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South African Journal of Obstetrics and Gynaecology
Journal Prestige (SJR): 0.136  Number of Followers: 2  Open Access journalISSN (Print) 0038-2329 - ISSN (Online) 2305-8862 Published by Health and Medical Publishing Group  [2 journals]
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- Improving surgical and medical outcomes, beyond maternal mortality
Authors: A Paterson, L Cairncross, T Adams, B M Biccard, S Maswime
Pages: 2 - 3
Abstract: No abstract.
PubDate: 2022-11-02
Issue No: Vol. 28, No. 1 (2022)
- Diathermy v. scalpel Pfannenstiel incision in repeated caesarean sections:
A randomised controlled trial
Authors: A A-Mageed, I A El-Fotoh, R Fouad, N Gamal, E N Salama, M Abdel-Rasheed, D Farouk
Pages: 4 - 7
Abstract: Background. Most surgeons do not choose diathermy over scalpel skin incision, as they speculate that the thermal effect produced owing to tissue resistance to electrical current may lead to postoperative pain, delayed wound healing and wound complications. Objective. To compare the use of cutting diathermy skin incision with scalpel skin incision with regard to incision time, haemostasis, postoperative pain, wound healing and wound complications. Methods. A randomised controlled trial was performed on 476 women who underwent caesarean sections. They were randomised into two groups: group 1 (women scheduled for conventional scalpel skin incision) and group 2 (women scheduled for cutting diathermy skin incision). Results. The incision time, blood loss, visual analogue scale (VAS) pain score and doses needed for analgesia were significantly lower in group 2 than in group 1 (p<0.001). The groups did not show any significant difference regarding wound complications. Wound healing in both groups was by primary intention. Conclusions. Diathermy skin incision is superior to scalpel skin incision, with no postoperative pain and good wound healing.
PubDate: 2022-11-02
Issue No: Vol. 28, No. 1 (2022)
- Safe caesarean sections in South Africa: Is internship training
sufficient'
Authors: L Temlett, D G Bishop, N Moran
Pages: 4 - 9
Abstract: Background. In Africa, the maternal mortality rate after caesarean section (CS) is 50 times higher than that in high-income countries. In South Africa (SA), women who undergo CS have a three times higher mortality rate than those who deliver vaginally. Anaesthetic complications and obstetric haemorrhage are major drivers of poor outcomes, and the case fatality rate for CS at district hospitals is particularly high. Objectives. To assess the adequacy of anaesthetic and obstetric internship training in preparing interns to perform CS independently and safely. Methods. This was an observational cross-sectional survey of all community service officers (CSOs) in KwaZulu-Natal (KZN), SA, in 2020. Data were collected via an electronic survey that comprised 68 questions in 4 domains, covering personal information, obstetric surgical training, obstetric anaesthetic training and support received as a CSO. Results. Surveys were sent to 228 CSOs in KZN, with 160 responses received (70% response rate). Respondents included participants from 8 medical schools and 33 internship facilities across the country. One in 8 interns (n=21/160) did not perform the required 10 CSs. Supervision in theatre was provided by an obstetric specialist for at least 1 CS in n=57/160 (35.62%; 95% confidence interval (CI) 28.54 - 43.39) participants, and n=45/160 (28.13%; 95% CI 21.66 - 35.64) interns never performed an emergency CS. Interns had limited opportunity to be the primary surgeon for complicated cases. Only 1/5 interns performed >5 obstetric general anaesthetics. Conclusions. This survey showed that there are deficiencies in the current CS-related training of interns in SA. A lack of exposure to adequate obstetric surgical training and obstetric general anaesthesia is likely to impact on the performance of CSOs and on the safety of the CS service provided at district hospitals. The content and quality of the CS-related intern training programme needs to be enhanced to improve the competence of CSOs. The Health Professions Council of South Africa (HPCSA)’s stipulations for internship training must be adhered to and should look to include simulation training, basic surgical skills courses and prioritisation of exposure to complicated surgical scenarios.
