Obstetrics and Gynaecology Forum - Volume 21, Issue 1, 2011
Volume 21, Issue 1, 2011
Source: Obstetrics and Gynaecology Forum 21, pp 1 –3 (2011)More Less
Invariably there is an unhappy story behind every case of litigation involving obstetric care where a child has been compromised. Families live with the consequences, and, if litigating, obviously feel somebody is at fault and the claimants deserve compensation. Even if the doctor's care was exemplary, the doctor too will be distressed at the outcome, but, if sued, will have to cope with the tensions of litigation. However, the effect spreads further than just those directly involved.
Author T.J. De VilliersSource: Obstetrics and Gynaecology Forum 21, pp 9 –14 (2011)More Less
The scope of practise of the modern gynaecologist is forever expanding. Management of a woman presenting with menopause must include an assessment and planning of future bone health. Osteoporosis is defined as a systemic skeletal condition where bone strength has deteriorated to such an extent, that fracture can result when falling from own body height. Bone strength is determined by a combination of bone density and micro architectural integrity. The most common osteoporosis related fractures are fractures of the vertebrae. Major non-vertebral osteoporosis related fractures are fractures of the hip, wrist, pelvis, sacrum, ribs, sternum, clavicle and humerus. All these fractures are important in terms of disability and pain. Osteoporosis related fractures result in significant morbidity and increased mortality. Osteoporosis related fractures are common and will affect at least a third of women above the age of 50 years. Osteoporosis affects an estimated 75 million people in Europe, USA and Japan but in view of increased life expectancy, it is estimated to increase by 240% by 2050. It is estimated that more than 2 million osteoporosis related fractures occurred in the USA during 2005 at a cost of $19 billion. Hip fractures accounted for 72% of costs.
Source: Obstetrics and Gynaecology Forum 21, pp 16 –24 (2011)More Less
Women with polycystic ovarian syndrome (PCOS) have an increased incidence of World Health Organisation (WHO) group II anovulatory infertility.
The aetiology of the association of anovulation with PCOS is believed to be hyperinsulinaemia and is accentuated by obesity. Approximately 50% of women with PCOS are overweight and indeed there is evidence that even normal weight women with PCOS have increased intra-abdominal fat. More than 50% of lean women with PCOS are insulin resistant.
Hyperinsulinaemia and elevated leptin production from adipose tissue lead to increased ovarian androgen production by increasing ovarian theca cell cytochrome P450-scc and "cytochrome P450c-17" enzyme activity, as well as by increasing the frequency of luteinising hormone (LH) pulses, thus augmenting ovarian androgen production. This is in addition to the increase in serum free androgen levels, due to the inhibition of hepatic sex hormone binding globulin. The result is that serum and ovarian androgen levels are raised in association with impaired folliculogenesis. Methods employed to induce ovulation consist of weight loss, anti-estrogens, insulin sensitizers, gonadotrophins, laparoscopic ovarian drilling and letrozole.
Source: Obstetrics and Gynaecology Forum 21, pp 26 –30 (2011)More Less
Preterm delivery is one of the leading causes of neonatal and infant mortality and the leading cause of infant morbidity. It is responsible for more than 70% of neonatal deaths and nearly 50% of long-term neurologically disabled infants and children. All efforts should therefore be made to reduce these sad losses to women and their families and the sometimes preventable permanent neurological harm to children.
Many pregnancies are complicated by psychosocial problems. In South Africa, women are exposed to many psychosocial stressors, including poverty and traumatic stress. South African women have some of the highest rates of antenatal depression in the world (up to 40% in comparison to international rates of 10-15%). Furthermore rates of intimate partner violence are high, with 30% of pregnant women reporting intimate partner violence in the last year. In the past, routine screening for these problems at antenatal visits, have been neglected. However, more recently, the American College of Obstetricians and Gynecologists has recommended that all pregnant women, regardless of social status, should have a psychosocial screening done once in each trimester. They recommended that the screening should include a wide range of psychosocial conditions, including depression, intimate partner violence and stress. In a plea for action to improve maternal health, Al-Saleh and Di Renzo recently referred to maternal stress as a cause of disability.
Source: Obstetrics and Gynaecology Forum 21, pp 31 –36 (2011)More Less
Preterm prelabour rupture of membranes (PPROM) is a condition that has posed challenges in definition, etiology and management. It can be defined as the spontaneous rupture of membranes, at least one hour before the onset of uterine activity, occurring from 24 to 37 completed weeks (259 days).
The incidence of PPROM ranges between 2-12% in current literature and the occurrence of PPROM as a complication in preterm labour is estimated at 40 - 45% across the globe.
Up to 36% of woman with PPROM have a positive culture of the amniotic fluid adding chorio-amnionitis (often present in the sub-clinical form) to the risk profile in these patients as both a cause and/or consequence of PPROM.
Within the current literature there is a spectrum of articles addressing the areas of controversy such as timing of delivery as well as the use of tocolytics, antibiotics and/or corticosteroids.
This review article aims to give an overview of the general management of PPROM as well as address management options in the so called "very early" (pre-viable, <24 weeks) and "late preterm" (>34 weeks) cases.
Source: Obstetrics and Gynaecology Forum 21, pp 38 –39 (2011)More Less
The obstetrician is very often confronted with antepartum haemorrhage. After stabilising the patient haemodynamically the hunt for a cause is persued. After excluding a placenta praevia, abruptio placentae, local causes (cervical lesions, infection e.g. gonorrhoea and urinary tract infection) and vasa praevia the, diagnosis of antepartum haemorrhage of unknown origin (APHUO) is made. This condition usually awakens the feeling of uneasiness, doubt and uncertainty in the clinician. Rightly so, as the evidence is scarce and no clear guidelines on its management exists.