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). OBJECTIVES: To conduct a systematic review of the effects of antepartum or intrapartum deinfibulation on childbirth outcomes in women with type III FGM. SEARCH STRATEGY: 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. SELECTION CRITERIA: Studies of pregnant women or girls with type III FGM who were deinfibulated antepartum or intrapartum were included. DATA COLLECTION AND ANALYSIS: 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. CONCLUSION: Larger studies are required to have full confidence in these findings. PROSPERO REGISTRATION: CRD42015024464.