Background. Vacuum-assisted caesarean delivery may result in a quicker delivery of the fetal head than the use of forceps, and improve maternal and fetal outcomes. The new CaesAid vacuum-assisted delivery (VAD) cup was designed specifically for this use. Objectives. To assess whether the CaesAid VAD cup influences the duration of fetal head delivery at caesarean section when compared with forceps, and whether there are differences in perioperative complications in the mother and fetus. Methods. We carried out a retrospective clinical audit of 132 patients who underwent caesarean delivery at the Netcare Christiaan Barnard Memorial Hospital in Cape Town, South Africa, from April to November 2017, aided by either CaesAid VAD cup (C group, n =67) or forceps (F group, n =65). Results. The uterine incision-to-delivery interval was significantly shorter ( p =0.001) in the C group than the F group (median 38 (interquartile range (IQR) 20) v. 60 (IQR 50) seconds, respectively). The maternal blood loss was lower in the C group than the F group (250 mL v. 288 mL; p =0.025). There was no significant difference in Apgar scores or admissions to the neonatal intensive care unit. Neonatal skin injuries were less common in the C group (no cases v. 8 in the F group; p =0.004). Conclusion. The results of this audit suggest that the CaesAid VAD cup is a safe and efficient alternative to forceps for aiding the delivery of the fetal head at caesarean section. However, the routine use of vacuum cups is debatable. Further research could provide more insight into this procedure as a part of obstetric practice.
背景。与使用产钳相比，真空辅助剖宫产可以更快地娩出胎儿头，并改善产妇和胎儿的结局。新的凯撒真空辅助分娩(VAD)杯是专门为这种使用而设计的。目标。评估与产钳相比，CaesAid VAD杯是否影响剖宫产时胎头娩出时间，以及母婴围手术期并发症是否存在差异。方法。我们对2017年4月至11月在南非开普敦Netcare克里斯蒂安巴纳德纪念医院(Netcare Christiaan Barnard Memorial Hospital)剖腹产的132例患者进行了回顾性临床审计，这些患者使用CaesAid VAD杯(C组，n =67)或产钳(F组，n =65)辅助。结果。C组子宫切开至分娩间隔明显短于F组(中位数38(四分位间距(IQR) 20)和60 (IQR 50)秒)(p =0.001)。C组产妇失血量低于F组(250 mL vs 288 mL;p = 0.025)。在阿普加评分或新生儿重症监护病房入院方面没有显著差异。C组新生儿皮肤损伤发生率较低(0例vs . F组8例;p = 0.004)。结论。本审计结果表明，CaesAid VAD杯是一种安全、有效的替代产钳辅助剖宫产胎儿头娩出的方法。然而，常规使用真空杯是有争议的。进一步的研究可以提供更多的深入了解这一程序作为产科实践的一部分。
{"title":"An audit of the CaesAid vacuum-assisted delivery cup compared with forceps delivery of the fetal head in caesarean section","authors":"N. Stolwijk, P. R. Jong","doi":"10.7196/sajog.1377","DOIUrl":"https://doi.org/10.7196/sajog.1377","url":null,"abstract":"Background. Vacuum-assisted caesarean delivery may result in a quicker delivery of the fetal head than the use of forceps, and improve maternal and fetal outcomes. The new CaesAid vacuum-assisted delivery (VAD) cup was designed specifically for this use. Objectives. To assess whether the CaesAid VAD cup influences the duration of fetal head delivery at caesarean section when compared with forceps, and whether there are differences in perioperative complications in the mother and fetus. Methods. We carried out a retrospective clinical audit of 132 patients who underwent caesarean delivery at the Netcare Christiaan Barnard Memorial Hospital in Cape Town, South Africa, from April to November 2017, aided by either CaesAid VAD cup (C group, n =67) or forceps (F group, n =65). Results. The uterine incision-to-delivery interval was significantly shorter ( p =0.001) in the C group than the F group (median 38 (interquartile range (IQR) 20) v. 60 (IQR 50) seconds, respectively). The maternal blood loss was lower in the C group than the F group (250 mL v. 288 mL; p =0.025). There was no significant difference in Apgar scores or admissions to the neonatal intensive care unit. Neonatal skin injuries were less common in the C group (no cases v. 8 in the F group; p =0.004). Conclusion. The results of this audit suggest that the CaesAid VAD cup is a safe and efficient alternative to forceps for aiding the delivery of the fetal head at caesarean section. However, the routine use of vacuum cups is debatable. Further research could provide more insight into this procedure as a part of obstetric practice.","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7196/sajog.1377","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43551934","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. Procalcitonin (PCT) is an established marker for sepsis, particularly bacterial, but its use in diagnosing pregnancy-associated sepsis (PAS) is relatively unexplored. Objective. To investigate whether PCT could be used for the diagnosis of PAS in our study population, and what the appropriate values might be for the diagnosis. Methods. The