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Tesi sul tema "Obstetrics and gynaecology"
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1
Abdul-Kadir, Rezan Ahmed. "Inherited bleeding disorders in obstetrics and gynaecology". Thesis, University of London, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.391628.
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2
Logan, Susan. "Screening for Chlamydia trachomatis in obstetrics and gynaecology". Thesis, University of Aberdeen, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.288266.
Testo completoAbstract (sommario):
In 1996, a RCOG Study Group reporting on the prevention of pelvic infection highlighted the considerable role C. trachomatis played in female reproductive morbidity and the potential advantages of DNA based assays. A national screening programme was suggested, as Sweden and the USA had demonstrated that screening women could decrease prevalence and pelvic inflammatory disease rates. In the UK, out with genito-urinary medicine clinics, awareness of the infection and screening was virtually non-existent. Women attending obstetric and gynaecology-affiliated clinics were at increased risk of ascending infection compared to the general public and ideally placed for opportunistic screening. However, patients were TESTED only if symptomatic, by specimens taken from the endocervix for culture or antigen detection assay. It was from this background that the studies commenced. The thesis comprises of: - A questionnaire survey assessing sexually active women’s knowledge of C. trachomatis infection and perceived acceptability of different methods and settings for screening. Women attending induced abortion and family planning clinics in Aberdeen and Leeds were recruited. - A prevalence study, aiming to identify who should undergo screening. Sexually active women attending six different clinical settings in Aberdeen’s Obstetrics & Gynaecology department were screened for Chlamydia. - A study assessing test performance and acceptability of four different screening approaches (enzyme immunoassay of endocervical specimens and ligase chain reaction assay of endocervical, clinician-collected vulva!, and urine specimens) to opportunistically screen pregnant and non-pregnant women, under 25 years of age. - A study evaluating patient-collected vulval swabs, as an alternative to non-invasive screening by urine. Women under 25 years of age attending a family planning clinic were opportunistically screened and test performance and acceptability evaluated. - A study determining whether the measurement of chlamydial IgG antibodies alone or in combination with medical history and/or transvaginal ultrasound can predict tubal infertility in subfertile women.
3
Poggenpoel, Elizabeth J. "Primary obstetric ultrasound : comparing a detail ultrasound only protocol with a booking ultrasound protocol". Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/4326.
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4
Cooper, Natalie Ann MacKinnon. "Ambulatory gynaecology : guidelines and economic analysis". Thesis, University of Birmingham, 2013. http://etheses.bham.ac.uk//id/eprint/4421/.
Testo completoAbstract (sommario):
The aim of this thesis was to investigate the role of outpatient hysteroscopy in modern gynaecological care by conducting a series of systematic reviews and meta-analyses to examine how the procedure can be optimised to reduce pain and by performing a cost effectiveness analysis. The systematic reviews concluded that women undergoing outpatient hysteroscopy should take simple analgesia beforehand and that the hysteroscopist should adopt a vaginoscopic approach using a small diameter, rigid hysteroscope and normal saline as the distension medium. If dilatation of the cervix is required this should be done under a paracervical block. These findings were incorporated into a clinical guideline and the quality of the evidence that the reviews provided was assessed using the SIGN and GRADE methods. A comparison of the assessments found that they gave varying estimates of the quality of evidence and that neither offered a perfect solution to the assessment of evidence quality when writing clinical guidance. The economic analysis found that initial testing with outpatient hysteroscopy was the most cost-effective testing strategy for investigation of heavy menstrual bleeding when compared to other diagnostic tests, regardless of a woman’s wish for future fertility or prior treatment with a levonorgestrel intrauterine system.
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Chilopora, Garvey Chipiliro. "Clinical officers in Malawi : expanding access to comprehensive emergency obstetrics care". Master's thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/3037.
Testo completoAbstract (sommario):
Includes abstract.Includes bibliographical references (leaves 48-53).
Clinical officers perform much of major emergency surgery in Malawi, in the absence of medical officers. The aim of this study was to validate the advantages and disadvantages of delegation of major obstetric surgery to non-doctors.
6
Innala, Eva. "Acute intermittent porphyria, women and sex hormones. Screening for hepatocellular carcinoma in porphyria". Doctoral thesis, Umeå universitet, Obstetrik och gynekologi, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-36884.
Testo completoAbstract (sommario):
Background: Porphyrias are inherited disorders with impaired heme biosynthesis. Acute intermittent porphyria (AIP) is the most common porphyria in Sweden. AIP attacks may be life-threatening. Female sex hormones are regarded as important precipitating factors. Hepatocellular carcinoma (HCC) is a severe complication in the older AIP population. The aim of the thesis was to describe the clinical expression of AIP in women, experience of hormonal contraception and hormonal replacement therapies (HRT) and of pregnancies. Secondly, we evaluated gonadotropin-releasing hormone (GnRH) agonist treatment for prevention of menstrual-cycle-related AIP attacks. Thirdly, we evaluated whether an altered sex-steroid metabolism was present in AIP women compared with controls. Finally, we evaluated the benefit of screening for HCC in AIP in a 15-year follow-up study. Methods and results: In a retrospective population-based study in northern Sweden, 166 female AIP gene carriers ≥18 years of age participated. Manifest AIP (MAIP) was reported in 55%; 82% had severe attacks and 39% had menstrual-cycle-related attacks. Hormonal contraceptives were used by 94, and 12 reported that this precipitated AIP attacks. HRT and local vaginal treatments in menopause did not precipitate AIP attacks. Only 10% reported impairment of AIP symptoms during pregnancy. In the retrospective follow-up study of GnRH-agonist treatment, 11 of 14 women improved during treatment. Porphyria attacks were triggered in two women after estradiol add-back and in 5 of 9 women after progesterone add-back. In the sex-steroid metabolism study, levels of s-progesterone, estradiol, allopregnanolone and pregnanolone during the menstrual cycle in 32 AIP gene carriers were compared with 20 healthy controls. Progesterone metabolism in the AIP group differed from controls. In the AIP group levels of allopregnanolone, but not pregnanolone, were significantly lower. In the prospective HCC screening study AIP gene carriers aged >55 years were included. On average 62 subjects participated during 15 years. HCC was diagnosed in 22 of 180 eligible AIP gene carriers in the region (male:female, 12:10, 73% MAIP). The annual incidence of HCC was 0.8%. The risk of HCC was 64-fold higher than in the general population over 50 years of age in this region, and even higher for AIP women (93-fold). Increased 3- and 5-year survival was seen in the regularly screened AIP group. Liver lab tests were not useful in HCC screening. Conclusion: The clinical expression of AIP in women is pronounced and menstrual-cycle-related attacks are common. Hormonal contraceptives can induce AIP attacks and caution is recommended. GnRH-agonist treatment can ameliorate menstrual-cycle-related attacks of porphyria. Dose findings for GnRH-agonists and add-back regimes, especially for progesterone, are intricate. Progesterone metabolism in the AIP group differs from that in healthy controls. HCC screening in AIP gene carriers >50 years of age enables early diagnosis and a possibility for curative treatments. Annual HCC screening with liver imaging is recommended in AIP gene carriers >50 years of age.
7
Benedetto, C. "Physiopathological aspects of prostanoids£t and platelet function in obstetrics and gynaecology". Thesis, Brunel University, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.233348.
