Background. Neuraxial analgesia in the form of a labour epidural has been shown to be the most effective analgesic strategy for the labouring mother. In developed countries, data are readily available as to the number of women receiving labour epidural analgesia, as well as the complication rates of labour epidurals. However, data for South Africa (SA) on labour epidural analgesia services are limited, and there were no published data for Rahima Moosa Mother and Child Hospital (RMMCH), Johannesburg, SA. Objective. To describe the labour epidural analgesia service at RMMCH over the period of 1 year. Methods. A retrospective audit using consecutive convenience sampling was done reviewing all epidural records at RMMCH from 1 January to 31 December 2014. Results. During the study period, labour epidural analgesia was administered for 187 (1.6%) of 11 853 deliveries. Epidural records were collected for all administered labour epidurals. The most common indications documented were labour analgesia (41.7%) and primigravida (28.9%). Labour epidurals were not administered for specific medical conditions. The incidence of complications was 22.6%, and these were minor and self-limiting. Hypotension was the most common complication (12.3%). Patient satisfaction with labour epidural analgesia, where documented, was high (98.4%). Conclusion. This audit revealed a low incidence of labour epidural analgesia at RMMCH during the study period. The incidence of complications was in keeping with that seen in developed countries. Poor documentation was noted to be a problem.
{"title":"An audit of the labour epidural analgesia service at a regional hospital in Gauteng Province, South Africa","authors":"T. Leonard, H. Perrie, J. Scribante, S. Chetty","doi":"10.7196/SAJOG.1314","DOIUrl":"https://doi.org/10.7196/SAJOG.1314","url":null,"abstract":"Background. Neuraxial analgesia in the form of a labour epidural has been shown to be the most effective analgesic strategy for the labouring mother. In developed countries, data are readily available as to the number of women receiving labour epidural analgesia, as well as the complication rates of labour epidurals. However, data for South Africa (SA) on labour epidural analgesia services are limited, and there were no published data for Rahima Moosa Mother and Child Hospital (RMMCH), Johannesburg, SA. Objective. To describe the labour epidural analgesia service at RMMCH over the period of 1 year. Methods. A retrospective audit using consecutive convenience sampling was done reviewing all epidural records at RMMCH from 1 January to 31 December 2014. Results. During the study period, labour epidural analgesia was administered for 187 (1.6%) of 11 853 deliveries. Epidural records were collected for all administered labour epidurals. The most common indications documented were labour analgesia (41.7%) and primigravida (28.9%). Labour epidurals were not administered for specific medical conditions. The incidence of complications was 22.6%, and these were minor and self-limiting. Hypotension was the most common complication (12.3%). Patient satisfaction with labour epidural analgesia, where documented, was high (98.4%). Conclusion. This audit revealed a low incidence of labour epidural analgesia at RMMCH during the study period. The incidence of complications was in keeping with that seen in developed countries. Poor documentation was noted to be a problem.","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.1314","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42552948","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. African men with infertility appear to be concerned about the blame for male infertility falling on their wives. Objective. To explore the concerns of men with infertility about the blame for male infertility falling on their wives. Methods. Participants were recruited through their wives, who were receiving treatment for infertility from the obstetrics and gynaecology unit of a public hospital in Ghana. The men had been identified as having male factor infertility. A semi-structured interview guide was designed and used to conduct in-depth interviews. Each participant was interviewed twice. The first interview lasted ~20 - 30 minutes. The second was by telephone, for validation of the findings, and lasted ~10 minutes per participant. Each interview was transcribed verbatim for conventional content analysis. Results. The findings revealed that the men described three main concerns: traditional influences, emotional disturbances and pressure on wives. Conclusion. The men’s narrations of their experiences indicated that they were very concerned about the blame for male infertility falling on their wives. There is a need for health education on male infertility in Ghana.