study included 40 pregnant, post-abortal and postpartum women with PAS, identified using systemic inflammatory response syndrome criteria. Patients with hypertensive disorders, premature rupture of membranes, severe trauma, liver cirrhosis and lung or thyroid malignancies were excluded. Forty healthy term pregnant women with sterile urine cultures were taken as controls. PCT levels were obtained at admission and statistically compared between the groups. Severity and culture positivity in PAS were also assessed. Results. Severe PAS was present in 30 patients. Overall culture positivity was seen in 55% ( n =22) of subjects. Culture-positive patients had higher PCT levels (3.03 μg/L) compared with the culture-negative (1.77 μ/L), though this did not reach statistical significance ( p =0.235). Mean (standard deviation) PCT in PAS patients was 2.46 (0.56) μ/L, while in healthy controls it was 0.091 (0.019) μg/L. This difference was statistically significant ( p 0.125 μg/L is suggested as the critical level for PAS diagnosis in appropriate clinical settings. Additionally, mean PCT levels differed significantly in severe v. non-severe PAS.
{"title":"Serum procalcitonin in pregnancy-associated sepsis: A case control study","authors":"R. Agarwal, P. Priyadarshini, M. Mehndiratta","doi":"10.7196/sajog.1397","DOIUrl":"https://doi.org/10.7196/sajog.1397","url":null,"abstract":"Background. Procalcitonin (PCT) is an established marker for sepsis, particularly bacterial, but its use in diagnosing pregnancy-associated sepsis (PAS) is relatively unexplored. Objective. To investigate whether PCT could be used for the diagnosis of PAS in our study population, and what the appropriate values might be for the diagnosis. Methods. The study included 40 pregnant, post-abortal and postpartum women with PAS, identified using systemic inflammatory response syndrome criteria. Patients with hypertensive disorders, premature rupture of membranes, severe trauma, liver cirrhosis and lung or thyroid malignancies were excluded. Forty healthy term pregnant women with sterile urine cultures were taken as controls. PCT levels were obtained at admission and statistically compared between the groups. Severity and culture positivity in PAS were also assessed. Results. Severe PAS was present in 30 patients. Overall culture positivity was seen in 55% ( n =22) of subjects. Culture-positive patients had higher PCT levels (3.03 μg/L) compared with the culture-negative (1.77 μ/L), though this did not reach statistical significance ( p =0.235). Mean (standard deviation) PCT in PAS patients was 2.46 (0.56) μ/L, while in healthy controls it was 0.091 (0.019) μg/L. This difference was statistically significant ( p 0.125 μg/L is suggested as the critical level for PAS diagnosis in appropriate clinical settings. Additionally, mean PCT levels differed significantly in severe v. non-severe PAS.","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7196/sajog.1397","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49101915","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.1485","DOIUrl":"https://doi.org/10.7196/sajog.1485","url":null,"abstract":"","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7196/sajog.1485","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42547556","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}
Objective: To describe general characteristics, clinical features, moment of diagnosis and treatment of patients with uterine leiomyosarcoma (LMS). Methods: From 2005 to 2014, clinical files of patients diagnosed with a uterine LMS at Hospital Nacional Edgardo Rebagliati Martins in Peru were reviewed. Results: Eleven cases with complete information were identified; mean age at diagnosis was 45.36 years (range, 27 - 61 years); most frequent symptom reported was pelvic pain in 6/11 (54%) patients. 8/11 (72%) patients were diagnosed after any surgical intervention. The most frequent clinical stage was IB in 10/11 (90%) cases. Initial treatment was total abdominal hysterectomy (TAH) + bilateral salpingo-oophorectomy (BSO) in 7/11 (62%) cases. Prevalence of undiagnosed uterine LMS in hysterectomies and myomectomies done for presumed leiomyomas was 0.24% and 0.22%, respectively. Conclusion: Clinical presentation of uterine LMS do not differ from usual leiomyoma. Most of the cases are diagnosed incidentally after surgical specimen analysis. Most accepted initial management to date is still en bloc TAH + BSO. Follow-up strategies should be implemented and be the goal of any long term program.
