Abdominal wound sepsis associated with gynaecological surgery at King Edward VIII Hospital, Durban.

OBJECTIVE: To establish the prevalence of postoperative wound infection in major gynaecological surgery. SETTING: King Edward VIII Hospital (KEH), a large urban referral hospital for the province of KwaZulu-Natal, serving an underprivileged population. METHOD: A prospective study of postoperative wound sepsis in 270 patients who had had emergency and elective laparotomies. Data for each patient were obtained pre-operatively and during the postoperative period. RESULTS: The prevalence of surgical wound sepsis was 11.9%. The wound sepsis rate in emergency, elective and semi-elective cases was 14.6%, 6.5% and 4% respectively. Twenty-three per cent of the patients were HIV-infected, and this group had a wound sepsis rate of 28.6% compared with 6.8% in HIV-negative cases (P = 0.03). CONCLUSION: Surgical wound sepsis in major gynaecological surgery is common at KEH. HIV infection is associated with a high rate of wound sepsis.

Epidural compared with general anaesthesia for caesarean delivery in conscious women with eclampsia.

OBJECTIVE: To compare retrospectively the outcome of caesarean section under epidural anaesthesia with that of general anaesthesia in "stable" women with eclampsia. DESIGN: Retrospective review. METHOD: Over the five-year study period, there were 533 women with eclampsia and of these 66 women (12.4%), fulfilled the criteria of being 'stable'. Of the 66 women, 37 received epidural, 27 general, and 2 spinal anaesthesia. RESULTS: There were no major complications with either general or epidural anaesthesia. Epidural anaesthesia was associated with higher one-minute Apgar scores. CONCLUSION: This study indicates that both maternal and neonatal outcomes are not affected adversely by the use of epidural anaesthesia in selected cases of eclampsia.