Obstetrics and Gynaecology Forum - Volume 22, Issue 4, 2012
Volume 22, Issue 4, 2012
Author C.J.M. StewartSource: Obstetrics and Gynaecology Forum 22, pp 7 –11 (2012)More Less
Prenatal diagnosis in the setting of a twin pregnancy is challenging. The frequency of abnormalities is higher in twin than in singleton pregnancies, particularly in monozygotic pregnancies. The finding of an abnormality in one twin with a normal co-twin occurs in about 85% of cases of abnormality and raises difficult management decisions. Determination of chorionicity is pivotal in further management as vascular anastamoses in monochorionic pregnancies influence the outcome as well as the interventions which are possible.
Options include expectant management of the pregnancy or selective fetocide. The latter carries risks to the pregnancy of miscarriage and preterm labour. These risks are higher in monochorionic than dichorionic pregnancies. In addition death of one twin of a monochorionic pair can result in death or organ damage in the co-twin. The method of selective fetocide also differs depending on chorionicity. In dichorionic twins, intracardiac injection of KCl is the method of choice, while in monochorionic pregnancies, cord occlusion by either laser coagulation or bipolar coagulation is used. Extensive counselling of parents is necessary prior to prenatal diagnosis, and especially prior to any intervention.
Source: Obstetrics and Gynaecology Forum 22, pp 13 –16 (2012)More Less
Historically, pregnancy was regarded as a state of confinement. More recently, however, research has demonstrated many potential health benefits of aerobic and strength-conditioning exercise in pregnancy and the postpartum period. It is now considered safe, and even advisable, for otherwise healthy pregnant women to initiate or continue an active lifestyle during pregnancy.
Many anatomical and physiological changes take place during pregnancy and while there is no evidence to suggest that exercise in pregnancy is associated with any maternal or fetal adverse outcomes, it is prudent to adjust exercise regimes where necessary to avoid potential harm. Contact sports as well as sports associated with a risk of falling should be avoided. Brisk walking, stationary cycling, and swimming are examples of aerobic exercises that are recommended in pregnancy.
It is advisable for all pregnant women wishing to pursue exercise in pregnancy to be screened for contra-indications and risk factors, and for subsequent recommendations to be made on an individual basis. It is useful to classify pregnant women into the sedentary, recreational, and competitive athlete, as this will help guide the intensity of exercise. All women should be aware of warning symptoms that may develop during physical activity, and advised to stop the exercise and seek medical advice should they occur.
Exercise forms only one component of a healthy lifestyle. A nutritious diet, adequate hydration, and abstinence from smoking, alcohol and illicit drugs are crucial in maintaining optimal health during pregnancy.
Author P. RoosSource: Obstetrics and Gynaecology Forum 22, pp 19 –23 (2012)More Less
With the increasing age of the population, cognitive dysfunction has become a serious concern in the elderly. The attention given to Alzheimer's disease has increased anxiety in many women, leading to fear that some symptoms which might be purely related to natural ageing are in fact a forewarning of later dementia.
The effect of the peri-menopause, post menopause and ovarian hormones on brain function is reviewed and strategies to prevent and modify cognitive dysfunction in women passed the menopause are discussed.
Source: Obstetrics and Gynaecology Forum 22, pp 25 –31 (2012)More Less
Prevention of unintended pregnancies in HIV infected women is a high priority. With the exception of male and female condoms contraceptive options provide no protection for STI and HIV transmission. Consistent and correct condom use needs to be encouraged in addition to the use of an effective contraceptive method. Data on hormonal contraceptive use and disease progression and transmission is limited but reassuring. There is concern about enhanced transmission of HIV with injectable progestogens suggesting possible harm.
The effect of ARV and anti-tuberculosis drugs should be taken into account when counselling on contraceptive methods.
The WHO MEC provides detailed evidence-based recommendations to ensure that patients with medical conditions, as well as those on drugs with possible interactions are fit to use a particular method and can safely select the most appropriate method of contraception.
Counselling, testing, and discussions about the risk for and prevention of STIs and HIV should be offered routinely in any consultation about contraception.
Author V. ThomasSource: Obstetrics and Gynaecology Forum 22, pp 33 –37 (2012)More Less
Most laparoscopic procedures are without serious consequence and the incidence of complications range from 1.0 to 12.5/1000 cases. Data currently suggest that the incidence of complications may be even lower than at open surgery. Despite this, laparoscopic gynaecological surgery is becoming highly litigious. Surgeons need to be aware of the risks encountered in laparoscopic surgery and how to best avoid these. Ongoing training is central to safe surgical practice.