Background. Pregnant patients with Factor V Leiden (FVL) mutation are at an increased risk of venous thromboembolic disease (VTED) and placental-mediated complications. Thromboprophylaxis with low-molecular-weight heparin (LMWH) can potentiallymitigate these risks. Objective. To describe the clinical course of a cohort of patients with FVL mutation with different underlying genotypes. Methods. The pregnancy outcomes, occurrence of VTED events and laboratory test results of pregnant women with FVL mutation managed at a quaternary medical centre over a period of 18 years in Johannesburg, South Africa, were analysed. Results. Over the period of analysis, 25 pregnant women with FVL mutation were referred to the haematology department for management. Ten patients (40%) had a family history, and 15 patients (60%) a personal history of VTED. The majority of provoked VTED events (90%) were secondary to combined oral contraceptive exposure. Previous pregnancy loss occurred in 4 (16%) patients, of whom 3 (75%) suffered recurrent losses. All women received prophylactic anti-Factor Xa (anti-FXa) dose-adjusted LMWH during anteand postnatal periods. All pregnancies resulted in live births with 1 VTED event recorded. Conclusion. Patients with FVL mutation show phenotypical heterogeneity in terms of pregnancy outcomes, VTED events and placentalmediated complications. Confounders contributing to the heterogeneity are not completely defined and deciding on appropriate treatment is not fully standardised but the live birth rate is encouraging.
{"title":"A case series of Factor V Leiden mutation in pregnancy","authors":"J. Bailly, B. Jacobson, S. Louw","doi":"10.7196/SAJOG.1517","DOIUrl":"https://doi.org/10.7196/SAJOG.1517","url":null,"abstract":"Background. Pregnant patients with Factor V Leiden (FVL) mutation are at an increased risk of venous thromboembolic disease (VTED) and placental-mediated complications. Thromboprophylaxis with low-molecular-weight heparin (LMWH) can potentiallymitigate these risks. Objective. To describe the clinical course of a cohort of patients with FVL mutation with different underlying genotypes. Methods. The pregnancy outcomes, occurrence of VTED events and laboratory test results of pregnant women with FVL mutation managed at a quaternary medical centre over a period of 18 years in Johannesburg, South Africa, were analysed. Results. Over the period of analysis, 25 pregnant women with FVL mutation were referred to the haematology department for management. Ten patients (40%) had a family history, and 15 patients (60%) a personal history of VTED. The majority of provoked VTED events (90%) were secondary to combined oral contraceptive exposure. Previous pregnancy loss occurred in 4 (16%) patients, of whom 3 (75%) suffered recurrent losses. All women received prophylactic anti-Factor Xa (anti-FXa) dose-adjusted LMWH during anteand postnatal periods. All pregnancies resulted in live births with 1 VTED event recorded. Conclusion. Patients with FVL mutation show phenotypical heterogeneity in terms of pregnancy outcomes, VTED events and placentalmediated complications. Confounders contributing to the heterogeneity are not completely defined and deciding on appropriate treatment is not fully standardised but the live birth rate is encouraging.","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46166525","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":"Claudia Naidu","doi":"10.7196/sajog.1574","DOIUrl":"https://doi.org/10.7196/sajog.1574","url":null,"abstract":"","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44455595","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.1526","DOIUrl":"https://doi.org/10.7196/sajog.1526","url":null,"abstract":"","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44516147","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":"Cover","authors":"Gertrude Fani","doi":"10.7196/sajog.1525","DOIUrl":"https://doi.org/10.7196/sajog.1525","url":null,"abstract":"","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43996408","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":"The caesarean section rate: Much ado about nothing?","authors":"S. Adam","doi":"10.7196/sajog.1524","DOIUrl":"https://doi.org/10.7196/sajog.1524","url":null,"abstract":"","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41976792","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.1522","DOIUrl":"https://doi.org/10.7196/sajog.1522","url":null,"abstract":"","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44166091","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. Delay to timely healthcare contributes to high maternal mortality and morbidity in developing countries. The so-called ‘Three delays’ model has been used extensively to investigate factors relating to maternal mortality. Objective. To investigate factors associated with delayed emergency obstetric care in Arsi Zone, Ethiopia. Methods. A cross-sectional study was conducted across 10 public health facilities in Arsi Zone, Ethiopia. The required sample size was calculated as 847, with the number of participants required at each facility determined proportionally. Results. Data from 775 respondents were used in the analysis. Approximately a quarter of respondents ( n =203; 26.2%) reported a delayed decision to seek emergency obstetric care. The mean time for delay was 90 minutes (range 30 minutes - 18 hours). Maternal age, educational level, monthly household income and antenatal visits were significant predictors of this first maternal delay. Close to a third of the respondents ( n =234; 30.2%) reported a transport-related delay in reaching a healthcare facility; some respondents walked at least 30 minutes to reach the facility. Approximately a quarter of respondents ( n =198; 25.5%) reported that they did not receive timely care after arriving at the healthcare facility. The mean delay was 42.3 minutes. Conclusion. The most common delay was related to difficulty in reaching the healthcare facility. In approximately half of the cases, the woman’s husband took the decision to access medical care. This suggests limited independent decision-making power of women in this context. Such factors should be considered in efforts to reduce maternal morbidity and mortality.
