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- Volume 19, Issue 2, 2013
South African Journal of Obstetrics and Gynaecology - Volume 19, Issue 2, 2013
Volume 19, Issue 2, 2013
Source: South African Journal of Obstetrics and Gynaecology 19 (2013)More Less
The 'Opinion' piece in this issue of SAJOG, 'Colleague bashing is unprofessional behaviour', was chosen to coincide with the SASOG Update Conference. We hope that all the delegates will read and reflect on the contents of this interesting article. Keeping with topical themes, an article reporting screening and a brief intervention for intimate partner violence among antenatal care attendees at primary health care clinics by Matseke and Peltzer gives us some ammunition to fight this scourge.
Author D.R. HallSource: South African Journal of Obstetrics and Gynaecology 19, pp 28 –29 (2013)More Less
Professionalism is recognised as fundamental to medical practice, yet it is challenging to teach. What all students learn formally must be complemented by their latent experiences in clinical practice. Disrespectful language towards colleagues or patients is a major source of distress for medical students, and clinical teachers must promote professional behaviour.
The effect of mefenamic acid and naproxen on heavy menstrual bleeding : a placebo-controlled study : researchSource: South African Journal of Obstetrics and Gynaecology 19, pp 31 –34 (2013)More Less
Background. Heavy menstrual bleeding is a common complaint. Various therapeutic approaches have been suggested.
Aim. To compare the efficacy of mefenamic acid and naproxen in reducing heavy menstrual bleeding.
Methods. Women referred to an outpatient centre for treatment of heavy menstrual bleeding were recruited. Participants who met the inclusion criteria were evaluated for 6 menstrual cycles. During 3 control cycles they recorded the amount of their bleeding on the Pictorial Blood Assessment Chart to confirm that their menstrual bleeding was heavy. One hundred and twenty participants were then randomly assigned to receive mefenamic acid, naproxen or placebo, and asked to fill in the same questionnaires during 3 intervention cycles. The data were analysed using SPSS version 15 for Windows.
Results. Participants receiving mefenamic acid experienced a marked decrease in bleeding during the 3 months of intervention, an initial sharp decrease being followed by a further lesser decrease (p<0.05 within group). Bleeding lessened dramatically in the first month of the intervention in participants receiving naproxen, and dropped still further in the second and third months (p<0.05 within group). In the placebo group there were slight changes in bleeding during the intervention (p>0.05 within group). However, the total decrease in bleeding was greatest in the naproxen arm, and the differences between the groups were statistically significant (p<0.05 between groups).
Conclusion. All three interventions had positive effects on the mean amount of bleeding, although naproxen was more effective than mefenamic acid and much more effective than placebo.
Pregnancy outcome in asymptomatic women with abnormal vaginal flora without any treatment and after treatment with vaginal clindamycin and clotrimazole : a randomised controlled trial : researchSource: South African Journal of Obstetrics and Gynaecology 19, pp 35 –38 (2013)More Less
Aims. To study the role of screening for and treatment of abnormal vaginal flora in early pregnancy, and its correlation with pregnancy outcome.
Methods. Eight hundred asymptomatic women seen at the antenatal clinic of Lok Nayak Hospital, New Delhi, India, at 12 - 24 weeks' gestation were screened for abnormal vaginal flora by means of examination of vaginal fluid smears on Gram-stained slides. Two hundred and forty-two women with abnormal vaginal flora were allocated randomly to receive either treatment (vaginal clindamycin and clotrimazole) or no treatment. The presence of abnormal vaginal flora was correlated with pregnancy outcomes in terms of preterm delivery or late miscarriage, premature rupture of the membranes (PROM) and puerperal sepsis.
Results. A total of 242 patients with abnormal vaginal flora for whom outcome data were complete were analysed. Intervention in women with abnormal vaginal flora was associated with a decrease in the rate of preterm delivery (30.3% v. 18.6%; relative risk 1.65; 95% confidence interval 1.04 - 2.63; p<0.05). The advantage did not extend to late miscarriage, PROM or puerperal sepsis, as the decrease in these outcomes did not attain statistical significance.
Conclusions. Screening for and treatment of asymptomatic abnormal vaginal flora in early pregnancy significantly reduces the rate of preterm delivery and consequent perinatal morbidity and mortality.
Screening and brief intervention for intimate partner violence among antenatal care attendees at primary healthcare clinics in Mpumalanga Province, South Africa : researchSource: South African Journal of Obstetrics and Gynaecology 19, pp 40 –43 (2013)More Less
Background. It has been found that pregnant women experience a higher rate of intimate partner violence (IPV) than women who are not pregnant. This paper presents findings of a brief IPV intervention provided to pregnant women attending prevention of mother-to-child transmission of HIV services.
Methods. Eighteen community workers were recruited and trained in assessment of and intervention for abuse during pregnancy. These were implemented for 10 months at 16 primary healthcare facilities in the Thembisile sub-district, Nkangala district, Mpumalanga Province, South Africa.
Results. A total of 2 230 pregnant women were screened for abuse; 7.2% (160) screened positive and received a brief intervention. This was a 20-minute session on safety behaviours and strategies for dealing with the abuse, including referral to local support services. Eighty-four women attended a follow-up interview 3 months after the intervention. The mean danger assessment score of 6.0 before intervention fell significantly to 2.8 after 3 months.
Conclusion. The brief intervention provided to these women contributed to a significant reduction in the level of IPV.
Cost and cost-effectiveness of conventional and liquid-based cytology in South Africa : a laboratory service provider perspective : researchSource: South African Journal of Obstetrics and Gynaecology 19, pp 44 –48 (2013)More Less
Background. South Africa has a high prevalence of cervical cancer. Early detection can significantly reduce the burden of this disease. New screening technologies to detect cervical pathology have become available in recent years.
