1
|
André K, Stuart A, Källén K. Maternal origin matters: Country of birth as a risk factor for obstetric anal sphincter injuries. Int J Gynaecol Obstet 2024; 166:426-434. [PMID: 38358267 DOI: 10.1002/ijgo.15427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE Obstetric anal sphincter injuries (OASIS) are severe complications to vaginal births with potential long-term consequences. Maternal origin has been proposed to affect the overall risk, but the association and underlying explanation are uncertain. The objective was to assess the association between maternal country of birth and OASIS. METHODS A Swedish nationwide cohort study including singleton term vaginal births during 2005-2016. Data were extracted from the Swedish Medical Birth Registry and Statistics Sweden. Modified Poisson regression analyses were performed to obtain crude and adjusted risk ratios (RRs). Adjustments were made in four cumulative steps. Sub-analyses were performed to investigate the risk of OASIS associated with female genital circumcision (FGC). RESULTS In all, 988 804 births were included. The rate of OASIS in Swedish-born women was 3.5%. Women from East/Southeast Asia had an increased risk of OASIS (adjusted RR [aRR] 1.71, 95% confidence interval [CI] 1.60-1.83), as did women born in Sub-Saharan Africa (aRR 1.60, 95% CI 1.49-1.72). The risk remained significantly increased also after adjustment for maternal height. By contrast, women from South/Central America had a decreased risk of OASIS (aRR 0.65, 95% CI 0.56-0.76). FGC was associated with an increased risk of OASIS (aRR 3.05, 95% CI 2.60-3.58). Episiotomy appeared to have an overall protective effect (aRR 0.95, 95% CI 0.92-0.98), but not significantly more protective among women with female genital mutilation. CONCLUSIONS Country of birth plays an important role in the risk of OASIS. Women from East/Southeast Asia and Sub-Saharan Africa are at significantly increased risk as compared with Swedish-born women, whereas women from South/Central America are at lower risk. FGC is also a significant risk factor for OASIS.
Collapse
Affiliation(s)
- Kristin André
- Institution of Clinical Sciences, Lund University, Lund, Sweden
- Department of Obstetrics and Gynecology, Helsingborg Central Hospital, Helsingborg, Sweden
| | - Andrea Stuart
- Institution of Clinical Sciences, Lund University, Lund, Sweden
- Department of Obstetrics and Gynecology, Helsingborg Central Hospital, Helsingborg, Sweden
| | - Karin Källén
- Institution of Clinical Sciences, Lund University, Lund, Sweden
- Centre for Reproductive Epidemiology, Tornblad Institute, Lund University, Lund, Sweden
| |
Collapse
|
2
|
Bonavina G, Spinillo SL, Sotiriadis A, Bulfoni A, Kaltoud R, Salvatore S, Candiani M, Ivo Cavoretto P. Effect of type III female genital mutilation on obstetric outcomes: A systematic review and meta-analysis. Heliyon 2024; 10:e29336. [PMID: 38628703 PMCID: PMC11019231 DOI: 10.1016/j.heliyon.2024.e29336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/05/2024] [Accepted: 04/05/2024] [Indexed: 04/19/2024] Open
Abstract
Background Controversial evidence suggests a potential association between female genital mutilation (FGM/C) and adverse obstetric outcomes, with type III FGM/C (infibulation) carrying the greatest risk. The aim of this systematic review and meta-analysis was to assess current rate of adverse obstetric outcomes in women with type III female genital mutilation and cutting (FGM/C; infibulation) delivering across different settings worldwide. Methods We searched PubMed, Scopus, Embase, and ClinicalTrials.gov databases from inception to Jan 1, 2023. Studies were selected if they included the main outcome of postpartum haemorrhage (PPH) or secondary outcomes, which included major conditions affecting maternal-neonatal health during labour and delivery. DerSimonian-Laird random effects meta-analysis including pooled effect estimates with corresponding 95 % confidence intervals was performed. Heterogeneity was assessed using the I2 statistic. Meta regression for relevant covariates was performed when data on relevant confounders were available. The Newcastle-Ottawa scale (NOS) was used to assess quality of observational studies. The level of evidence was assessed with the GRADE method. Results 14 observational studies including 15,320 type III FGM/C women and 59,347 controls were eligible. The risk for postpartum haemorrhage was significantly increased in type III FGM/C, in the main analysis (OR 1.83, 95 % CI 1.03 to 3.24, I2 = 93 %), in pooling of data adjusted for confounders (aOR 1.76, CI 1.42 to 2.17, I2 = 0 %), and in sensitivity analysis of higher quality studies with NOS≥7 (OR 2.76, CI 1.38 to 5.51, I2 = 95 %). Meta-regression showed that nulliparity was significantly and positively associated with postpartum haemorrhage. Similarly, analysis of data adjusted for confounders showed an increased risk of episiotomy in type III FGM/C (aOR 1.56, CI 1.03 to 2.35, I2 = 52 %). Sensitivity analysis of studies with NOS≥7 revealed a significant increase for episiotomy (OR 7.53, CI 1.19 to 47.54, I2 = 96 %), perineal tears (OR 4.24, CI 1.09 to 16.46, I2 = 66 %), prolonged second stage of labour (OR 5.19, 95 % CI 1.00 to 26.85, I2 = 66 %), and Apgar score less than 7 (OR 4.19, CI 1.64 to 10.70, I2 = 0 %). No difference was found regarding obstetric anal sphincter injuries and mode of delivery in these women. Deinfibulation achieved similar obstetric and neonatal outcomes to women who never had type III FGM. The overall quality of the studies was adequate (median NOS score: 7; IQR: 6-8), the level of evidence, according to the GRADE assessment, was low. Conclusions These results consistently show an increased risk of adverse obstetric outcomes in women with FGM/C type III. Infibulation substantially increases the risk for PPH, particularly in nulliparae. Systematic Review registration: PROSPERO CRD42023421993.