{"title":"Uterine leiomyosarcoma: A ten-year review in a referral hospital in Peru, 2005 – 2014","authors":"Omar Fernando Yanque Robles","doi":"10.7196/SAJOG.1355","DOIUrl":"https://doi.org/10.7196/SAJOG.1355","url":null,"abstract":"Objective: To describe general characteristics, clinical features, moment of diagnosis and treatment of patients with uterine leiomyosarcoma (LMS). Methods: From 2005 to 2014, clinical files of patients diagnosed with a uterine LMS at Hospital Nacional Edgardo Rebagliati Martins in Peru were reviewed. Results: Eleven cases with complete information were identified; mean age at diagnosis was 45.36 years (range, 27 - 61 years); most frequent symptom reported was pelvic pain in 6/11 (54%) patients. 8/11 (72%) patients were diagnosed after any surgical intervention. The most frequent clinical stage was IB in 10/11 (90%) cases. Initial treatment was total abdominal hysterectomy (TAH) + bilateral salpingo-oophorectomy (BSO) in 7/11 (62%) cases. Prevalence of undiagnosed uterine LMS in hysterectomies and myomectomies done for presumed leiomyomas was 0.24% and 0.22%, respectively. Conclusion: Clinical presentation of uterine LMS do not differ from usual leiomyoma. Most of the cases are diagnosed incidentally after surgical specimen analysis. Most accepted initial management to date is still en bloc TAH + BSO. Follow-up strategies should be implemented and be the goal of any long term program.","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48777254","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}
A. Hurry, A. Hassan, S. Hosseini, H. Khazraei, Mohammed Abdzaid Akool, L. Moosavi, S. Pourahmad
Background: Obstetric trauma is the mostcommon cause of fecal incontinence in multiparous women.The literature has shown that women with obstetric trauma to the anal sphincter have decreased perineal body thickness (PBT).We aimed to analyze the role of PBT by endoanalultrasonographyinassessment of this type of fecal incontinence in multiparous patients. Methods : Forty-fourfemales with anal incontinence and 36 asymptomatic ones that had two or more previous deliveries were investigated with endoanalultrasonographyfrom January2016 to December 2016. All patients were divided into three groups on thebasis of PBT: 10 mm or less, 10 to 12 mm, more than12 mm. The degree of FI was measured using the incontinence score of Wexner. Sphincter angle defect was separately measured for each patient. Results : The mean age of all our 80 patients was 46.9±1.3 years (26–77 years) and the mean PBT in incontinent patients was 8.78 ± 2.84 mm and 12.65± 16.76mm in asymptomatic subjects (P < 0.001). The mean Wexner score was 8.6 (2-20 in incontinent patients). External sphincter defect angles were negatively correlated with PBT (p = 0.045).For 89% of the patients there was a history of vaginal delivery and 62.5% had undergone one or more prior episiotomies during delivery. Conclusion : A PBT less than 10 mm is associated with sphincter defect in most incontinent patients. Perineal body thickness plays such a significantly important role in fecal incontinence that it should be one of the factors involved in anal incontinency evaluations.
