3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Reducing maternal morbidity and mortality from caesarean section-related haemorrhage in Southern Gauteng(2017) Maswime, Tumishang Mmamalatsi SalomeIntroduction The number of maternal deaths from bleeding during and after caesarean section (BDACS) has increased dramatically in South Africa in recent years. Four studies were conducted to gain insight on measures to reduce maternal deaths from BDACS. The aim was to identify clinical and health system factors associated with near-miss and maternal death from BDACS. Methods A systematic review was done on near-miss from postpartum haemorrhage, with a sub-analysis on BDACS. The field research, done in southern Gauteng, included: 1) a six-month prospective near-miss audit of women with BDACS in 13 hospitals; 2) a two-year retrospective maternal death audit in seven hospitals; and 3) a health systems audit in 15 hospitals. Results The systematic review on near-miss from PPH found two studies that described near-miss from BDACS, with a mortality index of 0-11%. In the near-miss and maternal death audits, the main risk factors for BDACS were pre-operative anaemia and previous caesarean section. Atonic uterus was the main cause of haemorrhage, with associated failure to use second line uterotonic drugs. Failure to diagnose and treat shock was the main reason why women died. Most maternal deaths from BDACS occurred in regional hospitals. The hospital systems audit identified shortages of second line uterotonic drugs and surgical skills availability as contributors to near-miss and maternal death from BDACS. Conclusion Although bleeding may be arrested through obstetric surgical techniques and easily available drugs, severe BDACS is a complex disease that requires a multi-disciplinary approach in a functional health system, especially regarding the detection and management of hypovolaemic shock. Measures to reduce maternal morbidity and mortality from BDACS include health system strengthening, with high care and critical care facilities, and improving the availability of drugs and surgical skills at district and regional hospitalsItem Evaluation of the use of barrier contraceptives in women requesting termination of pregnancy at CHBAH(2015-04-22) Maswime, Tumishang Mmamalatsi SalomeIntroduction South Africa has a high prevalence of unintended pregnancies and HIV. Sixty eight thousand women die due to unsafe abortion annually worldwide, making it a leading cause of maternal mortality. In SA the maternal mortality has decreased from TOP. Maternal mortality from HIV is the leading cause of maternal mortality in South Africa. Unintended pregnancies are mainly a consequence of inconsistent and incorrect contraceptive use. The condom is the only contraceptive method which has the dual ability of preventing HIV and unintended pregnancies. We postulate that the failure of barrier contraception is a risk for both HIV and unwanted pregnancy. This study describes the contraceptive methods used by women at a TOP clinic and evaluates the use of barrier contraceptives amongst women requesting TOP, and the prevalence of HIV. Methods CHBAH is tertiary hospital in Southern Gauteng. Women with medical or surgical comorbidities that request a TOP are referred to the hospital. A prospective study using a cross sectional study design was performed at the Chris Hani Baragwanath Academic Hospital TOP clinic between February and October 2011. Data was collected using interviews and medical files. Results One hundred and nineteen women were interviewed. Most women 56 (47.06%) did not use any contraception at the time of conception. The most common reason for TOP was financial constraints, followed by relationship conflict. Pregnancy despite condom use was 34.45% (n=41). The percentage of women with condom failure, who were HIV positive was 34.14% (n=14). True condom failure was experienced by 12 women (pregnancy due to breakage/slippage of the condom. Conclusion Unintended pregnancy is mainly associated with not using contraceptives. The male condom was the most widely used contraceptive. The HIV prevalence in the group with condom failure was higher than the general antenatal population. There is a need for education regarding correct and consistent use of contraception.