Browsing by Author "Horak, Tracey Anne"

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    Adverse perinatal events observed in obese pregnant women in the Metro West Region
    (2014) Gadama , Luis Aaron; Horak, Tracey Anne; Fawcus, Susan R
    Background. Obesity is increasing globally and is defined as a Body Mass Index (BMI) over 30 kgms/m². It’s prevalence in the Metro West Maternity service is unknown. Objective .To assess the prevalence of obesity and determine its association with adverse perinatal and maternal outcomes among pregnant women in the Metro West Region, Cape Town, South Africa Study Design. This was a retrospective observational study that compared perinatal outcomes in women with normal pregnancy BMI to outcomes in women with high pregnancy BMI. Setting. Mitchells Plain and Guguletu Midwife Obstetric Units, Mowbray Maternity Hospital and Groote Schuur Hospital, Metro West Region, Cape Town, South Africa Population. A total of 970 pregnant women divided into BMI groups that had their first antenatal booking visit between January and April 2011. Methods. A list of folder numbers was compiled from the antenatal booking registry at the two MOUs. From the list, maternal folders were then traced through the CLINICOM tracking system, MOU delivery registers, antenatal clinic transfer registers and labour ward transfer registers to find place of delivery or outcome of pregnancy. Maternal and perinatal characteristics were then extracted from the folders into the data collection sheet and data was analysed by STATA. Descriptive statistics included proportions with percentages and median with interquartile ranges. Inferential statistics included Chisquared tests, Fisher Exact tests, Kruskal Wallis test, univariate and multivariable logistic regressions. Main outcome measures. Perinatal outcomes (stillbirth, macrosomia, shoulder dystocia, 5 minute Apgar Score less than 7, congenital abnormalities) observed in obese and morbidly obese compared to normal BMI pregnant women.
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    An analysis of the caesarean section rate at Mowbray Maternity Hospital using Robson's Ten group Classification System by Tracey Anne Horak.
    (2012) Horak, Tracey Anne; Fawcus, Susan R
    Includes synopsis. Includes bibliographical references.
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    Preference for mode of delivery in a low risk population in Cape Town, South Africa
    (2015) Naudé, Nadia; Horak, Tracey Anne; Fawcus, Susan R
    Introduction: Over the past few decades there has been an increase in caesarean section rates that has been well documented in many developed countries. The impact of this cannot be ignored as several studies have shown higher risks of maternal morbidity and mortality with caesarean section as compared to vaginal births. The reasons behind it are complex, with maternal request frequently being cited as a major contributor. A growing body of evidence shows that relatively few women would actually prefer to deliver by caesarean section. Caesarean section on request is not routinely offered in the public health care sector in South Africa, and is therefore unlikely to contribute significantly to the overall caesarean section rate. In the South African context very few studies examining women's preference for mode of delivery exist. Aims and Objectives: The primary aim of our study was to determine women's preference for mode of delivery during the third trimester of pregnancy in a low risk population. The secondary outcome was to describe the major reasons for their preferred mode of delivery. Methodology: We conducted a cross-sectional descriptive study of pregnant women attending antenatal care at two midwife obstetric units (MOUs) in Gugulethu and Mitchell's Plain in the Western Cape. Women were recruited during the third trimester of pregnancy and women over the age of 18, with a singleton low risk pregnancy, planning to deliver at the MOU, were eligible for inclusion. Two trained interviewers conducted an interview-based questionnaire regarding women's preference for mode of delivery. Data on demographic and socio-economic characteristics were also collected. We also described the major reasons behind women's preferred mode of delivery. Results: Of the 195 women that participated in our study, 160 (82.1 %) indicated a preference for vaginal delivery. This compared to only 5 (2.6 %) of the study participants who preferred a caesarean delivery, and 30 women (15.4 %) who were unsure about their preferred mode of delivery. Of the group preferring caesarean section, all five women (100 %) cited 'fear of vaginal birth' as the major reason for preferring a caesarean section. Of the 195 women that participated in our study, 106 (54.4 %) did not believe that women should be given the right to request a caesarean section in the absence of a medical indication, 14 women were unsure (7.2 %) and 75 of them believe that women should have the right to request a caesarean (38.5 %). Conclusion: The need for maternity services that are more women-centred has arisen, with an increasing emphasis on maternal choice and birth satisfaction. Our study contributed to the mounting body of evidence that the majority of women prefer to have a vaginal delivery. In the small group preferring caesarean section, 'fear of vaginal birth' was the major reason behind their preference. There were a considerable number of women in our study population who were unsure about their preference. This indicates a need for improved antenatal education. Knowledge about women's preference and the reasons they regard as important will aid health care providers in counselling patients appropriately regarding the risks and benefits of both delivery methods and thereby enable women to make an informed decision about their preferred mode of delivery.
