Obstetrics and Gynaecology Forum - Volume 25, Issue 3, 2015
Volume 25, Issue 3, 2015
Author J. MoodleySource: Obstetrics and Gynaecology Forum 25 (2015)More Less
The theme for this edition is safe caesarean delivery. Patient safety has in recent years been emphasised as a result of the broad dissemination of information on maternal health matters in the electronic media, and increasing numbers of complaints against health care professionals and providers.
Author P. De JongSource: Obstetrics and Gynaecology Forum 25, pp 7 –11 (2015)More Less
The rate of caesarean deliveries (the new term for caesarean sections) has risen worldwide over the past years, and the South African numbers reflect this phenomenon. Accurate rates are difficult to quantify, but the incidence of caesarean deliveries (CD) varies from less than 1% in some parts of Africa, to over 50% in China. In South Africa the rate is variable from about 21% in the state sector, to around 80% in the private sector. This mirrors the CD percentage in the UK private sector. Whilst the WHO suggested a 15% caesarean rate in 1985, this figure is unrealistic for the reasons mentioned in the paper. The article outlines the reasons for the rapidly increasing rate of CDs in South Africa. It is impossible to contemplate a "correct" rate of operative deliveries, as the percentage depends on patient's circumstances. However what is important, is that every woman who needs and deserves a CD, gets one.
Author S. GebhardtSource: Obstetrics and Gynaecology Forum 25, pp 13 –19 (2015)More Less
Caesarean delivery (CD) is associated with an almost three-fold higher risk of maternal death than vaginal delivery in South Africa. An emergency CD is associated with higher risks of severe bleeding and accidental injury to intra-abdominal organs (urinary bladder and bowel); as well as anaesthetic complications due to rapid induction of anaesthesia. The novice or inexperienced surgeon may be confronted with sudden difficulty during CD that, if not corrected within minutes, can lead to a maternal death or severe morbidity. In many cases it is (in retrospect) possible to predict the problematic operation. This article will guide doctors working in an obstetric service to make CD safer. Risk stratification in CD already begins at the antenatal clinic, where potential high-risk cases can be identified and referred before delivery. Morbid obesity or women with 2 or more previous CD are examples of cases where difficulty can be expected. During labour, women with a prolonged second stage, especially if there was an attempted (but failed) instrumental delivery; or women who develop pre-eclampsia at advanced labour are examples of cases where senior help should be requested. And then there are the situations where a woman with complications is too advanced in labour to refer, and the surgeon has to be able to deal with bleeding placenta praevia or CD for eclampsia at district level. The article further deals with the aspects of informed consent for CD as well as the WHO surgical safety checklist, a quality assurance tool to reduce morbidity and mortality. It can also be used to audit a CD service. It also encourages vital communication between the obstetrician, anaesthetist, scrub team and midwife.
Source: Obstetrics and Gynaecology Forum 25, pp 23 –28 (2015)More Less
Caesarean delivery is associated with a higher maternal mortality than vaginal birth. Anaesthesia complications are asignificant contributor to this fact. Reported avoidable anaesthetic mortality rates vary from 1 : 150 in Togo to 1 : 71429 in the UK. This high variation in reported rates can be ascribed to variations in skill/training and the availability and appropriate utilization of equipment and drugs. This review attempts to highlight these issues such that focused attention can be given to improve these factors in South Africa.
Author S. FawcusSource: Obstetrics and Gynaecology Forum 25, pp 31 –34 (2015)More Less
A survey of health professionals on the current use of forceps / ventouse and skills training for operative vaginal delivery : reviewAuthor J. DevjeeSource: Obstetrics and Gynaecology Forum 25, pp 37 –39 (2015)More Less
Background: There is a progressive shift away from the use of operative vaginal deliveries in favour of caesarean delivery in obstetrics. The current study aimed to assess on the use of forceps / ventouse and skills training for operative vaginal delivery by health care professionals. Study design: The questionnaires were distributed to health care workers employed in the Department of Obstetrics and Gynaecology in the KwaZulu-Natal (KZN) Provincial Hospitals to evaluate the possible reasons for the low operative vaginal delivery rates rates. Results: Of the 250 questionnaires distributed to health care workers of varying experience, 197 (85.6%) were complete and eligible for analysis. One hundred and nineteen (60%) of the respondents indicated that was a role for operative vaginal deliveries. Seventy-eight (40%) had reservations, including lack of confidence = 37(47%), fear of litigation = 13(16%), and fear of complications = 28(35%). 17 (9%) of the 197 medical doctors performed operative vaginal delivery after training, 189 (96%) preferred vacuum to forceps. Thirty-one (16%) of the respondents indicated that they taught the procedure to their colleagues. One hundred and sixty-six (84%) had learned operative vaginal delivery from essential steps in the management of obstetrics emergencies (ESMOE) training modules. Conclusion: Although the overall rate of operative vaginal delivery has been declining in our setting, with appropriate training and careful patient selection, operative vaginal delivery can be a valuable tool in the armamentarium of obstetrics.
Source: Obstetrics and Gynaecology Forum 25, pp 41 –44 (2015)More Less