3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Antenatal depression screening and perintal depression among women at Rahima Moosa Hospital(2018) Marsay, CarinaIn South Africa, 30-40% of women suffer from perinatal depression. This has devastating consequences for both mother and infant, as depressed mothers are at higher obstetric risk and have diminished capacity to care for the physical and emotional needs of their infants. Without adequate screening, approximately 75% of women with perinatal depression will remain undiagnosed and only 10% of these women will receive treatment. Studies conducted in low, middle and high income settings have shown that it is feasible and acceptable to incorporate mental health screening and depression assessment, with referral, into antenatal clinics. The study reported in this dissertation aimed to investigate whether women attending the antenatal clinic at Rahima Moosa Hospital would benefit from antenatal screening for perinatal depression. This would be achieved by determining whether antenatal screening for depression lead to reduced symptoms of depression. In addition, the study was designed to compare the specificity and sensitivity of the Whooley screening questions with the Edinburgh Postnatal Depression Scale (EPDS) in detecting major depression during pregnancy. Lastly, the study aimed to explore the lived experiences, and barriers to care, of women identified as suffering from perinatal depression who were referred for further management. A mixed-method, explanatory design, involving three phases, was used. In the first phase, data were collected using quantitative measures, including a standardised biographical interview, the EPDS, the Whooley screening questions and the Structured Clinical Interview of DSM5. During the second and third phases, quantitative measures were used again to identify changes from phase one. Data were also collected using qualitative indepth interviews to explain results in greater depth. Perinatal depression is a significant public health problem that needs to be addressed in order to improve maternal and child health. Only by listening to the needs of women experiencing perinatal depression can mental health care be improved within obstetric services. Welldesigned research studies which use an explanatory, transformative design can be used to guide effective screening programmes, improve treatment and inform national policy.Item Evaluation of pregnant women admitted with prelabour rupture of membranes (PROM)(2013) Iloanusi, Nicholas EmekaBackground and objectives Prelabour rupture of the membranes (PROM) is a major obstetric problem affecting about 20% of pregnancies. Complications include preterm labour, ascending intrauterine and perinatal infections, and neonatal mortality. Standard guidelines are formulated and continually reviewed to improve the clinical management of PROM and to reduce poor perinatal outcomes associated with this condition. The objectives of this study, conducted using women in Johannesburg as a sample population, were: 1) to audit the implementation of the standard protocol on management of PROM, and 2) to determine the maternal and fetal outcomes of this condition. Methods A cross-sectional descriptive study was done on women admitted to the antenatal wards of Chris Hani Baragwanath Academic Hospital with PROM. Inclusion criteria were that PROM was the main reason for admission, gestation ≥24 weeks, and maternal age 18 years or more. Hospital clinical files were studied for obstetric and clinical characteristics, adherence by doctors to the management protocol, and final outcome including latency period, induction rate, mode of delivery, and neonatal outcome. Results Ninety-seven women participated in the study. Their mean age was 27.0 years, and 37 (38%) were nulliparous. Eighty-five (87%) had attended antenatal clinic. Twenty-nine (30%) were HIV-infected, 23 (79%) of them on highly active antiretroviral treatment. 6 The mean gestational age on admission was 32.8 weeks, with 78 (80%) women having preterm PROM at GA<37 weeks and 52 (54%) at GA <34 weeks. The most frequent methods of diagnosis were visual inspection in 77 (79%), speculum examination in 49 (51%) and ultrasound scan in 81 (84%) of the women. Antibiotics were given to 96 women (99%), and antenatal corticosteroids were used in all women <34 weeks pregnant. No cases of clinical chorioamnionitis were detected. The mean latency from PROM to delivery for women <37 weeks pregnant was 15 days, and for those <34 weeks, it was 19 days. Twenty-nine women (30%) required induction of labour, and 25 (25.8%) had caesarean sections. There were 12 perinatal deaths (with the exclusion of three late neonatal deaths), resulting from prematurity (n=4), congenital anomalies (n=2), neonatal jaundice (n=2), respiratory distress syndrome (n=2) and perinatal asphyxia / hypoxic ischaemic encephalopathy (n=2). There were no recorded cases of either neonatal or puerperal sepsis. Conclusion The study may have under-represented term PROM, so the findings are most applicable to preterm PROM. The condition was mostly managed appropriately within the local protocol, especially in terms of corticosteroid and antibiotic use. Overt or clinically evident chorioamnionitis was not detected. However, the perinatal mortality rate was high, and whatever the causes of perinatal death in this group, it is clear that PROM is a high-risk condition deserving of close clinical attention.Item The predictive ability of clinical palpation for estimating amniotic fluid volume in suspected prolonged pregnancy(2013-04-11) Buchmann, Eckhart JohannesBackground and objectives In low resource settings, ultrasound scans may not be available for amniotic fluid volume (AFV) assessment as part of fetal evaluation for suspected prolonged pregnancies (≥41 weeks’ gestation). The objectives of this study were: 1) to describe AFV measurements using ultrasound in women with suspected prolonged pregnancies, and to relate these measurements to maternal and fetal factors; 2) to evaluate different clinical palpation methods for estimating AFV; and 3) to determine the ability of clinical palpation to estimate AFV and predict oligohydramnios, using ultrasound-based amniotic fluid index (AFI) as a gold standard, accounting for the influence of maternal and fetal factors. Methods The study included women referred to Chris Hani Baragwanath Academic Hospital from midwife-run antenatal clinics because of concern about prolonged pregnancy (gestational age ≥41 weeks). On arrival at hospital, the women had real-time ultrasound assessment of AFI by an experienced ultrasonographer. The researcher, blinded to the AFI result, estimated AFV by abdominal palpation using ballottability of fetal parts, uterine fluctuance, uterine irritability, easily felt fetal parts, and a general impression of AFV. After recording the palpation findings, the researcher made a best estimate of gestational age for each woman based on the last menstrual period, early pregnancy ultrasound scans if available, or other relevant clinical information. Oligohydramnios was defined as an AFI <5 cm. Results One hundred women participated, of whom 45 had a best estimate gestational age ≥41 weeks. The mean AFI was 8.1±4.3 cm; 23 women had an AFI <5 cm. Twenty women were HIV infected. In univariable and multivariable linear regression analysis, HIV infection and gestational age were inversely associated with AFI at a P value <0.05. On abdominal palpation, the symphysis-fundal height, uterine fundal fetal parts ballottement, and presenting part ballottement were significantly positively associated with AFI on univariable and multivariable linear regression analysis. For the binary outcome of oligohydramnios, only presenting part ballottement was associated with an AFI <5 cm (negatively), both crudely, and adjusted for gestational age and HIV infection using logistic regression analysis. For women with a fetal head fully palpable (‘five fifths’) above the pubic symphysis (n=55), an inability to ballot the presenting part had a sensitivity of 73%, specificity of 64%, and a negative predictive value of 90% for an AFI <5 cm. Conclusion While fetal part ballottement and symphysis-fundal height measurement showed significant associations with AFI, the predictive value of clinical palpation for oligohydramnios was poor. However, in settings where real-time ultrasound technology is unavailable, the assessment of presenting part ballottement may be of value in women with suspected prolonged pregnancy. In clinical settings similar to those in this study, a ballottable fetal head gives 90% assurance of normal AFV.