A retrospective review of the surgical management of tubal ectopic pregnancies at a tertiary Hospital in the Western Cape
Date
2017-12
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Stellenbosch : Stellenbosch University, 2017
Abstract
ENGLISH ABSTRACT: Aim:
To describe the surgical management of patients with tubal ectopic pregnancy at a tertiary hospital in the Western Cape. This includes patient demographics, clinical profile, peri-operative features, surgical managements and complications.
Methods:
This was a descriptive retrospective record review of all patients managed surgically for tubal ectopic pregnancy at Tygerberg Hospital from June 2013 – January 2015. Records were obtained from surgical logbooks and cross-referenced with patient databases. Records were then accessed from the electronic record-keeping system. Patient data were extracted onto an MS Excel spread sheet and analysed.
Results:
215 women were treated surgically for tubal ectopic pregnancy during this time period. The main risk factors identified were smoking (23,7%), previous miscarriage (17,3%) and previous ectopic pregnancy (10,2%). 198 patients (92,1%) were managed by laparotomy and 17 patients (7.9%) by laparoscopy. Registrars performed 97.5% of laparotomy cases whereas consultants performed 64.7% of laparoscopic cases. The total operative time was longer in the laparoscopy group 71,82 minutes vs. 54,1 minutes in the laparotomy group. The number of days spent post-operatively was shorter in the laparoscopy group 1,59 days vs. 2,77 days. 76.5% of the laparoscopic cases were performed on the elective lists whereas 96.5% of the laparotomies were performed in the various emergency theatres. All 5 surgical complications occurred in the laparotomy group.
Conclusion:
Tubal ectopic pregnancy at Tygerberg Hospital is mostly being managed by open surgery. There is thus great opportunity for improvement in this management to align with international standards. This would require input from doctors, nursing staff and management.
AFRIKAANS OPSOMMING: Doel: Om die chirurgiese hantering van pasiënte met buis ektopiese swangerskap by ‘n tersiêre hospital in die Wes-Kaap te beskryf. Dit sluit pasiënt demografie, kliniese profile, peri-operatiewe eienskappe, chirurgiese hanterings en komplikasies in. Metodes: Dit is ‘n beskrywende retrospektiewe rekord oorsig van alle pasiënte met buis ektopiese swangerskap wat chirurgies hanteer is by Tygerberg Hospitaal van Junie 2013 – Januarie 2015. Rekords is bekom van die elektroniese rekordhouding stelsel. Pasiënt data is onttrek na ‘n MS Excel spreiblad en ontleed. Resultate: 215 vroue met buis ektopiese swangerskap is chirurgies behandel gedurende hierdie tydperk. The vernaamste risikofaktore was rook (23,7%), vorige miskraam (17,3%) en vorige ektopiese swangerskap (10,2%). 198 pasiënte (92,1%) is hanteer met laparotomie en 17 pasiënte (7,9%) met laparoskopie. Kliniese assistente het 97,5% van laparotomie gevalle uitgevoer terwyl konsultante 64,7% van die laparoskopiese gevalle hanteer het. Die totale operasie tyd was langer in die laparoskopie groep, 71,82 minute vs 54,1 minuut in die lapatomie groep. Die aantal dae wat post-operatief spandeer is was korter in die laparoskopie groep, 1,59 dae vs 2,77 dae. 76,5% van die laparokopiese gevalle is uitgevoer op die elektiewe lyste terwyl 96,5% van die laparotomies uitgevoer is in verskeie nood-teaters. Al 5 chirurgiese komplikasies het voorgekom in die laparotomie groep. Opsomming: Buis ektopiese swangerskap by Tygerberg Hospitaal word meestal hanteer by oop chirurgie. Daar is dus ‘n groot geleentheid vir verbetering in hierdie hantering om in lyn met internasionale standaarde te kom. Die hulp van dokters, verpleegsters en bestuur word egter benodig.
AFRIKAANS OPSOMMING: Doel: Om die chirurgiese hantering van pasiënte met buis ektopiese swangerskap by ‘n tersiêre hospital in die Wes-Kaap te beskryf. Dit sluit pasiënt demografie, kliniese profile, peri-operatiewe eienskappe, chirurgiese hanterings en komplikasies in. Metodes: Dit is ‘n beskrywende retrospektiewe rekord oorsig van alle pasiënte met buis ektopiese swangerskap wat chirurgies hanteer is by Tygerberg Hospitaal van Junie 2013 – Januarie 2015. Rekords is bekom van die elektroniese rekordhouding stelsel. Pasiënt data is onttrek na ‘n MS Excel spreiblad en ontleed. Resultate: 215 vroue met buis ektopiese swangerskap is chirurgies behandel gedurende hierdie tydperk. The vernaamste risikofaktore was rook (23,7%), vorige miskraam (17,3%) en vorige ektopiese swangerskap (10,2%). 198 pasiënte (92,1%) is hanteer met laparotomie en 17 pasiënte (7,9%) met laparoskopie. Kliniese assistente het 97,5% van laparotomie gevalle uitgevoer terwyl konsultante 64,7% van die laparoskopiese gevalle hanteer het. Die totale operasie tyd was langer in die laparoskopie groep, 71,82 minute vs 54,1 minuut in die lapatomie groep. Die aantal dae wat post-operatief spandeer is was korter in die laparoskopie groep, 1,59 dae vs 2,77 dae. 76,5% van die laparokopiese gevalle is uitgevoer op die elektiewe lyste terwyl 96,5% van die laparotomies uitgevoer is in verskeie nood-teaters. Al 5 chirurgiese komplikasies het voorgekom in die laparotomie groep. Opsomming: Buis ektopiese swangerskap by Tygerberg Hospitaal word meestal hanteer by oop chirurgie. Daar is dus ‘n groot geleentheid vir verbetering in hierdie hantering om in lyn met internasionale standaarde te kom. Die hulp van dokters, verpleegsters en bestuur word egter benodig.
Description
Thesis (MMed)--Stellenbosch University, 2017
Keywords
Ectopic pregnancies, Mothers -- Mortality, Surgical complications, UCTD