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8
Chilopora, Garvey Chiliro. "Clinical Officers in Malawi: Expanding access to comprehensive emergency obstetric care". Master's thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/3035.
Testo completoAbstract (sommario):
Background: Clinical officers perform much of major emergency surgery in Malawi, in the absence of medical officers. The aim of this study was to validate the advantages and disadvantages of delegation of major obstetric surgery to non-doctors. Methods: During a three month period, data from 2131 consecutive obstetric surgeries in 38 district hospitals in Malawi were collected prospectively. The interventions included caesarean sections alone and those that were combined with other interventions such as subtotal and total hysterectomy repair of uterine rupture and tubal ligation. All these surgeries were conducted either by clinical officers or by medical officers. Results: During the study period, clinical officers performed 90% of all standard caesarean sections, 70% of those combined with subtotal hysterectomy, 60% of those combined with total hysterectomy and 89% of those combined with repair of uterine rupture. A comparable profile of patients was operated on by clinical officers and medical officers, respectively. Postoperative outcomes were almost identical in the two groups in terms of maternal general condition = both immediately and 24 hours postoperatively - and regarding occurrence of pyrexia, wound infection, wound dehiscence, need for re-operation, neonatal outcome or maternal death. Conclusion: Clinical officers perform the bulk of emergency obstetric operations, including complicated procedures, at district (level 1) hospitals in Malawi. The postoperative outcomes of their procedures are comparable to those of medical officers. Clinical officers constitute a crucial component of the health care team in Malawi for saving maternal and neonatal lives given the scarcity of physicians.
9
Willis, Debbie Susan. "Insulin and follicular function in polycystic ovaries". Thesis, Imperial College London, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.484080.
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10
Gadd, Stephanie Clare. "Insulin-like growth factor II in preovulatory follicles and ovarian cysts". Thesis, University of Southampton, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.296517.
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11
Oosthuizen, Lizle. "The impact of GnRH-agonist triggers on autologous in vitro fertilization outcomes: A retrospective analysis". Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33934.
Testo completoAbstract (sommario):
BACKGROUND: In vitro fertilization in assisted reproduction requires controlled ovarian stimulation with exogenous gonadotrophins and oocyte maturation before ultrasound guided aspiration. GnRH-agonists have been utilized as an alternative to hCG for oocyte maturation prior to follicle aspiration. GnRH-agonist triggers are proven to lower ovarian hyperstimulation syndrome risk, a condition that can be life threatening. Lower pregnancy rates have been reported in the literature with the GnRH-agonist trigger, leading to recommendations of elective embryo cryopreservation, delayed transfer and increased costs to the patient. AIM: To determine if intensive luteal phase support of GnRH-agonist triggered cycles with intramuscular progesterone and oral oestrogen can result in similar pregnancy rates when comparing fresh embryo transfer outcomes with those of hCG triggered cycles. STUDY DESIGN, SIZE, DURATION: The study was a retrospective analysis of 279 fresh embryo transfers in autologous IVF cycles, which took place over the period of one year at Cape Fertility Clinic in Cape Town. RESULTS: Biochemical (49.40% vs 41.84%), clinical (43.37% vs 36.22%) and ongoing pregnancy rates (37.35% vs 33.16%) were higher in the GnRH-agonist triggered arm in comparison to the hCG triggered arm, respectively. Miscarriage rates were similar at 24.29% in the GnRH-agonist arm, versus 20.73% in the hCG triggered arm. None of the results were statistically significant. CONCLUSION: Similar pregnancy rates can be achieved with both hCG and GnRH-agonist triggered IVF cycles by supporting the GnRH-agonist triggered luteal phase with intensive intramuscular progesterone support.
12
Schutte, Marcelle. "A review of intrauterine device placement during caesarean section at level two facilities in the Metro West, Cape Town". Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/34030.
Testo completoAbstract (sommario):
Study rationale In the Western Cape there are many intrauterine contraceptive devices (IUDs) inserted during caesarean section (C/S). Little is known about the long-term outcomes in the Metro West area. Objective To assess placement of IUDs at C/S and describe follow-up, with a view to compile best practice guidelines for insertion and follow-up in our clinic setting. Method A retrospective descriptive audit of clinical records was performed of all women who received an IUD at C/S between January and June 2018 at Mowbray Maternity Hospital (MMH) and New Somerset Hospital (NSH) in Cape Town. Results There were 2310 and 1376 C/S performed at MMH and NSH respectively. The IUD insertion rate was 17.4% (n=402) at MMH and 14.3% (n=197) at NSH. Almost two third of insertions were performed at the time of emergency caesarean section (59.1%; n=276). The majority of women experienced no immediate complications (84.4%). Only 77 women attended follow-up. The continuation rate at follow-up was 71.6%. The overall expulsion rate in hospital and at follow-up was 3%. Strings were visible in 53.2% of patients. An ultrasound was performed in 67.5 % (52/77) of patients. The IUD removal rate at follow-up was 24.7% (19/77). Discussion The poor follow-up rate is concerning, and measures must be taken to address this. The continuation rate of 71.6% is lower than expected but may have been biased by the low follow-up rate. Continuation rates improved with the experience of inserters which highlights the importance of training and supervision. Conclusion The immediate postpartum period may be the only opportunity to provide long acting reversable contraception to some women. In our study population follow-up rates are poor and therefore conclusions are difficult to accurately gauge. Measures must be taken to improve follow-up.
13
Momberg, Zoe. "Accuracy of ultrasound beyond 14 weeks to determine chorionicity of twin pregnancies". Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/22023.
Testo completoAbstract (sommario):
Determining the chorionicity of twin pregnancies is extremely important as this influences the frequency of surveillance, timing of delivery and management of complications. Monochorionic twins have 2.5 times the perinatal mortality of dichorionic twins, and in the case of a single intra-uterine fetal demise, the surviving twin of a monochorionic pair is at significant risk of neurological damage compared to a dichorionic pregnancy. Chorionicity can be accurately determined before 14 weeks gestation using the lambda or T-sign. After 14 weeks, these ultrasonographic signs become less reliable and the pregnancy may be assumed to be monochorionic for management purposes. The implication of this assumption is that on occasion premature dichorionic fetuses may be delivered unnecessarily. In South Africa, many women have their first antenatal visit after the first trimester or are not scanned by an experienced sonographer until after 14 weeks. There is thus a need for an accurate means to determine chorionicity in the second and third trimesters.
14
Paulsen, Carrie. "Incidence and nature of complications post primary repair of Obstetric Anal Sphincter Injury (OASI): Retrospective chart review". Master's thesis, Faculty of Health Sciences, 2019. https://hdl.handle.net/11427/31687.