{"title":"Factors associated with maternal delays in utilising emergency obstetric care in Arsi Zone, Ethiopia","authors":"Y. Amare, B. Dibaba, M. Bayu, M. Hussien","doi":"10.7196/SAJOG.1437","DOIUrl":"https://doi.org/10.7196/SAJOG.1437","url":null,"abstract":"Background. Delay to timely healthcare contributes to high maternal mortality and morbidity in developing countries. The so-called ‘Three delays’ model has been used extensively to investigate factors relating to maternal mortality. Objective. To investigate factors associated with delayed emergency obstetric care in Arsi Zone, Ethiopia. Methods. A cross-sectional study was conducted across 10 public health facilities in Arsi Zone, Ethiopia. The required sample size was calculated as 847, with the number of participants required at each facility determined proportionally. Results. Data from 775 respondents were used in the analysis. Approximately a quarter of respondents ( n =203; 26.2%) reported a delayed decision to seek emergency obstetric care. The mean time for delay was 90 minutes (range 30 minutes - 18 hours). Maternal age, educational level, monthly household income and antenatal visits were significant predictors of this first maternal delay. Close to a third of the respondents ( n =234; 30.2%) reported a transport-related delay in reaching a healthcare facility; some respondents walked at least 30 minutes to reach the facility. Approximately a quarter of respondents ( n =198; 25.5%) reported that they did not receive timely care after arriving at the healthcare facility. The mean delay was 42.3 minutes. Conclusion. The most common delay was related to difficulty in reaching the healthcare facility. In approximately half of the cases, the woman’s husband took the decision to access medical care. This suggests limited independent decision-making power of women in this context. Such factors should be considered in efforts to reduce maternal morbidity and mortality.","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7196/SAJOG.1437","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45771153","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}
M. R. Khatuja, P. Renjhen, S. Prasad, M. Kadiyan, L. Attuluri
Background. Awareness of the natural course of cervical cancer, screening and timely intervention can help to reduce morbidity and mortality associated with this disease. Objective. To assess the awareness about cervical cancer and the uptake of screening among adult women in northern Delhi, India. Methods. A cross-sectional observational study ( N =401) was conducted at a tertiary-care teaching hospital over a period of 3 months. A questionnaire was used to collect sociodemographic data and probe participants’ awareness of cervical cancer, preventive measures and sources of information. Data were analysed using an independent t -test, with a significance level of p <0.05. Results. The majority of participants (45%) were between 18 and 25 years old. Approximately a third (34%) were illiterate and 39.4% were educated only up to Grade 10. Almost all participants (99%) were married and 85.3% were unemployed. Only 31.9% of participants knew about cervical cancer, and of these only 26 (20.3%) were aware that cervical cancer is a preventable disease. Only 8.5% of the participants knew about Pap smears and only 1.6% had heard about the human papillomavirus vaccine. Participants indicated that health professionals were the main source of information. Only 2.2% of the entire sample reported having had a Pap smear before. Conclusion. Low awareness of cervical cancer and its prevention was found among the study population. A national education and communication strategy is recommended to improve awareness.
{"title":"Awareness of cervical cancer and its prevention among women attending a tertiary-care hospital in northern Delhi, India","authors":"M. R. Khatuja, P. Renjhen, S. Prasad, M. Kadiyan, L. Attuluri","doi":"10.7196/SAJOG.1415","DOIUrl":"https://doi.org/10.7196/SAJOG.1415","url":null,"abstract":"Background. Awareness of the natural course of cervical cancer, screening and timely intervention can help to reduce morbidity and mortality associated with this disease. Objective. To assess the awareness about cervical cancer and the uptake of screening among adult women in northern Delhi, India. Methods. A cross-sectional observational study ( N =401) was conducted at a tertiary-care teaching hospital over a period of 3 months. A questionnaire was used to collect sociodemographic data and probe participants’ awareness of cervical cancer, preventive measures and sources of information. Data were analysed using an independent t -test, with a significance level of p <0.05. Results. The majority of participants (45%) were between 18 and 25 years old. Approximately a third (34%) were illiterate and 39.4% were educated only up to Grade 10. Almost all participants (99%) were married and 85.3% were unemployed. Only 31.9% of participants knew about cervical cancer, and of these only 26 (20.3%) were aware that cervical cancer is a preventable disease. Only 8.5% of the participants knew about Pap smears and only 1.6% had heard about the human papillomavirus vaccine. Participants indicated that health professionals were the main source of information. Only 2.2% of the entire sample reported having had a Pap smear before. Conclusion. Low awareness of cervical cancer and its prevention was found among the study population. A national education and communication strategy is recommended to improve awareness.","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7196/SAJOG.1415","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41514097","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. Seroprevalence of cytomegalovirus (CMV) is high in developing countries. However, a pregnant woman’s immunity does not necessarily protect her baby against congenital CMV infection. Objectives. To determine the seroprevalence of CMV among pregnant women attending a public antenatal clinic (Windhoek Central Hospital, Namibia) and subsequently determine the risk of vertical transmission and congenital CMV infection. Methods. Blood samples and demographic information were collected from 344 pregnant women (age range 15 - 48 years). Serum was tested for anti-CMV IgG and IgM using an automated chemiluminescence assay, and an ELISA was used to assess specific IgG avidity. Fisher’s exact test was used to determine associations among variables. Results. Seroprevalence of anti-CMV IgG was found to be 100% across the study population, with positive or grey-zone anti-CMV IgM results found in 11 women (3.2%). Specific IgG avidity was high in all cases. Neither maternal nor gestational age was positively associated with a positive or grey-zone IgM result. Parity was significantly associated with CMV IgM seroprevalence, with the highest level observed in women who had had one previous pregnancy. Conclusion. This was the first study to investigate seroprevalence of CMV in Namibia. Despite the high seroprevalence among pregnant women, the burden of congenital CMV infection may b e carried by infants in the Namibian population. This may contribute to long-term disabilities, especially sensorineural hearing loss. Further studies are needed to determine the prevalence of congenital CMV in Namibia.
