{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T18:33:13Z","timestamp":1765996393919,"version":"3.48.0"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T00:00:00Z","timestamp":1765929600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Introduction<\/jats:title>\n The impact of female genital mutilation (FGM) on obstetric outcomes in high-income countries remains unclear and is an area of ongoing research. This nationwide study aimed to examine the risk of emergency cesarean section among primiparous women from countries where FGM is practiced, in comparison to Swedish-born women. Additionally, the study explored whether a confirmed diagnosis of FGM contributes to this potential risk.<\/jats:p>\n <\/jats:sec>\n \n Materials and methods<\/jats:title>\n A Swedish nationwide cohort study including primiparous singleton term deliveries (\u226537\u2009+\u20090\u2013\u2009<\u200942\u2009+\u20090 weeks) during 2014\u20132020. Data was extracted from the Swedish Medical Birth Register and the National Patient Register. We compared the risk of emergency cesarean section between women born in an FGM-practicing country and women born in Sweden by using multivariable logistic regression. Two subgroup analyses were performed.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Women born in FGM-practicing countries (n\u2009=\u200913 246) had a significantly increased risk of emergency cesarean section (aOR 1.28, 95% CI: 1.21\u20131.35) compared to Swedish-born women (n\u2009=\u2009199 914). Including FGM diagnosis as a covariate did not alter the result. When excluding women born in FGM-practicing countries outside Sub-Saharan Africa the aOR was amplified (aOR 1.58, 95% CI: 1.47\u20131.69). To further isolate the effect of FGM itself, we restricted the analysis to women born in FGM-practicing countries and compared those with a recorded FGM diagnosis to those without. This analysis showed no significant association between FGM diagnosis and emergency cesarean section (aOR 1.05, 95% CI: 0.90\u20131.23).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Primiparous women from FGM-practicing countries have an increased risk of emergency CS compared to Swedish-born women, when giving birth in Sweden. The presence of FGM diagnosis did not contribute to this risk. Further research is needed to understand the underlying mechanisms for this to be able to improve obstetric care for migrant populations.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0339166","type":"journal-article","created":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T18:30:22Z","timestamp":1765996222000},"page":"e0339166","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk of emergency cesarean section when giving birth in Sweden: A nationwide cohort study comparing women born in countries practicing female genital mutilation, with Swedish-born women"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6062-5430","authenticated-orcid":true,"given":"Bita","family":"Eshraghi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1091-5576","authenticated-orcid":true,"given":"Jonas","family":"Hermansson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lena","family":"Marions","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,12,17]]},"reference":[{"key":"pone.0339166.ref001"},{"key":"pone.0339166.ref002"},{"issue":"1","key":"pone.0339166.ref003","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0244888","article-title":"Trend in female genital mutilation and its associated adverse birth outcomes: A 10-year retrospective birth registry study in Northern Tanzania","volume":"16","author":"IR Suleiman","year":"2021","journal-title":"PLoS One"},{"issue":"1","key":"pone.0339166.ref004","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1186\/s12884-018-1937-4","article-title":"Sequela of female genital mutilation on birth outcomes in Jijiga town, Ethiopian Somali region: a prospective cohort study","volume":"18","author":"K Gebremicheal","year":"2018","journal-title":"BMC Pregnancy Childbirth"},{"key":"pone.0339166.ref005","first-page":"1","article-title":"The impact of female genital mutilation\/cutting on obstetric outcomes and its management","author":"YK Akpak","year":"2020","journal-title":"J Matern Fetal Neonatal Med"},{"key":"pone.0339166.ref006","unstructured":"World Health Organization. WHO guidelines on the management of health complications from female genital mutilation. Geneva, Switzerland; 2016."