South African midwives’ knowledge of placental triage
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Date
2021-02
Authors
Van Rensburg, Amori
Journal Title
Journal ISSN
Volume Title
Publisher
University of the Free State
Abstract
The placenta is an underexplored and underappreciated organ. Examining the placenta is routine after birth. It is given a glance-over, but never a second thought. Placental histology provides a valuable in-depth investigation into placental pathology. Abnormalities can be identified by a macroscopic examination of the placenta. This investigation can be considered as a triage of the placenta to determine if histological investigation is required. One of the biggest contributors to litigation in obstetrics comprises to children with Cerebral Palsy (CP). Factors contributing to the development of CP can be shown to be present in utero, rather than during labour, by sending the placenta for histology. Litigation costs in South Africa in the field of maternal and child health is increasing exponentially. This increased risk for litigation and the high number of unexplained stillbirths are the drivers behind the value of macroscopic placental examination and histology. This research focussed on answering the research question: What is the existing knowledge of midwives educated in South Africa regarding placental triage? To answer this research question, a quantitative research approach was chosen, and a survey method used. A questionnaire was developed to determine and describe the knowledge of South African midwives. The total number of participants were 157. Of all participants, 64% stated that they always examine placentas. The Department of Health South Africa (DoHSA) require a basic examination of the placenta to always be performed. The regulation relating to the conditions under which registered midwives may carry their profession, R2488, also stipulates that a placenta must be inspected for completeness of the disc and membranes. This finding confirms non-conformity to the guidelines for submission of placentas for histology. The overall median for the questionnaire was 61.9%. The lowest obtained score was 14.3% and the highest score was 81%. This indicated that the participants had 60% knowledge of the macroscopic placental examination. Little literature is available regarding investigated placental examination or knowledge within South Africa. The DoHSA admits to constraints in the education system leading to poor competency and limited clinical exposure. As most participants were employed in the public sector, it was expected that they complied with the procedures described in the in the documentation prescribed by the DoHSA. Yet, through the study findings it became clear that some midwives were not compliant. Only 61% of participants answered that there were placental histology services available in the units they worked in. That left a gap of 40% of institutions that did not have these services available and raises the question of what was being done in these facilities when an abnormal placenta was identified. In conclusion, forty per cent (40%) of participants did not know what the histology report of the placenta could be used for. This proved that more awareness should be shared on this subject and the benefits it provides, for midwives. A staggering 97% of participants stated that the institution they worked at could benefit from further education regarding placentas and placental histology. It is reassuring that 88% stated that they could benefit from advanced training regarding examination of placentas. It is evident that examination of the placenta is paramount in the prevention of litigation cases and for future treatment of the mother and baby.
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Keywords
Dissertation (M.Soc.Sc. (Nursing))--University of the Free State, 2021, Placenta, Pathology, Histology, Macroscopic examination, Midwife, Education, Competence, Knowledge, Practice guidelines