A Clinical Study on Acute Surgical Emergencies and Their Management in Pregnant Women

Author(s): A. Sanjeev Kumar1 , Boda Kumaraswamy2

BACKGROUND Though most of the diagnostic and management decisions regarding pregnant patients will follow the usual tenets of surgery, there are important differences in a pregnant patient which the treating surgeon should be aware of. We wanted to study retrospectively the incidence and types of surgical emergencies treated in pregnant women in a tertiary hospital. METHODS Totally 52 patients with, non-gynaecological and non-obstetric surgical emergencies, or gynaecological and non-obstetric surgical emergencies were included. Patients with complaints of pain in the abdomen, vomiting and fever were included. Patients with obstetrical emergencies and medical diseases were excluded. Relevant history from all the patients was elicited, followed by clinical examination and relevant investigations. Surgical interventions performed were observed and the data was analysed using standard statistical methods. RESULTS 52 pregnant women with acute surgical emergencies were studied. The patients were aged between 25 years and 45 years with a mean age of 33.16± 2.45 years. There were 23/52 (44.23%) primi gravida, 21/52 (40.38%) women were second gravida and the remaining 08/52 (15.38%) were Multipara. Pregnant women in first trimester were 18/52 (34.61%), 19/52 (36.53%) were in second trimester and 15/52 (28.84%) were in third trimester. Pregnant women with urolithiasis were 8/52 (15.38%), with appendicitis were 07/52 (13.46%), sub-occlusion intestinal obstruction were 07/52 (13.46%), with cholecystitis were 06/52 (11.53%), with intestinal obstruction were 05/52 (09.61%), with burns were 03/52 (05.76%), with incarcerated hernia were 02/52 (03.84%), with salpingitis were 01/52 (01.92%), with pelvic mass were 03/52 (05.76%), with adnexal diseases were 02/52 (03.84%), with pancreatitis were 04/52 (07.69%), with crush injuries were 02/52 (03.84%) and with intestinal perforation in 02/52 (03.84%) patients. CONCLUSIONS In the management of acute surgical emergencies in pregnant women, the normal anatomical and physiological changes occurring during pregnancy sometimes makes the clinical evaluation and early diagnosis as well as the use of diagnostic methods difficult. The higher complication rate in the treatment of the surgical abdomen in the pregnant patient may be due to delay in diagnosis and also because of fear of unnecessary procedures and tests. These patients require special and timely attention to details of signs, increased suspicion, serial physical examination, clinical awareness and systematic evaluation and appropriate investigations considering the risk to foetus and mother.