Faculty of Health Sciences (ETDs)

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    Patients’ experience of postponement of surgery for an elective caesarean delivery
    (2024) Dhulab, Jaimal Ashok
    Background Surgical postponement has been shown to be an indicator of quality of care and management of the operating theatre. In South African government hospitals there are many factors that lead to postponement of surgery such as staff shortages and issues relating to infrastructure. Postponement of surgical procedures results in a misuse of valuable scarce resources. Postponement of surgery may have a significant bearing on the parturient. Patients presenting for elective caesarean delivery are known to be at high risk for developing perinatal anxiety. There is limited research into the experiences of obstetric patients that have been postponed for elective caesarean delivery. Objectives To identify, explore, and relate experiences of patients who have experienced a postponement of surgery for an elective caesarean delivery. Methods A qualitative, exploratory, descriptive and contextual design was followed using phenomenological and observational methods to describe the experience of elective caesarean section delivery patients who were postponed at Rahima Moosa Mother and Child Hospital. Semi-structured, open-ended interviews were undertaken with participants between May 2021 and August 2021. Data saturation was achieved after eight interviews and the data were analysed using inductive thematic analysis. Results A complex interlink of six themes was identified revealing poor communication, which resulted in anger and frustration, as well as fear and anxiety. Patients’ interactions with healthcare workers also brought to light experiences of guilt and disempowerment. Patients indicated that support structures and coping strategies were utilized to maintain a sense of trust and reassurance in the treatment and care that they received. Conclusion Postponement of surgery has detrimental effects on patients presenting for elective caesarean delivery. Early and effective communication may improve patients’ experience of postponement. Inter-professional communication and collaboration among doctors and nurses are key to providing quality patient care.
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    A survey of current practice in anaesthesia for caesarean delivery in a Department of Anaesthesiology
    (2024) Watermeyer, Benjamin David
    South Africa has an increasing caesarean delivery (CD) rate and as such anaesthesia for CD has become a fundamental skill for all levels of anaesthetists. The Essential Steps in the Management of Obstetric Emergencies (ESMOE) guidelines provide a framework for practitioners with specific focus on dosage in neuraxial anaesthesia, perioperative fluids and management of hypotension. Aims The aim of this study was to describe the current practices of anaesthesia for patients requiring CD, including the management practices of common complications, within the University of the Witwatersrand Department of Anaesthesiology. Methods: A prospective, contextual and descriptive study design was followed using an anonymous, self-administered online questionnaire. Descriptive statistics were used to assess adherence to guidelines and comparison made between senior and junior anaesthetist’s practices. Results: Junior anaesthetists performed significantly more CD anaesthetics per month and had more training in ESMOE guidelines compared to senior anaesthetists. Senior anaesthetists were more likely to use a higher dose of bupivacaine. Phenylephrine as a first line anti-hypotensive agent was used by 99.4% of participants. The considered safe minimum platelet count for spinal anaesthesia was 75 x 10^9/l by 61.3% of participants. A significant difference between junior and senior anaesthetists was found where senior anaesthetists were more likely to accept a lower platelet count. A sensory level post administration of spinal anaesthetic was assessed by all participants with 53.1% using an ice brick and 35.0% requesting the surgeon to pinch the patient. Conclusion: In the Witwatersrand Department of Anaesthesiology anaesthetists do follow the ESMOE guidelines of clinical practice for CD. While there are some differences in practice approaches, these were found to be within internationally accepted practice. There would be a benefit of improved awareness of the ESMOE guidelines within the department as well as further training on the different approaches to CD anaesthesia.