Obstetric Surgery

Pregnancy is not a disease but a condition undertaken by most women during their reproductive lives. Pregnancy, however, is a time when health can be threatened. Any pregnancy carries the risk for hemorrhage, obstructed labor, or the need for a cesarean delivery. The sheer volume of maternal morbidity and mortality worldwide indicates that every pregnant woman is at risk for surgically preventable obstetric complications that can lead to death or disability. Maternal morbidity and mortality are significantly increased by conditions that can be prevented by access to safe obstetric surgery. Obstructed labor, which can lead to fistula formation, uterine perforation, hemorrhage, sepsis, or death, can be avoided by observing labor for deviations from normal and providing access to nearby safe cesarean delivery. Most lowand middleincome countries (LMICs) do not have birth attendants present at deliveries to monitor for abnormalities; most of these countries also lack the capacity to provide access to nearby hospitals, where safe and timely cesarean deliveries can be undertaken. Hemorrhage during pregnancy and the postpartum period can be catastrophic; the occurrence of hemorrhage remote from access to surgical services, such as uterine curettage or lifesaving hysterectomy, drives avoidable maternal mortality rates worldwide. This chapter uses the World Health Organization’s (WHO’s) six geographical regions: African Region, Region of the Americas, South-East Asia Region, European Region, Eastern Mediterranean Region, and Western Pacific Region.