Obstetrics and Gynaecology Forum - Volume 16, Issue 3, 2006
Volume 16, Issue 3, 2006
Source: Obstetrics and Gynaecology Forum 16 (2006)More Less
Extracted from text ... Obstetrics & Gynaecology Forum August 2006 61 EDITORIAL O&G Forum 2006;16:61 In this edition, selected articles from the latest Executive Summary of Saving Mothers III are provided. Saving Mothers III is the 2002- 2004 Report of the National Committee on Confidential Enquiries into Maternal Deathsin South Africa. Sound information is the prerequisite for health action. The data from Saving Mothers provides a strong information base to create data for advocacy on maternal health and to establish programmes to improve and increase both access to, and quality of maternal and neonatal health services so that mortality and morbidity can ..
Obstetric haemorrhage - third report on confidential enquiries into maternal deaths in South Africa 2002-2004 : reviewSource: Obstetrics and Gynaecology Forum 16, pp 65 –76 (2006)More Less
Obstetric haemorrhage was the third most common cause of maternal death in South Africa for the triennium 2002 to 2004, accounting for 442 deaths or 13% of the total. Antepartum haemorrhage (APH) accounted for 129, and postpartum haemorrhage (PPH) for 313 of these deaths. The number of APH maternal deaths increased from 100 in 1999-2001, to 129 in 2002-2004. The number of PPH maternal deaths increased from 240 in 1999-2001, to 313 in 2002-2004. Part of these increases could be due to better reporting. As in the previous triennium, maternal age over 35 years was a risk factor for deaths level from APH and PPH. Over 75% of deaths from APH and PPH occurred at either a one or two hospital. The proportion of APH deaths at level 1 hospitals decreased slightly from 36.7% in 1999 -2001 to 26.4% in the current triennium. Of concern, is the high proportion of PPH deaths that continue to occur at level 1 hospitals: 40.9% (1999-2001) and 42.2% in the current triennium. The pattern of causes of APH and PPH in 2002 - 2004 has not changed significantly from the previous triennium. Of the 129 causes of APH related maternal deaths, only 81 were assigned a causal subcategory. Of these, abruptio placentae accounted for the majority of APH deaths. Of the 313 deaths from PPH, there were 4 main groups of primary causes, all of which should be easily preventable by basic referral obstetric care. 67 (21.4%) of PPH deaths were from retained placenta, only a small proportion of which were thought to be morbidly adherent. 74 (23.6%) were due to uterine atony, either from prolonged labour or over distension of the uterus. 84 (26.8%) were due to uterine rupture making this the largest cause of PPH. Of these, 41 (13.1%) were in women with a previous caesarean section (C/S) and of particular concern, 43 (13.7%) occurred in women with no previous C/S. The remaining major cause of PPH was 'other uterine trauma', accounting for 78 (24.9%) of PPH deaths. This group was predominantly due to bleeding during and after C/S, with small numbers due to serious vaginal trauma, and rare complications such as uterine inversion and extra uterine pregnancy. This large number of deaths due to C/S associated bleeding raises concern about technical skills, particularly at level 1 hospitals. APH & PPH were the causes of death most likely to be assessed as 'Clearly Avoidable' by assessors: 76.8% for APH and 83% for PPH. Delay in seeking help by the patient occurred for 17.5% of APH deaths compared to 3.7% in the previous triennium; and for 17.8% of PPH deaths. Delay in transport between institutions, particularly from levels 1 to 2, remained a major problem, occurring in 27.8% of APH deaths, but had decreased slightly for PPH (10.9% of deaths). There were marked increases in problems related to lack of availability of blood, lack of health care facilities and lack of appropriately trained staff for both APH and PPH and this was particularly common at level 1 hospitals. Two thirds to three-quarters of cases had avoidable factors related to health workers at each level of care. For both APH & PPH, problem recognition and substandard management were the most frequently cited problems, occurring at all levels of care and showing no significant improvement from the previous triennium. For PPH, problem with monitoring and reacting to abnormal monitoring were problems which had increased from the previous triennium and occurred at all levels of care. Problems with restoring circulation in bleeding patients remained a serious problem, occurring in 78.9% of women dying from APH, and 82% from PPH. <br>Major improvements in the functioning of the health system and appropriate training of doctors and midwives at all levels of care, are essential if deaths from this preventable cause of maternal mortality (obstetric haemorrhage) are to be reduced.
Overview - third report on confidential enquiries into maternal deaths in South Africa 2002-2004 : overviewAuthor R.C. PattinsonSource: Obstetrics and Gynaecology Forum 16, pp 79 –82 (2006)More Less
Extracted from text ... Obstetrics & Gynaecology Forum August 2006 79 OVERVIEW O&G Forum 2006;16:79-82 Correspondence: Prof RC Pattinson email: email@example.com Introduction Confidential enquiries into maternal deaths (CEMD) can be defined as "a systematic multidisciplinary anonymous investigation of all or a representative sample of maternal deaths occurring at an area, region (state) or national level which identifies the numbers, causes and avoidable or remediable factors associated with them. Through the lessons learnt from each woman's death, and through aggregating the data, confidential enquiries provide evidence of where the main problems in overcoming maternal mortality lie and an analysis of what can be ..
Ten key recommendations from the third report on confidential enquiries into maternal deaths in South Africa 2002-2004 : recommendationsSource: Obstetrics and Gynaecology Forum 16, pp 85 –89 (2006)More Less
Extracted from text ... Obstetrics & Gynaecology Forum August 2006 85 RECOMMENDATIONS O&G Forum 2006;16:85-89 Correspondence: J Moodley Chairperson, NCCEMD, Women's Health and HIV Research Group, Nelson R Mandela School of Medicine Private Bag 7, Congella, 4013, South Africa. Tel/Fax: 27 - 031 - 2604241 Email: firstname.lastname@example.org Introduction The National Committee for the Confidential Enquiries into Maternal Deaths (NCCEMD) reviewed the recommendations as outlined in the Saving Mothers 1999-2001 report, assessing whether the recommendations are still relevant. New targets and indicators are identified for those recommendations that are still crucial for this report. For the first time in the Saving Mothers ..
Source: Obstetrics and Gynaecology Forum 16, pp 91 –94 (2006)More Less
Extracted from text ... Obstetrics & Gynaecology Forum August 2006 91 GUIDELINES O&G Forum 2006;16:91-94 Correspondence: Prof J Moodley email: email@example.com Introduction Hypertensive disease in pregnancy is one of the 5 major causes of maternal mortality and morbidity in South Africa. This important fact should always be remembered when pregnant mothers are provided with information and education during visits for antenatal care, during labour or in the puerperium. Information on hypertension in pregnancy should also be given to relatives of pregnant mothers and communities. Definition A blood pressure (BP) of 140/90mmHg or more during pregnancy is indicative of any hypertensive disease. The ..
Source: Obstetrics and Gynaecology Forum 16 (2006)More Less
Extracted from text ... O&G CPD ANSWER FORM - AUGUST 2006 Subscribe to the O&G Forum CPD programme and earn 16 CPD points per year CPD reference number A008/024/02/2006 Continuing Professional Development Point Questionnaire Accredited by the Wits CPD Office Instructions 1. Read the journal to find all the answers 2. Answer the questions and mark the answer form by putting an "X" in the appropriate square. 3. Make a photocopy for your records in case the form is lost in the mail. 4. Tear out page and place the answer form in a envelope, seal it and send to:- In House Publications, ..