The impact of COVID-19 on obstetrics and gynaecology care

The COVID-19 pandemic is the biggest global disturbance in living memory. Much debate has focused on economic outlay to various communities or groups by governments and health services, including access to personal protective equipment (PPE), and interventions to prevent transmission. Following the outbreak in early March 2020, South Africa, along with many other countries, is now in the midst of a 'second wave' of COVID-19 infections. The virus has forced us to question the evidence for the 'scientific' advice that is given to politicians and society. Predictions of the extent of COVID-19, for example, have often been based on calculations founded on statistical modelling, and not actual trends. This has produced diverse predictions, and may have fostered mistrust and fear among clinicians as well as society at large. One issue raised by the current COVID-19 pandemic is the conflict that exists between the needs to protect health and to preserve the economy. If simply applying maximum safety was the overriding consideration for COVID-19, all populations would be living and working from their homes and segregated from one another to prevent transmission. However, the world is based on an economic system, and no individual, family, section of society, community, region or nation can survive without resources. For many, those resources are acquired in the short term, and not stored.http://sajog.org.za/index.php/SAJOGhj2021Obstetrics and Gynaecolog

Clinical profiles of individuals with orofacial clefts: Results from fourteen Eastern African countries.

Background: More than 100,000 cleft lip and palate patients have benefited from reconstructive surgeries in Africa because of surgical support from non-governmental organizations such as Smile Train. The Smile Train Express is the largest cleft-centered patient registry with over a million records of clinical records, globally. In this study, we reviewed data from the Eastern African patient registry to analyze and understand the clinical profiles of cleft lip and palate patients operated at Smile Train partner hospitals in East Africa. Method: A cross-sectional study design was undertaken through a retrospective database review in fourteen Eastern African countries. The study population included all patients who had cleft lip and palate surgeries recorded in the Smile Train database between 2001 and 2019. Findings: 86,683 patient records from 14 Eastern African countries were included in this study. The mean age was (8.8), the mean weight was 22.3 kg and 20.8 kg for males and females, respectively, and 61.9% of the surgeries were performed on male patients. Left cleft lip and palate (21,062, 24.62%) and left cleft lip only (17,155, 20.05%) were the most common types of clefts, with bilateral cleft lip only (3958, 4.63%) being the least frequent. complete left cleft lip with complete left alveolus was the most frequent cleft combination observed (n = 21,746) and Cleft lip to cleft lip and palate to cleft palate ratio (CL:CLP: CP) was 4.73:7.1:1. Unilateral primary lip-nose repairs were the most common surgeries (66%). General anesthesia was used for 74,783 (86.2%) of the procedures. Interpretation: Most children with cleft lip and/or palate were underweight, possibly due to malnutrition or related to socioeconomic status. There were more male patients compared to females, which could be related to gender disparities. Access to surgical care for children born with congenital defects needs to be improved, and inequities need to be addressed via more evidence-based collaborative intervention strategies. Funding: Non

Judicious use of personal protective equipment to prevent the spread of COVID-19 in maternity units

More than 300 women give birth in South Africa (SA) every day. An increasing number of midwives, obstetricians and gynaecologists have tested positive for COVID-19 in SA, and this has led to the closures of maternity units. Recently, General Justice Gizenga Mpanza Regional Hospital in KwaZulu-Natal Province in SA closed after 16 healthcare workers (HCWs) and patients tested positive for SARS-CoV-2 virus, necessitating the redirection of patients to other healthcare centres in the area. Antenatal care and safe childbirth are crucial and cannot be postponed, making pregnant women and obstetric HCWs a vulnerable population for healthcare facility transmission. Reducing antenatal care consultations is associated with increased maternal and perinatal morbidity and mortality. Therefore it is imperative that maternity services remain functional.http://sajog.org.za/index.php/SAJOGam2021Obstetrics and Gynaecolog