Complicaciones obstétrico-ginecológicas en mujeres procedentes de países de riesgo de ablación/mutilación genital femenina:estudio comparativo

Abstract

More than 350,000 women lose their lives every year around the world due to complications in pregnancy or childbirth, and millions of other women develop some type of disability (Save the Children, 2011). Moreover, almost all maternal mortality (99%) occurs in developing countries, especially sub-Saharan Africa. In addition to these intolerable circumstance, harmful traditional practices take place (WHO, 2014), such as Ablation/Female Genital Mutilation (A/FGM). The evidence indicates that there is a relationship, probably causal, in terms of an increased risk of adverse obstetric outcomes in women who have suffered A/FGM, compared to those who have not. Identify the complications related to childbirth in women from countries at risk of A/FGM (who may be victims of it) and who gave birth between 2012 and 2015 at the University Hospital "Virgen de la Arrixaca" (HCUVA) of Murcia, compared to Spanish women. An observational, cross-sectional and retrospective quantitative study was carried out, in which we selected all women of sub-Saharan origin and/or nationality, coming from countries with risk of A/FGM, who gave birth in the HCUVA during those four years (n = 245). Through a propensity analysis, with a 1:2 pairing and based on the covariates "age" and "number of pregnancies", the group of Spanish women (n = 490), who had given birth in the same period of time and in the same hospital (out of a total of 18225), was determined for its comparative study. The collection of the data was carried out through the computerized clinical histories. Subsequently, a statistical analysis of the data obtained was carried out, using R free software, and the general use package for dynamic report generation with R, Knitr. The descriptive phase included two parts - an analysis of each variable separately (univariate) and another part to establish relationships between pairs of variables (bivariate). In the contrasts of hypothesis, we applied the Mann-Whitney U test for the ordinal variables, and we applied the Pearson's ?2 test for the categorical variables. We also estimated the number of women and girls with, or at risk of, A/FGM from our sample. According to the most relevant results obtained in our study, sub-Saharan women have a higher rate of intrapartum caesarean sections and urgent caesarean sections, severe postpartum hemorrhage, (2nd and 3rd degree) tears + episiotomies in the same birth, serious risk of loss of fetal well-being, failed induction and failure to progress in labour compared to Spanish women. Other complications that predominate in sub-Saharan women and not in Spanish women are anemia, maternal infections, metrorrhagia, retained placenta, intrauterine fetal death and fever. In addition, an underregistration/infracoding was observed in the detection of new cases of A/FGM in women of sub-Saharan origin at the time of delivery, as well as a shortage of genital examinations or the lack of registry of such in this risk group. In the HCUVA of Murcia, sub-Saharan women from countries where A/FGM is practiced, present a greater number of obstetric-gynecological complications at the time of delivery, compared to Spanish women. The detection of new cases of A/FGM by health professionals in a systematized and protocoled manner, and their multidisciplinary approach, would contribute not only to diminishing obstetric complications at the time of delivery in women who have already suffered A/FGM, but would also help prevent girls born to these women from suffering it later, by activating the prevention protocol already in Primary Care, as they are considered high risk.