Obstetric use of misoprostol: innovations, evidence, controversy and global health perspectives

Thesis (D.Sc.)--University of the Witwatersrand, Faculty of Health Sciences, 2012

Factors affecting the implementation of calcium supplementation strategies during pregnancy to prevent pre-eclampsia : a mixed-methods systematic review

OBJECTIVES: Daily calcium supplements are recommended for pregnant women from 20 weeks' gestation to prevent pre-eclampsia in populations with low dietary calcium intake. We aimed to improve understanding of barriers and facilitators for calcium supplement intake during pregnancy to prevent pre-eclampsia. DESIGN: Mixed-method systematic review, with confidence assessed using the Grading of Recommendations, Assessment, Development and Evaluations-Confidence in the Evidence from Reviews of Qualitative research approach. DATA SOURCES: MEDLINE and EMBASE (via Ovid), CINAHL and Global Health (via EBSCO) and grey literature databases were searched up to 17 September 2022. ELIGIBILITY CRITERIA: We included primary qualitative, quantitative and mixed-methods studies reporting implementation or use of calcium supplements during pregnancy, excluding calcium fortification and non-primary studies. No restrictions were imposed on settings, language or publication date. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data and assessed risk of bias. We analysed the qualitative data using thematic synthesis, and quantitative findings were thematically mapped to qualitative findings. We then mapped the results to behavioural change frameworks to identify barriers and facilitators. RESULTS: Eighteen reports from nine studies were included in this review. Women reported barriers to consuming calcium supplements included limited knowledge about calcium supplements and pre-eclampsia, fears and experiences of side effects, varying preferences for tablets, dosing, working schedules, being away from home and taking other supplements. Receiving information regarding pre-eclampsia and safety of calcium supplement use from reliable sources, alternative dosing options, supplement reminders, early antenatal care, free supplements and support from families and communities were reported as facilitators. Healthcare providers felt that consistent messaging about benefits and risks of calcium, training, and ensuring adequate staffing and calcium supply is available would be able to help them in promoting calcium. CONCLUSION: Relevant stakeholders should consider the identified barriers and facilitators when formulating interventions and policies on calcium supplement use. These review findings can inform implementation to ensure effective and equitable provision and scale-up of calcium interventions. PROSPERO REGISTRATION NUMBER: CRD42021239143

A research agenda to improve incidence and outcomes of assisted vaginal birth

Access to emergency obstetric care, including assisted vaginal birth and caesarean birth, is crucial for improving maternal and childbirth outcomes. However, although the proportion of births by caesarean section has increased during the last few decades, the use of assisted vaginal birth has declined. This is particularly the case in low- and middle-income countries, despite an assisted vaginal birth often being less risky than caesarean birth. We therefore conducted a three-step process to identify a research agenda necessary to increase the use of, or reintroduce, assisted vaginal birth: after conducting an evidence synthesis, which informed a consultation with technical experts who proposed an initial research agenda, we sought and incorporated the views of women's representatives of this agenda. This process has allowed us to identify a comprehensive research agenda, with topics categorized as: (i) the need to understand women's perceptions of assisted vaginal birth, and provide appropriate and reliable information; (ii) the importance of training health-care providers in clinical skills but also in respectful care, effective communication, shared decision-making and informed consent; and (iii) the barriers to and facilitators of implementation and sustainability. From women's feedback, we learned of the urgent need to recognize labour, childbirth and postpartum experiences as inherently physiological and dignified human processes, in which interventions should only be implemented if necessary. The promotion and/or reintroduction of assisted vaginal birth in low-resource settings requires governments, policy-makers and hospital administrators to support skilled health-care providers who can, in turn, respectfully support women in labour and childbirth. [Abstract copyright: (c) 2023 The authors; licensee World Health Organization.

Tranexamic acid for preventing postpartum haemorrhage

CITATION: Novikova, N, Hofmeyr, G. J. & Cluver, C. A. 2015. Tranexamic acid for preventing postpartum haemorrhage. Cochrane Database of Systematic Reviews, 6: Art. No.: CD007872, doi:10.1002/14651858.CD007872.pub3.The original publication is available at https://www.cochranelibrary.comBackground: Postpartum haemorrhage (PPH) is a common and potentially life-threatening complication of labour. Several options for preventing PPH are available, but further advances in this field are important, especially the identification of safe, easy to use and cost-effective regimens. Tranexamic acid (TA), which is an antifibrinolytic agent that is used widely to prevent and treat haemorrhage, merits evaluation to assess whether it meets these criteria. Objectives: To determine, from the best available evidence, whether TA is effective and safe for preventing PPH in comparison to placebo or no treatment (with or without uterotonic co-treatment), or to uterotonic agents.https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007872.pub3/fullPublisher's versio