Testo completoAbstract (sommario):
Background. A multitude of data exists regarding global incidence of OASI as well as its contributing factors and complications. Little to no data exists regarding the incidence of OASI or its complications and the nature of these complications within South Africa. Objective. To describe the rate and nature of complications of OASI that occur within 6 weeks following primary repair of an OASI, followed up at the GSH perineal clinic. Secondarily, to investigate the incidence of OASI and follow up rate post primary repair Methods. This was a retrospective chart review. Participants were identified from theatre record books between January 2014 and December 2015. The charts of those that attended the perineal clinic follow up were reviewed and complications and possible associated risk factors were identified from the clinical notes. Primary aims were to identify the incidence and nature of complications seen in this population as well as possible related risk factors. The secondary aims were to determine the incidence of OASI and follow up rate for complication following primary OASI repair. Results. The mean age of participants was 25.85 years with a mean body mass index of 25.15kg/m2 . The mean birthweight seen was 3382.05 grams. Constipation (10.87%), pain with defaecation (11.96%) and anal incontinence (10.87%) were the most frequently reported complications. Wound infection was found on examination in 3.26% of participants and wound dehiscence was seen in 6.67%. Incidence of OASI in this study group was 8.64 per 1000 vaginal deliveries. The follow up rate of these participants was 26.20%. A total of 374 OASI were repaired within this region during the study period. Only 97 of these attended follow up, for which 93 folders were available to be included in analysis Conclusion. The Incidence of OASI in this Western Cape region is within the range seen worldwide but the proportion of complications seem to be less than global data suggests despite adverse conditions, theatre delays and the fact that repairs were mostly performed by specialists in training. It was not possible to identify any relationship with possible associated factors. There is a very poor follow up rate within this community which needs to be explored and systems need to be put in place to ensure all participants are given the opportunity of follow up.
15
Montgomery, Colin Jaco. "Retrospective review of the incidence of venous thromboembolism in pregnancy and the puerperium and identification of presenting complaints of pregnancy-related venous thromboembolism at Groote Schuur Maternity Centre, Cape Town between 1 January 2016 and 31 December 2016". Master's thesis, Faculty of Health Sciences, 2019. https://hdl.handle.net/11427/31764.
Testo completoAbstract (sommario):
Background: Venous thromboembolism is one of the leading causes of morbidity and mortality around the world. In addition to the immediate morbidity, there is significant implications on delivery plans, future options of contraception and thromboprophylaxis in subsequent pregnancies. At present, no pre-test probability assessments are being used to predict venous thromboembolism in pregnancy. This is the first study in South-Africa, addressing venous thromboembolism in the perinatal period which specifically examines the epidemiology and clinical presentation in pregnancy and the post-partum period. Objectives: To determine the incidence of venous thromboembolism in Groote Schuur Maternity Centre and to identify specific variables in the clinical presentation that had a predictive value of a thromboembolic event. Methods: A quantitative, retrospective study with a descriptive comparative research design, for a twelve-month period from January 2016 to December 2016. All pregnant and postpartum patients who were sent for a venous duplex ultrasound, ventilation perfusion study or computerized tomography pulmonary angiogram from the Groote Schuur Maternity center were included. A folder review was conducted and the diagnosis and clinical presentation of all the patients were documented and analyzed. Incidence of VTE were estimated as the number of events per 1,000 deliveries. The number of hospital deliveries in 2016 were used as the denominator for calculating this incidence. Results: A total of 41 (0.12%) patients had a venous thromboembolism. Six patients had a deep venous thrombosis (0.02%) and 37 had a pulmonary embolism (0.11%). Among the 186 retrieved medical records, 11 (28%) of the diagnosis occurred in the puerperal period and 28 (72%) during pregnancy. Among the 28 events during pregnancy, one (3%) was in the first trimester, nine (23%) in the second trimester and 18 (46%) in the third trimester. The majority of confirmed pulmonary emboli (72.22%) and deep venous thrombosis (66.67%) were diagnosed during the third trimester in pregnancy. Among individuals with deep venous thrombosis, the most frequently reported symptoms and signs were leg pain (66.7%), leg swelling (66.7%) and tachycardia (66.7%). Patients without deep venous thrombosis presented more with leg swelling (76.3%), red discolouration (10.5%) and cellulites (10.5%). The only presenting clinical features that were significantly different were haemoptysis (p=0.01) and coughing (p=0.03). Among those individuals without pulmonary embolus, tachycardia (77.3%) and dyspnoea (49.1%) were commonly reported. Among the patients with a PE, the most frequently reported symptoms were tachypnoea (78.4%), dyspnoea (64.9%), tachycardia (62.2%), chest pain (51.4%) and coughing (46%). Features in the clinical presentation that were statistically significant were chest pain (p=0.01), haemoptysis (p=0.07), tachypnoea (p=0.01) and tachycardia (p=0.03). The greatest statistically significant clinical feature was the symptom of coughing (p< 0.01). The stepwise logistic regression for the univariate analysis showed that coughing (OR=3.83; 95% CI: 1.71 to 8.58; P< 0.01), chest pain (OR=2.57; 95% CI: 1.2-5.53; P=0.02), tachycardia (OR=1.03; 95% CI: 1.0 to 1.06; P=0.03), tachypnoea (OR=1.06; 95% CI: 1.0 to 1.12; P=0.05) and a median symptom of 3.5 (1.58; 95% CI: 1.23 to 2.06; P< 0.01) were the best explanatory variables. The stepwise logistic regression for the multivariate analysis showed that both tachycardia (OR=1.03; 95% CI: 1.0 to 1.06; P=0.03) and coughing (OR=3.43; 95% CI: 0.88 to 11.30; P=0.05) predicted a positive pulmonary embolus. A logistic regression for tachycardia showed a 23% increase in pulmonary embolus for every increase of 5 beats per minute in the heart rate above 100Bpm. This association was statistically significant (OR=1.23; 95% CI:1.08 to 1.39; P=0.0004) A logistic regression analysis of the association between tachycardia, tachypnoea and chest pain and the risk of having a pulmonary embolus showed a 4% increase in the risk of pulmonary embolus for every single unit increase in heart rate. When controlling for tachycardia and tachypnoea, chest pain was also associated with a 3.8 times increase in the odds of having a pulmonary embolus. This association was statistically significant (p=0.0002) Conclusion: In this study, we found that the incidence of venous thromboembolism in the Groote Schuur Maternity Centre was the same as in other developed and developing countries around the world. The majority of confirmed venous thromboembolisms were diagnosed during the third trimester in pregnancy. This study found a lower incidence of deep venous thrombosis in comparison to other studies. The clinical features that had some predictive value for pulmonary embolism were chest pain, coughing, tachypnoea, tachycardia and more than three symptoms or signs. Tachycardia was significant in the univariate-, multivariate analysis and stepwise logistic regression. In addition, there was a statistically significant association between tachycardia, tachypnoea and chest pain and the risk of having a pulmonary embolus. This study has revealed the need to develop pre-assessment algorithms in pregnancy and postpartum patients to reduce maternal and fetal, morbidity and mortality. Until such algorithms are developed, clinicians should use their own clinical judgment and proceed to diagnostic imaging for suspected VTE, where indicated.
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Matjila, Mushi Johannes. "The role of kisspeptin and its cognate receptor GPR54 in normal and abnormal placentation". Doctoral thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/15578.
