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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 4  |  Issue : 2  |  Page : 104-107

Surgical procedures in obstetrics and gynecology department of a teaching hospital in northern Nigeria: A 5 year review


1 Departments of Obstetrics and Gynecology, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
2 Department of Anesthesiology, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
3 Department of Community Medicine, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria

Date of Web Publication16-Oct-2014

Correspondence Address:
Idris S Abubakar
Department of Obstetrics and Gynecology, Aminu Kano Teaching Hospital, PMB 3452, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-9596.143088

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  Abstract 

Background: Surgical procedures in obstetrics and gynecology have witnessed significant improvements in terms of morbidity and mortality. This is not unrelated to advancement in asepsis and anesthesia over the years. This study aimed at describing the pattern of surgical procedures in obstetrics and gynecology at a tertiary health center in Northern Nigeria.
Patients and Methods: This is a retrospective study of patients who had surgical procedures in Obstetrics and Gynecology at Aminu Kano Teaching Hospital, Nigeria from 1 st January, 2005 to 31 st December 2009. The data retrieved from their case notes were analyzed using Mini Tab Electronic Statistical Software. Information extracted were age, type of surgery and anesthesia used. The data analyzed were presented using simple tables. X 2 and P value were used to test for significant statistical associations where appropriate.
Results: A total of 2741 operations were done within the period under review. The mean age of the patients was 29.95 ± 8.26 years. Emergency surgeries were performed in1643 (59.9%) patients while the remaining 1098 (40.1%) were elective. General anesthesia was used for the majority 2093 (76.4%) of the cases. Cesarean section accounted for the majority (62.6%) of the procedures performed. Other surgeries include myomectomy (4.2%), total abdominal hysterectomy (4.7%), and andlaparotomy (9.3%) among others. Obstetric cases accounted for 1510 (55.1%) of the surgeries conducted while 1231 (44.9%) were gynecological cases.
Conclusion: Most of the procedures were emergency obstetric surgeries performed under general anesthetic. Caesarean section rate was highest among all surgical procedures. There was statistically significant association between the type of surgery and the administered form of anesthesia.

Keywords: Caesarian delivery, gynecologic emergency, obstetric emergency, surgical procedures


How to cite this article:
Yakasai IA, Ibrahim SA, Abubakar IS, Ayyuba R, Mohammed AD, Gajida AU. Surgical procedures in obstetrics and gynecology department of a teaching hospital in northern Nigeria: A 5 year review . Arch Int Surg 2014;4:104-7

How to cite this URL:
Yakasai IA, Ibrahim SA, Abubakar IS, Ayyuba R, Mohammed AD, Gajida AU. Surgical procedures in obstetrics and gynecology department of a teaching hospital in northern Nigeria: A 5 year review . Arch Int Surg [serial online] 2014 [cited 2020 Oct 24];4:104-7. Available from: https://www.archintsurg.org/text.asp?2014/4/2/104/143088


  Introduction Top


Since the breakaway of the Specialty of Obstetrics and Gynecology from the surgical specialty and the formation of British College of Obstetricians and Gynecologist in 1929, there has been monumental increase in surgical procedures that are related purely to the female reproductive tract. [1] The advancement of science in asepsis [2] and anesthesia [3],[4] in the nineteenth century has made operations in the field of surgery safer and more reassuring. Elective operations are scheduled operations where patients are well prepared prior to surgery and as such have better outcome when compared to emergency operations where morbidity and mortality are higher. [5] Most of the emergencies present at odd hours [6] when less experienced personnel are on ground and patients are not optimally prepared for the operations as such, the outcome is poor with resultant increased morbidity and mortality. [7]

The concept of midwifery led care, home labor management and the beliefs of some women that, there is unnecessary intervention in the natural process of labor by health workers in the developed nations may account for decrease number of emergency obstetric surgical interventions [8] as opposed to developing nations where such forms of management are not institutionalized, and aversion to hospital deliveries. Hospital is regarded as second option when unorthodox health delivery system has failed, emergency surgical interventions naturally increases as majority of patients present with serious surgical complications. This study is aimed at describing the pattern of surgical procedures in obstetrics and gynecology at Aminu Kano Teaching Hospital over a 5 year period.


