The current study aimed to evaluate the association of circumcision with neonatal and neonatal outcomes. The mean age of circumcised women was significantly higher compared with uncircumcised women. 80- 5 % of women were circumcision type I. The existence of circumcision was significantly higher in rural compared to urban areas. The level of female education, his parents, spouse, and husband’s employment status were significantly associated with circumcision. The higher mean duration of the second stage of labor, the Third and second degree of tear, and the need for oxytocin induction were significantly higher among circumcised women compared with uncircumcised women.
The present study shows that circumcised women are older than uncircumcised ones. The results of the present study are consistent with Ravansar’s results [8].
which indicated that the circumcision outbreak decreases. These findings are probably due to increasing education and enhancing health awareness and changing beliefs in recent years. In addition, females’ circumcision showed a significant relationship with the level of female education, parents, spouse, and husband’s employment status. This finding is consistent with Ethiopia and Egypt’s reports about this health problem [20, 21], which indicated the outbreak of females’ circumcision is associated with lower educational background among families. The present study showed that circumcision is more common in rural areas compared to urban areas; this result is consistent with a study conducted in Ethiopia where the majority of circumcised women lived in rural areas [20].
It seems that increasing the level of literacy will help to put an end to this harmful phenomenon. People empowerment and preventive policies are needed, and efforts should be made to end the inappropriate cultural and social norms that normalize and increase this practice. It seems Improving literacy could help to reduce this harmful phenomenon. Additionally, People empowerment and preventive policies should be considered.
Our results showed Circumcised women had higher body mass index (and number of deliveries, respectively Unintended pregnancy was more in circumcised women than in uncircumcised ones.
Our results showed the mean (SD) age of investigated circumcised women was 28.92 (6.2) years. The circumcision level in 85.1% of women was level 1 and 14.9% had level 2 circumcision. None of the participants had level III or IV circumcision. Agreed with these findings, Sudan [1], and Gambia [19, 22] researches shows level I and level II had the most common level of circumcision in these countries.
In contrast, in other research from metropolitan Sydney areas level III circumcision was the most type of Circumcision [3].
In our study, the mode of delivery was not associated with female circumcision, these findings are in line with other research by Chidebe et al. [23] and Varol et al., respectively [6].
However, review studies described increased cesarean delivery rates among circumcised women and this harmful phenomenon is definitely associated with poor neonatal care and increasing cesarean section rates [24, 25]. In contrast to the results of the present study, Frega et al.2013 [18], Balachandran et al. [12], Kiros et al. [26], and Sylla et al. [27] findings also showed a higher risk of cesarean section in circumcised women. In our study, multiparous women were included in the research and elective Cesarean-section cases were excluded, therefore Cesarean-section cases can probably depend on other causes of obstetrics and gynecology including higher frequency of level I&II circumcision, age of the studied population. Moreover, Levels of III&IV circumcision cause obstruction in the birth canal which is associated with higher cesarean section rates [27].
Kaplan et al. 2011 [19], Frega et al. 2013 [18], and Sylla et al. 2020 [27], studies indicate a longer duration of the second labor stage related to circumcision. Consistent with these studies, our results demonstrated that circumcision was a significant prognostic factor related to the higher mean duration of the second stage labor among the studied population.
However, Kiros et al. did not find a relationship between circumcision and the duration of the second stage of childbirth. Contrary to our observation, Kiros et al. [26] also found that level-one circumcised women had a higher mean duration of the second stage of labor [17]. Moreover, multiparous circumcised women were a longer duration of the second stage of labor than uncircumcised women, it can be due to elasticity reduction of the genital area and direct mechanical obstruction caused by all levels of circumcision that increased the duration of the second labor stage among circumcised women [17]. Moreover, the higher body mass index of circumcised women could be related to the higher duration of the second labor stage that resulted in dysfunctional or assisted delivery. In addition, the findings of the present study showed that being under episiotomy is similar in both groups of circumcised and uncircumcised women.
