A Five-Year Review of Laparoscopic Gynaecological Surgeries in a Private-Owned Teaching Hospital, in Nigeria.

BACKGROUND: Laparoscopic surgery is associated with shorter hospital stay and less post-operative morbidity. Cost, expertise and availability of equipment, however remain limitations to the range of surgeries available in low resource settings. OBJECTIVES: To determine the indications, the patient characteristics and the surgical outcomes of laparoscopic gynaecological surgeries in a Nigerian private tertiary level hospital. METHODS: This retrospective observational study included all gynaecologic laparoscopy procedures done between August 2016 and July 2021, at the Babcock University Teaching Hospital (BUTH). Data were extracted from the hospital records with the use of a proforma designed for this purpose and were analyzed using the SPSS version 21.0. RESULTS: Laparoscopy accounted for 13.5% of gynaecological surgeries. They were majorly in nulliparous women (67.6%) of reproductive age (mean 33.9±10.2 years and median of 32 years). The commonest indication was secondary infertility (27.3%) and operative procedures were more commonly done (59.0%). The mean duration of surgery was 94.8±52.4 min and conversion to laparotomy rate was 8.6%. Operative procedures lasted longer (113.9±58.1 min) and accounted for most conversions, 10/12 (83.3%). Intraoperative complication rate was 2.2% and they were mostly (66.7%) entry related. The mean duration of hospitalization was 2.2± 1.6 days. CONCLUSION: The prevalence and indications for laparoscopic surgeries were similar to findings from other parts of Nigeria. Operative procedures were however more commonly done. In spite of the sustained increase in procedure rates, a steady decline in the duration of surgery, conversion and complication rates occurred. Private hospitals may have potential for uninterrupted progression of laparoscopic gynaecocologic surgeries in Nigeria.

CONTEXTE: La chirurgie laparoscopique est associée à un séjour hospitalier et moins de morbidité postopératoire. Coût, expertise et la disponibilité de l'équipement restent cependant des limites à la gamme de chirurgies disponibles dans des contextes à faibles ressources. OBJECTIFS: Pour déterminer les indications, le patient et résultats chirurgicaux de la chirurgies gynécologiques par laparascopie dans un hôpital privé nigérian de niveau tertiaire. MÉTHODES: Cette étude observationnelle rétrospective comprenait les procédures de laparoscopie gynécologique effectuées entre août 2016 et juillet 2021, au Babcock University Teaching Hospital (BUTH). Les données ont été extraites des dossiers de l'hôpital à l'aide d'un proforma conçu à cet effet et a été analysé à l'aide de version 21.0 du SPSS. RÉSULTATS: La laparoscopie représentait 13.5 % des gynécologues Chirurgies. Ils étaient principalement chez les femmes nullipares (67.6%) âge de reproduction (moyenne 33.9±10.2 ans et médiane de 32 ans). L'indication la plus courante était l'infertilité secondaire (27.3%) etles procédures opératoires étaient plus couramment effectuées (59.0 %). La durée moyenne de la chirurgie était de 94.8±52.4 min et la conversion en laparotomie était de 8.6 %. Les procédures opératoires ont duré plus longtemps (113.9±58.1 min) et représentait la plupart des conversions, 10/12 (83.3 %). Le taux de complicationsintra opérative était de 2.2 % et ils étaient principalement (66.7 %) apparenté. La durée moyenne de l'hospitalisation était de 2.2 ± 1.6 jour. CONCLUSION: La prévalence et les indications pour les chirurgies par laparoscopie étaient similaires aux résultats d'autres régions du Nigéria. Les procédures opératoires étaient cependant plus courantes. Malgré tout de l'augmentation soutenue des taux d'intervention, une baisse constante de la durée de la chirurgie, la conversion et les taux de complications sont survenus. Les hôpitaux privés peuvent avoir un potentiel de progression interrompue des chirurgies gynécologiques laparoscopiques au Nigeria. Mots-clés: Audit, endoscopie, laparoscopie, hôpital privé.

Maternal near-miss and death among women with postpartum haemorrhage: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey.