Self-reported Preference for Delivery Place among Women Presenting for Maternal Care Health Services at a Tertiary Hospital in the Eastern Cape Province, South Africa

South Africa’s healthcare system is based on the primary care model in which women with low-risk pregnancies are encouraged to deliver in clinics, community health centres and district hospitals while women with high-risk pregnancies are encouraged to deliver in secondary and tertiary hospitals. However in the South African setting quite a significant number of women with low-risk pregnancies are still delivering in tertiary hospitals. The objectives of this study were to determine the preference of delivery place in women with low-risk pregnancies presenting for maternal healthcare services at a tertiary hospital in the Eastern Cape province, South Africa, and the associated factors. A quantitative, observational, cross-sectional analytic design was utilised. Data were collected using an administered structured questionnaire on 200 women with low-risk pregnancies presenting for maternal healthcare services at the hospital. Data were analysed using software SPSS for Windows and EPI Info StatCalc. The study revealed that the majority of the women, 80 per cent (n = 161) preferred to deliver at a hospital as opposed to 20 per cent (n = 39) who preferred the community health centre independent of their age, parity, education, employment, income, location in relation to the health facility, beliefs regarding the reliability of ambulance and public transport as well as the affordability of public transport. The women’s reasons for preferring to deliver at a hospital were largely because they felt that it was well equipped and had skilled staff. Strategies such as the allocation of adequate human and infrastructural resources and educational campaigns to promote the utilisation of the primary healthcare settings should be implemented

Interventions for helping to turn term breech babies to head first presentation when using external cephalic version

CITATION: Cluver, C. A. et al. 2015. Interventions for helping to turn term breech babies to head first presentation when using external cephalic version. Cochrane Database of Systematic Reviews, 2: Art. No.: CD000184, doi:10.1002/14651858.CD000184.pub4.The original publication is available at https://www.cochranelibrary.comBackground: Breech presentation is associated with increased complications. Turning a breech baby to head first presentation using external cephalic version (ECV) attempts to reduce the chances of breech presentation at birth so as to avoid the adverse effects of breech vaginal birth or caesarean section. Interventions such as tocolytic drugs and other methods have been used in an attempt to facilitate ECV. Objectives: To assess, from the best evidence available, the effects of interventions such as tocolysis, acoustic stimulation for midline spine position, regional analgesia (epidural or spinal), transabdominal amnioinfusion, systemic opioids and hypnosis, or the use of abdominal lubricants, on ECV at term for successful version, presentation at birth, method of birth and perinatal and maternal morbidity and mortality.https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000184.pub4/fullPublisher's versio

Demographic, clinical and behavioural determinants of HIV serostatus non-disclosure to sex partners among HIV-infected pregnant women in the Eastern Cape, South Africa.

Drawing from a baseline sample of a cohort study, the study examines the extent and correlates of serostatus non-disclosure to sex partners and family members, and reasons for non-disclosure among HIV-infected pregnant women in the Eastern Cape Province, South Africa.This longitudinal cohort study recruited 1709 pregnant women living with HIV who attended three of the largest maternity centres in the Eastern Cape, South Africa, for delivery between September 2015 and May 2016. Relevant items on demographics, serostatus awareness, disclosure to sex partners and family members, and lifestyle behaviours were obtained using structured interviews. Age-stratified binary logistic regression models were used to determine the significant correlates of non-disclosure among the participants.A higher rate of HIV serostatus non-disclosure to sex partners (25.6%) in comparison to family members (20%) was reported by the participants. Younger age, not living with partners and alcohol use were significantly associated with non-disclosure of HIV serostatus to sex partners. Non-disclosure of HIV serostatus to sex partners was significantly (p<0.05) associated with poor adherence to the highly active anti-retroviral therapy (HAART), failure to keep clinic appointments and high viral load at the delivery of the baby. Perceived fear of intimate partner violence, fear of rejection, guilt of not disclosing at the onset of the relationship, sex partner's non-disclosure of HIV serostatus, and guilt of unfaithfulness were some of the reasons for non-disclosure of HIV serostatus to sex partners.Non-disclosure of HIV serostatus is a public health concern with serious implications for both mother-to-child transmission, as well as horizontal transmission, in our setting. Strategic efforts toward ending the epidemic of HIV and AIDS in South Africa should address the sociocultural and behavioural determinants of non-disclosure

Prevalence of HIV serostatus disclosure to sex partners and at least a family member.

<p>Prevalence of HIV serostatus disclosure to sex partners and at least a family member.</p

Demographic characteristics.

<p>Demographic characteristics.</p