Browsing by Author "Van Der Spuy, Zephne"

Now showing 1 - 2 of 2
  • No Thumbnail Available
    Item
    Open Access
    Pregnancy intendedness in a high-risk obstetric population in a regional hospital
    (2024) Akpakan, Akanimo; Van Der Spuy, Zephne; Kadwa, Khatija; Petro, Greg; Firmin, Carl
    Unintended pregnancies (UIP) are those that are mistimed, unplanned, or unwanted at the time of conception. It is estimated that, worldwide, 40% of pregnancies were unplanned in 2012 and this carries increased risks for both mothers and babies. This study was designed to utilise the London Measure of Unplanned Pregnancy (LMUP) to assess pregnancy intendedness in a high-risk obstetric population of women who were accessing care at a large regional hospital. Methods: This was a cross-sectional descriptive study. Women attending the High-Risk clinics or admitted with medical problems were recruited at George Regional Hospital. Once they consented to the study, the LMUP was administered by a single research team member. The LMUP is a psychometrically validated measure of pregnancy intention for a current or recent pregnancy. Questions enquire about the intention and timing of pregnancy, preconception behaviour, contraception usage, and partner's input and a score is obtained which indicates intendedness. It has been validated in our department in the 3 local languages. Results: A total of 200 women were recruited for the study. No potential participant declined to be interviewed. The mean age was 30.4+/- 6.3 years and the majority of participants were of mixed ancestry (n=135). HIV status was positive for 23 participants and unknown for 29. All participants completed the Perinatal Mental Health Score and 4 required referrals for supportive assistance. The LMUP indicated that 76 women had unintended pregnancies, 58 were ambivalent about their pregnancies and 66 had an intended pregnancy. Pre-pregnancy discussion and preparation were lacking for most of the participants despite pre-existing risk factors. Pregnancy intendedness was affected by several factors. Age (P = 0.02), relationship status (P = 0.001) and financial support (P = 0.005) were associated with intendedness. Employment, parity, language group, educational level, booking gestation, HIV status, and multiple comorbidities did not affect pregnancy intendedness. Other factors that had no influence were Perinatal Mental Health Score, preconceptual counselling/health improvement, and habits. Poor partner communication was common. Women at extremes of reproductive life had more unplanned pregnancies (P = 0.02). i There was good unprompted contraceptive knowledge but poor information about emergency contraception. Conclusion: In this high-risk group of obstetric patients, there was little preconception discussion or preparation and inadequate use of contraception among women who did not plan a pregnancy.
  • No Thumbnail Available
    Item
    Open Access
    Pregnancy Intendedness in a High-Risk Obstetric Population in a Tertiary Hospital.
    (2023) Whistance, Douglas; Van Der Spuy, Zephne
    Study rationale Recent surveys indicate that only about 41% of pregnancies in South Africa are intended. Unintended pregnancies place women and their unborn children at increased risk, especially in settings where there is already high maternal mortality. Objective This study was conducted to assess pregnancy intendedness in an antenatal population of women with perceived high obstetric risk, and to assess contraceptive knowledge and use in this high-risk group of pregnant women. Method This cross-sectional descriptive study assessed pregnancy intendedness in a group of 222 participants, aged 18 years and older, recruited from patients at a tertiary hospital who had one or more past, existing, or new medical or surgical condition that could adversely impact their pregnancy. Participants' medical, surgical, and obstetric history, high risk obstetric factors and gestational age at booking were recorded from their hospital folders. Participants were privately guided through a questionnaire that included questions measuring pregnancy intendedness according to the London Measure of Unplanned Pregnancy (LMUP) and questions about their knowledge, use and access to contraceptive methods. Results The average age of the women was 31.34 years (SD=5.92). LMUP scores indicated that 17.6% of the women had unintended pregnancies, 40.5% were ambivalent while 41.9% of the pregnancies were intended. 40.1% of the women had experienced complications in previous pregnancies with 35.1% of them having a history of miscarriage. A third (33.8%) had two serious health conditions while 16.2% had three or more serious health conditions. Intendedness was found to be significantly linked to relationship status, agreement with a partner to have a baby, and pre-pregnancy health improvements. The respondents had little knowledge of contraceptive methods other than the depot-medroxyprogesterone acetate (DPMA) injectable, the combined oral contraceptive (COC) pill, the sub-dermal implant, and the loop intrauterine device with 76.1%, 26.1%, 13.5% and 4.5% of the women having ever used these respectively. Only 24 women (10.8%) had discussed planning a pregnancy with the doctor/s managing the serious health condition/s for which they had originally been referred to the hospital. Discussion The study findings for intendedness are in line with other data for South Africa and globally, suggesting that intendedness in women at high risk for obstetric complications does not differ from women who are at low risk. Challenges to effective family planning are also well known, with cultural attitudes about fertility, beliefs about contraceptive safety and male partners' lack of support for contraceptive use clearly implicated. Conclusion This study highlights that against the backdrop of these challenges, women who are already medically at risk are placed in situations of even higher risk. There is an urgent need for the reorganization and scale up of family planning services so that they are not isolated from general and specialist practice, are gender-inclusive and become an integral part of the management of chronic disease.