{"title":"The role of cervical length in predicting the success of induction of labour","authors":"A. Amupala, T. Cronje, S. Adam","doi":"10.7196/sajog.1639","DOIUrl":"https://doi.org/10.7196/sajog.1639","url":null,"abstract":"","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41879065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background. Several studies have demonstrated the negative impact of lower urinary tract symptoms on health-related quality of life domains. Uroflowmetry is a simple screening test performed after taking a detailed history and examination of the patient. However, unlike men, there are no universally accepted and population-specific uroflow nomograms available for women. Objective. To determine the normal reference values for various uroflow parameters in a healthy female South African population and to determine ethnic variations in measured parameters. Methods. This was a cross-sectional study done at a tertiary hospital in Pretoria. Recruited females included healthy staff members, students, patients, and their relatives who attended the gynaecology outpatient department. Quantile regression was used to formulate uroflow centiles using average and maximum urine flow rate over voided volume. Results. We recruited 336 females out of 353 volunteers ( n =306 for study group and n =30 for control group). The mean (standard deviation (SD)) age was 35.15 (10.24) years, voided volume (179.71 (136.10 mL)), voiding time (26.13 (19.48 s)), time to maximum flow rate (Qmax) (5.85 (4.19 s)), Qmax (20.01 (9.67 mL/s) and average flow rate (Qave) (10.16 (5.40 mL/s). Confidence limit flow-volumenomograms were developed, and these were validated against asymptomatic women ( n =30). Black females ( n =255) had statistically significantly higher average urine flow rate ( p =0.023) than white females ( n =55). Conclusion. The generated nomograms in healthy women add to current scientific literature on this topic. Potential ethnic variation in uroflowmetry parameters needs further exploration.
{"title":"A study to establish normal reference values of urine flow parameters in healthy South African females","authors":"Z. Abdool, NE Manana, P. Becker","doi":"10.7196/SAJOG.1638","DOIUrl":"https://doi.org/10.7196/SAJOG.1638","url":null,"abstract":"Background. Several studies have demonstrated the negative impact of lower urinary tract symptoms on health-related quality of life domains. Uroflowmetry is a simple screening test performed after taking a detailed history and examination of the patient. However, unlike men, there are no universally accepted and population-specific uroflow nomograms available for women. Objective. To determine the normal reference values for various uroflow parameters in a healthy female South African population and to determine ethnic variations in measured parameters. Methods. This was a cross-sectional study done at a tertiary hospital in Pretoria. Recruited females included healthy staff members, students, patients, and their relatives who attended the gynaecology outpatient department. Quantile regression was used to formulate uroflow centiles using average and maximum urine flow rate over voided volume. Results. We recruited 336 females out of 353 volunteers ( n =306 for study group and n =30 for control group). The mean (standard deviation (SD)) age was 35.15 (10.24) years, voided volume (179.71 (136.10 mL)), voiding time (26.13 (19.48 s)), time to maximum flow rate (Qmax) (5.85 (4.19 s)), Qmax (20.01 (9.67 mL/s) and average flow rate (Qave) (10.16 (5.40 mL/s). Confidence limit flow-volumenomograms were developed, and these were validated against asymptomatic women ( n =30). Black females ( n =255) had statistically significantly higher average urine flow rate ( p =0.023) than white females ( n =55). Conclusion. The generated nomograms in healthy women add to current scientific literature on this topic. Potential ethnic variation in uroflowmetry parameters needs further exploration.","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44649374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background. Ultrasound-guided high-intensity focused ultrasound (USgHIFU) is used to noninvasively treat symptomatic uterine fibroids. The thickness of the adipose tissue that the HIFU beam travels through is thought to be associated with decreased treatment outcome, although the evidence is anecdotal. Objectives. To determine whether the thickness of adipose tissue affects the percentage volume shrinkage of the uterine fibroid after treatment. Method. A retrospective study was performed at Chris Hani Baragwanath Academic Hospital (CHBAH) on patients who were treated with USgHIFU for symptomatic uterine fibroids between 11 October 2015 and 11 April 2018. Magnetic resonance imaging (MRI) images were used to measure the adipose tissue thickness and the percentage volume shrinkage of the uterine fibroid. Linear regression was used to determine an association between adipose tissue thickness and the percentage volume shrinkage of the uterine fibroid after treatment. Results . A total of 71 female patients who attended the CHBAH HIFU clinic were included in the study. Mean adipose tissue thickness was 17.49 mm (95% confidence interval (CI) 14.86 - 19.73). Mean pre- and post-treatment volume of the fibroid was 176 mL (95% CI 123.26 - 208.57) and 109 mL (95% CI 71.75 - 141.73), respectively. The mean fibroid volume reduction was 44.68% ( p <0.0001). We found no significant relationship between adipose tissue thickness and change in volume ratio of the fibroid. Conclusion . It is unclear whether adipose thickness affects treatment outcome when symptomatic uterine fibroids are ablated using USgHIFU. This study found no correlation between adipose tissue thickness and uterine fibroid shrinkage after HIFU treatment. Our findings suggest that the exclusion criteria for USgHIFU treatment of uterine fibroids should be reviewed.
