Tag Archives: Obstetric Labor Complications

Medical problems associated with OBSTETRIC LABOR, such as BREECH PRESENTATION; PREMATURE OBSTETRIC LABOR; HEMORRHAGE; or others. These complications can affect the well-being of the mother, the FETUS, or both.

Female genital mutilation/cutting: an update

Clin Exp Obstet Gynecol2015;42(3):300-3.
Female genital mutilation/cutting: an update.
Rouzi AA, Alturki F.
Female genital mutilation/cutting (FGM/C) is a cultural practice involving several types of external female genitalia cutting. FGM/C is known to occur in all parts of the world but is most prevalent in 28 countries in Africa and the Middle East and among immigrant communities in Europe, Australia, New Zealand, Canada, and the United States. Studies of FGM/C suffer from many methodological problems including inadequate analysis and an unclear reporting of results. The evidence to link FGM/C to infertility is weak. The management of epidermal clitoral inclusion cysts includes expensive investigations like comprehensive endocrinology tests and MRI resulting in unnecessary anxiety due to delay in surgical treatment. Similarly, unnecessary cesarean sections or rupture of the infibulation scar continue to occur because of the inadequate use of intrapartum defibulation. A significant amount of efforts is required to improve and correct the inadequate care of FGM/C women and girls.

Female circumcision as a public health issue

The New England Journal of Medicine. 1994;Sept 15:712-716FREE

Female circumcision as a public health issue

Toubia N


In many civilizations, certain surgical procedures have profound cultural and social meanings. Male circumcision, for example, has deeb importance as a symbol of religious and ethnic identity and has played a major part in the political and social history of many peoples. Female circumcision has particularly strong cultural meaning because it is closely linked to women’s sexuality and their reproductive role in society…

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An explorative study of Sudanese midwives’ motives, perceptions and experiences of re-infibulation after birth

Midwifery. 2004, 20(4); 299–311.

An explorative study of Sudanese midwives’ motives, perceptions and experiences of re-infibulation after birth

Berggren V, Abdel Salam G, Bergström S, Johansson E, Edberg A


Objective: to explore Sudanese midwives’ motives for and perceptions and experiences of re-infibulation after birth and to elucidate its context and determinants. Design: triangulation of methods, using observational techniques and open-ended interviews. Setting and participants: two government hospitals in Khartoum/Omdurman, Sudan, for the observations and in-depth interviews with 17 midwives. Findings: midwives are among the major stakeholders in the performance of primary female genital cutting (FGC) as well as re-infibulation. Focusing on re-infibulation after birth, midwives were trying to satisfy differing, and sometimes contradictory, perspectives. The practice of re-infibulation (El Adel) represented a considerable source of income for the midwives. The midwives integrated the practice of re-infibulation into a greater whole of doing well for the woman, through an endeavour to increase her value by helping her to maintain her marriage as well as striving for beautification and completion. They were also trying to meet socio-cultural requests, dealing with pressure from the family while balancing on the edge of the law. Key conclusions and implications for practice: the findings confirm that midwives are important stakeholders in perpetuating re-infibulation, and indicate that the motives are more complex than being only economic. The constant balancing between demands from others puts the midwives in a difficult position. Midwives’ potential role to influence views in the preventative work against FGC and re-infibulation should be acknowledged in further abolition efforts.

This article can be accessed online

Management of type III female genital mutilation in Birmingham, UK: A retrospective audit

Midwifery. 2014, 30(3):282–288 DOI: http://dx.doi.org/10.1016/j.midw.2013.04.008

Management of type III female genital mutilation in Birmingham, UK: A retrospective audit

Paliwal P, Ali S, Bradshaw S, Hughes A, Jolly K


Female genital mutilation: The abuse has to stop

Midwifery, 2014, 30, 277–278. DOI: http://dx.doi.org/10.1016/j.midw.2014.02.001

Female genital mutilation: The abuse has to stop

Bick D


Female genital mutilation (FGM) involves the partial or total removal of the female external genitalia or injury of the genitalia with no medical indication or resulting health benefit (World Health Organisation, 2008). It is a custom prevalent in sub-Saharan countries of Africa, with some countries including Egypt, the Sudan and Somalia estimated to have a FGM prevalence of around 90% (United Nations Children׳s Fund, 2013). More midwives and other health professionals in the UK and elsewhere are providing care and support for women who have sustained FGM as a consequence of increased migration from countries where FGM is practiced.

