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- Volume 19, Issue 3, 2013
South African Journal of Obstetrics and Gynaecology - Volume 19, Issue 3, 2013
Volume 19, Issue 3, 2013
Author R.C. PattinsonSource: South African Journal of Obstetrics and Gynaecology 19, pp 59 –60 (2013) http://dx.doi.org/10.7196/SAJOG.772More Less
Three conditions are responsible for almost two-thirds of potentially avoidable maternal deaths in South Africa: non-pregnancy-related infections (most are HIV-related), obstetric haemorrhage, and complications of hypertension in pregnancy. Although there has been a significant reduction in maternal deaths due to non-pregnancy-related infections, as shown in the Ninth Interim Saving Mothers report (in press; authored by R C Pattinson, J Moodley and S Fawcus), deaths due to obstetric haemorrhage and complications of hypertension in pregnancy have remained stubbornly high. Birth asphyxia is the most common cause of perinatal death in South Africa for babies weighing over 1 000 g, and this has not decreased significantly for more than a decade.
Source: South African Journal of Obstetrics and Gynaecology 19, pp 61 –65 (2013) http://dx.doi.org/10.7196/SAJOG.670More Less
Recurrent pregnancy loss (RPL) can be defined as more than two to three consecutive miscarriages before 24 weeks' gestation. A literature review was done to provide an evidence-based approach to RPL, identifying the risk factors and causes and also looking at the various special investigations that form part of the work-up and trying to assess which have been proven to be effective or of negative impact, and which of the management options lead to a better outcome. We concluded that the following special investigations should be part of the work-up for all patients with RPL: (i) genetic counselling and karyotyping of the abortus; (ii) anticardiolipin antibodies and lupus anticoagulant testing must be done on two occasions, 6 - 8 weeks apart; (iii) all patients qualify for a pelvic ultrasound scan and hysteroscopy; (iv) syphilis testing must be done routinely; and (v) testing of thyroid function and glucose monitoring/glycosylated haemoglobin (HbA1c) measurement must be done in all patients with a history of thyroid disease or diabetes mellitus, or clinical manifestations thereof. In approximately 50% of couples the cause of RPL remains unexplained, even after evaluation.
Stillbirth rates in singleton pregnancies in a stable population at Karl Bremer and Tygerberg hospitals over 50 years : researchSource: South African Journal of Obstetrics and Gynaecology 19, pp 67 –70 (2013) http://dx.doi.org/10.7196/SAJOG.662More Less
Objective. To determine the changes in stillbirth rates in singleton pregnancies in a stable population over a period of 50 years.
Methods. Stillbirth rates for singleton pregnancies where the fetus weighed ≥1 000 g were collected from 1962 to 2011. From 1972 to 2011, rates included fetuses weighing ≥500 g at birth.
Results. When the birth weight was ≥1 000 g, the stillbirth rate declined from 70 to 12.6 per 1 000 births, and when the birth weight was ≥500 g, it dropped from 34.2 to 24.5 per 1 000 births. The decline was very much slower towards the end of the study period.
Conclusion. To achieve further sustained reductions in stillbirth rates, healthcare workers should continue to emphasise quality of healthcare, but should also address and prevent specific conditions associated with stillbirth, such as smoking and drinking during pregnancy.
Clinical abdominal palpation for predicting oligohydramnios in suspected prolonged pregnancy : researchSource: South African Journal of Obstetrics and Gynaecology 19, pp 71 –74 (2013) http://dx.doi.org/10.7196/SAJOG.647More Less
Objective. In view of the scarcity of ultrasound in low-resource settings, to evaluate abdominal palpation for prediction of oligohydramnios in suspected prolonged pregnancy, using the ultrasound-obtained amniotic fluid index (AFI) as a gold standard, taking into account maternal and fetal factors that may affect amniotic fluid volume.
Methods. A cross-sectional analytical study at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa, on women referred from midwife-run clinics with suspected gestational age ≥41 weeks. Eligible women had their AFI measured, then had abdominal palpation by the researcher, who was blinded to exact gestational age and AFI findings. Palpation focused on ballottability of fetal parts, ease of feeling fetal parts, and impression of fetal compaction. Gestational age was then recalculated using information from earlier ultrasound scans and menstrual dates. Univariable and multivariable logistic regression was performed with oligohydramnios (AFI <5 cm) as the dependent variable.
Results. Of 100 women, 45 had a recalculated gestational age ≥41 weeks. Twenty-three had oligohydramnios. Gestational age was a significant independent predictor for oligohydramnios (odds ratio (OR) 1.78; 95% confidence interval (CI) 1.08 - 2.94). The only component of palpation significantly associated with oligohydramnios, after adjustment for gestational age, was non-ballottability of the presenting part (adjusted OR 4.02; 95% CI 1.05 - 15.4). Non-ballottability had a sensitivity and specificity for oligohydramnios of 87% and 40%, respectively, with a negative predictive value of 91%.
