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- Volume 15, Issue 1, 2009
South African Journal of Obstetrics and Gynaecology - Volume 15, Issue 1, 2009
Volume 15, Issue 1, 2009
Author B.G. LindequeSource: South African Journal of Obstetrics and Gynaecology 15 (2009)More Less
It is generally accepted that knowledge ages rapidly. This is true for medicine (as far back as the days of Osler - and in fact the days of Hippocrates) and for literally every other discipline. The practitioner who does not keep his or her knowledge up to date may therefore soon lack current factual knowledge. Developments in the field of medicine are so rapid that this situation will soon become hazardous to both patient and practitioner. The counter-argument, that experience leads to better understanding and that applied knowledge is in any case what is important, does not totally hold water. Experiential learning takes place in the context of a factual background that has to be maintained.
Gynaecological Oncology Society, Maternal and Fetal Society and Update meetings : CSIR, Pretoria, May 2009 : abstractsAuthor Leon SnymanSource: South African Journal of Obstetrics and Gynaecology 15, pp 4 –25 (2009)More Less
Maternal outcomes following introduction of antiretroviral therapy in the public sector : a prospective study at a tertiary hospital in the Eastern Cape : research articleAuthor Ebrahim BeraSource: South African Journal of Obstetrics and Gynaecology 15, pp 26 –33 (2009)More Less
Background. Antiretroviral therapy (ART) has been available in the public sector since 2004, but limited published data exist on maternal outcomes in South Africa following its introduction.
Objectives. A prospective study of maternal outcomes after the introduction of ART at Frere Hospital, East London, E Cape.
Methods. Pregnant women with indications for lifelong ART were commenced on treatment, and followed up until 6 weeks after delivery. Baseline demographic details were collected, including details on the gestation and mode of delivery. The mothers and their infants were then referred to local ART centres for continued care. Maternal outcomes measured were maternal death, and predefined maternal morbidity. Results were analysed using Epi-info software version 3.3.2 (2005).
Results. Data on 385 women are presented. The women initiated ART at a median age of 28 years. Median gestation at commencement of ART was 30 weeks. The median CD4 count and HIV-1 RNA viral load (VL) were 173 cells / μ l and 4.56 log10 copies / ml, respectively. Fifty-five (14.3%) and 19 women (4.9%) had World Health Organization (WHO) stage 3 and stage 4 disease, respectively. Twenty-five (6.5%) were concurrently on treatment for tuberculosis (TB) while 10% had other co-infections - meningitis, hepatitis, pneumonia and urinary tract infections. Immune reconstitution inflammatory syndrome (IRIS) occurred in 7.0% of cases, and pre-eclampsia developed in 7.5%. Median gestation at delivery was 39 weeks. Seven maternal deaths (1.8%) occurred in this cohort. All 7 women died in the postpartum period. Five women died within 5 weeks of commencing ART. Two women died of Pneumocystis jirovecii pneumonia (PCP) and another 2 died from liver failure - 1 death was presumed to be from lactic acidosis related to stavudine (d4T) toxicity. The 3 remaining deaths were due to PCP IRIS, meningitis and TB, respectively. The strongest predictor of maternal death was WHO stage 4 disease (p=0.0006). Maternal plasma VL > 5.00 log10 copies / ml, pre-eclampsia, IRIS, concurrent ART and tuberculosis treatment, and CD4 count < 100 cells / μ l were not significantly predictive of maternal death on multivariate analysis.
Conclusion. Despite the availability of ART in the public sector, maternal mortality remains a concern. Reasons include late entry of pregnant women into care, as well as suboptimal management of women initiated on ART who develop opportunistic infections. There is an urgent need to develop national ART guidelines specifically for pregnant women.
Source: South African Journal of Obstetrics and Gynaecology 15, pp 34 –36 (2009)More Less
Objective. To evaluate ovarian function in 29 patients who underwent uterine artery embolisation (UAE).
Methods. Twenty-nine patients with myomas of the uterus underwent UAE using polyvinyl alcohol (PVA) particles with a diameter of 150 - 550 μm. Follicle-stimulating hormone (FSH) levels were measured before and after UAE.
Results. The median age of the patients was 39 years (range 19 - 51 years). Two patients (7%) were menopausal before UAE was attempted. In 3 patients (10.3%), normal pre-procedural FSH values rose to menopausal levels afterwards (95% confidence interval (CI) 3.6 - 26.4%). Only 1 of these patients was younger than 40 years of age (39 years). Of 15 patients less than 40 years of age, 6.7% (95% CI 1.2 - 29.8%) therefore developed a significant rise in FSH levels. One patient, aged 35 years, developed temporary amenorrhoea and endometrial atrophy, which returned to normal within a year.
Conclusions. UAE resulted in ovarian failure in 7% of patients younger than 40 years of age and 10% of patients overall.
The postoperative analgesic effects of low-dose gabapentin in patients undergoing abdominal hysterectomy : research articleSource: South African Journal of Obstetrics and Gynaecology 15, pp 37 –40 (2009)More Less
Objective. Clinical studies have suggested that gabapentin may produce analgesia in postoperative patients. The aim of this study was to investigate the analgesic effects of low-dose gabapentin administered during the first 24 hours after abdominal hysterectomy.
Methods. A prospective, double-blind, randomised study was conducted on 98 patients undergoing abdominal hysterectomy. The patients were divided into two groups: 49 patients received oral gabapentin 400 mg 1 hour before surgery, followed by a further 100 mg 8, 16 and 24 hours after the initial dose, and 49 received placebo. Morphine (5 mg) was used for rescue analgesia. Pain intensity was self-evaluated using a 100 mm visual analogue scale. Data were analysed using SPSS software version 15.0, and the level of significance was set at p< 0.05.
Results. Compared with the placebo group, patients who received gabapentin perceived a significant reduction in postoperative pain in the first hours after hysterectomy (2 hours: 38.9±18.1 v. 74.9±15.2, p<0.05; 6 hours: 37.9±20.8 v. 76.6±22.4, p<0.05; 12 hours: 35.8±24.4 v. 79.7±25.7, p<0.05; 18 hours: 36.3±19.1 v. 71.7±20.7, p<0.05; 24 hours: 40.1±14.5 v. 52.7±21.1, p<0.05). Opioid requirements 2 hours after surgery were also significantly lower in the gabapentin group than in the placebo group (21 v. 40 patients, p<0.05). No side-effects were reported in either group.
Conclusions. Low-dose gabapentin can reduce opioid requirements after abdominal hysterectomy, and increase patient comfort postoperatively.
Source: South African Journal of Obstetrics and Gynaecology 15 (2009)More Less
A two-party political system, like Britain's or the USA's, leads to a cup-final atmosphere on election night, with the winner usually becoming obvious well before the final whistle. Already, though, when we think of the 2008 US presidential race, what stands out is not the final campaign between Barack Obama and that other decent chap but the brutal slugfest between the two Democratic candidates to become either the first woman or the first African-American to run for President. Now they're the best of pals, apparently. That's politics for you.