O&G Forum

OBSTETRICS & GYNAECOLOGY FORUM 2021 | ISSUE 2 | 7 O&G Forum 2021; 31: 06 - 09 ORIGINAL RESEARCH referral hospital that also receives patients fromneighbouring provinces, and Hospital 3 is a tertiary hospital which serves an estimated 2.5 million people mostly from informal settlements. e study population consisted of patients on day 2-3 post caesarean delivery. A sample size of 250 patients who underwent caesarean deliveries was required. Convenience sampling was performed to include 250 patients. Proportional sampling was further used to ensure that each hospital was represented adequately in the sample size. Hospital 3 reports performance of the most caesarean section deliveries (5373/ year), compared to Hospital 1 (2661/year) and Hospital 2 (1527/year). us 138 (55.2%) patients from Hospital 3, 71 (28.4%) patients from Hospital 1 and 41 (16.4%) patients from Hospital 2 were recruited, ensuring adequate representation of all three hospitals in the sample. Informed consent is obtained in a dialogue between clinician and patient where the patient is informed about the nature of the operation, its associated risks and bene ts, and alternative treatment modalities. [3] e adequacy of these components was assessed by a structured questionnaire, available in English. e questionnaire was divided into 2 parts, viz. the rst part included patient demographic information and the second part focused on assessing the adequacy of the informed consent process. Patients were able to indicate “yes” or “no” and elaborate if they wished to do so. e rst author conducted all the interviews over the study period. e interviewer was able to converse uently in all major South African languages. Patients under the age of 18 or those with limited mental capacity were excluded from this study. e research protocol was approved by the Health Sciences Research Ethics Committee (Protocol number 557/2018), and the respective hospitals. Informed consent was obtained from patients prior to enrolment in the study. Results During the study period of April-August 2019, 250 participants consented to participate in the study at the three hospitals: 71 (28.4%) patients from Hospital 1, 41 (16.4%) patients from Hospital 2, and 138 (55.2%) patients from Hospital 3. e proportion of participants that had elective and emergency caesarean delivery was 58 (23.2%) and 192 (76.8%) respectively. Indications for the 192 (76.8%) emergency caesarean deliveries are illustrated in Figure 1. e age of participants ranged from 18 to 43 year (median 28 years, Table 1. Comparison of language preferred versus language of consent (n=250) Language (n, %) Patients preference (n, %) Informed consent obtained (n, %) English 2 (0.8%) 163 (65.2%) Afrikaans 5 (2%) 0 Setswana 16 (6.4%) 7 (2.8%) Northern Sotho 66 (26.4%) 34 (13.6%) Southern Sotho 24 (9.6%) 8 (3.2%) isiXhosa 6 (2.4%) 0 isiZulu 37 (14.8%) 32 (12.8%) Tshivenda 11 (4.4%) 3 (1.2%) Tshitsonga 12 (4.8%) 0 Ndebele 15 (6%) 3 (1.2%) siSwati 20 (8%) 0 Shona 19 (7.6%) 0 Other languages 17 (6.8%) 0 Figure 1. Indications for caesarean delivery Figure 2. Patients’ perception of adequacy of information received prior to caesarean delivery IQR 24-33 years). All 250 participants were formally educated with the highest level achieved being primary school for 5 (2.0%) participants, high school without matriculation for 82 (32.8%), 115 (46.0%) having attained matriculation and 48 (19.2%) having obtained a degree/ diploma. Northern Sotho was the predominant home language with 66 (26,4%) and isiZulu coming in second at 37 (14,8%). However, English was the language in which most (n=163, 65.2%) informed consent was obtained, followed by Northern Sotho (n= 66, 26.4%). is may have been a factor accounting for the disparity in the number of patients that reported not being adequately counselled with regards to their caesarean delivery (Table 1). Responses to questions regarding the adequacy of information provided during the counselling for caesarean delivery were recorded as “yes” (adequate counseling) or “no” (inadequate counseling), according to the patient’s memory. A total of 189 participants, 75,6%, reported being told the name of the operation. Information on why the operation was necessary (n=231, 92.4%), the type of anaesthesia they would receive (n=201, 80.4%) and about the possibility of a blood transfusion (n=221, 88.4%) was made available to the large majority of respondents as indicated. Fewer participants reported to have been informed regarding risks of the operation (n=73, 29.2%), bene ts of the operation (n=64, 25.6%) and delivery options for future pregnancies (n=92, 36.8%). Consent was obtained either by the nursing sister who was the registered midwife in the labour ward. (n=1, 0.4%), medical intern (n=2, 0.8%), medical o cer (n=80, 32%) or obstetrics registrars\ (n=167, 66.8%). Figures 2 and 3 illustrate what was reported by the patients as extracted from the questionnaires. Abbreviations: cs: caesarean section ANC: Antenatal clinic