{"title":"Does perineal body thickness affect fecal incontinence in multiparous patients?","authors":"A. Hurry, A. Hassan, S. Hosseini, H. Khazraei, Mohammed Abdzaid Akool, L. Moosavi, S. Pourahmad","doi":"10.7196/SAJOG.1305","DOIUrl":"https://doi.org/10.7196/SAJOG.1305","url":null,"abstract":"Background: Obstetric trauma is the mostcommon cause of fecal incontinence in multiparous women.The literature has shown that women with obstetric trauma to the anal sphincter have decreased perineal body thickness (PBT).We aimed to analyze the role of PBT by endoanalultrasonographyinassessment of this type of fecal incontinence in multiparous patients. Methods : Forty-fourfemales with anal incontinence and 36 asymptomatic ones that had two or more previous deliveries were investigated with endoanalultrasonographyfrom January2016 to December 2016. All patients were divided into three groups on thebasis of PBT: 10 mm or less, 10 to 12 mm, more than12 mm. The degree of FI was measured using the incontinence score of Wexner. Sphincter angle defect was separately measured for each patient. Results : The mean age of all our 80 patients was 46.9±1.3 years (26–77 years) and the mean PBT in incontinent patients was 8.78 ± 2.84 mm and 12.65± 16.76mm in asymptomatic subjects (P < 0.001). The mean Wexner score was 8.6 (2-20 in incontinent patients). External sphincter defect angles were negatively correlated with PBT (p = 0.045).For 89% of the patients there was a history of vaginal delivery and 62.5% had undergone one or more prior episiotomies during delivery. Conclusion : A PBT less than 10 mm is associated with sphincter defect in most incontinent patients. Perineal body thickness plays such a significantly important role in fecal incontinence that it should be one of the factors involved in anal incontinency evaluations.","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7196/SAJOG.1305","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47879789","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}
Ö. Özyüncü, A. Tanaçan, Fatih Aktoz, Melek Büyükeren, R. Karabudak, M. Beksaç
Background. Multiple sclerosis (MS) is a disease that predominantly affects the young female population. It is important for an obstetrician to know the effects of pregnancy on MS, and vice versa. Objective. To demonstrate the impact of MS on pregnancy outcomes. Methods. We retrospectively evaluated demographic features, clinical characteristics, and obstetric outcomes of 47 pregnancies in 24 patients with MS, between January 2007 and December 2016. Results. Patients were divided into three groups: (i) 35 pregnancies in patients with MS who were in remission at the beginning of pregnancy; (ii) 10 pregnancies in patients with MS whose disease was exacerbated at the beginning of pregnancy; and (iii) 2 pregnancies in patients with active MS whose symptoms were relieved after becoming pregnant. The overall early pregnancy loss rate was 36.2%, whereas it was 60% and 31.4% in the exacerbation and remission groups, respectively; and the overall preterm delivery rate was 30%, while it was 29.1% and 50% in the remission and exacerbation groups, respectively. Conclusion. Miscarriage and preterm delivery seem to be significant obstetric complications in pregnant women with MS.
