An audit of surgical termination of pregnancy at a level 1 health facility in South Africa

Background: It was alleged that the termination of pregnancy (TOP) services in a certain district health facility were forgoing the opportunity to offer screening tests for human immunodeficiency virus (HIV) and syphilis for women seeking legal medical abortions. In addition, there were concerns regarding the lack of provision of contraceptive services, particularly in view of media reports of young women having repeated TOP procedures as a family planning method. It was therefore decided to perform an audit of the TOP services at this district health facility.Method: A semi-structured questionnaire was used to obtain information from all women undergoing a TOP during a sixmonth period at a district hospital in KwaZulu-Natal. Demographic information, clinical details and attitudes towards TOP were obtained. All women were interviewed in private prior to discharge from the clinic.Results: A total of 645 women were enrolled. Their mean age was 23 (range 15-44) years and 437 (67.8%) were primiparous. Of the 645 women, contraceptive failure (condom) occurred in 38 cases (6%). Two hundred and twenty-two (34.4%) had previously used a family planning method, the most common being depot preparations (35.1%), followed by condoms (28.9%) and oral contraception (15.8%). One hundred and nine (16.9%) women accepted the condoms offered while the remainder indicated that they would obtain contraceptives from the family planning clinic in their area of residence. Twentynine (5%) had at least one previous TOP while 25 (86%) and four (14%) had second and third requests for TOP respectively. None of the women had any serological screening tests performed or were given information about testing for sexually transmitted diseases, including HIV screening, prior to discharge from the clinic.Conclusion: Women having TOP at this district hospital are not offered counselling and information on screening for sexually transmitted diseases. In addition, few women take up the offer of contraceptives. There is a need for health care providers to strengthen reproductive health services at TOP clinics.Keywords: surgical termination of pregnancy, contraception, unwanted pregnancy, Durban, South Afric

How do South African obstetricians manage hypertensive disorders of pregnancy - a survey

Objective. To determine the current management of hypertensive disorders of pregnancy in South Africa.Method. A postal questionnaire was sent to 600 South African obstetricians.Results. The response rate was 72% (432/600), with 425 questionnaires suitable for analysis. South African obstetricians disagree on the definitions of various hypertensive disorders of pregnancy. Methyldopa was the antihypertensive used most frequently for the treatment of mild to moderate hypertension (diastolic blood pressure between 90 and 109 mmHg), while intravenous dihydralazine was preferred in severe hypertension (diastolic blood pressure ;0, 110 rnrnHg and proteinuria ≥, ++). To stop convulsions in eclampsia, 256 respondents (60%) said they would use diazepam, 28 (11%) said tlIey woUld continue with a diazepam infusion, and the remairling 228 (89%) preferred magnesium sulphate (MgS04) to prevent further convulsions. The intramuscular route was the preferred method of administration for MgS04. In cases of eclampsia, 273 respondents (64%) said they would use intravenous dihydralazine to lower high blood pressure (≥, 160/110 rnrnHg) and proteinuria; 98 respondents (23%) said they would use met.'1yldopa, 38 (9%) nifedipine, and 8 (2%) apresoline. Eight (2%) said they would not use antihypertensives. In patients with severe pre-eclampsia and impending eclampsia, 330 respondents (78%) said they would"use MgS04 as prophylaxis, 46 (11%) diazepam, and 6 (1.4%) phenobarbitone. Forty-three of the respondents did not prescribe prophylactic anticonvulsant therapy. To prevent pre-eclampsia, 247 of the respondents (58%) said they would prescribe Iow-dose aspirin.Conclusion. This study demonstrates that South African obstetricians show great uniformity in terms of the treatment of hypertensive disorders of pregnancy

Critical pathways for the management of preeclampsia and severe preeclampsia in institutionalised health care settings

