Effect of female genital cutting performed by health care professionals on labor complications in Egyptian women: a prospective cohort study
-
Wael F. Saleh
, Haitham A. Torky
Abstract
Aim:
To examine the effect of the degree of female genital cutting (FGC) performed by health-care professionals on perineal scarring; delivery mode; duration of second stage of labor; incidence of perineal tears and episiotomy in a cohort of uncircumcised versus circumcised (types I and II) women.
Methods:
A prospective cohort study included 450 primigravida women in active labor attending the Faculty of Medicine Cairo University Hospital between January 2013 and August 2014. Women were divided into three groups based on medical examination upon admission. Group I (Control) included 150 uncut women, Group II included 150 women with type I FGC and Group III included 150 women with type II FGC. A structured questionnaire elicited the information on women’s socio-demographic characteristics including age, residence, occupation, educational level, age of marriage and FGC circumstances. Association between FGC and labor complications was examined. Main outcomes: risk of perineal scarring; delivery mode; duration of second stage of labor; incidence of perineal tears and episiotomy.
Results:
Family history of genitally cut mother/sister was the most significant socio-demographic factor associated with FGC. FGC especially type II was associated with significantly higher incidence of vulvar scar (P<0.0002), perineal tears (P<0.0001) and increased likelihood of additional vaginal and perineal trauma [odds ratio (OR): 1.85, 95% CI: 0.60–5.65. P≤0.001]. There was insignificant difference in risks of cesarean section (CS), instrumental delivery, episiotomy and short-term neonatal outcomes.
Conclusion:
The study strengthens the evidence that FGC increases the risk of tears in spite of medicalization of the practice.
Author’s statement
Conflict of interest: Authors state no conflict of interest.
Material and methods: Informed consent: Informed consent has been obtained from all individuals included in this study.
Ethical approval: The research related to human subject use has complied with all the relevant national regulations, and institutional policies, and is in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional review board or equivalent committee.
References
[1] WHO. Female genital mutilation: an overview. Geneva: World Health Organization; 1998.Search in Google Scholar
[2] Wines. Female circumcision is curbed in Egypt. Br Med J. 1996;313:249.10.1136/bmj.313.7052.249Search in Google Scholar
[3] DHS. Egypt 2003 Egypt Interim Demographic and Health Survey, 2003 (English). http://www.measuredhs.com/pubs/pub.Search in Google Scholar
[4] UNICEF. Female genital mutilation/cutting: a statistical exploration 2005. New York: UNICEF; 2005.10.12968/indn.2005.1.8.73966Search in Google Scholar
[5] El-Zanaty, Fatma and Ann Way. 2009. Egypt Demographic and Health Survey 2008. Cairo, Egypt: Ministry of Health, El-Zanaty and Associates, and Macro International.Search in Google Scholar
[6] El-Zanaty 2014. Egypt Demographic and Health Survey 2014. Cairo, Egypt: Ministry of Health, El-Zanaty and Associates.Search in Google Scholar
[7] Shell-duncan B, Herlund Y. Female circumcision in Africa: dimensions of the practice and debates. Female circumcision in Africa: culture, controversy and change. Boulder CO: Lynne Reinner; 2000.10.1515/9781685850036-002Search in Google Scholar
[8] Askalany MSM. The Impact of Female Circumcision and Its Types on the Sexual and Reproductive Health of Married Women; MSc thesis, Assiut, 1998. pp. 51–80.Search in Google Scholar
[9] Dandash KF, Refaat AH, Eyada M. Female genital mutilation: a descriptive study. J Sex Marital Ther. 2001;27:453–8.10.1080/713846799Search in Google Scholar
[10] Amin MM, Rasheed S, Salem E. Lower urinary tract symptoms following female genital mutilation. Int J Gynaecol Obstet. 2013;123:21–3.10.1016/j.ijgo.2013.06.010Search in Google Scholar
[11] WHO/UNFPA/UNICEF. Female genital mutilation. A Joint WHO/UNICEF/UNFPA statement. Geneva: World Health Organization; 1997.Search in Google Scholar
[12] Michael M. Egypt officials ban female circumcision, 2007. USAToday website. Available at: http://usatoday30.usatoday.com/news/health/2007-06-29-2239170064_x.htm. Last accessed June 11, 2017.Search in Google Scholar
[13] Rasheed SM, Abd-Ellah AH, Yousef FM. Female genital mutilation in Upper Egypt in the new millennium. Int J Gynaecol Obstet. 2011;114:47–50.10.1016/j.ijgo.2011.02.003Search in Google Scholar
[14] Zayed AA, Ali AA. Abusing female children by circumcision is continued in Egypt. J Forensic Leg Med. 2012;19:196–200.10.1037/e734362011-054Search in Google Scholar
[15] Hassanin IM, Shaaban OM. Impact of the complete ban on female genital cutting on the attitude of educated women from upper Egypt toward the practice. Int J Gynaecol Obstet. 2013;120:275–8.10.1016/j.ijgo.2012.10.010Search in Google Scholar
[16] Yount KM. Like mother, like daughter? Female genital cutting in Minia, Egypt. J Health Soc Behav. 2000;43:336–58.10.2307/3090208Search in Google Scholar
[17] Banks E, Meirik O, Farley T, Akande O, Bathija H, Ali M. Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries. Lancet. 2006;367:1835–41.10.1016/S0140-6736(06)68805-3Search in Google Scholar
[18] Browning A, Allsworth JE, Wall LL. The relationship between female genital cutting and obstetric fistulae. Obstet Gynecol. 2010;115:578–83.10.1097/AOG.0b013e3181d012cdSearch in Google Scholar PubMed PubMed Central
