Analysis of Pregnancy-associated Surgical Interventions at the Volta River Authority Hospital in Akosombo, Ghana 2011-2015

Background: There is increasing recognition of the role of surgery in public health. The provision of Emergency and Essential Surgical Care is now a global health priority. To develop such care in low and middle-income settings, there is the need to systematically document the role of surgery in various aspects of essential care. This study is a systematic extraction of data and analysis of pregnancy-associated surgical interventions at the Volta River Authority Hospital (VRAH) in Akosombo from 2011 to 2015. Method: The study is a descriptive, retrospective review of records on pregnancy-related surgical interventions. A data extraction tool was developed which was used to collect the data. Analysis was largely descriptive. Relations were explored for some specific parameters of interest. Results: Data was extracted for 3221 cases. About a third (61%) constituted emergency surgeries with 40% coming from outside of the district where VRAH is located. The leading procedures performed were evacuation of retained products of conception due to incomplete abortions (75% of abortion-related cases), and caesarean sections. The major indications in abortion-related conditions were incomplete abortions (75%) while the leading indications for caesarean sections were previous uterine surgery (30.6% of caesarean sections), hypertensive diseases in pregnancy (14.2%) and cephalopelvic disproportion (11.6%). The majority of cases were performed by teams led by residents (28.2%) and housemen (24.2%). The mean duration of stay in the hospital post- surgery were 3.4 (SD + 1.9) days respectively. Duration of stay was significantly influenced by the age of patients (P-value=0.004) with younger (<20yrs) tending to stay beyond three days. Satisfactory state was recorded as at day 3 post-surgery in 99.8% of cases. Less than 1% of cases were referral to higher level facilities. Conclusion: A database of five years of pregnancy-associated surgical interventions at VRAH has been established. The analysis generates parameters important for monitoring and promoting the role the VRAH plays in improved maternal care and surgical training in Ghana. The diversity in the indications and procedures performed make the VRAH a candidate facility for the training of undergraduate and postgraduate medical students