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- Volume 18, Issue 1, 2012
South African Journal of Obstetrics and Gynaecology - Volume 18, Issue 1, 2012
Volume 18, Issue 1, 2012
Source: South African Journal of Obstetrics and Gynaecology 18, pp 3 –5 (2012)More Less
Antenatal invasive obstetric procedures in HIV-infected pregnant women are associated with a risk of mother-to-child HIV transmission. There are limited published data on the subject. The general consensus is that any HIV-infected pregnant woman who needs to undergo an invasive procedure should have combination antiretroviral therapy initiated before the procedure, regardless of the CD4+ cell count. The recommendations in this guideline, developed to assist clinicians in counselling and managing HIV-infected pregnant women in need of an invasive procedure, are based on small observational studies and local experience.
The effect of maternal HIV status on perinatal outcome at Mowbray Maternity Hospital and referring midwife obstetric units, Cape Town : original articleSource: South African Journal of Obstetrics and Gynaecology 18, pp 7 –10 (2012)More Less
Objectives. To study the effect of maternal HIV status on perinatal outcome at Mowbray Maternity Hospital (a secondary-level hospital in Cape Town) and its satellite community midwife obstetric units.
Design. A retrospective descriptive and comparative study.
Setting. Public sector maternity facilities serving historically disadvantaged populations.
Subjects. All deliveries at Mowbray Maternity Hospital and its referral midwife obstetric units from January to December 2008.
Outcome measures. Stillbirth, early neonatal death, perinatal mortality and neonatal encephalopathy rates in HIV-positive and HIV-negative subjects.
Results. There was a total of 18 870 deliveries at the units studied, 3 259 (17.2%) of them to HIV-positive mothers. The stillbirth rate in the HIV-positive population was 17.1/1 000 births, compared with 8.3/1 000 in the HIV-negative population (odds ratio (OR), 2.07, 95% confidence interval (CI) 1.5 - 2.8). The early neonatal death rate in the HIV-positive population was 4.6/1 000 live births, compared with 3.1/1 000 in the HIV-negative population (OR 1.46, 95% CI 0.8 - 2.6). The perinatal mortality rate in the HIV-positive population was 21.7/1 000 births, compared with 11.7 in the HIV-negative population (OR 1.91, 95% CI 1.4 - 2.5). A comparison of the pattern of primary obstetric causes of perinatal mortality showed that infection, intra-uterine growth restriction (IUGR) and antepartum haemorrhage (APH) were significantly more common as causes for perinatal death in the HIV-positive population. The risk of neonatal encephalopathy in the HIV-exposed population was 4.9/1 000 live births compared with 2.07 in the HIV-negative group (OR 2.36, 95% CI 1.28 - 4.35). The 1 643 women (8.7% of total deliveries) who were not tested for HIV were at particularly high risk of adverse perinatal outcome. This group included women who had either declined testing or not attended for antenatal care.
Conclusion. The perinatal mortality rate in the group of HIV-exposed mothers was significantly higher than that in the HIV-negative group due to a higher stillbirth rate. Infection, IUGR and APH were significantly more common obstetric causes for mortality in the HIV-infected population. The risk of neonatal encephalopathy was also significantly higher in the HIV-positive population.
Is the use of a GnRH antagonist effective in patients with polycystic ovarian syndrome? A South African perspective : original articleSource: South African Journal of Obstetrics and Gynaecology 18, pp 11 –14 (2012)More Less
Introduction. Polycystic ovarian disease (PCOS) can account for up to 35 - 40% of the female factor causes of infertility. These patients present as medically complex cases and are challenging to manage and treat successfully. They are resistant to treatment and are often offered controlled ovarian stimulation (COS) and in vitro fertilisation (IVF) technology.
Aim. The aim of this study was to assess whether there was a difference in the pregnancy outcomes of women with PCOS when a standard gonadotrophin-releasing hormone (GnRH) antagonist (cetrorelix) protocol was used for ovarian stimulation, compared with non-PCOS patients undergoing IVF.
Methods. A retrospective patient record audit was performed on 142 patients with PCOS and 501 non-PCOS patients undergoing a similar cetrorelix-based COS treatment protocol during a specified time period.
Results. The main primary outcome was an ongoing pregnancy at 12 weeks, achieved in 34% of patients in the PCOS group and 27% in the non-PCOS group. This was not significantly different (p=0.07). No patient in the PCOS group experienced severe hyperstimulation syndrome.
Conclusion. There was no significant difference in pregnancy rates in patients with PCOS undergoing GnRH-antagonist ovarian stimulation compared with non-PCOS patients. The fact that no hyperstimulation syndrome occurred makes this an attractive option for women with PCOS.
