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Inzama, Wilfred; Kaye, Dan K.; Kayondo, Simon P.; Nsanja, John P.
doi: 10.1002/ijgo.14588pmid: 36436881
Globally, 25% of pregnancies end up in induced abortion, the majority of which are unsafe. Abortion is safe when conducted according to WHO recommendations. The objective of the present study was to identify gaps in the data published on abortion and make recommendations to the Ministry of Health, Uganda. The search strategy included PubMed, Google Scholar articles (from October 2020 to May 2021) on unsafe abortion in Uganda, reviewed data from the Association of Obstetricians and Gynecologists of Uganda (AOGU) members' baseline survey (2019), Health Management Information System (HMIS) summary data (2015–2016 to 2019–2020), and the Uganda Demographic and Heath Survey (DHS) report (2011, 2016). From the 200 articles and national health surveys identified, 37 articles and two national representative surveys met our criteria: prevalence, factors, estimating cost of induced abortion, and complications associated with safe and unsafe abortion in both low‐ and high‐income countries. There are many unsafe abortions in restrictive environments. Abortion is one of the leading causes of maternal and morbidity. Physicians favor dilatation and curettage over manual vacuum aspiration and medical methods for the evacuation of retained products. Several gaps still exist in the published articles, HMIS data, and DHS data, leading to missed opportunities for data to inform policy and practice.
Sorensen, Herman A.; Obel, Josephine; Schroll, Jeppe B.; Krebs, Lone
doi: 10.1002/ijgo.14483pmid: 36181290
Most studies comparing vaginal breech delivery (VBD) with cesarean breech delivery (CBD) have been conducted in high‐income settings. It is uncertain whether these results are applicable in a low‐income setting. To assess the neonatal and maternal mortality and morbidity for singleton VBD compared to CBD in low‐ and lower‐middle‐income settings,the PubMed database was searched from January 1, 2000, to January 23, 2020 (updated April 21, 2021). Randomized controlled trials (RCTs) and non‐RCTs comparing singleton VBD with singleton CBD in low‐ and lower‐middle‐income settings reporting infant mortality were selected. Two authors independently assessed papers for eligibility and risk of bias. The primary outcome was relative risk of perinatal mortality. Meta‐analysis was conducted on applicable outcomes. Eight studies (one RCT, seven observational) (12 510 deliveries) were included. VBD increased perinatal mortality (relative risk [RR] 2.67, 95% confidence interval [CI] 1.82–3.91; one RCT, five observational studies, 3289 women) and risk of 5‐minute Apgar score below 7 (RR 3.91, 95% CI 1.90–8.04; three observational studies, 430 women) compared to CBD. There was a higher risk of hospitalization and postpartum bleeding in CBD. Most of the studies were deemed to have moderate or serious risk of bias. CBD decreases risk of perinatal mortality but increases risk of bleeding and hospitalization.
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