Dr Jarrod Zamparini1,2
1Department of Internal Medicine, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa, 2Obstetric Internal Medicine Unit, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
Biography:
Jarrod Zamparini is an Obstetric Physician in the Department of Internal Medicine at Charlotte Maxeke Johannesburg Academic Hospital where he established an Obstetric Internal Medicine Unit, the first of its type in South Africa. Jarrod is a founding and executive member of the Society of Obstetric Medicine of South Africa.
Abstract:
Background and purpose: Obstetric Medicine is not a recognised subspecialty in South Africa (SA), despite the high burden of medical diseases in pregnancy. In the 2020-22 triennium, medical causes, including non-pregnancy related infections and hypertensive disorders of pregnancy, accounted for 64% of maternal deaths.(1) In SA, HIV disproportionately affects women of childbearing age (prevalence of 22.3% vs 16.3% overall) while 68% are obese and 30.6% hypertensive.(2,3) The Obstetric Internal Medicine Unit (OBIMU) at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) was established in 2022, with an aim to provide specialized care for pregnant women with medical problems.
Methods: We conducted a record review of all consultations to the OBIMU over an 18-month period, analysing discharge summaries for women seen on the consult service. Demographic data, reason for and time to consultation and medical history were collected.
Results: Four-hundred and ninety-three (493) consultations were received during the study period. The median age of women in the cohort was 31 years, 5 months with a median gravidity of 3. Most consultations (n=238, 48%) were received from the Obstetric High Care Unit and the median time to consultation was 1 day. Indications for consultation included management of blood pressure (n=95, 19%), infection (n=72, 15%), cardiac disease (n=56, 11%) and haematological disorders (n=51, 10%). HIV was the most prevalent comorbidity (n=120, 24%) followed by hypertension (n=65, 13%), in keeping with national trends. Eight women (2%) died during their admission, primarily due to sepsis or acute liver failure.
Conclusion: Our review highlights the burden of hypertensive disorders and infectious diseases encountered by the OBIMU in an academic centre in South Africa. The findings emphasize the crucial role of Obstetric Medicine in providing specialized care for high-risk pregnancies and reducing adverse maternal outcomes. Further efforts are warranted to reduce mortalities due to sepsis and liver failure.
Keywords
HIV, Hypertension, Obstetric Medicine, South Africa
References
1. National Committee on the Confidential Enquiries into Maternal Deaths. Saving Mothers 2020-2022: Eighth triennial report on confidential enquiries into maternal deaths in South Africa. Executive Summary. 2024. Available from: https://www.health.gov.za/wp-content/uploads/2023/10/Saving-Mothers-Executive-Summary-2020-2022-1.pdf
2. Human Sciences Research Council (HSRC). THE SIXTH SOUTH AFRICAN NATIONAL HIV PREVALENCE, INCIDENCE, BEHAVIOUR AND COMMUNICATION SURVEY. 2023. Available from: https://sahivsoc.org/Files/SABSSMVI-SUMMARY-SHEET-2023.pdf
3. Statistics South Africa, editors. South Africa Demographic and Health Survey 2016. Key indicators report. Pretoria: Statistics South Africa; 2017.