Testo completoAbstract (sommario):
Poor invasion of trophoblast cells in early pregnancy has been associated with preeclampsia and intrauterine growth restriction as well as other adverse pregnancy outcomes such as miscarriage, preterm birth and intrauterine death. Hypertensive disorders of pregnancy, including pre-eclampsia are one of the leading causes of maternal mortality in South Africa (Third report on Confidential Enquiries into Maternal Deaths in South Africa (2002-2004)) and the rest of the world. The currently accepted mechanism underlying the development of preeclampsia implicates poor trophoblast invasion and inadequate transformation of the maternal spiral arteries. Despite extensive research in this area, the control of trophoblast invasion and early placental development remains poorly understood. A whole host of factors such as oxygen tension, activation of matrix metalloproteinases (MMPs), angiogenic factors (VEGF-A) and immunological factors such as TNF alpha, interleukins and TGFβ have been shown to be involved in the control of trophoblast invasion. Our knowledge of the molecular details of pregnancy is unfortunately limited to in-vitro experiments and animal studies. Recently kisspeptins and their cognate receptor GPR-54 originally involved in tumour metastasis suppression and regulation of puberty, have been implicated in the inhibition of trophoblast invasion. Expression levels of kisspeptin and its receptor in trophoblast cells are highest in the first trimester, when control of trophoblast invasion is critical, and lower towards term.
17
Dyer, Silke Juliane. "Infertility in the public health care system in South Africa : patients' experiences, reproductive health knowledge and treatment-seeking behaviour". Doctoral thesis, University of Cape Town, 2006. http://hdl.handle.net/11427/8905.
Testo completoAbstract (sommario):
Includes bibliographical references (leaves 231-252).Infertility is a common reproductive health problem in Africa. The experiences of men and women who are unable to conceive, their constructs of infertility, their motives for parenthood, and their health-seeking behaviour are, however, inadequately documented in South Africa. In order to improve our understanding of the patients' perspective of infertility, seven studies were conducted employing both qualitative and quantitative research methodology. Study participants were recruited from the infertility clinic at Groote Schuur Hospital, Cape Town, a tertiary referral centre within the public health care system. The central themes explored in the qualitative studies included reproductive health knowledge, health-seeking behaviour, barriers to health care, experiences related to involuntary childlessness, and the reality of infertility and HIV infection. Data from both men and women were collected through in-depth interviews, and the results were analysed according to the principles of descriptive analysis. In the quantitative studies psychological distress was measured and motives for parenthood were assessed with the use of two standardised instruments ( the Symptom Checklist-90-R for the measurement of acute psychological symptom status and the parenthood motivation list). In addition, participants' attitudes towards reproduction in HIV-infected individuals were evaluated. Standard statistical methods were used to analyse quantitative data. The results of these studies demonstrated that men and women had limited knowledge about fertility, infertility, and biomedical infertility management. Some men and women held traditional beliefs and had accessed traditional healers. Most informants appeared highly motivated to engage in biomedical infertility management. Treatment satisfaction varied and reasons for non-compliance were both service and patient-related. Infertile couples gave many reasons for wanting a child and expressed a strong desire for parenthood. For many men and women the inability to conceive was associated with negative emotions, marital instability, abuse, stigmatisation, and loss of social status. Psychological distress levels were significantly higher in infertile women when compared to women using contraception, and in infertile men when compared to fertile men. Infertile women who reported intimate partner abuse were particularly distressed. The diagnosis of HIV infection did not eliminate the wish for a child in infertile couples, and in the absence of medical assistance many continued to attempt conception. The concomitant experience of infertility and HIV infection was associated with considerable suffering The majority of HIV-negative, infertile men and women opposed reproduction in HlV-positive couples. Collectively, the results of these studies provide new insights into the manner in which men and women who access the public health system in South African construct, experience, and respond to infertility. Understanding those details of the patients' perspective should improve the management of infertility in this patient population.
18
Denny, Lynette. "An evaluation of alternative strategies for the prevention of cervical cancer in low-resource settings". Doctoral thesis, University of Cape Town, 2000. http://hdl.handle.net/11427/3041.
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Sherwood, Kerry Anne. "Out-of-pocket payment for assisted reproductive techniques in the public health sector in South Africa - how do households cope?" Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/11154.
Testo completoAbstract (sommario):
Includes bibliographical references.In South Africa assisted reproductive techniques (ART) are poorly covered by health insurances or government funding thereby often inflicting out-of-pocket payment (OPP) on patients. This can create treatment barriers or high financial burdens for households, with unknown consequences of the latter. This is the first study from South and sub-saharan Africa which explores the impact of ART-related OPP on households. The study was undertaken at Groote Schuur Hospital, Cape Town, where ART is subsidized but patients have to contribute to the cost of treatment. Eighty six consecutive IVF/ICS/ cycles were prospectively analysed through patient interviews. Data included socio-demographic, economic, and infertility information, emotional and financial stress among participants, as well as coping and financial strategies adopted by households. In keeping with international recommendations, catastrophic expenditure was defined as a direct cost of all ART cycles in the last 12 months equal to or exceeding 40% of the annual non-food households expenditure.
20
Naiker, Manasri. "A study comparing paracervical block with procedural sedation in the surgical management of incomplete/missed miscarriages". Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/13208.
Testo completoAbstract (sommario):
Includes bibliographical references.Objective: To compare the analgesic efficacy of Paracervical Block (1% lidocaine) with procedural sedation (Midazolam/Fentanyl) in the surgical management of incomplete/ missed miscarriages. Study design: An efficacy trial with a naturally occurring control group who received what is standard practice. The study compared two methods of analgesia. The study group received paracervical block and the control group received procedural sedation. The study ran over two consecutive months (December 2012/January 2013). Setting: Groote Schuur Hospital, a level three hospital situated in Cape Town, South Africa. Population: All women between 18 and 55 years of age that were admitted to Groote Schuur Hospital requiring a uterine evacuation following either a spontaneous incomplete or a missed miscarriage that were not excluded by any of the exclusion criteria. Methods: Over the two month period recruited participants (those patients who fit the inclusion criteria and were agreeable to participate) were allocated to either the control group (month 1) or the intervention group (month 2), depending on which month they had the uterine evacuation. Data was collected from the uterine evacuations of the recruited participants over the two month study period. Main outcome measure: The participants perceived pain during and after uterine evacuation (10 minutes and two hours), scored by the participant on an eleven point numerical pain scale. Secondary outcomes were the surgeons’ satisfaction with the analgesia, duration of procedure and complications/ side effects of the two methods of analgesia under study. Results: A total of 111 participants were recruited over the study period, 57 in the control group and 54 in the intervention group. The average pain score during the procedure was lower in the Paracervical block group compared with the procedural sedation group, but this difference was not statistically significant at a 5% level (t=-1.8495, p=0.0671). For the Paracervical block group, the ‘’pain during” mean and the standard deviation (SD) were 5.56 and 2.50 respectively, whilst for the Procedural sedation group, the mean and SD were 6.49 and 2.81 respectively. Conclusion: Paracervical block using 1% lidocaine is an effective and safe alternative to procedural sedation in the surgical management of incomplete/missed miscarriages.
21
Botha, Ursula M. "Unbooked mothers : outcome and contributory factors". Master's thesis, University of Cape Town, 2004. http://hdl.handle.net/11427/3032.
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Edelstein, Sascha. "The impact of body mass index (BMI) on metabolic and endocrine parameters in women with the polycystic ovary syndrome (PCOS)". Master's thesis, University of Cape Town, 2008. http://hdl.handle.net/11427/3042.
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Horak, Tracey Anne. "An analysis of the caesarean section rate at Mowbray Maternity Hospital using Robson's Ten group Classification System by Tracey Anne Horak". Master's thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/3046.
