Prevalence of known thrombophilia and incidence of venous thromboembolism in pregnant woment in the Western Cape Province of South Africa

Includes bibliographical references (leaves 29-32).Venous thromboembolism (VTE) is a major cause of maternal mortality worldwide. In many developed countries, all maternal deaths are investigated, and accurate statistics are available. In United Kingdom (UK) for example, VTE is the leading cause- and is increasing despite heightened awareness of risk factors, and wider use of thromboprophylaxis (1,2). The 1994-96 UK Confidential Enquiries reported an overall maternal mortality rate of 12.2 per 100, 000 deliveries, with specific mortality from VTE at 2.2 per 100, 000 deliveries, with approximately 15 deaths a year due to VTE

MOESM2 of Word balloon catheter for Bartholin’s cyst and abscess as an office procedure: clinical time gained

Additional file 2. Patient information leaflet “Word Balloon Catheter Insertion for Bartholin’s Cyst or abscess”

Pseudo (Platelet-type) von Willebrand disease in pregnancy: a case report

Abstract Background Pseudo (platelet-type)-von Willebrand disease is a rare autosomal dominant bleeding disorder caused by an abnormal function of the glycoprotein lb protein; the receptor for von Willebrand factor. This leads to an increased removal of VWF multimers from the circulation as well as platelets and this results in a bleeding diathesis. Worldwide, less than 50 patients are reported with platelet type von Willebrand disease (PT-VWD). Case presentation We describe the management of platelet type von Willebrand disease in pregnancy of a 26 year old Caucasian primigravida. The initial diagnosis was made earlier following a significant haemorrhage post tonsillectomy several years prior to pregnancy. The patient was managed under a multidisciplinary team which included obstetricians, haematologists, anaesthetists and neonatologists. Care plans were made for the ante- natal, intra-partum and post-partum periods in partnership with the patient. The patient’s platelet count levels dropped significantly during the antenatal period. This necessitated the active exclusion of other causes of thrombocytopenia in pregnancy. A vaginal delivery was desired and plans were made for induction of labour at 38 weeks of gestation with platelet cover in view of the progressive fall of the platelet count. The patient however went into spontaneous labour on the day of induction. She was transfused two units of platelets before delivery. She had an unassisted vaginal delivery of a healthy baby. The successful antenatal counselling has encouraged the diagnosis of the same condition in her mother and sister. We found this to be a particularly interesting case as well as challenging to manage due to its rarity. Psuedo von Willebrand disease in pregnancy can be confused with a number of other differential diagnoses, such as gestational thrombocutopenia, idiopathatic thrombocytopenia, thrombotic thrombocytopenic purpura and pre-eclampsia; all need consideration during investigations even in a case such as this where the diagnosis of platelet type von Willebrand disease was known before pregnancy. Conclusion Management of pseudo von Willebrand disease in pregnancy involves the co-operation of multidisciplinary teams, regular monitoring of platelet levels and factor VIII and replacement as appropriate. This case report highlights this rare condition and the need to exclude all the other differential diagnoses of thrombocytopenia in pregnant women with thrombocytopenia.</p

Hypertriglyceridemia induced acute pancreatitis in pregnancy: Learning experiences and challenges of a Case report

Hyperglyceridemia induced pancreatitis in pregnancy accounts for 4% of all cases of acute pancreatitis. Though rare, hypertriglyceridemia induced pancreatitis may lead to fatal maternal and fetal complications, even maternal death. Its management during pregnancy remains a challenge for many physicians. Management options are limited in pregnancy. In the refractory cases, management options and timing of delivery is debatable. Here we report a case of hyperglyceridemia induced pancreatitis and the challenges faced in the management

Metformin or insulin: logical treatment in women with gestational diabetes in the Middle East, our experience

Abstract Objective The debate still continues about the preferred modality of treatment of gestational diabetes requiring pharmacological treatment. Insulin was previously considered as the gold standard, but the National Institute of Health and Care Excellence now recommend metformin as the first line drug of choice. The pharmacological management of gestational diabetes mellitus in the Middle East with its high risk population has not been widely published. We aim to evaluate the safety and efficacy of using metformin in comparison to insulin, in our group of patients, and to study key associated morbidities. Results A total of 291 women registered in the clinic during the study period. One hundred and twenty-one (121) were women with gestational diabetes Mellitus requiring medical therapy. Among them, 107 delivered at term. Ninety (84%) women received metformin. Additional insulin was required in 32% of these patients. There was a significant difference in the birth weight of babies in the metformin with insulin group of 207 g (p value 0.04) in favour of metformin. There was no significant difference in maternal or neonatal morbidities between the groups. Metformin was thus found to be a safe, practical and cost effective medication to be offered to our population

MOESM1 of Metformin or insulin: logical treatment in women with gestational diabetes in the Middle East, our experience

Additional file 1: Table S1. Antenatal and Postnatal details: compares the antenatal complications and mode of delivery and complications. Table S2. Neonatal details; compares the weight of the babies. Table S3. Neonatal morbidity: The neonatal complications are compared