Includes bibliographical references. / In South Africa assisted reproductive techniques (ART) are poorly covered by health insurances or government funding thereby often inflicting out-of-pocket payment (OPP) on patients. This can create treatment barriers or high financial burdens for households, with unknown consequences of the latter. This is the first study from South and sub-saharan Africa which explores the impact of ART-related OPP on households. The study was undertaken at Groote Schuur Hospital, Cape Town, where ART is subsidized but patients have to contribute to the cost of treatment. Eighty six consecutive IVF/ICS/ cycles were prospectively analysed through patient interviews. Data included socio-demographic, economic, and infertility information, emotional and financial stress among participants, as well as coping and financial strategies adopted by households. In keeping with international recommendations, catastrophic expenditure was defined as a direct cost of all ART cycles in the last 12 months equal to or exceeding 40% of the annual non-food households expenditure.

No description available.

Includes abstract. Includes bibliographical references (leaves 56-64).

Includes synopsis. Includes bibliographical references.

STUDY QUESTION: What is the evidence pertaining to availability, effectiveness and safety of assisted reproductive technology (ART) in sub-Saharan Africa? SUMMARY ANSWER: According to overall limited and heterogeneous evidence, availability and utilization of ART are very low, clinical pregnancy rates largely compare to other regions but are accompanied by high multiple pregnancy rates, and in the near absence of data on deliveries and live births the true degree of effectiveness and safety remains to be established. WHAT IS KNOWN ALREADY: In most world regions, availability, utilization and outcomes of ART are monitored and reported by national and regional ART registries. In sub-Saharan Africa there is only one national and no regional registry to date, raising the question what other evidence exists documenting the status of ART in this region. STUDY DESIGN, SIZE, DURATION: A systematic review was conducted searching PUBMED, SCOPUS, AFRICAWIDE, WEB OF SCIENCE and CINAHL databases from January 2000 to June 2017. A total of 29 studies were included in the review. The extracted data were not suitable for meta-analysis. PARTICIPANTS/MATERIALS, SETTING, METHOD: The review was conducted according to PRISMA guidelines. All peer-reviewed manuscripts irrespective of language or study design that presented original data pertaining to availability, effectiveness and safety of ART in sub-Saharan Africa were eligible for inclusion. Selection criteria were specified prior to the search. Two authors independently reviewed studies for possible inclusion and critically appraised selected manuscripts. Data were analyzed descriptively, being unsuitable for statistical analysis. MAIN RESULTS AND THE ROLE OF CHANCE: The search yielded 810 references of which 29 were included based on the predefined selection and eligibility criteria. Extracted data came from 23 single centre observational studies, 2 global ART reports, 2 reviews, 1 national data registry and 1 community-based study. ART services were available in 10 countries and delivered by 80 centres in 6 of these. Data pertaining to number of procedures existed from 3 countries totalling 4619 fresh non-donor aspirations in 2010. The most prominent barrier to access was cost. Clinical pregnancy rates ranged between 21.2% to 43.9% per embryo transfer but information on deliveries and live births were lacking, seriously limiting evaluation of ART effectiveness. When documented, the rate of multiple pregnancy was high with information on outcomes similarly lacking. LIMITATIONS, REASONS FOR CAUTION: The findings in this review are based on limited data from a limited number of countries, and are derived from heterogeneous studies, both in terms of study design and quality, many of which include small sample sizes. Although representing best available evidence, this requires careful interpretation regarding the degree of representativeness of the current status of ART in sub-Saharan Africa. WIDER IMPLICATIONS OF THE FINDINGS: The true extent and outcome of ART in sub-Saharan Africa could not be reliably documented as the relevant information was not available. Current efforts are underway to establish a regional ART data registry in order to report and monitor availability, effectiveness and safety of ART thus contributing to evidence-based practice and possible development strategies. STUDY FUNDING/COMPETING INTEREST(S): No funding was received for this study. The authors had no competing interests. TRIAL REGISTRATION NUMBER: PROSPERO CRD42016032336

Includes abstract. / Includes bibliographical references. / Objective: To compare the analgesic efficacy of ketamine with Fentanyl/Midazolam in women requiring uterine evacuation for incomplete miscarriage as measured by the patients’ perceived pain. Study design: An efficacy trial with a naturally occurring control group who received what is currently standard practice. The study ran over two 4-week periods (25/06/2012 to 19/08/2012). Setting: Groote Schuur Hospital (a tertiary hospital) situated in Cape Town, South Africa. Population: All women between the ages of 18 and 55 years admitted to Groote Schuur Hospital for uterine evacuation following a spontaneous incomplete miscarriage or missed miscarriage that were not excluded by any of the exclusion criteria. Methods: Over a 2 month period (two 4-week periods), all patients meeting the inclusion criteria were allocated to either the control group (month 1) or the study group (month 2). Data was collected from all these evacuations during the study period at Groote Schuur Hospital.

