Deinfibulation for preventing or treating complications in women living with type III female genital mutilation: A systematic review and meta-analysis.
BACKGROUND
Deinfibulation is a surgical procedure carried out to re-open the vaginal introitus of women living with type III female genital mutilation (FGM).


OBJECTIVE
To assess the impact of deinfibulation on gynecologic or obstetric outcomes by comparing women who were deinfibulated with women with type III FGM or women without FGM.


METHODS
Major databases including CENTRAL, MEDLINE, and Scopus were searched until August 2015.


METHODS
We included nonrandomized studies that compared obstetric outcomes of women with deinfibulation, type III FGM (not deinfibulated during labor), and no FGM.


METHODS
Quality of evidence was determined following the GRADE methodology. Summary measures were calculated using odds ratios at 95% confidence intervals.


RESULTS
We found no randomized controlled trials. We included four case-control studies. The quality of evidence was very low. Compared with women with type III FGM at delivery, deinfibulated women had a significant reduction in the risk of having a cesarean delivery or postpartum hemorrhage. Compared with women without FGM, deinfibulated women had a similar risk of episiotomy, cesarean delivery, vaginal lacerations, postpartum hemorrhage, and blood loss at vaginal delivery. The length of second stage of labor, mean maternal hospital stay, and Apgar scores less than 7 were also comparable.


CONCLUSIONS
Low-quality evidence suggests deinfibulation improves birth outcomes for women with type III FGM.
CRD42015024466.
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
Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.|Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.
Olabisi
O
Oduwole
Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.|College of Medical Sciences, University of Calabar, Calabar, Nigeria.
Nuria
N
Nwachuku
Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.|Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.|College of Medical Sciences, University of Calabar, Calabar, Nigeria.
Martin M
MM
Meremikwu
D001034:Apgar Score; D002585:Cesarean Section / Q000706:statistics & numerical data*; D002921:Cicatrix / Q000601:surgery; D019093:Circumcision, Female / Q000009:adverse effects* / Q000145:classification; D005260:Female; D006801:Humans; D022125:Lacerations; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000209:etiology; D006473:Postpartum Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D011247:Pregnancy; D012086:Reoperation / Q000592:standards*; D014844:Vulva / Q000601:surgery
Deinfibulation; Female genital mutilation; Infibulation; Obstetric complications