Pregnancy with a pinhole introitus: A report of two cases and a review of the literature

Abstract

Objectives As over 125 million women worldwide have undergone female genital mutilation (FGM), 170,000 of whom are estimated to live in the UK alone, obstetricians and gynaecologists need to be aware of the grades and consequences of this devastating condition. Women with type III FGM, even when they are unable to have penetrative intercourse, can conceive, and obstetricians should be aware of this to ensure optimal care of these patients. To determine the most appropriate surgical approach, deinfibulation in pregnancy should follow some basic principles which take into account the psychological needs of women as well as the extent of scarring.

Cases We present two cases of women who had never engaged in penetrative intercourse and therefore presented with no knowledge that they were pregnant. They underwent antenatal deinfibulation and subsequent management based on individual request.

Conclusions Management in pregnancy can pose particular problems and should be individualised. In all childbearing women with FGM, even where intercourse has not been possible, pregnancy should be considered. Clinicians should be aware of the types of FGM and management should be undertaken by a designated clinician with appropriate expertise. Pregnant women who have undergone FGM should be examined to identify the requirement for antenatal surgical correction.

Chinese Abstract

摘要

目的 全世界1.25亿妇女经受了女性生殖器切割(FGM),经估计,其中有170000名妇女生活在英国,妇产科医生需意识到这种破坏性疾病的分级和带来的后果。FGM, 型的妇女即使不能进行插入式性交仍可受孕,妇产科医生应当了解这一情况以为此类患者提供最佳的治疗。为了确认最佳的手术方式,妊娠期的去锁阴术应当遵循一些基本原则,其中应考虑到女性的心理需要以及疤痕的范围。

病例 我们所报告的两例病例中的妇女没有进行过插入式性交,因此并未意识到自己已怀孕。基于两名妇女的个人需求,为她们实施了产前去锁阴术和术后管理.

结论 妊娠期管理可造成特定的问题并应当个体化。所有的育龄期FGM妇女,即使不能进行插入式性交,也应当考虑到怀孕的可能性。临床医生应当了解FGM的分型,也应由指定的具有专业知识的医师对FGM 进行处理。经受过FGM的妊娠妇女应接受检查以明确产前外科矫治的需要。

关键词

分娩;股间性交;去锁阴术;女性割礼;FGM;股性交;妊娠;手术终止妊娠