Abstract
BackgroundScreening for chorioamnionitis, or the risk thereof, by midwives is largely lacking during antenatal care and no best practice guidelines for chorioamnionitis in South Africa was noted.AimTo explore and describe midwives’ knowledge and practices related to the screening and management of women who are at risk of or diagnosed with chorioamnionitis.SettingPublic healthcare institutions in a health district in the Eastern Cape province of South Africa.MethodsA qualitative, exploratory, descriptive and contextual research design was used. Ten midwives were purposively included in this study, and semi-structured interviews were conducted with them. The data were analysed using an adapted version of Tesch’s eight steps for data analysis.ResultsThe main theme revealed that midwives lack knowledge regarding chorioamnionitis, resulting in incorrect practices including a lack of screening, misdiagnosis and mismanagement of the infectious condition.ConclusionsFindings of this research showed that midwives lacked knowledge regarding the screening and management of women with chorioamnionitis resulting in incorrect practices in this regard. There is thus a need for midwives to update their knowledge regarding the screening and management of chorioamnionitis and training (e.g. through a short learning programme).ContributionFindings of this study could be used by midwives to update their knowledge regarding screening and managing women with chorioamnionitis, which is expected to translate to better practices. Moreover, study findings were synthesised with the results of a literature review study to form the basis for the development of a best practice guideline for screening and managing women with chorioamnionitis.
Highlights
The neonatal death rate has generally declined globally by more than half from 1990 to 2018, yet neonatal deaths account for 47% of all under-5 child mortality (World Health Organization [WHO] 2019a)
The Saving Babies Report revealed that 2.2% of the neonatal deaths in South Africa are due to pregnancy-related infections, and 48.0% of unexplained intra-uterine deaths occurred in women with no obstetric complications (South Africa National Department of Health 2017)
Main theme: Midwives lack knowledge regarding chorioamnionitis, resulting in incorrect practices including a lack of screening, misdiagnosis and mismanagement of the infectious condition
Summary
The neonatal death rate has generally declined globally by more than half from 1990 to 2018 (from 37/1000 to 19/1000 live births), yet neonatal deaths account for 47% of all under-5 child mortality (World Health Organization [WHO] 2019a). Perinatal infection was reported by the WHO to be the third-highest death factor for maternal mortality rates in the world in 2013, and United Nations Children’s Fund (UNICEF) reported that primary causes of new-born deaths include premature births (35%), complications around the time of birth 24%), and infections such as sepsis and meningitis (15%) and pneumonia (6%) (UNICEF 2018) Inclusive of these infections is chorioamnionitis, which is defined as an inflammation (elicited by an immune response) or infection (elicited by bacterial infection) of the foetal sac, and is a cause of neonatal infections (El Malek, Embleton & Loughney 2015; Gantert et al 2010). Screening for chorioamnionitis, or the risk thereof, by midwives is largely lacking during antenatal care and no best practice guidelines for chorioamnionitis in South Africa was noted
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