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- Volume 9, Issue 2, 2003
South African Journal of Obstetrics and Gynaecology - Volume 9, Issue 2, 2003
Volume 9, Issue 2, 2003
Author J. MoodleySource: South African Journal of Obstetrics and Gynaecology 9, pp 31 –33 (2003)More Less
The 'big five' causes of maternal death in South Africa in the 3 years 1999 - 2001 were non-pregnancy-related infection (mainly AIDS), complications of hypertension in pregnancy, obstetric haemorrhage, pregnancy-related sepsis and preexisting medical conditions. Women 35 years and older were at greater risk of dying than younger women, and women in their first pregnancy or who had had 5 or more pregnancies were also at greater risk. Recommendations have been made by the National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD) that address the problems of avoidable factors. If implemented, these should result in a reduction of maternal deaths.
Source: South African Journal of Obstetrics and Gynaecology 9, pp 34 –37 (2003)More Less
<I>Objective.</I> To compare the safety and efficacy of misoprostol with that of dinoprostone for the induction of labour at term, or near term. <br><I>Design. </I> Three hundred and ninety-six women with term pregnancies were randomised to receive either oral or vaginal misoprostol, or dinoprostone. Women who had had a p revious caesarean section (CS) or those with a malpre sentation or who were parity ³ 5, were excluded. The control group received dinoprostone 1 mg inserted in the posterior fornix and repeated 6-hourly to a maximum of three doses. The study group received either oral misoprostol 20 µg 2-hourly to a maximum of four doses (80 µg), or vaginal misoprostol 25 µg in the posterior fornix with a switch to the oral misoprostol regimen if there was no change in the Bishop's score or no palpable uterine contractions. <br><I>Results.</I> There was no significant difference in vaginal delivery rate within 24 hours between the groups (58.1% v. 58%, p = 0.633). There were no significant differences in CS rates between the groups; however, more CSs were performed for fetal distress in the misoprostol group than in the dinoprostone group (28% v. 25%). There was a significantly higher incidence of hyperstimulation in the vaginal misoprostol group (21.4%) than in the other two groups (oral misoprostol 16.5%, dinoprostone 8.9%) (p = 0.004). The incidence of meconium staining of liquor was comparable between the groups. <br><I>Conclusions.</I> In selected women, the efficacy of misoprostol for the induction of labour at term is similar to that of dinoprostone but misoprostol is associated with a higher incidence of hyperstimulation.
Labour induction at term - a randomised trial comparing Foley catheter plus titrated oral misoprostol solution, titrated oral misoprostol solution alone, and dinoprostoneSource: South African Journal of Obstetrics and Gynaecology 9, pp 40 –45 (2003)More Less
<I>Objectives.</I> To compare three methods of labour induction. <br><I>Design.</I> Randomised controlled trial. <br><I>Setting</I>. Academic hospitals in Johannesburg, South Africa. <br><I>Subjects</I>. Women with intact membranes due for induction of labour. <br><I>Method.</I> Randomised, sealed opaque envelopes were used to allocate women to labour induction with extra-amniotic Foley catheter / titrated oral misoprostol solution (N = 174), titrated oral misoprostol solution alone (N = 176), or vaginal dinoprostone (N = 176). Misoprostol was dissolved in water and 20 - 40 g was given 2-hourly. <br><I>Outcome measures.</I> These were failure to deliver vaginally within 24 hours, additional measures for induction or augmentation of labour, analgesia, and maternal and fetal complications. <br><I>Results.</I> In the Foley catheter group, misoprostol was required in all but 1 case. Failure to deliver vaginally within 24 hours was similar for the three groups (79/174 v. 70/176 v. 70/176 respectively). Labour augmentation, caesarean section and instrumental delivery were used somewhat more frequently in the Foley / misoprostol group than in the misoprostol alone group, but these differences were not statistically significant. More analgesia was used in the Foley catheter / misoprostol group than in the misoprostol group (64/172 v. 46/175). Sideeffects and neonatal complications were similar for the three groups. <br><I>Conclusions.</I> Use of extra-amniotic Foley catheter placement showed no measurable benefits over the use of oral misoprostol alone, or vaginal dinoprostone.
Source: South African Journal of Obstetrics and Gynaecology 9, pp 46 –48 (2003)More Less
<I>Objectives.</I> To determine the main factors causing infertility in an urban, tertiary hospital population. To establish if any such major causal factor could be used to rationalise and improve the service for infertile couples in the public sector. <br><I>Design</I>. Aretrospective analysis of the hospital records of 206 women who had a tubal patency test (hysterosalpingogram) performed and the results of the investigations performed in the couples with infertility. <br><I>Results.</I> Of the 206 women 38 (18.5%) had normal fallopian tubes on hysterosalpingogram; 33 (16%) had unilateral obstruction and 135 (65.5%) had bilateral tubal obstruction. Of the latter group 81 (60%) had significant hydrosalpinges. Semen analysis results in 148 partners (71.8%) demonstrated a normal count in 85 (62%), normal motility in 70 (51%) and normal morphology in only 25 (18%). Testing for ovulation (mid-luteal phase progesterone) was positive in 91 of 124 women tested (73%). Compliance, technical and logistical problems were encountered with both semen analysis and mid-luteal phase progesterone tests. <br><I>Conclusions.</I> Infertility is a major problem in South Africa, with limited resources for investigation and treatment in the public sector. Tubal factor infertility was the most common cause of infertility demonstrated in this study. In the presence of bilateral tubal obstruction with hydrosalpinges the prognosis is so poor that unless assisted reproductive techniques are available and affordable, further infertility investigations do not seem justified. Recommendations on an approach to the infertile couple in the public sector is outlined.