BackgroundDespite a liberal abortion law, access to safe abortion services in South Africa is challenging for many women. Medication abortion was introduced in 2013, but its reach remains limited. We aimed to estimate the costs and cost effectiveness of providing first-trimester medication abortion and manual vacuum aspiration (MVA) services to inform planning for first-trimester service provision in South Africa and similar settings.MethodsWe obtained data on service provision and outcomes from an operations research study where medication abortion was introduced alongside existing MVA services in public hospitals in KwaZulu-Natal province. Clinical data were collected through interviews with first-trimester abortion clients and summaries completed by nurses performing the procedures. In parallel, we performed micro-costing at three of the study hospitals. Using a model built in Excel, we estimated the average cost per medical and surgical procedure and determined the cost per complete abortion performed. Results are presented in 2015 US dollars.ResultsA total of 1,129 women were eligible for a first trimester abortion at the three study sites. The majority (886, 78.5%) were eligible to choose their abortion procedure; 94.1% (n = 834) chose medication abortion. The total average cost per medication abortion was $63.91 (52.32–75.51). The total average cost per MVA was higher at $69.60 (52.62–86.57); though the cost ranges for the two procedures overlapped. Given average costs, the cost per complete medication abortion was lower than the cost per complete MVA despite three (0.4%) medication abortion women being hospitalized and two (0.3%) having ongoing pregnancies at study exit. Personnel costs were the largest component of the total average cost of both abortion methods.ConclusionThis analysis supports the scale-up of medication abortion alongside existing MVA services in South Africa. Women can be offered a choice of methods, including medication abortion with MVA as a back-up, without increasing costs.

Background: Second-stage Caesarean sections (CSs) are known to be associated with increased complications but most reports originate from tertiary hospitals, which attend to high-risk patients. Complication rates may differ in district hospitals, which attend to low-risk patients.

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SA Fam Pract 2010;52(1):64-68Introduction: The Term Breech Trial has led to obstetricians opting for Caesarean section as the mode of delivery for this presentation, even in poor countries. Concerns related to this approach are the resultant increase in Caesarean section rates and their associated complications, particularly in under-resourced countries, which are faced with financial and human-resource expertise constraints.

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Spontaneous uterine rupture (UR) in primigravidas with term pregnancies is a rare occurrence, but is increasing in frequency in high-income countries as a result of a concomitant rise in rates of gynaecological uterine surgery. We present a case from a low-and middle-income country of spontaneous UR at term with no known markers of such an adverse event. The spontaneous UR may have been due to the ingestion of traditional medicines. Health professionals and the community at large must be alerted to the possible dangers of the use of such medications in pregnancy. Recently there has been an increasing number of reports from high-income countries of spontaneous uterine rupture (UR) in term primigravidas. These reports relate mainly to women who have had uterine surgery such as hysteroscopic surgery, myomectomies, surgical correction of uterine anomalies and inadvertent uterine perforation. [1,2] We report a case of UR in a primigravida at term, which was probably due to the use of traditional/herbal medications, a common practice in low-and middle-income countries. S Afr J Obstet Gynaecol Case historyA 21-year-old primigravida presented to our hospital at 37 weeks' gestation with severe lower abdominal pain and vaginal bleeding. She had clinical and ultrasound features suggestive of hypovolaemic shock and intra-abdominal bleeding, and required an emergency laparotomy. History of presenting complaintOn the day of admission to our hospital, the patient reported lack of fetal movements but described what she felt as the baby 'moving up and down' in the upper abdomen. The patient stated that she had ingested half a cup of traditional medication (isiShlambezo; loosely translated this means 'that which cleans') the day before her hospital visit and had noticed increasing intensity of abdominal pain a few hours later. In the last month of her pregnancy she had also ingested a beaten-egg concoction daily, which her family had suggested would help to hasten her labour.The patient had received antenatal care at our hospital; no abnormalities were detected on physical examination at the first antenatal visit and her basic antenatal laboratory investigations were normal. She had had two non-scheduled visits to our hospital in the last trimester of pregnancy for lower abdominal pains prior to admission. At the first non-scheduled visit she was found to be 36 weeks pregnant by symphysis-fundal height assessment and the fetus was lying in the longitudinal position with the cephalus presenting. At this consultation a diagnosis of false labour was made and the patient was counselled on signs of labour and given an appointment to return in a week's time. On her second non-scheduled hospital visit she also complained of persistent lower abdominal pains and backache. According to early ultrasound findings she was 37 weeks pregnant by gestation and 38 by symphysis-fundal height measurement; pelvic examination revealed the cervical os to be closed. The patient was again thought to be in false labour and asked to return when she was in ...