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The effect of introducing Basic Antenatal Care Plus and Umbiflow on antenatal care and perinatal mortality
Thesis (PhD (Obstetrics and Gynaecology))--University of Pretoria, 2022.
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| Format: | Thesis |
| Language: | English |
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University of Pretoria
2022
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| _version_ | 1867613441678639104 |
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| access_status_str | Open Access |
| author2 | Pattinson, Robert Clive |
| author_browse | Pattinson, Robert Clive |
| author_facet | Pattinson, Robert Clive |
| collection | Thesis |
| dc_rights_str_mv | © 2022 University of Pretoria. All rights reserved. The copyright in this work vests in the University of Pretoria. No part of this work may be reproduced or transmitted in any form or by any means, without the prior written permission of the University of Pretoria. |
| description | Thesis (PhD (Obstetrics and Gynaecology))--University of Pretoria, 2022. |
| format | Thesis |
| id | oai:repository.up.ac.za:2263/85609 |
| institution | University of Pretoria (South Africa) |
| language | English |
| last_indexed | 2026-06-10T12:36:12.012Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UPSpace — University of Pretoria Institutional Repository |
| publishDate | 2022 |
| publishDateRange | 2022 |
| publishDateSort | 2022 |
| publisher | University of Pretoria |
| publisherStr | University of Pretoria |
| record_format | dspace |
| source_str | UPSpace — University of Pretoria Institutional Repository |
| spelling | oai:repository.up.ac.za:2263/85609 The effect of introducing Basic Antenatal Care Plus and Umbiflow on antenatal care and perinatal mortality Pattinson, Robert Clive tsakane.hlongwane@up.ac.za Hlongwane, T.M.A.G. (Tsakane) UCTD Antenatal care Hypertensive disorders of pregnancy Absent end-diastolic flow Fetal growth restriction Doppler ultrasound Stillbirths Thesis (PhD (Obstetrics and Gynaecology))--University of Pretoria, 2022. Objective: Stillbirths are a global challenge, especially in South Africa where we rank 50th of 54 upper middle income-countries in the world and 6th of 7 in Africa. The majority of antenatal stillbirths are categorised as unexplained or secondary to hypertensive disorders of pregnancy (HDP). Strategies to detect HDP are simple, namely measuring the blood pressure, but if not performed at the right time hypertension might not be detected and a stillbirth may result. Unexplained stillbirths are thought to be due to unrecognised placental insufficiency. No effective strategies to detect placental insufficiency are available in low- and middle-income countries. The objective of this thesis is to test strategies which if implemented would reduce these two major categories of stillbirth. The first strategy was to test whether increased antenatal contacts in the third trimester improved detection of HDP. The second strategy was to use an innovative approach viz. continuous wave Doppler ultrasound of the umbilical artery (CWDU-UmA) at a primary care level to detect placental insufficiency. (CWMU-UmA assesses the fetal blood flow to the placenta, and this has been shown to correlate very closely with placental function). Method: There were two major studies, the first examined the effect of implementing the new World Health Organisation (WHO) recommendations which among other things entailed increasing the antenatal contacts in the third trimester. These recommendations were integrated into the national basic antenatal care (BANC) guideline and called BANC Plus. An observational study was performed in four sites throughout South Africa over 15 months. The impact of the implementation had on contacts, measuring the blood pressure and identifying HDP was assessed. The second major study was a cohort analytic study involving nine catchment areas across South Africa. CWDU-UmA was implemented at primary healthcare clinics in these catchment areas and the incidence of abnormal placental blood flow and the effect of detecting this on stillbirths in women classified as having low-risk pregnancies was assessed. The lessons learnt from implementing CWDU-UmA in the various sites were explored. Results: Introduction of the BANC Plus guideline in the study sites significantly increased the antenatal contacts from an average of 4.7 to 5.9 over one year and women with HDP were identified significantly more frequently (12.0% to 19.5%). Screening with CWDU-UmA was performed using the UmbiflowTM device. Screening the low-risk pregnant populations demonstrated a high incidence of abnormal placental blood flow (13.0%) and absent end-diastolic flow (1.2%). The CWDU-UmA information together with an active standard management protocol demonstrated a significant reduction in the stillbirth rate (10.1/1000 vs 17.8/1000, RR 0.57, 95% CI 0.29–0.85) with no increase in the neonatal death rate. Conclusion: The implementation of BANC Plus resulted in an increase in antenatal contacts and detection of HDP. The high prevalence of absent end-diastolic flow and the step-change reduction in stillbirths found in the second study warrants screening of low-risk pregnant women in South Africa. Integrating CWDU-UmA into BANC Plus at the 30 week visit is feasible and should result in a significant reduction in stillbirths. South African Medical Research Council SAMRC Division of Research Capacity Development under SAMRC Institutional Clinician Researcher programme Council for Scientific and Industrial Research South African Medical Association University of Pretoria Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies Unit World Health Organisation, division of RPR Obstetrics and Gynaecology PhD (Obstetrics and Gynaecology) Unrestricted 2022-05-23T07:35:08Z 2022-05-23T07:35:08Z 2022-09 2022 Thesis * S2022 https://repository.up.ac.za/handle/2263/85609 en © 2022 University of Pretoria. All rights reserved. The copyright in this work vests in the University of Pretoria. No part of this work may be reproduced or transmitted in any form or by any means, without the prior written permission of the University of Pretoria. application/pdf University of Pretoria |
| spellingShingle | UCTD Antenatal care Hypertensive disorders of pregnancy Absent end-diastolic flow Fetal growth restriction Doppler ultrasound Stillbirths The effect of introducing Basic Antenatal Care Plus and Umbiflow on antenatal care and perinatal mortality |
| title | The effect of introducing Basic Antenatal Care Plus and Umbiflow on antenatal care and perinatal mortality |
| title_full | The effect of introducing Basic Antenatal Care Plus and Umbiflow on antenatal care and perinatal mortality |
| title_fullStr | The effect of introducing Basic Antenatal Care Plus and Umbiflow on antenatal care and perinatal mortality |
| title_full_unstemmed | The effect of introducing Basic Antenatal Care Plus and Umbiflow on antenatal care and perinatal mortality |
| title_short | The effect of introducing Basic Antenatal Care Plus and Umbiflow on antenatal care and perinatal mortality |
| title_sort | effect of introducing basic antenatal care plus and umbiflow on antenatal care and perinatal mortality |
| topic | UCTD Antenatal care Hypertensive disorders of pregnancy Absent end-diastolic flow Fetal growth restriction Doppler ultrasound Stillbirths |
| url | https://repository.up.ac.za/handle/2263/85609 |