Pregnancy outcomes, complications and experiences in Obstetrics and Gynaecology registrars

Tew, Catherine Louise
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Background: Registrar training is a stressful time associated with long working hours and strenuous physical activity that may impact pregnancy outcomes. There are few international and no South African studies which investigate the impact of registrar training on an obstetrician’s own pregnancy. Objectives: The primary objective was to evaluate pregnancy outcomes and complications in women who fell pregnant during their Obstetrics and Gynaecology (OBGYN) registrar time in South Africa. The secondary objective was to compare these findings to those experienced by psychiatry registrars and by the female partners of male OBGYN and psychiatry registrars who had fallen pregnant during registrar time, in order to determine the risk for adverse pregnancy outcomes in OBGYN registrars. The experiences of pregnant OBGYN registrars in a South African setting were described. Methods: A retrospective, nationwide, case-control study was conducted. OBGYN (n=34) and psychiatry (n=26) registrars, specializing within the past 11 years, and partners of male obstetrics and psychiatry registrars (n=19) completed an anonymous, online questionnaire. Psychiatry registrars, and partners of male registrars formed two separate control groups. Questionnaire data included demographics, pregnancy-specific questions and work-condition related questions. The data was managed using REDcap and analyzed retrospectively. Results: A total of 1984 questionnaires were distributed over a period of three months; seventy-nine respondents met the inclusion criteria and completed the survey. A positive pregnancy outcome was recorded for 86.4% of obstetricians, 96.7% of psychiatrists and 77.8% of partners. With regards to pregnancy complications, 48% of obstetricians and 50% of psychiatrists compared to 37% of partners reported at least one pregnancy complication (P=0.436). Working more than 17 hours in theatre (RR 1.95 CI 1.04 –3.84) or more than 81 hours per week (RR 2.12 CI 1.20 –3.84) were significantly associated with an increased relative risk of a complicated pregnancy in OBGYN registrars. OBGYN registrars had more night calls and hours of standing, less hours of sleep per call and greater exposure to hazardous substances compared to psychiatry registrars (p<0.01). Most OBGYN registrars identified long hours and night calls as the predominant causes of stress in pregnancy. Conclusion: These results suggest that both OBGYN and psychiatry registrars working in South African hospitals have a high proportion of pregnancy complications. They are subjected to adverse and stressful conditions such as long working hours, night calls and occupational hazards. Policies need to be put in place to address these working conditions for pregnant obstetricians during registrar training in South Africa
A research report submitted to the University of the Witwatersrand, Health Sciences Faculty, as part of the degree of Masters of Medicine in Obstetrics and Gynaecology 2021