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- Volume 17, Issue 3, 2011
South African Journal of Obstetrics and Gynaecology - Volume 17, Issue 3, 2011
Volume 17, Issue 3, 2011
Author Chantal StewartSource: South African Journal of Obstetrics and Gynaecology 17, pp 54 –55 (2011)More Less
The theme of this year's SASUOG Congress is 'The Magic of Ultrasound'. It is truly magical when the face of the fetus in utero can be seen in three dimensions as clearly as a photograph taken of a newborn. Even more dramatic is the real-time motion video of the fetus gyrating, sucking its fingers and moving hands away from its face to reveal its smile. When twins can be seen playing with each other's umbilical cords, small ventricular septal defects can be detected at 12 weeks' gestation, and pre-eclampsia and growth restriction can be predicted by ultrasound combined with blood tests, we are indeed in the realm of a new world. Less than a hundred years ago antibiotics had not yet been discovered, frogs were used to diagnose pregnancy, and close to one in a hundred women were dying during pregnancy. The technological advances that have been made are incredible. However, with advances in technology come problems of resources, of ethics and of training. Our challenge is to address these issues.
Laparoscopic myomectomy for infertile patients with intramural fibroids : a retrospective study at a tertiary endoscopic centre : original articleSource: South African Journal of Obstetrics and Gynaecology 17, pp 56 –62 (2011)More Less
Background. The safety of laparoscopic myomectomy has been questioned, especially in the case of fibroids.
Objectives. To assess the safety of laparoscopic myomectomy for intramural fibroids and study the subsequent effect on fertility.
Methods and settings. A retrospective study of a tertiary endoscopic centre specialising in laparoscopic myomectomy.
Results. Eighty-seven patients were studied, and there were no major complications. The conversion rate from laparoscopy to laparotomy was 3.4% (3/87), in all cases due to multiple fibroids. There was 1 case of uterine perforation during hysteroscopy. The overall pregnancy rate was 29/64 (45.3%), with a spontaneous pregnancy rate of 18/29 (62.0%).
Conclusions. Laparoscopic myomectomy can be regarded as a safe alternative to abdominal myomectomy in the hands of the experienced surgeon, resulting in good subsequent pregnancy rates.
Author Zeelha AbdoolSource: South African Journal of Obstetrics and Gynaecology 17, pp 64 –67 (2011)More Less
Introduction. The use of vaginal pessaries for conservative management of pelvic organ prolapse (POP) is well established. However, there are limited data on current clinical practice among gynaecologists, and the aim of this survey was therefore to evaluate vaginal pessary use among South African gynaecologists.
Methods. An anonymous self-administered one-page questionnaire was designed by the author and given out to South African gynaecologists at a local obstetrics and gynaecology meeting in 2009.
Results. The response rate was 31.7% (133/420). Of the respondents, 23.6% (29/123) offered vaginal pessaries as first-line treatment for POP in their clinical practice. The ring pessary was the commonest pessary used for all compartmental defects. The two most favoured reasons for pessary use were surgical or anaesthetic risk (64.0%, 85/133) and patient declining surgery (49.6%, 66/133). Recurrent involuntary expulsion (51.9%, 69/133), discomfort (41.3%, 55/133) and opting for surgery (39.1%, 52/133) were the three top reasons for discontinuation of pessary use. Of the respondents 87.6% (92/105) indicated that they would review patients within 6 weeks after initial pessary insertion, and thereafter 45.8% (44/96) would review patients at 3 - 6-monthly intervals.
Conclusion. Compared with surveys elsewhere, fewer South African gynaecologists offer vaginal pessaries as first-line treatment to patients with symptomatic pelvic organ prolapse. Practice trends similar to those elsewhere included choice of pessary, follow-up interval and reasons for pessary discontinuation.
Effect of topical lignocaine on postoperative pain after laparoscopic tubal sterilisation in awake patients : original articleSource: South African Journal of Obstetrics and Gynaecology 17, pp 68 –70 (2011)More Less
Objective. To evaluate postoperative pain after administration of topical lignocaine during laparoscopic sterilisation in awake patients using Falope rings.
Study design. Thirty-six women who underwent laparoscopic tubal sterilisation were assigned randomly to receive topical lignocaine (1%, 10 ml) or placebo. A 4-point verbal rating score was used to assess pain at ring application, 15 minutes and 1 hour thereafter, and at discharge. Side-effects, complications, extra pain medication requirements and satisfaction rates at follow-up were assessed postoperatively.
