Safeguarding Women and Children

Question 1

what is FGM?

Answer 1

Partial of total removal of female external genitalia or other injury to the female genital organs for non medical reasons

Question 2

FGM

type 1

Answer 2

‘sunna’ or traditional circumcision with removal of prepuce with or without part or the entire clitoris

Question 3

FGM

type 2

Answer 3

Clitoridectomy with removal of prepuce and clitoris together with partial or total excision of labia minora

Question 4

FGM

type 3

Answer 4

infibulation or ‘clasp circumcision’ with removal of part or all of external genitalia and stitching/narowing of vaginal opening leaving a small aperture for passing urine and menstrual blood

Question 5

FGM

type 4

Answer 5

unclassified

Question 6

what are the immediate complications of FGM?

Answer 6

• Death
• Shock and pain
• Haemorrhage
• Infection (septicaemia)
adjacent organ damage
• Acute urinary retention

Question 7

what are the long term complications affecting pelvic organs?

Answer 7

• Failure of healing
• Recurrent UTI and renal/bleeding calculus formation
• Urethral obstruction and difficulty in passing urine
• Pelvic infection and abscess formation
• Menstrual abnormalities and associated infertility
• Sexual dysfunction
• Fistulae

Question 8

what are the management options for FGM

Answer 8

• Problems with sexual intercourse or miturition – de-infibulation under GA
• Problems during and/or following delivery – de-infibrillation in second stage of labour under LA
• Individual problems – infection, adjacent organ damage, fistulae

Question 9

FGM

what is de-infibulation

Answer 9

• Obstructing skin divided in the middle
• Anterior/upward episiotomy in labour
• Edges of incised surfaces freshened and sutured
• Urethra needs to be protected to avoid injury
• Extensive reconstruction may be needed in severe cases
• De-infibulation carried out by people experienced in dealing with this problem

Question 10

What opportunities can be taken during pregnancy to identify domestic abuse?

Answer 10

• Ask at booking appointment
• See women at least once in antenatal period
• If notice an injury ask directly about domestic abuse
• Provide information about local agenices and emergency helplines

Question 11

definition of domestic abuse?

Answer 11

any incident of threatening behaviour or abuse between adults who are or have been intimate partners or family members

Question 12

what are some indicators of domestic abuse in maternity care?

Answer 12

• Late booking and/or poor attendance at antenatal clinic
• Repeat attendance at antenatal clinic, GP surgery or A&E for minor injuries
• Unexplained admissions
• Non compliance with treatment or early self discharge
• Repeat presentation with depression, anxiety, self harm and psychosomatic symptoms
• Injuries that are untended and of several different ages, especially to neck, head, breasts, abdomen and genitals
• Minimalization of signs of abuse on body
• STIs and frequent vaginal or UTI and pelvic pain
• Poor obstetric history – repeat miscariages, stillbirth, preterm labour, unwanted, unplanned pregnancy
• Constant pressure at examinations of partner answering questions and unwilling to leave the room
• Evasive or reluctant to speak or disagree in front of partner