In our study, the use of episiotomy was similar in circumcised and uncircumcised women, and the Number of parity was not related to the use of episiotomy.
Despite these findings, the use of episiotomy in level-one circumcised women was higher than in level-two uncircumcised. Results from the current study are strongly supported by a meta-analysis study on 585 participants [17].
In contrast to these findings Akpak et al. 2020 [1] 2020, Berg et al. 2014, and Chidebe et al. 2019 [23] showed higher episiotomy rates among circumcised women.
The majority of circumcised women were level 1 and level 2 circumcision and we did not exclude multiparous women who do not need episiotomy, furthermore lower degree of circumcision was related to lower episiotomy rates. Results from the current study strongly support this recommendation.
In our study, a perineal tear was more common in circumcised women compared to uncircumcised ones and the and lower perineal tears were observed among patients with higher parity. Chidebe et al. [23], Kaplan et al. [19], Akpak et al. [1], Varol et al. [6] in 201 and Kiros Gebremicheal et al. 2018 showed female circumcision is associated with Perineal tear in delivery reported complications associated with the abnormal repair ruptures site is more common in circumcised women. It seems Circumcision has adverse effects on the condition and tightness of perineal and vaginal tissue that causes perineal tear.
This study demonstrates that postpartum hemorrhage is not related to Circumcision. This result in line with the research by Chidebe et al. who did not confirm a relationship between bleeding and circumcision [23].
In contrast with our finding, a review of the literature demonstrates that circumcision increases the risk of bleeding from the episiotomy area, perineal tear, and postpartum hemorrhage among circumcised women [13, 24,25,26, 28]. It could be related to the Variation in female circumcision level in our studied population.
In our studied population, female circumcision increases the risk of oxytocin administration for induction. These findings are in line with the research by Frega et al. [18] 2013 which revealed Oxytocin administration for induction in the second labor stage is higher in circumcised women than in uncircumcised ones. Time by increasing uterine contractions [18].
in the most cases spontaneous uterine contractions plus voluntary abdominal pressure are insufficient [24]. therefore, Oxytocin is administered in during the second labor stage to reduce the expulsion time by increasing uterine contractions [18].
In this study, we compared neonatal outcomes between two groups. In studied neonates, An Apgar score of less than 3 was found none of studied neonates. Neonatal growth parameters, Apgar score, and neonatal death frequency were not statistically significant differences between the two groups.
In line with these findings, Odoru et al. 2006 [29] and Akpak et al. 2020 [1] report that circumcised women neonates had similar outcomes compared to uncircumcised women neonates. An earlier systematic review and meta-analysis study supported the similarity of the neonates’ Apgar score between circumcised and uncircumcised women [28]. In contrast with our results, Rashid Soleiman et al. 2021 [30] and Frega et al. 2013 [18] showed that circumcision is a prognostic factor low Apgar score of 5 minutes.
The association between higher levels of maternal circumcision and neonatal outcomes (including; stillbirth, need to ICU, extended hospitalization stay, and decrease in Apgar score) was shown in reports from African countries [13, 31, 32], but these associations were not supported by European countries reports [12, 33, 34] these findings highlight the effect of other important factors in the delivery process including proper hospital conditions, proficient staff, and proper management of the delivery process.
Contrary to the results of the present study, a number of researchers have identified female genital circumcision as an independent risk factor for increased maternal and fetal mortality. Additionally, Kaplan et al. 2013 showed higher practical interventions for intrauterine resuscitation of a distressed fetus among level-2 and 3 circumcised mothers compared to uncircumcised ones [19]. Additionally, Obermeyer in 2005 reported circumcision does not increase maternal and neonatal mortality but increases the risk of some pregnancy and delivery complications [35]. WHO study group reports first- and second-level circumcision is associated with higher infant mortality [13]. Reduced perineal tissue elasticity and obstruction following female circumcision (infibulation) can prolong the second labor stage that is contributing to the increased rate of fetal death, perinatal tear, and perineal episiotomy.