{"title":"Gestational Outcomes of Patients with Multiple Sclerosis; A Tertiary Center Experience","authors":"Ö. Özyüncü, A. Tanaçan, Fatih Aktoz, Melek Büyükeren, R. Karabudak, M. Beksaç","doi":"10.7196/SAJOG.1368","DOIUrl":"https://doi.org/10.7196/SAJOG.1368","url":null,"abstract":"Background. Multiple sclerosis (MS) is a disease that predominantly affects the young female population. It is important for an obstetrician to know the effects of pregnancy on MS, and vice versa. Objective. To demonstrate the impact of MS on pregnancy outcomes. Methods. We retrospectively evaluated demographic features, clinical characteristics, and obstetric outcomes of 47 pregnancies in 24 patients with MS, between January 2007 and December 2016. Results. Patients were divided into three groups: (i) 35 pregnancies in patients with MS who were in remission at the beginning of pregnancy; (ii) 10 pregnancies in patients with MS whose disease was exacerbated at the beginning of pregnancy; and (iii) 2 pregnancies in patients with active MS whose symptoms were relieved after becoming pregnant. The overall early pregnancy loss rate was 36.2%, whereas it was 60% and 31.4% in the exacerbation and remission groups, respectively; and the overall preterm delivery rate was 30%, while it was 29.1% and 50% in the remission and exacerbation groups, respectively. Conclusion. Miscarriage and preterm delivery seem to be significant obstetric complications in pregnant women with MS.","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7196/SAJOG.1368","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45348218","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}
Lymphangiomas are benign congenital malformations of lymphatic system, thought to happen due to obstruction of local lymph flow system. They can occur anywhere in the skin and the mucous membranes. Most common sites are the head and the neck but sometimes, they can be found in the intestines, the pancreas and the mesentery. Lymphangioma of the ovary is an extremely rare lesion. It was first described in 1908. Clinical manifestations can vary from asymptomatic ovarian mass to acute abdomen. They may be very frequently confused with malignant ovarian mass often leading to extensive surgery. A 34-year-old female presented with dull aching pain localized to lower abdomen from last 6 months. Ultrasound and CECT abdomen were suggestive of enlarged right ovary with massive ascites. Ca-125 was 685. Diagnostic laparoscopy revealed chylous ascites and further a frozen section revealed few atypical cells, further strengthening the diagnosis of malignant tumor. Staging laparotomy with total abdominal hysterectomy and salpingo-oophorectomy was finally done. Histopathology revealed lymphangioma, with no evidence of malignancy. CA-125 also showed a rapid decline following surgery. Lymphangiomas should be included in the differential diagnosis of ovarian cystic masses, especially in patients with chylous ascites. It is very important to discriminate such cases from other malignant tumors in order to avoid overtreatment. However, a careful follow up for at least 2 years is needed for patients with lymphangioma of the ovary in order to exclude recurrence.
{"title":"A rare case of ovarian Lymphangioma associated with chylous ascites and raised CA-125.","authors":"M. Mangla","doi":"10.7196/sajog.1347","DOIUrl":"https://doi.org/10.7196/sajog.1347","url":null,"abstract":"Lymphangiomas are benign congenital malformations of lymphatic system, thought to happen due to obstruction of local lymph flow system. They can occur anywhere in the skin and the mucous membranes. Most common sites are the head and the neck but sometimes, they can be found in the intestines, the pancreas and the mesentery. Lymphangioma of the ovary is an extremely rare lesion. It was first described in 1908. Clinical manifestations can vary from asymptomatic ovarian mass to acute abdomen. They may be very frequently confused with malignant ovarian mass often leading to extensive surgery. A 34-year-old female presented with dull aching pain localized to lower abdomen from last 6 months. Ultrasound and CECT abdomen were suggestive of enlarged right ovary with massive ascites. Ca-125 was 685. Diagnostic laparoscopy revealed chylous ascites and further a frozen section revealed few atypical cells, further strengthening the diagnosis of malignant tumor. Staging laparotomy with total abdominal hysterectomy and salpingo-oophorectomy was finally done. Histopathology revealed lymphangioma, with no evidence of malignancy. CA-125 also showed a rapid decline following surgery. Lymphangiomas should be included in the differential diagnosis of ovarian cystic masses, especially in patients with chylous ascites. It is very important to discriminate such cases from other malignant tumors in order to avoid overtreatment. However, a careful follow up for at least 2 years is needed for patients with lymphangioma of the ovary in order to exclude recurrence.","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7196/sajog.1347","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46890814","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}
N. Vijayan, A. Keepanasseril, N. Plakkal, V. Udupa, Subrahmanian Soundara Raghavan
Background. Expectant management of early-onset pre-eclampsia, with the aim of improving perinatal outcomes, may increase the risk of maternal morbidity. Objective. To study the maternal and perinatal outcomes and their association with various risk factors in women undergoing expectant management for early-onset pre-eclampsia. Methods. A retrospective cohort study was carried out in a tertiary centre in south India between April 2014 and June 2015. We studied 201 women with singleton pregnancies with pre-eclampsia diagnosed between 28 and 34 weeks’ gestation. Demographic data, medication and treatment details, and delivery data were extracted from maternal charts. The primary outcomes were: (i) composite maternal outcomes, defined as the development of any of eclampsia, abruptio placentae, pulmonary oedema or renal failure; and (ii) perinatal mortality. Logistic regression was used to assess the independent association risk factors with primary outcomes, after adjusting for other variables. Results. Sixty-nine women (34.3%) had one or more of the composite adverse maternal outcomes, and there were 74 (36.8%) cases of perinatal mortality. The presence of imminent symptoms (odds ratio (OR)=2.35) and multiparity (OR=2.31) were associated with composite adverse maternal outcomes, whereas low birth weight and breech vaginal delivery were associated with perinatal mortality. Perinatal mortality was higher in women with pre-eclampsia diagnosed between 28 and 30 weeks. Gestational age at diagnosis was not found to be associated with composite adverse maternal outcomes or perinatal morbidity. Conclusion. Expectant management in early-onset pre-eclampsia can be safely considered without increasing maternal risk, after thorough counselling about outcomes, based on the available neonatal facilities in low-resource settings.
