Ethics opinion : the practitioner in need of care

The generally used way of defining impairment when referring to medical practitioners is the inability to practice medicine with reasonable skill and safety for patients. This may be due to progressive physical or mental illness of the practitioner, loss of motor skills, deterioration through ageing or excessive use or abuse of alcohol or drugs, be it high schedule medication or illicit drugs (AMA 2011, Dhai 2006). It is important to note that the entire projection of the statement is towards the patient, care of the patient and safety aspects of the patients. A practitioner who may be impaired would internalise the dilemma but the reality is that the interest of the patient is paramount and that dictates the dealings with the practitioner.http://www.ogf.co.z

Vulvar conditions where allergy plays a role

The vulvar skin in the adult comprises about one percent of the body surface and it is a highly specialised and adaptable skin. The competency of the vulvar and vaginal skin to withstand injury and infection is a remarkable feat of humankind. However, a number of allergic conditions may affect this region of the female body. The major symptomatology of vulvar disease can be summarised as pain, pruritus, swelling, local masses and dyspareunia and most of these are common in allergic diseases in this area. Symptoms of contact dermatitis include severe pruritus, swelling and usually a date of onset. Several causes of contact dermatitis are known, including allergy to condom contents. Atopic vulvar dermatitis is the vulvar component of systemic atopy and the vulva displays the symptoms of pruritus and burning. Allergens may produce the condition known as painful vulva syndrome, which presents as vulvodynia. The vulva is sometimes the only affected part of the skin in women with eczema.http://www.allergysa.org/journal.htmhttp://reference.sabinet.co.za/sa_epublication/caciam201

Dysmenorrhoea

Dysmenorrhoea is a descriptive term for several conditions that cause menstrual pain. While various grades of menstrual pain occur commonly in the menstruating population, approximately 15% of this group of women experience sufficient pain and discomfort to report to healthcare services. Dysmenorrhoea is classified as either primary or secondary, and consideration should be given to a third type, i.e. once-off, at the time of passing an endometrial cast. Primary dysmenorrhoea is predominantly found in young women, is caused by prostaglandin activity, and responds well to oral contraceptive use, as well as nonsteroidal anti-inflammatory drug medication. Secondary dysmenorrhoea, which can occur in any age group, and appears as a consequence of other serious conditions, is the main challenge. The most common other serious conditions include endometriosis, the use of intrauterine contraceptive devices, pelvic infections, uterine adenomyosis, sometimes fibroids, and ovarian cysts. Clearly, these conditions must be considered, diagnosed and treated to resolve the main complaint of dysmenorrhoea.www.tandfonline.com/ojfpam201

FIGO has revised the staging of carcinoma of the vulva

Cancers are staged to allow for standardised terminology, appropriate prognosis, and worldwide communication. Therapeutic guidelines often flow from staging data. FIGO (International Federation of Gynecology and Obstetrics) has provided a staging system since 1958. More recently, International Union Against Cancer and the American Joint Commission on Cancer have also generated staging systems. As staging is based on research data and progressive science, the staging systems need to be revised frequently

The Child Act, consent matters and obstetrics and gynaecology

This edition of the O&G Forum is dedicated to various aspects of Obstetrical and Gynaecological care of nadolescents. In modern medical ethics, patient autonomy is considered a major principle in decision-making regarding one’s health. Those receiving healthcare should be allowed to exercise that right consciously and freely. Healthcare providers are obligated to respect this right and allow patients to practice their autonomy in the cause of their treatment.http://www.journals.co.za/content/journal/medogam2018Obstetrics and Gynaecolog

Postnatal depressive features in mothers of neonates admitted to a neonatal unit at Steve Biko Academic Hospital : the role of sociodemographic and psychosocial factors

BACKGROUND: Postnatal depression (PND) is one of the most common complications following delivery. The development of PND is closely linked with biological, psychological, socioeconomic and cultural factors. OBJECTIVES: To determine the prevalence and identify risk factors for PND in mothers delivering at Steve Biko Academic Hospital (SBAH) whose babies were admitted to the neonatal unit. METHODS: We conducted a prospective observational study at SBAH, Pretoria, South Africa (SA). Women who delivered between 26 and 42 weeks' gestation at SBAH and whose babies were admitted to the neonatal unit were recruited at delivery. Interview screening using the Edinburgh Postnatal Depression Scale (EPDS) was conducted regarding the mother’s experience of her pregnancy and delivery. Sociodemographic and psychosocial data from the mothers were included in a multiple logistic regression model to estimate association with PND symptoms. RESULTS: Between 11 March and 30 December 2017, 2 671 mothers delivered at SBAH. Of these, 196 (7.3%) babies were admitted to the neonatal intensive care unit (NICU) and 10 (0.3%) were admitted to the neonatal high care unit (NHC). Mothers’ accommodation during their babies’ admission to the neonatal unit (p=0.002), having poor interpersonal relationships (p<0.0001), and intimate partner violence (IPV) (p=0.004) were significantly associated with screening positive for PND. CONCLUSION: Accommodation during neonatal care, availability of counselling, inclusion of the partner in postnatal care and IPV are significant factors in the depressive symptoms experienced by mothers postpartum in this settinghttp://www.sajog.org.za/index.php/SAJOGpm2020Obstetrics and Gynaecolog

Exploring the adequacy of obtaining informed consent for caesarean deliveries : a patient perspective

