South African Journal of Obstetrics and Gynaecology - latest Issue
Volume 22, Issue 2, 2016
Author Will EdridgeSource: South African Journal of Obstetrics and Gynaecology 22, pp 37 –37 (2016) http://dx.doi.org/10.7196/SAJOG.2016.v22i2.1143More LessSpeaking to a person in their own language provides an opportunity to place that person at their ease, an essential requirement in medicine, and makes retrieving information from that person easier. An article in this edition discusses the conversion of an English uterovaginal pelvic organ prolapse questionnaire into the language of Afrikaans. This South African (SA) language is based on European Dutch brought by settlers in a migration from Europe in the 17th century. It is closer to modern Flemish, spoken in Belgium. Afrikaans is the first language of approximately 13% of the SA population. SA has 11 official languages. Zulu (or more correctly isiZulu) is the first language of 22% of the population. Several languages are spoken by only 5%. English is the first language of only 9%. There is clearly a great need to translate questionnaires into many languages and this is acknowledged by the article. Any person in SA wishing to perform research translates questionnaires into the predominant languages of that region. This facility in language should really be for everyday usage and not just for writing papers or for giving validity to academic research.
Validation of the prolapse quality-of-life questionnaire (P-QOL) : an Afrikaans version in a South African populationSource: South African Journal of Obstetrics and Gynaecology 22, pp 38 –41 (2016) http://dx.doi.org/10.7196/SAJOG.2016.v22i2.1077More Less
Background. The prolapse quality-of-life questionnaire (P-QOL) has been validated and translated into eight languages. The lack of an Afrikaans version of the P-QOL limits studies in Afrikaans-speaking patients with pelvic organ prolapse (POP).Objective. To validate an Afrikaans version of the P-QOL in a South African population.
Methods. The P-QOL was translated into Afrikaans by a medical translator and three gynaecologists. This descriptive study determined construct validity comparing 25 symptomatic (64.1%, n=39) and 14 asymptomatic (35.9%, n=39) participants' median domain scores. The POP stage was determined according to the POP quantification (POP-Q) scale and compared with their domain scores by means of percentages. A second P-QOL was completed and the stability determined by the test-retest method. The Cronbach alpha was used to determine internal consistency and the kappa value to determine measure of agreement.
Results. Symptomatic participants had higher median domain scores than asymptomatic participants. All asymptomatic participants had stage 0 POP and 33.3% of symptomatic participants had stage III POP. Stability was good, with an average of above 50%. The mean Cronbach alpha value was 0.94 and the kappa value indicated moderate to good strength of agreement between items (к=0.41 - 0.80).
Conclusion. The Afrikaans P-QOL was found to be valid and reliable to determine quality of life in women with POP, correlating with the findings of other validation studies and supporting the evidence that the P-QOL is a high-quality disease-specific quality-of-life questionnaire.
Patient knowledge about and intention to use the intrauterine contraceptive device (IUCD) at a tertiary-level hospitalSource: South African Journal of Obstetrics and Gynaecology 22, pp 42 –46 (2016) http://dx.doi.org/10.7196/SAJOG.2016.v22i2.1048More Less
Background. The intrauterine contraceptive device (IUCD) is a highly effective and safe method of contraception. Prevention of unwanted pregnancies has made its use a matter of national priority in certain countries. Despite numerous advantages and suitability, the uptake of the IUCD is poor. Patients in South Africa (SA) seem to lack knowledge regarding this contraceptive.Objectives. To determine the quantity and quality of knowledge about the IUCD, and to evaluate its acceptability for future use.
Methods. A prospective cross-sectional study was conducted at Pelonomi Tertiary Hospital. A total of 201 consecutive patients were interviewed using structured questionnaires: of these, 193 formed the final study group.
