Surgical Emergencies among Gynecological Surgeries in a Tertiary Care Center: a Descriptive Cross-sectional Study

Acharya, Indira; Thapa, Sumana

doi:10.31729/jnma.5888

Cited by 4 publications

(3 citation statements)

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“…Г острий біль у животі є поширеним явищем і причиною 5-10% усіх госпіталізацій у відділення невідкладної допомоги [5, 9,10,11,20,23]. Приблизно 4% жінок потрапляють до лікарень через розрив кісти яєчника, крововилив або перекрути утворення, а частота позаматкової вагітності становить до 16 випадків на 1000 вагітностей [13,14,15,16,17,19,21].…”

Section: репродуктивные нарушения у женщин детородного возраста котор...unclassified

Reproductive disorders in women of reproductive age who have undergone urgent surgery on the reproductive organs

Pyrohova

Dyakunchak

2022

RHW

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The objective: to analyze the long-term reproductive effects in women who after emergency gynecological surgery. Materials and methods. A retrospective analysis of the reproductive outcomes after urgent surgical operations (after 2 years) was performed in 300 gynecological patients aged 19 to 42 years. Results. A retrospective analysis showed that 69,3% of women who underwent emergency gynecological surgery had a history of gynecological diseases, but 30,7% of patients were not observed by a gynecologist. Before surgery, menstrual disorders were diagnosed in 42,0 % of patients, pathology of the lower genital tract – 19,7%, inflammatory diseases of the pelvic organs – 7,7 %. 8,2 % of women had gynecological operations before, 13,9 % – reproductive losses, and 11,1 % persons were examined and treated for infertility. The predominant method of surgical intervention in this cohort of patients was open laparotomy (59,7 %), laparoscopic intervention was performed in 40,3 % of cases. The most common indications for surgery were damage tubal pregnancy, ovarian apoplexy, complicated ovarian formation. Morphological verification of intraoperative findings showed that most often indications for operations were serous ovarian tumors (38,7 %), follicular tumors (22,4 %), complicated endometrioid and dermoid cysts (22,4 %), corpus luteum cysts with hemorrhage (9,2 %), paraovarian cysts (7,1 %). Rehabilitation postoperative therapy was performed for a limited number of patients (31,7 %), which could not but affect the state of reproductive health of women – an increase in the incidence of pain (42,0 %; p<0,05) and chronic pelvic pain (42,3%) in the absence of such before surgery, as well as infertility (from 11,1 % to 22,5 %; p<0,05). Conclusions. The lack of pathogenetically intra- and postoperative measures after urgent surgical interventions leads to increase the frequency of reproductive dysfunction, which requires the development and improvement of differentiated rehabilitation therapy and secondary prevention according to the nosology that caused urgent surgical operatrion.

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Section: репродуктивные нарушения у женщин детородного возраста котор...unclassified

Reproductive disorders in women of reproductive age who have undergone urgent surgery on the reproductive organs

Pyrohova

Dyakunchak

2022

RHW

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“…Хронічні захворювання сечової і травної систем, генітальний інфантилізм, ретенційні кісти яєчників, запальні захворювання органів малого таза, інфекції, що передаються статевим шляхом, порушення менструального циклу, дисменорея є чинниками ризику виникнення гострої гінекологічної патології [4,10,11,14,20]. Хірургічний стрес зумовлює катаболічний стан, який призводить до відносної гіпоксії тканин, підвищення резистентності до інсуліну, порушення профілів коагуляції, змін функції легень і травного тракту.…”

Section: Yur Dyakunchak VI Pyrohovaunclassified

Assessment of the prevalence of abnormal vaginal discharges in women of reproductive age who have undergone urgent gynecological surgery

Pyrohova

2022

RHW

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The problem of restoring women’s reproductive health after emergency operations for acute gynecological pathology has been social and medical significance in recent years. This is due to both the increase in its frequency and long-term negative outcomes – a decrease fertility rate, the development of pain syndrome, changes in hormonal homeostasis, etc. One of the manifestations of postoperative dysfunction in the organism is the appearance of an excessive amount of vaginal secretions in female patients. However, the targeted studies about the state of the vaginal microbiota in women after urgent surgical interventions for acute gynecological pathology are rare, and the results are contradictory.The objective: to assess the prevalence and nature of vaginal discharge in women of reproductive age after urgent gynecological operations. Materials and methods. The studied cohort included 125 women of reproductive age. The main group included 60 women of reproductive age after urgent operations because of ovarian apoplexy, ectopic pregnancy, complicated ovarian neoplasm; the comparison group – 35 patients after planned surgery for gynecological pathology; the control group consisted of 30 healthy women. The diagnosis of the causes of vaginal secretions and infection with sexually transmitted pathogens was carried out by the method of pH-metry, bacterioscopic and molecular biological research. The examination was carried out on the 5th day after the operation. Results. Before planned surgical operations, bacterial vaginosis was diagnosed in 22.9% of women in the comparison group, vulvovaginal candidiasis – in 2.9%. The urgency of the operation because of acute gynecological pathology led to the preoperative determination of the state of the vaginal microbiota in only 56.7% of patients in the main group, with the detection of bacterial vaginosis in 26.5%, aerobic vaginitis in 17.7%. After surgery, vaginal microbiota was abnormal in 78.3% of patients in the main group and in 34.3% – in the comparison group (bacterial vaginosis – 53.3% and 31.4%, respectively). Conclusions. Dysbiosis and inflammatory diseases (aerobic vaginitis) of the lower genital organs should be considered as one of the risk factors for acute gynecological pathology. Dysbiotic processes have a tendency to progress after surgery, which makes it necessary to carry out preoperative sanitation of the vagina to reduce the risk of postoperative complications development.