Testo completo
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Botha, Barend HJ. "Systematic review: Availability, effectiveness and safety of assisted reproductive techniques in Sub-Saharan Africa". Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29315.
Testo completoAbstract (sommario):
STUDY QUESTION: What is the evidence pertaining to availability, effectiveness and safety of assisted reproductive technology (ART) in sub-Saharan Africa?
SUMMARY ANSWER: According to overall limited and heterogeneous evidence, availability and utilization of ART are very low, clinical pregnancy rates largely compare to other regions but are accompanied by high multiple pregnancy rates, and in the near absence of data on deliveries and live births the true degree of effectiveness and safety remains to be established.
WHAT IS KNOWN ALREADY: In most world regions, availability, utilization and outcomes of ART are monitored and reported by national and regional ART registries. In sub-Saharan Africa there is only one national and no regional registry to date, raising the question what other evidence exists documenting the status of ART in this region.
STUDY DESIGN, SIZE, DURATION: A systematic review was conducted searching PUBMED, SCOPUS, AFRICAWIDE, WEB OF SCIENCE and CINAHL databases from January 2000 to June 2017. A total of 29 studies were included in the review. The extracted data were not suitable for meta-analysis.
PARTICIPANTS/MATERIALS, SETTING, METHOD: The review was conducted according to PRISMA guidelines. All peer-reviewed manuscripts irrespective of language or study design that presented original data pertaining to availability, effectiveness and safety of ART in sub-Saharan Africa were eligible for inclusion. Selection criteria were specified prior to the search. Two authors independently reviewed studies for possible inclusion and critically appraised selected manuscripts. Data were analyzed descriptively, being unsuitable for statistical analysis.
MAIN RESULTS AND THE ROLE OF CHANCE: The search yielded 810 references of which 29 were included based on the predefined selection and eligibility criteria. Extracted data came from 23 single centre observational studies, 2 global ART reports, 2 reviews, 1 national data registry and 1 community-based study. ART services were available in 10 countries and delivered by 80 centres in 6 of these. Data pertaining to number of procedures existed from 3 countries totalling 4619 fresh non-donor aspirations in 2010. The most prominent barrier to access was cost. Clinical pregnancy rates ranged between 21.2% to 43.9% per embryo transfer but information on deliveries and live births were lacking, seriously limiting evaluation of ART effectiveness. When documented, the rate of multiple pregnancy was high with information on outcomes similarly lacking.
LIMITATIONS, REASONS FOR CAUTION: The findings in this review are based on limited data from a limited number of countries, and are derived from heterogeneous studies, both in terms of study design and quality, many of which include small sample sizes. Although representing best available evidence, this requires careful interpretation regarding the degree of representativeness of the current status of ART in sub-Saharan Africa.
WIDER IMPLICATIONS OF THE FINDINGS: The true extent and outcome of ART in sub-Saharan Africa could not be reliably documented as the relevant information was not available. Current efforts are underway to establish a regional ART data registry in order to report and monitor availability, effectiveness and safety of ART thus contributing to evidence-based practice and possible development strategies.
STUDY FUNDING/COMPETING INTEREST(S): No funding was received for this study. The authors had no competing interests.
TRIAL REGISTRATION NUMBER: PROSPERO CRD42016032336
25
Krick, Daniela. "Study of efficacy of ketamine analgesia for surgical management of incomplete miscarriages". Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/3047.
Testo completoAbstract (sommario):
Includes abstract.Includes bibliographical references.
Objective: To compare the analgesic efficacy of ketamine with Fentanyl/Midazolam in women requiring uterine evacuation for incomplete miscarriage as measured by the patients’ perceived pain. Study design: An efficacy trial with a naturally occurring control group who received what is currently standard practice. The study ran over two 4-week periods (25/06/2012 to 19/08/2012). Setting: Groote Schuur Hospital (a tertiary hospital) situated in Cape Town, South Africa. Population: All women between the ages of 18 and 55 years admitted to Groote Schuur Hospital for uterine evacuation following a spontaneous incomplete miscarriage or missed miscarriage that were not excluded by any of the exclusion criteria. Methods: Over a 2 month period (two 4-week periods), all patients meeting the inclusion criteria were allocated to either the control group (month 1) or the study group (month 2). Data was collected from all these evacuations during the study period at Groote Schuur Hospital.
26
Mohlaba, Garish Masungi. "The prevalence and effects of HIV infection among a population of pregnant women needing obstetric intensive care in Cape Town". Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/3050.
Testo completoAbstract (sommario):
Includes bibliographical references (leaves 36-37).Care of the critically ill pregnant woman poses exceptional challenges in the intensive care unit and requires the skills of health care providers who have knowledge of the physiological changes of pregnancy as well as specific pregnancy-related disorders in order to achieve optimal management.
27
Membe, Gladys Chikumbutso. "External cephalic version for breech presentation at term : missed opportunities?" Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/13316.
Testo completoAbstract (sommario):
Includes bibliographical references.Background External Cephalic Version (ECV) is the manipulation of the baby, through the mother’s abdomen to a cephalic presentation. ECV is typically performed antenatally, in women with a breech presentation who are not in labour, at or near term, to improve their chances of having a normal vaginal delivery. ECV is one of the few obstetric interventions for which there is evidence that its use leads to a fall in caesarean section rates. ECV is an intervention that gives women another option, prior to considering caesarean section. Objective: To evaluate whether there were missed opportunities for performing ECV in women that had caesarean sections for breech presentation at term, and to determine the reasons why ECV was not offered or attempted for women with breech presentation, who had a caesarean section for that reason.
28
Ras, Lamees. "Comparison of short-term outcomes between two sacrospinous suture capture devices : a randomised controlled trial". Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20409.
Testo completoAbstract (sommario):
BACKGROUND Sacrospinous Fixation is a procedure for mid-compartment apical suspension in pelvic organ prolapse surgery with high success rates. The approach by traditional wide dissection has been well-documented. The literature is lacking however with regard to newer devices on the market that use less extensive dissection to perform this procedure. METHODS A randomised controlled trial was carried out comparing the Boston Scientific's Capio Slim® (control) and Bard's Fixt® (intervention) for bilateral sacrospinous fixation in women with mid-compartment prolapse requiring surgery and who met the study criteria. The primary outcome was time (in seconds) to successful bilateral suspension suture placements. Secondary outcomes examined were used to assess short-term safety and efficacy of the devices at the time of the procedure and at the six week follow-up.
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Enyeribe, Iwuh Ibezimako Augustus. "Maternal near miss audit in Metro West Maternity services". Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/16525.
