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- Volume 20, Issue 3, 2014
South African Journal of Obstetrics and Gynaecology - Volume 20, Issue 3, 2014
Volume 20, Issue 3, 2014
Author William EdridgeSource: South African Journal of Obstetrics and Gynaecology 20, pp 74 –75 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJOG.943More Less
The randomised controlled trial (RCT) is recognised as the gold standard of research methods, particularly to test efficacy. The primary benefit of the RCT, as everyone knows, is to prevent patient selection bias. And it should also guarantee some rigour of research methodology. It is always prospective.
Venous thromboembolism : risk profile and management of prophylaxis in gynaecological surgery patients : researchSource: South African Journal of Obstetrics and Gynaecology 20, pp 76 –79 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJOG.490More Less
Objectives. This study aims to describe the venous thromboembolism (VTE) risk profile of women undergoing elective gynaecological surgery in a tertiary hospital and to audit the VTE prophylaxis prescribed.
Methods. One hundred and nine women who underwent elective gynaecological surgery at Kalafong Provincial Tertiary Hospital were assessed in terms of their risk of developing perioperative VTE, using the modified Caprini VTE risk assessment model. An audit of the VTE prophylaxis they received was conducted postoperatively.
Results. Of the 109 women, 45% were classified as at very high risk for VTE, 38% as at high risk, 14% as at moderate risk and 3% as at low risk. The audit revealed that only 5% of patients received the correct VTE prophylaxis, 55% received inadequate prophylaxis and 40% received no prophylaxis.
Discussion. The majority of patients undergoing elective gynaecological surgery are either at high risk or very high risk for developing postoperative VTE-related morbidity. This group of patients require formal preoperative VTE risk assessment using a recognised scoring model. VTE prophylaxis should be administered according to recognised guidelines to avoid inadequate prophylaxis.
How safely can post-term pregnancies with uncertain gestational age be followed up using amniotic fluid index measurements? : researchSource: South African Journal of Obstetrics and Gynaecology 20, pp 80 –83 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJOG.870More Less
Objective. To review whether 2 weeks' follow-up is safe for women at 42 weeks with an uncertain gestational age (GA) and amniotic fluid index (AFI) of ≥10 cm, as well as reassuring cardiotocography (CTG).
Methods. A retrospective descriptive study of women with an uncertain GA of 42 weeks was done at Tygerberg Hospital. The women had weekly CTG and AFI determinations. Induction of labour followed non-reassuring CTG or an AFI of <5.
Results. A total of 135 women were studied. The time interval between first evaluation at uncertain 42 weeks and delivery ranged between 0 and 46 days (median 10 days). Of the women, 104 had normal vaginal deliveries and 31 (23.0%) caesarean sections. Eleven women (8.1%) with an AFI ≥10 had CS for fetal distress within 2 weeks of the visit at 42 weeks. No neonatal morbidity or mortality was noted.
Conclusion. Weekly monitoring with CTG and AFI at 42 weeks with unsure GA is safe. A follow-up visit after 2 weeks cannot be recommended, as 8% of women required CS within less than 2 weeks because of fetal distress.
Retrospective review of the medical management of ectopic pregnancies with methotrexate at a South African tertiary hospital : researchSource: South African Journal of Obstetrics and Gynaecology 20, pp 84 –87 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJOG.920More Less
Background. An ectopic pregnancy can be a life-threatening condition. Early diagnosis with ultrasonography and quantitative beta-human chorionic gonadotrophin (β-hCG) measurement has improved early and accurate diagnosis and treatment. Medical management with methotrexate internationally has a success rate of up to 93%, but there is a paucity of data on this treatment option in developing countries.
Objective. To determine the success of methotrexate treatment for ectopic pregnancies at a referral hospital in a developing country. This non-surgical, outpatient treatment seems a good option in hospitals with an ever-rising pressure on bed occupation and long waiting lists for emergency surgery.
Methods. A 5-year retrospective audit was performed on 124 patients treated for ectopic pregnancies with methotrexate at Tygerberg Hospital, Cape Town, South Africa.
Results. With success defined as a β-hCG level of <15 IU/L without requiring surgical intervention, the success rate was 44%. Fifteen per cent of medically managed patients required surgery. The remaining 41% were lost to follow-up. One patient had a major adverse outcome with a ruptured ectopic and required 2 units of blood, resuscitation and emergency laparotomy.
