Obstetrics and Gynaecology Forum - Volume 22, Issue 2, 2012
Volume 22, Issue 2, 2012
Source: Obstetrics and Gynaecology Forum 22, pp 9 –17 (2012)More Less
The most recent report on Maternal deaths in South Africa for 2008-2010 shows that there has been a significant increase in the number of maternal deaths (32.4%) due to obstetric haemorrhage and the Institutional Haemorrhage Maternal Mortality Ratio has increased from 18.8/100000 live births in 2005-2007 to 24.9/100000 live births in 2008-2010. This article is an abridged version of the chapter on the 688 maternal deaths from obstetric haemorrhage mentioned in the above report.
The chapter identifies priority provinces (Mpumulanga, Limpopo, Free State and North West) and priority problems (bleeding associated with caesarean section, abruptio placentae and ruptured uterus) for particular attention. Bleeding during and after caesarean section accounted for 26.2% of deaths due to obstetric haemorrhage, occurring most commonly in public hospitals particularly district and regional. Obstetric haemorrhage continues to be the most common avoidable cause of maternal death; 81% of the deaths having been assessed as avoidable. Resuscitation was sub-optimal in 22.3% of cases where it was attempted and the cases had sufficient information to assess.
Vignettes are presented to illustrate the numerous administrative problems and examples of poor quality of care. Interventions at different levels of care and by different stakeholders are discussed.
Source: Obstetrics and Gynaecology Forum 22, pp 19 –21 (2012)More Less
Health care worker inability to recognise critically sick patients based on standard vital observations or to act upon abnormal observations is a South African phenomenon and at present poorly understood.
Practices elsewhere in the world have shown that although health professionals are poor to comply with risk scoring systems, colour banded observation charts are more likely to result in prompt action.
The national committee for confidential enquiries into maternal deaths (NCCEMD) recommends the implementation of a colour banded observation chart to assist in improving earlier appropriate action in women with emerging adverse clinical events.
Introduction of a colour banded observation chart should be combined with a clear communication strategy. The process should be used to change the organisational culture to be more proactive in initiating early intervention to reduce the burden of unintended complications.
Author Tobie De VilliersSource: Obstetrics and Gynaecology Forum 22, pp 22 –36 (2012)More Less
Concerns about possible adverse effects of hormone replacement therapy (HRT) in postmenopausal women have led researchers to develop compounds that retain the beneficial effects of estrogen while removing their potential for adverse effects on the breast and the endometrium. One such group is the selective estrogen receptor modulators (SERMs).
Source: Obstetrics and Gynaecology Forum 22, pp 23 –26 (2012)More Less
Objective: The objective of this paper was to review the maternal deaths classified as acute collapse in South Africa as reported through the confidential maternal deaths process. Methods: All the chapters discussing maternal deaths in the Saving Mothers triennial reports were reviewed to assess the cumulative impact of deaths classified as acute collapse. Information were analysed to illustrate factors emerging when combining data, and were scrutinised for changes over the past 12 years. Results: Between 1999 and 2010 a total of 517 maternal deaths were classified acute collapse as the primary cause of death. The final cause of death was unknown in 280 cases (42.7%). Cardiac, respiratory and immune system failure were the most common known final or contributory causes of death. In 490 cases where assessment could be made regarding health care workers, the most common factors were associated with problem recognition, diagnosis, monitoring of patients and substandard care. Conclusion: Acute collapse is a condition reflecting systems affecting health care. Strengthening the pool of skills and introduction of a standardised observation policy should result in improved outcomes.
Maternal deaths due to adverse drug reactions to nevirapine-containing HAART : new recommendations for ARV therapy in pregnancy in South Africa : reviewAuthor N.F. MoranSource: Obstetrics and Gynaecology Forum 22, pp 29 –32 (2012)More Less
This article draws attention to an important problem that has been contributing to maternal mortality and morbidity in South Africa, particularly over the past two years, namely adverse drug reactions to anti-retroviral drugs, specifically nevirapine. However, this article should in no way be understood as raising objections to the use of highly active antiretroviral therapy (HAART) in pregnancy as a key component of the national strategy to reduce maternal deaths and to combat the HIV epidemic in general.
Bayer HealthCare launches Qlaira - The first estradiol-based oral contraceptive globally and now in South Africa : product newsSource: Obstetrics and Gynaecology Forum 22 (2012)More Less