Testo completoAbstract (sommario):
Includes bibliographical referencesBackground: A near miss occurs when a pregnant woman experiences a severe life threatening complication during pregnancy or up to 42 days after the end of the pregnancy and survives. The near miss rate is defined as the number of near misses per 1000 live births. In 2011, World Health Organization (WHO) produced a useful tool for identifying near misses according to composite criteria which include the occurrence of a severe maternal complication together with organ dysfunction and/or specified critical interventions. The ratio of maternal near miss cases to maternal deaths and the mortality index both reflect the quality of care provided in a maternity service Maternal deaths have been audited in the Metro West maternity service for many years but there has been no routine monitoring or evaluation of maternal near misses. Aim of study: The study aim was to perform a near miss audit in Metro West, specifically (a) measuring the near miss rate, the maternal mortality ratio and the mortality index, (b) performing an in-depth investigation of the associated demographic, clinical and health system factors of the near miss cases, and (c) providing input into the development of an on -going system of auditing near misses cases in Metro West. Methods: A retrospective observational study conducted over 6 months between mid- March 2014 to mid -September 2014. This service includes 9 level one maternity facilities which refer all complicated maternal cases to two secondary hospitals, New Somerset (NSH) and Mowbray Maternity (MMH); or to the tertiary hospital, Groote Schuur Maternity Center (GSH). All cases of near miss managed at the three hospitals were identified weekly by the author with the assistance of onsite health providers. These cases included near misses that occurred at level one facilities and were referred on to one or more of the three hospitals. Strict criteria were used to ascertain a case as a near miss according to the WHO near miss definitions. The folders of all the near misses were reviewed and relevant data entered into a data collection form which was adapted from the WHO near miss data form. In addition, these identified folders were reviewed by two senior obstetric specialists to confirm adherence to the WHO inclusion criteria for near miss classification, and also to determine avoidable factors in the management of the near miss cases. Maternal deaths occurring during the same time period of the Near Miss audit were identified from monthly mortality meetings and the ongoing maternal mortality audit system in Metro West. Results: 112 near miss cases and 13 maternal deaths were identified, giving a total of 125 women with severe maternal outcomes. There were a total of 19,222 live births in Metro West facilities. The Maternal mortality ratio (M MR) was 67.6 per 100,000 live births and the maternal near miss rate was 5.83 per 1000 live births. The maternal near miss to death ratio was 8.6:1 and the mortality index was 10.4% Hypertension, obstetric hemorrhage and pregnancy related sepsis were the major causes of the near miss cases accounting for 50(44.6%), 38(33.9%), and 13 (11.6%) of near misses respectively. These three conditions all had low mortality indices; 1.9%, 1.9% and 0 for hypertension, pregnancy related sepsis and hemorrhage respectively. Less common conditions were, medical /surgical conditions, non-pregnancy related infections and acute collapse, accounting for 7 (6.3%), 2 (1.8%), and 2 (1.8%) of near misses respectively. Although these numbers were small, these three conditions accounted for more maternal deaths with mortality indices of 66.7 %, 33.3% and 33.3% for non- pregnancy related infections, medical /surgical conditions, and acute collapse respectively. There were 25 (22.3%) of the near miss cases who were HIV positive. The majority of near misses 99(88.4%) had antenatal care. Analysis of avoidable factors showed that, the most common problems were lack of antenatal clinic attendance (11.6%) and inter-facility transport problems (6.3%). For health provider related avoidable factors, the highest number of avoidable factors were identified at level 2 (38.2%), followed by level one (25.9%) and level 3 (7.1%). The most common factors were problem recognition, monitoring and substandard care Discussion and Conclusions: The near miss rates and maternal mortality ratio in Metro West were lower than for some other developing countries, but higher than rates in high income countries. The mortality index was low for direct obstetric conditions such as hypertensive disorders, obstetric hemorrhage and pregnancy related sepsis, reflecting good quality of care and referral mechanisms for these conditions. The mortality indices for non-pregnancy related infections, medical/surgical conditions and acute collapse were much higher and, suggest that medical problems may need more focused attention. Ongoing near miss audit would be valuable for Metro West but would require identification and monitoring systems to be institutionalized.
30
Patel, Malika. "An evaluation of expectations and experiences of women having routine ultrasound examination for fetal abnormalities in the midtrimester of pregnancy". Master's thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/3053.
Testo completo
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Gadama, Luis Aaron. "Adverse perinatal events observed in obese pregnant women in the Metro West Region". Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/13209.
Testo completoAbstract (sommario):
Includes bibliographical references.Background. Obesity is increasing globally and is defined as a Body Mass Index (BMI) over 30 kgms/m². It’s prevalence in the Metro West Maternity service is unknown. Objective .To assess the prevalence of obesity and determine its association with adverse perinatal and maternal outcomes among pregnant women in the Metro West Region, Cape Town, South Africa Study Design. This was a retrospective observational study that compared perinatal outcomes in women with normal pregnancy BMI to outcomes in women with high pregnancy BMI. Setting. Mitchells Plain and Guguletu Midwife Obstetric Units, Mowbray Maternity Hospital and Groote Schuur Hospital, Metro West Region, Cape Town, South Africa Population. A total of 970 pregnant women divided into BMI groups that had their first antenatal booking visit between January and April 2011. Methods. A list of folder numbers was compiled from the antenatal booking registry at the two MOUs. From the list, maternal folders were then traced through the CLINICOM tracking system, MOU delivery registers, antenatal clinic transfer registers and labour ward transfer registers to find place of delivery or outcome of pregnancy. Maternal and perinatal characteristics were then extracted from the folders into the data collection sheet and data was analysed by STATA. Descriptive statistics included proportions with percentages and median with interquartile ranges. Inferential statistics included Chisquared tests, Fisher Exact tests, Kruskal Wallis test, univariate and multivariable logistic regressions. Main outcome measures. Perinatal outcomes (stillbirth, macrosomia, shoulder dystocia, 5 minute Apgar Score less than 7, congenital abnormalities) observed in obese and morbidly obese compared to normal BMI pregnant women.
32
Oosthuizen, Lizle Joann. "Impact of obesity on semen analysis parameters". Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/19888.
Testo completoAbstract (sommario):
Includes bibliographical referencesThis study aims to address the lack of data on the link between BMI and infertility in the South African population by describing the prevalence of male overweight and obesity in a group of men undergoing infertility investigation, as well as assessing any semen analysis abnormalities in these groups. It also aims to describe how well men can predict their BMI category and determine whether weight loss would be an acceptable part of infertility management in overweight or obese male partners. Beliefs surrounding healthy weight and fertility will also be addressed.
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Smith, Patricia Anne. "The use of misoprostol in cervical ripening and induction of labour in the term pregnancy". Master's thesis, University of Cape Town, 1997. http://hdl.handle.net/11427/26251.