OBJECTIVE: To investigate the burden and health service events surrounding severe maternal outcomes (SMO) related to life-threatening postpartum haemorrhage (PPH) in Nigerian public tertiary hospitals. DESIGN: Secondary analysis of a nationwide cross-sectional study. SETTING: Forty-two tertiary hospitals. POPULATION: Women admitted for pregnancy, childbirth or puerperal complications. METHODS: All cases of SMO [maternal near miss (MNM) or maternal death (MD)] due to PPH were prospectively identified using WHO criteria over a 1-year period. MAIN OUTCOME MEASURES: Incidence of SMO, health service events, case fatality rate (CFR) and mortality index (MI: % of death/SMO). RESULTS: Postpartum haemorrhage occurred in 2087 (2.2%) of the 94 835 deliveries recorded during the study period. A total of 354 (0.3%) women had an SMO (103 MD; 251 MNM). It was the most frequent obstetric haemorrhagic complication across hospitals. PPH had the highest maternal mortality ratio (112/100 000 live births) and the recorded MI (29.1%) and CFR (4.9%) were second only to that of ruptured uterus. About 83% of women with SMO were admitted in a critical condition with over 50% being referred. MD was more likely when PPH led to neurological (80.8%), renal (73.5%) or respiratory (58.7%) organ dysfunction. Although the timing of life-saving interventions was not statistically different between the cases of MD and MNM, close to one-quarter of women who died received critical intervention at least 4 hours after diagnosis of life-threatening PPH. CONCLUSIONS: Postpartum haemorrhage was a significant contributor to obstetric haemorrhage and SMO in Nigerian hospitals. Emergency obstetric services should be enhanced at the lower levels of healthcare delivery to reduce avoidable deaths from PPH. FUNDING: The original research that generated the data for this secondary analysis, and the publication of this secondary analysis, was funded by the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by the World Health Organization. We have no other funding issue to declare for our study. TWEETABLE ABSTRACT: One hundred and three maternal deaths and 251 near-misses resulted from PPH in 42 Nigerian tertiary facilities in 1 year.

When getting there is not enough: a nationwide cross-sectional study of 998 maternal deaths and 1451 near-misses in public tertiary hospitals in a low-income country.

OBJECTIVE: To investigate the burden and causes of life-threatening maternal complications and the quality of emergency obstetric care in Nigerian public tertiary hospitals. DESIGN: Nationwide cross-sectional study. SETTING: Forty-two tertiary hospitals. POPULATION: Women admitted for pregnancy, childbirth and puerperal complications. METHODS: All cases of severe maternal outcome (SMO: maternal near-miss or maternal death) were prospectively identified using the WHO criteria over a 1-year period. MAIN OUTCOME MEASURES: Incidence and causes of SMO, health service events, case fatality rate, and mortality index (% of maternal death/SMO). RESULTS: Participating hospitals recorded 91 724 live births and 5910 stillbirths. A total of 2449 women had an SMO, including 1451 near-misses and 998 maternal deaths (2.7, 1.6 and 1.1% of live births, respectively). The majority (91.8%) of SMO cases were admitted in critical condition. Leading causes of SMO were pre-eclampsia/eclampsia (23.4%) and postpartum haemorrhage (14.4%). The overall mortality index for life-threatening conditions was 40.8%. For all SMOs, the median time between diagnosis and critical intervention was 60 minutes (IQR: 21-215 minutes) but in 21.9% of cases, it was over 4 hours. Late presentation (35.3%), lack of health insurance (17.5%) and non-availability of blood/blood products (12.7%) were the most frequent problems associated with deficiencies in care. CONCLUSIONS: Improving the chances of maternal survival would not only require timely application of life-saving interventions but also their safe, efficient and equitable use. Maternal mortality reduction strategies in Nigeria should address the deficiencies identified in tertiary hospital care and prioritise the prevention of severe complications at lower levels of care. TWEETABLE ABSTRACT: Of 998 maternal deaths and 1451 near-misses reported in a network of 42 Nigerian tertiary hospitals in 1 year.