- Title
- A best practice guideline for screening and managing chorioamnionitis
- Creator
- Du Plessis, Allison Herlene
- Subject
- Bacterial diseases
- Date Issued
- 2020
- Date
- 2020
- Type
- Thesis
- Type
- Doctoral
- Type
- PhD
- Identifier
- http://hdl.handle.net/10948/46374
- Identifier
- vital:39575
- Description
- Due to the complex nature of chorioamnionitis, women are often misdiagnosed, undiagnosed or only diagnosed after birth when it is too late to prevent maternal and neonatal complications. A lack of a comprehensive best practice guidelinefor screening and managing women withchorioamnionitis resultsin delayed treatment and management that could minimise maternal and neonatal complications. Saving Babiesreported that unexplained intra-uterine deathsremained the main primary (obstetric) cause of death for babies with a weight above 1000g (24.4%of all deaths). Of these unexplained uterine deaths, 33% are of normal birth weight (>2500g), and,therefore,most likely term gestation. Saving Babies further reported that 22.9% of all live births in South Africa was premature and 22.8% of birthswere unexplained intra-uterine deaths. Prematurity is one major complication of chorioamnionitis. When susceptibility for chorioamnionitis is considered during early pregnancy, it is possible to intervene and prevent or even reduce the incidences and complications of chorioamnionitis.A qualitative research study was conducted in three phases. In Phase One(Part One), a theoretically constructed patient scenario of chorioamnionitis was presented to ten midwives,and semi-structured individual interviews were done to elicit information regarding how they screen for and manage chorioamnionitis. In Phase One(Part Two), experienced medical practitioners in the field of obstetrics and gynaecology were individually interviewed, also using semi-structured individual interviewsto gain their views regarding chorioamnionitis as a contributing factor to maternal morbidity and mortality. Qualitative findings in Phase Oneindicated that there is a general lack of knowledge regarding chorioamnionitis among midwives, resulting ininadequate screening, misdiagnosis and mismanagement of the condition. Experienced medical practitioners confirmed that chorioamnionitis is underdiagnosed, misdiagnosed or undiagnosed and underreported,and they hold views that it is difficult to treat and control pregnancy-related infections according to current practice.An integrative literature review was conductedin Phase Twoand literature regarding diagnostic biomarkers, screening options to diagnose chorioamnionitis and management of chorioamnionitis were extracted. After evidence synthesisofPhase Oneand Phase Twodata, a best practice guidelinefor screening and managing viiwomen withchorioamnionitiswas developed usingthe National Institute for Health and Clinical Excellence guideline development approach in Phase Three. The purpose of the best practice guideline for screening and managing women with chorioamnionitis was to provide a guideline onhow to manage women who are at risk and those who present with signs and symptoms of chorioamnionitis at any stage during their pregnancy. Five recommendations were made that involve screening for chorioamnionitisand causative factors, biomarkers to diagnose chorioamnionitis, management of chorioamnionitis that includes pharmacological and non-pharmacological management, and health education to women.Ethics for this research study were guided by the ethical principles and guidelines of the Belmont Report. The trustworthiness of this research study was adopted from Ravitch and Carl,and was based on criticality, reflexivity, collaboration, and rigour. An independent coder and reviewer wereto verify the data that were included in the best practice guideline. Expert reviewersappraised the best practice guidelineusing Appraisal of Guidelines for Research and Evaluation II tools.
- Format
- xx, 334 leaves
- Format
- Publisher
- Nelson Mandela University
- Publisher
- Faculty of Health Sciences
- Language
- English
- Rights
- Nelson Mandela University
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NMU School of Clinical Care Sciences
| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | SOURCE1 | du Plessis, AH 199219613 Thesis April 2020.pdf | 4 MB | Adobe Acrobat PDF | View Details Download |