South African Medical Journal - Volume 100, Issue 4, April 2010

Objective. To determine the leading causes of perinatal deaths and to evaluate any changes, with the inclusion of placental histology.

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Method. At perinatal mortality meetings, primary and final causes of death were assigned for the period 1 July 2006 - 30 June 2007. All singleton babies born to women residing in the metropolitan area serviced by Tygerberg Hospital were included in the prospective descriptive study.

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Results. The total number of singleton births was 10 396. The total of perinatally related losses (TPRL) rate was 26.2 per 1 000 births. The leading primary obstetric causes of death were: infections (47 - 17.3%), spontaneous preterm labour (PTL) (41 - 15.1%), antepartum haemorrhage (APH) (40 - 14.7%), intra-uterine growth restriction (IUGR) (40 - 14.7%), fetal abnormality (31 - 11.4%), hypertensive disorders (25 - 9.2%), unexplained intra-uterine deaths (IUD) (20 - 7.4%), intrapartum hypoxia (12 - 4.4%) and maternal disease (9 - 3.3%). A total of 162 placentas were sent for histology; 58 reports changed the primary cause of death.

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Conclusion. The TPRL rate for singleton pregnancies was 26.2 per 1 000 births for the study period. The TPRL rates in 1986 and 1993 were 36.7 and 30.5 per 1 000 deliveries. Infection is now the leading primary cause of death, followed by spontaneous PTL, APH and IUGR. During the previous two study periods, APH was the leading primary cause of death, followed by spontaneous PTL. Unexplained IUDs ranked third in 1986, fourth in 1993 and seventh in this study because of the availability of placental histology. Placental histology reports changed 21.3% of the primary causes of death.

Background. Psoriasis vulgaris is a chronic, relapsing, immune-mediated, potentially devastating disease, influenced by genetic and environmental factors, that can cause substantial morbidity and psychological stress and have a profound negative impact on patient quality of life.

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Objective. These guidelines for the management of psoriasis have been developed in an attempt to improve the outcomes of treatment of this condition in South Africa. Psoriasis has a major impact on the quality of life of sufferers, and it is expected that these guidelines, if implemented, will play a role in achieving improved outcome.

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Scope. These guidelines were developed to address the diagnosis and treatment of psoriasis, of differing degrees of severity and in patients of all ages, by all health care professionals involved with its management.

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Recommendations. All health care workers involved in the management of psoriasis should take note of these guidelines and try to implement them in clinical practice as far as possible. All treatment methods and procedures not substantiated by evidence from the literature should be discontinued and avoided to decrease the financial burden of psoriasis treatment.

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Validation. These guidelines were developed through general consensus by a group of 8 South African dermatologists (the 'Working Group') sanctioned by the Dermatological Society of South Africa (DSSA), by adaptation for the South African situation of the current guidelines used in the USA, the UK, Germany, Canada and Finland. Draft documents were made available for comment to the dermatological community as a whole via the official website of the DSSA, and the guidelines were presented and discussed at the annual congress of the DSSA in 2008. All input from these sources, where appropriate, were then incorporated into these guidelines.

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Guidelines sponsor. Schering-Plough initiated the project and sponsored the meetings of the working group and all costs generated by these meetings.

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Plans for guideline revision. The field of biologicals and cytokine modulators is in a rapid phase of development, and revision of the scope and content of these guidelines will be ongoing as longer-term data emerge.