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    A retrospective review of surgical site infection following caesarean section at Mowbray Maternity Hospital
    (2016) Sonntag, Kim; Horak, Tracey Anne; Fawcus, Susan R
    Introduction: Pregnancy related sepsis is a major cause of maternal mortality and morbidity in South Africa. Caesarean section (CS) is the most important risk factor in the development of puerperal infection, and surgical site infection (SSI) after CS increases maternal morbidity as well as medical costs. Mowbray Maternity Hospital (MMH), is a secondary level, public maternity hospital. The caesarean section rate at MMH has increased considerably over the last fifteen years, and the perception has been that there have been increasing numbers of patients developing SSI post-CS. This study was designed to look more closely at the incidence of SSI and to describe the patients identified with SSI. Methods: This was a retrospective observational study. Cases of severe SSI, as defined by the Centres for Disease Control and Prevention (CDC), following CS at MMH from December 2011 to December 2014 were identified. Following ethical approval, patient records were sourced, data collected and analysed using Stata and Statistica. Results: In the 3-year study period, 14982 CS were performed with 98 patients identified with severe SSI. Folders were retrieved for 96 patients, with 2 patients' folders missing and 29 patients with a missing maternity case record (MCR). The overall incidence of severe SSI was 0.65%, with an incidence of 0.88% in Year 1, 0.90 in Year 2 and 0.70 in Year 3. Of the cases, 79 (80.6%) had been in labour, 16 (16.3%) patients had had prolonged rupture of membranes (PROM) and 32 (32.7%) had prolonged labour, with a median of 5 vaginal examinations. An emergency CS was performed in 90 (91.8%) patients, 7 (7.2%) had an elective CS and 1 (1.0%) patient had this data missing. Deep incisional SSI was diagnosed in 74 (75.5%) patients and 24 (24.5%) patients were identified with organ/space SSI. Intravenous (IV) antibiotics was the main treatment in all 96 cases, with 23 (23.5%) patients requiring a wound debridement, 17 (17.2%) a laparotomy, which proceeded to a hysterectomy in 12 (12.3%) patients. In the majority of cases, no organism was cultured, Whereas multiple organisms were cultured in 16 cases, of which 12 were identified as MRSA, and 18 as Klebsiella pneumoniae. There were no maternal deaths or Intensive Care Unit (ICU) admissions. Discussion and Conclusion: The incidence of severe SSI is in keeping with other institutions, with the lowest incidence being found in Year 3, which may be explained by the change in referral population and/ or the full implementation of the Best Care Always (BCA) bundles of care. Of the 98 patients with severe SSI, 80.6% had been in labour, 32.7% had prolonged labour and 91.8% had an emergency CS performed. These are all factors which are known to increase the likelihood for development of post-CS SSI.
