There has been an increase in Caesarean section rates in many developed countries with maternal request frequently being cited as a reason. There are few studies examining African women’s preference ...for mode of delivery. The objectives this study were to determine women’s preference for mode of delivery in a low risk population to describe the major reasons for their preferences.
Women over the age of 18 with a singleton low risk pregnancy were recruited during the third trimester. Two trained interviewers conducted a questionnaire in the women’s preferred language regarding her preference for mode of delivery.
Of the 195 women that participated, 160 (82.1 %) indicated a preference for vaginal delivery, 5 (2.6 %) preferred a Caesarean delivery, and 30 women (15.4 %) were unsure about their preferred mode of delivery.
There was a significant association between delivery preference and age, ethnicity and HIV status.
Level of education, employment, income, relationship status, and parity demonstrated no statistical association.
In addition, 106 (54.4 %) did not believe that women should be given the right to request a Caesarean section.
The majority of women prefer to have a vaginal delivery. In this low risk population, 15.4 % of women were unsure about their preference.
PurposeThe Western Cape Pregnancy Exposure Registry (PER) was established at two public sector healthcare sentinel sites in the Western Cape province, South Africa, to provide ongoing surveillance of ...drug exposures in pregnancy and associations with pregnancy outcomes.ParticipantsEstablished in 2016, all women attending their first antenatal visit at primary care obstetric facilities were enrolled and followed to pregnancy outcome regardless of the site (ie, primary, secondary, tertiary facility). Routine operational obstetric and medical data are digitised from the clinical stationery at the healthcare facilities. Data collection has been integrated into existing services and information platforms and supports routine operations. The PER is situated within the Provincial Health Data Centre, an information exchange that harmonises and consolidates all health-related electronic data in the province. Data are contributed via linkage across a unique identifier. This relationship limits the missing data in the PER, allows validation and avoids misclassification in the population-level data set.Findings to dateApproximately 5000 and 3500 pregnant women enter the data set annually at the urban and rural sites, respectively. As of August 2021, >30 000 pregnancies have been recorded and outcomes have been determined for 93%. Analysis of key obstetric and neonatal health indicators derived from the PER are consistent with the aggregate data in the District Health Information System.Future plansThis represents significant infrastructure, able to address clinical and epidemiological concerns in a low/middle-income setting.
Edward Joseph Stewart (1926 - 2013) was born in 1926 in Swaziland. He travelled to Cape Town for further education, first at Zonnebloem College, then Trafalgar High School. He graduated MB ChB at UCT ...in 1951, the first Swaziland-born medical graduate. After considering community practice in Kenya, he met his wife, Dulcima Maurice, and they settled in Cape Town. He established a private general practice, first in Vasco and then in Elsies River - his home for almost fifty years.
To document the prognosis after conservative management of patients with membrane rupture at gestations less than 28 weeks.
Prospective observational study of 78 women with confirmed membrane rupture ...at less than 28 weeks gestation, managed conservatively. Antibiotics were given from the time of membrane rupture till delivery. Patients were delivered if clinical infection supervened, there was fetal compromise, spontaneous labour ensued or if the pregnancy continued to 34 completed weeks gestation.
The mean gestational age at membrane rupture was 23.3
±
3.17 weeks (16.5–27.8) and the median 24 weeks. Mean latency period was 24.1
±
29.1 days (1.5–154) with a median of 12.5 days. Eight women (10%) delivered between 24 and 48
h, 25 (32%) within 7 days and 55 (70%) within 1 month. Of note is that 23 patients (30%) had latency periods of greater than 1 month. The mean gestational age at delivery was 26.7
±
3.92 weeks. Overall of the 78 women there were 81 fetuses delivered, of which 35 (43%) survived. Survival was related to latency period, birth weight and gestational age at delivery. Sixteen women (20%) developed chorioamnionitis. There was no increase in the incidence of clinical infection with increasing latency period. Compression limb abnormalities occurred in 17% of neonates and lung hypoplasia in 18%.
Conservative management of patients with very preterm prelabour membrane rupture offers a survival rate of at least 40% with no serious complications in a study of 78 women.
This study aimed to explore the decision-making process of patients with pregnancies affected by serious congenital abnormalities.
The study design was an exploratory qualitative study. The sample ...for this study was pregnant individuals who had a prenatal diagnosis of a serious congenital abnormality and were offered termination of pregnancy. Semi-structured face-to-face interviews with closed and open-ended questions, recorded and transcribed verbatim, were used to collect the data; this was then analyzed using a thematic data analysis approach.
Five topics were developed: “Health care services”, “Home”, “Being a mother”, “Finding meaning”, and “The aftermath”. The first four topics describe the decision-making process where the participants filtered through multiple factors to reach their final decision. Although the participants consulted with their families, partners, and community, they made the final decision themselves. The final topics describes activities which were necessary for closure and coping.
This study has provided valuable insight into the decision-making process, which can be used to improve services offered to patients.
Information should be communicated clearly with follow-up appointments to discuss further. Healthcare professional should show empathy and assure the participants that their decision is supported.
•There are limited qualitative data on termination of pregnancy decision-making for serious congenital abnormalities in the African setting.•This paper provides insight into the decision-making process of pregnant individuals from the Western Cape, South Africa.•Decision-making for terminating pregnancy affected by congenital abnormality is multifaceted but with one deciding factor.•Contrary to what is anecdotally expected, in this study the participants made the final decision.•Tragic optimism was necessary for the participants to carry on with their lives.
Objective
Many studies, largely from high‐income countries (HIC), have reported outcomes in babies with trisomy 18 (T18), with a paucity of data from Africa. Knowledge of outcomes is important in ...counselling women prenatally diagnosed with T18. We aimed to review all prenatally diagnosed cases of T18 between January 2006 and December 2021.
Method
Demographic data, diagnosis, gestation and outcome data were obtained from the Astraia® database and patient files.
Results
We included 88 pregnant women of whom 46 terminated their pregnancies (30 beyond 24 weeks' gestation). Three underwent foeticides, one had a caesarean section for maternal obstetric reasons and 26 underwent inductions of labour without foetal monitoring. Four neonates were live born but none lived >8 h. In those who continued their pregnancies, the mean gestation at delivery was 34.8 weeks, 14 (33%) were live births and only 5 survived for >24 h with none surviving to 1 year of life.
Conclusion
In our cohort, infants with T18 had lower live birth rates and shorter survival than in the current literature from HIC. This may be due to the implementation of non‐aggressive intrapartum care and comfort care for the neonates. This has implications for counselling in our setting.
Key points
What's already known about this subject?
Trisomy 18 has a poor prognosis and is often regarded as life‐limiting
Most studies on outcome are from high‐income countries with a paucity of data from Africa
What does the study add?
Significantly lower survival rates for trisomy 18 in low‐middle‐income countries
Induction of labour without foetal monitoring results in a limited life span for babies with T18. This data can be shared in counselling these women to help them in making their choice of further pregnancy management.
Short‐term survival rates are influenced by the extent of intrapartum and neonatal intervention
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