Conclusion. Medical management of ectopic pregnancies is a safe and effective management option, as proven by international data, but at Tygerberg Hospital the safety of this treatment modality cannot be guaranteed because of poor follow-up. Improvement in patient selection with consideration of predictors of success and thorough counselling, as well as full informed consent, is recommended before using this treatment modality. A new follow-up system should be developed at Tygerberg Hospital to guarantee patient safety.
Are we missing at-risk babies? Comparison of customised growth charts v. standard population charts in a diabetic population : researchSource: South African Journal of Obstetrics and Gynaecology 20, pp 88 –90 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJOG.869More Less
Background. Diabetes in pregnancy is associated with both accelerated fetal growth and intrauterine growth restriction.
Objective. To compare the difference in occurrence of large-for-gestational-age (LGA) and small-for-gestational-age (SGA) fetuses in a pregnant diabetic population using population-based growth charts and customised growth charts.
Methods. Retrospective observational study at Steve Biko Academic and Kalafong hospitals, Pretoria, South Africa. Information from an electronic database was used to retrospectively generate customised centiles using a web-based tool (www.gestation.net). The first fetal growth scan of the third trimester, as determined by ultrasound, was plotted for each patient on both the population-based and customised growth charts. We compared the growth category on the population-based growth chart with that on the customised growth chart.
Results. Of the patients, 44 had type 1, 66 type 2 and 173 gestational diabetes. The growth of 79/283 fetuses would have been reclassified had customised growth charts been used. Of cases in which fetal growth was classified as appropriate for gestation on the population-based growth charts, 58 fetuses would have been LGA and 14 SGA had customised growth charts been used. Four of the fetuses that were SGA and three that were LGA on the population-based growth charts would have been classified as appropriately grown on the customised growth charts. This was a statistically significant difference (p<0.001), with a Cohen's kappa of 0.45 indicating moderate agreement.
Conclusions. Customised growth charts identified more babies with aberrations of growth, who may need vigilant antenatal care and elective delivery and may be at increased health risk in the future.
Disseminated peritoneal leiomyomatosis : a case report and review of current events in the media and the literature : case reportSource: South African Journal of Obstetrics and Gynaecology 20, pp 91 –92 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJOG.874More Less
Disseminated peritoneal leiomyomatosis (DPL) is a rare, mostly benign clinical condition where multiple smooth-muscle nodules or growths of various sizes of uterine origin implant on the abdominal, pelvic and peritoneal surface. The condition can occur spontaneously, or iatrogenically after surgical seeding. We present the case of a 46-year-old woman who was incidentally diagnosed with DPL during a laparoscopic sling procedure for stress urinary incontinence. This patient had undergone a laparoscopic supracervical hysterectomy 9 years earlier for menorrhagia and uterine fibroids. During this procedure the uterine specimen had been removed with a laparoscopic morcellator. With the increase in laparoscopic hysterectomies and myomectomies, this case highlights the need for surgical diligence in removal of all morcellated fragments of the specimen. The patient should be made aware of the potential risks of this technique of tissue extraction.
Source: South African Journal of Obstetrics and Gynaecology 20, pp 93 –94 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJOG.794More Less
A rare case of growing teratoma syndrome (GTS) of the ovary is presented, with a review of the literature. A 36-year-old woman had 6 months' duration of back pain and abdominal fullness. She had undergone surgery elsewhere (right salpingo-oophorectomy) followed by chemotherapy for a histopathologically diagnosed immature teratoma of the right ovary 6 years previously. Imaging showed evidence of extensive peritoneal cystic metastases indenting the liver and in the pelvis and right suprarenal region. As tumour markers were within the normal range, a diagnosis of GTS was made. The patient underwent exploratory laparotomy with total hysterectomy and left salpingo-oophorectomy, and debulking of peritoneal deposits. Histopathological examination identified mature cystic teratoma. The available literature on this condition, with definitions, understanding of the pathophysiology and prognosis, is reviewed.
Source: South African Journal of Obstetrics and Gynaecology 20, pp 94 –95 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJOG.837More Less
Epithelial ovarian cancer is one of the most common ovarian tumours. Ovarian cancer affects women in the age group >60 years much more frequently than younger women. At the time of diagnosis, cancer will already have spread beyond the ovaries in approximately 75% of cases. We report a case of epithelial ovarian cancer presenting with liver and thoracic vertebral metastases 4 months after completion of treatment, as part of distant spread. The patient was then treated with gemcitabine-based chemotherapy. Palliative radiotherapy was given for the involved spine.