Testo completoAbstract (sommario):
OBJECTIVE: To compare the efficacy and safety of misoprostol (Cytotec) with prostaglandin E2 (prandin gel) in cervical ripening and induction of labour at term. STUDY DESIGN: Two independent studies were performed. The first was to evaluate misoprostol as a cervical ripening agent when compared to prandin gel and the second to compare their ability to induce labour. Two hundred and forty patients requiring cervical ripening prior to induction of labour were recruited to the cervical ripening arm of the trial. Patients were randomly assigned to receive either 100 μg of misoprostol (half a 200 μg tablet) in the posterior fornix or 1mg prandin gel similarly inserted. A Bishop's score of the cervix was performed prior to drug insertion and repeated by the same clinician 24 hours thereafter if labour or delivery had not ensued. If labour commenced it were managed according to standard labour ward protocols. Three hundred and forty patients who required induction of labour for maternal or fetal reasons at term were recruited to the induction of labour arm of the trial. Half were randomly allocated to receive 100 μg misoprostol (half a 200 μg tablet) in the posterior fornix and half, 1mg prandin gel in the posterior fornix. If after 4 hours the labour had not ensued or the cervix remained too unfavourable for amniotomy, then a second dose of the drug was used. Labour and delivery was managed according to standard labour ward protocols. RESULTS: In the cervical ripening trial, data was analysed on 113 patients in the misoprostol arm and 116 in the prandin arm. The demographic characteristics were similar in both groups. Significantly more patients delivered within the 24-hour ripening period with misoprostol (88 (77.9%)) than with prandin gel (47 (40.5%)) (P < 0.001). In those patients delivered within 24 hours, the induction of labour to delivery interval was similar at, 9 hours 30 minutes (SD = 5h30) for misoprostol and 10 hours 51 minutes (SD = 5h09), with prandin gel. Significantly more patients in the prandin gel arm required oxytocin augmentation (25.5% versus 12.5% with misoprostol) but the caesarean section rate (13.6% with misoprostol and 12.7% with prandin gel) and analgesic usage were similar. Maternal side effects were similar in the two groups but tachysystole was significantly more common at 12.4% with misoprostol and 1.7% with prandin gel (P<0.01). In those patients undelivered at 24 hours, there was a significant improvement in the number of patients with a Bishop's score of > 4 with both drugs. Neonatal outcomes, including Apgar score and admission to the neonatal intensive care unit were not significantly different. In the induction of labour arm of the trial the demographic characteristics of both groups were similar. The use of misoprostol resulted in a significantly higher number of patients delivering within 12 hours of drug insertion than with prandin gel (136 (80%) with misoprostol versus 91 (66,9%) with prandin gel, P < 0.001). There was also a significantly shorter insertion to delivery interval with misoprostol (9hr13 (SD = 5hr 53)) than with prandin gel (12hr18 (SD = 6h22)), (P < 0.001). Thirty nine patients in the misoprostol group required a second dose of the drug versus 55 patients in the prandin gel group (P<0.05). Although the caesarean section rate was similar with the two drugs (30.6% with misoprostol and 34.1 % with prandin gel) significantly more patients had a caesarean section for fetal distress in the misoprostol group (21.8% vs 10.6%) (P < 0.05). Neonatal outcome, as assessed by Apgar score and admission to the neonatal intensive care unit, was however not different with either drug. Four patients had abruptio placentae in the misoprostol group and the incidence of tachysystole was significantly higher at 28.2% vs 15.3% with prandin gel (P< 0.01). Oxytocin was used for labour augmentation in 52.9% of patients with prandin gel and 27% with misoprostol (P < 0.05). Analgesic usage and other maternal side effects were similar with both drugs. CONCLUSION: Misoprostol is an effective cervical ripening and induction of labour agent when compared to prandin gel. However, it results in a higher incidence of tachysystole, caesarean section for fetal distress and abruption placentae and cannot yet be recommended for general use until the concern over adverse fetal and maternal outcome is addressed in larger trials.
34
Morrison, Candice Jane. "The polycystic ovary syndrome : a comparison of the presentation in adolescents compared to women aged 35 years and older attending the Gynaecological Endocrine clinic at Groote Schuur Hospital". Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/13791.
Testo completoAbstract (sommario):
PCOS is the commonest endocrinopathy occurring in women of reproductive age. This study aimed at comparing the presentation of adolescents to that of women ≥ 35 years presenting to the gynaecological endocrine clinic with a diagnosis of PCOS. This was a descriptive cohort study. Since 1996 all women with PCOS have their clinical, metabolic and endocrine data entered into a database. We compared the initial presentation of adolescents and women aged 35 and above.
35
Vollmer, Linda Ruth. "Teenage pregnancy a review of patients accessing obstetric care in the Peninsula Maternal and Neonatal Service". Master's thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/3056.
Testo completo
36
Chirwa, Nyatozi. "Retrospective review of women diagnosed with premature ovarian insufficiency". Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29770.
Testo completoAbstract (sommario):
Premature ovarian insufficiency (POI) is a clinical syndrome defined by loss of ovarian activity before the age of 40. It is characterized by menstrual disturbance (amenorrhoea or oligo-(amenorrhoea), raised gonadotrophin concentrations and low oestradiol levels. The diagnosis is confirmed by detection of raised serum follicle stimulating hormone and low oestradiol levels. POI can occur spontaneously, but it may also result from genetic defects, chemotherapy, radiotherapy or surgery. Oestrogen deprivation as a result of POI has serious implications for female health. In particular, bone mineral density, cardiovascular health, neurological systems and sexual health, may be impacted. The challenge posed by this important condition is the absence of standardized diagnostic criteria and management guidelines within our clinical practice. There are no local data about the causes and prevalence of POI in South Africa or adherence to international recommendations for management. The aim of this study was to review the women who have presented to our gynaecological endocrine service with POI and to assess their diagnosis and presentation. Based on this information we plan to adjust, where necessary, our current protocol of investigations. Methods: The study was conducted at the Gynaecological Endocrine clinic, at Groote Schuur Hospital (GSH), South Africa over a period of 11 months (June 2016 to May 2017). It was a retrospective folder review of women diagnosed with POI from 1983 to date. Ethics approval was granted by the Human Research Ethics Committee of the Faculty of Health Sciences of UCT [HREC REF:315/2016] and further permission to access patient records was given by the Hospital committee. A total of 442 patients with the diagnosis of POI were identified using the card index system in our Gynaecological Endocrine Clinic. Clinical folders and microfilms were reviewed and information transferred to a template. The data were then entered using a Microsoft Excel spreadsheet and analysed. A total of 303 patients aged less than 40 presenting with primary or secondary amenorrhoea/oligo-menorrhoea of at least 6 months’ duration with serum FSH concentrations of >25mIU/mL on at least two occasions were evaluated. Comparison between groups was done using the t-test with a p-value of less than 0.05 being considered significant. Results A total of 369 patients with POI were identified in our clinic and we were able to review 303 of these clinical records (66 missing). Patients were aged 12-40 years at the initial visit. Serum levels of FSH, LH and oestradiol were similar in patients with primary and secondary amenorrhoea. Chromosomal abnormalities were more likely in the 38 patients with primary amenorrhoea (57.6%) than in those with secondary amenorrhoea (23.6%). Of 237 patients who presented with secondary amenorrhoea, more complained of symptoms of oestrogen deficiency (78.2%) and had been pregnant before diagnosis (53.2%) than those with primary amenorrhoea (p<0.001). Immune disturbances were present in 4.6% patients, mostly in women with secondary amenorrhoea. The most common karyotype in the 38 patients with primary amenorrhoea was 45X0 (n=18). Of the patients with primary amenorrhoea 4 had gonadal dysgenesis. After completing investigations, the cause was not identified in 36.3% (n=110) of the patients, followed by genetic causes 20.8% (n=63), chemo/RT 9.6% (n=29), iatrogenic 5.0% (n=15) and autoimmune causes 4.6% (n=14). Investigations were incomplete in 22.8% n=72) of the women due to failure to continue follow-up. Conclusion: It is important to offer a comprehensive assessment to women with POI to establish the cause and institute appropriate treatment. Counselling on long term management and fertility options is essential. Many women do not complete investigations after receiving the initial diagnosis and greater awareness of POI needs to be developed, along with increased education of women planning fertility later in life, particularly if they are at risk of POI. Women with POI have unique needs that require special attention and our clinical services need to address these.
