title: Management of type III female genital mutilation in Birmingham, UK: a retrospective audit.
abstract: OBJECTIVE
  to audit clinical management of women with type III female genital mutilation (FGM) according to local guidelines. Secondary objectives were to describe the population that uses the service and compare obstetric outcomes of intrapartum deinfibulation and antenatal deinfibulation.
  
  
  METHODS
  retrospective audit.
  
  
  METHODS
  a hospital midwifery-led FGM specialist service in Birmingham, UK.
  
  
  METHODS
  253 women with type III FGM who gave birth between January 2008 and December 2009 METHODS: retrospective case analysis using patient records.
  
  
  METHODS
  proportion of women managed according to locally agreed criteria for the management of FGM; obstetric outcomes including perineal tears, episiotomy rates, estimated blood loss, infant APGAR scores and indications for caesarean section.
  
  
  RESULTS
  91 (36%) women booked into antenatal care after 16 weeks gestation. Only 26 (10.3%) were managed fully according to guidelines. The area with poorest performance was child protection, where the presence of normal genitalia was documented in only 52 (38.8%) of medical notes following birth of a female infant. The majority of women (214, 84.6%) had been deinfibulated in a previous pregnancy. Of the 39 infibulated at booking, only 9 (23.1%) were deinfibulated antenatally, the rest opted for intrapartum deinfibulation. Women who had intrapartum deinfibulation had a higher average blood loss and more tears than those deinfibulated antenatally, although this was not statistically significant.
  
  
  CONCLUSIONS
  alternative systems should be considered to improve documentation of child protection related information. Further research is needed to confirm or refute the adverse findings among those that delayed deinfibulation.
authors.affiliation: Heartlands Hospital, Heart of England Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK.
authors.forename: Priya
authors.initials: P
authors.lastname: Paliwal
authors.affiliation: Queen Elizabeth Hospital Birmingham, University Hospital Birmingham, Edgbaston, Birmingham B15 2TH, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Ali
authors.affiliation: School of Health & Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Bradshaw
authors.affiliation: Princess of Wales Women's Unit, Heartlands Hospital, Heart of England Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Hughes
authors.affiliation: School of Health & Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK. Electronic address: c.b.jolly@bham.ac.uk.
authors.forename: Kate
authors.initials: K
authors.lastname: Jolly
mesh_terms: D000293:Adolescent; D000328:Adult; D019093:Circumcision, Female / Q000009:adverse effects* / Q000451:nursing; D018864:Cultural Diversity; D005260:Female; D005836:Genitalia, Female / Q000601:surgery*; D006801:Humans; D008485:Medical Audit; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000209:etiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D013222:State Medicine; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: Deinfibulation; Female genital mutilation; Obstetric outcomes