{"title":"Association between adipose tissue thickness and fibroid shrinkage using ultrasound-guided high‑intensity focused ultrasound","authors":"Gcw Peiser, K. Jacobson, R. Spence, R. Setzen","doi":"10.7196/SAJOG.1637","DOIUrl":"https://doi.org/10.7196/SAJOG.1637","url":null,"abstract":"Background. Ultrasound-guided high-intensity focused ultrasound (USgHIFU) is used to noninvasively treat symptomatic uterine fibroids. The thickness of the adipose tissue that the HIFU beam travels through is thought to be associated with decreased treatment outcome, although the evidence is anecdotal. Objectives. To determine whether the thickness of adipose tissue affects the percentage volume shrinkage of the uterine fibroid after treatment. Method. A retrospective study was performed at Chris Hani Baragwanath Academic Hospital (CHBAH) on patients who were treated with USgHIFU for symptomatic uterine fibroids between 11 October 2015 and 11 April 2018. Magnetic resonance imaging (MRI) images were used to measure the adipose tissue thickness and the percentage volume shrinkage of the uterine fibroid. Linear regression was used to determine an association between adipose tissue thickness and the percentage volume shrinkage of the uterine fibroid after treatment. Results . A total of 71 female patients who attended the CHBAH HIFU clinic were included in the study. Mean adipose tissue thickness was 17.49 mm (95% confidence interval (CI) 14.86 - 19.73). Mean pre- and post-treatment volume of the fibroid was 176 mL (95% CI 123.26 - 208.57) and 109 mL (95% CI 71.75 - 141.73), respectively. The mean fibroid volume reduction was 44.68% ( p <0.0001). We found no significant relationship between adipose tissue thickness and change in volume ratio of the fibroid. Conclusion . It is unclear whether adipose thickness affects treatment outcome when symptomatic uterine fibroids are ablated using USgHIFU. This study found no correlation between adipose tissue thickness and uterine fibroid shrinkage after HIFU treatment. Our findings suggest that the exclusion criteria for USgHIFU treatment of uterine fibroids should be reviewed.","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47429657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background. Inadequately controlled labour pain is associated with numerous deleterious physiological and psychological effects. Epidural labour analgesia is accepted as the gold standard. Objectives. To establish the frequency of labour epidural analgesia for vaginal and caesarean section delivery in Gauteng Province (GP) private and public hospitals. Methods. GP maternity hospitals belonging to the three largest private hospital groups, and public academic, tertiary, regional and district maternity hospitals, were approached for inclusion in the study. A total of 24/47 private hospitals and 21/26 public hospitals agreed to participate in the present study and data from these hospitals were included in the data analysis. This was a retrospective study, and the delivery statistics and registers for 2015 were examined from all participating hospitals. Consecutive convenience sampling was applied. Results. A total of 3 560 labour epidurals were placed in the 45 participating hospitals in GP in 2015. About two-thirds (62%; n =2 208) of these labour epidurals were placed in the private sector. The median (interquartile range (IQR)) annual epidural frequency for all participating private hospitals was 6% (1.37 - 8.42). Only two public hospitals in GP were able to offer labour epidural services in 2015 and the annual proportion of deliveries with epidural placement was 4.1%. Both hospitals were academic hospitals affiliated with a single university. Conclusion. Similar to other developing countries, the labour epidural rates in GP hospitals were well below international labour epidural rates in 2015. This lack of service provision may be compromising patient care as well as the training of healthcare professionals.