Collapse
Affiliation(s)
- Giulia Bonavina
- Department of Obstetrics and Gynecology, IRCCS Humanitas Research Hospital, Humanitas University, 20090, Milan, Italy
- Department of Obstetrics and Gynecology, Port Sudan Maternity Teaching Hospital, Red Sea State University, 33312, Port Sudan, Red Sea State, Sudan
| | - Silvia Lina Spinillo
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
- University Vita-Salute, 20132, Milan, Italy
| | - Alexandros Sotiriadis
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Alessandro Bulfoni
- Department of Obstetrics and Gynecology, IRCCS Humanitas Research Hospital, Humanitas University, 20090, Milan, Italy
| | - Randa Kaltoud
- Department of Obstetrics and Gynecology, Port Sudan Maternity Teaching Hospital, Red Sea State University, 33312, Port Sudan, Red Sea State, Sudan
| | - Stefano Salvatore
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
- University Vita-Salute, 20132, Milan, Italy
| | - Massimo Candiani
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
- University Vita-Salute, 20132, Milan, Italy
| | - Paolo Ivo Cavoretto
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
- University Vita-Salute, 20132, Milan, Italy
| |
Collapse
|
3
|
Gnofam M, Crequit S, Renevier B, Abramowicz S. Prognostic factors of poor surgical outcome after clitoral reconstruction in women with female genital mutilation/cutting. J Sex Med 2023; 21:59-66. [PMID: 38014807 DOI: 10.1093/jsxmed/qdad150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/04/2023] [Accepted: 09/27/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Complications of surgical clitoral reconstruction for female genital mutilation/cutting (FGM/C) are a rare occurrence, but there has been reports of patients experiencing chronic pain or clitoral burial. AIM This study aims to assess which factors are predictive of the occurrence of surgical complications in women who had surgical reconstruction for FGM/C (type 1, 2, or 3). METHODS This monocentric retrospective study was conducted among patients who underwent clitoral reconstruction after FGM/C from January 2016 to March 2020. Demographic and clinical data were abstracted from the medical records. OUTCOMES The primary outcome was the occurrence of chronic pain (defined as occurrence or persistence of any clitoral pain >3 months after surgery), and the secondary outcome was the occurrence of clitoral burial. RESULTS A total of 87 women were included in the analysis. Univariate analysis indicated significantly higher rates of a history of physical abuse in the group of women who experienced chronic pain after surgery (4 [100%] vs 2 [37.1%], P = .049). Patients with clitoral burial were significantly younger than the rest of the sample in univariate analysis (median [IQR], 29.6 years [24.6-30.2] vs 33.8 [28.2-37.9]; P = .049). CLINICAL IMPLICATIONS Surgical treatment of women who underwent FGM/C should include the entire history of the patient and especially a record of experiencing physical abuse. STRENGTHS AND LIMITATIONS The study stands out for its originality, the extensive sample size gathered over nearly 4 years, the surgical clitoral reconstructions conducted by an experienced surgeon, and the minimal amount of missing data. However, because the occurrence of these complications was rare, the number of patients in the subgroups was extremely low, preventing a valid multivariate analysis to be conducted. CONCLUSION The study suggests that women with a history of physical abuse could be at greater risk for chronic pain after surgery and that younger women tend to experience more clitoral burial.
