South African Journal of Obstetrics and Gynaecology - Volume 10, Issue 3, October 2004

Extracted from text ... The modern clinician is expected to practise in accordance with the findings of evidence-based medicine. This implies that the clinician is familiar with the strongest evidence available. The latter is difficult for the following reasons: The results of a given clinical trial can only be applied to the specific population and circumstances as applicable to the study in question. A small group of individuals may react in a unique way to medication. Statistical significance does not always equate to clinical significance. Different methods of defining statistical significance may yield different answers when applied to the ..

Extracted from text ... The mainstay of current therapies for osteoporosis is antiresorptive agents such as calcium, vitamin D, oestrogen, selective oestrogen receptor modulators (SERMs), calcitonin and the bisphosphonates. These drugs reduce but do not eliminate fracture risk, and do not restore lost bone structure. Anabolic agents have the potential to increase bone mineral density (BMD), restore skeletal micro-architecture and reduce fracture risk to a greater extent than the antiresorptives. Fluoride was the first anabolic agent to be used in the treatment of osteoporosis, followed by growth hormone and insulin-like growth factor. More recently, strontium, statins and parathyroid hormone (PTH) have been added ..

<I>Background.</I> Infants are screened for neonatal jaundice (NNJ) at midwife obstetric units (MOUS) and treated with phototherapy at Bishop Lavis MOU. No information is available on the efficacy of the system. <br><I>Objective.</I> To determine the effectiveness of the current NNJ screening, treatment with phototherapy and referral system at the MOUs. <br><I>Methods.</I> Neonates whose total serum bilirubins (TSBs) were screened between 1 August 1999 and 31 July 2001 at Elsies River and Bishop Lavis MOUs, or who were admitted to Bishop Lavis MOUs for phototherapy, or who were referred to Tygerberg Children's Hospital (TBH) for further management were studied retrospectively. The duration of admission, number and location of those transferred, processing time of blood samples and indications for transfer, were recorded. <br><I>Results.</I> A total of 3 962 infants were screened, of whom 381 were admitted to Bishop Lavis MOU for phototherapy and 40 were transferred to TBH for a possible exchange transfusion. The mean processing time of the blood samples was 6.4 hours (<u>+</u> 1.9 hours). Serious deficiencies were identified in the TSB screening system as reflected by the long blood sample to laboratory processing time (BSLPT). <br><I>Conclusion.</I> The current screening and treatment system is effective as reflected by the number of patients screened and treated at the MOU. Only 10.4% of neonates admitted to Bishop Lavis for phototherapy were transferred to TBH. The long BSLPT should be reduced. <br><I>Recommendations.</I> More phototherapy units should be set up at the MOUs. Blood processing time would be shortened by contracting a laboratory closer to the MOU.

Extracted from text ... 69 SAJOG Background It has been estimated that annually one billion women around the world suffer from non-sexually transmitted urogenital infections, which include bacterial vaginosis, yeast vaginitis and lower urinary tract infections1. Although the initial response of the majority of patients to antibiotic treatment or anti-fungal therapies is positive, the recurrence rate is generally high. These infections remain a serious medical problem, particularly because they increase the risk of acquiring sexually transmitted diseases, including HIV, and can lead to preterm birth2. Although a number of reasons for the high incidence of these infections can be identified (sexual practices, excessive ..

<I>Objectives.</I> Use of nevirapine for prevention of mother-to-child transmission (PMTCT) of HIV-1 has been routine clinical care at Coronation Women and Children's Hospital since April 2000.We assessed the effect of regular audit and targeted interventions on the utilisation of the PMTCT programme. <br><I>Methods.</I> Review of antenatal cards and hospital records of women discharged following delivery, in three time periods between October 2000 and February 2002. Following the initial audit an intervention was implemented to eliminate weaknesses in our PMTCT service. Following the second audit the hospital became a pilot site for the Gauteng PMTCT programme. <br><I>Results.</I> In the initial audit 53.2% of women (159/299) were tested for HIV and received their results, while 56% (14/25) of identified HIV-infected women, and 16% (4/25) of their infants, received nevirapine. By the third audit 74.3% of women (266/358) received their results, and 86% (43/50) of HIV-positive women and 74% (37/50) of newborns were documented to have received nevirapine. In all three audits over 90% of women initiating antenatal care at the hospital were tested for HIV, while women who initiated care at district community clinics were less likely to receive testing. <br><I>Conclusions.</I> Ongoing audit has been important for targeting obstacles to detection of HIV-infected women and documented nevirapine uptake by women and infants. Rates of HIV testing and nevirapine use have increased significantly. Voluntary counselling and testing for HIV and use of nevirapine are acceptable to pregnant women in our setting. Roll-out of the pilot programme to district community clinics is essential for further improvement.

Extracted from text ... SAJOG 78 In the year 2000, 529 000 maternal deaths were recorded throughout the world. Of these, 95% occurred in Africa and Asia, 4% in Latin America and the Caribbean, and less than 1% in the developed countries. The global maternal mortality rate is 400 per 100 000 live births, while it is 830/100 000 in Africa, followed by 330/100 000 in Asia (excluding Japan). Worldwide, 13 developing countries account for 70% of all maternal deaths.1 According to a United Nations (UN) report, African women are 175 times more likely to die during pregnancy and childbirth than Westerners. Overall, ..