OBJECTIVES : The objective of this study was to assess the adequacy of informed consent obtained from patients prior to caesarean delivery. DESIGN : Descriptive study SETTING : Tertiary level hospitals in a major South African center in Pretoria, South Africa SUBJECTS : Two-hundred-and-fi fty patients who underwent elective and emergency caesarean deliveries OUTCOME MEASURES : The assessment of the adequacy of the informed consent was assessed via a questionnaire that the participants answered on day 2-3 post caesarean delivery. RESULTS : Average age of participants was 28.8 years (28.75 ± 5.92). Twenty three percent (23.2%) of the participants underwent elective and 76.8% underwent emergency caesarean deliveries. Seventy fi ve percent (75.6%) of the participants knew the name of the procedure, although only 29.2% were aware of the associated risks, and 59.2% of participants knew of their right to refuse the procedure. CONCLUSION : Adequate communication is essential to all aspects of medicine and this study has highlighted the inadequacy of the informed consent process that takes place at our institution. Information regarding risks and complications was not adequately communicated. A standardized informed consent document that healthcare professionals can use for counseling, starting antenatally, should be considered.https://journals.co.za/journal/medogam2022Obstetrics and GynaecologyStatistic

Part 2 : Ultrastructural changes of fibrin networks during three phases of pregnancy : a qualitative investigation

INTRODUCTION: Normal pregnancy is characterized by significant alterations in the haemostatic system accompanied by an augmented risk of thrombosis. MATERIALS AND METHODS: The fibrin network ultrastructure of different phases of pregnancy, namely early pregnancy (week 8 – 14), late pregnancy (week 36 – 40) as well as post-partum (week 6 – 8 after birth) were compared to non-pregnant fibrin networks as well as each other to establish whether differences in fibrin network morphology exist during pregnancy. Scanning electron microscopy was employed to analyse fibrin network morphology. RESULTS: The fibrin networks from all phases of pregnancy appeared similar to each other, exhibiting prominent coagulant formation, an increase in the formation of minor, thin fibers, and the presence of granular globules. Al three phases however differ from the typical fibrin network ultrastructure exhibited by the fibrin networks from non-pregnant individuals. The increase in estrogen associated with pregnancy may cause the increase in coagulation factors and ultimately the pro-thrombotic state characteristic of pregnancy. CONCLUSIONS: Since no differences were apparent between the different phases of pregnancy it suggests that activation of the coagulation system commences with pregnancy and this pro-thrombotic state continues till at least 8 weeks after birth. These results may shed light on possible pathological mechanisms employed in the development of abnormal or ailing pregnancy.http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1097-0029hb201

Estrogen causes ultrastructural changes of fibrin networks during the menstrual cycle : a qualitative investigation

INTRODUCTION : Hormonal fluctuations may influence fibrin structure. During the menstrual cycle, plasma fibrinogen levels change, mainly due to the variations of estrogen. Throughout the menstrual cycle estrogen levels peak twice, first during the mid-follicular phase and then a lower second peak during the luteal phase. MATERIALS AND METHODS : In order to investigate the possible changes in the fibrin network throughout the menstrual cycle, the fibrin network ultrastructure of six healthy female participants were studied at different intervals in the menstrual cycle where differences in estrogen levels are prevalent. Blood plasma smears were prepared for scanning and transmission electron microscopy analysis. RESULTS : The external and internal structure of the fibrin fibers showed different morphologies throughout the menstrual cycle. The fibrin fibers were smooth during days 1–5. However, during days 12–14 of the menstrual cycle the fibrin fiber morphology started to change, becoming less smooth. During the luteal phase of the cycle (days 20–25), the network appears sticky, where the minor, thin fibers are more prominent between the thick fibers when compared to the menstrual phase. CONCLUSION : The two estrogen peaks of the menstrual cycle coincide with the changes seen in the current qualitative research, where the fibrin morphology changes during the same time as the estrogen peaks occur. Purified fibrinogen confirmed that it is indeed estrogen that causes the altered fibrin network morphology. This research is the first to show ultrastructural changes in fibrin fiber morphology resulting from estrogen changes during the menstrual cycle.http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1097-00292015-08-31hb201

FIGO staging for carcinoma of the vulva : 2021 revision

To revise the FIGO staging for carcinoma of the vulva using a new approach that involves analyses of prospectively collected data. The FIGO Committee for Gynecologic Oncology reviewed the recent literature to gain an insight into the impact of the 2009 vulvar cancer staging revision. The Committee resolved to revise the staging with a goal of simplification and actively collaborated with the United States National Cancer Database to analyze prospectively collected data on carcinoma of the vulva. Many tumor characteristics were collected for all stages of vulvar cancer treated between 2010 and 2017. Statistical analysis was performed with SAS software. Overall survival was estimated based on tumor characteristics. Log-rank and Wilcoxon tests were used to analyze overall survival similarities between and within groups of tumor characteristics. Characteristics with similar survivals were then grouped into the same stages and substages. Kaplan–Meier overall survival curves were generated for the resulting stages and substages. There were 12 063 cases with available data. The resulting new staging for carcinoma of the vulva has two substages in Stage I, no substage in Stage II, three substages in Stage III, and two substages in Stage IV. The Kaplan–Meier overall survival curves showed clear separation between stages and substages. The 2021 vulvar cancer staging is the first from the FIGO Committee for Gynecologic Oncology to be derived from data analyses. This revision has a new definition for depth of invasion, uses the same definition for lymph node metastases utilized in cervical cancer, and allows findings from cross-sectional imaging to be incorporated into vulvar cancer staging. The 2021 FIGO staging for carcinoma of the vulva is data-derived, validated, and much simpler than earlier revisions.The American College of Surgeons’ (ACoS) Commission on Cancer (CoC) and National Cancer Database (NCDB).http://www.wileyonlinelibrary.com/journal/ijgohj2022Obstetrics and Gynaecolog