Outcome of Labour in Women with Female Genital Mutilation

Abstract

Female Genital Mutilation (FGM) or Female Circumcision is widely practiced and highly prevalent in Sudan, and it has long been blamed for adversely affecting childbirth. This is a prospective observational case control study to assess the pattern of labour and to determine the possible complications of labour in women with female genital mutilation and to determine the relationship of certain demographical factors to the FGM status of a woman. The study was carried out at two referral hospitals in Khartoum State; Soba University Hospital and Ibrahim Malik Hospital during the period between First of August and Third of September 2002. Two hundred forty five women attending for vaginal delivery and fulfilling the inclusion criteria were recruited in the study, 163 women with FGM constituted the cases and 82 women without FGM were taken as controls. Information regarding their FGM status, personal characteristics, demographic factors and health indicators were recorded and they were followed up during labour and delivery, up until they were discharged. The prevalence of FGM among the studied women was 67% and 82.82%of women with FGM were infibulated. Tribe and religion were the main demographic factors affecting the FGM status of a woman. Women with female genital mutilation were found to have significantly narrower diameter of the introitus than those without FGM (P = 0.000). They also have longer mean duration of labour but this was not statistically significant. They were also found to have longer mean duration of the second and third stages of labour (P = 0.022 for 2nd stage and P = 0.000 for 3rd stage). The mean amount of postpartum blood loss was significantly greater in women with female genital mutilation (P = 0.00). Women with FGM were significantly at higher risk of having episiotomy during delivery (P = 0.000). They were also found to be more likely to have their labour augmented (P = 0.00556).There were no significant differences in the rate of caesarean section or instrumental vaginal deliveries. Regarding the fetal outcome no significant differences were found in the Apgar score or rate of stillbirths. According to the above results recommendations are made to encourage birth attendants to be more conservative in performing episiotomies and to establish manuals and protocols for management of women with FGM.