[19] Berg RC, Underland V. The obstetric consequences of female genital mutilation/cutting: a systematic review and meta-analysis. Obstet Gynecol Int. 2013;2013:496564.10.1155/2013/496564Search in Google Scholar
[20] Frega A, Puzio G, Maniglio P, Catalano A, Milazzo GN, Lombardi D, et al. Obstetric and neonatal outcomes of women with FGM I and II in San Camillo Hospital, Burkina Faso. Arch Gynecol Obstet. 2013;288:513–9.10.1007/s00404-013-2779-ySearch in Google Scholar
[21] Chibber R, El-Saleh E, El Harmi J. Female circumcision: obstetrical and psychological sequelae continues unabated in the 21st century. J Matern Fetal Neonatal Med. 2011;24:833–6.10.3109/14767058.2010.531318Search in Google Scholar
[22] Hakim LY. Impact of female genital mutilation on maternal and neonatal outcomes during parturition. East Afr Med J. 2001;78:255–8.10.4314/eamj.v78i5.9049Search in Google Scholar
[23] De Silva S. Obstetric sequelae of female circumcision. Eur J Obstet Gynecol Reprod Biol. 1989;32:233–40.10.1016/0028-2243(89)90041-5Search in Google Scholar
[24] Larsen U, Okonofua FE. Female circumcision and obstetric complications. Int J Gynaecol Obstet. 2002;77:255–65.10.1016/S0020-7292(02)00028-0Search in Google Scholar
[25] Refaat A. Medicalization of female genital cutting in Egypt. East Mediterr Health J. 2009;15:1379–88.Search in Google Scholar
[26] Global Strategy to stop health – care providers from performing FGM. UNAIDS, UNDP, UNFPA, UNHCR, UNICEF, UNIFEM, WHO, FIGO, ICN, IOM, MWIA, WCPT, WMA. WHO/RHR/10.9; 2010. Technical.Search in Google Scholar
[27] Meleigy M. Egypt tightens ban on female genital mutilation after 12 year old girl dies. Br Med J. 2007;335:15.10.1136/bmj.39266.425752.DBSearch in Google Scholar PubMed PubMed Central
[28] Prual A, Bouvier-Colle MH, de Bernis L, Bréart G. Severe maternal morbidity from direct obstetric causes in West Africa: incidence and case fatality rates. Bull World Health Organ. 2000;78:593–602.Search in Google Scholar
[29] Ronsmans C, Etard JF, Walraven G, Høj L, Dumont A, de Bernis L, et al. Maternal mortality and access to obstetric services in West Africa. Trop Med Int Health. 2003;8:940–8.10.1046/j.1365-3156.2003.01111.xSearch in Google Scholar PubMed
[30] Serour GI. Medicalization of female genital mutilation/cutting. Afr J Urol. 2013;19:145–9.10.1016/j.afju.2013.02.004Search in Google Scholar
©2018 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Editorial
- Maternal medicine: an evolving discipline
- Corner of Academy
- Pregnancy after malignant disease – challenges and possibilities
- Review articles
- Animatio: a history of ideas on the beginning of personhood
- Expectant management of caesarean scar ectopic pregnancy: a systematic review
- Highlight articles
- Maternal outcomes in first and second trimester termination of pregnancy: which are the risk factors?
- A preliminary study of uterine scar tissue following cesarean section
- Catastrophic antiphospholipid syndrome (Ronald Asherson syndrome) and obstetric pathology
- Comparison of healthcare utilization and outcomes by gestational diabetes diagnostic criteria
- Adverse pregnancy outcomes and inherited thrombophilia
- Effect of female genital cutting performed by health care professionals on labor complications in Egyptian women: a prospective cohort study
- Letters to the Editor
- Effect of female genital cutting performed by health care professionals on labor complications in Egyptian women: methodological concerns
- Reply to: Effect of female genital cutting performed by health care professionals on labor complications in Egyptian women: methodological concerns
- Short communication
- Maternal plasma LPCAT 1 mRNA correlates with lamellar body count
- Original articles
- Experimental neonatal hypoxia ischemia causes long lasting changes of oxidative stress parameters in the hippocampus and the spleen
- Altered thymocyte and T cell development in neonatal mice with hyperoxia-induced lung injury
Articles in the same Issue
- Frontmatter
- Editorial
- Maternal medicine: an evolving discipline
- Corner of Academy
- Pregnancy after malignant disease – challenges and possibilities
- Review articles
- Animatio: a history of ideas on the beginning of personhood
- Expectant management of caesarean scar ectopic pregnancy: a systematic review
- Highlight articles
- Maternal outcomes in first and second trimester termination of pregnancy: which are the risk factors?
- A preliminary study of uterine scar tissue following cesarean section
- Catastrophic antiphospholipid syndrome (Ronald Asherson syndrome) and obstetric pathology
- Comparison of healthcare utilization and outcomes by gestational diabetes diagnostic criteria
- Adverse pregnancy outcomes and inherited thrombophilia
- Effect of female genital cutting performed by health care professionals on labor complications in Egyptian women: a prospective cohort study
- Letters to the Editor
- Effect of female genital cutting performed by health care professionals on labor complications in Egyptian women: methodological concerns
- Reply to: Effect of female genital cutting performed by health care professionals on labor complications in Egyptian women: methodological concerns
- Short communication
- Maternal plasma LPCAT 1 mRNA correlates with lamellar body count
- Original articles
- Experimental neonatal hypoxia ischemia causes long lasting changes of oxidative stress parameters in the hippocampus and the spleen
- Altered thymocyte and T cell development in neonatal mice with hyperoxia-induced lung injury