An Audit of the Gynecological Emergencies requiring Emergency Laparotomy in a Tertiary Care Hospital: Timeline of Events from Arrival to Emergency to Arrival to Operation Theater

Abstract

Introduction: Gynecological emergencies can threaten the life of the female and cause loss of fertility and organ. Ruptured ectopic pregnancy is the most prevalent of the gynecological potentially life-threatening emergencies (G-PLEs). Diagnostic tools are medical history, clinical examination, imaging, and lab investigations, mainly human chorionic gonadotropin (β-HCG) and hemoglobin. Surgery is the mainstay of treatment and the approach can be laparotomy and laparoscopy. Objective: The objective of this study is to assess the time taken from arrival in the emergency department (ED) to arrival to diagnosis and to assess the time taken from arrival to ED to arrival to operation theater (OT) and correlate the time taken with patient morbidity. Methods: The study was done between April 1, 2021 and September 30, 2021. All patients with suspected gynecological emergencies requiring emergency laparotomy/laparoscopy arriving at the ED were included in the study. Data collection was from medical records – six time intervals were collected. Results: There were 16 ruptured ectopic pregnancies during the study period. ED to OB consultation was in <60 min in 12 (75%) cases. ED to ultrasound (USG) and diagnosis were in <60 min in 11 (73%) cases. Diagnosis to OT was in <60 min in only 8 (50%) cases. Delay after diagnosis was due to delay in admission in four (delay in the decision by attendees mostly due to financial constraints), delay in the decision for surgical intervention in three, and nonavailability of blood in one patient. All 5 (100%) patients with grades III and IV of shock had hemoperitoneum >1.5 L and 3 (60%) required postoperative intensive care unit (ICU). Conclusion: Higher morbidity was seen in a higher grade of shock. It is essential to recognize the degree of physiological deterioration with the help of an early warning scoring system. Timely surgical intervention with simultaneous efforts for resuscitation reduces morbidity and mortality.