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- Volume 21, Issue 2, 2015
South African Journal of Obstetrics and Gynaecology - Volume 21, Issue 2, 2015
Volume 21, Issue 2, 2015
Author William EdridgeSource: South African Journal of Obstetrics and Gynaecology 21 (2015) http://dx.doi.org/10.7196.SAJOG.1045More Less
Obstetrics and gynaecology are vast subjects. Each contains 40 elements or so, many of which subdivide into separate topics. Medical students are expected to acquire knowledge of these in 6 weeks, 2 months or 3 months, and will be examined by someone who may have been rereading the information for 25 years. Medical students suffer from a further problem - someone once said, 'What I hear, I forget; what I see, I remember; what I do, I understand.' A student may never see one of the conditions in the exam and may never have been actively involved in the process of choice regarding investigation or management. The result may be that, to the untrained examiner, a bright student may appear ignorant, foolish or careless, and may be inappropriately marked down.
Attitudes towards and knowledge about intrauterine contraceptive devices among women in the reproductive age group in a resource-constrained setting : researchSource: South African Journal of Obstetrics and Gynaecology 21, pp 27 –32 (2015) http://dx.doi.org/10.7196.SAJOG.950More Less
Background. One of the strategies to reduce maternal mortality includes accessible and appropriate contraceptive services to all women. The intrauterine contraceptive device (IUCD) has been identified as a cheap and effective means of contraception by the South African National Department of Health.
Objective. To explore knowledge about the IUCD among women using the public health sector and identify any misconceptions.
Methods. A sample of 150 women attending antenatal/postnatal clinics were interviewed using a structured questionnaire.
Results. Forty-six percent (n=69) had some experience with the injectable form of contraception, and 2.7% (n=4) had used the IUCD; 70.7% (n=106) knew that the device does not prevent HIV transmission, 40.7% (n=61) knew that HIV-positive women can use the IUCD, 75.3% (n=113) believed that the IUCD causes heavy bleeding, 36.7% (n=55) knew that the device does not stop fertility indefinitely, 33.3% (n=50) knew that the IUCD can be inserted in the immediate postpartum period, and 26.7% (n=40) knew that the duration of use is 10 years. In terms of attitudes, 40.0% (n=60) expressed concern about the pain during insertion, 33.3% (n=50) believed the IUCD can cause cancer, and 32.0% (n=48) believed that the device interferes with normal sexual activity. Most participants 77.3% (n=116) acquired the information they had about the IUCD from the clinic during teaching and counselling sessions.
Conclusion. This survey documented poor knowledge about the IUCD among women using the public health sector. However, the fact that there are few misconceptions and that clients rely on the clinic information should be seen as an opportunity to improve the situation.
A clinical audit of female urinary incontinence at a urogynaecology clinic of a tertiary hospital in Durban, South Africa : researchSource: South African Journal of Obstetrics and Gynaecology 21, pp 33 –38 (2015) http://dx.doi.org/10.7196.SAJOG.983More Less
Background. Urinary incontinence (UI) is a common condition with an increasing prevalence worldwide. Although it is not a life-threatening condition, it can be very disabling.
Objective. To describe the clinical profiles, risk factors, diagnosis, treatment and clinical outcomes of women with different subtypes of UI who attended a tertiary hospital in Durban, South Africa.
Methods. A retrospective chart review was performed. A structured data form was used to obtain the relevant information.
Results. Seven hundred and fifty-eight of 945 charts with a diagnosis of UI were analysed. Stress urinary incontinence (SUI) was the most common subtype of UI (30%). The mean (standard deviation (SD)) age was 50.9 (15.2) years; mean (SD) parity 2.8 (1.4) and mean (SD) body mass index 29.2 (5.3) kg/m2. Indians (n=366, 48.3%) were the predominant racial group; black Africans constituted 32.7% (n=248). Mid-urethral tape was the preferred surgical treatment for SUI (n=134, 62.0%). Urge UI was treated mainly with pharmaceutical agents (n=138, 74.2%) with physiotherapy as adjunctive therapy. Urogenital fistulas were repaired via laparotomy (n=42, 53.9%) and vaginally (n=25, 32%). Mid-urethral tapes and Burch colposuspension had success rates of 97% and 83.3%, respectively. Both laparotomy and vaginal fistula repairs had success rates of 95%.
Conclusions. Stress UI was the most common subtype of UI observed in this study. Patients were predominantly Indians and overweight or obese. The majority of patients with urogenital fistulas were black Africans. Surgical outcomes at our centre were in keeping with those in international reports.
Female genital mutilation/cutting : knowledge, practice and experiences of secondary schoolteachers in North Central Nigeria : researchSource: South African Journal of Obstetrics and Gynaecology 21, pp 39 –43 (2015) http://dx.doi.org/10.7196.SAJOG.1047More Less
Background. Despite global efforts at eradicating female genital mutilation/cutting (FGM/C), the act continues to be performed globally.
