Obstetrics and Gynaecology Guidelines 2020 Update: Essential Medicines and Healthcare
Explore the latest updates in obstetrics and gynaecology guidelines for 2020, including information on miscarriages, termination of pregnancy, HIV in pregnancy, and maternal mental health. Access detailed evidence and changes in medication dosages and additions. Stay informed for improved healthcare practices.
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Chapter 6: Obstetrics & gynaecology NATIONAL DEPARTMENT OF HEALTH AFFORDABLE MEDICINES ESSENTIAL MEDICINES PROGRAMME PRIMARY HEALTHCARE GUIDELINES 2020 update 1
EVIDENCE Please access the National Essential Medicines List Committee (NEMLC) report for detailed evidence (including rationale, references and costings) informing decision-making on medicine addition, amendments and deletions: http://www.health.gov.za/index.php/standard-treatment-guidelines-and- essential-medicines-list/category/285-phc DISCLAIMER This slide set is an implementation tool and should be used alongside the most recently published STG available on the EML Clinical Guide Application. This information does not supersede or replace the STG itself. 2
Miscarriage DESCRIPTION Bleeding from the genital tract < 22 weeks gestation, which may or may not be associated with lower abdominal pain REASON Aligned to Adult Hospital Level STGs and EML, 2019 and SAMF, 2016 CHANGES Misoprostol, PV, DOSE and DIRECTIONS FOR USE AMENDED . Anti-D Immunoglobulin, DOSE AMENDED 3
Termination of pregnancy (TOP) DESCRIPTION Termination of pregnancy for pregnancies where gestation 12 weeks and 0 days, on request. CHANGES Misoprostol, sub-lingual, ADDED. Anti-D Immunoglobulin, DOSE AMENDED REASON Aligned to Adult Hospital Level STGs and EML, 2019 and SAMF, 2016 4
HIV in pregnancy DESCRIPTION HIV is currently the commonest cause of maternal deaths in South Africa. Transmission of HIV from mother to infant may occur during pregnancy, delivery and/or breastfeeding. With appropriate ART and VL suppression, maternal mortality as well as perinatal transmission of HIV can be substantially reduced. CHANGES TDF, FTC, and DTG ADDED TDF, 3TC, and EFV INDICATION AMENDED Nevirapine DELETED Delivery VL ADDED REASON Aligned with 2019 PMTCT Guideline 5
Maternal mental health DESCRIPTION This includes antenatal and postnatal depression, as well as postpartum psychosis. REASON To increase recognition and improve management of these conditions as there is potential for significant negative impact on the mother s ability to carry the pregnancy to term and to care for her baby. CHANGES New sections added with descriptions, general and referral criteria measures 6
