ABSTRACT
Maternal mortality is defined as death of a woman while pregnant or within 42 days of the termination of pregnancy, irrespective of the duration and the site of pregnancy, from any cause related to or aggravated by the pregnancy or its management.1 Maternal mortality is one of the leading causes of death for young women in low-and middle-income countries (LMICs); this includes death from both obstetric and gynecologic etiologies. As a region, sub-Saharan Africa accounts for 62% of maternal deaths worldwide and has a regional maternal mortality estimated at 510 per 100,000 live births, resulting in a one-sixteenth lifetime risk of dying of a pregnancy-related cause in this region.1,2 Gynecologic mortality and morbidity are often overlooked when in fact in sub-Saharan Africa, at least 14% of maternal mortality is thought to be caused by the sequelae of unsafe abortion and one-sixth from sepsis, with ectopic pregnancy also contributing significantly to this burden of disease. This results from the fact that little attention is given to the gynecologic care of women in LMICs and few women access the healthcare system unless they are seeking prenatal care. Therefore, there is significant gynecologic pathology encountered when working in these settings and many conditions present emergently. Often, patients present with severe bleeding and hemorrhagic shock, or they present with septic shock from infectious conditions such as septic abortion or pelvic abscesses. Understanding good surgical technique for core gynecologic procedures such as manual vacuum aspiration, dilation and curettage, laparotomy for pelvic abscesses, treatment of ectopic pregnancies, and hysterectomy is critical to reduce maternal mortality and mortality.
