New guidelines for Zika virus 2016

Zika virus has caused a self- limiting pyrexial illness across Africa and South East Asia for decades. Recently there has been a rapid spread of the Zika virus in South America. However, to date, the zika virus has not been found further south than Uganda in Africa.1 The vector species, Aedes aegypti, is common in South Africa especially in the eastern coastal plains but it may also be found inland. In urban areas, the mosquito breeds in small collections of water such as discarded tyres and buckets or the leaf axils of Strelitzia nicolae (banana tress). Aedes argypti is made up of 2 subspecies. The African subspecies tends not to bite humans and is probably less susceptible to Zika virus when compared to the American ones.http://reference.sabinet.co.za/sa_epublication/medogam2016Obstetrics and Gynaecolog

Risk assessment in obstetrics

The major goal of obstetric care is to ensure the birth of a healthy baby with minimal risk to the mother. Therefore determining which interventions are most likely to improve patient safety is an important global health issue. The Oxford English Dictionary defines risk as: 'hazard, chance of bad consequences, loss.'www.ogf.co.zaam201

Inevitable demise of clinical skills in examination of patients

No abstract available.http://www.ogf.co.z

Preventing the development of type 2 diabetes in women with gestational diabetes

Gestational diabetes is a carbohydrate intolerance that is first detected in pregnancy and usually disappears after birth. It is characterised by fasting and post-prandial hyperglycemia. The immediate maternal and fetal consequences of gestational diabetes on pregnancy are well known. During the last decade, there has been increasing evidence suggesting that women with gestational diabetes are at increased risk of developing diabetes and metabolic syndrome in later life. A meta-analysis of 20 cohort studies involving 675 455 women reported that women with gestational diabetes had a 7.5-fold increased risk of developing type 2 diabetes compared with those women who had a normoglycemic pregnancy (RR 7.43, 95% CI 4.79-11.51). Women with a history of gestational diabetes had a relative risk of 4.69 within 5 years of pregnancy and this risk doubled to 9.34 after 5 years.http://www.ogf.co.z

The impact of climate change on maternal and child health

It can be argued that there are three colliding pandemics that are currently affecting the planet and its people: COVID-19, global inequities and climate change. Regrettably, these are all the result of human action or inaction and are preventable. The United Nations Conference of the Parties (COP26), held in November 2021 in Glasgow, addressed some of these issues. Prince Charles called this meeting the ‘last chance saloon to save the planet.’ e main objective of COP26 was to reduce global heating and limit global warming to the target maximum temperature of 1.5-degree Celsius above preindustrial levels. According to the National Aeronautics and Space Administration (NASA), since the late 19th century, the earth surface temperature rose by.18 degrees Celsius, caused by increased carbon dioxide and other emissions into the atmosphere, with the years 2016 and 2020 being tied as the warmest years on record. However, many, including a group of scientists called ‘Scientist Rebellion’ were not convinced that COP26 would make any di erence to the warming of the planet. President of COP26, Alok Sharma admitted that the objective of the conference was not reached but remained cautiously optimistic: “We can now say with credibility that we have kept 1.5 degrees alive. But its pulse is weak and it will only survive if we keep our promises and translate commitments into rapid action”.https://www.obstetricsandgynaecologyforum.comam2023Obstetrics and Gynaecolog

Factors affecting VBAC success at a tertiary level Hospital in Pretoria, South Africa

There is growing concern about rising global caesarean delivery (CD) rates. One of the strategies to overcome this problem is to reduce primary caesarean section. A trial of labour following a previous CD is another option that may be explored. AIM The aim of the study was to determine the success rate and risk factors for women attempting vaginal birth after a prior caesarean delivery (VBAC). METHODS This was a retrospective analysis from 2013-2018 of women attempting a vaginal birth after caesarean section at a tertiary level hospital in Pretoria, South Africa. RESULTS The VBAC success rate was 36%. Factors that were associated with a successful VBAC were a third pregnancy, previous successful VBAC (61%), presentation in the active phase of labour and a neonatal birthweight of less than 3kg. CONCLUSION Pregnant women with a CD in a prior pregnancy should be appropriately counselled regarding delivery options. Risks and benefi ts of elective repeat caesarean delivery versus trial of labour should be clearly explained to expectant mothers.http://reference.sabinet.co.za/sa_epublication/medoghttps://journals.co.za/journal/medogam2022Obstetrics and Gynaecolog

Early detection of pre-eclampsia

Pre-eclampsia is a major cause of maternal and perinatal morbidity and mortality. The current recommended screening approach is to identify risk factors from maternal history and demographic characteristics. Blood pressure and urinary proteins must be determined at every ante-natal visit. Patients with gestational hypertension and/or gestational proteinuria require increased antenatal surveillance because they have an increased risk for developing pre-eclampsia during pregnancy. We recommend that these patients be considered for management at District level. Local protocols must in place for emergency treatment and referral of patients who develop a sudden acute hypertensive emergency.http://reference.sabinet.co.za/sa_epublication/medogam2016Obstetrics and Gynaecolog

Late termination of pregnancy for fetal anomalies : experience at a tertiary-care hospital in South Africa

Early diagnosis and appropriate management of congenital anomalies can help prevent neonatal morbidity and mortality. Termination of pregnancy for severe congenital anomalies is permitted under South African law. Objective. To determine factors causing delayed diagnosis of lethal congenital abnormalities requiring late termination of pregnancy at Steve Biko Academic Hospital in Pretoria, South Africa. Methods. Medical records of pregnant women who presented with lethal fetal anomalies over a period of 7.5 years were analysed. Patients' demographic profile, the interval from referral to feticide, gestational age at first scan and diagnosis, type of anomaly and feticide methods were considered. The cohort was divided in two groups based on timing of termination (i.e. earlier than 28 weeks and later than 28 weeks' gestation) for statistical comparison. Results. The majority of women (n=45; 78.9%) were younger than 35 years and had no chronic medical conditions or risk factors (n=40; 70%). Although 30 women (52.6%) had been booked for antenatal examination early in their pregnancy, only three (5.2%) had a first-trimester scan. Mean time to referral was not significantly different between the women whose pregnancies terminated earlier than 28 weeks and those with a termination after 28 weeks (p=0.671). Conclusion. A basic ultrasound scan in the second trimester is recommended for all pregnant women. Task shifting can be a viable option to provide this facility at primary and secondary health centres. A national registry should be established to document all late terminations for fetal anomalies.http://www.sajog.org.za/index.php/SAJOGpm2020Obstetrics and Gynaecolog

Remembering what the doctor said : use of patient information leaflets given during O&G consultation

Women consulting with O&G specialists are frequently in situations where important decisions must be made. These women receive detailed information on illness, treatment options and prognosis. Memory of medical information is therefore essential to understand recommended treatment. Ley’s model of effective communication in medical practice highlights the importance of memory, understanding of information and satisfaction with treatment. It is estimated that 40-80% of medical information provided by healthcare workers is forgotten immediately. The greater the amount of information provided; the smaller the proportion correctly recalled.https://journals.co.za/content/journal/medogpm2020Obstetrics and Gynaecolog

Rights of the fetus : voice of the unborn baby and constitutional court decision

No abstract available.http://www.sajbl.org.zaam2023Obstetrics and Gynaecolog