{"title":"Maternal and Perinatal Outcomes in Women Undergoing Expectant Management of Early-Onset Preeclampsia: A Retrospective Cohort Study","authors":"N. Vijayan, A. Keepanasseril, N. Plakkal, V. Udupa, Subrahmanian Soundara Raghavan","doi":"10.7196/SAJOG.1378","DOIUrl":"https://doi.org/10.7196/SAJOG.1378","url":null,"abstract":"Background. Expectant management of early-onset pre-eclampsia, with the aim of improving perinatal outcomes, may increase the risk of maternal morbidity. Objective. To study the maternal and perinatal outcomes and their association with various risk factors in women undergoing expectant management for early-onset pre-eclampsia. Methods. A retrospective cohort study was carried out in a tertiary centre in south India between April 2014 and June 2015. We studied 201 women with singleton pregnancies with pre-eclampsia diagnosed between 28 and 34 weeks’ gestation. Demographic data, medication and treatment details, and delivery data were extracted from maternal charts. The primary outcomes were: (i) composite maternal outcomes, defined as the development of any of eclampsia, abruptio placentae, pulmonary oedema or renal failure; and (ii) perinatal mortality. Logistic regression was used to assess the independent association risk factors with primary outcomes, after adjusting for other variables. Results. Sixty-nine women (34.3%) had one or more of the composite adverse maternal outcomes, and there were 74 (36.8%) cases of perinatal mortality. The presence of imminent symptoms (odds ratio (OR)=2.35) and multiparity (OR=2.31) were associated with composite adverse maternal outcomes, whereas low birth weight and breech vaginal delivery were associated with perinatal mortality. Perinatal mortality was higher in women with pre-eclampsia diagnosed between 28 and 30 weeks. Gestational age at diagnosis was not found to be associated with composite adverse maternal outcomes or perinatal morbidity. Conclusion. Expectant management in early-onset pre-eclampsia can be safely considered without increasing maternal risk, after thorough counselling about outcomes, based on the available neonatal facilities in low-resource settings.","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7196/SAJOG.1378","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46414532","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}
A 35-year-old nulliparous patient with secondary infertility presented to a tertiary hospital in Johannesburg with abnormal uterine bleeding, and a history of two previous right-sided haemopneumothoraces. The second episode had been related to her menstruation, and required the insertion of an intercostal drain in order to treat the large haemothorax. A pleural biopsy revealed pleural endometriosis. She was treated with dienogest (Visanne) on discharge, and was awaiting follow-up with the cardiothoracic surgeons for continued and definitive management.
