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

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.