{"title":"Labour epidurals in Gauteng Province, South Africa","authors":"J. Wagner, S. Chetty, F. Paruk, P. Kamerman","doi":"10.7196/SAJOG.1636","DOIUrl":"https://doi.org/10.7196/SAJOG.1636","url":null,"abstract":"Background. Inadequately controlled labour pain is associated with numerous deleterious physiological and psychological effects. Epidural labour analgesia is accepted as the gold standard. Objectives. To establish the frequency of labour epidural analgesia for vaginal and caesarean section delivery in Gauteng Province (GP) private and public hospitals. Methods. GP maternity hospitals belonging to the three largest private hospital groups, and public academic, tertiary, regional and district maternity hospitals, were approached for inclusion in the study. A total of 24/47 private hospitals and 21/26 public hospitals agreed to participate in the present study and data from these hospitals were included in the data analysis. This was a retrospective study, and the delivery statistics and registers for 2015 were examined from all participating hospitals. Consecutive convenience sampling was applied. Results. A total of 3 560 labour epidurals were placed in the 45 participating hospitals in GP in 2015. About two-thirds (62%; n =2 208) of these labour epidurals were placed in the private sector. The median (interquartile range (IQR)) annual epidural frequency for all participating private hospitals was 6% (1.37 - 8.42). Only two public hospitals in GP were able to offer labour epidural services in 2015 and the annual proportion of deliveries with epidural placement was 4.1%. Both hospitals were academic hospitals affiliated with a single university. Conclusion. Similar to other developing countries, the labour epidural rates in GP hospitals were well below international labour epidural rates in 2015. This lack of service provision may be compromising patient care as well as the training of healthcare professionals.","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43824353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background. Maternal sepsis is a major cause of maternal mortality worldwide and constitutes one of the leading causes of preventable maternal mortality and morbidity. Puerperal sepsis following a caesarean delivery has been shown to be a leading cause of sepsis in women. Objectives. To describe the epidemiology, risk factors, management interventions and maternal outcome of patients with maternal sepsis admitted to a South African (SA) intensive care unit (ICU) over a 2-year period. Methods. We conducted a single-centre, retrospective review of data of 54 patients admitted to a tertiary referral ICU in SA with the diagnosis of maternal sepsis from 1 January 2015 to 31 December 2016. Clinical characteristics, management interventions and maternal outcomes of patients with maternal sepsis were described and assessed. Results. There were 39 884 deliveries during the study period and 16 060 (40.3%) were by caesarean section (CS). Sepsis was diagnosed in 1.7% ( n =678) of the patients and 8.0% ( n =54) of these patients were admitted to ICU. The median (interquartile range (IQR)) maternal age was 30 (26 - 34) years. Sepsis post CS accounted for 50% ( n =27), sepsis post vaginal birth for 12.9% ( n =7), septic incomplete miscarriages for 24.0% ( n =13), sepsis post preterm deliveries for 9.2% ( n =5) and sepsis post exploratory laparotomy for ruptured ectopic pregnancy for 3.7% ( n =2). Coagulase-negative Staphylococcus was the most commonly isolated organism. The median (IQR) duration of ICU stay was 4 (2 - 6) days. All patients required mechanical ventilation. The mean (standard deviation (SD)) duration of ventilation was 2.5 (1.7) days. More than a quarter of women (29.6%; n =16) required inotropic support, while 90.7% ( n =49) required blood products and 9.2% ( n =5) required renal replacement therapy. Complications in ICU were metabolic acidosis (46.3%), acute kidney injury (40.7%), coagulopathy (25.9%), circulatory shock (12.9%), acute respiratory distress syndrome (9.2%), cardiac arrest (9.2%) and abnormal liver enzymes (7.4%). Mortality was 11.1% ( n =6). Conclusions. Maternal sepsis remains a significant cause of morbidity and mortality. The identification of associated risk factors will help guide appropriate interventions.
