O&G Forum

OBSTETRICS & GYNAECOLOGY FORUM 2022 | ISSUE 3 | 23 occura er12weeksgestationandassuch,thedenialofTOPservices due to advanced gestational age demonstrates the need for more trained second trimester TOP providers. e Kalafong Women’s Health Clinic (KWHC) provides both medical and surgical TOPs as per WHO guidelines for women with a gestational age of less than 12 weeks. 8 Medical TOP using a combination of mifepristone 200mg per os followed by 800 micrograms of misoprostol 24 to 48 hours later either buccally, sublingually or per vagina is o ered to all women <63 days pregnant. is regimen has been validated by the WHO and has an e cacy of up to 97% particularly in women <63 days pregnant. 7,8 In contrast to surgical TOP which is labour intensive and time-consuming, women undergoing medical TOP can be managed as outpatients provided they meet the correct criteria. According to unit statistics since the introduction of outpatient based medical TOP at KWHC the number of TOPS performed monthly has gone from 40 to 120 on average per month. ere is currently only one other government facility in the Tshwane area, Laudium Clinic which also provides TOP services. Data is lacking on the demographics, barriers to accessing the services and the experiences of the services provided to the population served by the KWHC. Information on this is essential to evaluate the inadequacies in the system and identify area of improvement. e aim of this study was to describe the population making use of the TOP service at KPTH, determine the accessibility to the service and to evaluate their experiences of the services provided at KPTH. Methods e study is a prospective descriptive study conducted at the KPTH Women’s Health Clinic, in Atteridgeville, Pretoria. All healthy pregnant women who attended the KWHC for TOP between February 2020 to April 2020, who were willing and able to provide consent to take part in the study were included. Exclusion criteria included women under the age of 16 years and women unwilling or unable to provide consent to take part in the study. e study was performed over a period of three months from February 2020 to April 2020. During this time 245 patients who attended the KWHC took part in the study. Participants were requested to complete two di erent questionnaires with a combination of closed-ended and open- ended questions. e Initial Questionnaire and the Follow-up Questionnaire were developed with the aim of answering the objectives of the proposed study. Questionnaires were available in both English and Setswana. e self-administered initial questionnaire took approximately 10-15 minutes to complete. e follow up questionnaire was interviewer-administered and was completed at the two-week follow-up date for those who underwent a medical TOP. All data was collected anonymously. Completed questionnaires were placed in sealed envelopes and placed in a closed container, in a locked cupboard situated in the KWHC. All data was captured on a password protected Microso Excel Spreadsheet with access limited to the principal investigator, statistician, and supervisor. Data was analysed using Microso Excel. Ethics approval was obtained from the Human Research Ethics Committee, University of Pretoria; number 630/2019. Results e KWHC reviewed 2406 women for possible termination of pregnancy (TOP) from November 2019 to November 2020, during which time 1205 TOPs were performed. e study was conducted in 2020 a er ethics approval was attained and 245 women voluntarily enrolled and completed the questionnaire. Of the 245 women enrolled, 102 went on to complete the follow up questionnaire. is number was lower as only 44.5% (n=109) of the women were eligible for medical TOP a er assessment at the clinic and others chose not to continue with follow interview. Demographics e majority of the study population were between the ages of 19 to 35 (78.4% (n=193)), and 9.8% (n=24) were between 16 to 18 years old. Results of demographics are depicted in table 1. We had data from 242 women about their highest level of education, of which 35.1% (n=86) have a tertiary level of education, while 61.6% (n=151) have only a secondary or high school level education. Alarmingly, 48.8% (n=119) of participants were unemployed. Table 1: Showing participant demographics by age group AGE GROUP 16 – 18 years of age (n=24) 19-35 years of age (n=193) >35 years of age (n=27) Total n=244 PARITY Nulliparous 21 (8.6%) 59 24.1%) 1 (0.4%) 81 (33.1%) 1 2 (0.8%) 72 (29.4%) 4 (1.6%) 78 (31.8%) 2 1 (0.4%) 41 16.7%) 9 (3.7%) 51 (20.8%) ≥3 0 21 (8.6%) 13 (5.3%) 34 (13.9%) HIV STATUS Positive 0 28 (11.4%) 7 (2.9%) 35 (14.3%) Negative 22 (9.0%) 150 (61.2%) 16 (6.5%) 188 (76.7%) Unknown 3 (1.2%) 14 (5.7%) 4 (1.6%) 21 (8.6%) HIGHEST LEVEL OF EDUCATION Primary 1 (0.4%) 2 (0.8%) 2 (0.8%) 5 (2.0%) Secondary 23 (9.4%) 111 (45.3%) 17 (6.9%) 151 (61.6%) Tertiary 0 79 (32.2%) 7 (2.9%) 86 (35,1%) Unknown 1 (0.4%) 0 1 (0.4%) 2 (0.8%) RELATIONSHIP STATUS Single 23 (9.4%) 131 (53.5%) 17 (6.9%) 171 (69.8%) In a Relationship 1 (0.4%) 58 (23.7%) 10 (4.1%) 69 (28.2%) Unknown 1 (0.4%) 3 (1.2%) 0 4 (1.6%) EMPLOYMENT STATUS Unemployed 7 (2.9%) 99 (40.4%) 13 (5.3%) 119 (48.6%) Study/school 17 (6.9%) 59 (24.1%) 2 (0.8%) 78 (31.8%) Employed 1 (0.4%) 31 (12.7%) 11 (4.5%) 43 (17.6%) Unknown 0 3 (1.2%) 1 (0.4%) 4 (1.6%) O&G Forum 2022; 32: 22-27 ORIGINAL RESEARCH