■有争议的证据表明,女性生殖器切割(FGM/C)与不良产科结局之间存在潜在关联,III型FGM/C(阴部)风险最大。本系统评价和荟萃分析的目的是评估在全球不同环境中实施III型女性生殖器切割和切割(FGM/C;阴锁)的女性的不良产科结局的当前发生率。
■我们搜索了PubMed,Scopus,Embase,和ClinicalTrials.gov数据库从成立到2023年1月1日。如果研究包括产后出血(PPH)的主要结局或次要结局,其中包括在分娩和分娩期间影响孕产妇-新生儿健康的主要条件。进行DerSimoian-Laird随机效应荟萃分析,包括合并效应估计和相应的95%置信区间。使用I2统计量评估异质性。当相关混杂因素的数据可用时,对相关协变量进行Meta回归。纽卡斯尔-渥太华量表(NOS)用于评估观察性研究的质量。使用GRADE方法评估证据水平。
■14项观察性研究符合条件,包括15,320名III型女性女性和59,347名对照。III型FGM/C的产后出血风险显着增加,在主要分析中(OR1.83,95%CI1.03至3.24,I2=93%),在合并经过混杂因素调整的数据中(AOR1.76,CI1.42至2.17,I2=0%),以及对NOS≥7的高质量研究的敏感性分析(OR2.76,CI1.38至5.51,I2=95%)。Meta回归分析显示,无产程与产后出血呈显著正相关。同样,校正混杂因素后的数据分析显示,III型FGM/C患者会阴侧切的风险增加(aOR1.56,CI1.03~2.35,I2=52%).对NOS≥7的研究的敏感性分析显示,会阴切开术显着增加(OR7.53,CI1.19至47.54,I2=96%),会阴撕裂(OR4.24,CI1.09至16.46,I2=66%),延长第二产程(OR5.19,95%CI1.00至26.85,I2=66%),Apgar评分小于7(OR4.19,CI1.64至10.70,I2=0%)。这些妇女的产科肛门括约肌损伤和分娩方式没有差异。与从未进行过III型女性生殖器切割的妇女相比,去阴部取得了相似的产科和新生儿结局。研究的总体质量是足够的(中位NOS评分:7;IQR:6-8),证据的水平,根据等级评估,很低。
这些结果一致显示,女性女性女性女性III型FGM/C患者产科不良结局的风险增加。阴锁合会大大增加PPH的风险,特别是在无名氏中。系统审查注册:PROSPEROCRD42023421993。
UNASSIGNED: Controversial evidence suggests a potential association between female genital mutilation (FGM/C) and adverse obstetric outcomes, with type III FGM/C (infibulation) carrying the greatest risk. The aim of this systematic review and meta-analysis was to assess current rate of adverse obstetric outcomes in women with type III female genital mutilation and cutting (FGM/C; infibulation) delivering across different settings worldwide.
UNASSIGNED: We searched PubMed, Scopus, Embase, and ClinicalTrials.gov databases from inception to Jan 1, 2023. Studies were selected if they included the main outcome of postpartum haemorrhage (PPH) or secondary outcomes, which included major conditions affecting maternal-neonatal health during labour and delivery. DerSimonian-Laird random effects meta-analysis including pooled effect estimates with corresponding 95 % confidence intervals was performed. Heterogeneity was assessed using the I2 statistic. Meta regression for relevant covariates was performed when data on relevant confounders were available. The Newcastle-Ottawa scale (NOS) was used to assess quality of observational studies. The level of evidence was assessed with the GRADE method.
UNASSIGNED: 14 observational studies including 15,320 type III FGM/C women and 59,347 controls were eligible. The risk for postpartum haemorrhage was significantly increased in type III FGM/C, in the main analysis (OR 1.83, 95 % CI 1.03 to 3.24, I2 = 93 %), in pooling of data adjusted for confounders (aOR 1.76, CI 1.42 to 2.17, I2 = 0 %), and in sensitivity analysis of higher quality studies with NOS≥7 (OR 2.76, CI 1.38 to 5.51, I2 = 95 %). Meta-regression showed that nulliparity was significantly and positively associated with postpartum haemorrhage. Similarly, analysis of data adjusted for confounders showed an increased risk of episiotomy in type III FGM/C (aOR 1.56, CI 1.03 to 2.35, I2 = 52 %). Sensitivity analysis of studies with NOS≥7 revealed a significant increase for episiotomy (OR 7.53, CI 1.19 to 47.54, I2 = 96 %), perineal tears (OR 4.24, CI 1.09 to 16.46, I2 = 66 %), prolonged second stage of labour (OR 5.19, 95 % CI 1.00 to 26.85, I2 = 66 %), and Apgar score less than 7 (OR 4.19, CI 1.64 to 10.70, I2 = 0 %). No difference was found regarding obstetric anal sphincter injuries and mode of delivery in these women. Deinfibulation achieved similar obstetric and neonatal outcomes to women who never had type III FGM. The overall quality of the studies was adequate (median NOS score: 7; IQR: 6-8), the level of evidence, according to the GRADE assessment, was low.
UNASSIGNED: These results consistently show an increased risk of adverse obstetric outcomes in women with FGM/C type III. Infibulation substantially increases the risk for PPH, particularly in nulliparae. Systematic Review registration: PROSPERO CRD42023421993.