Pharmaceutical versus mechanical induction of labor

Labor induction is one of the most common obstetric interventions carried out in obstetric institutions. More than one fifth of labors needs induction. To date, many methods are available for labor induction with the pharmaceutical and mechanical methods being the commonest. The most common pharmaceutical agents used are prostaglandins, oxytocin, synthetic progesterone antagonists, and nitric oxide. Mechanical induction is carried out through using balloon catheters, hygroscopic dilators, artificial membrane rupture, or membrane stripping. Though pharmaceutical methods had largely replaced mechanical induction of labor, no consensus guidelines recommend their use. Studies from literature are still conflicting. However, it is generally agreed that the use of a combined approach with both pharmaceutical and mechanical methods of induction yields the best outcome. This article will review the different methods for labor induction, their effectiveness, and adverse events

Safety of pregnancy in uterine fibroids

Uterine fibroid is one of the most common intrauterine masses among females at the reproductive age. Pregnancy and uterine fibroids are highly correlated. Pregnancy-related hormones influence the size of uterine fibroids, and fibroids have many impacts on pregnancy. Although most if the uterine fibroids are asymptomatic during pregnancy, serious complications may occur. The main complications include abortion, premature rupture of membranes, premature labor, abruptio placentae, peripartum hemorrhage, fetal malpresentation, fetal intrauterine growth retardation, small for gestational age infants, and fetal anomalies. The main risk factors for complications are related to the fibroid number, size, volume, location, and type. Large, multiple, retroplacental, submucosal, subserosal, pedunculated, or low-lying fibroids carries the highest risk for complications during pregnancy. This review will address the prevalence of uterine fibroids during pregnancy, its effects, and complications

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially