A systematic review and meta-analysis of valued obstetric and gynecologic (OB/GYN) procedures in resource-poor areas

Abstract

Background Obstetric and gynecologic procedures are valuable in rural settings. Data identifying common procedures may better prepare surgeons to meet patient needs in remote settings. Materials and methods A literature review using key MeSH terms was performed according to methods described by the Cochrane Collaboration and PRISMA on studies that described obstetric and gynecologic surgery in rural high-income countries or any setting in middle- to low-income countries. Meta-analysis was performed using random effects modeling for odds ratios of cesarean delivery and hysterectomy as proportions of total surgical volume. Results A total of 195 studies were included for qualitative synthesis and 22 for quantitative analysis. Obstetric and gynecologic procedures made up a 19% of all surgical cases. As compared to other obstetric and gynecologic surgical procedures, cesarean delivery was the most common procedure with odds ratio of 2.39 (95% confidence interval 1.48–3.86), and hysterectomy was the second most common procedure with odds ratio of 1.60 (1.57–1.64). However, heterogeneity between the studies was extremely high and risk of bias was high, limiting quality of findings. Conclusion Greater provision of surgical care can be enhanced by defining which procedures are most needed, which include many obstetric and gynecologic procedures, most commonly cesarean delivery and hysterectomy.

FIGO statement: Disparities in patients' access to benign gynecological surgery

“…In general, compared to men, women are less likely to participate in shared decision-making or to choose the type of surgical procedure [12]. The quantity and quality of information available pertaining to surgical procedures and preoperative counseling is less optimal when proposing to perform surgery on women.…”

Review of Obstetric and Gynecological Surgical Procedures in a Tertiary Hospital in Jigawa, North-West Nigeria

“…[6] A recent systematic review and meta-analytical study reported that in resource poor countries, O&G procedures made up 19% of all surgical cases. [7] Most common O&G surgeries are usually CD, followed by myomectomy. [7] The aim of the study was to determine the pattern of surgical procedures in Obstetrics and Gynecology at Rasheed Shekoni Federal University Teaching Hospital (RSFUTH) Dutse Nigeria over a 3 year period.…”

“…[7] Most common O&G surgeries are usually CD, followed by myomectomy. [7] The aim of the study was to determine the pattern of surgical procedures in Obstetrics and Gynecology at Rasheed Shekoni Federal University Teaching Hospital (RSFUTH) Dutse Nigeria over a 3 year period.…”

Which combination cause less inflammatory response during laparoscopic hysterectomy? Ligasure plus monopolar cautery or harmonic plus bipolar cautery?

“…Hysterectomy is the second most common surgery for women after cesarean section and the abdominal removal of the uterus is the most commonly used method by surgeons. 1 Hysterectomy can also be done through the vagina or as a laparoscopic or robot-assisted surgery. Regardless of the type of surgery used, hysterectomy is a major surgical procedure and studies have shown that these kind of major surgical trauma promotes an immunologic dysfunction that predisposes the patient to significant morbidity.…”