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- Volume 11, Issue 2, 2005
South African Journal of Obstetrics and Gynaecology - Volume 11, Issue 2, 2005
Volume 11, Issue 2, 2005
Author Louis-Jacques Van BogaertSource: South African Journal of Obstetrics and Gynaecology 11, pp 18 –22 (2005)More Less
Source: South African Journal of Obstetrics and Gynaecology 11, pp 24 –27 (2005)More Less
<I>Objective.</I> To review the anticipated changes in caesarean section (CS) rates following the restructuring of maternity health care services from regional to district level. <br><I>Hypothesis.</I> A change in provision of maternity services from regional to district level results in a decline in the CS rates. <br><I>Method.</I> A retrospective audit was undertaken of CS rates 3 months before and 3 months after the 'down-scaling' of obstetric services from regional to district level at Addington Hospital, Durban. In addition the booking status of patients, indication for the CS, appropriateness of the CS decision and perinatal outcome were evaluated. <br><I>Results.</I> Despite a 32% reduction in the total number of deliveries, the CS rate was essentially unchanged following the restructuring of the obstetric service (24.6% and 22.9% for the two periods respectively). The proportion of CSs for complicated high-risk cases declined from 9.62% to 4%. The perinatal mortality rate decreased from 84.5/1 000 to 59.4/1 000 deliveries. An inappropriate decision for a CS was made in one-third of the cases. <br><I>Conclusion.</I> The restructuring of the health service and decline in the number of high-risk patients seen should have resulted in a decline in the CS rate. Lack of change in the latter may suggest possible influence of the skill of the health care providers.
Source: South African Journal of Obstetrics and Gynaecology 11, pp 28 –38 (2005)More Less
<I>Objective.</I> Oxytocin is one of the most frequently used drugs in labour and there are many different dosage regimens. The aim of this study was to examine the use of oxytocin by obstetricians in South Africa. <br><I>Methods.</I> A specially designed questionnaire was drawn up and distributed to specialists according to an address list obtained from the South African Society of Obstetricians and Gynaecologists. <br><I>Results.</I> Three hundred and fifty questionnaires were distributed, with 174 processed for analysis. The majority of obstetricians (70.3%) reported that they would not use oxytocin for induction of labour in a patient with a previous lower-segment caesarean section, and 63.7% said that they would not consider the use of oxytocin in a patient with a multifetal pregnancy. Most respondents used oxytocin for induction of labour in multigravid patients and 91.9% also used oxytocin for augmentation in these patients. However, clinicians would not use oxytocin if the patient was a grand multipara. <br><I>Conclusions.</I> Most clinicians adhere to accepted protocols practised internationally, with a few exceptions. The use of oxytocin for both induction and augmentation of labour in women with one previous caesarean section is not practised in South Africa, despite evidence suggesting its safety.
Source: South African Journal of Obstetrics and Gynaecology 11, pp 40 –46 (2005)More Less
<I>Background.</I> Caesarean section (CS) is a very common surgical procedure worldwide. Suturing the peritoneal layers at CS may or may not confer benefit, hence the need to evaluate whether this step should be omitted or not. <br><I>Objectives.</I> To assess the effects of non-closure as an alternative to closure of the peritoneum at CS on intraoperative, immediate and later postoperative, and long-term outcomes. <br><I>Search strategy.</I> We searched the Cochrane Pregnancy and Childbirth Group Trials Register (November 2002) and the Cochrane Central Controlled Trials Register (October 2003). <br><I>Selection criteria.</I> Randomised controlled trials that compared leaving the visceral and/or parietal peritoneum unsutured at CS with suturing the peritoneum, in women undergoing elective or emergency CS. <br><I>Data collection and analysis.</I> Trial quality was assessed and data were extracted by two reviewers. <br><I>Main results.</I> Nine trials involving 1 811 women were included and analysed. The methodological quality of the trials was variable. Non-closure of the peritoneum reduced operating time when both layers or one layer was not sutured. For both layers, the operating time was reduced by 7.33 minutes (95% confidence interval (CI): -8.43 - -6.24). There was significantly less postoperative fever and reduced postoperative stay in hospital for non-closure of the visceral peritoneum and non-closure of both layers. There were no other statistically significant differences. The trend for analgesia requirement and wound infection tended to favour non-closure, while endometritis results were variable. Long-term follow-up in 1 trial showed no significant differences. The power of the latter study to show differences was low. <br><I>Conclusions.</I> There was improved short-term postoperative outcome if the peritoneum was not closed. Long-term studies following CS are limited, but data from other surgical procedures are reassuring. At present there is no evidence to justify the time taken and cost of peritoneal closure.