Obstetrics and Gynaecology Forum - latest Issue
Volume 26, Issue 4, Oct/Nov 2016
Author Zephne M. van der SpuySource: Obstetrics and Gynaecology Forum 26, pp 1 –1 (Oct/Nov 2016)More Less
Evidence-based medicine has become part of our clinical environment. Our clinical practice has been influenced by what data are available within the literature and this impacts on how we practise medicine. In an editorial in the BMJ in 1996 David Sackett and his co-authors defined evidence-based medicine as the “conscientious, explicit and judicial use of current/best evidence in making decisions about the care of the individual patient.” This has meant integrating clinical expertise with good or excellent available clinical evidence from systematic research. He pointed out that “best available external clinical evidence” meant using relevant research from both basic sciences and patient-centred clinical research in reviewing diagnostic tests, the value of prognostic markers and the available therapeutic regimens. In addition, rehabilitative and preventative options need to be included in this equation. Central to evidence-based medicine is the patient and consumer’s input.
Author N. MbataniSource: Obstetrics and Gynaecology Forum 26, pp 5 –8 (Oct/Nov 2016)More Less
Cervical cancer is the second commonest gynaecological cancer (after breast cancer) affecting women in Sub Saharan Africa. Countries with well organised screening programmes have managed to reduce the incidence of the disease. Even in these countries a number of women are, however, diagnosed with advanced stage disease. The reasons for poor uptake of the current screening methods include: lack of understanding of the benefits of screening, lack of access to care either due to long distances to clinical facilities or financial problems. Acceptance of the currently available testing techniques by women, who should be screened, remains a challenge.
For more than 50 years, the Pap smear has been used as a primary screening test. The Human Papilloma Virus (HPV) test, has been incorporated as either a primary or secondary screening test, and has proven to be more sensitive than the Pap smear. The low specificity of HPV testing results in over-referral to colposcopy and over treatment of patients. Cervical intraepithelial lesions grade 2 and 3 (CIN 2 and 3), both otherwise known as HSIL on Pap smear reports are considered precancerous. Cervical intra-epithelial neoplasia grade 1 (CIN1) is considered a risk factor for cervical cancer. This article aims to simplify the interpretation and management of Pap smears for the clinician involved in Women’s health.
Source: Obstetrics and Gynaecology Forum 26, pp 11 –15 (Oct/Nov 2016)More Less
Death of a dream! That is what it means for a woman to be diagnosed with premature ovarian failure. For a patient to learn, unexpectedly, that she will not be able to conceive a biological child, can result in severe psychological and emotional trauma. The preliminary diagnosis of “premature menopause” however, has resulted in many red-faced clinicians when patients, labeled with this diagnosis, manage to conceive spontaneously. Today it is well known that intermittent and unpredictable ovarian function can result in spontaneous pregnancies even after the diagnosis of “ovarian failure” has been made. This confirms the total inappropriateness of the terms “menopause” or “failure” and lead to adoption of the term, “insufficiency”, already described in 1942. This article consider possible treatment options in patients with primary ovarian insufficiency to increase spontaneous pregnancy rates, as well as the necessary screening tests important to perform, before initiating fertility treatment.
Author M. MatjilaSource: Obstetrics and Gynaecology Forum 26, pp 17 –21 (Oct/Nov 2016)More Less
Stillbirth is an overwhelming experience for the couples involved and is a demanding condition to manage. The impact on short and long-term psychosocial morbidity can be severe and unrecognized. The lack of universal consensus on the definition and classification of stillbirth makes interpretation of research findings challenging. Recurrent stillbirth remains an even more poorly defined entity. This review examines risks for recurrent stillbirth, medical and patient-related factors associated with stillbirth and its recurrence, as well as the management of a pregnancy after previous stillbirth.
Source: Obstetrics and Gynaecology Forum 26, pp 23 –28 (Oct/Nov 2016)More Less
Worldwide and locally maternal mortality from cardiac disease has seen a steady rise over the last decade. The tendency to postpone motherhood, the current obesity epidemic and the improved medical and surgical management of patients with congenital and acquired heart disease have all contributed to this increase in cardiac disease in pregnancy. It is increasingly important for all health professionals to be well versed in contraception options and pre-conception counseling for women with cardiovascular disease.
This article provides a summary of the risk of maternal mortality in women with heart disease and discusses the need for effective pre-conception counseling and contraception provision.
Author S. FawcusSource: Obstetrics and Gynaecology Forum 26, pp 30 –36 (Oct/Nov 2016)More Less
This article describes and defines the widespread problem of disrespect and abuse of women in maternity facilities, which is a violation of their human rights. It cites global and South African studies which describe the extent of the problem and possible reasons for its occurrence. These include attitudinal or behavioural components as well as health system factors which facilitate disrespectful and abusive behaviour.
Projects and initiatives to promote Respectful Maternity care are described globally and in South Africa. The patient centred maternity care initiative in the Cape Town Metro recommends a behaviour change approach and also promotes health system arrangements which enable privacy, cleanliness and good quality of care. In particular ‘caring for the carers’, notably the country’s midwives, and promoting birth companions for women in labour are both essential features.
Respectful maternity care is not a ‘soft’ issue but an essential component of ensuring quality of care and promoting maternal and perinatal health. Women’s lives and their birth experiences matter!