September 2004, Vol. 94, No. 9 SAMJ
P OSITION S TATEMENT
conjunction with lifestyle modifications will remain the treatment of choice for acute menopausal symptoms for the immediate future. It is hoped that future research will be able to identify a patient profile or method of application where longer use of HT is without risk. This will unlock the true potential of HT in the prevention and treatment of osteoporosis and allow new research on the role of HT in primary
prevention.
Key reading
1. Barret-Connor E, Slone S, Greendale G, et al. The postmenopausal Estrogen/Progestin Intervention Study: primary outcomes in adherent women. Maturitas 1997; 27: 261-274.
2. Cardoza L, Bachmann G, McClish D, et al. Meta-analysis of estrogen therapy in the management of urogenital atrophy in menopausal women: second report of the Hormones and Urogenital Therapy Committee. Obstet Gynecol 1998; 92: 722-727.
3. Chlebowski RT, Hendrix SL, Langer RD, et al. Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women. JAMA 2003; 289(24): 3243- 3253.
4. Hulley S, Grady D, Bush T, et al, for the Heart and Estrogen/Progestin Replacement Study (HERS) Research Group. Randomized trial of estrogen plus progestin for secondary
prevention of coronary heart disease in postmenopausal women. JAMA 1998; 280: 605-613.
5. MacLennan A, Lester S, Moore V. Oral oestrogen replacement therapy versus placebo for hot flushes. Cochrane Database Syst Rev 2001; 1: CD002978.
6. Manson JE, Hsia J, Johnson KC, et al. Women’s Health Initiative Investigators. Estrogen plus progestin and the risk of coronary heart disease. N Engl J Med 2003; 349: 523-534.
7. Shumaker S, Legault C, Rapp SR, et al. Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women: the Women’s Health Initiative Memory Study: a randomized controlled trial. JAMA 2003; 289: 2651-2662.
8. Warren MP. A comparative review of the risks and benefits of hormone replacement therapy regimes. Am J Obstet Gynecol 2004; 190: 1141-1167.
9. WHI Steering Committee. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy. JAMA 2004; 291(14): 1701-1712.
10. Writing Group for WHI Investigators. Risks and benefits of estrogen and progestin in healthy postmenopausal women. JAMA 2002; 288: 321-333.
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This statement was prepared under the chairmanship of Dr T J de Villiers. It was reviewed by the Council of SAMS during July 2004, after which the final consensus statement was compiled.
This consensus meeting was supported by an unrestricted educational grant from Novo Nordisk Pty Ltd.
S
CIENTIFICL
ETTERTo the Editor: One of the key recommendations of the Second Report on Confidential Enquiries into Maternal Deaths in South Africa 1999 - 2001, was that regional anaesthesia (RA) ‘should be promoted in all sites performing caesarean sections’ (CSs). A target was given for 75% CSs to be performed under RA.1
We wished to know the extent to which RA was being used in the Free State and at which hospitals. This was so that institutions where the 75% target was not being achieved could be identified and measures then considered, where
appropriate, to achieve the recommended target.
The study was retrospective and identified the types of anaesthesia administered to patients receiving a CS in level 1 and 2 hospitals in the Free State, from 1 September 2002 to 30 November 2002. The study method was to visit each hospital in
December 2002 or January 2003 and retrieve the information from theatre record books.
In our results, both spinal and epidural (only 4 patients) techniques were recorded as RA; patients who required a general anaesthetic due to a failed spinal were also recorded under RA, as at least this had been attempted.
The results were as follows. During the 3-month study period, CSs were performed in 19/24 level 1 hospitals and all 5 level 2 hospitals in the Free State. A total of 1 734 CSs were performed. For 5 patients there was a failure to record the type of anaesthesia. Of the remaining 1 729 CSs, 1 231 (71.2%) were performed using RA.
The data for each hospital are presented in Table I.
A survey of the use of regional anaesthesia for caesarean
sections in level 1 and 2 hospitals in the Free State
S CIENTIFIC L ETTER
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September 2004, Vol. 94, No. 9 SAMJ
Table I. Types of anaesthesia administered for caesarean sections in Free State level 1 and 2 hospitals from 1 September 2002 to 30 November 2002 (new names of hospitals in brackets)
Not
Level Name of hospital RA GA Total recorded % RA use 95% CI
1 Bothaville (Nala) 0 17 17 0 0 0; 19.5
1 Jagersfontein (Diamond) 0 8 8 0 0 0; 36.9
1 Ladybrand (Mantsopa) 0 13 13 0 0 0; 24.7
1 Winburg 0 9 9 0 0 0; 33.6
1 Odendaalsrus (Thusanong) 5 76 81 0 6.2 2.0; 13.8
1 Heilbron (Tokollo) 2 26 28 0 7.1 0.9; 23.5
1 Clocolan (John Daniel Newsberry) 3 15 18 0 16.7 3.6; 41.4
1 Frankfort (Mafube) 15 23 38 1 39.5 24.0; 56.6
1 Sasolburg (Metsimaholo) 64 44 108 0 59.3 50.0; 68.5
1 Harrismith (Thebe) 29 16 45 0 64.4 48.8; 78.1
1 Senekal 11 3 14 0 78.6 49.2; 95.3
1 Moroka (Dr J S Moroka) 45 11 56 0 80.4 67.6; 89.8
1 Reitz (Nketoana) 15 3 18 0 83.3 58.6; 96.4
1 Bothshabelo 111 11 122 0 91.0 84.4; 95.4
1 Ficksburg (Phuthuloha) 20 2 22 0 90.9 70.8; 98.9
1 National 26 2 28 0 92.9 76.5; 99.1
1 Parys 20 1 21 0 95.2 76.2; 99.9
1 Phekolong 23 0 23 0 100.0 85.2; 100
1 Virginia (Katleho) 1 0 1 0 100.0 *
2 Manapo (Mofumahadi Manapo Mopeli) 139 58 197 0 70.6 64.2; 76.9
2 Goldfields (Bongani) 162 60 222 0 73.0 67.1; 78.8
2 Bethlehem (Dihlabeng) 90 23 113 0 79.6 72.2; 87.1
2 Boitumelo 123 22 145 2 84.8 79.0; 90.7
2 Pelonomi 327 55 382 2 85.6 82.1; 89.1
Total 1 231 498 1 729 5 71.2 69.1; 73.3
* Cannot be calculated.
RA = regional anaesthesia: GA = general anaesthesia.
Overall we found that the 75% RA use target was achieved in 3/5 level 2 hospitals (60%) and 9/19 (47%) level 1 hospitals in the Free State.
It was noted that there were 6 hospitals in which RA is not used, or rarely used (< 10% of cases). In one of these, Odendaalsrus, a relatively large number of CSs were performed (81 cases).
This is the first survey we are aware of that has
quantitatively investigated which type of anaesthetic is used for CS in South Africa. The information obtained is being used to help us construct training programmes in RA, aimed at those institutions where RA is being relatively underutilised.
This study was funded by the Free State Provincial Department of Health.
G Lamacraft S Hollingworth J G Dowie M J Schmidt B J S Diedricks Department of Anaesthesiology University of the Free State Bloemfontein
G Joubert
Department of Biostatistics University of the Free State Bloemfontein
1. Pattinson RC, ed. Saving Mothers. Second Report on Confidential Enquiries into Maternal Deaths in South Africa 1999 - 2001. Pretoria: Department of Health, 2003.
