Obstetrics and Gynaecology Forum - Volume 24, Issue 3, 2014
Volume 24, Issue 3, 2014
Source: Obstetrics and Gynaecology Forum 24, pp 1 –2 (2014)More Less
Urogenital fistulae (UGF) is one of the most dreadful complications encountered in obstetrics and gynaecology and constitutes a major surgical challenge to physicians. It is a source of great misery and unhappiness in the patient and a major liability and anxiety to the doctor. When it is surgical related, there are grave medicolegal implications. In South Africa, a country straddling the first and third world, urogenital fistulae caused by obstructed labour and those caused by gynaecological surgery are seen in approximately equal proportions. In most other African countries, especially Sub-Saharan states, obstetric related fistulae are far commoner. In high income countries, obstetric fistulae is rare.
From dyspnoea to respiratory failure in pregnancy, Obstetrics & Gynaecology Forum 24(2) May 2014 : pp 9-13 : erratumAuthor S. CebakuluSource: Obstetrics and Gynaecology Forum 24 (2014)More Less
Choosing the appropriate surgical procedure for stress urinary incontinence in the mature-age woman : reviewSource: Obstetrics and Gynaecology Forum 24, pp 9 –11 (2014)More Less
Urinary incontinence in the mature-age woman is a significant health problem associated with isolation, depression, and an increased risk for institutionalization. Stress urinary incontinence (SUI) is a common type of incontinence seen in this age group. In a review addressing epidemiological data, the prevalence of SUI in women greater than 65 years ranged from 10-40%. With the rapid increase in the active elderly population worldwide, clinicians can expect to encounter SUI with increasing frequency.
Postpartum haemorrhage following manual removal of retained placenta from an inverted uterus and the role of mersilene tape : lessons to learn : reviewAuthor Nnabuike Chibuoke NgeneSource: Obstetrics and Gynaecology Forum 24, pp 13 –15 (2014)More Less
Acute uterine inversion (AUI) is a rare obstetric emergency. Manual removal of placenta in such circumstances often leads to massive postpartum haemorrhage (PPH) if the procedure is performed before correction of the inversion. In the case reported, a 20 year old G3, P1+1 at term, had a spontaneous vaginal delivery in a district hospital. During the third stage of labour, she developed AUI with the placenta still attached to the uterus. An attending medical officer removed the placenta manually before attempting reduction of the inversion. A massive PPH and shock developed. The medical doctor phoned the referral centre to transfer the patient but the obstetrician receiving the phone call advised that the patient should be taken for an emergency laparotomy at the same district hospital so as to reduce the inversion and possibly apply a uterine tourniquet to manage ongoing PPH. At laparotomy, the inversion was corrected and uterine compression sutures using mersilene tapes were applied. The patient was subsequently transferred to the referral centre. The lessons to be discussed in this case are: manual removal of placenta prior to repositioning of an inverted uterus; treatment options for AUI at a district hospital; and the use of uterine compression suture for the prevention of recurrent AUI.
Source: Obstetrics and Gynaecology Forum 24, pp 17 –20 (2014)More Less
Despite the high population rates in developing countries, one in three couples are affected with infertility. The main causes of infertility in Africa are tubal occlusion and male factor due to sexually transmitted infections, postabortal and postpartum sepsis. Assisted reproductive technologies (ART) is often the only solution for these couples which are prohibitively expensive and sparsely available. This paper discusses alternative strategies to modify stimulation protocols and laboratory methods to make ART more affordable in low resource settings and public institutions.
Author T.D. NaidooSource: Obstetrics and Gynaecology Forum 24, pp 24 –28 (2014)More Less
Anal incontinence (AI) impacts negatively on the quality of life of affected individuals. Information regarding this condition in South Africa is sparse. Determining the true incidence of AI is often difficult. Sphincter disruption and nerve damage, as a complication of childbirth are thought to be the main contributory factors to the development of post-partum AI. Local studies suggest that pregnancy itself may be a risk factor for AI and there appears to be an interracial variation in incidence. There is no correlation between symptoms of AI and occult anal sphincter injury. Women with symptoms of AI should be offered assessment, treatment, and follow up evaluations. The reluctance of patients and health personnel to acknowledge or discuss it, compounds the difficulties in determining the true incidence of, and influence of the various etiological factors for AI in our South African population.
Source: Obstetrics and Gynaecology Forum 24, pp 29 –32 (2014)More Less
The aim of pelvic reconstructive surgery is to restore normal anatomy, to relieve symptoms of prolapse and incontinence and to restore the normal function of the lower urinary tract and bowel, and to improve sexual function. Approaches to pelvic reconstructive surgery include the transvaginal, transabdominal, laparoscopic or a combination of these approaches. The transvaginal approach has the advantage of reduced postoperative pain, shorter hospital stay, quicker return to normal activities and no abdominal scars when compared to the abdominal approach. However, the transabdominal approach is associated with better efficacy and long term results. Laparoscopy (minimally invasive surgery) for urinary incontinence and pelvic organ prolapse have gained increasing popularity in the past decades. The laparoscopic approach has been proposed with a view of combining the high efficacy of the transabdominal approach with the minimal invasiveness of the transvaginal technique.