Thrombocytopenia during pregnancy in women with HIV infection receiving no treatment

 Background. Thrombocytopenia (TCP) complicates 5 - 8% of pregnancies. Most cases of TCP are gestational, and the condition is usually mild and occurs in the latter part of pregnancy. Apart from pregnancy-associated medical complications such as pre-eclampsia, HIV infection is a recognised cause of TCP, and a relatively high prevalence of TCP during pregnancy would be expected in a setting with a high antenatal seroprevalence of HIV.Methods. This was a sub-analysis of the data from a prospective trial in which the incidence of postpartum sepsis in HIV-infected women was compared with that in HIV-uninfected women. Women who were considered at low risk and eligible for vaginal delivery were recruited at 36 weeks’ gestation, and followed up for 6 weeks after delivery. Full blood counts and CD4counts of HIV-infected women were obtained at baseline and repeated 6 weeks after delivery.Results. The prevalence of TCP was 5.3% during pregnancy and 1.2% 6 weeks after delivery. The prevalence was similar among HIV-infected (6.0%) and HIV-uninfected women (4.7%) (p=0.292). Among the HIV-infected women, who were not receiving antiretroviral therapy (mean CD4 cell count of 453 cells/µL), there was no significant association between immunosuppression and the severity of TCP.Conclusions. Most of the TCP seen during pregnancy is of the gestational variety, and in this study HIV infection did not increase its prevalence or its severity.

Patients’ experiences of termination of pregnancy at a regional hospital in Durban, South Africa

Background. Safe and effective termination of pregnancy (ToP) services have helped to resolve the uncertainty that surrounds unwantedpregnancies globally and in South Africa (SA). It is important to determine the demographic profile of women requesting ToP and to assessthe reasons for ToP and the beliefs and experiences of women seeking these services in order to improve service delivery.Objectives. To determine the sociodemographic profile and emotional and psychological experiences of women undergoing ToP at aregional hospital in Durban, SA.Methods. The study population consisted of women seeking either medical or surgical ToP at the Addington Hospital ToP clinic from Juneto August 2021. The participants were requested to complete a structured self-reporting questionnaire on their sociodemographics, theirawareness of, attitude to and knowledge of ToP, and their reasons for seeking ToP services, as well as contraception method and use. Thequestionnaire also captured their experience after the ToP was completed.Results. Of the 246 participants, the majority (92.3%) were aged 16 - 35 years, with 62.6% having little or no income and dependent ontheir family or partner for financial support. Most of the participants (73.2%) were parous and had secondary education and above (94.3%).Furthermore, 59.0% of the participants indicated they were not on any form of contraception before becoming pregnant, even though 70.3%of them were single. The most cited reasons for ToP were lack of finance (37.5%), schooling (33.9%), and not feeling ready to be a parent(20.0%). Although some participants (35.7%) were fearful of ToP, most of them (78.0%) reported feeling relieved after the procedure.Conclusion. Unemployment and financial dependency appeared to be common reasons for seeking ToP in our study population. Most ofthe women were single and many had not used any contraception prior to the pregnancy

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Microbicides and HIV prevention

Currently, there are an estimated 15,000 new infections that occur on a daily basis despite availability of ARVs since 1996. Between 2003 and 2005, for each new person who got treatment for HIV, about 10 people became infected. This underscores the need for effective preventive methods.Male condoms, despite being able to prevent more than 80% of HIV infections when used correctly and consistently, are not acceptable to most male clients.Women in many areas where HIV had reached epidemic proportions are unable to negotiate its use. The female condom has similar limitations, as it also requires the cooperation of the male partner, in addition to being poorly accessible and expensive. Hence, efforts need to be stepped up to find a method which will empower women to take charge of HIV prevention. A microbicide is a substance that can be used to prevent (or at least significantly reduce) the heterosexual transmission of HIV and other sexually transmitted infections, when applied vaginally or rectally.Microbicide agents come in different preparations and/or formulations. The first generation microbicides are gels and creams; whereas subsequent generations include vaginal rings, films, sponges, gels with barrier devices and suppositories, and work by altering the environment of the genital tract to make it unsuitable for the virus to act and survive. Antiretroviral agents, being specific in their mode of action by attacking the HIV, are part of the third generation microbicides. Another possibility is to combine different agents with different mechanisms of action e.g. combining an agent altering the genital tract pH and that inhibiting fusion or entry of the virus to the target cell. Obstetrics & Gynaecology Forum Vol. 17 (3) 2007: pp. 71-7

Emergency peripartum hysterectomy

(East African Medical Journal: 2001 78(2): 70-74