  Patients and Methods Top


This is a retrospective study of patients who had surgery at Obstetrics and Gynaecology at Aminu Kano Teaching Hospital (AKTH), Nigeria from 1 st January, 2005 to 31 st December 2009. During the study period, there was only one physician anesthetist with few trainees. Nurse anesthetists constituted the bulk of the anesthetic manpower with limited experience in regional anesthesia. All the operations were performed by the surgeons employed by the teaching hospital ranging from registrars to consultants.

The case notes were retrieved from the records department and the data were analyzed using Mini Tab Electronic Statistical Software. The following information was extracted: age, nature of surgery (emergency or elective), type of anesthesia, and types of surgery. The data analyzed were presented using simple tables. Chi-square and P-values were used for test of statistical significance.


  Results Top


A total of 2741 operations were done in the department between 2005 and 2009. The age of the patients ranged from 14-76 years with a mean of 29.95 ± 8.26 years.

During the study period, there was only one physician anesthetist with few trainees. Nurse anesthetist were the bulk anesthetic manpower with limited experience in regional anesthesia. Majority of the subjects 2094 (76.4%) are less than 35 years of age while 647 (23.6%) are above or equal to 35 years [Table 1]. Emergency surgeries were performed in 1643 (59.9%) patients while the remaining 1098 (40.1%) were elective.

General anesthesia was used for the majority 2093 (76.4%) of the cases; 606 (22.1%) had spinal subarachnoid block (SAB) while 42 (1.5%) had local anesthesia for their procedures [Table 2].
Table 1: Age distribution of the patients

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Table 2: Types of anesthesia, surgery and frequency

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Caesarean operation accounted for the majority (62.6%) of the procedures performed. Other surgeries include myomectomy (4.2%), total abdominal hysterectomy (4.7%), vesico-vaginal fistula (VVF) repair (2.2%), laparotomy (9.3%) and others (17.0%). Obstetric cases accounted for up to 1510 (55.1%) of the surgeries conducted while 1231 (44.9%) were gynecological cases. There were no mentions of significant anesthetic related morbidity and mortality during the period under review.

On univariate analysis, there was statistically significant association between type surgery (Emergency or Elective) and the type of anesthesia used (General, SAB or Local) χ2 = 14.709, df = 2, P = 0.001 [Table 3]. Similarly, there was statistically significant association between the type of procedure (obstetric or gynecological) and the type of anesthesia used, (General, SAB, or Local) χ2 = 116.942, df = 2, P = 0.000 [Table 4], [Table 5], [Table 6].
Table 3: Types of surgery (emergency or elective) and anesthesia

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Table 4: Type of procedure and anaesthesia

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Table 5: Age group and type of anesthesia

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Table 6: Types of surgery and age group

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A statistically significant association was also established between age range of the patients and the type of anesthesia used, χ2 = 13.326, df = 2, P = 0.001. Likewise, a statistically significant association was also established between age range of the patients and the indications for the surgery χ2 = 108.952, df = 2, P = 0.000.


  Discussions Top


In this review, emergency surgeries were the majority constituting 59.9% of all surgeries. Ahmed [9] revealed a rising trends in emergency surgical admissions in Zaria. Aisien and colleagues [10] also showed a high rate of emergency caesarean section (90%) when compared with elective caesarean section (10%) in Jos. This trend of increasing number of emergency obstetric and gynecological surgical procedures in a tertiary health facility setting is likely due to failure of secondary health facilities, possibly as a result of dearth of skilled manpower. This may affect elective surgical procedures due to fatigue of health care providers.

General anesthesia was used for most of the procedures performed in this review (62.6%). This is mainly due to the high rate of emergency procedures (59.9%) when compared with elective procedures (40.1%). Most of the obstetric procedures could be done under spinal subarachnoid block considered as safe and popular in the UK. [11] However, in comparison, a retrospective analysis of 2284 consecutive caesarean sections in Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, during the period under study showed similarities in terms of nature of obstetric procedure - emergency CS = 1784 (78.2%) versus elective CS 498 (21.8%). [12] In sharp contrast, 87% of the caesarean sections were performed under spinal subarachnoid block performed by physician anesthetists which compares favorably with figures in the UK. Thus, with improved skilled anesthetic manpower, the trend in type of anesthetic administered for obstetric and gynecological procedures could be reversed in favor of safer, regional techniques.