Includes bibliographical references (leaves 36-37). / Care of the critically ill pregnant woman poses exceptional challenges in the intensive care unit and requires the skills of health care providers who have knowledge of the physiological changes of pregnancy as well as specific pregnancy-related disorders in order to achieve optimal management.

BACKGROUND Sacrospinous Fixation is a procedure for mid-compartment apical suspension in pelvic organ prolapse surgery with high success rates. The approach by traditional wide dissection has been well-documented. The literature is lacking however with regard to newer devices on the market that use less extensive dissection to perform this procedure. METHODS A randomised controlled trial was carried out comparing the Boston Scientific's Capio Slim® (control) and Bard's Fixt® (intervention) for bilateral sacrospinous fixation in women with mid-compartment prolapse requiring surgery and who met the study criteria. The primary outcome was time (in seconds) to successful bilateral suspension suture placements. Secondary outcomes examined were used to assess short-term safety and efficacy of the devices at the time of the procedure and at the six week follow-up.

Includes bibliographical references / Background: A near miss occurs when a pregnant woman experiences a severe life threatening complication during pregnancy or up to 42 days after the end of the pregnancy and survives. The near miss rate is defined as the number of near misses per 1000 live births. In 2011, World Health Organization (WHO) produced a useful tool for identifying near misses according to composite criteria which include the occurrence of a severe maternal complication together with organ dysfunction and/or specified critical interventions. The ratio of maternal near miss cases to maternal deaths and the mortality index both reflect the quality of care provided in a maternity service Maternal deaths have been audited in the Metro West maternity service for many years but there has been no routine monitoring or evaluation of maternal near misses. Aim of study: The study aim was to perform a near miss audit in Metro West, specifically (a) measuring the near miss rate, the maternal mortality ratio and the mortality index, (b) performing an in-depth investigation of the associated demographic, clinical and health system factors of the near miss cases, and (c) providing input into the development of an on -going system of auditing near misses cases in Metro West. Methods: A retrospective observational study conducted over 6 months between mid- March 2014 to mid -September 2014. This service includes 9 level one maternity facilities which refer all complicated maternal cases to two secondary hospitals, New Somerset (NSH) and Mowbray Maternity (MMH); or to the tertiary hospital, Groote Schuur Maternity Center (GSH). All cases of near miss managed at the three hospitals were identified weekly by the author with the assistance of onsite health providers. These cases included near misses that occurred at level one facilities and were referred on to one or more of the three hospitals. Strict criteria were used to ascertain a case as a near miss according to the WHO near miss definitions. The folders of all the near misses were reviewed and relevant data entered into a data collection form which was adapted from the WHO near miss data form. In addition, these identified folders were reviewed by two senior obstetric specialists to confirm adherence to the WHO inclusion criteria for near miss classification, and also to determine avoidable factors in the management of the near miss cases. Maternal deaths occurring during the same time period of the Near Miss audit were identified from monthly mortality meetings and the ongoing maternal mortality audit system in Metro West. Results: 112 near miss cases and 13 maternal deaths were identified, giving a total of 125 women with severe maternal outcomes. There were a total of 19,222 live births in Metro West facilities. The Maternal mortality ratio (M MR) was 67.6 per 100,000 live births and the maternal near miss rate was 5.83 per 1000 live births. The maternal near miss to death ratio was 8.6:1 and the mortality index was 10.4% Hypertension, obstetric hemorrhage and pregnancy related sepsis were the major causes of the near miss cases accounting for 50(44.6%), 38(33.9%), and 13 (11.6%) of near misses respectively. These three conditions all had low mortality indices; 1.9%, 1.9% and 0 for hypertension, pregnancy related sepsis and hemorrhage respectively. Less common conditions were, medical /surgical conditions, non-pregnancy related infections and acute collapse, accounting for 7 (6.3%), 2 (1.8%), and 2 (1.8%) of near misses respectively. Although these numbers were small, these three conditions accounted for more maternal deaths with mortality indices of 66.7 %, 33.3% and 33.3% for non- pregnancy related infections, medical /surgical conditions, and acute collapse respectively. There were 25 (22.3%) of the near miss cases who were HIV positive. The majority of near misses 99(88.4%) had antenatal care. Analysis of avoidable factors showed that, the most common problems were lack of antenatal clinic attendance (11.6%) and inter-facility transport problems (6.3%). For health provider related avoidable factors, the highest number of avoidable factors were identified at level 2 (38.2%), followed by level one (25.9%) and level 3 (7.1%). The most common factors were problem recognition, monitoring and substandard care Discussion and Conclusions: The near miss rates and maternal mortality ratio in Metro West were lower than for some other developing countries, but higher than rates in high income countries. The mortality index was low for direct obstetric conditions such as hypertensive disorders, obstetric hemorrhage and pregnancy related sepsis, reflecting good quality of care and referral mechanisms for these conditions. The mortality indices for non-pregnancy related infections, medical/surgical conditions and acute collapse were much higher and, suggest that medical problems may need more focused attention. Ongoing near miss audit would be valuable for Metro West but would require identification and monitoring systems to be institutionalized.

No description available.