{"title":"Seroprevalence of cytomegalovirus among pregnant women in Windhoek, Namibia, 2016","authors":"B. E. van der Colf, G. V. van Zyl, S. Mackenzie","doi":"10.7196/SAJOG.1441","DOIUrl":"https://doi.org/10.7196/SAJOG.1441","url":null,"abstract":"Background. Seroprevalence of cytomegalovirus (CMV) is high in developing countries. However, a pregnant woman’s immunity does not necessarily protect her baby against congenital CMV infection. Objectives. To determine the seroprevalence of CMV among pregnant women attending a public antenatal clinic (Windhoek Central Hospital, Namibia) and subsequently determine the risk of vertical transmission and congenital CMV infection. Methods. Blood samples and demographic information were collected from 344 pregnant women (age range 15 - 48 years). Serum was tested for anti-CMV IgG and IgM using an automated chemiluminescence assay, and an ELISA was used to assess specific IgG avidity. Fisher’s exact test was used to determine associations among variables. Results. Seroprevalence of anti-CMV IgG was found to be 100% across the study population, with positive or grey-zone anti-CMV IgM results found in 11 women (3.2%). Specific IgG avidity was high in all cases. Neither maternal nor gestational age was positively associated with a positive or grey-zone IgM result. Parity was significantly associated with CMV IgM seroprevalence, with the highest level observed in women who had had one previous pregnancy. Conclusion. This was the first study to investigate seroprevalence of CMV in Namibia. Despite the high seroprevalence among pregnant women, the burden of congenital CMV infection may b e carried by infants in the Namibian population. This may contribute to long-term disabilities, especially sensorineural hearing loss. Further studies are needed to determine the prevalence of congenital CMV in Namibia.","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7196/SAJOG.1441","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42871873","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}
J. Hanekom, R. Hattingh, W. Nel, K. Thirion, C. Willemse, G. Joubert, C. Boltman, J. Botes
Background. Informing patients about available anaesthesia options allows patients to share in decision-making. Objectives. To determine the preference for general or regional anaesthesia among patients admitted for elective caesarean delivery at a district hospital in Bloemfontein, South Africa, and whether the patients were informed about their anaesthesia options by their doctor. Methods. Consecutive sampling was used. Patients ≥18 years old and who had had a caesarean delivery under general or regional anaesthesia participated in the study. Data were collected using a questionnaire, which was completed during formal interviews with patients. Results. Of the 50 patients interviewed, 30 (60.0%) preferred regional anaesthesia. With regard to the current surgery, 58.0% stated that they were informed of the available anaesthesia options. Conclusion. The majority of the patients in our study preferred regional anaesthesia. Although only 58.0% reported that they received information, many of those valued the doctor’s opinion in their choice of anaesthesia.
{"title":"Patients’ preference for general or regional anaesthesia for caesarean deliveries at a district hospital, Free State, South Africa","authors":"J. Hanekom, R. Hattingh, W. Nel, K. Thirion, C. Willemse, G. Joubert, C. Boltman, J. Botes","doi":"10.7196/SAJOG.1444","DOIUrl":"https://doi.org/10.7196/SAJOG.1444","url":null,"abstract":"Background. Informing patients about available anaesthesia options allows patients to share in decision-making. Objectives. To determine the preference for general or regional anaesthesia among patients admitted for elective caesarean delivery at a district hospital in Bloemfontein, South Africa, and whether the patients were informed about their anaesthesia options by their doctor. Methods. Consecutive sampling was used. Patients ≥18 years old and who had had a caesarean delivery under general or regional anaesthesia participated in the study. Data were collected using a questionnaire, which was completed during formal interviews with patients. Results. Of the 50 patients interviewed, 30 (60.0%) preferred regional anaesthesia. With regard to the current surgery, 58.0% stated that they were informed of the available anaesthesia options. Conclusion. The majority of the patients in our study preferred regional anaesthesia. Although only 58.0% reported that they received information, many of those valued the doctor’s opinion in their choice of anaesthesia.","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7196/SAJOG.1444","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47541449","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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