Case records and commentaries in obstetrics and gynaecology
Abstract
Introduction
Gynaecologic surgery contributes to 16% of all surgical workload in rural Kenya (3).
Most of this surgery is performed by Gynaecologist trained at Kenyatta National
Hospital. The study provided a form of audit of gynaecological surgery done in the
Kenyatta National Hospital, which will be useful in management of the department in
terms of staff; theatre allocation and other resources, and review of competence of staff
conducting training and being trained.
Objective
To describe the gynaecological surgeries, clinical outcome and complications over one
year period at KNH from 15t January 2003 to 315t December 2003.
Study design
This was a retrospective descriptive study
Study population
Retrospectively women who had undergone gynaecological surgery in both elective and
Emergency gynaecology wards between 1st January 2003 and 315t December 2003 both
days inclusive.
Data source
Theatre registration book and patients' files from the records department.
Results:
The population studied was 605 and had a mean age of 32.5 years with a median of 30.0
years and a range of 6-99 years; 71.3% were married, 43% had a primary education,
46.4% were housewives and 21.8% self-employed. There were 286 (47.4%) elective
surgeries and 319 (52.6%) emergency surgeries done. Majority of Emergencies (69.5%)
were salpingectomies and majority (33.2%) of the electives were hysterectomies.
Ectopic pregnancy was a 'cause of majority (97.8%) of the salpingectomies done and
77.5% of the hysterectomies were due to symptomatic uterine fibroids. Most of the
salpingectomies were done by Registrars (92.9%) and most of the hysterectomies were
done by the Senior Registrars (61.8%). Registrars did not do hysterectomy. Most of the
surgeries (95.7%) were uneventful. Anesthetic complications were more common in
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emergency surgery (0.6%) whereas wound infection (3.1%) was more common III
elective surgery but the differences were not statistically significant (p>0.05).
Conclusion:
The majority of gynaecological operations done at KNH were emergencies. Majority of
emergencies were done salpingectomy and were mainly due to ectopic pregnancy; the
main surgeon doing this operation being the registrar. Majority of electives were
hysterectomies due to mainly uterine fibroids and were done by senior registrars. The
registrars did not do hysterectomies.
Recommendations:
There is a need for auditing the output of gynaecological surgery regularly. Registrars did
no hysterectomies. The Registrars should be given opportunities to perform
hysterectomies in anticipation of the tasks a head of their future practices at the provincial
and district Hospital.
Citation
Master of Medicine (Obstetrics and Gynaecology) University of Nairobi, 2007Publisher
University of Nairobi, Department of Obstetrics & Gynaecology