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- Volume 16, Issue 1, 2010
South African Journal of Obstetrics and Gynaecology - Volume 16, Issue 1, 2010
Volume 16, Issue 1, 2010
Author Franco GuidozziSource: South African Journal of Obstetrics and Gynaecology 16 (2010)More Less
On behalf of the Local Organising Committee I wish to extend a warm welcome to all who are attending the 2010 SAMS Congress and hope that you thoroughly enjoy it. This is the first national congress following FIGO, and we have had to work very hard to put together a programme that will not only be informative and progressive but will also provide aspects that are diverse yet reflect the reality of both the ageing male and female.
Risk factors for perinatal HIV-1 transmission in pregnant women requiring lifelong antiretroviral therapy : a longitudinal study at a tertiary hospital in South Africa : researchSource: South African Journal of Obstetrics and Gynaecology 16, pp 6 –13 (2010)More Less
Objectives. To estimate the infant HIV-1 transmission rate and to evaluate risk factors for transmission in pregnant women at an Eastern Cape tertiary hospital requiring lifelong antiretroviral therapy (ART).
Methods. Pregnant women who initiated lifelong ART during pregnancy and others who conceived on lifelong ART were followed up antenatally, through delivery, until 6 weeks postpartum. A qualitative HIV-1 DNA polymerase chain reaction (PCR) was done on the infants at 6 weeks. Risk factors evaluated for perinatal HIV transmission included CD4 count, duration of ART, plasma HIV-1 RNA viral load (VL) at delivery, preterm birth, and mode of delivery.
Results. Data on 838 women with 858 live births are presented. The median CD4 count was 192 cells/μl, and the median duration of ART was 12 weeks. Of 618 women (73.7%) with VL results at delivery, 555 women (89.8%) had a VL <1 000 copies/ml. HIV-1 DNA PCR was performed on 665 out of 831 infants (80%) from 6 weeks onwards. Transmission occurred in 16 infants (2.4%; 95% confidence interval (CI) 1.4 - 4.0). The transmission rate was 7.8% with maternal plasma VL ≥1 000 copies/ml (p=0.018), 4.2% with duration of ART <10 weeks (p=0.010), and 8.6% with preterm birth (p=0.046). On multivariable regression analysis VL ≥1 000 copies/ml (adjusted odds ratio (AOR) 12.82; 95% CI 1.72 - 95.53) and duration of ART <10 weeks (AOR 4.91; 95% CI 1.40 - 17.18) remained significant predictors of transmission.
Conclusions. Maternal plasma VL at delivery and duration of ART are significant independent predictors of perinatal HIV-1 transmission, but transmission can occur with undetectable plasma VL at delivery.
Delivery of the extremely low-birth-weight vertex-presenting baby - caesarean section or the vaginal route? : reviewSource: South African Journal of Obstetrics and Gynaecology 16, pp 14 –16 (2010)More Less
Improvements in neonatal care have resulted in a downward shift of the viability threshold for preterm babies. In general, the lower the gestational age and birth weight at delivery, the higher the chance of mortality and morbidity. Some may argue that the softer cranium and vulnerable brain of the extremely low-birth-weight baby should not be exposed to the 'stresses' of vaginal birth. In this article we briefly discuss the difficulties in decision making surrounding the lowest thresholds of viability and examine what the literature has to say regarding route of delivery. It is important that parents only make these difficult decisions after being fully informed of the likely short- and long-term outcomes. With regard to route of delivery we conclude that in the absence of an obstetric indication there is no clear evidence to support performing a caesarean delivery.
High prevalence of urinary incontinence and poor knowledge of pelvic floor exercises among women in Ladysmith : researchSource: South African Journal of Obstetrics and Gynaecology 16, pp 18 –21 (2010)More Less
Introduction. The purpose of the study was to determine the prevalence of urinary incontinence in Ladysmith, KwaZulu-Natal, the health-seeking behaviour of affected women, and women's knowledge of pelvic floor exercises.
Methods. Between September 2005 and November 2005, a questionnaire was administered to 99 women aged 21 - 76 years.
Results. We found that 35.4% (95% confidence interval (CI) 25.9 - 44.8%) of the sample had urinary incontinence. The most common type of incontinence was stress urinary incontinence, reported by 62.9% (95% CI 46.5 - 79.2%). Of the 99 women, 32.3% (95% CI 23.1 - 41.5%) had heard of pelvic floor muscle exercises and 18.2% (95% CI 10.6 - 25.8%) had actually done them. Of the 35 women with urinary incontinence 25.7% had sought professional help, most commonly because of a worsening in condition.
Conclusion. Although the prevalence of urinary incontinence in Ladysmith is high, knowledge about the condition and its management among both women and health service providers is poor.
Association between clomiphene citrate and central retinal vein occlusion : a case report : case reportSource: South African Journal of Obstetrics and Gynaecology 16, pp 24 –25 (2010)More Less
Central retinal vein occlusion (CRVO) is a common retinal vascular disorder associated with cardiovascular disorders and other related risk factors. A case of CRVO secondary to clomiphene citrate has been reported. We present a case that also illustrates the association between clomiphene citrate and CRVO, and hope that it will serve to increase awareness among physicians who use the drug.