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- Volume 13, Issue 3, 2007
South African Journal of Obstetrics and Gynaecology - Volume 13, Issue 3, 2007
Volume 13, Issue 3, 2007
Author Tobie De VilliersSource: South African Journal of Obstetrics and Gynaecology 13, pp 76 –78 (2007)More Less
Attitudes regarding HRT changed significantly in 2002, after the publication of the first results of the Women's Health Initiative study (WHI). The fear of a reported increased risk of coronary artery disease (CAD) and breast cancer resulted in a 50% decrease in the use of HRT. The message delivered to a captive worldwide audience was simple and clear : HRT may only be used for the treatment of severe menopause-related symptoms, for the shortest possible time and at the lowest effective dose.
Source: South African Journal of Obstetrics and Gynaecology 13, pp 80 –83 (2007)More Less
Objective. To evaluate the success rate of sacrocolpopexy in 153 patients with stage 3 and 4 vault prolapse.
Methods. A retrospective review was done on 153 patient records from a database in a urogynaecological unit. For the sacrocolpopexy procedure, semi-absorbable mesh was placed along the anterior and posterior vaginal walls, and attached to the anterior longitudinal ligament of the sacrum.
Results. The median age was 65 years and parity 3.0; 94% of the patients were white. Previous surgery for prolapse was reported by 48% of the patients and 25% were on thyroid hormone treatment. The vault prolapse was stage 3 in 81 patients (52.9%) and stage 4 in 72 (47.1%). At surgery, the mesh extended from the vaginal vault to the sacrum in 7 patients (4.6%). In the remaining 146 patients (95.4%) the mesh was attached to the posterior vaginal wall and in 133 (86.9%) a second strip of mesh was fixed to the anterior vaginal wall. Follow-up was possible in 149 patients (97.4%), with a median of 29 months. Recurrent prolapse (any type) occurred in 22 patients (14.4%) and 12 had repeat surgery for recurrent prolapse (7.8%). In total, 25 patients (16.3%) had repeat surgery for any indication.
Conclusions. Vault prolapse is difficult to treat owing to absence of support of the upper vagina, but sacrocolpopexy delivered acceptable results.
Combined abdominal sacrocolpopexy and Burch colposuspension for the treatment of stage 3 and 4 anterior compartment prolapseSource: South African Journal of Obstetrics and Gynaecology 13, pp 84 –90 (2007)More Less
Objective. To review our experience with sacrocolpopexy and Burch colposuspension for stage 3 and 4 anterior compartment prolapse.
Methods. Review of 154 patient records drawn from a urogynaecological database, with stage 3 and 4 anterior compartment prolapse treated by sacrocolpopexy and Burch colposuspension.
Results. The median age of the patients was 60 years and a third of them had had previous prolapse surgery. Patients presented with bladder (41%) and bowel (55%) symptoms, and most complained of prolapse protruding through the vaginal introitus (86%). Recurrent prolapse, stage 2 - 4, occurred in 24 patients (15.6%); 9.7% were anterior compartment prolapses. Where mesh was omitted from the anterior vaginal wall but placed on the posterior vaginal wall, significantly more recurrent anterior compartment prolapses occurred (95% confidence interval (CI) 0.2%; 34.8%) compared with cases where mesh was placed both anteriorly and posteriorly to the vagina. Perioperative complications occurred in 13% of patients. A tension-free vaginal tape (TVT) procedure for urinary stress incontinence was done at a later stage in 8% of the patients.
Conclusion. Sacrocolpopexy effectively treated anterior compartment prolapse where mesh was attached to the anterior vaginal wall as well. A Burch colposuspension probably did not make a difference.
Source: South African Journal of Obstetrics and Gynaecology 13, pp 92 –96 (2007)More Less
Background. This study describes the demographics and clinical characteristics of women with obstetric fistulas attending the urogynaecological unit at King Edward VIII Hospital (KEH), KwaZulu-Natal (KZN), South Africa.
Method. A prospective clinical review of all women admitted with the diagnosis of an obstetric fistula at KEH from 1999 to 2003.
Results. A total of 41 cases from the rural areas of KZN and the Eastern Cape were identified. The mean age was 29 years (range 15 - 51 years), and 21 were primigravidas, 14 of whom had unplanned pregnancies. All were from low socioeconomic backgrounds and had limited or no access to antenatal care, either due to their social circumstances or to lack of health care facilities. The duration of labour was prolonged in all; there were 5 live births, and 2 neonatal deaths.
Conclusion. Obstetric fistulas are still common in KZN and the Eastern Cape, and occur mainly in women from rural areas.
