Gynaecological emergencies in the tropics: recent advances in management

First Presentation and Diagnosis of a Rare Advanced Gynaecological Cancer in Emergency Department: A Case Report

A case of rare endometrial carcinosarcoma with locoregional spread and sigmoid fistula presenting for the very first time at a hospital emergency department (ED). A 56-year-old female presented with abdominal pain, diarrhea, fever, and pancytopenia, which was diagnosed as advanced gynaecological cancer following assessment, imaging, and tissue biopsy. Increased pressure on the ED owing to coronavirus disease 2019 pandemic may cause the first presentation of gynae-oncology cases to ED physician. A full return of all primary care services may reduce such pressure, improve early detection of gynaecological malignancies, allow early multidisciplinary team care, and result in better patient experience in the long run.

A Clinicopathological Study of 236 Cystic Ovarian Lesions at Jos University Teaching Hospital, Jos, Nigeria

Background

Cystic ovarian lesions are defined by an ovarian fluid containing space limited by a membrane. The exact prevalence of the disease is unknown. A proper diagnosis is imperative for the choice of appropriate therapy. The objective of this study is to establish the different histological variants of ovarian cysts diagnosed at the Histopathology Department of Jos University Teaching Hospital between January 1, 2000, and December 31, 2019.

Methodology

This is a descriptive study of consecutive cases of ovarian cysts at the Jos University Teaching Hospital, Jos, Nigeria between January 1, 2000, and December 31, 2019. Demographic and histopathologic data were collated from patients' request forms and duplicate copies of histology reports of all histologically diagnosed cases of ovarian cysts at the Histopathology Department during the study period.

Result

A total of 236cases of cystic ovarian lesions were seen during the period of the study. Benign and malignant cases constituted 226(95.76%) and 10(4.24%) cases respectively. Corpus luteum cyst was the commonest histological type accounting for 28.33% of cases. Lesions located on the right ovary were 145(61.44%), while those on the left were 95(40.25%). The commonest symptom was abdominal pain. The age range was 4-70years, with a mean, median and mode of 35.02+11.9 years, 33.0 years, and 35.0 years respectively.

Conclusion

The vast majority of ovarian cysts in our environment are benign, and commonly occurs in women during their reproductive age. Abdominal pain is the commonest presentation and cysts of the ovary occur more on the right.

Clinical Presentation and Management Outcome of Emergency Adolescent Gynecological Disorders at Federal Teaching Hospital, Abakaliki, Nigeria

Background:

Gynecological emergencies which affect the adolescents may pose a serious challenge to both the patient and the gynecologist.

Objectives:

The objective of this study is to determine the clinical presentations and management outcomes of emergency adolescent gynecological disorders at Federal Teaching Hospital, Abakaliki.

Materials and Methods:

This is a retrospective review of all cases of adolescent gynecological emergencies managed at Federal Teaching Hospital Abakaliki between January 1, 2012, and December 31, 2014. Data obtained from their case notes were analyzed using the IBM statistics version 20 (IBM Corp., Armonk, NY, USA). Data were presented using percentages and pie chart.

Results:

The prevalence of adolescent gynecological emergency disorders was 5.1%. The majority (82%) of the patients belong to the age bracket 15–19 with a mean age of 16.7 (2.4) years. About 90% of the patients were nulliparous. Unmarried patients comprised 80% of the study group. Vaginal bleeding was the most common clinical presentation (86%). The two most common diagnoses were abortion (60%) and sexual assault (26%). Only 10% of sexually active adolescent were using any form of contraception. Care received includes manual vaccum aspiration, laparotomy, and antibiotics. Blood transfusion was given in 18% of the cases. No death was recorded in all the cases.

Conclusion:

Abortive conditions and sexual assault were the most common clinical diagnosis among adolescents in the study. The percentage of adolescent assaulted in our study is unacceptable and should be prevented and efforts should be made to reduce the high unmet need for contraception seen in the study.

Determinants of decision-to-intervention time in the management and therapeutic outcome of emergency gynecological surgeries in south east Nigeria

Background

Prompt and timely response in the management of gynecological surgical cases can significantly affect the therapeutic surgical outcome of patients in emergency situations. The aim of this study was to evaluate the decision-to-intervention time (DIT), its determinants, and the significance in the therapeutic outcome of emergency gynecological surgeries managed at a federal teaching hospital in south east Nigeria over an 18-month period.

Methods

This was a prospective descriptive study of 105 emergency gynecological cases managed at a federal teaching hospital over an 18-month period. Patients were recruited at the point of admission and followed up until discharge for outcome. Data were abstracted with a data entry pro forma and then analyzed with the Epi Info™ statistical software version 7.0.

Results

The incidence of gynecological surgical emergencies was 5.1% of the total gynecological cases managed during the study period. The mean DIT was 4.25 (range 1.45–5.50) hours with delay in intervention, mainly due to delays in securing blood/blood products and other materials for resuscitation (46.7%) and a lack of finance (15.2%). Six maternal deaths were recorded, giving a case fatality ratio of 5.7%, while the commonest maternal complications associated with the delays were hemorrhage (61.9%) and the need for blood transfusion (57.1%), respectively. The risk ratio of losing ≥1,000 mL of blood, anemia, hemorrhagic shock, and wound infection in those with DIT ≥120 minutes was statistically greater and significant at 95% confidence interval.

Conclusion

Inadequacies in health care services and policies due to poor infrastructure, organizational framework, and financing were the major determinants of the prolonged DIT and therapeutic outcomes.