Antepartum or intrapartum deinfibulation for childbirth in women with type III female genital mutilation: A systematic review and meta-analysis.
BACKGROUND
There remains no consensus on the best timing of deinfibulation in women with type III female genital mutilation (FGM).


OBJECTIVE
To conduct a systematic review of the effects of antepartum or intrapartum deinfibulation on childbirth outcomes in women with type III FGM.


METHODS
The following major databases were searched: Cochrane Central Register for Controlled Trials (CENTRAL), MEDLINE, Scopus, Web of Science, and ClinicalTrials.gov, from inception until August 2015 without any language restrictions.


METHODS
Studies of pregnant women or girls with type III FGM who were deinfibulated antepartum or intrapartum were included.


METHODS
Two team members independently screened and collected data. Quality of evidence was assessed using GRADE. Summary odds ratios and proportions were calculated when possible.


RESULTS
There is no evidence of a significant difference between antepartum and intrapartum deinfibulation for obstetric outcomes such as duration of labor, perineal lacerations, episiotomies, postpartum hemorrhage, and cesarean deliveries. Outcomes in women living with type III FGM and those who have undergone deinfibulation were not statistically different; however, trends show a benefit for deinfibulation. All studies were underpowered to detect statistical differences.


CONCLUSIONS
Larger studies are required to have full confidence in these findings.
CRD42015024464.
Department of Public Health, College of Medical Science, University of Calabar, Calabar, Nigeria.|Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.
Ekpereonne
E
Esu
Department of Obstetrics and Gynecology, College of Medical Science, University of Calabar, Calabar, Nigeria.
Atim
A
Udo
Experimental and Maternal Medicine Unit, Department of Obstetrics and Gynecology, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.
Babasola O
BO
Okusanya
Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.
David
D
Agamse
Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.|Department of Pediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria.
Martin M
MM
Meremikwu
D002585:Cesarean Section / Q000706:statistics & numerical data*; D002921:Cicatrix / Q000601:surgery; D019093:Circumcision, Female / Q000009:adverse effects* / Q000145:classification; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D036801:Parturition; D006473:Postpartum Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D011247:Pregnancy; D012086:Reoperation / Q000592:standards*; D013997:Time Factors; D014844:Vulva / Q000601:surgery
Childbirth; Deinfibulation; Female genital mutilation; Meta-analysis; Systematic review