EP19.04: Use of ultrasound in diagnosis and management of post‐Caesarean section peritonitis at a referral hospital in Rwanda

Post-Caesarean section peritonitis is the leading cause of maternal morbidity and mortality at the main referral hospital in Rwanda. Ultrasound is routinely used at time of diagnosis to identify abdominal free fluid and to identify abscesses requiring re-operation during hospitalisation. We performed a prospective observational cohort study at the University Teaching Hospital Kigali (CHUK) from January until May 2015. All patients admitted with the diagnosis of post-Caesarean section peritonitis undergoing exploratory laparotomy at CHUK were enrolled. Patients were followed to either discharge or death. Sonographic findings were documented for patients at admission and during hospitalisation. Study variables included admission physical exam, intraoperative findings, subsequent surgeries, and management. Data were analysed using STATA version 14. A total of 44 women were enrolled in the study. Sonographic findings on admission were available for 25 (57%). Nineteen patients (76%) had documented free fluid in the abdomen and pelvis whereas 6 patients (24%) did not. This was not predictive of intraoperative findings, hysterectomy (p = 0.097) or mortality (p = 0.570). Thirty-five patients had a second surgery during hospitalisation, 20 (57%) for planned re-operation and 15 (43%) for emergency re-operation. Ultrasound was used to diagnose abdominal free fluid in all 15 patients prior to surgical intervention. Six of the 15 (40%) subsequently died. The overall mortality was 29.5% (13 of 44). Ultrasound is a low-cost technology available in resource-limited environments, and it is an essential tool in the diagnosis and management of post-Caesarean peritonitis in Rwanda. The low number of patients in this cohort may have contributed to the lack of statistical significance in predicting outcome.