Obstetrics and Gynaecology Forum - Volume 25, Issue 2, 2015
Volume 25, Issue 2, 2015
Author R. BurtonSource: Obstetrics and Gynaecology Forum 25, pp 3 –9 (2015)More Less
Pregnant women with ebola virus disease (EVD) are at increased risk of severe disease and death compared to non-pregnant patients. Pregnancy loss is common in all trimesters, and women may be in labour at presentation. The fetus, placenta and amniotic fluid are highly infectious, and remain so even if the mother survives and is ebola PCR negative on blood testing. All liveborn neonates to date have died. This article will give an overview of the current outbreak in West Africa, and clinical presentation and management of EVD, and the challenges of managing pregnant women with EVD. Despite the good news that new infections in West Africa have now significantly declined, this is no time for complacency. Ebola virus disease may yet reach South Africa, either if there is a resurgence of cases, or in future outbreaks. It is vital that health care providers are prepared; this includes obstetricians and midwives. There have been no reported cases of pregnant women developing EVD who have travelled from the affected region to other countries, however this is not impossible. The final section of this paper will give guidelines for the diagnosis and management of ebola virus disease in pregnancy in a South African context. In an outbreak situation, the major challenge is maximising use of resources to optimise maternal survivial and keep health care workers safe from infection. In countries where sporadic, imported cases may occur, such as South Africa, the problem is identifying a pregnant woman who is an ebola suspect, given that there are no specific symptoms, and the differential diagnosis is of both obstetric and non-obstetric conditions is therefore wide.
Author A.C. StoltzSource: Obstetrics and Gynaecology Forum 25, pp 13 –16 (2015)More Less
The World Health Organisation (WHO) estimates a staggering 8.6 million new tuberculosis cases every year (Global TB report, 2013). Seventy five percent of the 8.6 million cases are from the Africa region. More than 500 000 of these cases are new multi-drug resistant tuberculosis (MDR TB) that has doubled from 2009 as well as 2011 and this number is currently doubling annually. Many of these cases are primary MDR TB infection or re-infection rather than previously treated tuberculosis progressing to MRD TB. Evidence is growing for increased transmission in congregate settings and hospitals. Currently drug susceptible tuberculosis treatment rapidly induces negative transmission compared to multi- and extreme drug resistant tuberculosis treatment that is not effective and the patient can be positive for months and still transmitting disease.
Author S. AdamSource: Obstetrics and Gynaecology Forum 25, pp 19 –22 (2015)More Less
South Africa has a high burden of HIV disease. Approximately 29% of antenatal clinic attendees are infected with HIV. A compromised immune system in pregnancy was thought to render the HIV positive woman more susceptible to complications. Recent data suggests that HIV causes few adverse effects on pregnancy. Similarly, pregnancy is not associated with HIV disease progression. Appropriate use of anti-retroviral therapy is a major determinant in the fall of HIV/AIDS related morbidity and mortality as well as perinatal transmission. Maternal mortality due to non-pregnancy related infection, of which HIV is the major contributor, is declining. This is a reflection of improved prevention of mother-to-child transmission of HIV guidelines in South Africa. All pregnant women are now initiated on lifelong anti-retroviral therapy. It is hoped that this will improve maternal health and thus directly impact of infant well-being.
Source: Obstetrics and Gynaecology Forum 25, pp 27 –32 (2015)More Less
Infections acquired in utero or during the birth process are a significant cause of fetal and neonatal mortality and an important contributor to early and later childhood morbidity. The original concept of the TORCH perinatal infections was to group five infections with similar presentations, including rash and ocular findings. This TORCH complex encompasses the infections caused by Toxoplasma gondii, rubella virus, cytomegalovirus, herpes simplex virus both types 1 and 2 and other infective organisms. This review will concentrate on the traditional TORCH infections with Syphilis, Parvovirus B 19, Group B Streptococci infection and Varicella discussed under 'Other Infections(8). Treatments each vary as discussed however no specific therapy for certain infections has yet been established, thus prevention protocols should be heeded to.
Source: Obstetrics and Gynaecology Forum 25, pp 35 –40 (2015)More Less
A wound can be defined as the disturbance of the skin's normal structure and function and the soft tissue beneath it. Wound complications are major contributors to both early and late postoperative morbidity. It can cause significant physical and emotional distress to both patients and the treating physician. Most surgeons will agree that wound complications can be challenging to treat and everything possible should be done to prevent it from happening.