ETD Collection

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    Perintal survival of infants weighing more thatn 500g whose mothers died in the puerperium before being discharged: a retrospective descriptive study at Charlotte Maxeke Johannesburg academic hospital from 2003 to 2012
    (2015) Blaise, Bucyibaruta Joy
    A growing body of evidence confirms a slow reduction in neonatal deaths, of which the majority occur in the early neonatal period. The burden of perinatal deaths is heavy in developing countries where the perinatal death rate is about five times higher than its rate in developed countries. Similarly, about 99% of maternal deaths occur in developing countries. However, to the best of our knowledge, little is known about perinatal outcomes of infants born to mothers who die from complications of childbirth. This gap in the existing literature motivated us to undertake the study, which aimed to investigate the perinatal outcomes of infants born to mothers who died from complications of childbirth at Charlotte Maxeke Johannesburg Academic Hospital. It consisted of a retrospective study, over a 10 year period, on infants weighing 500 g and more or with gestational age of 22 weeks and above born to mothers who died from complications of childbirth. A sample size of 122 mothers and 128 infants eligible were analysed through quantitative methods. Among these infants, 85 (66.4%) were born alive. The identified top four obstetrical causes of maternal deaths were: non-pregnancy related infections including HIV/AIDS, Hypertensive disorders of pregnancy, pre-existing maternal diseases and postpartum haemorrhage. HIV and hypertension accounted for more than 50% of maternal deaths. The findings revealed that emergency caesarean section was high (70%) and the perinatal survival rate was 55%. Maternal parity, Apgar scores at one minute and mode of delivery were identified as the main predictors which were statistically associated with perinatal survival, with correlation coefficient of + 0.7 (P=0.030), + 0.4 (P=0.000) and + 0.1 (P=0.002) respectively. Concerning infants born alive, early neonatal survival rate was 84%. Apgar score at five minutes and maternal parity were the sole predictors that were statistically associated with neonatal outcomes, with correlation coefficient of +0.3 (P=0.000) and + 0.1 (P=0.019). These findings demonstrated that with appropriate labour monitoring, adequate neonatal resuscitation and good perinatal care, the majority of those infants would be born alive with four out of five surviving to hospital discharge.
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    A review of maternal death records of HIV + women in Sedibeng District, Gauteng
    (2012) Sejake, Senate Betty
    Introduction: The maternal mortality ratio in Sedibeng District, Gauteng Province, from 2002 – 2004 was 220/100000. For the past decade HIV has been identified as a factor that has slowed the decline in maternal deaths in South Africa. The purpose of this study was to describe personal and service level factors contributing to maternal mortality of HIV positive women. It is hoped that the results of this study will be useful in developing interventions that will assist to curb the maternal mortality ratio. Methodology: Maternal death records were reviewed for the period 2004-2009. Data was collected on antenatal care, hospital care after admission and access to HIV services. The data were analysed using Stata 10. The results were compared with the national guidelines for the care of HIV positive pregnant women so as to identify discrepancies between the two. Results: One hundred and twenty five maternal death records were reviewed. Of these, 90% booked late for antenatal care i.e. beyond 20 weeks gestation. The majority (60.8%) of the women were HIV positive. Of the HIV positive women, 37.5% had CD 4 counts less than 200, which made them eligible for antiretroviral therapy. Of those that were eligible for antiretroviral therapy, 50.0% did not access the antiretrovirals due to late booking and loss to follow-up. Another main finding was that 36% died during the postnatal period. Conclusion: The antenatal bookings occurred after 12 weeks gestation which limited the time for starting patients on antiretroviral therapy. The high number of deaths during the postnatal period may indicate poor postnatal care and follow-up; as antiretroviral therapy could have been started during the postnatal period. Recommendations: Early antenatal booking and early HIV testing should be encouraged in communities. Antenatal services should be integrated so that HIV positive pregnant women are treated comprehensively and that the focus is not only on HIV, but also on other conditions such as TB, pneumonia, anaemia and hypertension. All pregnant HIV positive women must be done CD 4 counts; and all those found to be eligible for antiretroviral therapy should be given antiretrovirals timeously. Such women should be followed up and monitored closely. Postnatal check-up at 3 days should be strengthened for the mother-and-baby pair.