CME : Your SA Journal of CPD - Volume 24, Issue 11, 2006
Volume 24, Issue 11, 2006
Author Chantal StewartSource: CME : Your SA Journal of CPD 24, pp 623 –626 (2006)More Less
Nicotine and carbon monoxide are the substances in cigarette smoke that are responsible for most of the adverse effects in pregnancy. <BR>Smoking in pregnancy is associated with an increase in miscarriage, low birth weight babies, abruptio placentae, placenta praevia and perinatal mortality. <BR>Women who smoke have an earlier onset of menopause when compared with non-smoking women. <BR>Smoking impairs fertility in both men and women via its effect on gametes and ovarian function. <BR>Smoking is an important co-factor in the development of cervical cancer. <BR>A wide range of cognitive and behavioural problems such as attention deficit hyperactivity disorder (ADHD) have been identified in children of mothers who smoke during pregnancy. <BR>There is an association between smoking in pregnancy and an increase in childhood cancers, such as leukaemia and lymphoma.
Author Franco GuidozziSource: CME : Your SA Journal of CPD 24, pp 628 –635 (2006)More Less
In the age group 15 - 24 years, women are 2.5 times more likely to be HIV infected. <BR>Treatment principles for managing vulvovaginal candidiasis in HIV-positive women should be identical to those used in HIV-negative women. <BR>Approximately 50% of genital ulcers in HIV-infected women will be idiopathic and are called aphthous ulcers, while the rest are most commonly due to herpes simplex virus, mixed bacteria, syphilis, <I>Haemophilus ducrei</I>, mycobacteria or cytomegalovirus infections. <BR>Acyclovir-resistant HSV may be encountered in 11 - 17% of HIV-infected women and valacyclovir, famciclovir, foscarnet or cidofovir may need to be considered. <BR>HIV-positive women with PID have higher temperatures, lower WBC counts, more syphilis, more bacterial vaginosis, less chlamydia, less abdominal tenderness and twice as much tubo-ovarian abscess formation compared with HIV-negative women. <BR>Severe immunosuppression and high viral load significantly increase the likelihood of HPV infections, abnormal smears and SIL, and overall, HIV-infected women have a 5-6-fold increase of developing SIL. <BR>Colposcopic examination is warranted after a single Pap smear shows cytological atypia, ascus, low-grade or highgrade SIL or AGUS in an HIV-positive woman. <BR>Even though ablative or excisional procedures are the treatment of choice for CIN 2 or 3, the need for second or third therapeutic procedures is often required. Hysterectomy is not advocated as there is a 50% rate of recurrence at the vaginal vault. <BR>Menstrual disorders in HIV-infected women may not be directly due to the HIV, but to various factors that are not directly related to the disease. <BR>Condoms are the mainstay of contraception and should be encouraged either as the sole contraceptive or in addition to any other form of contraceptive method used.
Author Peter De JongSource: CME : Your SA Journal of CPD 24, pp 638 –642 (2006)More Less
Pelvic organ prolapse is caused by vaginal parity, ageing, hysterectomy and raised intra-abdominal pressure. <BR>A new system of staging pelvic organ prolapse has been developed, validated and introduced. <BR>Staging is no longer subjective (small, medium, large, etc.), but objectively measured. <BR>New terminology and definitions replace previously used terms such as cystocele, rectocele and vault prolapse. <BR>Prosthetic graft material has been introduced to improve the quality of pelvic reconstructive surgery. <BR>The one-operation-fits-all approach needs to be revised, and a more objective evidence-based approach considered.
Author J.S. BagrateeSource: CME : Your SA Journal of CPD 24, pp 643 –646 (2006)More Less
Miscarriage is the commonest complication of pregnancy. <BR>Historically, surgical evacuation was the treatment of choice to prevent death from haemorrhage and sepsis. <BR>Access to medical care, progress in ultrasonography and legalisation of abortion have allowed the use of conservative treatment such as medical and expectant management. <BR>Transvaginal ultrasound is essential in making a diagnosis of early fetal demise. <BR>Surgical evacuation after resuscitation remains the gold standard for treatment of women who are haemodynamically unstable or who have concurrent sepsis. <BR>Appropriate counselling, availability of transport and access to the health care facility are prerequisites to conservative treatment of miscarriage. <BR>Clinicians must know the exclusion criteria before embarking on medical treatment with misoprostol. <BR>All rhesus-negative women receiving surgical and medical management of first-trimester miscarriage must receive anti-D immunoprophylaxis.
Management of symptomatic menopausal women with breast cancer, benign breast disease or a family history of breast cancer : main articleAuthor Dennis A. DaveySource: CME : Your SA Journal of CPD 24, pp 648 –652 (2006)More Less
The number of breast cancer survivors is increasing due to the increased use of mammographic screening and adjuvant therapy. <BR>Adjuvant therapy for breast cancer increases the severity of menopausal symptoms and the incidence of amenorrhoea. <BR>Overall data on risk of HRT on breast cancer survivors are inconclusive. <BR>SSRIs, gabapentin or clonidine may be the best of the non-hormonal agents for treatment of vasomotor symptoms. <BR>Non-hormonal agents are often ineffective and one-third of women are prepared to use HRT. <BR>HRT is the most efficacious treatment and is an option in women with severe vasomotor symptoms refractory to non-hormonal agents. <BR>Benign breast disease is a risk factor for breast cancer depending on histology and family history. <BR>Women with a family history of breast cancer are at increased risk depending on the degree and number of relatives and require close surveillance. <BR>HRT is not thought to increase the risk further in women with a family history of breast cancer, and HRT is not contraindicated.
Prescribing combined oral contraceptives for women with pre-existing medical conditions : clinical pharmacologySource: CME : Your SA Journal of CPD 24, pp 659 –661 (2006)More Less
COCs are safe and effective when used correctly and consistently. <BR>COCs have non-contraceptive benefits, e.g. anti-androgen. If the woman has significant cardiovascular risk factors, alternative methods should be considered. <BR>The risk of venous thromboembolism is lower with COC use than with pregnancy. <BR>Dual protection is recommended if there is risk of transmission of sexually transmitted infections including HIV. <BR>If a woman is taking medication which lowers the efficacy of the low-dose COC (< 35 µg EE) an alternative or additional method is recommended. <BR>For missed pills, apply the two for twenty and three for thirty rule.