Guidelines on Obstetrics, Gynaecology, and Pregnancy Care Updates
The provided content highlights recent changes in obstetrics and gynaecology guidelines, focusing on termination of pregnancy, antenatal supplements, anaemia in pregnancy, and urinary tract infections. Updates include improved access to safe termination of pregnancy, recommendations for supplements to prevent complications, and revised treatment approaches for anaemia and urinary tract infections during pregnancy.
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Chapter 6: Obstetrics & gynaecology NATIONAL DEPARTMENT OF HEALTH AFFORDABLE MEDICINES ESSENTIAL MEDICINES PROGRAMME PRIMARY HEALTHCARE GUIDELINES 2018 1
EVIDENCE Please access the National Essential Medicines List Committee (NEMLC) report for detailed evidence (including rationale, references and costings) informing decision-making on medicine addition, amendments and deletions: http://www.health.gov.za/index.php/standard-treatment-guidelines-and- essential-medicines-list/category/285-phc DISCLAIMER This slide set is an implementation tool and should be used alongside the most recently published STG available on the EML Clinical Guide Application. This information does not supersede or replace the STG itself. 2
Termination of pregnancy (TOP) DESCRIPTION Termination of pregnancy for pregnancies where gestation 12 weeks and 0 days, on request. CHANGES Section on management of TOP for gestation 12 weeks (and 0 days) for accredited sites, ADDED. Medical TOP limited to those < 9 weeks as ultrasound in primary care not mandatory. REASON To improve access to safe TOPs at primary level of care. 3
Antenatal supplements DESCRIPTION Supplements before and during pregnancy and lactation can help to prevent, or lessen the effect of, a number of conditions or complications associated with pregnancy like anaemia and pre- eclampsia in mothers and neural tube defects in the developing fetus. CHANGES new section Prevention of neural tube defects - Folic acid, oral, 5 mg daily, ADDED Prevention of anaemia Iron (Ferrous sulphate or ferrous fumarate), AMENDED Prevention of pre-eclampsia Calcium, elemental, 1 g daily (given as calcium carbonate, oral 12 hourly, AMENDED REASON Clarify use of folate supplementation. Previously given to prevent megaloblastic anaemia. Encourage pre- conception use of supplements. - - 4
Anaemia in pregnancy DESCRIPTION Anaemia in pregnancy is a haemoglobin (Hb) < 11 g/dL. CHANGES Folic acid, oral, for prevention of megaloblastic anaemia, DELETED (folic acid added as routine supplement see section 6.4.1: Antenatal supplements) Dosing of ferrous, oral, AMENDED from 8 hourly to 12 hourly REASON Fortification of foods to supply >400mcg/day folate means that additional folate to prevent anaemia not needed. 5
Urinary tract infection in pregnancy DESCRIPTION Cystitis: infection of lower urinary tract infection: lower abdominal pain, frequency of micturition and/or dysuria Pyelonephritis: infection of upper urinary tract infection, temperature 38 C, renal angle tenderness, vomiting, tachypnoea, tachycardia, hypotension, confusion CHANGES New section Cystitis: nitrofurantoin, oral, 100 mg 6 hourly for 7 days, ADDED Pyelonephritis: pre-referral dose of ceftriaxone, IV, 1 g as a single dose, ADDED REASON Common conditions presenting in pregnancy Need for clarification of safe antibiotic choice in pregnancy, addressing the penicillin allergy 6
Puerperal sepsis DESCRIPTION Infection that develops within six weeks of delivery. Presents with temperature 38 C ( 2 days), offensive vaginal discharge (lochia) and/or abdominal pain within the first 10 days postpartum. CHANGES New section Pre-referral dose of ceftriaxone, IV, 1 g as a single dose, ADDED REASON To increase awareness and pre-referral treatment of a common, potentially life- threatening condition 7
Prevention of vertical transmission of hepatitis B DESCRIPTION Babies born to mothers with acute hepatitis B infection at the time of delivery or to mothers who are HBsAg-positive or HBeAg-positive ADDITIONS Infants should receive: Hepatitis B immunoglobulin, IM Hepatitis B vaccine, IM Both should be given within 12 hours of delivery REASON Alignment with Paediatric (2017) and Adult Hospital (2015) STGs and EML 8
HIV In pregnancy DESCRIPTION HIV- infected pregnant mother - prophylaxis against cryptococcal meningitis. REASON Restricted to 2nd trimester onwards due to safety concerns. Women CrAg+ in1st trimester are referred for management. CHANGES Fluconazole for CrAg+ patients AMENDED: restricted to 2nd trimester onwards 9
Maternal mental health DESCRIPTION This includes antenatal and postnatal depression, as well as postpartum psychosis. REASON To increase recognition and improve management of these conditions as there is potential for significant negative impact on the mother s ability to carry the pregnancy to term and to care for her baby. CHANGES New sections added with descriptions, general and referral criteria measures 10
