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Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Birgitta Essén, Uppsala University, Sweden
- Second opponent: Professor Jone Trovik, University of Bergen
- Third member and chair of the evaluation committee: Associate Professor Sigurd Høye, University of Oslo
Chair of the Defence
Professor II Guttorm Nils Haugen, University of Oslo
Principal Supervisor
Professor II Ingvil Krarup Sørbye, University of Oslo
Summary
The impact of female genital mutilation/cutting (FGM/C) on obstetric outcomes in high-income countries is not clear.
FGM/C alters the anatomy in the vulva to various extents. Type 3 includes the narrowing of the vaginal opening through the creation of a covering seal (infibulation). Surgical deinfibulation is a common procedure that is recommended for preventing obstetric complications.
The aim of the thesis was to investigate type of FGM/C, timing of deinfibulation and risk of cesarean section and obstetric anal sphincter injury in Norway.
The hypotheses were that type 3 FGM/C was associated with greater risk of cesarean section than no FGM/C, and that deinfibulation before or during pregnancy was associated with a lower risk.
In retrospective cohort studies, nulliparous Somali-born women who had given birth in Norway were identified by The Medical Birth Registry and data collected from medical records.
The overall cesarean section rate was 28%. Unexpectedly, the risk of cesarean section was near 50% lower in women with type 3 FGM/C than in women with no FGM/C. Women who were deinfbulated before or during pregnancy had higher risk than those not deinfibulated before labor.
Among women with a vaginal birth, the rate of obstetric anal sphincter injury (OASI) was 10% with no significant differences with respect to FGM/C status. Deinfibulation during labor was associated with 50% lower risk compared to deinfibulation before labor.
Compared to nulliparous women in the general population, the cesarean section rate was 40% higher, while the OASI rate was twice as high among the Somali women.
Nulliparous Somali-born women need to be handled as a high-risk group of cesarean section and OASI, regardless of FGM/C. Factors related to migration and the obstetric care are likely to be involved in the excess risk. Deinfibulation during pregnancy should not be routinely recommended.
Additional information
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