{"title":"I don’t experience any insults but my wife does”: The blame game of male infertility in Ghana","authors":"F. Naab, A. Kwashie","doi":"10.7196/SAJOG.1278","DOIUrl":"https://doi.org/10.7196/SAJOG.1278","url":null,"abstract":"Background. African men with infertility appear to be concerned about the blame for male infertility falling on their wives. Objective. To explore the concerns of men with infertility about the blame for male infertility falling on their wives. Methods. Participants were recruited through their wives, who were receiving treatment for infertility from the obstetrics and gynaecology unit of a public hospital in Ghana. The men had been identified as having male factor infertility. A semi-structured interview guide was designed and used to conduct in-depth interviews. Each participant was interviewed twice. The first interview lasted ~20 - 30 minutes. The second was by telephone, for validation of the findings, and lasted ~10 minutes per participant. Each interview was transcribed verbatim for conventional content analysis. Results. The findings revealed that the men described three main concerns: traditional influences, emotional disturbances and pressure on wives. Conclusion. The men’s narrations of their experiences indicated that they were very concerned about the blame for male infertility falling on their wives. There is a need for health education on male infertility in Ghana.","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.1278","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41372615","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. Rossouw, E. Langenegger, J. Burke, A. V. Rensburg, A. Pecoraro
Unrepaired cyanotic heart disease is considered a high-risk lesion owing to the consequent increase in maternal and fetal complications. In the presence of pulmonary hypertension, maternal mortality approaching 50% has been reported, and pregnancy is therefore considered contraindicated. We present a case of a 32-year-old woman presenting at 34 weeks’ gestation in heart failure due to newly diagnosed cyanotic complex cardiac disease. The diagnosis of left atrial isomerism with a common atrium, single atrioventricular valve, and a restrictive ventricular septum defect was made. Cyanosis was due to mixing at atrial level, without features of Eisenmenger’s syndrome. Her intrapartum multidisciplinary management is described in detail. The patient was discharged home in a condition similar to her baseline, together with her healthy neonate.
{"title":"The peripartum management of a 32-year-old patient presenting at 34 weeks’ gestation with unrepaired cyanotic heart disease","authors":"J. Rossouw, E. Langenegger, J. Burke, A. V. Rensburg, A. Pecoraro","doi":"10.7196/SAJOG.1265","DOIUrl":"https://doi.org/10.7196/SAJOG.1265","url":null,"abstract":"Unrepaired cyanotic heart disease is considered a high-risk lesion owing to the consequent increase in maternal and fetal complications. In the presence of pulmonary hypertension, maternal mortality approaching 50% has been reported, and pregnancy is therefore considered contraindicated. We present a case of a 32-year-old woman presenting at 34 weeks’ gestation in heart failure due to newly diagnosed cyanotic complex cardiac disease. The diagnosis of left atrial isomerism with a common atrium, single atrioventricular valve, and a restrictive ventricular septum defect was made. Cyanosis was due to mixing at atrial level, without features of Eisenmenger’s syndrome. Her intrapartum multidisciplinary management is described in detail. The patient was discharged home in a condition similar to her baseline, together with her healthy neonate.","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.1265","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43093896","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}
Obstructed labour is a well-known clinical entity in maternity units, cephalopelvic disproportion being the most common cause. Here, we report a rare case of obstructed labour resulting from a large vesical calculus. The patient was a referred case from a district hospital for delayed progress of labour. The diagnosis of large vesical calculus causing labour obstruction was made by doing a vaginal examination. On vaginal examination, a large calculus of apparent size ~7 cm . 6 cm was palpated behind the anterior vaginal wall, which was preventing the descent of the head of the fetus. An emergency caesarean section was performed with simultaneous removal of vesical calculus by cystotomy. The postoperative period was uneventful.
{"title":"Labour dystocia: Vesical calculus can be the cause","authors":"M. Naik, K. Yadav","doi":"10.7196/SAJOG.1310","DOIUrl":"https://doi.org/10.7196/SAJOG.1310","url":null,"abstract":"Obstructed labour is a well-known clinical entity in maternity units, cephalopelvic disproportion being the most common cause. Here, we report a rare case of obstructed labour resulting from a large vesical calculus. The patient was a referred case from a district hospital for delayed progress of labour. The diagnosis of large vesical calculus causing labour obstruction was made by doing a vaginal examination. On vaginal examination, a large calculus of apparent size ~7 cm . 6 cm was palpated behind the anterior vaginal wall, which was preventing the descent of the head of the fetus. An emergency caesarean section was performed with simultaneous removal of vesical calculus by cystotomy. The postoperative period was uneventful.","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.1310","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48156317","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":"Open to debate","authors":"W. Edridge","doi":"10.7196/SAJOG.1416","DOIUrl":"https://doi.org/10.7196/SAJOG.1416","url":null,"abstract":"","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.1416","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45236880","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. Matjila, J. Anthony, M. Vatish, J. Moodley, I. Bhorat, E. Nicolaou, P. Soma-Pillay, S. Monokoane, H. Lombaard, L. Chauke, T. Pillay, E. Mokaba
Pre-eclampsia is one of the leading causes of maternal and perinatal mortality and morbidity worldwide, and places a significant burden on the South African (SA) healthcare system. The soluble fms-like tyrosince kinase (sFlt-1)/placental growth factor (PlGF) ratio can serve as a diagnostic aid for PE, and should be used in combination with clinical judgement and other ancillary tests. The Preeclampsia Advisory Board was convened on 31 March 2017, with experts in the field of PE from various hospitals and universities around the country in attendance. An international expert gave insight into best practices from countries that have implemented the Elecsys immunoassay sFlt-1/PlGF ratio. Others recommend that the sFlt-1/PlGF ratio be implemented in clinical practice when clinical diagnosis is in doubt in patients with suspected PE, in the interests of avoiding unnecessary hospitalisation and interventions. The strength of the test lies in its negative predictive value in ruling out PE. Ruling out PE could drive cost savings, as fewer women would be needlessly admitted to hospital, and there could, in addition, be fewer iatrogenic preterm deliveries, which are associated with considerable morbidity and cost. As most data are derived from high-income countries, multicentre studies are required to assess the clinical performance of this test within the context of SA.
