Obstetrics and Gynaecology Forum - latest Issue
Volume 27, Issue 1, 2017
Author G.B. TheronSource: Obstetrics and Gynaecology Forum 27, pp 1 –2 (2017)More LessDuring the pre-antiretroviral era 50% of transmissions occurred during labour and delivery. Elective Caesarean sections prior to the onset of labour in low and most middle income countries were not a feasible option. The success of the landmark 076 study conducted in the USA in reducing perinatal mother to child transmission (PMTCT) of HIV to 8.3% compared to 25,5% in the control group was published in 1994.1 The significant reduction in MTCT left health workers in high HIV prevalence countries in sub-Sahara Africa despondent. The intrapartum use of intravenous zidovudine (AZT) was not available and affordable. The HIVNET012 study conducted in Uganda and published in 1999 compared intrapartum single dose (sd) nevirapine (NVP) to the mother and new born infant to oral AZT used 3 hourly intrapartum and administered twice daily for 7 days to the infant.2 A 47% reduction in MTCT in the sdNVP arm compared to the AZT arm of the study was found. A reduction in HIV transmission from the estimated 21% to 43% in lesser resourced countries at that time to 12% at 6 to 8 weeks of age by using sdNVP was achieved. Intrapartum and neonatal sdNVP was both feasible and affordable in high HIV prevalence countries in sub- Sahara Africa and was embraced by most of these countries.
Author Colin MaraisSource: Obstetrics and Gynaecology Forum 27, pp 7 –11 (2017)More LessPremenstrual tension syndrome and to a lesser extent premenstrual dysphoric disorder are common conditions in females of reproductive age with far reaching implications for quality of life and relationships. As physicians, it is our duty to make sure we diagnose these disorders correctly and institute evidence based therapy where appropriate. A detailed, prospective, patient completed symptom diary for at least two consecutive months forms the cornerstone of the evaluation and active exclusion of other conditions such as mayor depressive disorder is of vital importance. Patient education and psychological support should form part of the foundation on which selective serotonin receptor inhibitors and other pharmacological treatment are built.
Author Thabo MatsasengSource: Obstetrics and Gynaecology Forum 27, pp 12 –15 (2017)More LessPolycystic ovary syndrome (PCOS) can be a challenging and frustrating condition for both treating clinician and patient alike. It is a common endocrine disorder occurring in 5-10% of women in the reproductive age. The aetiology is multifactorial and is still not very well understood. Despite diagnostic controversies the Rotterdam criteria is the universally adopted and practiced. It describes the diagnosis of PCOS by the presence of at least two of three (chronic anovulation, clinical and/or biochemical hyperandrogenism and polycystic ovaries on ultrasound) [Figure 1]. For comprehensive and holistic care of patients with PCOS, one has to understand the (short and long term) complications associated with the disorder. For the purpose of this article, however, we will address only the challenges in the reproductive age and they include menstrual irregularities, hirsutism and/or acne, infertility, obesity and psychological disorders.
Source: Obstetrics and Gynaecology Forum 27, pp 16 –18 (2017)More Less
While exclusive breastfeeding is the preferred form of infant feeding, failure to exclusively breastfeed is common, mostly due to impaired breastmilk production. Galactogogues are dopamine antagonists which may increase prolactin concentrations and breastmilk production. Breastmilk production is initially under influence of prolactin, but once lactation is established, serum concentrations of prolactin correlate poorly with breastmilk volume. Prescribing galactogogues beyond 2 weeks postpartum therefore has no effect on lactation performance. Key is to focus on education and breastfeeding technique. Should a galactogogue be required, avoid antipsychotics due to exposure in the neonate, who has a developing central nervous system. Consideration could be given to metoclopramide or domperidone, taking into account the benefit-risk when using, both for the mother and neonate.
Source: Obstetrics and Gynaecology Forum 27, pp 19 –24 (2017)More Less
In this era of information overload, pregnancy can be quite daunting for the new mother and her doctor who needs to advise her on safe practices and a healthy life style during her pregnancy. It is often the case that women turn to family, friends and social media for advice, ultimately being presented with conflicting information. This article serves to explore some pregnancy "dos and don'ts" and provide evidence based advice and expert opinion based on established international guidelines where available. Topics covered include the ingestion of soft cheese and the risks of listeriosis, sushi, caffeine, cats and the risks of Toxoplasmosis, hair dye, hot baths, air travel and shift work. Well proven and dangerous habits such as alcohol use and smoking have not been covered in this article.
Source: Obstetrics and Gynaecology Forum 27, pp 25 –28 (2017)More Less
The combined oestrogen/progestin oral contraceptive pill (COC) is 60 years old. During this time the dose and types of both estrogen and progestin has changed considerably. Most changes have occurred in order to mitigate or avoid problems and side effects. The approach to control serious side effects, most prominently thrombo-embolic disease was initially through oestrogen dose reduction and the mechanism to control minor side effects was through progestin potency and specificity modification. While this approach worked for oestrogen dosage reduction, it has not appeared to work so well for the newer progestins whose use is still related to clotting disorders. The use of Estetrol (a naturally occurring selective estrogen receptor modulator-SERM) appears to be about to change the major side effect profile of COCs. Estetrol can be used in women with a history of clotting disorders without increasing the risk of thrombo-embolic disease and breast malignancy when used in combination with the fourth generation progestin, drospirenone. Drospirenone is also being used as a progestin only oral contraceptive and appears to be able to induce reliable suppression of ovulation, and regular withdrawal bleeding even when some pills are missed. Drospirenone, a fourth generation progestin appears to be safe and effective either when used on its own or in combination with the fourth generation estrogen, esteterol.