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Female genital cutting

J Obstet Gynaecol Can. 2014 Aug;36(8):671-2.FREE

Female genital cutting

Kotaska A, Avery L

Comment in J Obstet Gynaecol Can. 2014 Aug;36(8):672.


Female genital cutting (FGC) is unethical. It causes physical, psychological, and emotional harm, and is rarely performed with consent. SOGC Clinical Practice Guideline no. 299 on FGC outlines this argument well.1 However, re-infibulation is inappropriately bundled together with FGC. Re-infibulation is fundamentally different, surgically and ethically, from FGC. The two need to be examined independently, particularly since the guideline prohibits re-infibulation…

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Effects of female genital cutting on physical health outcomes: a systematic review and meta-analysis

BMJ Open. 2014 Nov 21;4(11):e006316. doi: 10.1136/bmjopen-2014-006316.FREE

Effects of female genital cutting on physical health outcomes: a systematic review and meta-analysis

Berg RC, Underland V, Odgaard-Jensen J, Fretheim A, Vist GE


OBJECTIVE: Worldwide, an estimated 125 million girls and women live with female genital mutilation/cutting (FGM/C). We aimed to systematically review the evidence for physical health risks associated with FGM/C.

DESIGN: We searched 15 databases to identify studies (up to January 2012). Selection criteria were empirical studies reporting physical health outcomes from FGM/C, affecting females with any type of FGM/C, irrespective of ethnicity, nationality and age. Two review authors independently screened titles and abstracts, applied eligibility criteria, assessed methodological study quality and extracted full-text data. To derive overall risk estimates, we combined data from included studies using the Mantel-Haenszel method for unadjusted dichotomous data and the generic inverse-variance method for adjusted data. Outcomes that were sufficiently similar across studies and reasonably resistant to biases were aggregated in meta-analyses. We applied the instrument Grading of Recommendations Assessment, Development and Evaluation to assess the extent to which we have confidence in the effect estimates.

RESULTS: Our search returned 5109 results, of which 185 studies (3.17 million women) satisfied the inclusion criteria. The risks of systematic and random errors were variable and we focused on key outcomes from the 57 studies with the best available evidence. The most common immediate complications were excessive bleeding, urine retention and genital tissue swelling. The most valid and statistically significant associations for the physical health sequelae of FGM/C were seen on urinary tract infections (unadjusted RR=3.01), bacterial vaginosis (adjusted OR (AOR)=1.68), dyspareunia (RR=1.53), prolonged labour (AOR=1.49), caesarean section (AOR=1.60), and difficult delivery (AOR=1.88).

CONCLUSIONS: While the precise estimation of the frequency and risk of immediate, gynaecological, sexual and obstetric complications is not possible, the results weigh against the continuation of FGM/C and support the diagnosis and management of girls and women suffering the physical risks of FGM/C.

TRIAL REGISTRATION NUMBER: This study is registered with PROSPERO, number CRD42012003321.

This article can be accessed in this LINK

Maternal infibulation and obstetrical outcome in Djibouti.

J Matern Fetal Neonatal Med. 2014 Sep 19:1-23. [Epub ahead of print]

Maternal infibulation and obstetrical outcome in Djibouti.

Minsart AF, N’guyen TS, Hadji RA, Caillet M.