{"title":"Characteristics and outcomes of obstetric patients with maternal sepsis requiring admission to a South African intensive care unit: A retrospective review","authors":"J. Lafon, Edward Buga, G. Nethathe","doi":"10.7196/SAJOG.1635","DOIUrl":"https://doi.org/10.7196/SAJOG.1635","url":null,"abstract":"Background. Maternal sepsis is a major cause of maternal mortality worldwide and constitutes one of the leading causes of preventable maternal mortality and morbidity. Puerperal sepsis following a caesarean delivery has been shown to be a leading cause of sepsis in women. Objectives. To describe the epidemiology, risk factors, management interventions and maternal outcome of patients with maternal sepsis admitted to a South African (SA) intensive care unit (ICU) over a 2-year period. Methods. We conducted a single-centre, retrospective review of data of 54 patients admitted to a tertiary referral ICU in SA with the diagnosis of maternal sepsis from 1 January 2015 to 31 December 2016. Clinical characteristics, management interventions and maternal outcomes of patients with maternal sepsis were described and assessed. Results. There were 39 884 deliveries during the study period and 16 060 (40.3%) were by caesarean section (CS). Sepsis was diagnosed in 1.7% ( n =678) of the patients and 8.0% ( n =54) of these patients were admitted to ICU. The median (interquartile range (IQR)) maternal age was 30 (26 - 34) years. Sepsis post CS accounted for 50% ( n =27), sepsis post vaginal birth for 12.9% ( n =7), septic incomplete miscarriages for 24.0% ( n =13), sepsis post preterm deliveries for 9.2% ( n =5) and sepsis post exploratory laparotomy for ruptured ectopic pregnancy for 3.7% ( n =2). Coagulase-negative Staphylococcus was the most commonly isolated organism. The median (IQR) duration of ICU stay was 4 (2 - 6) days. All patients required mechanical ventilation. The mean (standard deviation (SD)) duration of ventilation was 2.5 (1.7) days. More than a quarter of women (29.6%; n =16) required inotropic support, while 90.7% ( n =49) required blood products and 9.2% ( n =5) required renal replacement therapy. Complications in ICU were metabolic acidosis (46.3%), acute kidney injury (40.7%), coagulopathy (25.9%), circulatory shock (12.9%), acute respiratory distress syndrome (9.2%), cardiac arrest (9.2%) and abnormal liver enzymes (7.4%). Mortality was 11.1% ( n =6). Conclusions. Maternal sepsis remains a significant cause of morbidity and mortality. The identification of associated risk factors will help guide appropriate interventions.","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41856127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
vinutha vinod, RG Bhat, Parvati Bhat, N. Zahoor, S. Bhat
Background. Although most pregnant women experience spontaneous labour at term, induction of labour is indicated whenever continuation of pregnancy is detrimental to either the fetus or the mother. Objectives . To study the factors associated with the successful induction of labour and to compare the maternal and fetal outcomes between induced and spontaneous labour . Methods. We conducted a prospective observational and comparative study from September 2015 to December 2016 at Dr TMA Pai Hospital – a secondary level hospital at Manipal Academy of Higher Education (MAHE). Women with a singleton pregnancy, live fetus, vertex presentation and gestational age (GA) >36 weeks were included in the study, and those with antepartum haemorrhage, scarred uterus, anomalous fetus and intrauterine fetal demise were excluded. Results. Out of 1 575 deliveries during the study period, 550 were induced (34%). A total of 300 inductions fulfilled the inclusion criteria and formed the study group. Multiparity, body mass index (BMI) 38 weeks were factors associated with successful induction. Among the components of the Bishop score, dilatation was a better predictor of vaginal delivery ( p <0.001) and post-dated pregnancy was the most common indication (33.6%). The rates of caesarean section (CS) delivery (33% v. 12%) and neonatal intensive care unit (NICU) admissions (4% v. 1%) were more in the induced group compared with the spontaneous group. Conclusion. Multiparity, BMI <25 and advancing GA are predictors of successful induction. Induction is safe but carries a high risk of CS delivery and NICU admissions.
