New hope for high-risk pregnancies

Posted on 24 March 2022

For women facing a high-risk pregnancy, access to specialist healthcare is crucial. Dr Sibusiso Nhlapo’s highly specialised obstetrics-gynaecology practice at Mediclinic Highveld now provides potentially lifesaving care in an underserved area.

An absence of specialist obstetrics care is no longer a concern for pregnant women in the Secunda/Trichardt area of Mpumalanga. They can now go to Mediclinic Highveld, where Dr Sibusiso Nhlapo, a specialist in high-risk pregnancies, has set up a thriving practice.

Dr Nhlapo specialises in high-risk pregnancies complicated by medical conditions and foetal anomalies. He’s become a lifesaver in an area where antenatal services – especially in the public sector – are generally provided by midwives.

“My coming to Secunda really helped in adding to a number of gynaecologists in the area, who were inundated with work because of the volume of patients,” he says.

Mpumalanga is plagued by a shortage of healthcare providers, and it’s rural patients who struggle most with antenatal services. Accessing these services in Pretoria or Johannesburg is costly and waiting lists are often long.

Concern for women’s health

Dr Nhlapo comes from a family of teachers but decided to specialise in obstetrics and gynaecology because of his concern for the health and wellbeing of his mother and four sisters. He completed a BSc in Biological Sciences at the University of Zululand, followed by an MBChB at the Medical University of South Africa. While working as a GP, he completed an MPH (Health Promotion) and an MSc (Clinical Epidemiology) at the University of Pretoria.

He then attained his MMed degree in obstetrics and gynaecology at the University of Stellenbosch, followed by a fellowship in obstetrics and gynaecology at the Colleges of Medicine of South Africa. He’s currently completing his studies to qualify as a maternal-foetal specialist.

What makes a pregnancy high risk?

South Africa has a high burden of maternal and neonatal mortality rates, and timeous foetal screening will go a long way in reducing that burden. The risk factors for complicated pregnancies are:

• Advanced maternal age
• Underlying chronic conditions, including thyroid disease; recurrent deep venous thrombosis (DVT); HIV; hypertension; diabetes; and systemic lupus erythematosus (an autoimmune disease that causes widespread tissue damage)
• Previous pregnancies complicated by preeclampsia; preterm delivery; antepartum haemorrhage; and post-partum haemorrhage
• Previous pregnancies complicated by stillbirths; congenital malformations; and aneuploidy (presence of an abnormal number of chromosones in a cell).

3 reasons why foetal screening is important

1. Early diagnosis of anomalies not compatible with life allows parents to make early decisions on how they will proceed with the pregnancy.
2. In certain cases, intrauterine intervention can improve outcomes for babies.
3. Some problems with the foetus require multidisciplinary management, and this can be identified during screening.

10th time lucky

Dr Nhlapo says his most challenging case was that of a woman who had suffered nine miscarriages. In her 10th pregnancy she went to see Dr Nhlapo. “It put me on the spot,” he admits. “But I successfully managed her pregnancy and although the baby was delivered preterm, she was alive and is doing well.”

So, what does the future look like for high-risk pregnancies in Mpumalanga?

Dr Nhlapo says maternal-foetal specialist services will help other gynaecologists who need to refer high-risk patients. But his focus remains on women and their health. “Offering the service in the province mitigates the inconveniences that pregnant patients face while already dealing with complicated pregnancies,” he says.