The objective of the present study was to assess the relation between female genital mutilation and obstetric outcome in an East African urban clinic with a standardized care, taking into account medical and socioeconomic status. Methods This was a cohort study conducted in Djibouti between October 1, 2012 and April 30, 2014. Overall 643 mothers were interviewed and clinically assessed for the presence of female genital mutilation. The prevalence of obstetric complications by infibulation status was included in a multivariate stepwise regression model. Results Overall, 29 of 643 women did not have any form of mutilation (4.5%), as opposed to 238 of 643 women with infibulation (37.0%), 369 with type 2 (57.4%), and 7 with type 1 mutilation (1.1%).Women with a severe type of mutilation were more likely to have socio-economic and medical risk factors. After adjustment, the only outcome that was significantly related with infibulation was the presence of meconium-stained amniotic fluid with an odds ratio of 1.58 (1.10-2.27), p-value=0.014. Conclusions Infibulation was not related with excess perinatal morbidity in this setting with a very high prevalence of female genital mutilation, but future research should concentrate on the relation between infibulation and meconium.

This article can be accessed in this LINK

Evidence to inform education, training and supportive work environments for midwives involved in the care of women with female genital mutilation: A review of global experience

Midwifery. 2014 Sep 6. pii: S0266-6138(14)00222-8. doi: 10.1016/j.midw.2014.08.012. [Epub ahead of print]

Evidence to inform education, training and supportive work environments for midwives involved in the care of women with female genital mutilation: A review of global experience.

Dawson A, Turkmani S, Fray S, Nanayakkara S, Varol N, Homer C.


OBJECTIVE: to identify how midwives in low and middle income countries (LMIC) and high income countries (HIC) care for women with female genital mutilation (FGM), their perceived challenges and what professional development and workplace strategies might better support midwives to provide appropriate quality care.

DESIGN: an integrative review involving a narrative synthesis of the literature was undertaken to include peer reviewed research literature published between 2004 and 2014.

FINDINGS: 10 papers were included in the review, two from LMIC and eight from HIC. A lack of technical knowledge and limited cultural competency was identified, as well as socio-cultural challenges in the abandonment process of the practice, particularly in LMIC settings. Training in the area of FGM was limited. One study reported the outcomes of an education initiative that was found to be beneficial.

KEY CONCLUSIONS: professional education and training, a working environment supported by guidelines and responsive policy and community education, are necessary to enable midwives to improve the care of women with FGM and advocate against the practice.

IMPLICATIONS FOR PRACTICE: improved opportunities for midwives to learn about FGM and receive advice and support, alongside opportunities for collaborative practice in contexts that enable the effective reporting of FGM to authorities, may be beneficial and require further investigation.

This article can be accessed in this LINK

Type I Female Genital Mutilation: A Cause of Completely Closed Vagina

J Sex Med. 2014 May 30. doi: 10.1111/jsm.12605. [Epub ahead of print]

Type I Female Genital Mutilation: A Cause of Completely Closed Vagina.

Rouzi AA, Sahly N, Alhachim E, Abduljabbar H.


INTRODUCTION: Female genital mutilation (FGM) ranges in severity from a nick of the clitoris to partial or total removal of the external genitalia. Sexual complications after FGM include sexual dysfunction, difficult intercourse, and dyspareunia. AIM: We report a case of Type I FGM presenting as complete vaginal closure and urinary retention.

METHODS: A 16-year-old adolescent was referred for obliterated vagina and urinary retention. She had recurrent urinary tract infections, difficulty in voiding, and cyclic hematuria. At the age of 1 year she had been taken by her mother to a pediatric surgeon to have a Type I FGM procedure. On examination, the urethral meatus and vaginal orifices were completely closed by the FGM scar. She underwent uneventful surgical opening of the vagina.

RESULTS: A normal vaginal orifice was created and normal flow of urine and menses occurred.

CONCLUSION: Type I FGM can present as complete vaginal closure and urinary retention. Proper diagnosis and treatment are of paramount importance.

This article can be accessed in this LINK