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.

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

Reprod Health. 2016 Oct 10;13(1):131.FREE

Episiotomy and obstetric outcomes among women living with type 3 female genital mutilation: a secondary analysis.

Rodriguez MI, Seuc A, Say L, Hindin MJ

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

METHODS: We 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.

RESULTS: Type 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.

CONCLUSIONS: Among 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.

This article can be accessed in this LINK

432 Somali women’s birth experiences in Canada after earlier female genital mutilation

Birth. 2000 Dec;27(4):227-34.
432 Somali women’s birth experiences in Canada after earlier female genital mutilation.
Chalmers B, Hashi KO
BACKGROUND: Women with previous female genital mutilation (sometimes referred to as circumcision) are migrating, with increasing frequency, to countries where this practice is uncommon. Many health care professionals in these countries lack experience in assisting women with female genital mutilation during pregnancy and birth, and they are usually untrained in this aspect of care. Somali women who customarily practice the most extensive form of female mutilation, who were resident in Ontario and had recently given birth to a baby in Canada, were surveyed to explore their perceptions of perinatal care and their earlier genital mutilation experiences.
METHOD: Interviews of 432 Somali women with previous female genital mutilation, who had given birth to a baby in Canada in the past five years, were conducted at their homes by a Somali woman interviewer.
RESULTS: Findings suggested that women’s needs are not always adequately met during their pregnancy and birth care. Women reported unhappiness with both clinical practice and quality of care.
CONCLUSIONS: Changes in clinical obstetric practice are necessary to incorporate women’s perceptions and needs, to use fewer interventions, and to demonstrate greater sensitivity for cross-cultural practices and more respectful treatment than is currently available in the present system of care.

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…

This article can be accessed in this LINK

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.

This article can be accessed in this LINK

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…

This article can be accessed in this LINK

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