Pattern and delivery outcome of nulliparous pregnant women with female genital cutting (FGC) in Calabar, Nigeria

Background: Every year, at least 2 million females are at risk of varying degrees of mutilation of their external genitalia. This potentially hazardous prehistoric practice has persisted despite decades of outcry for its termination in diverse settings, especially in Africa, Asia, and the Middle East. Effective evaluation of interventions, require regular assessment of pattern of the practice as well as associated adverse effects, especially among nulliparous pregnant women. Assessment among this subpopulation is key, since nulliparous pregnant women may represent a generational change in trend of the practice. This study was therefore aimed at assessing pattern of female genital mutilation (FGM) and its delivery outcome among nulliparous pregnant women in Calabar and its environs, where the practice is socioculturally rooted. Methods: Medical records were used to assess number of vaginally-delivered pregnant women in UCTH within one year beginning January, 2017. Prospective observational cross-sectional study design was carried out to assess presence of obstetric complications among all nulliparous pregnant women with FGM. Convenience sampling was used to recruit nulliparous pregnant women without FGM as comparative study group, who were also observed for presence of obstetric complications. Data was entered and analyzed using SPSS version 21.0, and p-value was set at 0.05. Results: During the study period, 2,160 vaginal deliveries were conducted in the facility. Of this number 780 had various forms of FGM yielding prevalence rate of 36.1%. Among those with FGM, 448 were nulliparous constituting cases, which were matched with same number of nulliparous pregnant women without FGM as controls. Mean age was 26.2 ± 3.7 years and commonest age group (32.1%) was 25 to 29 years. Most subjects had spontaneous vaginal delivery (84.6%) and at least one form of obstetric complication (89.7%). Episiotomy (22.3%) was the commonest complication, and was significantly commoner among subjects with FGM (25.8% vs. 16.4%, p<0.00). Conclusion: There is high prevalence of FGM in the study setting, and episiotomy is still a common complication of the practice. There is need to improve on intervention efforts, especially through women education and empowerment, involvement of traditional, community and religious leaders, and effective legislation against the practice, especially in endemic settings.