Priya Paliwal1, Sarah Ali2, Sally Bradshaw3, Alison Hughes4, Kate Jolly5. 1. Heartlands Hospital, Heart of England Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK. 2. Queen Elizabeth Hospital Birmingham, University Hospital Birmingham, Edgbaston, Birmingham B15 2TH, UK. 3. School of Health & Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK. 4. Princess of Wales Women's Unit, Heartlands Hospital, Heart of England Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK. 5. School of Health & Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK. Electronic address: c.b.jolly@bham.ac.uk.
Abstract
OBJECTIVES: 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. DESIGN: retrospective audit. SETTING: a hospital midwifery-led FGM specialist service in Birmingham, UK. PARTICIPANTS: 253 women with type III FGM who gave birth between January 2008 and December 2009 METHODS: retrospective case analysis using patient records. MAIN OUTCOME MEASURES: 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. FINDINGS: 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 AND IMPLICATIONS FOR PRACTICE: 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.
OBJECTIVES: 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. DESIGN: retrospective audit. SETTING: a hospital midwifery-led FGM specialist service in Birmingham, UK. PARTICIPANTS: 253 women with type III FGM who gave birth between January 2008 and December 2009 METHODS: retrospective case analysis using patient records. MAIN OUTCOME MEASURES: 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. FINDINGS: 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 AND IMPLICATIONS FOR PRACTICE: 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: R Elise B Johansen; Mai Mahgoub Ziyada; Bettina Shell-Duncan; Adriana Marcusàn Kaplan; Els Leye Journal: BMC Health Serv Res Date: 2018-04-04 Impact factor: 2.655
Authors: Laura Jones; Emma Danks; Joanne Clarke; Lailah Alidu; Benjamin Costello; Kate Jolly; Alison Byrne; Meg Fassam-Wright; Pallavi Latthe; Julie Taylor Journal: BMJ Open Date: 2019-10-17 Impact factor: 2.692