South African Journal of Obstetrics and Gynaecology - Volume 10, Issue 2, June 2004

Spinal anaesthesia is the method of choice for caesarean section. There is however a significant associated morbidity and mortality in South Africa, particularly in inexperienced hands. This review provides recommendations for safe practice for anaesthetists at all levels of expertise, with particular reference to the management of haemodynamic instability.

<I>Objective.</I> To determine the prevalence and co-factors associated with the practice of dual protection against sexually transmitted infections (STIs) and unwanted pregnancy in a cross-sectional sample of South African women. <br><I>Design.</I> Secondary analysis of cross-sectional household survey data. <br><I>Methods.</I> Statistical analysis of responses by sexually active women to the question, 'Was a condom used on the last occasion you had sex?' were obtained from the women's questionnaire of the South African Demographic and Health Survey in relation to a number of other variables. <br><I>Results.</I> (i) 10.5% of all sexually active women aged 15 - 49 years used a condom at last sex and 6.3% used a condom as well as another contraceptive method; (ii) condom use is more likely among younger, more educated, more affluent, and urban women, and among women who change partners more frequently; (iii) reasons for not using condoms are more likely to be associated with the personal attitudes of women or their partners than with poor knowledge of or lack of access to condoms; (iv) women who have no need or desire to prevent pregnancy are less likely to use condoms; and (v) there is a minority of sexually active women, characterised by social disadvantage, who have difficulty obtaining condoms. <br><I>Conclusions.</I> There is an urgent need for targeted programmes that increase dual protection with condoms.

&lt;I&gt;Background.&lt;/I&gt; In South Africa injectable progestogen-only contraceptives (IPC) are typically administered to women immediately after delivery. Several guidelines advise that breast-feeding women should not commence IPC until 6 weeks postpartum on the basis of theoretical risks to the infant. &lt;br&gt;&lt;I&gt;Objective.&lt;/I&gt; We examined women's preferences regarding timing of postpartum IPC initiation, as well as women's contraceptive and breast-feeding behaviours and pregnancy risk in the early postpartum period. <br><I>Design and data collection.&lt;/I&gt; A cross-sectional study was conducted among 200 antenatal clinic (ANC) attendees and 180 mothers attending a child health clinic (CHC). At the ANC, women were given information on the theoretical risks of IPC and re-interviewed about their postpartum contraceptive intentions. &lt;br&gt;&lt;I&gt;Results.&lt;/I&gt; Most ANC women planned to use IPCs (92%) and to breast-feed (98%) after delivery. Most CHC mothers had used IPCs (91%) and had breast-fed (83%) after delivery. When women at the ANC were provided with appropriate information they made decisions about when to initiate IPC by balancing the theoretical risks of IPC to their infant against their personal risk of pregnancy and ability to return to a clinic in the early postpartum period. &lt;br&gt;&lt;I&gt;Conclusion.&lt;/I&gt; It is important to include informed choice in postpartum IPC initiation guidelines.

&lt;I&gt;Objectives.&lt;/I&gt; To determine exposure to domestic violence by a partner or spouse among pregnant women attending a public sector hospital in Durban, South Africa. &lt;br&gt;&lt;I&gt;Design.&lt;/I&gt; Six hundred and four randomly chosen women from a low-income community were interviewed over a 6-month period using a standardised questionnaire. &lt;br&gt;&lt;I&gt;Results.&lt;/I&gt; Thirty-eight per cent had experienced domestic violence at some point in their lives. Physical abuse (52%) was the most common, and 35% had been abused during the current pregnancy. &lt;br&gt;&lt;I&gt;Conclusion.&lt;/I&gt; Domestic violence is common in pregnancy among women attending a public sector hospital.

&lt;I&gt;Objective.&lt;/I&gt; To analyse severe acute maternal morbidity (SAMM) and maternal mortality in the Pretoria region over a 2-year period (2000 - 2001). &lt;br&gt;&lt;I&gt;Setting.&lt;/I&gt; Public hospitals in the Pretoria region, South Africa, serving a mainly indigent urban population. &lt;br&gt;&lt;I&gt;Methods.&lt;/I&gt; A descriptive study was performed whereby women with SAMM and maternal deaths were identified at daily audit meetings and an audit form was completed for all cases fulfilling the definition of SAMM ('near miss') and for all maternal deaths. &lt;br&gt;&lt;I&gt;Results.&lt;/I&gt; The number of maternal deaths declined slightly but not significantly from 18 deaths in 2000 to 16 in 2001. This represents a change in the maternal mortality ratio (MMR) from 130/100 000 live births in 2000 to a MMR of 100/100 000 live births in 2001. However, when data for women with SAMM and maternal deaths were combined, there was a significant increase in major maternal morbidity from 90 cases (SAMM and maternal death rate 649/100 000 live births) in 2000 to 142 cases (SAMM and maternal death rate 889/100 000 live births) in 2001 (&lt;I&gt;p&lt;/I&gt; = 0.006). This increase was due to a significant increase in severe maternal morbidity related to abortions and obstetric haemorrhages. &lt;br&gt;&lt;I&gt;Conclusion.&lt;/I&gt; Analysis of maternal deaths only in the Pretoria region failed to identify abortions and haemorrhages as major maternal care problems. When data for women with SAMM were combined with data for maternal deaths, however, these problems were clearly identified, and remedial action could be taken. Including SAMM in maternal death audits increases the rapidity with which health system problems can be identified.