Collapse
Affiliation(s)
- Mayi Gnofam
- Département d'obstétrique et de gynécologie, Hôpital Louis Mourier (Assistance Publique Hôpitaux de Paris), Colombes, 92700, France
- Département d'obstétrique et de gynécologie, Hôpital Maison Blanche (Centre hospitalier universitaire de Reims), Reims, 51092, France
| | - Simon Crequit
- Département d'obstétrique et de gynécologie, Centre hospitalier intercommunal André Grégoire, Montreuil, 93100, France
| | - Bruno Renevier
- Département d'obstétrique et de gynécologie, Centre hospitalier intercommunal André Grégoire, Montreuil, 93100, France
| | - Sarah Abramowicz
- Département d'obstétrique et de gynécologie, Centre hospitalier intercommunal André Grégoire, Montreuil, 93100, France
| |
Collapse
|
4
|
Rabiepour S, Ahmadi Z. The effect of female circumcision on maternal and neonatal outcomes after childbirth: a cohort study. BMC Pregnancy Childbirth 2023; 23:46. [PMID: 36670393 PMCID: PMC9854179 DOI: 10.1186/s12884-022-05316-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 12/19/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Circumcision has many side effects and complications on women's lives and affects their physical, mental, and social health. The present study aimed to investigate the effect of female circumcision on maternal and neonatal outcomes. METHODS Methods: A prospective cohort study was performed with 320 pregnant women by convenience sampling (160 individuals were circumcised and 160 were uncircumcised). Circumcision and its level were confirmed using observation. The data relating to demographic, midwifery history, medical history, maternal and neonatal outcomes were compiled using a questionnaire. All Statistical analyses were conducted by SPSS ver. 16.0. P-values less than 0.05 were considered significant. RESULTS The mean age of circumcised women was significantly higher vs. Uncircumcised women (28.92±6.2 vs. 25.42±4.8; P < 0.001). Circumcision was significantly higher in rural compared to urban areas (51.9% vs.18.1%). The level of female education, his parents, spouse, and husband's employment status were significantly associated with circumcision (P < 0.001). 94.4% of uncircumcised nulliparous women and 86.9% of circumcised women experienced Intended Pregnancy (P=0.02). Eighty- five percent of women were circumcision type I. The higher mean duration of the second stage of labor, Second and Third degree of tear, and need for oxytocin in induction were significantly higher among circumcised women (P = 0.03, 0.003, 0.002, respectively). The existence one stage of labor, Second and Third degree of tear, and the need for oxytocin in induction were significantly higher among circumcised women (P = 0.03, 0.003, 0.002, respectively). CONCLUSION These findings underscore that Circumcision a prevalent predictor of poor neonatal outcomes and delivery processes, therefore this circumcised women needs intensive care during delivery.
Collapse
Affiliation(s)
- Soheila Rabiepour
- grid.412763.50000 0004 0442 8645Professor Reproductive research center, Urmia university of Medical ScienceUrmia, Urmia, Iran
| | - Zeynab Ahmadi
- Consultation on midwifery, Reproductive Health Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran.
| |
Collapse
|
5
|
Taraldsen S, Vangen S, Øian P, Sørbye IK. Risk of obstetric anal sphincter injury associated with female genital mutilation/cutting and timing of deinfibulation. Acta Obstet Gynecol Scand 2022; 101:1163-1173. [PMID: 35946127 PMCID: PMC9812199 DOI: 10.1111/aogs.14424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION A greater risk of obstetric anal sphincter injury has been reported among African migrants in several host countries compared with the general population. To what degree female genital mutilation/cutting affects this risk is not clear. In infibulated women, deinfibulation prevents anal sphincter injury. Whether the timing of deinfibulation affects the risk, is unknown. This study aimed to investigate the risks of anal sphincter injury associated with female genital mutilation/cutting and timing of deinfibulation in Norway, and to compare the rates of anal sphincter injury in Somali-born women and the general population. MATERIAL AND METHODS In a historical cohort study, nulliparous Somali-born women who had a vaginal birth in the period 1990-2014 were identified by the Medical Birth Registry of Norway and data collected from medical records. Exposures were female genital mutilation/cutting status and deinfibulation before labor, during labor or no deinfibulation. The main outcome was obstetric anal sphincter injuries. RESULTS Rates of obstetric anal sphincter injury did not differ significantly by female genital mutilation/cutting status (type 1-2: 10.2%, type 3: 11.3%, none: 15.2% P = 0.17). The total rate of anal sphincter injury was 10.3% compared to 5.0% among nulliparous women in the general Norwegian population. Women who underwent deinfibulation during labor had a lower risk than women who underwent deinfibulation before labor (odds ratio 0.48, 95% confidence interval 0.27-0.86, P = 0.01). CONCLUSIONS The high rate of anal sphincter injury in Somali nulliparous women was not related to type of female genital mutilation/cutting. Deinfibulation during labor protected against anal sphincter injury, whereas deinfibulation before labor was associated with a doubled risk. Deinfibulation before labor should not be routinely recommended during pregnancy.
