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




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Reproductive Health

, 13:131

Female genital mutilation

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.

KeywordsFemale genital mutilation Episiotomy FGM Circumcision Obstetrics AbbreviationsFGMFemale genital mutilation

WHOWorld Health Organization

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Author: Maria I. Rodriguez - Armando Seuc - Lale Say - Michelle J. Hindin

Source: https://link.springer.com/







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