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“…У генезі порушень репродуктивного здоров'я жінок привертає увагу зростаюча роль «гострих гінекологічних захворювань», які, як правило, характеризуються наявністю симптомокомплексу «гострого живота» і вимагають невідкладного хірургічного лікування [4,9,12,15,17]. Переважну частину ургентних гінекологічних операцій проводять у пацієнток фертильного віку, що вимагає розроблення індивідуалізованої реабілітаційної терапії з огляду на неоднорідність симптомокомплексу «гострого живота» [15,20,21].…”

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Aspects of the rehabilitation of the reproductive function of women after urgent gynecological surgery

Dyakunchak

2022

RHW

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The objective: to assess the hormonal homeostasis and ovarian reserve in women of reproductive age after urgent gynecological operations due to the symptom complex of “acute abdomen”.Materials and methods. The studied cohort included 90 women 19–40 years old. The main group included 60 women after emergency surgery for ectopic pregnancy (23 patients), ovarian apoplexy (18 patients), complicated ovarian tumor (19 patients), and at the rehabilitation stage they refused to receive the proposed hormonal therapy; control group – 30 women of reproductive age without somatic and gynecological pathology. A complex study of the reproductive system was carried out: ultrasound (transvaginal) examination of the pelvic organs with the calculation of the number of antral follicles, determination of the levels of estradiol, follicle-stimulating hormone, luteinizing hormone, prolactin, thyroid-stimulating hormone, free testosterone index, anti-Müllerian hormone (AMH), and 25(OH)D level in blood serum. The examinations were carried out 3 and 6 months after surgery. Statistical processing of the results was performed using the Microsoft Excel 7.0 and “Statistica 6.0” standard programs.Results. The average age of the patients was 26.4±3.5 years. Before the current surgical intervention, 21 % of patients in the main group were diagnosed premenstrual syndrome, dysmenorrhea, abnormal uterine bleeding, pelvic inflammatory disease, and ovarian tumors. In the postoperative period, the most often menstrual cycle (MC) disorder was an increase in its duration (56.7 % of patients). 63.3 % of patients after urgent gynecological operations had normogonadotropic dysfunction of the ovaries, which is characterized by anovulation, insufficiency of the luteal phase and the ovarian blood flow disorders. The restoration of normal two phases of MC after 6 months was found in 34.2 % of the patients who did not have the hormonal correction. In 18.3 % of patients with ovulatory MC, the insufficiency of the luteal phase is characterized by a decrease of progesterone concentration in the blood serum on the 18–20th day of MC and a disperancy in the endometrium structure. Transient hyperprolactinemia was found in 15.0 % of patients. The surgical injury of the ovary in some patients leads to a decrease in the ovarian reserve. AMH indicators in 61.1 % of patients with the effect of surgical energies on the affected ovary were significantly reduced (0.67±0.4 ng/ml) compared to controls (2.1±0.3 ng/ml; p<0.01) until the 6th month after the operation. Similar dynamics were absent in patients operated on for a ruptured tubal pregnancy. The recovery of the two phases of MC during a six-month observation was established in only 47.4 % of patients with torsion of an ovarian tumor.As a result of the lack of complex rehabilitation therapy, the repeated operations due to the ruptured tubal pregnancy happened in 13.5 % of patients, recurrence of apoplexy and/or ovarian tumors – in 25.8 % of women.Conclusions. Acute gynecological pathology, which requires immediate surgery, occurs in 21 % of patients with the disorders of the reproductive system. In 63.3 % of women after urgent gynecological operations, normogonadotropic dysfunction of the ovaries was observed, which was characterized by anovulation, insufficiency of the luteal phase and ovarian blood flow disorders. The absence of rehabilitation complex therapy causes recurrence of acute gynecological pathology in 13.5–25.8 % of operated women.

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Surgical Emergencies among Gynecological Surgeries in a Tertiary Care Center: a Descriptive Cross-sectional Study

Cited by 4 publications

References 9 publications

Reproductive disorders in women of reproductive age who have undergone urgent surgery on the reproductive organs

Reproductive disorders in women of reproductive age who have undergone urgent surgery on the reproductive organs

Assessment of the prevalence of abnormal vaginal discharges in women of reproductive age who have undergone urgent gynecological surgery

Aspects of the rehabilitation of the reproductive function of women after urgent gynecological surgery

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