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- South African Journal of Obstetrics and Gynaecology
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- Volume 21, Issue 1, 2015
South African Journal of Obstetrics and Gynaecology - Volume 21, Issue 1, 2015
Volume 21, Issue 1, 2015
Author William EdridgeSource: South African Journal of Obstetrics and Gynaecology 21 (2015) http://dx.doi.org/10.7196/SAJOG.1001More Less
The quality of healthcare provided by a healthcare system is not always easily assessed. How can one assess the smile of reassurance from a nursing sister or the feeling of satisfaction of a patient when visiting a doctor in a resource-limited setting? There are, however, some objective measures of healthcare activity. In the case of obstetrics there is perinatal mortality. This can be adjusted to compensate for the rate of premature birth, and then expressed as the perinatal care index. Maternal mortality is another yardstick of care in obstetrics and that part of gynaecology that deals with early pregnancy.
Source: South African Journal of Obstetrics and Gynaecology 21, pp 4 –5 (2015) http://dx.doi.org/10.7196/SAJOG.954More Less
More than half of all global maternal deaths occur in Africa. A large percentage of these deaths are preventable, and lack of access to adequate critical care facilities is a contributing factor. There are limited published data on the clinical and management challenges presented by the critically ill obstetric patient admitted to the intensive care unit in our setting, and more data are required in order to better define the critical care needs of this group of patients.
A prospective study on the impact of waiting times for radiotherapy for cervical cancer at Charlotte Maxeke Johannesburg Academic Hospital, South Africa : researchSource: South African Journal of Obstetrics and Gynaecology 21, pp 6 –9 (2015) http://dx.doi.org/10.7196/SAJOG.985More Less
Background. Radiotherapy plays a vital role in the management of cervical cancer. However, because of high patient load and limited resources, waiting lists are unacceptably long. This is a highly curable malignancy that often occurs in economically active, relatively young women. The impact of treatment delays on society is therefore disproportionately large when compared with many other malignancies. Delays also impact negatively on the healthcare system and place further stress on an already burdened department.
Objective. To evaluate the potential impact of radiotherapy delays.
Methods. Eighty-one patients requiring radical radiotherapy for cervical cancer were selected. Patients were re-evaluated every 4 weeks while waiting, and again at simulation.
Results. Median delay from first consultation to simulation was 55 days. Longer delays were not statistically correlated to tumour progression. Most of the upstaging occurred around 40 - 65 days. One in four patients received blood transfusions and required hospital admission. Four patients needed haemostatic brachytherapy for bleeding.
Conclusion. A relationship between time waited and disease progression could not be proven. However, numbers were small and statistical tests were probably underpowered. The study does, however, highlight unacceptably long delays for radiotherapy, and a wait of less than 40 days is recommended.
Author S. BudhramSource: South African Journal of Obstetrics and Gynaecology 21, pp 10 –11 (2015) http://dx.doi.org/10.7196/SAJOG.929More Less
Cardiac arrest in pregnancy is a rare event, and resuscitation of the pregnant patient is complicated by the impact on resuscitative measures of the normal physiological changes of pregnancy. A case of successful resuscitation of a pregnant patient with a cardiac arrest and a normal neurocognitive outcome is reported.
Uterine rupture in a primigravida with a term pregnancy : case report and lessons to learn : case reportAuthor J. MoodleySource: South African Journal of Obstetrics and Gynaecology 21, pp 12 –13 (2015) http://dx.doi.org/10.7196/SAJOG.973More Less
Spontaneous uterine rupture (UR) in primigravidas with term pregnancies is a rare occurrence, but is increasing in frequency in high-income countries as a result of a concomitant rise in rates of gynaecological uterine surgery. We present a case from a low- and middle-income country of spontaneous UR at term with no known markers of such an adverse event. The spontaneous UR may have been due to the ingestion of traditional medicines. Health professionals and the community at large must be alerted to the possible dangers of the use of such medications in pregnancy.
Author Z. AbdoolSource: South African Journal of Obstetrics and Gynaecology 21, pp 14 –15 (2015) http://dx.doi.org/10.7196/SAJOG.905More Less
The use of vaginal pessaries for symptomatic pelvic organ prolapse (POP) is well established. Recently pessaries have been offered routinely as a first-line treatment option for symptomatic POP, and in patients with medical comorbidity, those who are unfit for surgical intervention, and young women who still wish to bear children. The favourable physical and chemical properties of silicone have made pessaries safer to use for the treatment of POP. Complications associated with neglected pessaries are well documented, and it is probable that complications are rare when pessary care is regular. We present a case of partial encapsulation of a ring pessary despite regular follow-up at a tertiary urogynaecological unit, and review the literature pertaining to early entrapment of vaginal ring pessaries.
Primary amenorrhoea : Swyer syndrome in a woman with pure 46,XY gonadal dysgenesis and late presentation : case reportAuthor A. ChrysostomouSource: South African Journal of Obstetrics and Gynaecology 21, pp 16 –17 (2015) http://dx.doi.org/10.7196/SAJOG.891More Less
Simple 46,XY gonadal dwysgenesis, also called Swyer syndrome, is a very rare condition, estimated to occur in approximately 1/100 000 people. The condition first becomes apparent in adolescence, with delayed puberty and primary amenorrhoea. This is a case study of a patient who presented with primary amenorrhoea and primary infertility. She was a 24-year-old phenotypically female patient with a delayed diagnosis of Swyer syndrome.
Source: South African Journal of Obstetrics and Gynaecology 21, pp 18 –20 (2015) http://dx.doi.org/10.7196/SAJOG.922More Less
Background. Three-way balanced translocations are unusual and can lead to infertility as well as abnormal embryos. In this case report, we describe a couple who experienced repeated miscarriages as a result of the male partner being a carrier of a three-way translocation t(5;8;12).
Objectives. Array comparative genomic hybridisation (array-CGH) was used to screen embryos for chromosome imbalances.
Methods. Embryo biopsy, preimplantation genetic diagnosis using a 24sure+ kit to detect translocations in embryos.
Results. Of 10 embryos tested, 2 were found to have an unbalanced translocation, 4 were aneuploid, 2 failed to amplify and 2 were euploid. Transfer of the two euploid embryos resulted in a singleton pregnancy and subsequent birth of a baby.
Conclusion. Array-CGH in conjunction with a 24sure+ kit should be used as a routine screening method for embryos of balanced translocation carriers, as it can decrease the time to pregnancy and prevent repeated miscarriages.
Müllerian duct anomaly with congenital rectovaginal fistula : a rare case presentation : case reportSource: South African Journal of Obstetrics and Gynaecology 21, pp 22 –23 (2015) http://dx.doi.org/10.7196/SAJOG.746More Less
Pregnancy in a rudimentary horn is a rare form of ectopic gestation and associated with high maternal mortality. Unicornuate uterus with a rudimentary horn is caused by disordered fusion of Müllerian ducts during embryonic life, which can be associated with ipsilateral renal agenesis, congenital rectovaginal fistula, imperforate anus, hypospadias and other anatomical variants of cloacal dysgenesis. Despite advances in imaging techniques such as ultrasound, the diagnosis of rudimentary horn remains elusive with confirmatory diagnosis made on laparotomy. Our patient presented with an unruptured rudimentary horn pregnancy in the second trimester with a past history of surgical correction of rectovaginal fistula. Exploratory laparotomy was done and the rudimentary horn was excised. We report this case because of the very rare association of unicornuate uterus with rudimentary horn with congenital rectovaginal fistula, which forms when the Müllerian eminence opens in the dorsal segment of the endodermal cloaca.