Obstetrics and Gynaecology Forum - Volume 19, Issue 4, 2009
Volume 19, Issue 4, 2009
Author Zephne Van der SpuySource: Obstetrics and Gynaecology Forum 19, pp 106 –107 (2009)More Less
The World Health Assembly (1948) defined reproductive health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes". Between the ages of 15 to 44 reproductive ill-health accounts for 36% of the burden of disease among women and 12 % among men. This presents a considerable challenge to our discipline and one which should enjoy priority in provision of both curative and preventative health services.
Author Kendall O'CallaghanSource: Obstetrics and Gynaecology Forum 19, pp 112 –118 (2009)More Less
Puerperal sepsis remains one of the leading causes of maternal deaths in South Africa and a large number of these deaths are avoidable. The National Committee on Confidential Enquiry into Maternal Deaths (NCCEMD) identified these avoidable factors which included missed diagnoses, lack of appreciation of the severity of the disease, delay in transferring ill patients and substandard management. In order to achieve the 5th Millennium Development Goal of improving maternal health and reducing the maternal mortality rate these avoidable factors need to be addressed.
One of the key recommendations of the Saving Mothers Report of the NCCEMD states that protocols on the management of important conditions causing maternal deaths (including puerperal sepsis) must be available and utilised appropriately in all institutions where women deliver and that all midwives and doctors must be trained on the use of these protocols.
Health care practitioners should be aware of the risk factors for the development of puerperal sepsis, especially emergency caesarean section for obstructed labour and HIV-infection, in order to offer appropriate antibiotic prophylaxis. The signs and symptoms of puerperal sepsis should be clearly understood and an accurate initial assessment should be made so that the appropriate management can be started timeously. This includes managing the patient at the appropriate level of care, initiating appropriate antibiotic therapy, evacuating the uterus if necessary and deciding on the need for laparotomy.
Author L.J. RogersSource: Obstetrics and Gynaecology Forum 19, pp 120 –125 (2009)More Less
The vulval ulcers that are seen in obstetrics and gynaecological practice in South Africa are most commonly caused by sexually transmitted diseases, especially herpes simplex infection. These ulcers have become more common due to the Human immunodeficiency virus (HIV) epidemic, and are also responsible for increased transmission of HIV, due to mucosal interruption. There are many other rarer causes of vulval ulcers, especially in young women, who may have aphthous ulcers of the vulva, and in older women, where malignancy should be excluded. Vulval ulcers do not always have an appearance that is characteristic of their cause, so there should be a low threshold for biopsy of any abnormal vulval skin.
Source: Obstetrics and Gynaecology Forum 19, pp 127 –133 (2009)More Less
Emergency contraception (EC) can be used as a backup contraceptive to help prevent unintended and unplanned pregnancies after unprotected sexual intercourse. These methods include the use of emergency contraceptive pills (ECPs) or copper containing intrauterine devices (IUD). These ECPs should not be used as regular contraception. Mifepristone (not available in South Africa as EC) and levonorgestrel are very effective, with few adverse effects, and are preferred to combined oestrogen and progestogen administration. Levonorgestrel can be used in a single dose (1.5 mg) instead of two doses (0.75 mg) 12 hours apart. A Copper IUD can be retained for ongoing contraception.
Despite the proven efficacy of ECP, increased access to ECPs enhances use but has not been shown to reduce unintended pregnancy rates at a population level. Further research is needed to explain this finding and to define the best ways to use EC to produce a public health benefit. Efforts should be targeted at vulnerable groups such as adolescents and women presenting for urgent care. At the time of the visit regular contraception should be promoted and initiated.
Author L.K. SchoemanSource: Obstetrics and Gynaecology Forum 19, pp 135 –138 (2009)More Less
Meconium is rarely passed into the amniotic fluid before 34 weeks although it is present in the fetal gut from as early as 10 weeks. The passage of meconium into the amniotic fluid is a feature of advancing gestational age and reflects physiological maturation of the fetal gut. Certain specific maternal and fetal disorders may be associated with the passage of meconium into the liquor amnii. Opinions regarding the significance of meconium-stained liquor detected during labour have varied although there is consensus that meconium aspirated into the lungs of the neonate may lead to meconium aspiration syndrome. The efficacy of various interventions designed to prevent meconium aspiration syndrome are discussed.
Author Athol KentSource: Obstetrics and Gynaecology Forum 19, pp 141 –143 (2009)More Less
Screening is intuitively a good thing in that it is a rational attempt to limit the effects of a condition. Early detection, when interventions can cure or change the course of the disease is an attractive notion but the screening process must be effective.
There are various riders to an effective screening process and some of these are being critically reviewed in the gynaecological domain. Cervical cytology has long been held up as the gold standard of screening programmes but with the new understanding of the natural history of Human Papillomavirus and its involvement in cervical cancer, the place and effectiveness of cytology is being reviewed.
The role of vaccines against the oncogenic strains of the Human Papillomavirus provide fresh hope of reducing the burden of the disease but effects they will have on screening for the virus or the cytological changes it causes bear careful scrutiny.
Other cancers in women - ovarian and breast - do have screening programmes but these are also being reviewed critically and found to be wanting.