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- Volume 19, Issue 1, 2013
South African Journal of Obstetrics and Gynaecology - Volume 19, Issue 1, 2013
Volume 19, Issue 1, 2013
Author L. C. SnymanSource: South African Journal of Obstetrics and Gynaecology 19 (2013)More Less
Cervical cancer remains one of South Africa's biggest women's health problems, affecting one out of 41 South African women. It is estimated that this disease kills approximately 8 women in the country every day, and World Health Organization projections are that this number will increase to about 12 deaths per day in 2025. These alarming statistics should be seen in the context of cervical cancer as a preventable disease.
A comparison of orally administered misoprostol and membrane sweeping for labour induction in uncomplicated singleton post-term pregnancies : researchSource: South African Journal of Obstetrics and Gynaecology 19, pp 4 –7 (2013)More Less
Objectives. This study assessed the efficacy of the two outpatient processes of single-dose 50 µg oral misoprostol (OM) and membrane sweeping (MS) on the outcome of labour induction and the possibility of reducing the need for hospital admission for cervical ripening/ labour induction in uncomplicated post-term singleton pregnancies at a tertiary health institution in south-western Nigeria.
Methods. A total of 100 patients were equally randomised into the two groups between April 2007 and March 2010. Primary outcome measures were delivery within 48 hours after the start of induction and route of delivery. Secondary outcome measures were time interval from induction to onset of labour (latency period), time interval from start of induction to delivery (duration of labour), need for oxytocin augmentation, labour complications, Apgar scores at 1 and 5 minutes, and need for neonatal intensive care unit (NICU) admission.
Results. Both groups were similar at the baseline with regard to age, parity and days beyond 40 weeks' gestation. There was a significantly shorter induction to onset of labour (latency) interval in the OM group, with a mean of 17.0 hours compared with 31.9 hours in the MS group (p=0.005), with 82.0% of the patients in the OM group in spontaneous labour within the latency period of 18 hours as opposed to 32.6% of the MS group (p<0.005). Forty-two patients in the OM group and 40 in the MS group had a vaginal delivery (84.0% v. 87.0%, p=0.361), with 12 and 20 patients in the OM and MS groups, respectively, requiring oxytocin augmentation (p=0.023). The duration of labour was significantly shorter in the OM group, in which 78.6% of those who had a vaginal delivery achieved it within 9 hours, compared with 57.5% in the MS group (p=0.036). Overall, neonatal outcomes and need for NICU admission were similar and comparable in the two groups. On a preference scale, 43% of the women in the MS group felt positive about the intervention, compared with 92% of the women in the OM group.
Conclusion. The study demonstrated a shorter latency period, less need for oxytocin augmentation and shorter duration of labour in patients who received OM. The two induction agents were similar with regard to neonatal outcomes and need for NICU admission. Both showed good safety profiles for outpatient care, although further assessment of the safety profile with larger studies will be needed. More patients felt positive about the intervention in the OM group than in the MS group.
A comparison of post-incisional subcutaneous, intramuscular, and subcutaneous plus intramuscular infiltrations of lidocaine in postcaesarean section pain control : researchSource: South African Journal of Obstetrics and Gynaecology 19, pp 8 –12 (2013)More Less
Background. How best to relieve pain after caesarean section (CS) is still debated by many obstetricians. Pre- and post-incisional infiltrations with local anaesthetics have been widely tested and compared. However, the effect of the site of post-incisional infiltration with a local anaesthetic on the quality of pain reduction is not well documented.
Objectives. To compare the effects of post-incisional infiltration of lidocaine into the subcutaneous tissue, rectus abdominis, or both subcutaneous tissue and rectus abdominis on pain after CS.
Methods. Two hundred candidates for elective CS were randomly allocated to four matched groups of equal size. They received postincisional infiltration of either 1% lidocaine (in the rectus abdominis, the subcutaneous tissue, or both) or saline. The pain intensity and analgesic demand after CS, as well as the time to ambulation and breastfeeding, were documented and compared between the groups.
Results. Post-CS pain intensity and analgesic demand were significantly lower, and the time to ambulation was significantly less, in the lidocaine groups than in the placebo group. The time to breastfeeding, however, was comparable between the two groups. Among the patients who received lidocaine, the site of infiltration was associated with no significant differences in terms of post-CS pain intensity and need for analgesics, or time to ambulation and breastfeeding.
Conclusion. The site of post-incisional local wound infiltration with lidocaine is not a clinically important factor in pain relief after CS.
Source: South African Journal of Obstetrics and Gynaecology 19, pp 14 –16 (2013)More Less
Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is characterised by absence of the vagina and uterus and the presence of normal ovaries. It is a rare congenital anomaly of the female genital tract with a prevalence of 1 in 5 000 female newborns. There is no standard treatment, but a few techniques for creating a vagina, allowing a normal sex life, have been described. We report on a new laparoscopic vaginoplasty procedure that will create a further option for patients with vaginal agenesis.
Source: South African Journal of Obstetrics and Gynaecology 19, pp 17 –18 (2013)More Less
Bloody discharge from the nipple is frightening, but during pregnancy and lactation it may be totally benign. An underlying causative condition should be identified following careful diagnostic investigation. No surgical intervention is needed unless a mass is discovered or the findings on cytological examination of the discharge are suspicious or positive at the initial visit or during follow-up. We report a case of bilateral bloody nipple discharge that started during pregnancy and resolved spontaneously after delivery. This condition is known as 'rusty pipe syndrome'.
Delayed and successful manual removal of abnormally adherent placenta necessitated by uterine sepsis following conservative management with adjuvant methotrexate - a rewarding clinical experience : case reportSource: South African Journal of Obstetrics and Gynaecology 19, pp 19 –21 (2013)More Less
Abnormally adherent placenta is characterised by direct attachment of chorionic villi to the uterine wall, often resulting in life-threatening postpartum haemorrhage. Traditionally this complication has been managed by peripartum hysterectomy, which is associated with massive blood loss, injuries to the urinary tract and, importantly, permanent loss of fertility. Encouraging results reported in recent years have led to a gradual shift towards conservative management of select cases of placenta accreta, with the primary aim of conservation of the uterus and fertility. This strategy also avoids the surgical morbidity of peripartum hysterectomy. We report a case of placenta accreta in which delayed manual removal necessitated by uterine sepsis following conservative management with methotrexate was completely successful.
Source: South African Journal of Obstetrics and Gynaecology 19, pp 22 –23 (2013)More Less
No reports have described effects on the fetus of maternal jaundice caused by drug-induced hepatotoxicity during pregnancy, particularly in the first trimester. We report on two pregnant women who developed severe drug-induced hepatic failure and hyperbilirubinaemia during the period of fetal organogenesis. Both were diagnosed and treated promptly, and neither of the newborns had organic abnormalities. Prompt discontinuation of the drug suspected to be causing the condition is the optimal management, immediately decreasing the maternal bilirubin level and improving the perinatal prognosis. It appears that brief exposure of the fetus to maternal hyperbilirubinaemia during the first trimester may not affect fetal development, even if the mother's bilirubin level temporarily exceeds 171.0 µmol/l.