Antepartum or intrapartum deinfibulation for childbirth in women with type III female genital mutilation: A systematic review and meta‐analysis

Abstract

Background: There remains no consensus on the best timing of deinfibulation in

FGM Sister Study: Exploring the views of female genital mutilation/cutting survivors, male partners and healthcare professionals on the timing of re-opening surgery

“…To date there has been slow progress in the development of evidence-based care to improve health outcomes for FGM/C-survivors, in particular, around the optimal timing of deinfibulation (26,29,30), with recommendations typically based on expert opinion rather than robust evidence (29). Deinfibulation can be undertaken outside of or during pregnancy (30). There is however considerable variation within and between clinical recommendations for when deinfibulation should take place (29).…”

“…WHO guidelines on the management of FGM/C(26) recommend either antepartum or intrapartum deinfibulation with a suggestion that timing should be based on wider contextual factors including: patient preference, access to health-care facilities, place of delivery and the HCPs skill level. In addition to a lack of consensus about when deinfibulation should be performed, there is also debate about whether timing affects outcomes with some individual studies suggesting that obstetric risks increase the later deinfibulation is undertaken (33,34), although these findings were not substantiated in a recent systemic review of low quality observational evidence comparing childbirth outcomes between antepartum and intrapartum deinfibulation (30). This review(30) did however report that the limited data show a benefit for deinfibulation.…”

“…The WHO has suggested that deinfibulation is beneficial for the health and well-being of girls and women and reduces the risk of negative outcomes in childbirth (26). Currently however, there is no clear consensus on the optimal timing of deinfibulation for type 3 FGM/C-survivors (26,29,30). Recommendations for future FGM/C research suggest that "there is a urgent need for well-designed research to inform evidence-based guidelines, and to improve the healthcare of women and girls with FGM/C" (29)(pg.8).…”

Exploring the views of female genital mutilation survivors, their male partners and healthcare professionals on the timing of deinfibulation surgery and NHS FGM care provision (the FGM Sister Study): protocol for a qualitative study

“…There has been slow progress in the development of evidence-based care to improve health outcomes for FGM survivors, in particular, around the optimal timing of deinfibulation 20 23 24. Deinfibulation can be undertaken outside of or during pregnancy24; however, there is considerable variation within and between clinical recommendations for when deinfibulation should occur 23. For example, Royal College of Obstetricians and Gynaecologists (RCOG) guidelines25 recommend that deinfibulation should be offered prior to pregnancy and preferably before first sexual intercourse.…”

Deinfibulation for treating urologic complications of type III female genital mutilation: A systematic review

“…For adult women, a single study suggests that the procedure is best performed before pregnancy but may be carried out between 20–28 weeks of pregnancy, or during labor . There remains an evidence gap on the best timing for deinfibulation…”