- A-Z Publications
- South African Journal of Obstetrics and Gynaecology
- Previous Issues
- Volume 18, Issue 3, 2012
South African Journal of Obstetrics and Gynaecology - Volume 18, Issue 3, 2012
Volume 18, Issue 3, 2012
Source: South African Journal of Obstetrics and Gynaecology 18, pp 70 –76 (2012)More Less
Aim. To assess the impact of HIV infection on maternal deaths in South Africa from 2008 to 2010.
Method. Data extracted from the National Committee on Confidential Enquiries into Maternal Deaths database of maternal deaths, numbers of births from the District Health Information System (DHIS), and the estimated prevalence of HIV infection in the general population from the antenatal HIV and syphilis surveys were analysed. Estimations of the institutional maternal mortality ratios (iMMRs) for HIV-positive women compared with HIV-negative women and women of unknown status were made for each province and category of underlying cause of disease.
Results. The estimated iMMR for HIV-positive women was 430/100 000 live births and that for HIV-negative women 75/100 000 live births. In all categories of causes of death, the iMMR was increased in HIV-positive women. The major categories of causes of maternal death in HIV-negative women were complications of hypertensive disorders of pregnancy (18.8/100 000 live births), obstetric haemorrhage (17.2/100 000 live births) and medical and surgical disorders (11.5/100 000 live births), while in HIV-positive women they were non-pregnancy-related infections (NPRIs) (267.3/100 000 live births), obstetric haemorrhage (38.4/100 000 live births) and pregnancy-related sepsis (miscarriages and sepsis following viable pregnancies - 34.1/100 000 live births). The major complications resulting in deaths were shock (38.0%), cardiac failure (31.9%) and respiratory failure. Tuberculosis (26.9%), community-acquired pneumonia (26.7%) and pneumocystis pneumonia (13.3%), and cryptococcal meningitis (4.2%) and other meningitis (8.7%) were the main underlying causes of death in the NPRI group, of which 87.4% were HIV positive. Complications of highly active antiretroviral therapy (HAART) were recorded as the underlying cause of death in 73 women (8.1% of those on HAART).
Conclusion. HIV infection is the most important condition contributing to maternal death in South Africa. HIV-positive women are more likely to die of any underlying cause than HIV-negative women, with NPRI being the most common contributory condition.
Partner violence and associated factors among pregnant women in Nkangala district, Mpumala : researchSource: South African Journal of Obstetrics and Gynaecology 18, pp 77 –81 (2012)More Less
Objectives. To determine the prevalence of physical partner violence and associated factors among pregnant women in Nkangala district, Mpumalanga, South Africa.
Design. In a cross-sectional study, 1 502 pregnant women systematically selected at primary health care facilities were interviewed using a structured questionnaire.
Results. Almost 9% of the subjects reported experiencing physical partner violence in the past 6 months. About 19% of the women tested positive for HIV, 12.6% reported that their partners were HIV positive, and 17.3% reported having had a sexually transmitted infection (STI) other than HIV in the past 12 months. Multivariate analysis revealed that having 1 - 3 (odds ratio (OR) 2.24, 95% confidence interval (CI) 1.16 - 4.35) and 4 or more children (OR 8.00, 95% CI 2.92 - 21.96), concern that the partner drinks too much (OR 4.50, CI 2.49 - 8.00), having had an STI (other than HIV) in the past 12 months (OR 1.95, CI 1.07 - 3.58), and experiencing severe psychological distress (OR 2.02, CI 1.06 - 3.85) were significantly associated with physical partner violence in the past 6 months.
Conclusion. Physical partner violence among pregnant women in this predominantly rural setting is moderately common. Factors identified as associated with physical partner violence can be taken into consideration in partner violence interventions.
Validation of the King's Health Questionnaire for South Africa in English, Afrikaans and isiXhosa : researchSource: South African Journal of Obstetrics and Gynaecology 18, pp 82 –84 (2012)More Less
Objective. To validate the King's Health Questionnaire for urinary incontinence in the local South African English, Afrikaans and isiXhosa female community.
Design. A cohort analytical study.
