A case series of post-partum haemorrhage managed using Ellavi uterine balloon tamponade in a rural regional hospital

CITATION: Theron, G. B. & Mpumlwana, V. 2021. A case series of post-partum haemorrhage managed using Ellavi uterine balloon tamponade in a rural regional hospital. South African Family Practice, 63(1):a5266, doi:10.4102/safp.v63i1.5266.The original publication is available at https://safpj.co.zaUterine balloon tamponade (UBT) should be attempted once emergency measures have been applied and medical treatment for post-partum haemorrhage (PPH) resulting from an atonic uterus has failed. Sinapi Biomedical (Pty) Ltd developed the Ellavi UBT, a free-flow pressure-controlled UBT unit. The device is affordable for use in lesser-resourced countries. A case series of Ellavi UBT used by medical officers in a rural regional hospital without specialist supervision was conducted. This case series was conducted in St Elizabeth’s Hospital in Lusikisiki, South Africa. The hospital serves as the regional hospital for the Ingquza Hill Subdistrict in the Eastern Cape Province. The Nelson Mandela Academic Hospital (NMAH) in Mthatha is the tertiary referral hospital. Workshops were conducted on the use of Ellavi UBT, and devices were made freely available to the hospital. The case series included 10 patients. Six patients delivered by caesarean section, and four had normal vertex deliveries. All patients had additional oxytocin infusions, and eight patients received misoprostol. Following the insertion and inflation of the Ellavi UBT, the PPH stopped in seven patients, was much reduced in one patient and reduced in one patient. In one case, the Ellavi UBT had no effect on the bleeding. All 10 patients were referred to the NMAH. All patients in the case series had good outcomes. The insertion of the Ellavi UBT and subsequent referral proved to be feasible in a rural regional hospital. All patients included in the case series arrived at the referral hospital and had a good outcome.https://safpj.co.za/index.php/safpj/article/view/5266Publisher's versio

A case series of post-partum haemorrhage managed using Ellavi uterine balloon tamponade in a rural regional hospital

Uterine balloon tamponade (UBT) should be attempted once emergency measures have been applied and medical treatment for post-partum haemorrhage (PPH) resulting from an atonic uterus has failed. Sinapi Biomedical (Pty) Ltd developed the Ellavi UBT, a free-flow pressure-controlled UBT unit. The device is affordable for use in lesser-resourced countries. A case series of Ellavi UBT used by medical officers in a rural regional hospital without specialist supervision was conducted. This case series was conducted in St Elizabeth’s Hospital in Lusikisiki, South Africa. The hospital serves as the regional hospital for the Ingquza Hill Subdistrict in the Eastern Cape Province. The Nelson Mandela Academic Hospital (NMAH) in Mthatha is the tertiary referral hospital. Workshops were conducted on the use of Ellavi UBT, and devices were made freely available to the hospital. The case series included 10 patients. Six patients delivered by caesarean section, and four had normal vertex deliveries. All patients had additional oxytocin infusions, and eight patients received misoprostol. Following the insertion and inflation of the Ellavi UBT, the PPH stopped in seven patients, was much reduced in one patient and reduced in one patient. In one case, the Ellavi UBT had no effect on the bleeding. All 10 patients were referred to the NMAH. All patients in the case series had good outcomes. The insertion of the Ellavi UBT and subsequent referral proved to be feasible in a rural regional hospital. All patients included in the case series arrived at the referral hospital and had a good outcome

Stillbirth rates in singleton pregnancies in a stable population at Karl Bremer and Tygerberg hospitals over 50 years

CITATION: Odendaal, H. J., Gebhardt, G. S. & Theron, G. B. 2013. Stillbirth rates in singleton pregnancies in a stable population at Karl Bremer and Tygerberg hospitals over 50 years. South African Journal of Obstetrics and Gynaecology, 19(3):67-70, doi:10.7196/SAJOG.662.The original publication is available at http://www.sajog.org.zaObjectives. To determine the changes in stillbirth rates in singleton pregnancies in a stable population over a period of 50 years. Methods. Stillbirth rates for singleton pregnancies where the fetus weighed 1 000 g or more were collected from 1962 to 2011. From 1972 to 2011, rates included fetuses weighing 500 g or more at birth. Results. When the birth weight was 1 000 g or more the stillbirth rate declined from 70 to 12.6 per 1 000 births, and when the birth weight was 500 g or more it dropped from 34.2 to 24.5. The decline was very much slower towards the end of the study period. Conclusion. To achieve further sustained reductions in stillbirth rates, healthcare workers should continue to emphasise quality of healthcare, but they should also address and prevent specific conditions associated with stillbirth, such as smoking and drinking during pregnancy.http://www.sajog.org.za/index.php/SAJOG/article/view/662Publisher's versio

Initial feasibility and acceptability of a comprehensive intervention for methamphetamine-using pregnant women in South Africa.

