Women's accounts of the gestational diabetes experience ­ a South African perspective

Background. Considering the perspectives of African women affected by gestational diabetes mellitus (GDM) may facilitate the development of culturally sensitive interventions to address this public health concern. Objective. To identify the personal experiences, challenges, coping strategies and health decisions made by urban indigenous South African women affected by GDM. Methods. The experiences of urban African women (n=10) previously affected by GDM were documented during focus group discussions. The Diabetes Conversation Map educational instrument was used to facilitate discussions. Sessions were audio-recorded, transcribed and thematically analysed. Results. Participants experienced shock and fear on diagnosis of GDM, but family support and sharing their experiences with their peers provided relief from anxiety. They were aware of the inconsistent implementation of GDM diagnostic procedures at tertiary hospitals and community health clinics, which exacerbated their confusion. Despite their initial difficulty in adjusting to a diet perceived as unpalatable, adopting a healthier lifestyle was considered a positive consequence of a GDM diagnosis. Healthy lifestyle changes were partially retained post partum and were reported to have a positive effect on other family members. The participants had little awareness of their long-term risk of developing diabetes mellitus and the need for regular follow-up screening. Unexpectedly, the majority of participants concurred that being HIV-positive would be less stressful than living with diabetes. Conclusion. Participants viewed being HIV-positive as preferable to having GDM, which may reflect the distress caused by inadequate pretest counselling, inconsistent health information, inconsistent screening practices and suboptimal support from healthcare professionals

Clinical Abdominal Palpation for Predicting Oligohydramnios in Suspected Prolonged Pregnancy

Objective. In view of the scarcity of ultrasound in low-resource settings; to evaluate abdominal palpation for prediction of oligohydramnios in suspected prolonged pregnancy; using the ultrasound-obtained amniotic fluid index (AFI) as a gold standard; taking into account maternal and fetal factors that may affect amniotic fluid volume. Methods. A cross-sectional analytical study at Chris Hani Baragwanath Academic Hospital; Johannesburg; South Africa; on women referred from midwife-run clinics with suspected gestational age ?41 weeks. Eligible women had their AFI measured; then had abdominal palpation by the researcher; who was blinded to exact gestational age and AFI findings. Palpation focused on ballottability of fetal parts; ease of feeling fetal parts; and impression of fetal compaction. Gestational age was then recalculated using information from earlier ultrasound scans and menstrual dates. Univariable and multivariable logistic regression was performed with oligohydramnios (AFI 5 cm) as the dependent variable.Results. Of 100 women; 45 had a recalculated gestational age ?41 weeks. Twenty-three had oligohydramnios. Gestational age was a significant independent predictor for oligohydramnios (odds ratio (OR) 1.78; 95 confidence interval (CI) 1.08 - 2.94). The only component of palpation significantly associated with oligohydramnios; after adjustment for gestational age; was non-ballottability of the presenting part (adjusted OR 4.02; 95 CI 1.05 - 15.4). Non-ballottability had a sensitivity and specificity for oligohydramnios of 87 and 40; respectively; with a negative predictive value of 91.Conclusion. When ultrasound is not available; ballottability of the presenting part may have value for excluding oligohydramnios and assisting clinical decisions in suspected prolonged pregnancy

The Value of Routine Mid-Trimester Ultrasound in Low-Risk Pregnancies at Primary Care Level

This study investigated the effect of routine second-trimester ultrasound scanning on obstetric management and pregnancy outcomes. This was an open cluster; randomised; controlled trial. Clusters of women with low-risk pregnancies presenting in the second trimester were randomised to receive an ultrasound scan followed by usual antenatal care; or to an unscanned control group undergoing conventional antenatal care only. Out of the 962 women randomised; follow-up was successful for 804 (83.6); with 416 allocated to the ultrasound scan group and 388 controls. There were no significant differences between the ultrasound scan group and the control group in terms of prenatal hospitalisa- tion; mode of delivery; miscarriage; perinatal mortality rate and low birthweight rate. Ultrasound dating was associated with a lower rate of induction of labour for post-term pregnancy (1.4vs. 3.6; P=0.049). However; ultrasound scanning in low-risk pregnancies was not associated with improvements in pregnancy outcome