Obstetrics and Gynaecology Forum - Volume 25, Issue 4, 2015
Volume 25, Issue 4, 2015
Author P.S. SteynSource: Obstetrics and Gynaecology Forum 25, pp 1 –2 (2015)More Less
Unmet need for contraception remains high in many settings. It is highest among the most vulnerable in society including adolescents, the poor, those living in rural areas, people living with HIV, and other marginalised people. In 2012, an estimated 225 million women had an unmet need for contraception. Unmet need for contraception is defined as when they were at risk of becoming pregnant but did not wish to conceive, and were not using a modern method to prevent pregnancy. In addition to this many women using contraceptives are not satisfied with their method which potentially puts them at risk for discontinuation without replacement with a more acceptable method, leading to unintended pregnancy. Another barrier to use of contraceptives are the denial of choice for potential users with medical problems because of the condition or the fear of side-effects or adverse interaction with other medication taken.
Author T. Sheridan AdamsSource: Obstetrics and Gynaecology Forum 25, pp 8 –13 (2015)More Less
Malignancy in pregnancy is rare. Cervical and, to a lesser extent, ovarian cancer are the commonest gynaecological malignancies diagnosed in pregnancy. Cancer care may involve surgery, radiation or chemotherapy. The timing of treatment in pregnancy is paramount as it may impact on the fetus. A balance needs to be found in treating the patient optimally thus maintaining oncological safety and fetal preservation (when possible). The management of cervical cancer depends on the clinical stage, histology and gestational age. In early stage cervical cancer, treatment can be delayed or neoadjuvant chemotherapy offered depending on the gestation. Locally advanced cervical cancer diagnosed early in 1st trimester pregnancy should be offered chemo radiation which induces a termination of pregnancy and women should be adequately counselled. At a later gestation, the current trend is to delay treatment with careful follow-up or neoadjuvant chemotherapy. Only 1-3% of adnexal masses in pregnancy are malignant. In most cases, surgery can be delayed unless the patient is symptomatic or if there is concern regarding extra-ovarian disease with ascites. It is recommended that women with a gynaecological cancer in pregnancy, be cared for by a multidisciplinary team.
Author G.R. HowarthSource: Obstetrics and Gynaecology Forum 25, pp 17 –22 (2015)More Less
The steadily increasing obstetric claims' inflation has been accompanied by increases in the cost of obstetric indemnity to such an extent that the issue may threaten private obstetric practice in South Africa with sequelae that could extend to the State. The reasons for and the consequences of the problem have been opined upon but little has been done to resolve the issue. The Government is currently reflecting upon the problem and emphasis may be placed on statutory resolution. Even should this occur it will be beyond the control of the profession and is unlikely to resolve the issue in the immediate future. There is a steadily growing body of American literature that suggests that resolution may be within the grasp of the profession. While resolution will by no means be easy the work to date suggests improved patient safety that may well be accompanied by a substantial decreased litigation risk that would hopefully improve the situation.
Source: Obstetrics and Gynaecology Forum 25, pp 25 –28 (2015)More Less
Stress urinary incontinence has a prevalence of up to 50%. The open Burch colposuspension was first described in 1961. This procedure proved to be very effective in the treatment of genuine stress urinary incontinence and it remained the gold standard until the advent of the midurethral sling in 1995. Although the laparoscopic Burch was also introduced in the early 1990's the midurethral sling gained rapid traction due to the minimally invasive nature, ease of use, decreased operating time and excellent short and long term results. With the passage of time several studies have highlighted the potential complications associated with the use of vaginal mesh. The public's perception on the use of vaginal mesh has shifted the attention back to non-mesh options in the treatment of genuine stress incontinence. The aim of this article is to clarify the role of the Burch colposuspension in the era of the midurethral sling. The review will highlight the efficacy of the open versus the laparoscopic Burch, discuss potential complications associated with this technique and also compare the laparoscopic Burch directly with the transvaginal and transobturator midurethral slings. The selection of patients and surgical technique for the laparoscopic Burch are also discussed. The Burch procedure remains an excellent choice for the treatment of genuine stress urinary incontinence in patients who wish to avoid the use of vaginal mesh.
Source: Obstetrics and Gynaecology Forum 25, pp 31 –38 (2015)More Less
Endometriosis is defined by the presence of endometrial-like glands and stroma outside of the uterus. It has an incidence of up to 50% in women seeking treatment for pain and infertility, places a large economic burden on countries throughout the world and is functionally debilitating for affected women. Although surgeons and physicians have noted its presence for centuries there is still much debate as to its true etiology. In this presentation we aim to review some of the theories surrounding the pathogenesis of endometriosis under the following themes: background risk, origin, initiation, maintenance and progression of the disease. The progress in understanding the development of endometriosis has paved the way for advances in medical management options and possible non-invasive diagnosis of this condition.
Methods: A search was performed on databases: PubMed/MEDLINE, EBSCOHost, BioMed Central, ScienceDirect, Ovid and Internet Archive in September 2014. Keywords used in search were: endometriosis, pathogenesis and pathophysiology. This yielded 132 results, of which 43 articles were reviewed. Additional articles were identified as citations within publications and which were also reviewed.
Author D. KrickSource: Obstetrics and Gynaecology Forum 25, pp 40 –44 (2015)More Less
Female Genital Mutilation (FGM) is a cultural practice involving several types of external female genitalia cutting. The tradition is most prevalent in 29 countries in Africa and the Middle East. It comprises various procedures which damage or remove the external female genital organs for no medical reason. There are no known health benefits and FGM has been recognised to cause both short and long term physical and psychological damage. Generally, the risks and complications associated with different types are similar, but they tend to be significantly more severe and prevalent the more extensive the procedure. Owing to migration, the practice of FGM has been gaining attention and globally health care practitioners are increasingly confronted with this issue. This review aims to provide an overview of the most recent statistics on FGM, the serious short-term and long-term physical, obstetric and psychological complications, defibulation technique and the law in South Africa.