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- South African Journal of Obstetrics and Gynaecology
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- Volume 15, Issue 3, 2009
South African Journal of Obstetrics and Gynaecology - Volume 15, Issue 3, 2009
Volume 15, Issue 3, 2009
Appropriate technology and education for improved intrapartum care in under-resourced countries : innovationsAuthor David WoodsSource: South African Journal of Obstetrics and Gynaecology 15, pp 78 –79 (2009)More Less
Each year, over a million infants die worldwide during labour, while an even greater number die on the first day of life. As deaths in the first 24 hours after delivery make up approximately a third of neonatal deaths and a fifth of deaths in under-5s, intrapartum events resulting in these losses need to be urgently addressed if the fourth Millennium Development Goal of reducing under-5 deaths by two-thirds is to be met by 2015.
Source: South African Journal of Obstetrics and Gynaecology 15, pp 82 –85 (2009)More Less
Objective. A national survey of the management of anterior vaginal prolapse by gynaecologists and urologists in South Africa.
Methods. 822 questionnaires were sent by post to all registered gynaecologists and urologists in South Africa.
Results. 47 questionnaires were returned undelivered, and 234 (30.2%) were returned completed. The respondents comprised 180 gynaecologists (23.2%) and 54 urologists (7.0%). The POP-Q staging system was most commonly used (37.6%), but 36.3% did not use any recognised system. Urodynamic investigation was done pre-operatively by 8.6% of the gynaecologists and 20.8% of the urologists (p=0.0121, 95% confidence interval (CI) 24.0 - 0.7%). Anterior colporraphy was done by 85.5% of the respondents and vaginal paravaginal repair by 41.9%, and mesh was used by 55.1%. Urologists made use of mesh more often than gynaecologists (p=0.001, 95% CI 43.3 - 16.9%).
Conclusion. The practice of anterior vaginal prolapse repair was fairly standard except for a few reports of preoperative urodynamics by gynaecologists and high use of synthetic mesh by urologists.
Combined stress urinary incontinence surgery at the time of prolapse surgery - is it justified? : reviewSource: South African Journal of Obstetrics and Gynaecology 15, pp 86 –88 (2009)More Less
Objectives. To review the current literature in order to formulate an evidence-based approach to the problem of preventing stress urinary incontinence (SUI) following prolapse surgery.
Design. We reviewed the current English language literature available on PubMed (Medline), as well as current relevant textbooks in print.
Results. It appears that a prophylactic anti-incontinence procedure is justified in patients with pre-operative SUI, as well as in those with a positive stress test at reduction. In patients with no pre-operative evidence of occult SUI, management is still controversial.
Conclusions. Further research is needed, specifically with regard to standardisation of the stress test, the place of suburethral slings and the role of pelvic floor ultrasound.
Source: South African Journal of Obstetrics and Gynaecology 15, pp 90 –93 (2009)More Less
The definition of shoulder dystocia and the incidence vary. Worldwide, shoulder dystocia may be increasing. In this update we look at the complications for both mother and fetus, and review the risk factors and strategies for possible prevention. Management options include the McRoberts position, techniques to deliver the anterior and posterior shoulder, and finally salvage manoeuvres, which include posterior axillary sling traction (PAST), the Zavanelli manoeuvre and fracture of the clavicles. In cases of fetal death associated with undelivered shoulder dystocia, one can consider the trans-abdominal performance or facilitation of traditional vaginal manoeuvres.
We suggest a simplified mnemonic, 'MAPS' - M: McRoberts, A: anterior shoulder, P: posterior shoulder, and S: salvage. A video teaching programme will be available shortly on the World Health Organization Reproductive Health Library (www.who.int/rhl; firstname.lastname@example.org).
Does completion of the Essential Steps in Managing Obstetric Emergencies (ESMOE) training package result in improved knowledge and skills in managing obstetric emergencies? : researchSource: South African Journal of Obstetrics and Gynaecology 15, pp 94 –99 (2009)More Less
Objective. To assess the effect of the Essential Steps in Managing Obstetric Emergencies (ESMOE) training programme on improving knowledge and skills of interns.
Method. Interns starting their internship in Obstetrics and Gynaecology in May 2008 were asked to participate in the ESMOE training programme at all the sites where facilitators had been trained in ESMOE. At these sites, interns completing their obstetric and gynaecology rotations were asked to undergo an evaluation at the end of April; this group acted as a control group. Interns participating in the ESMOE training had the same evaluation before starting the course in May and at the end of August.
Outcomes. Scores obtained in knowledge testing by multiple choice questions (MCQ) and skills testing by objective structured clinical examination (OSCE).
Results. A total of 68 interns completing their O&G rotation in April wrote the MCQ paper from 8 hospitals. Twenty of them were randomly chosen to do the skills test. This group served as the control for the study group that underwent the training. Seventy-eight of the new group of O&G interns starting in May wrote the MCQ paper as a pre-test, and 21 were randomly chosen to do the skills test. The ESMOE training was then conducted. In August, this group re-wrote the MCQ paper as a post-test, and 24 were randomly selected to do the skills test. The post-test MCQ scores of the study group were significantly higher than their pre-test scores and those of the control group of interns (79 (58 - 93), 75 (48 - 91) and 77 (57 - 86) respectively). Similarly, the post-test OSCE scores of the post-test study group were significantly higher than their pre-test scores and those of the control group of interns (30.75 (25 - 38), 19.75 (8.5 - 27.5) and 24.5 (14.4 - 31) respectively).
Conclusion. Completion of the ESMOE training package resulted in a significant improvement of interns' knowledge and skills compared with that before the course or with other interns who had already completed their O&G rotation.
Author James DrifeSource: South African Journal of Obstetrics and Gynaecology 15 (2009)More Less
As I write, 6 000 gynaecologists are packing their bags to come to Cape Town. At the end of the FIGO Congress they will have many memories to take home, but for all of them an abiding image will be the looming presence of Table Mountain. Whether or not they ride the cableway, and even if the summit is cloud-capped all week, they will remember the sandstone crag that defines the city. People who live nearby forget the impact of such iconic sights. When I was a medical student in Edinburgh I was far too sophisticated to join the tourists visiting the local castle, though I had to admit that the rock on which it stood could look breathtaking in the rare Scottish sunshine.