Objectives. To determine the cost and cost-effectiveness of liquid-based cytology (LBC) versus conventional cervical cytology, from the perspective of the National Health Laboratory Service (NHLS).
Methods. The unit of effectiveness was defined as the number of cervical intraepithelial neoplasm (CIN) II or higher lesions detected. Costs were assessed retrospectively for the financial year (2010/11) from a laboratory service provider perspective. A cost-effectiveness analysis was performed by combining secondary data collected from NHLS expenditure records and cytology laboratory data sources with data from the literature.
Results. Total average cost per conventional slide was found to be R (South African rands) 64 (95% confidence interval (CI) 59 - 69) compared with R85 (95% CI 77 - 92) for an LBC slide. Conventional cytology was found to be more cost-effective (R10 786; 95% CI 9 335 - 12 699) than LBC (R18 911; 95% CI 16 180 - 22 435) in detecting CIN II or greater lesions. An improvement in the specificity of LBC and/or a decrease in the cost of consumables utilised in processing LBC specimens could potentially make it a cost-effective alternative to conventional cytology.
Conclusion. An estimate of the total average public sector laboratory cost per slide for each modality was calculated. Definitive assessment of cost-effectiveness will require a prospective study that incorporates human papillomavirus testing and is conducted from a societal perspective.
Views and attitudes of pregnant women regarding late termination of pregnancy for severe fetal abnormalities at a tertiary hospital in KwaZulu-Natal : researchSource: South African Journal of Obstetrics and Gynaecology 19, pp 49 –52 (2013)More Less
Aim. To study the views and attitudes of pregnant women with severe fetal anomalies regarding late termination of pregnancy (LTOP).
Methods. Data were collected over a 3-month period using semi-structured interviews of pregnant women with severe fetal anomalies (lethal and non-lethal) detected after 24 weeks' gestation at a single tertiary/quaternary fetal medicine unit in KwaZulu-Natal, South Africa. The interviews were conducted both during pregnancy and within 2 weeks after delivery. The women who underwent LTOP and those who continued with their pregnancies were compared in respect of a variety of demographic and socio-economic characteristics.
Results. During the study period, 15 pregnant women with severe fetal anomalies were interviewed. Of these, 5 (33.3%) requested termination and 10 (66.6%) opted to continue the pregnancy. The women who continued their pregnancies were significantly younger (mean age 25 years, range 20 - 32 years) than those who requested termination (mean age 31 years, range 22 - 35 years) (p<0.05). Mean parity was 1 (range 0 - 3) in the patients who continued the pregnancy and 2 (1 - 3) in those who terminated it. The majority of the women were Christians, and there was no significant difference between the groups in their choices. Many women indicated that their partners and immediate family members influenced decision making. All the women said that they were given sufficient time by the hospital staff to make their decision whether to terminate or continue the pregnancy after the options had been explained to them in a non-threatening manner. Before delivery, the common reasons for continuing with the pregnancy included fear of killing an unborn baby, that a baby is God's gift and the baby will be well after it is born, that nature should be allowed to take its course, and that there should be no interference with the pregnancy. The main reasons for opting for LTOP were the cost implications of raising an abnormal baby, that the baby would suffer during his or her life, and being unable to cope with a severely handicapped child. After delivery and seeing the baby, most women felt that they made the correct choice.
Conclusion. Despite the small numbers from a single academic institution, this study illustrates that even while pregnant with an anomalous fetus, patients' views and attitudes regarding LTOP for severe fetal anomaly were variable. Younger primigravidas were more likely to continue the pregnancy in the hope that the baby would be born normal. Good support from partner and family after delivery was associated with less regret about the decision that had been made. Larger follow-up studies assessing long-term views and attitudes of women regarding LTOP will be important for comparison with the initial decision-making process and for future prenatal counselling.
A randomised clinical trial to determine the effect of beta-adrenergic blocking with propranolol on labour : scientific letterSource: South African Journal of Obstetrics and Gynaecology 19, pp 53 –55 (2013)More Less
Background. Dysfunctional labour is a common problem, particularly in disadvantaged communities. Women who are anxious during labour have high adrenaline levels, which could lead to dysfunctional uterine contractions through beta-adrenergic receptor stimulation.
Objective. To determine whether beta-adrenergic blocking with propranolol would reduce the incidence of dysfunctional labour and decrease the caesarean section rate at Universitas and Pelonomi hospitals, Bloemfontein, South Africa.
Study design. A double-blind randomised controlled trial.
Methods. Women with prolonged labour during the active phase were randomised into receiving propranolol or a placebo. A standard protocol for managing labour was maintained, including pain relief and oxytocin infusion when necessary. Age, gravidity, parity, maternal weight, blood pressure and pulse rate before and 1 hour after administration of propranolol or placebo, amount of oxytocin given before and after randomisation, time and method of pain relief, time and method of delivery, Apgar score, fetal weight, indication for caesarean section, and any complications experienced were documented.
Results. Of the 53 women enrolled in the study, 25 received propranolol and 28 the placebo. There was no statistically significant difference between the two groups in number of caesarean sections performed (p=0.59). The only statistically significant difference was the number of cases in which oxytocin augmentation was used after randomisation. In the propranolol group, only 7 (28.0%) received oxytocin after propranolol was given, while in the placebo group 17 (60.7%) received oxytocin after the placebo was administered (p=0.03).
Conclusion. Beta-adrenergic blocking with propranolol did not reduce the caesarean section rate or the duration of labour in our population, but decreased the need for oxytocin.