Obstetrics and Gynaecology Forum - Volume 20, Issue 1, 2010
Volume 20, Issue 1, 2010
Author H.J. OdendaalSource: Obstetrics and Gynaecology Forum 20 (2010)More Less
South Africa faces numerous challenges. In my opinion, one of the greatest challenges is to improve the availability and quality of education, from pre-primary school level to tertiary education. Education is the key to the improvement of living standards. It can eventually help to alleviate the other great challenge South Africa is facing, namely poverty. Education can empower people. It can expose people to essential and knowledge new to them, to alternative views and teach them to be questioning of outdated practices. Furthermore, people can be taught to understand and respect democracy, ethical values, the value of life and the rights of minorities, women, children and the elderly. Once the burden of poverty has been put aside, and even while it is being done, other facets of social life will start improving.
Source: Obstetrics and Gynaecology Forum 20, pp 5 –10 (2010)More Less
Oxytocin is one of the most commonly used drugs in obstetric practice but it is also the drug associated with the most preventable adverse events in childbirth. In this review we look at the use of oxytocin augmentation in the multigravida. We look at the concept of whether the multigravida is different to the primigravida. We provide a differential diagnosis for poor progress in the multigravida and look at the use of the partogram. Oxytocin recommended regimens are discussed and we look at how one can measure the effects of oxytocin. We summarize the evidence for the use of oxytocin in augmentation of the multigravida and then provide strategies to avoid problems if oxytocin is used in the multigravid patient. We conclude that the multigravida is very different to the primigravida and that use of oxytocin for augmentation in the multigravida should be strongly discouraged. If used, one should seriously consider the risks associated with oxytocin augmentation in the multigravida which includes uterine rupture. Use needs to be decided on a senior consultant level and it should only be used with continuous fetal monitoring, intrauterine pressure monitoring and only after all other causes of poor progress in the multigravida have been excluded. Consent, with explanation of all the risks associated with augmentation, should be obtained from the mother before augmentation is initiated. If oxytocin is going to be used for augmentation in the multigravida there must be a standardized protocol, there must be a doctor on site who is able to perform emergency caesarean section and who is available to respond to all emergencies. A low-dose, low-frequency dosing regimen should be used with weaning to the lowest dose necessary to maintain contractions.
Author L.A. KennethSource: Obstetrics and Gynaecology Forum 20, pp 13 –19 (2010)More Less
Source: Obstetrics and Gynaecology Forum 20, pp 21 –27 (2010)More Less
The lifetime risk of dying due to pregnancy in sub-Saharan Africa is 1 in 22. Many of these pregnancies are unintended. Long acting reversible contraception (LARC) has great potential in reducing these pregnancies as they are highly effective and do not rely a great deal on compliance and correct use. They have better continuation rates than short term hormonal contraception and as per definition require administration less than once per cycle or month. Despite these obvious advantages they remain largely underutilized even in developed countries even though being more cost effective. Lack of knowledge and myths amongst women and health professional remain a barrier to their use especially in adolescents at risk for unintended pregnancy. The World Health Organization (WHO) Medical eligibility criteria for contraceptive use provides guidance to health professionals in selecting the appropriate contraception for women. The LARC methods include copper intrauterine devices (Cu - IUDs), levonorgestrel- intrauterine systems (LNG-IUS), progestogen-only injectable contraceptives (POIC), progestogen-only subdermal implants and combined vaginal rings.
The possible role of fructose-overload in the aetiology and outcome of polycystic ovarian syndrome (PCOS) in obese women : reviewSource: Obstetrics and Gynaecology Forum 20, pp 29 –32 (2010)More Less