Effect of female genital cutting performed by health care professionals on labor complications in Egyptian women: a prospective cohort study.

AIM: To examine the effect of the degree of female genital cutting (FGC) performed by health-care professionals on perineal scarring; delivery mode; duration of second stage of labor; incidence of perineal tears and episiotomy in a cohort of uncircumcised versus circumcised (types I and II) women. METHODS: A prospective cohort study included 450 primigravida women in active labor attending the Faculty of Medicine Cairo University Hospital between January 2013 and August 2014. Women were divided into three groups based on medical examination upon admission. Group I (Control) included 150 uncut women, Group II included 150 women with type I FGC and Group III included 150 women with type II FGC. A structured questionnaire elicited the information on women's socio-demographic characteristics including age, residence, occupation, educational level, age of marriage and FGC circumstances. Association between FGC and labor complications was examined. MAIN OUTCOMES: risk of perineal scarring; delivery mode; duration of second stage of labor; incidence of perineal tears and episiotomy. RESULTS: Family history of genitally cut mother/sister was the most significant socio-demographic factor associated with FGC. FGC especially type II was associated with significantly higher incidence of vulvar scar (P<0.0002), perineal tears (P<0.0001) and increased likelihood of additional vaginal and perineal trauma [odds ratio (OR): 1.85, 95% CI: 0.60-5.65. P≤0.001]. There was insignificant difference in risks of cesarean section (CS), instrumental delivery, episiotomy and short-term neonatal outcomes. CONCLUSION: The study strengthens the evidence that FGC increases the risk of tears in spite of medicalization of the practice.

Audit of maternal mortality ratio and causes of maternal deaths in the largest maternity hospital in Cairo, Egypt (Kasr Al Aini) in 2008 and 2009: lessons learned.

This study examined maternal deaths at Cairo University Maternity Hospital between January 2008 and December 2009. The aim was to calculate Maternal Mortality Ratio (MMR) as well as identify the causes and predisposing factors to maternal deaths. Data were collected from the files of the hospitalized pregnant women in the hospital. There were 38 maternal deaths and MMR was 79 per 100,000 live births for the two years examined. The main causes of death were obstetric hemorrhage, hypertensive disorders of pregnancy and cardiac arrest. Substandard medical care and the delay in seeking of medical advice were two contributing factors to maternal deaths recorded. The need for audit and publication of all obstetric hospitals MMR to compare and identify areas of improvements is recommended.

Reproductive health and HIV awareness among newly married Egyptian couples without formal education.

OBJECTIVE: To assess awareness of several reproductive health and HIV issues and to determine the sources of reproductive health knowledge. METHODS: A cross-sectional survey of 150 randomly recruited, newly married couples without formal education attending gynecology or andrology outpatient clinics in Cairo, Egypt, was conducted from January 2012 to January 2013. Participants were interviewed separately and asked to respond to a semi-structured questionnaire on reproductive health and HIV awareness. RESULTS: Most participants had not received premarital counseling or undergone premarital testing. Awareness about HIV was relatively high: 117 (78.0%) women and 128 (85.3%) men had heard of HIV and had some awareness of the modes of HIV transmission. Only 24 (16.0%) women had ever used a condom compared with 36 (24.0%) men. Only two men out of the 150 couples questioned were aware of the free HIV hotline. Television and friends were the main sources of reproductive health knowledge. CONCLUSION: Routine premarital counseling and testing by reproductive health, gynecology, and andrology specialists need to be enforced. Mass media is an essential source of knowledge about HIV and reproductive health. Premarital, reproductive health, and HIV education programs need to be improved.