AFJOG

African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 2 | 2024 | 25 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. Figure 2: HIV Status (N=290) Reasons for emergency gynaecological surgery There were 228 (78,6%) women who underwent pregnancy related surgery, while 62 (21.4%) had non-pregnancy related surgery. Of the 228 women, there were234 pregnancy related procedures for emergency surgery (Table 2). There were six participants out of the 228 women who each had 2 reasons for the pregnancy related emergency surgery, explaining the total of 234 pregnancy related reasons. Of the six participants, three of the women were taken to theatre for wound debridement and evacuation of the uterus at the same time. While the other 3 had evacuation of the uterus and a relook laparotomy. Out of the 234 pregnancy related procedures, ectopic pregnancy was by far the commonest occurrence as there were 112 (47.9%) procedures related to this. Among the 62 women who had non-pregnancy related surgery, ovarian cyst complocations were commonest with 25 (40.3%) procedures related to this, followed by 14 (22.6%) with pelvic inflammatory disease and 11 (17.1%) who had ovarian torsion surgical interventions. Table 2. Reasons for emergency surgery (pregnancy related) Frequency Percentage Ectopic pregnancy 112 47.9 Evacuation of uterus (incomplete miscarriage) 34 14.5 Evacuation of uterus (septic miscarriage) 24 10.3 Suction evacuation (molar pregnancy) 22 9.4 Evacuation of uterus (post NVD) 17 7.3 Evacuation of uterus (post c/s) 13 5.6 Hysterectomy for sepsis (post- delivery) 4 1.7 Other 8 3.4 Total 234 100.0 Table 3. Reasons for emergency surgery (non pregnancy related) Frequency Percentage Pelvic inflammatory disease 14 22.6 Wound sepsis- post surgery 3 4.8 Hysterectomy for sepsis 1 1.6 Ovarian torsion 11 17.1 Other cyst complications 25 40.3 Bartholin’s abscess 8 12.9 Total 62 100.0 Pre-operative status A total of 125 (43.1%) women had a tachycardia prior to surgery and 130 (44.8%) had anaemia. Anaemia is defined as a haemoglobin (Hb) less than 12 to 15 g/dl, but the Hb of 10 and less was used as the cut off in the cohort study. Hypovolaemic shock in the study was defined as systolic blood pressure of <100mmHg with tachycardia (heart rate >100), and anaemia. Only 27 participants (9.3%) were in shock prior to surgery (Table 4). Distribution of the patients in hypovolaemic shock were ectopic pregnancy- n=14 (51.9%), incomplete miscarriage- n=12 (44.4%) and intra-abdominal bleeding- n=1 (3.7%). Table 4. Pre-operative haemodynamic status Valid Frequency Percentage Yes 27 9.3 No 263 90.7 Total 290 100.0 Post-surgical complications Figure 3 refers to post-surgical complications. There were no mortalities in this study period. In most cases (N=248; 85.5%) there were no complications related to surgery. Only 42 (14.5%) women had complications of which post-operative anaemia (N=16; 5.5% of the entire cohort of 290 women) and wound sepsis (N=9; 3.1% of entire cohort) were the commonest. The group other included 6 cases of septic intra-abdominal collections, 2 vaginal bleeding post evacuation of the uterus and 1 urinary retention. Figure 3: Post-surgical complications (N=290) Decision intervention times (DIT) In 174 (60%) cases, the decision for surgery was made within 4 hours. Within 10 hours, the decision was already made in 207 (71.4%) of the cases. Table 5 indicates the time it took from booking the theatre case to the actual surgery being performed. A total of 179 (61.7%) women took more than 4 hours from the time they were booked for surgery to the time they arrived in theatre. Only 1 (0.3%) participant was able to get to theatre within 30 minutes from the time of booking for theatre. Twenty (6.9%) participants took more than 24 hours from decision to intervention time (DIT). There were 8 cases (2.8%) with decision intervention time (DIT) within 1 hour and 46 cases (15.9%) within 2 hours. Out of the 27 (9.3%)