背景。虽然大多数孕妇在足月自然分娩，但只要继续妊娠对胎儿或母亲有害，就应引产。目标。目的:探讨成功引产的相关因素，比较引产与自然分娩的母婴结局。方法。我们于2015年9月至2016年12月在马尼帕尔高等教育学院(MAHE)二级医院TMA Pai医院进行了一项前瞻性观察和比较研究。本研究纳入单胎妊娠、活胎、顶胎、胎龄(GA)≥36周的孕妇，排除产前出血、子宫瘢痕、胎儿异常和宫内死胎。结果。在研究期间的1575例分娩中，550例为引产(34%)。符合纳入标准的入选者共300人，组成研究组。多胎、体重指数(BMI) 38周是诱导成功的相关因素。在Bishop评分的组成部分中，扩张是阴道分娩的较好预测指标(p <0.001)，而晚期妊娠是最常见的指征(33.6%)。诱导组的剖宫产率(33% vs . 12%)和新生儿重症监护病房(NICU)入院率(4% vs . 1%)高于自发组。结论。多胎儿、BMI <25和GA进展是诱导成功的预测因素。引产是安全的，但有较高的CS分娩和NICU入院风险。
{"title":"Induction of labour – a misused blessing: Prospective study of factors influencing the success of induction and comparison of fetomaternal outcomes with spontaneous labour","authors":"vinutha vinod, RG Bhat, Parvati Bhat, N. Zahoor, S. Bhat","doi":"10.7196/SAJOG.1634","DOIUrl":"https://doi.org/10.7196/SAJOG.1634","url":null,"abstract":"Background. Although most pregnant women experience spontaneous labour at term, induction of labour is indicated whenever continuation of pregnancy is detrimental to either the fetus or the mother. Objectives . To study the factors associated with the successful induction of labour and to compare the maternal and fetal outcomes between induced and spontaneous labour . Methods. We conducted a prospective observational and comparative study from September 2015 to December 2016 at Dr TMA Pai Hospital – a secondary level hospital at Manipal Academy of Higher Education (MAHE). Women with a singleton pregnancy, live fetus, vertex presentation and gestational age (GA) >36 weeks were included in the study, and those with antepartum haemorrhage, scarred uterus, anomalous fetus and intrauterine fetal demise were excluded. Results. Out of 1 575 deliveries during the study period, 550 were induced (34%). A total of 300 inductions fulfilled the inclusion criteria and formed the study group. Multiparity, body mass index (BMI) 38 weeks were factors associated with successful induction. Among the components of the Bishop score, dilatation was a better predictor of vaginal delivery ( p <0.001) and post-dated pregnancy was the most common indication (33.6%). The rates of caesarean section (CS) delivery (33% v. 12%) and neonatal intensive care unit (NICU) admissions (4% v. 1%) were more in the induced group compared with the spontaneous group. Conclusion. Multiparity, BMI <25 and advancing GA are predictors of successful induction. Induction is safe but carries a high risk of CS delivery and NICU admissions.","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44289555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Contents","authors":"Gertrude Fani","doi":"10.7196/sajog.1633","DOIUrl":"https://doi.org/10.7196/sajog.1633","url":null,"abstract":"","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41572385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-25DOI: 10.21203/RS.3.RS-271807/V1
I. Bhorat, T. Reddy
Background: Gestational diabetes is characterized by three main factors: macrosomia, increased metabolic rate and large vascular cross sections. A critical and crucial finding in diabetic pregnancies is that significant acidaemia and hyperlacticemia can occur in fetuses in the absence of hypoxaemia. The increased metabolic rate results in significant increases in oxidative metabolism but this capacity is reduced in fetuses due to low pyruvate dehydrogenase activity increasing the risk for acidosis. This pathophysiology is not recognized by standard monitoring models which revolves around placental insufficiency which is in fact not the problem in a gestational diabetic pregnancy. A proposed risk scoring system has been developed based on our previous studies to risk categorise gestational diabetics in terms of fetal outcome.Methods: The diabetic cases from four case-control studies were combined to form a total sample of 159 cases for validation of the risk scoring system. Univariate logistic regression was used to assess the effect of individual risk factors with proposed cutoffs on adverse pregnancy outcome. The diagnostic accuracy of the total summative score, was assessed by computing the area under the ROC curve.Results: Four potential parameters were identified to risk- categorise fetuses in a gestational diabetic pregnancy ie the myocardial performance index (MPI), E/A ratio (marker of diastolic dysfunction), increasing fetal weight (macrosomia) and increased amniotic fluid index (AFI). The total score, obtained by summation of the composite scores for parameters ranged from 0 to 11. The total score performed as an excellent predictor of adverse outcome, evidenced by the ROC area under the curve of 0.94. A cutpoint of 6 on the score confers a sensitivity of 84.2% and specificity of 90.2% for detection of adverse outcome. Conclusion: To our knowledge this is the first Gestational Diabetic Scoring system proposed to predict an adverse outcome.