},{"issue":"12","key":"pone.0339166.ref007","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0279295","article-title":"Risk of obstetric anal sphincter tear among primiparous women with a history of female genital mutilation, giving birth in Sweden","volume":"17","author":"B Eshraghi","year":"2022","journal-title":"PLoS One"},{"issue":"3","key":"pone.0339166.ref008","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003088","article-title":"Painful gynecologic and obstetric complications of female genital mutilation\/cutting: A systematic review and meta-analysis","volume":"17","author":"JM Lurie","year":"2020","journal-title":"PLoS Med"},{"issue":"12","key":"pone.0339166.ref009","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2020-003307","article-title":"A systematic review and meta-analysis of the consequences of female genital mutilation on maternal and perinatal health outcomes in European and African countries","volume":"5","author":"F Sylla","year":"2020","journal-title":"BMJ Glob Health"},{"key":"pone.0339166.ref010","first-page":"542859","article-title":"An updated systematic review and meta-analysis of the obstetric consequences of female genital mutilation\/cutting","volume":"2014","author":"RC Berg","year":"2014","journal-title":"Obstet Gynecol Int"},{"key":"pone.0339166.ref011"},{"key":"pone.0339166.ref012","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.bpobgyn.2015.09.002","article-title":"Caesarean births among migrant women in high-income countries","volume":"32","author":"L Merry","year":"2016","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"issue":"4","key":"pone.0339166.ref013","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1111\/birt.12718","article-title":"Cesarean birth rates among migrants in Europe: A systematic review","volume":"50","author":"V Cadman","year":"2023","journal-title":"Birth"},{"issue":"2","key":"pone.0339166.ref014","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1111\/ajo.12954","article-title":"Female genital mutilation: Obstetric outcomes in metropolitan Sydney","volume":"59","author":"G Davis","year":"2019","journal-title":"Aust N Z J Obstet Gynaecol"},{"issue":"1","key":"pone.0339166.ref015","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1186\/s12884-016-1123-5","article-title":"Obstetric outcomes for women with female genital mutilation at an Australian hospital, 2006-2012: a descriptive study","volume":"16","author":"N Varol","year":"2016","journal-title":"BMC Pregnancy Childbirth"},{"issue":"9","key":"pone.0339166.ref016","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1111\/j.1471-0528.2009.02215.x","article-title":"Effects of female genital mutilation on birth outcomes in Switzerland","volume":"116","author":"S Wuest","year":"2009","journal-title":"BJOG"},{"issue":"3","key":"pone.0339166.ref017","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1007\/s00192-017-3466-5","article-title":"Are obstetric outcomes affected by female genital mutilation?","volume":"29","author":"AA Balachandran","year":"2018","journal-title":"Int Urogynecol J"},{"issue":"2","key":"pone.0339166.ref018","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1111\/ajo.12954","article-title":"Female genital mutilation: Obstetric outcomes in metropolitan Sydney","volume":"59","author":"G Davis","year":"2019","journal-title":"Aust N Z J Obstet Gynaecol"},{"issue":"2","key":"pone.0339166.ref019","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1002\/ijgo.15880","article-title":"Female genital mutilation\/cutting in women delivering in France: An observational national study","volume":"168","author":"H Cinelli","year":"2025","journal-title":"Int J Gynaecol Obstet"},{"key":"pone.0339166.ref020"},{"key":"pone.0339166.ref021","unstructured":"Socialstyrelsen [National Board of Health and Welfare]. 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Multiple Indicator Cluster Survey (MICS6) Briefing.; 2018."},{"issue":"5","key":"pone.0339166.ref044","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0198124","article-title":"Maternal height and risk of caesarean section in singleton births in Sweden-A population-based study using data from the Swedish Pregnancy Register 2011 to 2016","volume":"13","author":"I Mogren","year":"2018","journal-title":"PLoS One"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0339166","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T18:30:27Z","timestamp":1765996227000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0339166"}},"subtitle":[],"editor":[{"given":"Adewale Olufemi","family":"Ashimi","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,12,17]]},"references-count":44,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,17]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0339166","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,17]]}}}