The Sexual Function and Influence of Urinary Incontinence Questionnaire (SFIUIQ) - assessing sexual function of urinary incontinent women in South AfricaSource: South African Journal of Obstetrics and Gynaecology 13, pp 98 –103 (2007)More Less
Objective. To develop and psychometrically validate a questionnaire that assesses sexual function of urinary incontinent women in South Africa and the influence of incontinence on their sexual function.
Design. A prospective descriptive study.
Setting. Urogynaecology and gynaecology outpatient clinics at Tygerberg Hospital, Stellenbosch University, South Africa.
Subjects. All patients attending the urogynaecology or gynaecology outpatient clinic at Tygerberg Hospital, who were older than 18 years, not pregnant and could communicate in either Afrikaans or English.
Outcome measures. The content validity, reliability (internal consistency) and construct validity (convergent and discriminant validity) of the Sexual Function and Influence of Urinary Incontinence Questionnaire (SF-IUIQ).
Results. Of the subjects 33% were not sexually active. Sexual quality of life was significantly influenced by urinary incontinence in 37.7% of individuals. Leakage during sexual activity occurred in 32%.
Conclusions. The SF-IUIQ is a reliable and valid measure of sexual function in urinary incontinent women, and of the influence of urinary incontinence on sexual function.
Gamete intrafallopian transfer versus super-ovulation with intrauterine insemination for the treatment of infertilitySource: South African Journal of Obstetrics and Gynaecology 13, pp 104 –109 (2007)More Less
Background. A prospective randomised controlled trial comparing gamete intrafallopian transfer (GIFT) with intrauterine insemination (IUI) was undertaken at the Fertility and Reproductive Biology Unit of the Department of Obstetrics and Gynaecology, Tygerberg Hospital, between July 1999 and June 2000.
Method. Eighty-five women were included in the study and were randomly allocated between the two groups after routine infertility investigations, 41 women to IUI and 44 women to GIFT. A combination of clomiphene citrate and human menopausal gonadotropin was administered to both groups to achieve ovulation.
Results. Six (13.6%) of the 44 cycles in the IUI group and 24 (53.3%) of the 45 cycles in the GIFT group achieved conception. The mean number of cycles needed to achieve pregnancy in IUI was 7.3 (44/6) and in GIFT was 2.05 (45/24). The ongoing pregnancy rate of GIFT was 39.7% more effective than that of IUI (p=0.0001.The total ongoing pregnancy rate of GIFT was 30.8% superior to that of IUI (p=0.0021). When 2 follicles were obtained in an IUI cycle, GIFT was 41.6% more effective (p=0.0024), and when more than 2 follicles were obtained, GIFT was 28.3% more effective (p=0.0265).
Conclusions. The number of mature follicles significantly increased the chance of pregnancy with IUI. In comparing the number of cycles needed to achieve a pregnancy, 1 GIFT cycle is equivalent to more than 3 IUI cycles. It is important to note that 4 IUI cycles will give equivalent or even better results if 2 - 3 follicles are recruited per cycle. In spite of the greater efficacy of GIFT, the authors conclude that at least 3 to 4 IUI cycles should be attempted before GIFT, on the basis that it is more cost effective and less invasive.
Source: South African Journal of Obstetrics and Gynaecology 13, pp 110 –117 (2007)More Less
This guideline was compiled for use in the Western Cape Province of South Africa by a Provincial Reference Group with contributions from staff of the health facilities and academic institutions in the province. It follows on the recommendations of the Saving Mother's Report (recommendation No. 1 - to have protocols on the management of important conditions causing maternal deaths available at all institutions). It was accredited by the Western Cape Clinical Guidelines Advisory Committee, a group established by the Provincial Government of the Western Cape to advise on matters related to the development of clinical guidelines that deal with interventions provided at all levels of care, and to accredit those guidelines that meet pre-specified standards or criteria. Professor J Volmink, director of the South African Cochrane Centre, chairs the advisory group.
The goal should be to reduce deaths due to postpartum haemorrhage (PPH) to less than 5% of the total maternal deaths.
Author Athol KentSource: South African Journal of Obstetrics and Gynaecology 13, pp 118 –119 (2007)More Less
The major journals have published much on replacement therapy after the menopause in 2007. It has been intriguing watching the pendulum swing, and the following summaries of what they printed give a good idea where the establishment now stands.
Transdermal estrogen HRT
HRT and breast cancer
A new approach to incontinence
Neural tube defects and fortification
Author James DrifeSource: South African Journal of Obstetrics and Gynaecology 13 (2007)More Less
As I write, England have just got through to the Rugby World Cup Final, to face either Argentina or South Africa. Suddenly everyone here is a rugby enthusiast. Only a few weeks ago the team was being written off as a bunch of has-beens and no-hopers. When it comes to sporting loyalty, English fans are as changeable as English weather. Our newspapers are worse. The semi-final against France gave them an excuse for rerunning stories of European military campaigns going back to the eleventh century AD.