Obstetrics and Gynaecology Forum - Volume 23, Issue 3, 2013
Volume 23, Issue 3, 2013
Source: Obstetrics and Gynaecology Forum 23 (2013)More Less
Author Mergan NaidooSource: Obstetrics and Gynaecology Forum 23, pp 7 –10 (2013)More Less
Family Medicine became a registered specialty in 2007. A consensus was reached on the core competencies that were needed for a family physician (FP). These competencies were encapsulated in the 5 unit standards that are exit outcomes for FPs.
The re-engineering of primary health care (PHC) and the introduction of the National Health Insurance by the South African Department of Health has created the opportunity for the FP to work in district clinical specialist teams (DCSTs) and the district health system. The FP is expected to work with ward based teams as a health advocate to ensure essential messages dealing with areas of maternal health are addressed in the municipal ward. Community interventions in dealing with obstetric haemorrhage have to be provided by working with community health workers. Women and their families need to be given advice on the need for ante natal care, delivering in health facility and dealing with haemorrhage if delivery occurs unexpectedly. Clinical guidelines such as the basic ante-natal care package should be correctly and consistently used for all antenatal attendees to primary health care clinics (PHC) clinic.
The FP will ensure that appropriate training of professional midwives and doctors occur at PHC clinics and district hospitals (DH). Recommendations of the 5th Saving Mothers Report must be implemented and monitored in DHs. The FP is expected to audit maternal morbidity and mortality and develop quality improvement plans to ensure that outcomes are optimized. The WHO near miss approach for maternal health needs to be introduced and monitored at all DH.
The roles of the FP are seen as a family medicine expert, a communicator, a collaborator, a manager, a health advocate, a scholar and a professional.
A review of uterine rupture and maternal mortality from this cause in South Africa, 2008-2010 : reviewAuthor S. FawcusSource: Obstetrics and Gynaecology Forum 23, pp 15 –19 (2013)More Less
Uterine rupture is a catastrophic obstetric emergency which inevitably results in severe morbidity but also may result in maternal and perinatal death.
This article will review clinical aspects of uterine rupture and then present data on deaths from uterine rupture in South Africa during the 2008-2010 time period.
Avoiding unnecessary caesarean sections : a key strategy for reducing obstetric hemorrhage deaths : reviewAuthor N.F. MoranSource: Obstetrics and Gynaecology Forum 23, pp 21 –26 (2013)More Less
The Saving Mothers 2008-2010 Report showed a worrying trend of increasing deaths due to obstetric hemorrhage (OH), which is now the second most common category of maternal death in South Africa, (after non-pregnancy related infections), and the most common category of direct maternal death. In particular in 2008-10, there was a big increase in the numbers of maternal deaths associated with caesarean section (CS) bleeding (mainly bleeding after CS). These deaths occurred at all levels of hospital care. The National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD) has resolved to place a special focus on this issue as there has been no reduction in CS-related hemorrhage deaths since 2010, despite the fact that the great majority of these deaths have been assessed as being avoidable. The NCCEMD has released a communication entitled "Alert on Maternal Deaths due to Obstetric Haemorrhage" in which various recommendations have been made to prevent obstetric hemorrhage deaths, with a particular focus on facility requirements for safe CS, intra-operative procedure, post-operative monitoring and algorithms for managing the intra or post-operative bleeding.
Use of a uterine tourniquet as a temporising measure during transfer of patients with obstetric hemorrhage : reviewSource: Obstetrics and Gynaecology Forum 23, pp 29 –31 (2013)More Less
Haemorrhage is the second commonest cause of maternal death and the leading direct cause, accounting for 14.1% of all deaths during pregnancy, childbirth and the puerperium. Deaths from postpartum haemorrhage (PPH) during or following Caesarean Section (CS) is of serious concern and the National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD) in South Africa has identified it as a priority issue as 26.2% of obstetric hemorrhage (OH) deaths were associated with abdominal deliveries. Furthermore, the clinical impression is that CS rates have been increasing over the last decade in South Africa.
Source: Obstetrics and Gynaecology Forum 23, pp 33 –34 (2013)More Less
Maternal deaths due to obstetric haemorrhage are the second most common cause of maternal death in South Africa and the most common direct obstetric cause. As the table below shows, both numbers and rates of deaths from this cause have increased in the last decade.
Over 80 % of all these deaths are avoidable. They occur at all levels of care, but are most frequent at district and regional hospitals.
Of particular concern is the increasing number of women who die from bleeding associated with Caesarean Section (C/S) (about 60 women every year, constituting 27.6% of all haemorrhage deaths).
Safety of quadrivalent human papillomavirus vaccine administered routinely to females : product newsAuthor Nichola P. KleinSource: Obstetrics and Gynaecology Forum 23 (2013)More Less