Impact of home-based exercise on quality of life of women with primary dysmenorrhoea : original articleSource: South African Journal of Obstetrics and Gynaecology 18, pp 15 –18 (2012)More Less
Primary dysmenorrhoea is chronic cyclical pelvic pain associated with menstruation in the absence of an identifiable pathological condition. While medical treatments are available for primary dysmenorrhoea, exercise is accepted as an effective intervention. This study aimed to investigate the impact of home-based exercise on pain intensity and quality of life in women with primary dysmenorrhoea. Of 45 women with primary dysmenorrhoea included in the study, 40 completed it. At the beginning of the study baseline physical activity was determined using the International Physical Activity Questionnaire (IPAQ). Pain intensity was measured on the visual analogue scale (VAS), and health-related quality of life (HRQoL) was assessed with the SF-36 health survey. A standard home-based exercise intervention was recommended for all the patients, and the outcome measures were re-assessed at the first, second and third menstrual cycles. At each menstrual cycle VAS showed a significant decrease (p<0.001). When the eight domains of the SF-36 health survey and the physical and mental component summary scores were compared between the first and fourth visits, all domains showed significant improvement (p<0.012). In our study, home-based exercise intervention seemed to provide a significant improvement in HRQoL and pain in patients with primary dysmenorrhoea.
Prediction of successful induction of labour with dinoprostone in a homogeneous group of patients : original articleSource: South African Journal of Obstetrics and Gynaecology 18, pp 19 –22 (2012)More Less
Objectives. The aim of the present study was to compare the efficiency of transvaginal ultrasonography and the Bisho's scoring system in predicting the success of labour induction.
Methods. Transvaginal ultrasonography for cervical evaluation and cervical palpation for Bishop scoring were performed in all patients by the same obstetrician. This prospective study was conducted in the Perinatology and Maternity Care Unit of Etlik Zübeyde Hanim Maternity and Women's Health Teaching and Research Hospital between September 2007 and February 2008. Eighty-four patients induced with prostaglandin E2 (dinoprostone) for medical indications were included in the study.
Results. No significant association was found between transvaginal measurement of cervical length and the success of labour induction (p=0.201). We found no statistically significant difference between failure of labour induction and successful labour induction in terms of transvaginal measurement of cervical length (area under the curve (AUC) 0.583; 95% confidence interval (CI) 0.452 - 0.714). A significant association between the Bishop's score and failure of labour induction (p=0.029) was found. A statistically significant relationship was found between failure of labour induction and successful labour induction in terms of the Bishop's score (AUC 0.632; 95% CI 0.513 - 0.751). The best cut-off point for predicting successful labour induction was a Bishop's score of 2 or more. The sensitivity and specificity levels associated with this point were 82.4% and 44.9%, respectively (positive predictive value 50.9% and negative predictive value 78.6%).
Conclusions. Bishop's scoring system was more successful than assessment of cervical length by ultrasound in predicting failed induction in a homogeneous group of patients in whom labour was induced with prostaglandin E2.
Abdominal blockage of iliohypogastric and ilio-inguinal nerves for management of post-caesarean pain : a novel method : original articleSource: South African Journal of Obstetrics and Gynaecology 18, pp 23 –27 (2012)More Less
Objective. The aim of this study was to compare pain relief after caesarean section achieved by an intra-abdominal iliohypogastric and ilio-inguinal (IHII) nerve block with levobupivacaine with that in patients given a placebo.
Study design. A total of 60 healthy women scheduled for caesarean delivery under general anaesthesia were enrolled in the study. The patients were randomised to an abdominal IHII nerve block with levobupivacaine (levobupivacaine group) or administration of saline (placebo group). Instead of the classic percutaneous method, the block was administered intra-operatively from the peritoneal aspect. Scores on a visual analogue scale (VAS) at 2, 6, 12 and 24 hours, adverse effects, morphine consumption and success of blockage by a pinprick test were recorded.
Results. In the levobupivacaine group, the pinprick test showed there to be successful bilateral block in 22 patients and unilateral block in 5, while the block failed in 3. No block was recorded in the placebo group. When morphine consumption at 12 and 24 hours were compared, consumption was found to be significantly low for both time points in the levobupivacaine group. VAS scores 2, 6 and 12 hours after the operation were also significantly lower in the levobupivacaine group.
Conclusion. A block of the IHII nerves from inside the abdomen just before abdominal closure appears to be an effective and safe way of relieving pain after caesarean section.