{"title":"A Proposed Fetal Risk Scoring System for Gestational Diabetes to assist in optimizing Timing of Delivery","authors":"I. Bhorat, T. Reddy","doi":"10.21203/RS.3.RS-271807/V1","DOIUrl":"https://doi.org/10.21203/RS.3.RS-271807/V1","url":null,"abstract":"\u0000 Background: Gestational diabetes is characterized by three main factors: macrosomia, increased metabolic rate and large vascular cross sections. A critical and crucial finding in diabetic pregnancies is that significant acidaemia and hyperlacticemia can occur in fetuses in the absence of hypoxaemia. The increased metabolic rate results in significant increases in oxidative metabolism but this capacity is reduced in fetuses due to low pyruvate dehydrogenase activity increasing the risk for acidosis. This pathophysiology is not recognized by standard monitoring models which revolves around placental insufficiency which is in fact not the problem in a gestational diabetic pregnancy. A proposed risk scoring system has been developed based on our previous studies to risk categorise gestational diabetics in terms of fetal outcome.Methods: The diabetic cases from four case-control studies were combined to form a total sample of 159 cases for validation of the risk scoring system. Univariate logistic regression was used to assess the effect of individual risk factors with proposed cutoffs on adverse pregnancy outcome. The diagnostic accuracy of the total summative score, was assessed by computing the area under the ROC curve.Results: Four potential parameters were identified to risk- categorise fetuses in a gestational diabetic pregnancy ie the myocardial performance index (MPI), E/A ratio (marker of diastolic dysfunction), increasing fetal weight (macrosomia) and increased amniotic fluid index (AFI). The total score, obtained by summation of the composite scores for parameters ranged from 0 to 11. The total score performed as an excellent predictor of adverse outcome, evidenced by the ROC area under the curve of 0.94. A cutpoint of 6 on the score confers a sensitivity of 84.2% and specificity of 90.2% for detection of adverse outcome. Conclusion: To our knowledge this is the first Gestational Diabetic Scoring system proposed to predict an adverse outcome.","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41585404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background. Pregnant women in South Africa (SA) traditionally use herbal medicines even though the potential risk or benefit is not fully elucidated. Objectives. To determine the prevalence of the use of herbal medicines in pregnant women in our setting, as well as explore the reasons for use. Methods. This cross-sectional study was conducted at King Edward VIII Hospital, from 1 September 2014 to 31 December 2014. Women were interviewed using a structured questionnaire during the post-delivery period, irrespective of outcome. The questionnaires enquired about women’s demographic data, social and previous obstetric history and herbal medication use during current pregnancy. Results. Two hundred and ninety-nine women were interviewed. The prevalence of herbal medication use was 33.7% ( n =101), mainly via the oral route. Fifty-eight (57.4%) of these women used herbal medication throughout their pregnancy. Reasons given for herbal ingestion included general well-being, or to make labour easier or come sooner. There was a high rate of caesarean delivery among pregnant women who used herbal medication compared with those who did not (79.2% v. 52.8%; p =0.001). One hundred and eighteen women had meconium-stained liquor; 59% of the herbal medication users compared with 29.6% of the non-users ( p <0.001) comprised this group.The perinatal mortality rate was also higher among users ( p <0.04). There were no maternal deaths. Conclusion. Herbal medicine was used by a third of black South African pregnant women in this study and was associated with significant adverse obstetric and perinatal outcomes.
