Abstract

BackgroundTo investigate the association between type of episiotomy and obstetric outcomes among 6,187 women with type 3 Female Genital Mutilation (FGM).MethodsWe 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.ResultsType 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.ConclusionsAmong 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.

Highlights

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

  • More than 200 million girls and women have been subjected to FGM, and an estimated three million girls are at risk every year

  • Our findings suggest that anterior episiotomy, to release scar tissue, may reduce some obstetrical risk among women with the most extensive type of FGM

Read more

Summary

Introduction

To investigate the association between type of episiotomy and obstetric outcomes among 6,187 women with type 3 Female Genital Mutilation (FGM). Female Genital Mutilation (FGM) includes a range of procedures involving partial or total removal of the external female genitalia for non-therapeutic reason [1]. Compared to women without FGM, women with FGM have an increased risk of episiotomy, caesarean delivery, haemorrhage, extended maternal hospital stay, infant resuscitation, and inpatient perinatal death [3]. The risk of adverse obstetric outcomes varies by FGM type, with the most extensive forms of FGM being associated with the greatest risk [3, 5]. Women with Type 3 FGM have been shown to have increased risk of episiotomy, caesarean delivery, postpartum haemorrhage and stillbirth [3]. New guidelines from the WHO examine the evidence for optimizing the health care

Objectives
Methods
Results
Conclusion
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call