Results. Almost half (49.2%, n=95) of our patients were aware of the existence of the IUCD. Its use was very low, with only one patient having used it before. Overall qualitative knowledge was poor, even among those aware of the existence of the IUCD. There was a significant association between level of education and knowledge, with patients having passed grade 12 or higher significantly more likely to have knowledge of the IUCD than those at lower levels (relative risk 1.57, 95% confidence interval 1.18 - 2.08). Forty-five percent (n=86) of patients indicated a desire for future IUCD use.
Conclusion. Despite the availability of the IUCD in SA clinics and hospitals, its uptake is poor. Awareness of this method seems to have improved over the past few years, but the qualitative knowledge is still considerably lacking. Education plays a major role in the knowledge of contraception. Better educational aids at all facilities will increase its use and reduce unwanted pregnancies.
Birth preparedness and complication readiness among pregnant women in a rural community in southern NigeriaSource: South African Journal of Obstetrics and Gynaecology 22, pp 47 –51 (2016) http://dx.doi.org/10.7196/SAJOG.2016.v22i2.1088More Less
Background. Birth preparedness and complication readiness (BPACR) has been advocated as a strategy to overcome costly delays in decision-making to seek skilled attendance at delivery, which in turn contribute significantly to maternal mortality from obstetric causes.
Objective. To assess the determinants of BPACR among pregnant women in a rural community in Edo State, Nigeria.
Methods. A descriptive cross-sectional study was done in Anegbette, a rural community in Etsako Central Local Government Area of Edo State. A house-to-house survey was carried out to identify pregnant women and all eligible women in the study area were included in the study.
Results. A total of 277 pregnant women participated in the study. The mean age (standard deviation) of respondents was 28.7 (5.8) years. Less than half (134, 48.4%) of the respondents were well prepared while 143 (51.6%) were poorly prepared. After adjustment for confounding effect using binary logistic regression analysis, educational level (odds ratio (OR) 0.653, 95% confidence interval (CI) 0.330 - 0.956), occupation (OR 0.384, 95% CI 0.148 - 0.990) and utilisation of antenatal care (OR 3.407, 95% CI 1.830 - 5.074) were significant predictors of BPACR.
Conclusion. BPACR was poor among women in the rural community. In order to improve maternal health among rural women in Nigeria, government and donor agency funding for safe motherhood programmes should focus on female empowerment and encourage community participation towards promotion of maternal health.
Source: South African Journal of Obstetrics and Gynaecology 22, pp 52 –56 (2016) http://dx.doi.org/10.7196/SAJOG.2016.v22i2.1068More Less
Background. Peripartum hysterectomies are lifesaving procedures but definitions vary. Indications are variable and dependant on resources and geographical factors.
Objectives. To evaluate the incidence, aetiology and complications associated with peripartum hysterectomies in a tertiary hospital in South Africa.
Methods. A retrospective audit at an academic referral centre over a 5-year period from February 2009 to March 2014 was performed. Procedures from a gestation of 24 weeks until 6 weeks postpartum were included.
Results. One hundred and sixty cases met inclusion criteria. Nine case records were unavailable. The incidence was 2.77 per 1 000 deliveries. Main indications were sepsis (60, 39.7%), atony (24, 15.9%), morbidly adherent placenta (21, 13.9%), tears (14, 9.3%), uterine rupture (8, 5.3%), placenta praevia (7, 4.6%) and unclassified bleeding (6, 4.0%). There were 6 maternal deaths. Five related to sepsis and one to hypovolaemic shock. One hundred and thirty-eight (91.4%) women required high or intensive care admission.
Conclusion. Sepsis is an important aetiology for peripartum hysterectomies, particularly in southern Africa. The high rate of sepsis may be due to HIV infection, low socioeconomic standards, late diagnosis, limited access to healthcare, sterility issues and differences in the definition and inclusion criteria used for a peripartum hysterectomy.
