Browsing by Author "Van der Merwe, J. L."

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    Patient profile of a tertiary obstetric-cardiac clinic
    (South African Heart Association, 2014) Van der Merwe, J. L.; Hall, D. R.; Herbst, P.; Doubell, A.
    Background: Cardiac disease is the most important medical cause of maternal mortality in South Africa. Management of women with cardiac disease in pregnancy is highly specialised and they should ideally be evaluated early in pregnancy and in a multidisciplinary fashion with the aim of formulating a perinatal management plan. In order to facilitate the efficient management of these patients in the context of a large tertiary hospital in South Africa a combined obstetric-cardiac (O-C) clinic was established at Tygerberg Academic Hospital (TBH) in 2010. Objective: The purpose of this review is to describe the patient profile of an obstetric-cardiac clinic in South Africa, specifically the TBH O-C clinic and to share the lessons learnt from establishing this clinic. Methods: Retrospective review performed at TBH, a referral centre in the Western Cape Province of South Africa. All women evaluated and/or managed at the Obstetric-Cardiac clinic between 10 August 2010 and 4 December 2012 were included. Results: There were 231 women, rheumatic heart disease (n=79; 34.2%) was the predominant cardiac disease followed by congenital heart disease (n=78; 33.8%), medical conditions (n=38; 16.4%) and previous peripartum cardiomyopathy (n=9; 3.9%). Eighty-two women (35.5%) were perceived to be extremely high risk and their entire pregnancies were managed in the Obstetric-Cardiac clinic. The most common RHD lesion was mitral regurgitation (34.2%) and mixed mitral valve disease (24.1%). The most frequent CHD was ventricular septal defects (n=27; 35%). Conclusions: The cardiac disease profile of patients seen at this obstetric-cardiac clinic in a South African tertiary hospital reflects a transition from the disease profile of a typical developing country (high burden of rheumatic heart disease) to the disease profile seen in a more developed country (high burden of congenital heart disease). This could indicate improved quality of socio-economic development and the health care system. The increasing complexity of cardiac pathology that has to be dealt with in pregnant patients presenting to a tertiary hospital requires close collaboration between the obstetrician, cardiologist, cardiac surgeon and anesthetist caring for these patients. A dedicated obstetric-cardiac clinic is a good model to utilise in a tertiary hospital when aiming to optimise the care of patients with cardiac disease in pregnancy.
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    Weight-related quality of life in obese, pregnant women in South Africa
    (Taylor & Francis, 2017-09-11) Tisane, Matshidiso Agnes; Hall, David R.; Van der Merwe, J. L.
    Objective: The global obesity pandemic includes pregnant women. Obesity may negatively impact quality of life (QOL). A validated, obesity-specific, QOL assessment tool was used to assess the impact of obesity on five specific domains. Methods: A prospective cohort study was performed at Tygerberg Academic Hospital in South Africa. Morbid obesity was defined as a body mass index (BMI) of 40–49.9 kg/m2 and super-obesity as BMI > 50 kg/m2, using the first recorded weight during the pregnancy. Pregnant women with a BMI ≥ 40 were approached in the high-risk antenatal clinic where written informed consent was taken before recruitment. Using the QOL tool they answered statements about their current experiences. Results: A total of 66 morbidly obese and 46 super-obese women were enrolled across an age range of 18–45 years. Physical function and self-esteem were the domains with the lowest QOL scores. When comparing morbid with super obesity, all scores were significantly lower in the latter group except for the domains of self-esteem and sexual life. Conclusion: Morbid and super-obesity occur across the full spectrum of the adult reproductive period. Physical function and self-esteem are most affected while QOL is linked to the degree of obesity.