BACKGROUND: Preeclampsia is a complex disease in which several providers should interact continuously and in a coordinated manner to provide proper health care. However, standardizing criteria to treat patients with preeclampsia is problematical and severe flaws have been observed in the management of the disease. This paper describes a set of critical pathways (CPs) designed to provide uniform criteria for clinical decision-making at different levels of care of pregnant patients with preeclampsia or severe preeclampsia. METHODS: Clinicians and researchers from different countries participated in the construction of the CPs. The CPs were developed using the following steps: a) Definition of the conceptual framework; b) Identification of potential users: primary care physicians and maternal and child health nurses in ambulatory settings; ob/gyn and intensive care physicians in secondary and tertiary care levels. c) Structural development. RESULTS: The CPs address the following care processes: 1. Screening for preeclampsia, risk assessment and classification according to the level of risk. 2. Management of preeclampsia at primary care clinics. 3. Evaluation and management of preeclampsia at secondary and tertiary care hospitals: 4. Criteria for clinical decision-making between conservative management and expedited delivery of patients with severe preeclampsia. CONCLUSION: Since preeclampsia continues to be one of the primary causes of maternal deaths and morbidity worldwide, the expected impact of these CPs is the contribution to improving health care quality in both developed and developing countries. The CPs are designed to be applied in a complex health care system, where different physicians and health providers at different levels of care should interact continuously and in a coordinated manner to provide care to all preeclamptic women. Although the CPs were developed using evidence-based criteria, they could require careful evaluation and remodelling according to each system's demands. Additionally, the CPs need to be tested in large-scale, multi-level studies in order to thoroughly examine and evaluate their efficacy and effectiveness

Hair Trace Element and Electrolyte Content in Women with Natural and In Vitro Fertilization-Induced Pregnancy

The objective of the present study was to perform comparative analysis of hair trace element content in women with natural and in vitro fertilization (IVF)-induced pregnancy. Hair trace element content in 33 women with IVF-induced pregnancy and 99 age- and body mass index-matched control pregnant women (natural pregnancy) was assessed using inductively coupled plasma mass spectrometry. The results demonstrated that IVF-pregnant women are characterized by significantly lower hair levels of Cu, Fe, Si, Zn, Ca, Mg, and Ba at p < 0.05 or lower. Comparison of the individual levels with the national reference values demonstrated higher incidence of Fe and Cu deficiency in IVF-pregnant women in comparison to that of the controls. IVF pregnancy was also associated with higher hair As levels (p < 0.05). Multiple regression analysis revealed a significant interrelation between IVF pregnancy and hair Cu, Fe, Si, and As content. Hair Cu levels were also influenced by vitamin/mineral supplementation and the number of pregnancies, whereas hair Zn content was dependent on prepregnancy anthropometric parameters. In turn, planning of pregnancy had a significant impact on Mg levels in scalp hair. Generally, the obtained data demonstrate an elevated risk of copper, iron, zinc, calcium, and magnesium deficiency and arsenic overload in women with IVF-induced pregnancy. The obtained data indicate the necessity of regular monitoring of micronutrient status in IVF-pregnant women in order to prevent potential deleterious effects of altered mineral homeostasis

A randomised controlled trial on suture materials for skin closure at caesarean section: Do wound infection rates differ?

Objective.The aim of this study was to determine wound complication rates following the use of suture materials and staples for skin closure at caesarean section (CS). Study design: A randomised, controlled, prospective study was undertaken. Results. A total of 1 100 women was assigned randomly into 3 groups: polyglycolic acid (PGA) suture group (N=361), skin staple (SS) group (N=373) and nylon suture group (N=366). The overall wound infection rate was 7%. There was no difference in respect of number of patients, age, parity and gestation between the study groups. Those who had nylon sutures as opposed to PGA sutures were 9.5 times more likely to experience wound infection (p=0.055). Women who had SS were at 6.93 times higher risk of wound infection than those who had PGA sutures (p=0.014). Other factors influencing wound infection rates included: rupture of membranes >12 hours were 13.7 times (95% confidence interval (CI) 3.9 - 47.9,