Obstetrics and Gynaecology Forum - Volume 23, Issue 1, 2013
Volume 23, Issue 1, 2013
Author D.W. SteynSource: Obstetrics and Gynaecology Forum 23 (2013)More Less
The aim of medical education is to produce physicians who will work competently in the future. For obstetric care this implies an optimal outcome for mothers and their babies. However, local data indicate an unacceptably high rate of avoidable factors related to suboptimal management, resulting in poor maternal and perinatal outcomes. A lack of basic skills, including inability to interpret clinical findings, underlies these errors.
Effect of the human papillomavirus (HPV) quadrivalent vaccine in a subgroup of women with cervical and vulvar disease : retrospective pooled analysis of trial data : product newsSource: Obstetrics and Gynaecology Forum 23 (2013)More Less
Source: Obstetrics and Gynaecology Forum 23, pp 9 –13 (2013)More Less
The provision of effective and safe contraception during the postnatal period is an important aspect of maternal care. There is still a high unmet need for modern contraception postpartum. The postnatal ward is not the most appropriate setting to discuss future contraception for the first time; however it should be discussed at the latest in the first week postpartum and a future contraceptive plan needs to be established by week four as women may be fertile before the return of their menstrual cycle.
Breastfeeding can prevent pregnancy based on natural postpartum infertility due to the suppression of ovulation and guidelines to improve the efficacy of breastfeeding as a contraceptive method were developed. The World health Organization provides evidence-based recommendations (World Health Organisation (WHO) Medical Eligibility Criteria (MEC) to ensure that patients with medical conditions are fit to use a particular method and can safely select the most appropriate method of contraception. Breastfeeding, modern contraceptive methods, sterilisation and emergency contraception should be considered in all cases.
There are concerns about the possible hormonal effects of combined hormonal contraceptives on the suppression of quality and quantity of milk production as well as possible absorption by the infant. The increased risk of thromboembolism postpartum is also of concern when using COCs and it is recommended that the earliest date to commence is 21 days postpartum if there are no other risk factors for the development of VTE.
Women should receive written information on contraceptives, provided with detailed advice about possible side-effects, including the availability of emergency contraception if needed and a follow-up appointment should be arranged.
Author L.X. LindequeSource: Obstetrics and Gynaecology Forum 23, pp 15 –17 (2013)More Less
The Bartholin's glands are located bilaterally at the posterior portion of the vestibule, distal to the hymenal remnants and are secretory in function. Although not solely so, they are responsible for the natural lubrication of the vagina and vulva and are normally not palpable or visible on examination of the pelvis.
Symptomatic Bartholin duct masses are a common presenting complaint in women presenting acutely to a gynaecological department and can present a therapeutic dilemma. Symptoms most often arise when an abscess forms in an obstructed duct, and unless this is draining spontaneously, it may require a degree of surgical intervention. Incision and drainage has proved to have a high recurrence rate and should thus be supplemented with the insertion of a Word catheter or the placement of sutures securing the ductal wall to the perineal epithelium, known as marsupialisation. Other methods of treatment have proved less effective.
Less often malignancies can arise from the Bartholin structures and occur most frequently in women aged 40 to 70 years. It is thus mandatory to biopsy the ductal and or gland wall in women of this age presenting with a suspicious enlargement of this area of the vulva on the first visit as primary neoplasms of this origin, although rare, are highly metastatic and may require extensive surgical intervention.
Source: Obstetrics and Gynaecology Forum 23, pp 21 –23 (2013)More Less
Background : Deep infiltrating endometriosis (DIE) is a debilitating disease that affects women's quality of life and reproductive function. In clinical practice women with deep infiltrating endometriosis are often misdiagnosed or have several surgeries with suboptimal outcomes. This might be explained by several factors, lack of awareness of the disease, underestimation of the extent of the disease pre-operatively and lack of experience in surgical skill. Treatment and diagnosis of DIE is done by laparoscopy. Surgery is complication prone. There seems to be an ongoing debate in the literature on the best technique in managing rectovaginal endometriosis.
Objective : Firstly, to review the literature on pre-operative modalities in mapping out the extent of the endometriosis, and plan surgery. And secondly, to look at the literature regarding what best surgical technique to use for optimal symptom relief and a lower complication rates.
Conclusion : There seems to be a shift to more conservative surgery, with similar symptom relief and lower complication rates. There needs to be greater awareness of RVE among gynaecologist. Surgical experience, not ego should dictate the surgical intervention of a surgeon. At best these patients should be managed at specialized units.
Author S. NosarkaSource: Obstetrics and Gynaecology Forum 23, pp 25 –27 (2013)More Less
Human immunodeficiency virus (HIV) is a chronic disease that mostly affects individuals of reproductive age. Many of these individuals express the desire to have their own biological children. The two major ethical concerns remain the welfare of the offspring and the avoidance of seroconversion of the uninfected partner.
Currently the life expectancy of an HIV infected individual is estimated at 20 years from the time of diagnosis. Today HIV treatments and practices can limit the risk of viral transmission to the offspring and uninfected partner. A multidisciplinary team approach and pre-conceptual counselling always remains mandatory in the management of these couples.
Treatment should be individualised depending on which partner is affected and the underlying cause of infertility. Three scenarios are possible with regard to HIV status: positive female partner and negative male partner, negative female partner and positive male partner and both partners positive. These options will be discussed further.
Health care facilities should thus, if it is economically and technically feasible, aim to offer fertility services to HIV infected individuals and discordant couples who are willing to use risk reducing treatment modalities.
Source: Obstetrics and Gynaecology Forum 23, pp 29 –33 (2013)More Less
Worldwide, training in ethics theory and practice, as an integral part of medical training, is gaining in importance. This article problematises for our South African context the Western and masculine biases that are still prevalent in most of the dominant moral theories taught, such as Kantianism, Utilitarianism and Principlism. A greater emphasis on both feminist and indigenous African moral theories is needed - not only because women and African students become better represented within the profession as elsewhere in society, but also because it is scientifically and socially called for. In the latter regard it will be shown that feminist and African moral theories may address and help to correct the masculine and Western biases lodged within the more established moral theories normally taught in medical schools. In particular, both feminist and African moral theories emphasise relationship and community over individualism. However, a further question arises from this comparison, namely to what extent feminist and African moral thinking are compatible. By drawing out their most salient similarities, we show that there is indeed an important overlap between the two strands of thought, though we also caution against their conflation. Nevertheless, together they stand as an important corrective to still dominant Western moral theories.