The purpose of the present study was to determine the feasibility, acceptability, and initial efficacy of a women-focused intervention addressing methamphetamine use and HIV sexual risk among pregnant women in Cape Town, South Africa. A two-group randomized pilot study was conducted, comparing a women-focused intervention for methamphetamine use and related sexual risk behaviors to a psychoeducational condition. Participants were pregnant women who used methamphetamine regularly, had unprotected sex in the prior month, and were HIV-negative. Primary maternal outcomes were methamphetamine use in the past 30 days, frequency of unprotected sexual acts in the past 30 days, and number of antenatal obstetrical appointments attended. Primary neonatal outcomes were length of hospital stay, birth weight, and gestational age at delivery. Of the 57 women initially potentially eligible, only 4 declined to participate. Of the 36 women who were eligible and enrolled, 92% completed all four intervention sessions. Women in both conditions significantly reduced their methamphetamine use and number of unprotected sex acts. Therefore, delivering comprehensive interventions to address methamphetamine use and HIV risk behaviors among methamphetamine-using pregnant women is feasible in South Africa. Further testing of these interventions is needed to address methamphetamine use in this vulnerable population

Comparison of isothermal microcalorimetry and BACTEC MGIT960 for the detection of the metabolic activity of Mycobacterium tuberculosis in sputum samples

Introduction This study explores the uses of microcalorimetry to detect Mycobacterium tuberculosis (TB) in sputum. Microcalorimetry measures metabolic heat evolution during cellular proliferation of tuberculosis (TB) and is considered as a possible alternative to conventional diagnostic tools.Objectives To compare the time to detection (TTD) from the BACTEC (TM) MGIT (TM) 960 and the calScreener (TM) calorimetric system.Methods Sixty-four sputa samples were selected from patients with confirmed pulmonary tuberculosis. Those sample were then decontaminated and analysed using calorimetry and BACTEC MGIT 960 system.Results The incubation period until detection of M. tuberculosis in the sample was 8 center dot 5 +/- 3 center dot 7 days for the MGIT system and 10 center dot 1 +/- 4 center dot 1 days (mean +/- SD) for calorimetry.Conclusions The microincubations in the 48-well format calScreener offers potential for rapid and accurate diagnostic of TB in different samples. Although TTD from calorimetry is still longer than with the MGIT, our findings suggest that several improvements are possible. Still, the instrument is ideal for continuous, real-time analysis of net metabolic heat release of limited sample numbers.Significance and Impact of the Study Our result emphasizes that with further optimization, calorimetry can become an alternative detection method for tuberculosis

Intrapartum HIV transmission rate in a central hospital in the Western Cape Province after universal antiretroviral therapy roll-out

Obstetrics and GynaecologyCITATION: Van der Merwe, T.A., Van Zyl, G.U., Lombard, C.J., Theron, G.B. 2020. Intrapartum human immunodeficiency virus transmission rate in a central hospital in the Western Cape province after universal antiretroviral therapy roll-out. Southern African Journal of Infectious Diseases, 35(1):a192. https://doi.org/10.4102/sajid.v35i1.192.The original publication is available at https://sajid.co.za/index.php/sajidhttps://doi.org/10.4102/sajid.v35i1.192Publishers versionMaster

Acceptability and feasibility of mHealth and community-based directly observed antiretroviral therapy to prevent mother-to-child HIV transmission in South African pregnant women under Option B+: an exploratory study

Objective: To examine the acceptability and feasibility of mobile health (mHealth)/short message service (SMS) and community-based directly observed antiretroviral therapy (cDOT) as interventions to improve antiretroviral therapy (ART) adherence for preventing mother-to-child human immunodeficiency virus (HIV) transmission (PMTCT). Design and methods A mixed-method approach was used. Two qualitative focus group discussions with HIV-infected pregnant women (n=20) examined the acceptability and feasibility of two ART adherence interventions for PMTCT: 1) SMS text messaging and 2) patient-nominated cDOT supporters. Additionally, 109 HIV-infected, pregnant South African women (18–30 years old) receiving PMTCT services under single-tablet antiretroviral therapy regimen during pregnancy and breastfeeding and continuing for life (“Option B+”) were interviewed about mobile phone access, SMS use, and potential treatment supporters. Setting: A community primary care clinic in Cape Town, South Africa. Participants: HIV-infected pregnant women. Main outcomes Acceptability and feasibility of mHealth and cDOT interventions. Results: Among the 109 women interviewed, individual mobile phone access and SMS use were high (>90%), and 88.1% of women were interested in receiving SMS ART adherence support messages such as reminders, motivation, and medication updates. Nearly all women (95%) identified at least one person close to them to whom they had disclosed their HIV status and would nominate as a cDOT supporter. Focus group discussions revealed that cDOT supporters and adherence text messages were valued, but some concerns regarding supporter time availability and risk of unintended HIV status disclosure were expressed. Conclusion: mHealth and/or cDOT supporter as interventions to improve ART adherence are feasible in this setting. However, safe HIV status disclosure to treatment supporters and confidentiality of text messaging content about HIV and ART were deemed crucial

Delphi consensus statement on intrapartum fetal monitoring in low-resource settings

OBJECTIVE: To determine acceptable and achievable strategies of intrapartum fetal monitoring in busy low-resource settings. METHODS: Three rounds of online Delphi surveys were conducted between January 1 and October 31, 2017. International experts with experience in low-resource settings scored the importance of intrapartum fetal monitoring methods. RESULTS: 71 experts completed all three rounds (28 midwives, 43 obstetricians). Consensus was reached on (1) need for an admission test, (2) handheld Doppler for intrapartum fetal monitoring, (3) intermittent auscultation (IA) every 30 minutes for low-risk pregnancies during the first stage of labor and after every contraction for high-risk pregnancies in the second stage, (4) contraction monitoring hourly for low-risk pregnancies in the first stage, and (5) adjunctive tests. Consensus was not reached on frequency of IA or contraction monitoring for high-risk women in the first stage or low-risk women in the second stage of labor. CONCLUSION: There is a gap between international recommendations and what is physically possible in many labor wards in low-resource settings. Research on how to effectively implement the consensus on fetal assessment at admission and use of handheld Doppler during labor and delivery is crucial to support staff in achieving the best possible care in low-resource settings