Collapse
Affiliation(s)
- Sølvi Taraldsen
- Norwegian Research Center for Women's Health, Division of Obstetrics and GynecologyOslo University HospitalOsloNorway
- Institute of Clinical MedicineUniversity of OsloNorway
| | - Siri Vangen
- Norwegian Research Center for Women's Health, Division of Obstetrics and GynecologyOslo University HospitalOsloNorway
- Institute of Clinical MedicineUniversity of OsloNorway
| | - Pål Øian
- Department of Obstetrics and GynecologyUniversity Hospital of North NorwayTromsøNorway
| | - Ingvil K. Sørbye
- Norwegian Research Center for Women's Health, Division of Obstetrics and GynecologyOslo University HospitalOsloNorway
- Department of Obstetrics and GynecologyOslo University HospitalOsloNorway
| |
Collapse
|
6
|
Jatta F, Sundby J, Vangen S, Lindskog BV, Sørbye IK, Owe KM. Association between Maternal Origin, Pre-Pregnancy Body Mass Index and Caesarean Section: A Nation-Wide Registry Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115938. [PMID: 34205921 PMCID: PMC8197892 DOI: 10.3390/ijerph18115938] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/28/2021] [Accepted: 05/29/2021] [Indexed: 02/03/2023]
Abstract
Aims: To explore the association between maternal origin and birthplace, and caesarean section (CS) by pre-pregnancy body mass index (BMI) and length of residence. Methods: We linked records from 118,459 primiparous women in the Medical Birth Registry of Norway between 2013 and 2017 with data from the National Population Register. We categorized pre-pregnancy BMI (kg/m2) into underweight (<18.5), normal weight (18.5–24.9) and overweight/obese (≥25). Multinomial regression analysis estimated crude and adjusted relative risk ratios (RRR) with 95% confidence intervals (CI) for emergency and elective CS. Results: Compared to normal weight women from Norway, women from Sub-Saharan Africa and Southeast Asia/Pacific had a decreased risk of elective CS (aRRR = 0.57, 95% CI 0.37–0.87 and aRRR = 0.56, 0.41–0.77, respectively). Overweight/obese women from Europe/Central Asia had the highest risk of elective CS (aRRR = 1.42, 1.09–1.86). Both normal weight and overweight/obese Sub-Saharan African women had the highest risks of emergency CS (aRRR = 2.61, 2.28-2.99; 2.18, 1.81-2.63, respectively). Compared to women from high-income countries, the risk of elective CS was increasing with a longer length of residence among European/Central Asian women. Newly arrived migrants from Sub-Saharan Africa had the highest risk of emergency CS. Conclusion: Women from Sub-Saharan Africa had more than two times the risk of emergency CS compared to women originating from Norway, regardless of pre-pregnancy BMI.
Collapse
Affiliation(s)
- Fatou Jatta
- Institute of Health and Society, Department of Community Medicine and Global Health, University of Oslo, 0317 Oslo, Norway; (F.J.); (J.S.)
| | - Johanne Sundby
- Institute of Health and Society, Department of Community Medicine and Global Health, University of Oslo, 0317 Oslo, Norway; (F.J.); (J.S.)
| | - Siri Vangen
- Norwegian Research Centre for Women’s Health, Department of Obstetrics and Gynecology, Oslo University Hospital, 0424 Oslo, Norway; (S.V.); (I.K.S.)
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | | | - Ingvil Krarup Sørbye
- Norwegian Research Centre for Women’s Health, Department of Obstetrics and Gynecology, Oslo University Hospital, 0424 Oslo, Norway; (S.V.); (I.K.S.)
| | - Katrine Mari Owe
- Norwegian Research Centre for Women’s Health, Department of Obstetrics and Gynecology, Oslo University Hospital, 0424 Oslo, Norway; (S.V.); (I.K.S.)
- Department of Child health and development, Norwegian Institute of Public Health, 0213 Oslo, Norway
- Correspondence: ; Tel.: +47-91683023
| |
Collapse
|