3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Time until first analgesic requirement, post caesarean section under spinal anaesthesia, in HIV-positive patients at Chris Hani Baragwanath Hospital(2011-10-11) Wagner, Janine LouiseBACKGROUND Multiple studies have been conducted comparing the efficacy and duration of analgesia obtained from spinal anaesthesia containing local anaesthetics as well as opioids. The literature available has not considered the individual‟s HIV status as a variable. Postoperative analgesic duration and requirements in this group of patients may differ due to the occurrence of acute and chronic pain syndromes, pain arising from the disease itself, side effects of treatment for HIV infection, or opportunistic infections. Response to opioid analgesia may be altered due to previous opioid exposure, potential increase in nociception, drug interactions and emotional status. OBJECTIVES The primary objective of this study was to determine the time to post-operative analgesic request in HIV-positive and negative individuals having caesarean sections under spinal anaesthesia containing bupivacaine or bupivacaine and fentanyl. The secondary objectives of this study were to determine if factors such as height, ethnicity, level of education, CD4 count, and antiretroviral therapy impacted on the duration of analgesia obtained.Item Midline versus Pfannenstiel incision scars in repeat caesarean sections(2009-09-22T11:08:20Z) Haacke, Karl OlafIt is a commonly held belief that a repeat caesarean section through a low vertical scar provides easier access and fewer complications than an operation through a previous Pfannenstiel incision. To test this hypothesis the records of one hundred and twenty one repeat caesarean sections were retrospectively reviewed by the author. These records were reviewed at the two large teaching hospitals of the University of the Witwatersrand, Chris Hani Baragwanath and Johannesburg General Hospital. Statistically significant findings were that older women were more likely to have had an initial midline incision. Incision to delivery times were faster via the midline (4 min) than the Pfannenstiel incision (5.5 min). Total operating times did not differ significantly. The findings do show that repeat midline incisions are faster (1.5 min) to deliver, but do not address the patient’s need for a cosmetically pleasing wound scar.Item Comparison of a private midwife obstetric unit and a private consultant obstetric unit(2008-09-18T09:27:32Z) Seedat, Bibi AyeshaBackground: The role of Midwife Obstetric Units (MOUs) as lead caregivers for low risk pregnancies has been a topic of much debate in recent years. It has been suggested that MOUs are more cost effective, and have a less interventionist approach to low risk pregnancies, when compared to Consultant Obstetric Units (COUs). Objectives: The primary objective of this study was to compare intrapartum delivery procedures, methods of delivery, and maternal and neonatal wellbeing for low risk pregnancies between a MOU and a COU. The second objective was to investigate the predictors of key outcomes such as caesarean sections and perineal tears. The research was carried out at a private obstetric unit in Gauteng from January 2005-June 2006. Materials and Methods: The study design was a retrospective cohort study, by means of a record review of routinely collected data. 808 subjects (212 COU and 596 MOU patients) satisfied the criteria for a low risk pregnancy during the defined period and were included in the analysis. Results: Overall the MOU had fewer interventions than the COU, but had very similar maternal and neonatal outcomes. MOU patients were less likely to have an epidural than COU patients (p<0.001), and more likely to utilise a bath for pain relief (p<0.001). The MOU was also less likely to induce a patient than the COU (p=0.002). Primiparous patients accounted for more than 95% of the caesarean section (C/S) rate (p<0.001), with the COU performing 2.2 times more C/S on primiparous patients than the MOU. Vaginal birth in the MOU was 2.6 times more likely to be an underwater birth (UWB) than the COU (p<0.001). Positive predictors for C/S were COU care, primiparous status and induction of labour. UWB was a positive predictor for grade 1 and 2 perineal tears. There were no maternal or neonatal deaths, in either unit, during the study period. There were no significant differences between the MOU and COU for maternal morbidity indicators (tears, postpartum haemorrhage, and retained placenta) or neonatal morbidity indicators (Apgar < 7 at 5 minutes and neonatal ICU admission). Conclusion: The MOU had fewer intrapartum interventions (epidurals and induction of labour) and lower C/S rates than the COU for low risk pregnancies, yet maternal and neonatal outcomes were similar. This study suggests that the MOU can function just as effectively as the COU for low risk pregnancies. Therefore the establishment of more MOUs would have immense resource implications for both the public and private health sectors in South Africa.