Browsing by Author "Patel, Malika"
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- ItemOpen AccessA review of intrauterine device placement during caesarean section at level two facilities in the Metro West, Cape Town(2020) Schutte, Marcelle; Patel, Malika; Petro, GregoryStudy rationale In the Western Cape there are many intrauterine contraceptive devices (IUDs) inserted during caesarean section (C/S). Little is known about the long-term outcomes in the Metro West area. Objective To assess placement of IUDs at C/S and describe follow-up, with a view to compile best practice guidelines for insertion and follow-up in our clinic setting. Method A retrospective descriptive audit of clinical records was performed of all women who received an IUD at C/S between January and June 2018 at Mowbray Maternity Hospital (MMH) and New Somerset Hospital (NSH) in Cape Town. Results There were 2310 and 1376 C/S performed at MMH and NSH respectively. The IUD insertion rate was 17.4% (n=402) at MMH and 14.3% (n=197) at NSH. Almost two third of insertions were performed at the time of emergency caesarean section (59.1%; n=276). The majority of women experienced no immediate complications (84.4%). Only 77 women attended follow-up. The continuation rate at follow-up was 71.6%. The overall expulsion rate in hospital and at follow-up was 3%. Strings were visible in 53.2% of patients. An ultrasound was performed in 67.5 % (52/77) of patients. The IUD removal rate at follow-up was 24.7% (19/77). Discussion The poor follow-up rate is concerning, and measures must be taken to address this. The continuation rate of 71.6% is lower than expected but may have been biased by the low follow-up rate. Continuation rates improved with the experience of inserters which highlights the importance of training and supervision. Conclusion The immediate postpartum period may be the only opportunity to provide long acting reversable contraception to some women. In our study population follow-up rates are poor and therefore conclusions are difficult to accurately gauge. Measures must be taken to improve follow-up.
- ItemOpen AccessClinical outcomes and women's experiences before and after the introduction of mifepristone into second-trimester medical abortion services in South Africa(Public Library of Science, 2016) Constant, Deborah; Harries, Jane; Malaba, Thokozile; Myer, Landon; Patel, Malika; Petro, Gregory; Grossman, DanielObjective To document clinical outcomes and women's experiences following the introduction of mifepristone into South African public sector second-trimester medical abortion services, and compare with historic cohorts receiving misoprostol-only. METHODS: Repeated cross-sectional observational studies documented service delivery and experiences of women undergoing second-trimester medical abortion in public sector hospitals in the Western Cape, South Africa. Women recruited to the study in 2008 (n = 84) and 2010 (n = 58) received misoprostol only. Those recruited in 2014 (n = 208) received mifepristone and misoprostol. Consenting women were interviewed during hospitalization by study fieldworkers with respect to socio-demographic information, reproductive history, and their experiences with the abortion. Clinical details were extracted from medical charts following discharge. Telephone follow-up interviews to record delayed complications were conducted 2-4 weeks after discharge for the 2014 cohort. RESULTS: The 2014 cohort received 200 mg mifepristone, which was self-administered 24-48 hours prior to admission. For all cohorts, following hospital admission, initial misoprostol doses were generally administered vaginally: 800 mcg in the 2014 cohort and 600 mcg in the earlier cohorts. Women received subsequent doses of misoprostol 400 mcg orally every 3-4 hours until fetal expulsion. Thereafter, uterine evacuation of placental tissue was performed as needed. With one exception, all women in all cohorts expelled the fetus. Median time-to-fetal expulsion was reduced to 8.0 hours from 14.5 hours (p<0.001) in the mifepristone compared to the 2010 misoprostol-only cohort (time of fetal expulsion was not recorded in 2008). Uterine evacuation of placental tissue using curettage or vacuum aspiration was more often performed (76% vs. 58%, p<0.001) for those receiving mifepristone; major complication rates were unchanged. Hospitalization duration and extreme pain levels were reduced (p<0.001), but side effects of medication were similar or more common for the mifepristone cohort. Overall satisfaction remained unchanged (95% vs. 91%), while other acceptability measures were higher (p<0.001) for the mifepristone compared to the misoprostol-only cohorts. CONCLUSION: The introduction of a combined mifepristone-misoprostol regimen into public sector second-trimester medical abortion services in South Africa has been successful with shorter time-to-abortion events, less extreme pain and greater acceptability for women. High rates of uterine evacuation for placental tissue need to be addressed.
