Browsing by Author "Osman, Ayesha"

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    A review of antenatally-diagnosed congenital heart disease in a Western Cape tertiary facility: outcomes and diagnostic discrepancy
    (2025) Smith, Damian; Zuhlke, Liesl; Osman, Ayesha; Aldersley, Thomas
    Objective: To describe the cases of fetal congenital heart disease (CHD), the diagnostic discrepancy (DD) between pre- and postnatal echocardiography (echo) and their outcomes in a state tertiary facility in the Western Cape. Study design: A retrospective descriptive study was conducted on 106 cases of structural CHD diagnosed at the Groote Schuur Hospital (GSH) Maternal Fetal Medicine Unit (MFMU) between January 2018 and December 2019. Primary measurements included maternal obstetric data, fetal diagnosis, extracardiac and genetic abnormalities, pregnancy outcome, postnatal Echo results, intervention and outcomes (catheterisation, surgery). Results: At first presentation to the MFMU, median maternal age was 32 years (Interquartile range (IQR: 26 – 38 years), with a median gestation of 21 completed weeks (IQR: 19 – 25 weeks) and a mean BMI of 28.1 (± 6.8). Amniocentesis was performed in 43/106 cases (40.6%), with a positive genetic abnormality in 23/43(53.5%), highest in the IUFD group (75.0%). Of the cases diagnosed, 21/106 were terminated (n=19.6%), intrauterine fetal death (IUFD) occurred in 21/106 cases (n=19.6%) with 62 live births (n=58.5%). In 2/106 cases there was no record of delivery (n=1.9%). DD rate was 16/47 (n=34.0%). Atrioventricular septal defect was both the commonest prenatal CHD diagnosis and most associated with DD. Conclusions: The DD rate of AVSD seen in the study carries important management implications both during pregnancy and in the immediate post-natal period, highlighting the critical importance of accurate fetal diagnosis. Increasing prenatal screening capacity, regular audit, and prenatal collaboration with paediatric cardiology may improve diagnostic accuracy.
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    Antenatal AVSD diagnosis at Groote Schuur Hospital A retrospective cohort study
    (2019) Annor, Charlene Adjoa Adobea; Stewart, Chantal; Osman, Ayesha
    The antenatal diagnosis of a fetal atrioventricular septal defect (AVSD) impacts the prognosis of an unborn child, and may have psychosocial and financial implications for mothers receiving this diagnosis. Outcomes relevant to our local population may be used to improve counselling for parents receiving this diagnosis. During a literature review, there was a lack of existing published data on antenatal AVSD outcomes from the developing world. To ascertain the outcomes of antenatal AVSD diagnosis in fetal, neonatal and infant life, we performed a retrospective study of all AVSD's diagnosed at a tertiary referral hospital in Cape Town (Groote Schuur Hospital) between 1 January 2010 and 31 December 2016. We examined ultrasound records and case folders from the antenatal, neonatal and infancy periods, up to a year of life or demise. The resultant cohort had a total of 55 cases. We found that fetal outcomes in Cape Town, South Africa are similar to those in developed countries. Pregnancies were terminated in just over a third of cases and similarly, the over-all survival to one year of life excluding termination of pregnancy was 29,73%. The bulk of these fetuses demised in the antenatal period, and the rate of demise positively correlated with the presence of associated organ abnormalities and aneuploidies. In those born alive, the correlation between an antenatal AVSD diagnosis and the same diagnosis during postnatal echocardiography was 59,09%, with the remaining 40,91% having other complex cardiac abnormalities diagnosed. Corrective cardiac surgery in the neonatal period or infancy occurred in 46,15% of those born alive, with good outcomes. This study shows similarity between survival of fetuses diagnosed with antenatal AVSD in the developing and developed world. It will be instrumental in appropriately counselling South African parents who receive the diagnosis. In order to assess if prenatal AVSD diagnosis improves neonatal and infant outcomes, a further study comparing this group to the outcomes of infants with postnatally diagnosed AVSD is necessary. More research is needed in an African context regarding the outcomes of babies diagnosed with antenatal anomalies.
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    Cohort Profile: The Western Cape Pregnancy Exposure Registry (WCPER)
    (2022-06) Kalk, Emma; Heekes, Alexa; Slogrove, Amy; Phelanyane, Florence; Davies, Mary-Ann; Myer, Landon; Euvrard, Jonathan; Kroon, Max; Petro, Greg; Fieggen, Karen; Stewart, Chantal; Rhoda, Natasha; Gebhardt, Stefan; Osman, Ayesha; Anderson, Kim; Boulle, Andrew; Mehta, Ushma
    Purpose: The 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. Participants: Established 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 date: Approximately 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 plans: This represents significant infrastructure, able to address clinical and epidemiological concerns in a low/middle-income setting.