PubDate: 2022-11-02
Issue No: Vol. 28, No. 1 (2022)
- A comparison of malignant histopathological diagnoses on uterine
curettings and hysterectomy specimens
Authors: A Ismail, R Wadee
Pages: 10 - 15
Abstract: Background. Endometrial carcinoma (EC) is a common gynaecological malignancy in postmenopausal females. Diagnosis is made on endometrial biopsy, where histological subtype and tumour grade are used to predict disease progression and to plan surgical management. Objectives. To determine the accuracy of preoperative biopsies compared with the final diagnosis on hysterectomy specimens. Methods. This was a retrospective, cross-sectional study in which 126 biopsies and corresponding hysterectomy specimens, collected over a 3-year period, were reviewed. Patient demographics and histological features were recorded and statistically analysed. Results. The most prevalent tumours were endometrioid endometrial carcinoma (EEC) (48.5%), serous carcinomas (25.4%) and carcinosarcomas (16.7%). The majority (66.7%) of tumours were high-grade tumours on biopsy and hysterectomy specimens (58.7%). EECs had a poor sensitivity level (65.1%) compared with other subtypes but had a high specificity rate (90%). There was moderate agreement between biopsy and excision specimen diagnoses. High-grade tumours had a high sensitivity level (94.3%). Conclusions. Our study showed moderate agreement between histopathological diagnoses on biopsy and excision specimens. There was a high sensitivity level for biopsies of high-grade tumours, concordant with other studies. Accurate preoperative tumour subtyping and grading are needed to guide surgical management. It is envisaged that use of a combined histological and molecular tumour classification will better guide patient treatment and allow for reproducible results.
PubDate: 2022-11-02
Issue No: Vol. 28, No. 1 (2022)
- Maternal experiences of care following a stillbirth at Steve Biko Academic
Hospital, Pretoria, South Africa
Authors: A S Jimoh, J E Wolvaardt, S Adam
Pages: 16 - 21
Abstract: Background. Despite improvements in obstetrics and neonatal care, the stillbirth rate remains high (23 per 1 000 births) in South Africa (SA). The occurrence of a stillbirth is a dramatic and often life-changing event for the family involved. The potential consequences include adverse effects on the health of the mother, strain on the relationship of the parents, and strain on the relationship between the parents and their other children. The standard of care in SA follows the Royal College of Obstetricians and Gynaecologists Green-top guidelines. Objectives. To explore maternal experiences of in-patient care received in cases of stillbirth. Methods. A descriptive phenomenological approach was performed in the obstetrics unit at Steve Biko Academic Hospital, Pretoria, SA. Post-discharge interviews were conducted with women who experienced a stillbirth. The healthcare workers in the obstetric unit were also interviewed on the care provided to these patients. Data analysis was performed using the Colaizzi’s method. Results. Data from the interviews with the 30 patients resulted in five themes relating to the maternal experience of stillbirth: ‘broken heart', ‘helping hand’, ‘searching brain’, ‘soul of service’ and ‘fractured system’. Healthcare worker participants emphasised the importance of medical care (the clinical guidelines) rather than maternal care (the psychosocial guidelines). Conclusion. While the medical aspects of the guidelines are adhered to, the psychosocial aspects are not. Consequently, the guidelines require adaptation, especially taking into consideration African cultural practices, and the inclusion of allocated responsibility regarding the application of the psychosocial guidelines, as this is the humanitarian umbilical cord between healthcare workers and those in their care.