{"title":"Consensus statement on the potential implementation of the sFlt-1/PlGF ratio in women with suspected pre-eclampsia","authors":"M. Matjila, J. Anthony, M. Vatish, J. Moodley, I. Bhorat, E. Nicolaou, P. Soma-Pillay, S. Monokoane, H. Lombaard, L. Chauke, T. Pillay, E. Mokaba","doi":"10.7196/SAJOG.1411","DOIUrl":"https://doi.org/10.7196/SAJOG.1411","url":null,"abstract":"Pre-eclampsia is one of the leading causes of maternal and perinatal mortality and morbidity worldwide, and places a significant burden on the South African (SA) healthcare system. The soluble fms-like tyrosince kinase (sFlt-1)/placental growth factor (PlGF) ratio can serve as a diagnostic aid for PE, and should be used in combination with clinical judgement and other ancillary tests. The Preeclampsia Advisory Board was convened on 31 March 2017, with experts in the field of PE from various hospitals and universities around the country in attendance. An international expert gave insight into best practices from countries that have implemented the Elecsys immunoassay sFlt-1/PlGF ratio. Others recommend that the sFlt-1/PlGF ratio be implemented in clinical practice when clinical diagnosis is in doubt in patients with suspected PE, in the interests of avoiding unnecessary hospitalisation and interventions. The strength of the test lies in its negative predictive value in ruling out PE. Ruling out PE could drive cost savings, as fewer women would be needlessly admitted to hospital, and there could, in addition, be fewer iatrogenic preterm deliveries, which are associated with considerable morbidity and cost. As most data are derived from high-income countries, multicentre studies are required to assess the clinical performance of this test within the context of SA.","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.1411","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44654326","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. Uterine fibroids are the most common of the benign gynaecological tumours, the definitive traditional treatment for which is either myomectomy or hysterectomy. Uterine artery embolisation (UAE) offers an alternative non-invasive option for treatment. There remain concerns as to the effects of UAE on ovarian reserve in women desirous of preserving ovarian function. Objectives. To determine the effect of UAE on ovarian reserve, as assessed by anti-Mullerian hormone (AMH) measured before and after embolisation, and to assess the trend in serum AMH in the medium term, up to 12 months post UAE. Methods. A cohort study between October 2012 and May 2015 recruited 40 women with symptomatic uterine fibroids. Serum AMH was measured prior to embolisation and post embolisation, at 2 weeks, 6 months and 12 months. Using descriptive statistics and bivariate analysis, pre-embolisation and post-embolisation AMH concentrations were compared. P <0.05 was considered statistically significant. Results. The median participant age was 38.5 years (range 31 - 45). Of the women recruited, 47.5% (19) were nulliparous, and 72.5% (29 women) of the total desired a pregnancy in the future. The median (standard deviation) AMH immediately prior to embolisation was 1.3 ng/mL (1.53), and post embolisation at 2 weeks, 0.9 ng/mL (1.98); at 6 months, 2.2 ng/mL (2.63); and 12 months, 3.5 ng/mL (1.54) ( p = 0.96). Conclusion. In the short to medium term, UAE for treatment of symptomatic fibroids was not found to be detrimental to ovarian reserve. There is a need for longer-term studies evaluating its effects on fecundity, considering that most women in the present study had a strong desire to maintain their fertility.
