Surgical Management of Complicated Upper Genital Tract Infections in Yaoundé and Subsequent Fertility Outcomes

Background: Complicated Upper Genital Tract Infections (CUGTI), such as tubo-ovarian abscesses and pelvic peritonitis, represent severe gynecological emergencies with significant implications for morbidity and mortality in low-resource settings. Delayed diagnosis frequently results in severe infectious forms requiring surgical management, with potential long-term reproductive consequences. Data on their surgical management and reproductive outcomes in sub-Saharan African settings are scarce. This study describes the clinical profile, surgical management, and subsequent fertility of patients treated for CUGTI at a tertiary care hospital in Yaoundé, Cameroon. Methods: A descriptive cross-sectional study with retrospective and prospective data collection was conducted at the Yaoundé Gynaeco-Obstetric and Pediatric Hospital from January 2018 to May 2023. Women surgically treated for intraoperatively confirmed complicated UGTI were included. Data on socio-demographics, clinical presentation, paraclinical findings, surgical management, and postoperative outcomes were collected. Fertility outcomes were assessed at least 12 months after surgery. Data were analyzed using IBM SPSS 26 version. Results: Among 63 patients with a preoperative suspicion of CUGTI, 53 were included for analysis. The mean age was 29.5 years, with the 26 - 35 age group most represented (45.3%). Pelvic pain (67.9%) and fever (56.6%) were the most common presenting symptoms. A history of sexually transmitted infection (STI) was reported by 43.4% of patients. The most frequent per-operative findings were pelvic peritonitis (34%), tubo-ovarian abscess (32%), and generalized peritonitis (28.3%). Laparotomy was the primary surgical approach (88.7%). Conservative surgical gestures (e.g., abscess drainage, uterine suture) predominated. The postoperative mortality rate was 5.6%. Among 40 patients eligible for fertility assessment, only 8 (20%) achieved a subsequent pregnancy, predominantly within 1 - 2 years post-surgery, with one case being ectopic. Conclusion: CUGTI predominantly affects young women and often presents with severe clinical features requiring mainly laparotomic intervention. The subsequent pregnancy rate remains low, underscoring the substantial impact of these infections on reproductive potential. These findings highlight the critical need for enhanced prevention, early diagnosis, and optimized multidisciplinary surgical management to improve both survival and fertility outcomes.