In response to the World Health Organization (WHO) statements and international concerns regarding the coronavirus disease 2019 (COVID‐19) outbreak, FIGO has issued comprehensive guidance for the management of pregnant women.

This study, accomplished with the use of a variety of data sources from health care facilities in a number of developing countries, demonstrates quite clearly the overall relatively low use of assisted vaginal delivery (AVD, obstetrical forceps and the vacuum extractor) in most of the facilities. The information available to the investigators did not allow an assessment of the comparative risks and benefits of AVD in these settings. Not surprising was that factors responsible for the low use of AVD were low availability of equipment and scarcity of adequately trained personnel, which varied in degree among the facilities studied. Also not unexpected was that the use of forceps delivery was much less common than assisted delivery with a vacuum extractor. Even in facilities in developed countries the rate of forceps deliveries has declined over the past three decades, with a concomitant increase in the use of the vacuum extractor (Patel et al. BMJ 2004;328:1302-5). This has occurred despite the fact that forceps deliveries are associated with fewer failures than vacuum extraction and that in cases of fetal distress, delivery can be accomplished more rapidly with forceps than with vacuum extraction. Of course, part, if not all, of the explanation for the declining use of forceps for AVD is that teaching and learning the skillful and safe use of forceps is far more difficult than learning the safe use of the vacuum extractor. This difficulty is augmented by the rise of caesarean delivery as an alternative for an attempted AVD and the decline in the number of practitioners who have sufficient experience using obstetrics forceps to be efficient teachers of the necessary skills using these instruments. Also, safe forceps delivery relies on an adequate knowledge of pelvic anatomy and a familiarity with the pros and cons of several types of forceps, neither of which is a requisite with the vacuum extractor. Evidence of this conundrum is a recent study of 5 years of deliveries (n = 5375) in an obstetric service in Mexico City in which there were only 146 forceps deliveries (i.e. approximately 29 per year) (Ayala-Y a~ nez et al. J Pregnancy 2015:489 267). Although this institution was not described as a training centre for physicians or nurse midwives, it nevertheless shows how few opportunities are available to train young practitioners in the use of forceps. Although the vacuum extractor is a reliable choice for AVD in most cases, it is of no use in a vaginal breech delivery. If spontaneous delivery of the after-coming head does not occur, the only safe alternative is the use of forceps (in most cases the Piper forceps). One of the most important conclusions of the authors of this study is the need for more comprehensive and reliable data collection in obstet-ric facilities in underdeveloped countries. This would allow an assessment of benefits and risks of AVD in these settings and a better estimate of where resources could most efficiently be directed to meet the need for more and better equipment and more trained pers...

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Objectives Previous research has demonstrated the effectiveness of misoprostol for treatment of incomplete abortion; however, few studies have systematically compared misoprostol's effectiveness with that of standard surgical care. This study documents the effectiveness of a single 600 micrograms dose of oral misoprostol versus manual vacuum aspiration (MVA) for treatment of incomplete abortion in a developing country setting.Design Open-label randomised controlled trial.Setting Two university teaching hospitals in Burkina Faso, West Africa.Population Women of reproductive age presenting with incomplete abortion. Conclusion Six hundred micrograms of oral misoprostol is as safe and acceptable as MVA for the treatment of incomplete abortion. Operations research is needed to ascertain the role of misoprostol within postabortion care programmes worldwide.

Approximately 15% of expected births worldwide will result in life-threatening complications during pregnancy, delivery, or the postpartum period. Providers skilled in emergency obstetric and newborn care (EmONC) services are essential, particularly in countries with a high burden of maternal and newborn mortality. Jhpiego and its consortia partners have implemented three global programs to build provider capacity to provide comprehensive EmONC services to women and newborns in these resource-poor settings. Providers have been educated to deliver high-impact maternal and newborn health interventions, such as prevention and treatment of postpartum hemorrhage and pre-eclampsia/eclampsia and management of birth asphyxia, within the broader context of quality health services. This article describes Jhpiego's programming efforts within the framework of the basic and expanded signal functions that serve as indicators of high-quality basic and emergency care services. Lessons learned include the importance of health facility strengthening, competency-based provider education, global leadership, and strong government ownership and coordination as essential precursors to scale-up of high impact evidence-based maternal and newborn interventions in low-resource settings.