Objective. To determine the experience of schoolteachers about FGM/C and their possible role in contributing to its eradication.
Methods. A prospective cross-sectional survey involving secondary schoolteachers from 18 secondary schools in Ilorin, North Central Nigeria, was undertaken during October and November 2014. All consenting participants completed a self-administered questionnaire on FGM/C. Statistical analysis was with SPSS version 20.0 with χ2 and logistic regression; a p-value of < 0.05 was considered significant.
Results. There were 371 participants (113 males (30.5%) and 258 females (69.5%)). More females than males were aware of FGM/C (205 v. 94; χ2 41.2; p=0.001); 180 women (69.8%) and 81 men (71.7%) wanted awareness and the implications of FGM/C to be taught in schools, while 46 women (17.8%) and 23 men (20.4%) had previously educated students about FGM/C. Also, 109 (42.3%) of the female teachers had been mutilated (mean (standard deviation) age 4.76 (4.86) years), and 49 mutilations (45.0%) had been performed by traditional circumcisers. Of the teachers, 44.0% of men and 24.5% of women had subjected their daughters to FGM/C (p=0.029), mostly for religious reasons. The men initiated the majority of their daughters' mutilations, while the mothers-in-law were the main initiators among the women; 44 (17.0%) women and 23 (20.4%) men held the opinion that females should be circumcised, while the majority considered education and legislation to be the most important interventions to encourage its eradication. Predictors of the likelihood to support discontinuation of FGM/C include awareness of government policy about FGM/C and having a mutilated daughter.
Conclusion. Education, reorientation and motivation of teachers will position them as agents for eradicating FGM/C.
Limitations of middle cerebral artery peak systolic velocity in the detection of severe anaemia : a case reportSource: South African Journal of Obstetrics and Gynaecology 21, pp 44 –45 (2015) http://dx.doi.org/10.7196.SAJOG.898More Less
Doppler examination of the fetal middle cerebral artery (MCA) is considered highly reliable in detecting severe fetal anaemia. We present a case of a mother with severe pre-eclampsia at 32 weeks' gestation and non-immune fetal hydrops without obvious cause. Since the MCA peak systolic velocity (PSV) was normal, severe anaemia was not considered as a possible cause, but after delivery the infant was found to be severely anaemic and died. Histological examination of the placenta revealed multiple extensive haemorrhages (subchorionic, intraparenchymal and intravillous), and autopsy indicated that the most likely cause of death was severe anaemia and hypoxia due to multiple and extensive placental haemorrhages, which had developed over the course of several days. We postulate that the MCA PSV failed to indicate severe anaemia because of the combination of subacute anaemia with severe profound hypoxia due to placental insufficiency.
Source: South African Journal of Obstetrics and Gynaecology 21, pp 46 –47 (2015) http://dx.doi.org/10.7196.SAJOG.906More Less
We report a rare case of primary postpartum haemorrhage due to a traumatic cause following spontaneous vaginal delivery in which surgical intervention failed. It was successfully treated by transcatheter embolisation of the uterine artery. This technique, although well known, is still underused in such conditions.
Source: South African Journal of Obstetrics and Gynaecology 21, pp 48 –49 (2015) http://dx.doi.org/10.7196.SAJOG.844More Less
Postpartum urinary retention (PUR), which is defined as difficulty in emptying the bladder completely after delivery, may be clinically pronounced or silent. The incidence differs according to the definition. Although many risk factors for this disturbance are identified in the literature, every patient at risk does not necessarily present with PUR. There is no consensus in the literature regarding management.
Spontaneous rupture of the spleen - a rare and potentially fatal surgical emergency in the second trimester : report of a case : case reportSource: South African Journal of Obstetrics and Gynaecology 21, pp 50 –51 (2015) http://dx.doi.org/10.7196.SAJOG.858More Less
Spontaneous (non-traumatic) rupture of the normal spleen in pregnancy is a rare clinical event that can endanger the lives of both mother and baby. The aetiology of the condition is unknown, but it occurs most commonly in multiple pregnancies and in the third trimester. We present a case of a spontaneous splenic rupture of a normal spleen at 14 weeks' gestation. Following prompt and aggressive surgical intervention, both mother and baby survived.
Source: South African Journal of Obstetrics and Gynaecology 21, pp 52 –53 (2015) http://dx.doi.org/10.7196.SAJOG.890More Less
Cornelia de Lange syndrome (CdLS) is a rare genetic disorder of unknown causation, associated with multiple congenital anomalies. Prenatal genetic diagnosis is possible, and the syndrome can occur in subsequent pregnancies of families with affected children as a result of mosaicism. The syndrome has been diagnosed antenatally by careful ultrasound examination, but is usually only diagnosed after birth. We report the case of a patient admitted to our clinic with intrauterine death of the fetus. CdLS was diagnosed on the basis of multiple structural abnormalities seen after delivery.