Obstetrics and Gynaecology Forum - Volume 26, Issue 1, 2016
Volume 26, Issue 1, 2016
Source: Obstetrics and Gynaecology Forum 26, pp 6 –9 (2016)More Less
The history of stem cells is interesting and is tainted with debate and controversy as it has been the cause of heated debate between religious groups, scientists, the public and governments. There are two types of stem cell transplants - autologous and allogeneic. An autologous stem cell transplant is one in which the patient receives stem cells from his own blood, whereas an allogeneic transplant is one where the patient receives stem cells from a donor. Umbilical cord blood contains a multiplicity of cell types, including stem cells. Umbilical cord blood can potentially be used for autologous transplantation, allogeneic transplantation of family members or allogeneic transplantation of unrelated individuals to treat a number of diseases such as certain cancers, haematological diseases, genetic immunodeficiency states, to name a few. In some countries public cord blood banks have been established which focus on making tissue available to unrelated individuals (the most cost-effective use). In South Africa, there is no public cord blood bank and private companies provide cord blood banking for possible autologous or in-family use. With the costs involved in private cord blood banking this facility is only available to the privileged few, with the real risk of parents who cannot afford it going out of their way to procure the funds needed. Directed donation of umbilical cord blood should only be considered for families at high risk of certain genetic and haematological diseases that could potentially benefit from stem cell therapy. The storing of cord blood for "biological insurance" in low risk families should be strongly discouraged.Parents who ask for information about umbilical cord blood banking should get unbiased and accurate information regarding the advantages and disadvantages and any conflict of interest should be disclosed. Parents should never compromise themselves financially in order to store cord blood and at no stage should there be deviation from sound medical practice in order to collect cord blood.
Source: Obstetrics and Gynaecology Forum 26, pp 13 –17 (2016)More Less
Although adnexal masses in adolescents are rare occurrences, the implications of diagnosis and surgical treatment can affect the adolescent psychologically and have an impact on future fertility. Most masses are benign and should be treated conservatively. Malignant masses in this age group generally respond well to chemotherapy and thus conservative, fertility sparing surgery is the treatment of choice. It is important, therefore, to have a comprehensive approach in order to formulate management strategy with the least effect on future reproductive potential. This article reviews the most common causes of adnexal masses and highlights important points to be considered while obtaining a history and during examination and discusses the current recommendations for treatment of adnexal masses in adolescents.
Source: Obstetrics and Gynaecology Forum 26, pp 19 –24 (2016)More Less
Counselling regarding congenital CMV infection is challenging as it may have a protracted clinical course from the time of suspected maternal infection until evidence of fetal damage. Gestational age at infection is the strongest predictor of adverse outcome but is often impossible to determine.Fetal infection, confirmed by amniotic fluid PCR, cannot be reliably diagnosed before 20 weeks gestation but this is usually not an issue outside of routine screening programmes. Although a positive PCR confirms fetal infection, it does not have prognostic value in the individual patient and it must be remembered that a negative PCR result is not fully reassuring as the sensitivity is not 100%. Fetal blood parameters, obtained by cordocentesis, are most useful for prognosticating in addition to ultrasound features, but manifestations of fetal damage (particularly central nervous system involvement) may only become apparent late in the third trimester. If imaging features of central nervous system involvement are present, late termination of pregnancy can be considered due to the high likelihood of severe brain damage, in line with the South Africa Termination of Pregnancy Act. A vaccine against CMV would be the best solution to this difficult and unpredictable clinical problem, but a phase III trial is still needed to prove efficacy. Hygiene education is beneficial in primary prevention but has not been implemented widely in South Africa. For secondary prevention or treatment, CMV hyper-immune globulin has not demonstrated efficacy so far. Valaciclovir is currently the most promising drug and careful case selection of infected fetuses without CNS involvement would be prudent.
Source: Obstetrics and Gynaecology Forum 26, pp 25 –30 (2016)More Less
Preterm birth is a global problem that is associated with significant morbidity and mortality as well as the consumption of valuable, scarce resources. It also has potentially significant, long-term, implications for neurological development. One of the oldest drugs in the arsenal of the obstetrician, namely antenatal corticosteroids (ACS) have been used for decades for well documented benefits pertaining, but not limited to the fetal/neonatal respiratory system. These drugs cross the placenta. They are administered within a specific gestational age range to mothers at risk of preterm delivery within the next seven days. In view of the robust evidence supporting the benefits of ACS, some researchers have sought to broaden the indications. The conviction that there are only benefits should not be cast in stone. Recent publications raise issues of possible harm. The current evidence is briefly reviewed to address specific indications and contra-indications as well as the evidence about the drug itself.