{"title":"Anti-Mullerian hormone before and after uterine artery embolisation in reproductive-age women seeking treatment for symptomatic fibroids","authors":"C. Muteshi, A. Murage, Stephen Ngugi","doi":"10.7196/SAJOG.1331","DOIUrl":"https://doi.org/10.7196/SAJOG.1331","url":null,"abstract":"Background. Uterine fibroids are the most common of the benign gynaecological tumours, the definitive traditional treatment for which is either myomectomy or hysterectomy. Uterine artery embolisation (UAE) offers an alternative non-invasive option for treatment. There remain concerns as to the effects of UAE on ovarian reserve in women desirous of preserving ovarian function. Objectives. To determine the effect of UAE on ovarian reserve, as assessed by anti-Mullerian hormone (AMH) measured before and after embolisation, and to assess the trend in serum AMH in the medium term, up to 12 months post UAE. Methods. A cohort study between October 2012 and May 2015 recruited 40 women with symptomatic uterine fibroids. Serum AMH was measured prior to embolisation and post embolisation, at 2 weeks, 6 months and 12 months. Using descriptive statistics and bivariate analysis, pre-embolisation and post-embolisation AMH concentrations were compared. P <0.05 was considered statistically significant. Results. The median participant age was 38.5 years (range 31 - 45). Of the women recruited, 47.5% (19) were nulliparous, and 72.5% (29 women) of the total desired a pregnancy in the future. The median (standard deviation) AMH immediately prior to embolisation was 1.3 ng/mL (1.53), and post embolisation at 2 weeks, 0.9 ng/mL (1.98); at 6 months, 2.2 ng/mL (2.63); and 12 months, 3.5 ng/mL (1.54) ( p = 0.96). Conclusion. In the short to medium term, UAE for treatment of symptomatic fibroids was not found to be detrimental to ovarian reserve. There is a need for longer-term studies evaluating its effects on fecundity, considering that most women in the present study had a strong desire to maintain their fertility.","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.1331","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44143582","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.1425","DOIUrl":"https://doi.org/10.7196/sajog.1425","url":null,"abstract":"","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.1425","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47880500","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}
Acute fatty liver of pregnancy (AFLP) is an uncommon but life-threatening condition unique to pregnancy, affecting ~1 in 10 000 pregnancies, and is the most common cause of liver failure in pregnancy. Here the case is described of a 35-year-old patient who presented at 21 weeks’ gestation complaining of vomiting, epigastric pain and food intolerance. During the course of her hospital stay of 31 days, she developed electrolyte imbalances and derangement in liver functions, with coagulopathy and bicytopenia. While she was being investigated for the cause of the biochemical abnormalities, she developed sepsis and anasarca, with a deterioration of her general condition, and it was decided to eliver the fetus. A diagnosis of AFLP was made on histological evaluation of a liver biopsy performed 3 days prior to delivery.
{"title":"An atypical presentation of acute fatty liver of pregnancy","authors":"O. U. Onwuagbu, C. Mnyani, N. Ntshwanti, R. Wadee","doi":"10.7196/SAJOG.1271","DOIUrl":"https://doi.org/10.7196/SAJOG.1271","url":null,"abstract":"Acute fatty liver of pregnancy (AFLP) is an uncommon but life-threatening condition unique to pregnancy, affecting ~1 in 10 000 pregnancies, and is the most common cause of liver failure in pregnancy. Here the case is described of a 35-year-old patient who presented at 21 weeks’ gestation complaining of vomiting, epigastric pain and food intolerance. During the course of her hospital stay of 31 days, she developed electrolyte imbalances and derangement in liver functions, with coagulopathy and bicytopenia. While she was being investigated for the cause of the biochemical abnormalities, she developed sepsis and anasarca, with a deterioration of her general condition, and it was decided to eliver the fetus. A diagnosis of AFLP was made on histological evaluation of a liver biopsy performed 3 days prior to delivery.","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.1271","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48839870","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}
Vulvovaginal disease is often difficult and problematic. Standard information is often lacking, as may be the knowledge of the individual gynaecologist, who is required to make diagnoses and decide on a management course. Difficulties associated with vulvar and vaginal conditions may not be as commonplace for the practising gynaecologist as the dilemma of an uncomplicated pregnancy at 40 weeks, or how to perform a challenging caesarean section or how to manage painful and heavy menstruation, but the average gynaecologist must be aware that many patients with vulvar and vaginal conditions are not adequately treated, and that the classification of some conditions often seems incomplete and confusing. The simplest and yet most complex of these conditions is vulvar thrush, or candidiasis, ‘Candida albicans’. Many gynaecologists know that Candida is the genus and Candida albicans a species, one of a multitude of Candida spp., which leads to a difficulty – the common treatment