Urethral Injury Following Genital Mutilation in Pregnancy: A Rate Cause of Postpartum Haemorrhage

OBJECTIVE: To reveal the danger in genital mutilation in pregnancy METHOD:The authors present the case of a 20-year old primigravida who was subjected to this ritual in the third trimester, sustained focal injuries to the urethra which initially healed, but during delivery 4 weeks later, and resulted in significant primary postpartum haemorrhage. RESULTS: Her pregnancy was unsupervised; she received 2 doses of tetanus toxoid 4 weeks apart in a local health center. The pregnancy was uneventful until she was subjected to the genital cutting 4 weeks earlier by an appointed lady in the community whom she recognized as a health assistant who gave her the tetanus toxoid injection. The aim was to enable her achieve “a safe vaginal delivery and be accepted as a woman in her Community”. The procedure involved slicing of the upper part of her urethral region along with the clitoris with a “sharp object”, a local herb was applied and there was no significant bleeding as her thighs were strapped together for about 2 hours when the ritual singing was completed Her cervix could barely admit two fingers; there was neither evidence of laceration nor active haemorrhage from the uterus. A diagnosis of primary post partum haemorrhage due to genital injuries secondary to female genital mutilation in pregnancy in imminent shock was made. Immediate resuscitation included rapid infusion of 1 liter of normal saline; she received two units of compatible whole blood at a pre transfusion packedcell volume of 18%. CONCLUSION: There is the need to establish National Policies and Programmes that will be effectively backed with legal instruments to abolish female genital mutilation. Health care providers and policy makers in the mean time should be aware and well trained in the management of FGM complications to decrease the risks of mortality and serious morbidity. The obvious danger of this barbaric ritual in pregnancy labour and pueperium is highlighted for increased sanctions and advocacy at all level of healthcare. Nig Jnl Orthopaedics & Trauma Vol.2(2) 2003: 130-13