4. Electronic Theses and Dissertations (ETDs) - Faculties submissions
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Item Maternal deaths due to hypertensive disorders in pregnancy: a four year review in a tertiary hospital(2024) Khan, Z. L.Background Hypertensive disorders of pregnancy (HDP) are leading causes of maternal mortality worldwide. In South Africa (SA) they account for the second most important cause of maternal mortality. Despite its prevalence and devastating consequences, no progress has been made in reducing deaths due to HDP during the last decade. Objectives The aim of this research study is to describe maternal deaths due to complications arising from HDP, in a tertiary hospital, specifically looking at maternal characteristics, management, timing, causes and avoidable factors. Methods This is a retrospective cross-sectional study involving a review of patient records at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) between January 2015 and December 2018. Patient files were retrieved from records, captured onto an Excel Spreadsheet and analysed using basic statistics. Results Patients that died were young, booked early and attended antenatal care. Few patients had risk factors for HDP but aspirin prophylaxis was not given. Antihypertensive treatment as well as Magnesium Sulphate (MgSO4) was often not initiated appropriately. Eclampsia was the most common cause of death and 87% of patients died in the post-partum period. Conclusions Early, quality antenatal care, early detection of disease, referral to the appropriate level of care and adequate treatment as well as timely delivery is necessary to reduce maternal deaths due to HDP. Large scale studies are needed to identify specific quality of care issues at all levels of care in order to implement measures to improve the outcomes.Item A comparison of early onset pre-eclampsia and late onset preeclampsia(2024) Joomratee, J.Background: Early onset pre-eclampsia (EOPE) occurs before 34 weeks while late onset preeclampsia (LOPE) occurs after 34 weeks. The maternal and neonatal outcomes has are different with EOPE having a higher frequency of maternal and neonatal complications. Objectives To compare the clinical presentations, laboratory parameters, maternal and neonatal outcomes in women with EOPE and LOPE. Methods: This was a cross sectional prospective record review. Convenient sampling was performed every fifth day and recruited preeclamptic women that delivered at Chris Hani Baragwanath Academic Hospital (CHBAH) and Rahima Moosa Mother and Child Hospital (RMMCH). Descriptive statistics were employed. Results: There were 104 women of which 64 (61.5%) had EOPE and 40( 38.5%) had LOPE. A higher frequency of Posterior Reversible Encephalopathy Syndrome (P=0.040), blurred vision (P=0.009), headache (P= <0.001) eclampsia (P=0.011) and HELLP syndrome (0.004) was observed in EOPE. The number of still births (P<0.001), neonates with an APGAR of less than 7 at 5 minutes (p=0.001), and neonatal admissions (P= <0.001) were higher in EOPE. There was no difference in the outcome between the HIV positive and negative women Conclusion: With EOPE, end organs appear to be more severely affected than in LOPE. The HIV prevalence between the two groups was comparable