Obstetrics and Gynaecology Forum - Volume 17, Issue 3, 2007
Volume 17, Issue 3, 2007
Source: Obstetrics and Gynaecology Forum 17, pp 64 –69 (2007)More Less
Injuries during pelvic floor surgery may involve the ureter, bladder and urethra. Detailed knowledge of the anatomy of these structures and the application of this knowledge during surgery, together with appropriate pre-operative imaging will help to reduce morbidity from urological injuries during pelvic floor surgery. This article discusses the anatomy of the ureter, bladder and urethra in relation to injuries to these structures during pelvic surgery and gives an approach to their management. In addition, the article places emphasis on the need for recognition of injuries at the time of surgery and for having a high degree of suspicion of urological injuries in the post-operative period. Diagnostic measures when ureteric injuries are suspected are also discussed. It should be remembered however that injuries to these structures may be both functional and anatomical; this article will concentrate on the anatomical injuries.
Source: Obstetrics and Gynaecology Forum 17, pp 71 –73 (2007)More Less
Currently, there are an estimated 15,000 new infections that occur on a daily basis despite availability of ARVs since 1996. Between 2003 and 2005, for each new person who got treatment for HIV, about 10 people became infected. This underscores the need for effective preventive methods. Male condoms, despite being able to prevent more than 80% of HIV infections when used correctly and consistently, are not acceptable to most male clients. Women in many areas where HIV had reached epidemic proportions are unable to negotiate its use. The female condom has similar limitations, as it also requires the cooperation of the male partner, in addition to being poorly accessible and expensive. Hence, efforts need to be stepped up to find a method which will empower women to take charge of HIV prevention.
A microbicide is a substance that can be used to prevent (or at least significantly reduce) the heterosexual transmission of HIV and other sexually transmitted infections, when applied vaginally or rectally. Microbicide agents come in different preparations and / or formulations. The first generation microbicides are gels and creams; whereas subsequent generations include vaginal rings, films, sponges, gels with barrier devices and suppositories, and work by altering the environment of the genital tract to make it unsuitable for the virus to act and survive. Antiretroviral agents, being specific in their mode of action by attacking the HIV, are part of the third generation microbicides. Another possibility is to combine different agents with different mechanisms of action e.g. combining an agent altering the genital tract pH and that inhibiting fusion or entry of the virus to the target cell.
Rupture of the uterus in Durban in the new millenium : why is it still happening? : original articleAuthor N.F. MoranSource: Obstetrics and Gynaecology Forum 17, pp 79 –83 (2007)More Less
This was an audit of the number of cases of uterine rupture that occurred hospital, in a large metropolitan setting. The audit showed that uterine ruptures are more likely to occur in women with 1 previous caesarean section undergoing vaginal birth after caesarean section (VBAC) than in women with unscarred uterine. In addition, both the perinatal and maternal mortality was high in women with ruptured uterine. This audit sends the message that great attention must be given to women undergoing vaginal birth after caesarean section. The factors that need to be taken into account are staffing - both medical and nursing, the indications for previous caesarean section, the parity of the patient and the need to counsel the patient intensively about the pros and cons of VBAC.
Maternal and perinatal outcomes of pregnancies complicated by multidrug resistant tuberculosis and hiv-1-co infection in Durban, KwaZulu-Natal, South Africa : original articleSource: Obstetrics and Gynaecology Forum 17, pp 85 –89 (2007)More Less
Setting: King Edward VIII and King George V Hospitals, Durban, KwaZulu-Natal.
Objective: To identify the impact of co-infection with multi drug resistant tuberculosis (MDR TB) and Human Immunodeficiency Virus syndrome (HIV-1) during pregnancy, on maternal and perinatal outcomes.
Design: Prospective study between 1996 and 2001 at the antenatal and obstetric wards. Symptomatic women were investigated for tuberculosis and those with confirmed MDR TB were followed up prospectively. Maternal and perinatal outcomes were recorded.
Results: Five women had MDR TB, 3 of who were HIV-1 co- infected. All women had received TB treatment in the past. Second line TB therapy was commenced based on sputum susceptibility results. One woman decided on termination of pregnancy and another delivered preterm. No overt teratogenic features were noted in the newborns but 2 had clinical and neurological features of intrauterine growth restriction.
Conclusion: These cases highlight the clinical issues associated with the management of pregnant women with MDR TB in a setting of high rates of HIV infection.