Faculty of Health Sciences
School of Medicine
Department of Obstetrics and Gynaecology
Selected Highlights from Research Findings
Appropriate care of the ill parturient (pregnant woman)
MIHCSR has also been conducting audits into severe acute maternal morbidity and mortality since 1997. This allows for monitoring the impact of changes in protocols over time. The introduction of strict protocols based on the findings of the original audits has led to the overall reduction in maternal deaths in the Tshwane Area. The audits found that the major problems in maternal care are pathological causes of death (AIDS, hypertension complications, postpartum haemorrhage, pregnancy related sepsis) and health system causes (lack of coverage, lack of transport, not following standard protocols, not monitoring patients effectively). As a result of the findings, MIHCSR has developed various programmes to address these problems including: How to implement new clinical progammes successfully (Kangaroo Mother Care) and How to improve the quality of care in current practice - Basic antenatal care programme. The aim of these programmes is to manage obstetric emergencies. The latter is being developed in conjunction with the National Department of Health, The South African Society of Obstetricians and Gynaecologists, The South African College of Obstetricians and Gynaecologists, the Maternal Fetal Society of South Africa, all medical schools of South Africa and the Royal College of Obstetricians in London. The package will consist of modules that can be completed in one hour and be used to train the new interns and provide the materials and training structure for the "fire-drills" suggested by the National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD) in the Saving Mothers report of 2002-2004. This programme, known as Essential Steps in Managing Obstetric Emergencies (ESMOE) will be available for all medical schools and nursing colleges. It will be tested in various sites throughout South Africa. The effect of the programme will be monitored by the MaMMAS severe acute maternal morbidity programme and maternal deaths in South Africa. With these programmes, the Unit hopes to ensure that patients receive adequate basic antenatal care. In the baseline data for two sub-districts per province, the proportion of antenatal cards that scored above 80% (hence adequate antenatal care) was 11%. After the introduction of the programme the proportion rose to 47%, a major improvement. In addition, the Unit has been closely involved in the testing of the Basic Antenatal Care Quality Improvement Package (BANC). This has exposed some weakness in the training of trainers’ methodology and the next step is to develop effective methods for scaling-up interventions like BANC. Integrating BANC into other primary health care packages and further integration into the district health care model will test this. The project on the evaluation of the cardiovascular system using Echocardiography stemmed from this. The aim of this project is to understand the pathophysiology behind the cardiovascular changes in women with severe pre-eclampsia. This arises from the MaMMAS programme where it was found that despite general improvement in outcomes with the new strict protocols, the proportion of women with severe pre-eclampsia and cardiovascular complications had not changed. A better understanding of the pathophysiology might help us develop better management protocols. This is an ongoing project.
Contact person: Prof RC Pattinson.