Effects of Female Genital Mutilation on Birth Outcomes in Switzerland

Abstract

Several investigators have hypothesized that outpatient preinduction cervical ripening with nitric oxide donors such as isosorbide mononitrate (IMN) would reduce the elapsed time from hospital admission to delivery and improve women's experience of induction of labor. This double-blind randomized placebo-controlled trial investigated whether vaginal self-administration at home by woman at term would improve the process of induction of labor. The study subjects were 350 nulliparous singleton women with cephalic presentation at Ն37 weeks' gestation, requiring cervical ripening before induction of labor. The participants self-administered IMN (n ϭ 177) or placebo (n ϭ 173) vaginally at home without fetal monitoring at 48, 32, and 16 hours before the scheduled time of admission for induction of labor. The primary study outcome measures were the elapsed time interval from hospital admission to delivery and the women's experience of home treatment for cervical ripening. Maternal satisfaction was determined with a questionnaire, using a 10 point scale with 1 ϭ extremely good and 10 ϭ not at all good.There was no statistically significant difference between the 2 study groups in the admission to delivery interval; the mean difference was 1.59 hours, with a 95% confidence interval (CI) of Ϫ5.08 to 1.89, P ϭ 0.37. Compared to placebo, however, IMN was more effective in inducing a mean change in modified Bishop score from recruitment to hospital admission (mean difference: 0.65 [95% CI, 0.14-1.17, P ϭ 0.013]). With regard to maternal satisfaction, the overall experience of home treatment was positive in both groups. Women in the placebo group reported it to be marginally more positive than those in the IMN group (placebo: 3.23 vs. IMN: 3.84; the mean difference was 0.61, with a 95% CI of 0.02-1.21, P ϭ 0.043). No difference between the 2 groups was reported in either pain or anxiety levels or in the willingness to have the treatment in a subsequent pregnancy.These data show that administration of IMN at home is effective in ripening the cervix but does not shorten the admission to delivery interval or improve maternal satisfaction. The investigators conclude from these findings that IMN in this setting has limited clinical value. EDITORIAL COMMENT(The appeal of the nitric oxide donor isosorbide mononitate (IMN) is its potential to induce cervical ripening without precipitating uterine contractions and thereby obviate the need for fetal heart rate monitoring, and allow cervical ripening to be conducted on an outpatient ba-OBSTETRICS Volume 64, Number 11 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACT This investigation was conducted as part of the Mother-Infant Rapid Intervention at Delivery (MIRIAD) study, a prospective, multicenter trial assessing routine rapid human immunodeficiency virus (HIV) screening of pregnant women in inpatient and outpatient settings. This study compared rapid HIV testing with conventional HIV testing in outpatient obstetric settings among a population of pregnant women who presented late in care wi...

Infibulated women have an increased risk of anal sphincter tears at delivery: a population‐based Swedish register study of 250 000 births

“…However, these studies did not identify the different nationalities in the African group and thus it was not possible to distinguish presumed infibulated women from those who were not non‐infibulated. Another study from Switzerland based on 122 women with different kinds of FGM showed results in line with ours, with an increased risk for third‐degree vaginal tears (30).…”

Research gaps in the care of women with female genital mutilation: an analysis

“…Studies performed in Western settings, however, suggest that a high standard of obstetric care (e.g. defibulation and follow‐up of the pregnancy) can minimise these risks . Risks of episiotomy or third‐degree perineal tears seem to remain significantly higher in some studies .…”

“…The authors encourage additional studies to better investigate if true causality exists . It has been reported that serious obstetric complications are caused by the scarring and inelastic tissue resulting from FGM; however, few studies have focused on the different degrees and types of scar, depending on the kind of cutting and complications. Miscommunication, distrust, delays in seeking care, and avoiding medical interventions can contribute to negative obstetric outcome …”

“…With respect to obstetric outcomes and postpartum perineal re‐education, 24 references were identified (Table ): 16 research studies; five clinical guidelines; one expert opinion; one policy statement; and one letter to the editor . On defibulation performed outside of pregnancy or labour, nine references were identified: four research articles; one guideline; three expert opinions; and one case report .…”

“…defibulation and follow‐up of the pregnancy) can minimise these risks . Risks of episiotomy or third‐degree perineal tears seem to remain significantly higher in some studies . A recent systematic review suggested a disparity between women with and without FGM for prolonged labour, obstetric lacerations, instrumental delivery, obstetric haemorrhage, and difficult delivery.…”