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n Obstetrics and Gynaecology Forum - Birth asphyxia and perinatal outcome in a low resourced setting in northern KZN : review
Aim: To identify avoidable factors for birth asphyxia during the antenatal and intrapartum care.
Method: All asphyxiated babies born at Lower Umfolozi District War Memorial Hospital (LUDWMH) from November 2010-January 2011 were analysed. Babies with congenital anomalies, congenital infections and extreme prematurity were excluded. Substandard care and avoidable factors were identified and divided into patient-related, healthcare worker-related and administrative associated; and recorded with a coding system similar to that of the Perinatal Problem Identification Programme (PPIP).
Results: There were 20 intrapartum asphyxiated babies. Analysis of antenatal care showed healthcare worker-related avoidable factors in 20% and patient related avoidable factors in 20%. Analysis of intrapartum care showed healthcare worker related avoidable factors in 40%, administrative avoidable factors in 30% and patient related factors in 20%. The most common patient related factor was a delay in seeking help during labour (25%). The most common health worker related avoidable factor was fetal distress not detected during fetal monitoring. The main administrative problem was a delay in caesarean section due to an inadequate number of staffed theatres (84%).
Conclusion: This audit identifies resource deficiencies. Healthcare workers must have regular in-service training and education on fetal monitoring, interpretation and timeous action when an abnormal CTG occurs. The hospital management must be involved in delays in CS due to staff shortages and alternate arrangements made to ensure optimal service delivery at all times. There still exists in our community, a number of women who don't access healthcare to an appropriate level during pregnancy. Health education for the general public and pregnant women in this area should be emphasised.
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