Care for the terminally ill: a review of deaths in the gynaecological wards of a tertiary institution, 1986-2000.

BACKGROUND: There is yet no formula to predict the expected date of death, however this information may be invaluable to the terminally ill, care givers, friends and family members to write the will, arrange for end-of-life care, settle disputes, and to make plans for burial ceremonies.

OBJECTIVE: The study is an audit of all deaths in the gynaecological wards to determine the causes of death and highlight the care option for the terminally ill patient.

STUDY METHODS: The admission ward registers and the duplicate copies of issued death certificates between 1986-2000 were studied. Details of the individual patients diagnosis and at death or discharge were collected and crosschecked with the patient's casenote. The collected data was subjected to statistical analysis using appropriate computer software.

RESULTS: A total of 10,485 admissions were recorded in the study period. There were 89 (0.85%) deaths and 27(0.26%) discharges against medical advice. The yearly rate of death varied between 0.36% and 1.66% admissions. Patients' discharging themselves from the gynaecological wards against medical advice started in 1992, and was at a maximum (2.0%%) in 1996. Carcinoma of the cervix (30.3%) was the most frequent cause of death next was ovarian cancer (29.2%). Death following complications from criminal abortions (11.2%) was fourth while deaths subsequent to operation for uterine fibroids and ectopic pregnancies were 2.2% each. Patients dying from complication of abortion were the youngest (22.6 years +/- 9.13), while patients dying from endometrial carcinoma were the oldest (64.75 years +/- 9.84). The mean age of patients dying from advance gynacological malignancies was 44.13 years +/- 17.07, which is significantly higher than the mean age of patients dying from complications of abortion, P<0.00015 (Student's T-Test, two tail, type 2).

CONCLUSION: Advanced malignancies of the cervix, ovary and chorion carcinoma are the major causes of gynaecological deaths. Next, are deaths resulting from the complication of criminal abortion. Patients' discharge against medical advice as option of care needs further investigation.