Factors predictive of abnormal semen parameters in male partners of couples attending the infertility clinic of a tertiary hospital in south-western NigeriaSource: South African Journal of Obstetrics and Gynaecology 22, pp 57 –61 (2016) http://dx.doi.org/10.7196/SAJOG.2016.v22i2.1082More Less
Background. Infertility is a common gynaecological problem and male factors contribute significantly to its aetiology. Semen analysis has remained useful for investigation of male factor infertility.
Objective. To assess the pattern of semen parameters, and predictive factors associated with abnormal parameters, in male partners of infertile couples attending a Nigerian tertiary hospital.
Methods. A descriptive study of infertile couples presenting at the clinic between January 2012 and December 2015 at Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria was done. Seminal fluid from the male partners was analysed in the laboratory using the World Health Organization 2010 criteria for human semen characteristics. Data were analysed using SPSS 17 and logistic regression analysis was used to determine the predictive factors associated with abnormal semen parameters.
Results. A total of 443 men participated in the study and 38.2% had abnormal sperm parameters. Oligozoospermia (34.8%) and asthenozoospermia (26.9%) were the leading single-factor abnormalities found, and astheno-oligozoospermia occurred in 14.2% and oligoasthenoteratozoospermia in 3.6% of cases. The prevalence of azoospermia was 3.4%. Smoking habit, past infection with mumps and previous groin surgery significantly predicted abnormal semen parameters (p=0.025, 0.040 and 0.017, respectively). Positive cultures were recorded in 36.2% of cases and Staphylococcus aureus was the most common.
Conclusion. Male factor abnormalities remain significant contributors to infertility and men should be encouraged, through advocacy, to participate in investigations into infertility, to reduce stigmatisation and ostracising of women with infertility, especially in sub-Saharan Africa.
Skene’s gland duct cysts - the utility of vaginal/transperineal imaging in diagnosis and mapping for surgery : case reportSource: South African Journal of Obstetrics and Gynaecology 22, pp 62 –64 (2016) http://dx.doi.org/10.7196/SAJOG.2016.v22i2.1063More LessWe report three patients with Skene’s gland cysts diagnosed on transvaginal and transperineal 2D and 3D sonography. We demonstrate that pelvic floor imaging is a useful diagnostic tool and aids in preoperative surgical planning. The real-time nature of this form of imaging and the addition of 3D ultrasonography demonstrate internal architecture and spatial relationships of periurethral pathology, thus aiding presurgical mapping. In this case series patients were followed up and results of surgical procedures and histological findings were recorded. Marsupialisation and resection are accepted surgical options in symptomatic Skene’s gland cysts. Usually simple drainage will not suffice for management of a symptomatic Skene’s gland cyst, as demonstrated in one of our cases. Asymptomatic cysts can be followed conservatively.
Source: South African Journal of Obstetrics and Gynaecology 22, pp 65 –66 (2016)More LessDuctus venosus (DV) has a pivotal role in the fetal circulation. It serves as a conduit connecting the fetal umbilical and portal venous system with the inferior vena cava. The absence of DV is an uncommon anomaly. In case of agenesis of DV, the umbilical vein joins the fetal systemic venous circulation via the intrahepatic or extrahepatic route. We report a case of absent DV with associated anomaly diagnosed in the first trimester using three-dimensional (3D) colour Doppler.
Source: South African Journal of Obstetrics and Gynaecology 22, pp 67 –68 (2016) http://dx.doi.org/10.7196/SAJOG.2016.v22i2.1094More LessLarge abdominal masses increase intra-abdominal pressure, thus changing the haemodynamics of the patient by elevating the diaphragm and causing partial occlusion of the inferior vena cava (IVC). Large abdominal masses present many challenges, including life-threatening risks due to severe cardiovascular, pulmonary, and circulatory problems, as well as technical difficulties of surgery and postoperative complications. We report a case of a large pelvic-abdominal myoma with perioperative pulmonary compromise. The goal of this report was to familiarise other surgeons with the alterations in the pathophysiology and management of large abdominal masses.