{"title":"Thoracic Endometriosis Syndrome","authors":"D. Guidozzi, Esther Rockson","doi":"10.7196/SAJOG.1340","DOIUrl":"https://doi.org/10.7196/SAJOG.1340","url":null,"abstract":"A 35-year-old nulliparous patient with secondary infertility presented to a tertiary hospital in Johannesburg with abnormal uterine bleeding, and a history of two previous right-sided haemopneumothoraces. The second episode had been related to her menstruation, and required the insertion of an intercostal drain in order to treat the large haemothorax. A pleural biopsy revealed pleural endometriosis. She was treated with dienogest (Visanne) on discharge, and was awaiting follow-up with the cardiothoracic surgeons for continued and definitive management.","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7196/SAJOG.1340","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47034936","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}
A. Cersosimo, E. A. Júnior, E. Santana, B. D. C. França, F. Vasques
Background. Low placental weight is associated with adverse perinatal outcomes. Adolescent pregnant women are associated with higher preterm labour, low birth weight and fetal growth restriction rates than adult pregnant women. Objective. To compare placental and newborn weights between groups of adolescent (≤19 years old) and adult mothers (20 - 28 years old). Methods. A prospective cross-sectional study was conducted with primiparous mothers who had their deliveries at ≥37 weeks’ gestation, and without maternal chronic disease or obstetrical intercurrence. Adolescents were divided into two groups (group A1, aged <15 years; group A2, 15 - 19 years), and the outcomes compared with a control group of adult mothers aged 20 - 28 years (group B). Group A1 included 23 newborns and 18 placentas, group A2 comprised 28 newborns and 28 placentas, and group B included 27 newborns and 27 placentas. The placental and newborn weights were compared between the groups using Student’s t -test for paired samples. Results. The mean (standard deviation (SD)) weights of the newborns and placentas in group A were significantly lower than those in group B: 3167.8 g (359.6) v. 3404.0 g (136.8) ( p =0.0016) and 573.7 g (98.7) v. 651.0 g (109.8) ( p =0.0028), respectively. The mean (SD) newborn and placental weights in group A1 were significantly lower than those in group A2: 2996.0 g (373.7) v. 3309.0 g (273.6) ( p =0.0012) and 513.0 g (94.9) v. 612.5 g (73.8) ( p =0.0026), respectively. Conclusion. The placental and newborn weights were significantly lower in the adolescent groups, and this difference was more pronounced in the younger of the adolescent groups.
{"title":"Comparison of newborn and placental weights between adolescent and adult women","authors":"A. Cersosimo, E. A. Júnior, E. Santana, B. D. C. França, F. Vasques","doi":"10.7196/SAJOG.1296","DOIUrl":"https://doi.org/10.7196/SAJOG.1296","url":null,"abstract":"Background. Low placental weight is associated with adverse perinatal outcomes. Adolescent pregnant women are associated with higher preterm labour, low birth weight and fetal growth restriction rates than adult pregnant women. Objective. To compare placental and newborn weights between groups of adolescent (≤19 years old) and adult mothers (20 - 28 years old). Methods. A prospective cross-sectional study was conducted with primiparous mothers who had their deliveries at ≥37 weeks’ gestation, and without maternal chronic disease or obstetrical intercurrence. Adolescents were divided into two groups (group A1, aged <15 years; group A2, 15 - 19 years), and the outcomes compared with a control group of adult mothers aged 20 - 28 years (group B). Group A1 included 23 newborns and 18 placentas, group A2 comprised 28 newborns and 28 placentas, and group B included 27 newborns and 27 placentas. The placental and newborn weights were compared between the groups using Student’s t -test for paired samples. Results. The mean (standard deviation (SD)) weights of the newborns and placentas in group A were significantly lower than those in group B: 3167.8 g (359.6) v. 3404.0 g (136.8) ( p =0.0016) and 573.7 g (98.7) v. 651.0 g (109.8) ( p =0.0028), respectively. The mean (SD) newborn and placental weights in group A1 were significantly lower than those in group A2: 2996.0 g (373.7) v. 3309.0 g (273.6) ( p =0.0012) and 513.0 g (94.9) v. 612.5 g (73.8) ( p =0.0026), respectively. Conclusion. The placental and newborn weights were significantly lower in the adolescent groups, and this difference was more pronounced in the younger of the adolescent groups.","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7196/SAJOG.1296","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42542090","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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