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- South African Journal of Obstetrics and Gynaecology
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- Volume 20, Issue 2, 2014
South African Journal of Obstetrics and Gynaecology - Volume 20, Issue 2, 2014
Volume 20, Issue 2, 2014
Author William EdridgeSource: South African Journal of Obstetrics and Gynaecology 20 (2014) http://dx.doi.org/10.7196/SAJOG.917More Less
Recommended treatments for a variety of problems are introduced with good intentions after evaluation, and sometimes, after unimagined complications or complications of unimagined extent, later withdrawn. For example, in the middle and late 1800s, in reputable teaching institutions in America and Europe, ergotamine was recommended not only to prevent postpartum haemorrhage but also to augment labour. The result - placental abruption, intrauterine fetal death and uterine rupture, maternal death, and, for those babies who survived, possible cerebral palsy.
The use of mesh implants in vaginal prolapse surgery : position statement and recommendations of the South African Urogynaecology Association : position statementAuthor E.W. HennSource: South African Journal of Obstetrics and Gynaecology 20, pp 43 –46 (2014) http://dx.doi.org/10.7196/SAJOG.846More Less
Anterior vaginal prolapse repair : a randomised trial of traditional anterior colporrhaphy and self-tailored mesh repair : researchSource: South African Journal of Obstetrics and Gynaecology 20, pp 47 –50 (2014) http://dx.doi.org/10.7196/SAJOG.749More Less
Background. Anterior colporrhaphy has been the traditional standard surgical treatment for anterior vaginal prolapse. However, since it is associated with a 40% recurrence rate, an attempt has been made to resolve the problem of recurrence by means of artificial mesh.
Objective. To compare traditional colporrhaphy with self-tailored mesh in anterior colporrhaphy.
Methods. One hundred and six women were enrolled in a prospective randomised controlled trial and divided into two groups: traditional anterior colporrhaphy (n=54) and anterior self-tailored mesh repair (n=52). The standard pelvic organ prolapse quantification (POPQ) system was used. Women with symptomatic anterior vaginal prolapse ≥POPQ stage II were included. Those with concomitant stress urinary incontinence, dominant posterior vaginal prolapse, active vaginal infections and suspected malignancy were excluded. Outcomes at the end of the procedure, intraoperative and postoperative complications, and follow-up (4 weeks, 6 months, 1 year) were noted. Patients were assessed for recurrence (≥POPQ stage II), complications, satisfaction and acceptability.
Results. Postoperative outcome was significantly better than preoperative staging, but no significant difference was seen in the two groups. On follow-up, the primary endpoints (Aa, Ba, tVL) did not differ significantly between the two groups. There were more complications in the mesh group. Satisfaction and acceptability were similar in the two groups.
Conclusion. Although the outcomes in the two groups were similar, duration of surgery and blood loss were significantly greater in the mesh group. The use of mesh in anterior prolapse repair needs to be evaluated further.
Abnormal cervical cytology requiring colposcopy among women under the age of 30 years in the Western Cape Province, South Africa : researchSource: South African Journal of Obstetrics and Gynaecology 20, pp 51 –53 (2014) http://dx.doi.org/10.7196/SAJOG.766More Less
Background. Although cervical cancer is the second most common cancer among women in South Africa, the Department of Health's current national screening policy only offers women a free cervical smear at 30, 40 and 50 years of age.
Methods. Data on cervical smears were obtained from the computerised records of the Cytopathology Laboratory at Groote Schuur Hospital (GHS), Cape Town, for the years 2009 and 2010. Total and age-specific prevalences of women who had undergone cervical smear screening were calculated.
Results. Of a total of 108 542 cervical smears processed at GHS, 21% were cervical smears taken from women under 30 years of age; 3 080 women were referred for colposcopy at GSH, and 19% of these women were under 30 years of age.
Conclusion. These results suggest that 'first-time' screening at 30 years could be too late for many young women with invasive or microinvasive cancer.
Pregnancy outcomes in super-obese women - an even bigger problem? A prospective cohort study : researchSource: South African Journal of Obstetrics and Gynaecology 20, pp 54 –59 (2014) http://dx.doi.org/10.7196/SAJOG.820More Less
Objective. To investigate whether differences exist in adverse pregnancy outcomes between morbidly obese (body mass index (BMI, kg/m2) 40 - 49.9) and super-obese women (BMI ≤50).