- ItemOpen Access
- ItemOpen AccessFactors that influence choice of contraception at mid trimester termination of pregnancy at Groote Schuur Hospital vs. New Somerset Hospital, Cape Town(2021) Klassen, Thalia; Patel, Malika; Spence, TreviBackground: Little is known about factors which influence women's attitudes toward and choice of contraception following mid-trimester termination of pregnancy. Contraceptive counselling is part of the work-up and is an essential part of the documentation required by the department of health. Aim: To investigate the motivation behind the contraceptive choice in those women who present for a mid-trimester termination of pregnancy presenting to Groote Schuur Hospital and New Somerset Hospital and to see if there were any differences in the choice of contraception between these two groups of women Methods: We interviewed women accessing mid-trimester TOPs at two state hospitals within the Cape Town West Metropole using a purpose built non-validated, qualitative questionnaire for the purpose of this study. Findings: The injectable was the most used contraceptive method before TOP and LARCS were more utilized after TOP. Duration of action of methods and personal preference were what motivated the choice of contraception for most women in this study with no statistically significant difference between the two groups. Women in this study did not indicate that counselling influenced their choice. However, there was an eight-fold increase in the uptake of LARCS post TOP. Knowledge of its long duration of action was the motivating factor for choosing a LARC and this information would have been imparted during the counselling process. Women who underwent a medical TOP were more likely to choose an injectable contraceptive whereas women who underwent surgical TOPs chose the IUCD. Delay to diagnosing pregnancy and decision to TOP where reasons for TOP being delayed to the mid trimester. Conclusion: Counselling provided at TOP, positively impacted women's contraceptive choices, improving the uptake of highly effective contraceptive methods. Stronger sexual education programmes that teach young women about their menstrual cycles, contraception and how to prevent unintended pregnancies needs to form part of basic education core curriculums as well as primary health care programmes. Negative staff attitudes towards this essential service needs to be addressed.
- ItemOpen AccessValidation of the Utian quality of life scale in peri- and postmenopausal women in the metro west region of Cape Town(2016) Spence,Trevi A O; Patel, Malika; van der Spuy, Zephne Margaret; Steyn, Petrus SBackground: Menopause is a universal event and today most women are reaching the age when menopause occurs. Very little research has been done in South Africa about the perimenopausal period, particularly with regard to quality of life (QoL). The Utian Quality of Life Scale (UQOL) was designed to determine the QoL in peri- and postmenopausal women, and not just to measure their symptoms. The aim of this study was to validate the UQOL in a local urban population in State sector hospitals in Cape Town. Methods: This was a prospective, cross-sectional study. Participants were recruited from the Mature Women's Clinic at Groote Schuur Hospital (GSH), and Gynaecology Out Patient Departments (GOPD) at GSH and New Somerset Hospital (NSH). Four questionnaires were administered- a demographics questionnaire, the UQOL, the WHOQOL-BREF and the Greene Climacteric Scale. Women were contacted telephonically after 3-14 days for retest of the questionnaires to establish reliability. Results: Fifty two participants were initially recruited and 49 were retested. Results showed that the UQOL is a valid instrument with which to measure QoL in our study population. The test-retest reliability was good, with only 2 questions having significantly different answers (p-value < 0.05). Internal consistency (Cronbach's alpha) was >0.7 for the occupational domain of the UQOL only. The health, emotional, and sexual domains had alpha values of 0.673 and 0.691 and 0.634 respectively, which are acceptable. The Cronbach's alpha for the health domain improved to 0.739 when question 8 was removed from the health domain. Construct validity was demonstrated by a statistically significant correlation between the domains of the UQOL and the WHOQOL-BREF. Secondary factor analysis confirmed the domain structure of the UQOL. The scores from the domains seem to indicate that perceived QoL in our study population is not significantly impaired, with the sexual domain showing the most negative impact on QoL. The WHOQOL-BREF demonstrated good internal consistency in our study population. Conclusions: The UQOL is a valid instrument to measure QoL related to the menopause in our patients. No questions were deleted from the original scale. Further research is needed in Afrikaans and Black African languages. The sexual experiences of peri- and post-menopausal women should also be explored. Menopause did not seem to adversely affect QoL in the women who participated in this study. The WHOQOL-BREF is a good tool to measure general QoL in our study population.