PubDate: 2022-11-02
Issue No: Vol. 28, No. 1 (2022)
- Concurrent chemo-radiation induced renal and haematological toxicities in
patients with invasive cervical cancer undergoing treatment
Authors: F Motala, P Pillay, K Govender
Pages: 22 - 25
Abstract: Background. Cervical cancer constitutes a major problem in women’s health in South Africa (SA). Concurrent chemo-radiation is the standardised treatment for patients with invasive cervical cancer. There is limited evidence on the differences in the concurrent chemo-radiation treatment toxicity between HIV-positive and HIV-negative patients. Objective. To determine the renal and haematological toxicities associated with concurrent chemo-radiation in women undergoing treatment for invasive cervical cancer, using renal and haematological biomarkers. Methods. A prospective study was conducted among 82 women that presented for concurrent chemo-radiation treatment at the Inkosi Albert Luthuli Central Hospital in SA. Thirty two (39%) of participants were HIV-positive. Data collected using questionnaires and the hospital’s databases were analysed with SPSS data analysis software. Toxicity was scored using the Cooperative Group Common Toxicity Criteria. Results. More than 90% of both HIV-positive and HIV-negative participants completed all 5 cycles of chemotherapy. The main finding in both cohorts was Grade 1 and 2 haematological toxicity. Haemoglobin was significantly decreased in 74% of participants. No renal toxicity was identified in this study. The reasons for not completing treatment were abscondment during treatment (3%) and discontinuation of treatment by the physician (1%). Conclusion. Concurrent chemo-radiation was well tolerated in both HIV-positive and HIV-negative participants. The same concurrent chemo-radiation protocol can be applied to both HIV-positive and HIV-negative patients. However, the study population was small and findings need to be replicated in more extensive studies.
PubDate: 2022-11-02
Issue No: Vol. 28, No. 1 (2022)
- Provision of postpartum long-acting reversible contraception: A quality
improvement intervention with pre- and post-intervention evaluation.
Authors: E E Wynne, G J Hofmeyr
Pages: 26 - 29
Abstract: Background. Unintended pregnancies remain an important health challenge in South Africa (SA) and worldwide. Improving access to contraception and long-acting reversible contraception in particular, may reduce the number of unintended pregnancies. Objective. To determine the impact of a training and supportive mentoring programme on postpartum uptake of long-acting reversible contraceptive (LARC) methods. Methods. A quality-of-care improvement intervention with pre- and post-intervention evaluation of LARC uptake was conducted at a midwife-led, on-site obstetric unit in the Eastern Cape, SA. Midwives were trained in contraceptive counselling and postpartum etonorgestrel implant insertion. The researcher provided counselling and postpartum intrauterine device (IUD) insertion services. Results. In the 10 weeks prior to the intervention, neither the IUD nor the implant were provided in the unit. In the 10 weeks after the intervention, uptake of the IUD was n=27/289 (9.3%) and the implant n=21/289 (7.3%). Use of no contraception or condoms increased from n=22/273 (8.1%) to n=41/289 (14.2%) (p<0.02). The increase was accounted for by a change in staff in the last 4 weeks of the intervention period (n=33/105 (31.4%) v. n=8/184 (4.4%) during the first 6 weeks; p<0.00). Conclusion. Competing responsibilities of maternity staff may limit the contraceptive options offered to postpartum women. A programme of training and supportive supervision resulted in a substantial increase in levels of LARC uptake. Strategies are needed to institutionalise comprehensive postpartum contraceptive provision nationally.
PubDate: 2022-11-02
Issue No: Vol. 28, No. 1 (2022)
- Bicornuate uterus with second trimester fetal demise in a rudimentary horn
Authors: R Nelson
Pages: 30 - 32
Abstract: Bicornuate uterus is a congenital uterine anomaly associated with reproductive complications such as recurrent pregnancy loss, preterm birth, cervical insufficiency and uterine rupture. A bicornuate uterus occurs owing to failure of septal resorption after fusion of the paramesonephric ducts during organogenesis, resulting in a uterus divided into two horns. Most cases are only identified once reproductive difficulty is experienced or as an incidental finding in patients with a normal obstetric history. Here we present a patient who had two previous normal vaginal deliveries at term who was incidentally found to have a bicornuate uterus with second trimester fetal demise in the rudimentary horn. A hysterotomy and bilateral tubal ligation was performed, and the patient was discharged in good health after 48 hours.
PubDate: 2022-11-02
Issue No: Vol. 28, No. 1 (2022)
