ArticleAJOG global reports2026
Female genital mutilation/cutting and obstetrical anal sphincter injury risk in the United States.
Article in AJOG global reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundFemale genital mutilation/cutting (FGM-C) affects more than 230 million women and girls worldwide and carries increased risk of adverse obstetrical outcomes, including obstetrical anal sphincter injury (OASIS). With growing global migration, obstetrical care providers may increasingly encounter individuals affected by FGM-C in historically low-prevalence settings such as the United States. Therefore, it is essential to understand the association between FGM-C and adverse obstetrical outcomes in settings such as the United States to inform evidence-based practice.
objectiveTo estimate the association between FGM-C and OASIS, among inpatient, singleton, vaginal deliveries among people delivering in-hospital in the United States. The secondary objectives were to estimate the association between FGM-C and postpartum hemorrhage and prolonged second stage of labor in this population and the role of episiotomy in mitigating risk of OASIS in this population. STUDY
designWe conducted a population-based, retrospective cohort study of pregnant individuals delivering singleton fetuses in the United States using the Healthcare Cost and Utilization Project National Inpatient Sample (NIS) database (2016-2019, inclusive). Exposure and outcome variables were derived using International Classification of Diseases-10 disease and procedure codes. Weighted multivariate logistic regression models were used to estimate the odds ratio (OR) for the association between FGM-C and OASIS and secondary outcomes.
resultsDuring the study period, 2020,780 delivery-related discharges were captured, representing an estimated 10,168,193 singleton vaginal deliveries nationwide using the complex survey design of the NIS. A total of 795 (0.03%) individuals were diagnosed with FGM-C and 39,668 with OASIS (1.4%) during the study period. After adjusting for potential confounders, vaginal deliveries affected by FGM-C had 3.02 times the odds of sustaining OASIS (95% CI: 2.23-4.07), 1.99 times the odds of experiencing postpartum hemorrhage (95% CI: 1.45-2.73), and 2.33 times the odds of a prolonged second stage of labor (95% CI: 1.23-4.39) compared to unaffected individuals. Performance of episiotomy attenuated the risk of OASIS (aOR 1.12, 95% CI: 0.59-2.11).
conclusionSingleton vaginal deliveries complicated by FGM-C have significantly increased odds of experiencing adverse obstetric outcomes, including OASIS, postpartum hemorrhage, and prolonged second stage of labor. Episiotomy may be protective against OASIS in this population.
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