Results. The pain scores were significantly lower in the lignocaine group than in the placebo group at 15 minutes (2.06 v. 2.94) and 1 hour (1.187 v. 2.33) and at discharge (0.18 v. 1.1). The side-effects and complications were similar in the two groups. Procedure satisfaction and acceptability were higher in the lignocaine group (p=0.005).
Conclusion. Topical lignocaine applied to the fallopian tubes at the time of laparoscopic tubal sterilisation decreases postoperative pain and improves satisfaction rates even if done under sedation and local anaesthesia.
Awareness and use of and barriers to family planning services among female university students in Lesotho : original articleSource: South African Journal of Obstetrics and Gynaecology 17, pp 72 –78 (2011)More Less
Background. Unwanted pregnancy and sexually transmitted infections (STIs) among young women can be prevented through dual protection (i.e. condom use plus another method). Unmet needs for contraception and rates of unintended pregnancy among young women are high in the developing world.
Aim. To assess the level of awareness of contraceptives and utilisation of family planning services among young women, and barriers that hinder effective use of such services.
Methods. In a quantitative descriptive survey, 360 female undergraduate students at the National University of Lesotho responded to a hand-delivered self-administered questionnaire.
Results. Awareness of family planning was high (97.5%). The condom was the most commonly known and used family planning method. The level of sexual experience and the prevalence of contraceptive use were high. Access to services was good. There were some misconceptions, e.g. that contraceptives other than the condom, such as natural family planning (4.7%), the vaginal ring (3.3%) and male or female sterilisation (2.8%), can prevent STIs. Married status was associated with current use of contraceptives, and having been formally taught about family planning was associated with the belief that it causes cancer. The unmet contraceptive need in the sample was 24.9%.
Conclusion. Levels of awareness and utilisation of family planning services are high among female students at the University of Lesotho. There is a need to introduce family planning teaching based on accurate facts into the school curriculum.
Source: South African Journal of Obstetrics and Gynaecology 17, pp 80 –81 (2011)More Less
We report 3 cases of advanced abdominal pregnancy in HIV-positive women managed at the East London Hospital complex between 2005 and 2009. Despite the complexity of diagnosis and management of this life-threatening condition, no adverse effects occurred in the women in our series and 2 of the babies survived.
Source: South African Journal of Obstetrics and Gynaecology 17, pp 82 –89 (2011)More Less
Combined ultrasound very early diagnostic scan (CUVEDIS) : the advantages of fetal anomaly scan at the NT examination
What you see depends on what you look at : genetic-fetal ultrasound perspective
First-trimester fetal cardiovascular system
Ultrasound in placenta accreta
Invasive testing in HIV-positive women
Fetal euthanasia - who benefits?
Clinical anatomy of the pelvic floor
Pelvic floor trauma
Mesh surgery for incontinence and prolapse : an imaging perspective
Adnexal masses in pregnancy - how to work them out
Nasal bone : fact or myth?
Early (14 - 16-week) scan versus late (18 - 22-week) scan
Fetal anaemia - why is it still a headache?
Skeletal dysplasias, the genetic link
The fetal heart - what really matters
Ultrasound safety and the ALARA principle
Routine scan policy - from the dark ages to the bright future
Counselling for Down syndrome screening in private practice
Postmortem - how it assists in diagnosis
Obstetrics and gynaecology ultrasound services can assist medical officers at primary health care level : Khayelitsha CHC
Twin pregnancy with a complete hydatiform mole and surviving coexistent fetus : case report and review of the literature
Author H.S. CronjeSource: South African Journal of Obstetrics and Gynaecology 17 (2011)More Less
When the sensitivity of a test such as the Pap smear is determined, both positive and negative results should be submitted to the gold standard of histology. If this is not done, the sensitivity will be unrealistically high. The human papillomavirus (HPV) test has not been adequately investigated in this way. In this letter I report a preliminary study in which the HPV test was evaluated against histology in all cases.
Author James DrifeSource: South African Journal of Obstetrics and Gynaecology 17 (2011)More Less
At my age a doctor is expected to take an interest in medical history, but actually it became my guilty pleasure long before I retired. Whenever I was asked to give a talk on 'The historical perspective' I cheerfully agreed, even before I knew what the conference was about. Unearthing facts about the past was fascinating whether my title was, say, 'Contraception through the ages' or 'The origins of the endoscope', but I'm afraid audiences found the results equally boring. Seasoned conference-goers know all about crocodile dung in Ancient Egypt or candles in 19th-century Vienna, and could only hope that I would get them the wrong way round.