背景。南非(SA)的孕妇传统上使用草药，尽管潜在的风险或益处尚未完全阐明。目标。确定本地区孕妇使用草药的流行程度，并探讨使用草药的原因。方法。这项横断面研究于2014年9月1日至2014年12月31日在爱德华八世国王医院进行。无论结果如何，妇女在分娩后使用结构化问卷进行访谈。调查问卷询问了妇女的人口统计数据、社会和以前的产科史以及目前怀孕期间使用草药的情况。结果。共有299名女性接受了采访。使用草药的患病率为33.7% (n =101)，主要通过口服途径。这些妇女中有58人(57.4%)在整个怀孕期间使用草药。服用草药的原因包括一般的健康，或使分娩更容易或更快。使用草药的孕妇剖宫产率高于未使用草药的孕妇(79.2% vs 52.8%;p = 0.001)。118名妇女喝了沾有粪污的酒;使用草药者占59%，而不使用草药者占29.6% (p <0.001)。服用者的围产期死亡率也较高(p <0.04)。没有产妇死亡。结论。在这项研究中，三分之一的南非黑人孕妇使用草药，这与显著的不良产科和围产期结局有关。
{"title":"Ingestion of herbal medication during pregnancy and adverse perinatal outcomes","authors":"L. Kekana, M. Sebitloane","doi":"10.7196/SAJOG.1615","DOIUrl":"https://doi.org/10.7196/SAJOG.1615","url":null,"abstract":"Background. Pregnant women in South Africa (SA) traditionally use herbal medicines even though the potential risk or benefit is not fully elucidated. Objectives. To determine the prevalence of the use of herbal medicines in pregnant women in our setting, as well as explore the reasons for use. Methods. This cross-sectional study was conducted at King Edward VIII Hospital, from 1 September 2014 to 31 December 2014. Women were interviewed using a structured questionnaire during the post-delivery period, irrespective of outcome. The questionnaires enquired about women’s demographic data, social and previous obstetric history and herbal medication use during current pregnancy. Results. Two hundred and ninety-nine women were interviewed. The prevalence of herbal medication use was 33.7% ( n =101), mainly via the oral route. Fifty-eight (57.4%) of these women used herbal medication throughout their pregnancy. Reasons given for herbal ingestion included general well-being, or to make labour easier or come sooner. There was a high rate of caesarean delivery among pregnant women who used herbal medication compared with those who did not (79.2% v. 52.8%; p =0.001). One hundred and eighteen women had meconium-stained liquor; 59% of the herbal medication users compared with 29.6% of the non-users ( p <0.001) comprised this group.The perinatal mortality rate was also higher among users ( p <0.04). There were no maternal deaths. Conclusion. Herbal medicine was used by a third of black South African pregnant women in this study and was associated with significant adverse obstetric and perinatal outcomes.","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43345317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Obstetric medicine is a subspecialty of internal medicine that involves the management of medical conditions that may affect the course of pregnancy. It is an established subspecialty in many parts of the world, with recognised training programmes and an active international society; however, no formal training programme has been developed in South Africa (SA) as yet. Medical problems are responsible for the majority (60%) of maternal deaths in SA and women of childbearing potential are disproportionately affected by medical conditions such as HIV and obesity. Obstetric physicians would play a complementary role in the care of pregnant patients and could contribute to improving maternal health and lowering the maternal mortality rate in SA.
{"title":"Making the case for an obstetric medicine subspecialty in South Africa","authors":"J. Zamparini, L. Wium","doi":"10.7196/SAJOG.1589","DOIUrl":"https://doi.org/10.7196/SAJOG.1589","url":null,"abstract":"Obstetric medicine is a subspecialty of internal medicine that involves the management of medical conditions that may affect the course of pregnancy. It is an established subspecialty in many parts of the world, with recognised training programmes and an active international society; however, no formal training programme has been developed in South Africa (SA) as yet. Medical problems are responsible for the majority (60%) of maternal deaths in SA and women of childbearing potential are disproportionately affected by medical conditions such as HIV and obesity. Obstetric physicians would play a complementary role in the care of pregnant patients and could contribute to improving maternal health and lowering the maternal mortality rate in SA.","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45198337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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