681 Effects of clitoral reconstruction for female genital mutilation on perinatal outcomes: a retrospective case-control study

Abstract

To investigate the perinatal outcomes of women with a history of female gentiale mutilation (FGM) who underwent clitoral reconstruction (CR) compared with women with FGM who did not undergo CR. Retrospective case-control study of pregnant women with a history of FGM who underwent CR between 10/2005 and 06/2017 in a tertiary center. Participant inclusion criteria were pregnant women >18 years who underwent CR after FGM. Only the first subsequent delivery after CR was included. Exclusion criteria included: pregnancies that resulted in stillbirths, abortion, or multiple gestations, and when the type of FGM was not retrospectively available. Each woman with CR was matched for age, ethnicity, FGM type, parity, and gestational age at the time of delivery with two women with FGM who did not undergo CR during the same period of time. Management of labor, perinatal outcomes, and neonatal outcomes were compared between both groups. Predictive analyses were performed by using logistic regression analyses adjusting for the type of FGM, infant weight at birth, and need for operative vaginal delivery. 84 women were included in the study (CR group: 28; control group:56). There was no significant difference in demographic characteristics or FGM type between the groups. In the CR group, patients required significantly fewer episiotomies (29.4%) compared to the control group (63.6%, p=0.02), even after excluding operative vaginal deliveries (15.4% vs 58.3, p<0.01). CR reduces the risk of episiotomy (aOR=0.17, 95%CI[0.04-0.68]; p=0.01). In the CR group, 47% of the patients had an intact perineum after delivery, compared to 20.4% in the control group (p=0.04). CR increases the odds of having an intact perineum at birth by 3.46 times (CI95%[1.04-11.49]; p=0.04). This study demonstrates that CR is associated with improved perineal obstetrical adaptation. CR after FGM increases the chances of having an intact perineum after delivery and reduces the risk of episiotomy compared to women with FGM who did not underwent CR.