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The Relationship Between Female Genital Cutting and Obstetric Fistulae

Browning, Andrew MB, BS; Allsworth, Jenifer E. PhD; Wall, L. Lewis MD, DPhil

doi: 10.1097/AOG.0b013e3181d012cd
Original Research

OBJECTIVE: To evaluate any association between female genital cutting and vesicovaginal fistula formation during obstructed labor.

METHODS: A comparison was made between 255 fistula patients who had undergone type I or type II female genital cutting and 237 patients who had not undergone such cutting. Women were operated on at the Barhirdar Hamlin Fistula Centre in Ethiopia. Data points used in the analysis included age; parity; length of labor; labor outcome (stillbirth or not); type of fistula; site, size, and scarring of fistula; outcomes of surgery (fistula closed; persistent incontinence with closed fistula; urinary retention with overflow; site, size, and scarring of any rectovaginal fistula; and operation outcomes), and specific methods used during the operation (use of a graft or not, application of a pubococcygeal or similar autologous sling, vaginoplasty, catheterization of ureters, and flap reconstruction of vagina). Primary outcomes were site of genitourinary fistula and persistent incontinence despite successful fistula closure.

RESULTS: The only statistically significant differences between the two groups (P=.05) were a slightly greater need to place ureteral catheters at the time of surgery in women who had not undergone a genital cutting operation, a slightly higher use of a pubococcygeal sling at the time of fistula repair, and a slightly longer length of labor (by 0.3 day) in women who had undergone genital cutting.

CONCLUSION: Type I and type II female genital cutting are not independent causative factors in the development of obstetric fistulae from obstructed labor.

LEVEL OF EVIDENCE: II

Type I and type II female genital cutting are not independent causative factors in the development of obstetric fistulae from obstructed labor.

From the Barhirdar Hamlin Fistula Centre, Barhirdar, Ethiopia; and the Department of Obstetrics and Gynecology and the Department of Anthropology, Washington University, St. Louis, Missouri.

Dr. Allsworth was supported in part by Clinical and Translational Science Award UL1RR024992 and by grant KL2RR024994 from the National Center for Research Resources, a component of the National Institutes of Health, and National Institutes of Health Roadmap for Medical Research.

The authors thank Birhanu Menber for assisting with patient care and collecting data.

The contents of this article are solely the responsibility of the authors and do not necessarily represent the official view of the National Center for Research Resources or the National Institutes of Health.

Corresponding author: L. Lewis Wall, MD, DPhil, Department of Obstetrics and Gynecology, Washington University School of Medicine, Campus Box 8064, 660 South Euclid Avenue, St. Louis, MO 63110; e-mail: walll@wustl.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2010 The American College of Obstetricians and Gynecologists