Browsing by Subject "PIH"

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    A clinical audit on the quality of care and the outcome of patients with pregnancy induced hypertension within a primary-secondary care pathway: the Wesfleur-New Somerset Hospital Axis, Cape Town, South Africa.
    (2020) Sobamowo, Theophilus Oluwadayo; Ras, Tasleem; Ugoagwu Abiola Abimbola
    Background: Pregnancy Induced Hypertension (PIH) and its complications contribute to a significant burden of disease both in developed and developing countries of the world. Unfortunately, PIH has no cure, the delivery of the baby and the placenta is required. Early detection of pregnancy induced hypertension and close monitoring remains the key to achieving a favourable outcome. This study aimed to determine the quality of care given to women diagnosed with Pregnancy Induced Hypertension (PIH) within a care pathway spanning peri-urban primary and urban secondary level facilities. Methods: This was a retrospective clinical audit of medical records of patients diagnosed with PIH. It was conducted in the Wesfleur -New Somerset Hospital drainage area, using a locally validated data extraction tool, based on the South African Maternal Care Guidelines. The data were analyzed using descriptive methods to report on the frequencies and proportions of the variables, and analyzed to report on statistical significance of correlations. Results: The prevalence rate of pregnancy induced hypertension in this study was 12%. The overall pregnancy induced hypertension complication prevalence in the study for mothers was 7.7%, and that of babies was 30.7%. Facilities generally performed well according to the audit indicators detailing structures and processes that should be followed, as outlined by the standard guidelines used. Two process indicators were correlated with adverse outcomes: 66.1% of patients were appropriately referred, resulting in statistically better foetal outcomes (p = 0.059); and those who booked early in the pregnancy had less PIH-induced complications than those who booked late (p = 0.012) Conclusion: This study followed a standardized audit methodology and found that the quality of care in this peri-urban area is of a good standard and identified areas for quality improvement and further enquiry to ensure continual improvement in maternal and fetal outcomes.
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    Quality of care and outcome of patients with pregnancy-induced hypertension: a retrospective observational study before and during the COVID-19 pandemic along the Wesfleur-New Somerset Hospital Axis, Cape Town, South Africa
    (2026) Fakir, Abdul Waaghied; Ras, Tasleem
    Background: The COVID-19 pandemic disrupted global healthcare systems and may have affected care for non-COVID conditions like pregnancy-induced hypertension (PIH), which is a leading cause of maternal and perinatal deaths. This study aimed to evaluate the quality of care and outcomes for PIH patients along a single district-level referral pathway in Cape Town, South Africa, during the pandemic. Methods: A retrospective clinical study of clinical records was conducted on all 57 PIH cases identified over six months (January to June 2021) at Wesfleur and New Somerset Hospitals. We assessed the quality of care using the Donabedian framework, which includes structure, process, and outcomes. Analysis focused on demographics, adherence to clinical protocols, and maternal and foetal outcomes. We then compared these against pre-pandemic benchmarks. Statistical analyses included descriptive statistics, chi-square tests, and exploratory multivariate logistic regression. Results: The prevalence of PIH was 9.7%. Process indicators showed resilient care, with 100% adherence to clinical monitoring and referral protocols. This was a substantive improvement from the 66.1% compliance before the pandemic. Maternal complication rates were low, with eclampsia and HELLP syndrome both at 1.75%. However, rates of foetal distress were high at 23.0%, and preterm delivery was at 16.0%. Within the constraints of the sample size, multivariate analysis suggested un-booked status was a strong, independent predictor of maternal complications (aOR=4.3, p=0.010), while late antenatal booking predicted foetal distress (OR=2.9, p=0.022). The cohort showed high rates of modifiable risk factors, including smoking at 38.5% and obesity at 42.0%. Conclusion: This facility-level audit indicates that, within this specific pathway, adherence to essential PIH management protocols leads to low maternal complication rates. However, the consistently high adverse perinatal outcomes, related to late antenatal care seeking, highlight a significant gap in early intervention. These findings emphasise the need for early antenatal booking and strengthening community-oriented interventions to overcome patient-related barriers to care during public health emergencies.