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    Review of Late Preterm birth at Mowbray Maternity Hospital
    (2018) Chambers, Kate Melanie; Horak, Tracey Anne; Fawcus, Susan R; Petro, Gregory
    Introduction: Preterm births are common in all obstetric hospitals and present multiple challenges to both the obstetrician and the paediatrician. Preterm delivery is an important cause of perinatal morbidity and mortality, and places significant psychosocial stress on all involved. Late Preterm Birth (LPTB) is an important topic with many consequences for mother, child and society. It would be of interest to quantify the problem of late preterm birth at Mowbray Maternity Hospital (MMH); quantifying the deliveries into spontaneous versus medically indicated, and to explore the reasons and outcomes for each category. Aims and Objectives: To review the causes, indications for, and outcomes (maternal and neonatal) of all late preterm births delivered at Mowbray Maternity Hospital. Methods: This was a retrospective descriptive study, conducted at Mowbray Maternity Hospital, between January 1 st 2016 and March 31 st 2016. The study population, consisting of 231 patients, includes all deliveries at MMH during the above time period, which fit the inclusion criteria of a gestational age (GA) of between 34⁺⁰ and 36⁺⁶ weeks. All data pertaining to the patient’s previous history, risk factors and current pregnancy were captured and analyzed using Stata. This study was approved by the UCT Ethics Committee (HREC) and institutional approval was obtained from Mowbray Maternity Hospital. All information was treated with confidentially and in accordance with the Helsinki Declaration. Results: During the study period, 1st January 2016 and 31st March 2016, there were a total of 2342 deliveries. Of these deliveries 36 (1.5%) were found to have a GA < 28 weeks (these included those that were categorised as miscarriages); 24 (1%) were between 28 – 31⁺⁶ weeks; 56 (2.4%) were between 32 – 33⁺⁶ weeks and 1833 (78.2%) had a GA above 37 weeks. 162 (6.9%) folders were missing and therefore GA was not calculated, leaving 231 (9.9%) deliveries of late preterm infants. Of the 231 patients included, 64 (27.7%) were noted to have a poor obstetric history, 38 (16.5%) had a history of a previous preterm delivery. Gestational age was calculated by Early Ultrasound Scan (EUS) in 44.2% of cases; Late Ultrasound Scan (LUS) in 36.4 % of cases; Last Normal Menstrual Period (LNMP) in 14.3% of cases and booking palpation in 5.12% of cases. At least one maternal characteristic associated with preterm labour was seen in 131 (56.7%) of the included patients. There were 20 (8.7%) sets of twins. Of the 231 patients, 129 (55.8%) presented in spontaneous labour and 102 were delivered late preterm for medical reasons; this included 70 (30.3% of 231) who had labour induced and 32 (13.9% of 231) who were delivered via caesarean section despite not being in labour for reasons that prevented an Induction of Labour (IOL)/vaginal birth. There were 251 babies delivered in the late preterm category, and of these, 250 (99.6%) were born alive, with 1 Early Neonatal Death (ENND) and 1 macerated stillborn. Of the 251 newborns, 63 (25.1%) were admitted to at least one of the neonatal wards during their hospital stay. Of these, 64.1% spent time in the High Care Unit (HCU), 28.1% spent time in the Neonatal Intensive Care Unit (NICU) and 68.8% spent time in Kangaroo Mother Care (KMC) unit (majority of these newborns had been in either HCU or NICU prior to KMC). Of the 63 neonates admitted to a neonatal ward; there were 37 (36.3%) from the 102 mothers delivered for medical reasons and 26 (20.2%) from the 129 mothers who had presented in spontaneous labour. The overall correlation between gestational age calculated by EUS/LUS/LMNP and Ballard score was calculated as 37%. The average length of stay in the hospital for the newborns, whether admitted or with mom, was 4.96 days. Discussion and Conclusion: Late Preterm Birth accounts for 9.9% of all births and 66.6% of all preterm births at Mowbray Maternity Hospital. This is a substantial proportion of MMH deliveries, putting pressure on already strained resources. This pressure is confounded by the fact that 25.1% of these neonates are admitted to a neonatal ward. 44.2% of these births are medically initiated and this should give cause for thought as to whether our protocols that govern certain medical conditions in pregnancy could possibly be altered to prolong pregnancies and reduce the incidence of Late Preterm Birth.