“SPECTRUM OF GYNAECOLOGICAL DISORDERS PRESENTING AS EMERGENCIES IN AN INDIAN TERTIARY CARE HOSPITAL: A PROSPECTIVE CLINICAL STUDY”

Abstract

Background: Acute gynecological disorders presenting as emergencies represent a significant component of emergency department workload in tertiary care hospitals in India and are associated with substantial morbidity, delayed reporting, and resource utilization challenges. This prospective clinical study aimed to analyse the spectrum of gynaecological emergencies at a tertiary care hospital in Southern India, evaluating demographic factors (age), time to presentation, treatment initiation (medical or surgical), response to treatment, hospital stay, and final outcomes across classified etiologies including uterine causes, vaginal and adnexal pathology, and emergencies related to neighbouring abdominal organs. Methods: This prospective observational study included 89 women aged 18–65 years presenting with acute gynaecological complaints to the Emergency and Department of Obstetrics and Gynaecology of a tertiary care centre in Southern India during the study period. Data collected included age, time from onset of symptoms to hospital presentation, time to initiation of definitive medical or surgical treatment, diagnostic classification (uterine, vaginal, ovarian/adnexal, hormonal and emergencies related to neighbouring abdominal organs), response to treatment, duration of hospital stay, and final outcomes including complications and discharge status. Results: The majority of patients belonged to the reproductive age group, with a mean age of 32.4 ± 8.6 years. Ovarian and adnexal causes constituted the most common category of gynaecological emergencies (42.7%), followed by uterine causes (24.7%). Ectopic pregnancy, ovarian torsion and acute pelvic inflammatory disease were the predominant adnexal emergencies, while abnormal uterine bleeding accounted for a significant proportion of uterine presentations. The mean time to hospital presentation was 28.2 ± 16.5 hours, and the mean time to initiation of definitive treatment was 8.4 ± 4.7 hours. Surgical intervention was required in 60.7% of cases, while 39.3% were managed conservatively. Delayed presentation and delayed treatment initiation were significantly associated with longer hospital stay (mean 4.9 ± 2.3 days) and poorer outcome scores. Overall, a favourable clinical outcome was observed in 68.5% of patients, with complications occurring in 20.2% and a low mortality rate (2.2%). Early initiation of appropriate treatment was associated with better response and improved prognosis. Conclusion: Gynecological emergencies in Indian tertiary care settings demonstrate diverse clinical spectra influenced by demographic and healthcare access dynamics. Timely recognition and prompt therapeutic interventions reduce morbidity and hospital stay, emphasizing the need for streamlined emergency pathways in Southern India. Further standardised multicentric studies are recommended to formulate national emergency care protocols.