Methods. A prospective cohort study was undertaken at Tygerberg Hospital, a referral centre in the Western Cape Province of South Africa, of morbidly obese and super-obese pregnant women recruited from the antenatal clinic. Data were collected from the files 6 weeks after delivery. Primary outcomes included hypertension, diabetes mellitus and fetal macrosomia. Secondary outcomes included baseline characteristics, previous complications, antenatal and peripartum complications, and short-term neonatal outcomes.
Results. Sixty-six morbidly obese and 46 super-obese women were enrolled. Super-obese women experienced significantly higher incidences of pre-eclampsia (24% v. 9%; p=0.03) and interuterine growth restriction (13% v. 2%; p=0.02) than morbidly obese women, and both groups had a high incidence of gestational diabetes (24% v. 24%; non-significant (NS)). Both super-obese and morbidly obese women experienced high rates of caesarean section (54% v. 41%; NS). In super-obese women these procedures lasted longer (50 v. 41 minutes; p<0.01) and there were more surgical complications (36% v. 7%; p=0.01). Prolonged admission (>3 days) after delivery was also more common in super-obese women (65% v. 42%; p=0.03).
Conclusion. Super-obese women encounter more major pregnancy complications (especially hypertensive, pre-eclamptic and surgical) than morbidly obese women, emphasising the fact that these women should be managed at institutions with sufficient expertise.
Colon cancer presenting as a hepatic mass in pregnancy : a case report and review of the literature : case reportSource: South African Journal of Obstetrics and Gynaecology 20, pp 60 –62 (2014) http://dx.doi.org/10.7196/SAJOG.756More Less
The incidences of hepatic masses and colon cancer in pregnancy are low. The clinical features of each can mimic those of pregnancy, thereby posing a diagnostic challenge to clinicians, particularly when the clinical scenario is complicated by HIV infection. This report illustrates such diagnostic difficulties, and the need to offer diagnostic colonoscopy to HIV-infected pregnant women who present with both a hepatic mass and minor gastrointestinal symptoms. It also highlights an approach to the management of colon carcinoma presenting as a hepatic mass in pregnancy.
Source: South African Journal of Obstetrics and Gynaecology 20, pp 63 –64 (2014) http://dx.doi.org/10.1976/SAJOG.807More Less
In view of the rarity of cervical ectopic gestation and the potentially high morbidity that may be associated with its presentation and management, we report management of a case of cervical ectopic pregnancy using cervical cerclage with Mersilene tape as an intervention to reduce intraoperative haemorrhage during evacuation. The 36-year-old woman had a classic diagnosis of cervical ectopic pregnancy made in the consulting room with a transvaginal ultrasound examination. Evacuation with suction curettage was performed, and brisk bleeding was arrested with Mersilene tape. Placing a cervical cerclage is a relatively easy procedure to perform and may prevent major intraoperative bleeding, thereby minimising the risk of a major surgical procedure.
Bladder stone formation over a partially migrated intrauterine contraceptive device in a patient presenting with cyclical haematuria : case reportAuthor R.P. RajanSource: South African Journal of Obstetrics and Gynaecology 20 (2014) http://dx.doi.org/10.7196/SAJOG.792More Less
The case of a 42-year-old woman with a forgotten intrauterine contraceptive device (IUCD) presenting with irritative bladder symptoms and cyclical haematuria is reported. The threads of the IUCD were seen in the vagina during speculum examination. Partial migration of the IUCD into the bladder and formation of a large stone around it were confirmed by X-ray of the kidney, ureter and bladder and cystoscopy. Suprapubic cystolithotomy was performed, and the stone was removed together with the IUCD.
Selected abstracts from the 36th Biennial Conference of the South African Society of Obstetricians and Gynaecologists, Cape Town, 18 - 21 May 2014 : abstractsSource: South African Journal of Obstetrics and Gynaecology 20, pp 66 –71 (2014) http://dx.doi.org/10.7196/SAJOG.910More Less