Caesarean operation accounted for most of the surgeries performed (62.6%). Ameh and colleagues [13] reported a high prevalence of caesarean section (90%) among obstetrics and gynecological procedures performed by a general surgeon in a rural hospital in Northern Nigeria. This is mainly due to the high birth rate and pregnancy associated complications [14] in our region, and the fact that the patients present late in advanced labor.

The review also showed high prevalence of obstetric cases (55.1%) when compared with gynecological cases (44.9%). This is because most of women in this review were in the child bearing age group of 15-49 years with high risk of obstetric complications. [15] Statistically significant associations were found between the type of surgery and anesthesia, the type of procedure and anesthesia, the age range and the type of anesthesia and the age range of the patients and the indications for surgery.


  Conclusion Top


In this review, most of the procedures were emergency obstetric surgeries and general anesthesia was administered for the majority of these procedures. Caesarean section rate was the most commonly performed surgical procedure. There was statistically significant association between the type of surgery and the administered form of anesthesia.

 
  References Top

1.
Drift J. The start of life: A history of obstetrics. Postgrad Med J 2002;78:311-5. Available from: www.pmj.bmj.com/content/78/919.toc [Last accessed on 2013 Jul 21].  Back to cited text no. 1
    
2.
Anonymous. Obituary: Joseph, Baron Lister. Lancet 1912;I:465-72.  Back to cited text no. 2
    
3.
Lawrence E. Aurelia, Cecily and Ann: A brief survey of caesaren section. Dipl 1996;3:71-4.  Back to cited text no. 3
    
4.
O'Dowd MJ, Phillip EE. The history of obstetrics and gynecology. 2 nd edition, CRC press 2000.  Back to cited text no. 4
    
5.
Zambouri A. preoperative evaluation and preparation for anaesthesia and surgery. Hippokratia 2007;11:13-21.  Back to cited text no. 5
    
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Duty hours: Neurosurgery. Yale school of medicine. Available from: http://www.medicine.yale.edu/neurosurgery/education/tools/duty.aspx [Last accessed on 2013 Aug 05].  Back to cited text no. 6
    
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Kumar S, Toshi MK. Emergency total thyroidectomy for bleeding anaplastic thyroid carcinoma: A viable option for palliation. Indian J Palliat Care 2011;17:67-9.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
8.
Hatern M, Sandall J, Devane D, Soltani H, Gates S. Midwife-led versus other models of care for childbearing women: The Cochrane Collaboration, Cochrane Library. 2009; Available from: http://www.thecochranelibrary.com [Last accessed on 2013 Aug 05].  Back to cited text no. 8
    
9.
Ahmed A. Trends in emergency surgical admissions in a tertiary health centre in Nigeria. West Afr J Med 2009;28:106-9.  Back to cited text no. 9
    
10.
Aisien AO, Lawson JO, Adebayo AA. A five year appraisal of caesarean section in a Northern Nigeria University Teaching Hospital. Niger Postgrad Med J 2002;9:146-50.  Back to cited text no. 10
    
11.
Shibli KU, Russell IF. A survey of anaesthetic techniques used for caesarean section in the UK in 1997. Int J Obstet Anaesth 2000;9:160-7.  Back to cited text no. 11
    
12.
Galadanci HS, Mohammed AD, Atiku M, Habeeb M, Danjuma M. et al. Safety and acceptability of spinal subaracnoid block for caesarean section in Kano, Nigeria. Oral presentation 49 th WACS Annual Conference.   Back to cited text no. 12
    
13.
Ameh EA, Mbibu HN, Adams LM, Nmadu PT. Role of a general surgeon in obstetrics and gynecology in a rural setting. East Afr Med J 1998;75:27-9.  Back to cited text no. 13
    
14.
Zulzulya M. Maternal mortality in Nigeria: An indicator of women's status. Available from: www.consultancyafrica.com [Last accessed on 2013 Jul 22].  Back to cited text no. 14
    
15.
Doctor HV, Findley SE, Afenyadu GY. Estimating maternal mortality level in rural Northern Nigeria by the sisterhood method. Int J Popul Res 2012;2012:1-5.  Back to cited text no. 15
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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Abstract
Introduction
Patients and Methods
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