AFJOG

African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 2 | 2024 | 23 ORIGINAL RESEARCH African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 2 | 2024 | A retrospective review of gynaecological emergency surgery at Groote Schuur Hospital for the period of January to December 2019: a snapshot into women’s health in a Middle-Income Country, South Africa. ABSTRACT Background: Gynaecological emergencies are a common cause of morbidity and mortality among women of reproductive age worldwide. There is less audit done on the burden of emergency surgery in developing countries. Objectives: The planned study analysed the clinical processes and outcomes of gynaecological emergency surgeries performed at a tertiary level hospital in the Western Cape (Groote Schuur) in the year 2019. Methods: The study was a retrospective descriptive record review of patients who underwent emergency surgery at Groote Schuur Hospital. Data was captured manually and electronically using theatre database. Statistical analysis was performed using SPSS Statistics for Windows 2021. Results: We analysed 290 completed women records. The mean age was 30.16 years, with 230 (79.3%) women of reproductive age. There were 234 (79.1%) pregnancy related surgical procedures done. The most common occurrence among pregnancy related surgeries was ectopic pregnancy, accounting for 112 (47.9%) cases. A total of 130 (44.8%) women had anaemia and 125 (43.1%) had a tachycardia prior to surgery. Twenty-seven (9.3%) women were in hypovolaemic shock before surgery. A total of 179 (61.7%) women had the surgery 4 hours after being booked in theatre. Only 46 (15.9%) women accessed surgery within 2 hours. Twenty (6.9%) women had to wait for more than 24 hours for their operation to be done. The most common reason for the 24-hour delay, accounting for 85% (N=17), was the lack of emergency theatre time, as other cases from different disciplines were given priority. There were 42 (14.5%) women with complications post operatively and no mortality recorded. Conclusion: The study indicates good outcomes for emergency gynaecological surgeries performed at Groote Schuur Hospital in 2019. However, significant delays between the decision for surgical intervention and the actual performance of the surgeries were highlighted. The delays in hypovolaemic women were attributed to the need to compete with other surgical disciplines for emergency theatre time. 1. INTRODUCTION Gynaecological emergencies are a common cause of morbidity and mortality among women of reproductive age globally. [1,2] In developing nations, gynaecological emergencies present substantial challenges given the lack of health infrastructures and resources. Most of the literature in women reports on maternal mortality and morbidity. [3,4,5] Although this is exceptionally important, surgery beyond obstetrics is rarely documented, described, and audited. There is less research done both nationally and internationally specifically on gynaecological surgical emergencies performed. Women who require surgical intervention are in most cases booked on the general emergency theatre lists in both local and other institutions across South Africa. According to RCOG Good practice no.9 June 2009, sufficient operating facilities need to be available for gynaecological emergencies during regular working hours. [6] Prompt and timely reaction in managing gynaecological surgical cases during emergencies can greatly influence the surgical results for patients. [7] In cases such as ruptured ectopic pregnancy, the clinical characteristics will dictate the priority and urgency over other surgical emergencies. In addition, it is fitting for these women to anticipate receiving compassionate and timely care during an emotionally vulnerable period. As part of good clinical governance according to RCOG, regular review of clinical processes and outcomes through audits is essential for emergency gynaecological surgery .[6] Conducting an audit within the clinical environment enables the gathering of data with the intent of establishing professional benchmarks, evaluating clinical competence, and adapting clinical procedures as needed. [8] To achieve an outstanding provision of quality surgical treatment in Africa, comprehensive insight is required regarding the volume of surgical procedures conducted, the surgical resources at hand, and the peri- operative outcomes of patients. [9] Surgical care ought to be an essential element of healthcare systems for nations at every stage of development.[ 10] Annually, a minimum of 77.2million disability-adjusted life years could be averted through fundamental, life-saving surgical interventions. [11] Globally, the prevalent gynaecological emergencies include ectopic pregnancies, acute pelvic inflammatory diseases, miscarriages, and complicated ovarian cysts. [12] Ectopic pregnancy stands as the primary cause of maternal mortality during the first trimester and contributes to 10%– 15% of all maternal fatalities worldwide. [13] Comparing 2014 to 2016 data of the seventh triennial report on confidential enquiries into maternal death in South Africa, there was a 56% increase in ectopic deaths and a 17% increase in miscarriage deaths. [14] According to the African Surgery Outcomes Study (ASOS), most African patients receiving surgery were women (66.4%). Gynaecological and obstetric surgery contributed 11.55 and 33.3% respectively in the ASOS.[15] The study indicated that morbidity and mortality is on a rise in Low-Income Counties due to resource constraints. There are local studies that specifically reviewed ectopic pregnancy and not all TC Hlako 1 , TS Adams 2 1 Department of Obstetrics and Gynaecology, Groote Schuur Hospital, UCT, Cape Town, South Africa. 2 Department of Obstetrics and Gynaecology, Gynae oncology Unit, Groote Schuur Hospital, Cape Town, South Africa. CORRESPONDENCE: Dr TC Hlako | Email: drhlako@gmail.com A retrospective review of gynaecological emergency surgery at Groote Schuur Hospital for the period of January to December 2019: a snapshot into women’s health in a Middle- Income Country, South Africa.