Obstetrics and Gynaecology Forum - Volume 24, Issue 4, 2014
Volume 24, Issue 4, 2014
Author Zephne M. Van der SpuySource: Obstetrics and Gynaecology Forum 24 (2014)More Less
Author Stephen T. JefferySource: Obstetrics and Gynaecology Forum 24, pp 7 –13 (2014)More Less
A broad range of surgical options are now available for women presenting with uterine prolapse. A vaginal hysterectomy coupled with a robust vault support procedure remains an excellent choice in dealing with uterine prolapse. The importance of ensuring adequate fixation of the vault after hysterectomy cannot be overemphasized. The two best procedures for cuff support are sacrospinous fixation and high uterosacral ligament suspension. The latter can also be used for vault support following vaginal hysterectomy for uterine prolapse.
Retaining the prolapsed uterus and performing a hysteropexy operation has recently become a very popular surgical technique. This usually involves attaching uterine support sutures to either the sacrospinous or uterosacral ligaments without doing a hysterectomy. Vaginal mesh procedures are available for women with uterine prolapse. If a mesh is used, it is important to use a device that offers adequate apical support and the newer single incision sacrospinous support mesh kits may be superior.
The Le Fort colpopcleisis remains an excellent surgical procedure in the old and frail patient who has no desire to retain her potential for sexual activity. This is a minimally invasive operation with a significantly reduced risk of morbidity compared with more extensive procedures. The Manchester repair may now be re-emerging as treatment for uterine prolapse. The abdominal approach to uterine prolapse has recently become popular. This usually involves either a total or supracervical hysterectomy followed by sacrocolpopexy.
Author Graham HowarthSource: Obstetrics and Gynaecology Forum 24, pp 15 –20 (2014)More Less
Keeping out of trouble is in a doctor's best interest, however it is often easier said than done. This paper concentrates on key concepts - all beginning with the letter C - that may help the doctor avert trouble and complaints. The 12 Cs are communication, consent, clinical records, confidentiality, careful prescribing, chaperone, clerical issues, conduct, competence, cause analysis, cover and common sense. The clustering of important words around the letter C can be taken even further. What do clinicians wish to avert? Complaints, Council (HPCSA), claims, Coroner's (to borrow from the Northern hemisphere vernacular) inquests and criminal matters. In the last four medicine and law intersect. With respect to the HPCSA a patient may lay a complaint with the Council criticising a doctor's conduct or the care given. Although not strictly speaking legal the proceedings are quasi-legal in nature, and extremely important to the doctor as an adverse finding may interfere with registration and the ability to earn an income. When a patient sues, the doctor becomes involved in civil litigation. Alternatively, following a death, the doctor may be involved in an inquest. Finally, although criminal allegations involving clinicians are rare and usually restricted to allegations of indecent assault, or culpable homicide, their consequences are grave.
Author Edward J. CoetzeeSource: Obstetrics and Gynaecology Forum 24, pp 24 –27 (2014)More Less
In the last decade there have been numerous excellent randomised trials published showing the relationship between mild hyperglycaemia and adverse events for both mother and baby. It is now obvious that mothers can be "too sweet" for their unborn babies. In this review available evidence will be explored to demonstrate that if mild hyperglycaemia is identified and treated adverse events can be reduced. It is suggested that the new WHO classification should be used as baseline for management, but that health services that are less well-resourced could introduce more cost-effective strategies.
Author L.J. WalmsleySource: Obstetrics and Gynaecology Forum 24, pp 29 –35 (2014)More Less
The uptake of ART is increasing worldwide with far reaching changes in clinical practice and available technology since the first IVF birth in 1978. Poorer obstetric and perinatal outcomes following ART compared with spontaneous conception have previously been attributed to multiple pregnancies but there is now also consistent evidence of compromised outcomes for singleton pregnancies. The cause for this is thought to be due both to the underlying subfertility as well as the ART technique. The majority of ART pregnancies will be uncomplicated and this should be emphasized. Discussions regarding possible maternal and perinatal risks should be included in the informed consent process with all couples considering ART.
Source: Obstetrics and Gynaecology Forum 24, pp 36 –40 (2014)More Less
Obesity has become a global pandemic. It is a risk factor for fetal malformations, particularly spina bifida and cardiac abnormalities. Obesity decreases the likelihood of a complete detailed scan of fetal anatomy. This leads to an increased chance of missed abnormalities during the antenatal period. In addition, obesity has a negative impact on the sensitivity of all currently available screening tests for Downs's syndrome. New ultrasound technology may improve the image quality but is unable to compensate fully for the decreased resolution. In the current climate of medical litigation it is important for clinicians and patients to be aware of these limitations.