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During the study period, 1086 Somali and Sudanese women delivered at our institution, with 42% delivering by caesarean section. Among the 631 women with vaginal delivery, 27% had type III FGM/C and delivered with defibulation while 73% did not have type III FGM/C and delivered without defibulation. Demographic and clinical factors were similar between the two groups who delivered vaginally. The outcomes of labour with defibulation at delivery in women with type III FGM/C were not different from women without defibulation, except in regards to instrumental delivery and maternal blood loss. There were also no statistically significant differences between the two groups in neonatal outcomes.
During the study period, 1086 Somali and Sudanese women delivered at our hospital, with 455 (42%) delivering by caesarean section. The caesarean sections were done for obstetric indications, with none done for the indication of FGM/C. Among the 631 women with vaginal delivery, 27% had type III FGM/C and delivered with defibulation while 73% did not have type III FGM/C and delivered without defibulation. There was no spontaneous rupture of the infibulation scar before the intended defibulation at the time of crowning of the fetal head. Defibulation was successfully and easily performed with no woman experiencing any intraoperative complication. As shown in table 1, demographic and clinical factors were similar between the women who delivered vaginally with and without defibulation. Table 2 shows that there were no statistically significant differences between the two groups in the onset of labour, duration of the stage of labour, meconium-stained liquor, episiotomy, vaginal tears, the need for blood transfusion, or maternal duration of hospital stay. However, there was a statistically significant difference between the groups with regard to instrumental delivery and blood loss. There were more instrumental deliveries (9.1 vs 1.2%, p
In this comparison study, we hypothesised that the outcomes of labour with defibulation at delivery in women with type III FGM/C would be no different from women without defibulation. With the exception of two outcomes, instrumental delivery and maternal blood loss, the results were consistent with our hypothesis. Furthermore, no woman experienced any intraoperative complication. This suggests that defibulation at delivery is a safe procedure and that it reduces the risk of obstetric complications for women with type III FGM/C, as suggested in the systematic review by Berg et al.  The fact that the Somali and Sudanese women who delivered with defibulation had significantly fewer instrumental deliveries and less blood loss than the women who delivered without defibulation suggests that defibulation created a more favorable labour. It is possible that this care intervention redressed obstetric problems caused by inelastic scar tissue from FGM/C, which is the most plausible mechanistic pathway of the increased obstetric harms in women with type III FGM/C. 1e1e36bf2d