Conclusion. When ultrasound is not available, ballottability of the presenting part may have value for excluding oligohydramnios and assisting clinical decisions in suspected prolonged pregnancy.
Caesarean section wound infiltration with ropivacaine versus placebo : survey of chronic pelvic pain after 4 years' follow-up : researchSource: South African Journal of Obstetrics and Gynaecology 19, pp 75 –76 (2013) http://dx.doi.org/10.7196/SAJOG.623More Less
Objective. To test the hypothesis that optimal management of postoperative pain may reduce the risk of developing chronic pelvic pain in women who undergo caesarean section.
Methods. In a randomised trial in 2006/2007, ropivacaine was infiltrated through all the layers of the anterior abdominal wound in patients undergoing caesarean section. The outcome was a reduction in severe pain or the need for rescue narcotic analgesia within 1 hour after the operation in the ropivacaine group compared with a placebo group (relative risk 0.51; 95% confidence interval 0.38 - 0.69). A follow-up study 4 years later was designed to assess the prevalence of chronic pelvic pain by carrying out telephonic interviews with these women, of whom 77 were contactable and 75 were analysed. Data and statistical analysis were done using Microsoft Excel (2007), Epi Info (version 343) statistical and Review Manager 5 software.
Results. Three out of 40 women in the ropivacaine group and 3/35 in the placebo group had persistent pelvic pain (total rate of chronic pelvic pain 8.1%).
Conclusion. There was no significant difference in the prevalence of chronic pelvic pain between the ropivacaine wound infiltration group (7.5%) and the placebo group (8.6%) after 4 years' follow-up.
Source: South African Journal of Obstetrics and Gynaecology 19, pp 77 –80 (2013) http://dx.doi.org/10.7196/SAJOG.679More Less
Objective. To compare obstetric and perinatal outcome in teenage and non-teenage pregnancies.
Methods. We performed a retrospective analysis of case records of teenage pregnancies from January 2006 to December 2008. The subjects gave birth in the Department of Obstetrics and Gynaecology, University of Malaya Medical Centre, Kuala Lumpur, Malaysia, a referral tertiary care and teaching hospital with over 5 000 deliveries annually. Pregnancy outcomes in girls aged ≤19 years were compared with those in women aged >19 years. A total of 177 teenage pregnancies were compared with 200 pregnancies in older women.
Results. The prevalence of teenage pregnancies was 1.1%. Almost all subjects were in their first pregnancies. The study showed that teenage mothers had a significant risk of delivering low-birth-weight babies. There were no differences in the risk of anaemia, severe pre-eclampsia, caesarean delivery, postpartum haemorrhage or fetal distress in labour compared with the 200 women in the older age group. Of the pregnant teenagers, 26.9% did not receive any antenatal care at all.
Conclusion. The findings suggest that the long-held beliefs about the risks related to teenage pregnancy are not all justified. Early booking, adequate antenatal care and delivery by trained personnel should improve the obstetric and perinatal outcome in this age group.
Impact of the introduction of a colposcopy service in a rural South African sub-district on uptake of colposcopy : researchSource: South African Journal of Obstetrics and Gynaecology 19, pp 80 –85 (2013) http://dx.doi.org/10.7196/SAJOG.388More Less
Objective. To describe the establishment of a colposcopy service at a district hospital in a rural sub-district of the Western Cape, South Africa, and assess its impact on colposcopy uptake.
Design. A retrospective double-group cohort study using a laboratory database of cervical cytology results, clinical records and colposcopy clinic registers.
Setting. The Overstrand sub-district, where 80 000 people are served by seven clinics and a district hospital in Hermanus, 120 km from its referral hospitals in Cape Town and Worcester. A colposcopy service was established at Hermanus Hospital in 2008.
Subjects. All women in the sub-district who required colposcopy on the basis of cervical smears done in 2007 and 2009.
Outcome measures. Numbers of women booked for colposcopy at distant referral hospitals in 2007 and at the district hospital in 2009, the proportions who attended colposcopy, the time from cervical smear to colposcopy, and comparison between the two years.
Results. Uptake of colposcopy booked at distant referral hospitals was 67% in 2007. Uptake improved by 18% to 79% for the district hospital colposcopy service in 2009 (p=0.06). When patients from an area with no public transport to the district hospital were excluded from analysis, the improvement was more marked at 22% (p=0.02). The delay from cervical smear to colposcopy improved significantly from 170 to 141 days (p=0.02).
Conclusion. Establishment of a colposcopy service in a rural sub-district increased uptake of colposcopy and decreased the delay from cervical smear to colposcopy. The service removed 202 booked patients in one year from the colposcopy load of the referral hospitals.
Ovarian vein thrombosis - a rare but important complication of hysterectomy and oophorectomy : case reportSource: South African Journal of Obstetrics and Gynaecology 19, pp 86 –87 (2013) http://dx.doi.org/10.7196/SAJOG.571More Less