Setting and subjects. The study utilised a sample of convenience. Women with urinary incontinence attending the gynaecology clinic at Tygerberg Hospital, Western Cape, were invited to participate in the project. During the study period 108 patients were recruited for the study - of these 38 were Afrikaans, 34 isiXhosa and 36 English. We retested 30 of these patients, 11 in the Afrikaans group, 9 in the isiXhosa group and 10 in the English group.
Methods. Data analysis was performed using the Statistica V10 statistical package for Windows. The reliability of the questionnaire was assessed by its internal consistency, and by measurement of its test-retest reliability. Internal consistency was measured using Cronbach's alpha coefficient. To measure test-retest reliability, the responses of the two questionnaires were compared through correlation analysis.
Results. There was good internal consistency when comparing the different domains, except for domain 1. The slightly lower Cronbach's alpha values of 0.6 - 0.65 for this domain are still acceptable and could possibly be explained by looking at the specific questions. In general there was good test-retest reliability when comparing the different combined domains.
Conclusions. This study provides a validated English, Afrikaans and isiXhosa language version of the King's Health Questionnaire for women with urinary incontinence in South Africa. However, some aspects of the test-retest reliability need further supporting evidence.
Source: South African Journal of Obstetrics and Gynaecology 18, pp 85 –87 (2012)More Less
The mean incidence of bicornuate uterus in Müllerian duct anomalies is approximately 25%, and it is associated with abortion, preterm delivery and term delivery rates of 36%, 23% and 40.6%, respectively. Open abdominal metroplasty has been shown to significantly improve pregnancy outcomes in patients with bicornuate uterus. However, minimally invasive laparoscopic metroplasty could be an alternative.
A 24-year-old woman with a bicornuate uterus and poor reproductive outcomes underwent laparoscopic Strassman's metroplasty. The procedure was completed safely within 180 minutes with minimum blood loss. At follow-up hysteroscopy and laparoscopy 2 months later, minimal adhesions in the pelvis were noted and removed. There were no synechiae in the uterine cavity.
It is concluded that laparoscopic metroplasty is a safe and relevant alternative to conventional abdominal metroplasty, with minimal adhesion formation.
Vaginal breech births in a hospital where caesarean section is preferred for breech presentation : scientific letterSource: South African Journal of Obstetrics and Gynaecology 18, pp 88 –89 (2012)More Less
Objectives. Caesarean section has become the preferred delivery method for breech presentation at Chris Hani Baragwanath Academic Hospital in Johannesburg. This study was done to determine the circumstances and outcomes of vaginal breech deliveries at the hospital.
Methods. Retrospective review of case files. Births of babies weighing ≥800 g, alive at onset of labour and without severe congenital anomaly were included.
Results. There were 90 vaginal breech deliveries. Twenty-six (28.8%) were not detected as breech on admission in labour, and 23 (25.6%) were booked for intended emergency caesarean section. Fifty-five deliveries (61.1%) were written up by registrars. In most cases there was no detail on delivery method and duration of delivery. There were 8 perinatal deaths, including 4 of babies weighing ≥2 500 g. All of the latter resulted from intrapartum hypoxia.
Conclusions. This study has shown that vaginal breech births continue to occur as unexpected events. Techniques for vaginal breech delivery remain essential skills for obstetric clinicians.
Puerperal infection after caesarean section at Chris Hani Baragwanath Academic Hospital, Johannesburg : scientific letterSource: South African Journal of Obstetrics and Gynaecology 18, pp 90 –91 (2012)More Less
Objectives. To determine the incidence of puerperal sepsis after caesarean section (CS) at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
Methods. A longitudinal descriptive study was done on women undergoing CS, with follow-up for readmission or development of sepsis, including telephone calls 14 days after delivery. Puerperal sepsis was defined as fever (temperature ≥38°C) with vaginal bleeding, malodorous discharge or pain. Women who telephonically reported pain, bleeding or malodorous discharge were classified as having possible mild wound infection.
Results and conclusion. A total of 272 women were followed up. Four (1.5%) were readmitted with puerperal sepsis, and 30 (11.0%) had possible mild wound infection. There were no significant differences between women with no evidence of infection (n=238) and those with possible infection or puerperal sepsis (n=34) with respect to indicators of socio-economic status, antenatal care attendance, antenatal anaemia, HIV status, preterm birth, elective CS or skin incision used.