA COLLECTION AND ANALYSIS: Quality of evidence was determined following the GRADE methodology. Summary measures were calculated using odds ratios at 95% confidence intervals. RESULTS: We found no randomized controlled trials. We included four case-control studies. The quality of evidence was very low. Compared with women with type III FGM at delivery, deinfibulated women had a significant reduction in the risk of having a cesarean delivery or postpartum hemorrhage. Compared with women without FGM, deinfibulated women had a similar risk of episiotomy, cesarean delivery, vaginal lacerations, postpartum hemorrhage, and blood loss at vaginal delivery. The length of second stage of labor, mean maternal hospital stay, and Apgar scores less than 7 were also comparable. CONCLUSIONS: Low-quality evidence suggests deinfibulation improves birth outcomes for women with type III FGM.

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Obstetric and neonatal outcomes for women with reversed and non-reversed type III female genital mutilation

International Journal of Gynecology & Obstetrics. 2011 May; 113(2):141-143

Obstetric and neonatal outcomes for women with reversed and non-reversed type III female genital mutilation

Raouf SA, Ball T, Hughes A, Holder R, Papaioannou S

Abstract 

Objective To record and compare obstetric and neonatal complication rates in women with reversed and non-reversed type III femalegenital mutilation (FGM).

Methods A retrospective observational study comparing cesarean delivery rates and neonatal outcomes of primiparous and multiparous women who had or had not undergone reversal of FGM III.

Results Of the 250 women, 230 (92%) had an FGM reversal. Of these, 50 (21.7%) were primiparous (cesarean delivery rate 17/50; 34%) and 180 (78.3%) were multiparous (cesarean delivery rate 28/180; 15.6%). Of the 20 women who had not had an FGM reversal, 7 (35%) were primiparous (cesarean delivery rate 5/7; 71.4%) and 13 (65%) were multiparous (cesarean delivery rate 7/13; 53.8%). The cesarean delivery rates for primiparae and multiparae were 32.9% and 25%, respectively. Multiparous women with FGM III reversal had a lower possibility of cesarean delivery compared with the hospital multiparous population (P=0.003) and multiparae who had not undergone FGM III reversal (P=0.007). There was no significant association between Apgar scores or blood loss at vaginal delivery and FGM reversal.

Conclusion Reversal of FGM III significantly reduced the increased risk of cesarean delivery seen with multiparae who have FGM III.

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The use of intrapartum defibulation in women with female genital mutilation.

BJOG. 2001 Sep;108(9):949-51.

The use of intrapartum defibulation in women with female genital mutilation.

Rouzi AA, Aljhadali EA, Amarin ZO, Abduljabbar HS.

Department of Obstetrics and Gynaecology, King Abdulaziz University Hospital, Saudi Arabia.

OBJECTIVE: To assess the use of intrapartum defibulation for women who have had female genital mutilation.

DESIGN: A retrospective case analysis.

SETTING: King Abdulaziz University Hospital, a teaching hospital in Jeddah, Saudi Arabia.

SAMPLE: Two hundred and thirty-three Sudanese and 92 Somali women who were delivered at the hospital between January 1996 and December 1999.

METHODS: The outcome of labour of women with female genital mutilation who needed intrapartum defibulation were compared with the outcome of labour of women without female genital mutilation who did not need intrapartum defibulation.

RESULTS: One hundred and fifty-eight (48.6%) women had infibulation and needed intrapartum defibulation to deliver vaginally, 116 women (35.7%) did not have infibulation and gave birth vaginally without defibulation, and 51 (15.7%) women were delivered by caesarean section. There were no statistically significant differences, between women who underwent intrapartum defibulation and those who did not, in the duration of labour, rates of episiotomy and vaginal laceration, APGAR scores, blood loss and maternal stay in hospital. The surgical technique of intrapartum defibulation was easy and no intraoperative complications occurred.

CONCLUSIONS: Intrapartum defibulation is simple and safe, but sensitivity to the cultural issues involved is essential. In the longer term, continuing efforts should be directed towards abandoning female genital mutilation altogether.

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