An Updated Systematic Review and Meta-Analysis of the Obstetric Consequences of Female Genital Mutilation/Cutting

Table 2

Summary of GRADE assessments.

Outcomes	Model 1: unadjusted results. All studies	Model 2: adjusted results. All studies reporting adjusted results	Model 3: adjusted results. Prospective studies	Model 4: unadjusted results. Prospective studies
Prolonged labor	very low^1,2	very low^9,2	low^15	very low^16,2
Tears/lacerations	very low^3,2	very low^9	—	—
Caesarean section	very low^4,2,5	very low^10,2	low	very low^2,5
Episiotomy	very low^6,2	very low^11,12	—	—
Instrumental delivery	very low^7,2,5	very low^13	—	—
Hemorrhage	very low^8,2	very low^14	very low^2,5	very low^2,5
Difficult labor	very low^9,2,5	low	low^15	very low^16

GRADE working group grades of evidence:  High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate.
¹5 of 5 studies had low methodological study quality (one additional study includes this outcome, but we have not received the data).
²Considerable heterogeneity indicated by showed inconsistency across studies.
³12 of 14 studies had low methodological study quality (one additional study includes this outcome, but we have not received the data).
⁴12 of 15 studies had low methodological study quality.
⁵CI is wide and crosses limitations of precision.
⁶9 of 11 studies had low methodological study quality.
⁷7 of 8 studies had low methodological study quality.
⁸6 of 8 studies had low methodological study quality (one additional study includes this outcome but we have not received the data).
⁹3 of 4 studies had low methodological study quality.
¹⁰4 of 5 studies had low methodological study quality.
¹¹The study had low methodological study quality.
¹²Single study.
¹³2 of 2 studies had low methodological study quality.
¹⁴3 of 5 studies had low methodological study quality.
¹⁵Only one study of low to moderate methodological study quality but fairly large sample size and large effect estimate.
¹⁶Only one study of low to moderate methodological study quality, unadjusted results, but fairly large sample size and large effect estimate.