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    Exploring the role of clinical educators written feedback in demystifying clinical reasoning skills within the clinical evaluation examination in Physiotherapy: Perspectives from disciplinary expects and novices
    (2024) Osman, Ayesha; Bangeni, Abongwe
    An Academic literacies (AL) approach to teaching emphasises the need to make disciplinary literacy practices explicit to disciplinary novices who are in the process of entering a discourse community. Clinical reasoning (CR) skills, i.e., the valued practices and ways of being and doing involved in clinical practice, are conveyed to Physiotherapy students in contexts such as clinical supervision. However, the way in which this happens within the key setting of a clinical examination has not been given enough empirical attention. The numerous studies in the field of Physiotherapy clinical evaluation are mostly quantitative and tend to focus on the reliability of assessment tools. Few investigate the role of written feedback in making the values of the disciplines explicit, or how this feedback is received by third year students who are new to clinical practice. This dissertation aims to explore the extent to which the clinical evaluation examination of third year Physiotherapy students at the University of Cape Town serves as a site for the explicit conveying of CR skills. It does this by exploring the role of written feedback provided by disciplinary experts, namely, clinical educators (CEs) to disciplinary novices and explores the extent to which the literacy event of the clinical evaluation provides space for making these explicit to students who are being assessed. The study addresses this question from three interlinked perspectives: firstly, through a Critical Discourse Analysis (CDA) of CEs' feedback in the evaluation rubric that is used to examine students' clinical performance. This is followed by a thematic analysis of interviews with the CEs to gain insight into the disciplinary values and practices on which they draw when assessing and providing feedback to students. The student perspective is assessed through questionnaires where they are required to reflect on their experience of receiving feedback and being socialised into CR for the purpose of becoming competent physiotherapists. The findings highlight the challenges students face when navigating and decoding written feedback as novices to clinical practice. Upon analysis of students' and CEs' perceptions, there is alignment in their understanding of the purpose of the written feedback. The strong themes of ‘knowing the basics' and ‘the importance of communication' emerged from the CE interviews, which is also mirrored in the student reflections. However, students expressed the need for more detailed feedback, as well as positive feedback to strengthen and support good performance. The findings yielded by the CDA of the feedback foregrounds CEs' practice of questioning, which is used as an educational strategy within clinical education, with the intention of developing students' CR skills. The CDA revealed that this practice extends to the CEs' written feedback as well, where the practice of questioning which shapes one literacy event, namely clinical supervision, is transposed onto another, i.e., the clinical examination, as part of providing written feedback. The data from the student questionnaires reflect how the vocabulary/language used within this questioning presents challenges for an effective engagement with the feedback. This study argues that students' challenge with navigating and decoding CEs' written feedback serves to reinforce the expert / novice divide, highlighting the powerful position from which the CEs respond. It is envisaged that the findings can assist CEs in enhancing their feedback practices through greater consciousness of students' access to the discourse. It may also be used to conscientize students about the thinking behind CEs' ways of providing feedback to improve their performance in clinical practice.
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    The perinatal and obstetric outcomes of triplet conceptions at Groote Schuur Hospital in the five-year period: 1 January 2012 to 31 December 2016
    (2022) Turner, Jane; Stewart, Chantel; Osman, Ayesha
    Background: Triplet pregnancy rates have increased over the past few decades due to the advancing maternal age at conception and assisted reproductive technology. It is well known that the risk to both the mother and fetus are greater in multiple pregnancy when compared to singleton pregnancy. Groote Schuur Hospital (GSH), as a tertiary hospital, is the main referral unit for patients with high risk pregnancies in the Metro West region of the Western Cape and provides care to women with triplet pregnancies. There are no studies in South Africa reviewing the outcomes of triplet pregnancies; this study provided the opportunity to do so. Objectives: The outcomes of all triplet pregnancies at GSH were reviewed from 1 January 2012 to 31 December 2016. The primary objective of the study was to review the fetal and neonatal outcomes of triplet pregnancies at GSH. Fetal complications included the prevalence of fetal abnormalities, miscarriage, twin to twin transfusion syndrome, intrauterine growth restriction and discordant growth, stillbirths, preterm delivery, premature rupture of membranes and low birth weight. Neonatal complications included respiratory distress syndrome or hyaline membrane disease, intraventricular haemorrhage and necrotising enterocolitis. The secondary objective was to review maternal complications and outcomes, including anaemia, hyperemesis gravidarum, hypertensive disorders, gestational diabetes, preterm labour, antepartum and postpartum haemorrhage and operative complications. The demographic information, mode of conception and mode of delivery were also included.