of candidiasis, imidazoles, treats primarily the pseudohyphae-forming C. albicans and not its relatives. A patient affected by recurrent thrush will describe how ineffective imidazoles can be. Perhaps this failure of imidazole treatment should be attributed as much to the cyclical or recurring alteration of the vaginal environment, such as pH, as to deficiencies in therapy. Every student can explain that this changing environment may be caused by loss of the vaginal Lactobacillus spp., which may occur menstrually, with antibiotic use, pregnancy, or hormone treatments. However, this knowledge does not resolve the problem of a person with recurrent thrush who remains affected. Perhaps it is important to look beyond the Candida genus. Tinea spp. and many other fungi may infect the vulva, as they favour a naturally damp environment. Some are responsive to imidazoles. If feet are a possible source of these fungi, perhaps simple washing of feet last may prevent certain cases of recurring candidiasis that are otherwise inexplicable? Our understanding of pathogens in the vagina is lacking. Our understanding of the infinitely complex normal vaginal bacterial environment is also deficient: what are the normal organisms of the vagina and vulva? Mycoplasma spp. have been associated with many conditions, including bacterial vaginosis and pelvic inflammatory disease (PID), which is presumably a condition in which pathogenic organisms ascend from the vagina in association with sexual intercourse and pass into the uterus and adnexa. Mycoplasma and other species have been associated with PID, and yet further reading will show that their behaviour as pathogens is open to considerable debate and that they may also be commensals, found in circumstances where there is no pathology. There are many other organisms, including anaerobic streptococci, for which this is true. And so perhaps it is not the organism itself that is the ratelimiting step in creating a pathological state, but, as with Candida sp
{"title":"Vulvovaginal conditions remain difficult and unresolved","authors":"W. Edridge","doi":"10.7196/SAJOG.1365","DOIUrl":"https://doi.org/10.7196/SAJOG.1365","url":null,"abstract":"Vulvovaginal disease is often difficult and problematic. Standard information is often lacking, as may be the knowledge of the individual gynaecologist, who is required to make diagnoses and decide on a management course. Difficulties associated with vulvar and vaginal conditions may not be as commonplace for the practising gynaecologist as the dilemma of an uncomplicated pregnancy at 40 weeks, or how to perform a challenging caesarean section or how to manage painful and heavy menstruation, but the average gynaecologist must be aware that many patients with vulvar and vaginal conditions are not adequately treated, and that the classification of some conditions often seems incomplete and confusing. The simplest and yet most complex of these conditions is vulvar thrush, or candidiasis, ‘Candida albicans’. Many gynaecologists know that Candida is the genus and Candida albicans a species, one of a multitude of Candida spp., which leads to a difficulty – the common treatment of candidiasis, imidazoles, treats primarily the pseudohyphae-forming C. albicans and not its relatives. A patient affected by recurrent thrush will describe how ineffective imidazoles can be. Perhaps this failure of imidazole treatment should be attributed as much to the cyclical or recurring alteration of the vaginal environment, such as pH, as to deficiencies in therapy. Every student can explain that this changing environment may be caused by loss of the vaginal Lactobacillus spp., which may occur menstrually, with antibiotic use, pregnancy, or hormone treatments. However, this knowledge does not resolve the problem of a person with recurrent thrush who remains affected. Perhaps it is important to look beyond the Candida genus. Tinea spp. and many other fungi may infect the vulva, as they favour a naturally damp environment. Some are responsive to imidazoles. If feet are a possible source of these fungi, perhaps simple washing of feet last may prevent certain cases of recurring candidiasis that are otherwise inexplicable? Our understanding of pathogens in the vagina is lacking. Our understanding of the infinitely complex normal vaginal bacterial environment is also deficient: what are the normal organisms of the vagina and vulva? Mycoplasma spp. have been associated with many conditions, including bacterial vaginosis and pelvic inflammatory disease (PID), which is presumably a condition in which pathogenic organisms ascend from the vagina in association with sexual intercourse and pass into the uterus and adnexa. Mycoplasma and other species have been associated with PID, and yet further reading will show that their behaviour as pathogens is open to considerable debate and that they may also be commensals, found in circumstances where there is no pathology. There are many other organisms, including anaerobic streptococci, for which this is true. And so perhaps it is not the organism itself that is the ratelimiting step in creating a pathological state, but, as with Candida sp","PeriodicalId":49579,"journal":{"name":"South African Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7196/SAJOG.1365","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43509588","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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