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Schroeder, Amaal. "Outcome of twin deliveries according to planned mode of delivery at Level II hospitals within the Metro West Cape Town Health District". Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29684.
Testo completoAbstract (sommario):
Twin pregnancies are associated with greater fetal and neonatal morbidity and mortality compared to singleton pregnancies. It has been shown in a large multicentre randomised control trial by Barrett et al, that this risk is not significantly changed by planned mode of delivery in a twin pregnancy with a cephalic presenting first twin. This study was undertaken to assess the outcome of cephalic-presenting twin gestations according to planned mode of delivery in the local context of secondary level hospitals in the Metro West Cape Town Health District. Methods: This was a retrospective cohort study of twin deliveries at Mowbray Maternity Hospital and New Somerset Hospital over a 12 month period, starting from 1 January 2013 until the 31 December 2013. Study subjects included all twin deliveries with a cephalic presenting first twin, gestational age > 28w and 0 days, with no contraindication to vaginal delivery. The primary outcome was to document fetal and neonatal outcome according to the planned mode of delivery. Secondary outcomes included maternal outcomes and associations for combined delivery. Result: A total of 124 cases were identified. 95 had a planned vaginal delivery, and 29 had a planned caesarean section. In the planned vaginal delivery group, 61.1% delivered vaginally and 38.9% delivered via caesarean section. Nine of these caesarean sections were combined deliveries. The planned caesarean section group had a caesarean section rate of 93.1%. Two cases delivered vaginally. There was no statistical difference in the composite neonatal score between the two groups (21.1% and 29.3%, in the planned vaginal delivery and planned caesarean section groups respectively, p=0.092). There was also no significant differences in maternal outcomes between the two groups. Conclusion: The results of this study are in keeping with the findings of the Twin Birth Study. It showed no statistically significant difference in neonatal and maternal outcomes of twin gestations, with a cephalic presenting first twin, with respect to planned mode of delivery. A trial of vaginal birth is therefore a feasible option in our setting.
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Pheto, Peloentle. "An audit of uterotonic use for the prophylaxis and treatment of haemorrhage at caesarean delivery at Mowbray Maternity Hospital, Cape Town, South Africa". Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29673.
Testo completoAbstract (sommario):
Obstetric Haemorrhage is the leading cause of maternal death globally (1) and the third leading cause of death in South Africa (2). Concern has been expressed in South Africa that bleeding associated with caesarean delivery (CD) accounts for one-third of haemorrhage deaths and this has increased over the last ten years (3). The underlying cause of bleeding at CD is commonly uterine atony, and the majority of the CDs were performed at district hospitals (2,3,4). The Saving Mothers Reports describe inadequate use and documentation of uterotonics to prevent or treat bleeding at CD and have promoted the development of a standardised national protocol. While there is international agreement on the dosage and administration route for oxytocin to prevent OH after vaginal delivery, there is lack of consensus or standardisation of protocols for its prophylactic use at CD, with marked differences between country and facility protocols. Anaesthetists are concerned about the hypotensive effect of high dose intravenous boluses of oxytocin, particularly in women under spinal anaesthesia, and some maternal mortalities in the United Kingdom have been partially attributed to this (5). Hence it is important to balance safety with efficacy by promoting the lowest effective doses to minimise side effects but enable uterine contraction. Aim: The aim of this study was to perform a clinical audit of the documented use of uterotonics at CD at MMH to see how it adheres to the national protocol; and as a secondary outcome to measure the rate of haemorrhage at CD. Methods: This was a retrospective folder review of women who delivered by CD at MMH during the months of June and July 2017, including both elective and emergency operations. Information was obtained from women’s folders kept in the medical records department, using especially designed data extraction sheets. Data analysis was by simple descriptive statistics. Results: Three hundred and nineteen (319) folders from the study period were interrogated. This included 239 emergency CDs (75%) and 80 elective CDs (25%). They were all performed by obstetric registrars or medical officers with 89% being done under spinal anesthesia. Prophylactic oxytocin boluses at CD were given in 302 (94.7%) women but there was no documentation of its use in 17 (5.3%). One of the 302 women had a high dose IV bolus (7.5 IU) but the remainder had boluses below 5 IU. There were 75 women (23.5%) patients who received the national recommended dose of 2.5 IU IVI while 227 (71.1%) received alternative low dose boluses which were all less than 5 IU. The dose most commonly given was 3 IU; to 169 patients (53%) as a single or divided dose. There was wide variation in the dosage of prophylactic infusions with only 18 (5.6%) patients receiving the recommended intraoperative 7.5 IU infusion, while 221 (66.5%) received alternate infusion doses. Only 49 (15%) were discharged from theatre recovery to the postnatal ward with a prophylactic infusion running. In total 65 (20.4%) of the women received a 20 IU oxytocin infusion but it was unclear whether this was for prophylaxis or treatment. No intramuscular doses of oxytocin or syntometrine were given for prophylaxis. Among the 319 CDs, 13 (4.1%) had documented blood loss over 1000 ml and 24 (7.5%) had uterine atony reported by the surgeon. The most common treatment was 20 IU infusion followed by misoprostol (13 women), syntometrine (three women) and tranexamic acid (one woman). Additional surgical measures required were B-Lynch compression suture for one, and haemostatic sutures for two. There were no re-look laparotomies or hysterectomies during the study period and there were no major morbidity or mortalities from either CD or from anaesthetic complications. Discussion: Low dose bolus oxytocin and infusion is widely used at CD post fetal delivery at MMH, although the dose of 3 IU was most commonly used in contrast to the recommended 2.5 IU in the national protocol. There was variation in the usage and dosage of prophylactic oxytocin infusion. The rate of PPH in the subjects was low (4.1%) with the low dose prophylactic regimens used, suggesting that they were effective, although this may also have been contributed to by the skill of the surgeons. Consensus is needed among anaesthetists and standardisation of protocols on oxytocin prophylaxis at CD, particularly for training doctors working in district hospitals. Repeating this audit in district hospitals where there are higher CD case fatality rates would be important to shed light on practice in such facilities and improve healthcare delivery.
39
Cloete, Marinus. "Acupuncture for women with refractive Overactive Bladder Syndrome". Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/10188.
Testo completoAbstract (sommario):
To evaluate the efficacy of acupuncture in refractive OAB. The primary aim was to evaluate the effect on frequency, nocturia and urge urinary incontinence. The secondary aim was to evaluate the effect of the response on self-perceived quality-of-life.
40
Venter, Eben Kruger. "The Caesarean Section rate at Mowbray Maternity Hospital: Applying Robson's Ten group classification system". Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29234.
Testo completoAbstract (sommario):
Background
The United Nations (UN) aims to reduce the maternal mortality ratio (MMR) and improve access to reproductive health services. Caesarean sections (CS) are known to be associated with a raised mortality rate by a factor of 2.8 in addition to the raised morbidity rate (OR 3.1; 95% CI 3.0-3.3) compared to vaginal deliveries (VD). Globally, there has been a concerning trend in the caesarean section rate (CSR), rapidly increasing since the 1970’s, with some countries reporting CS rates as high as 40.5%. South Africa has a CSR of 25.7%, which is higher than the suggested rate by the World Health Organization (WHO) of 15%; a rate above which the WHO suggests no maternal and fetal benefit exists. Robson introduced a universal classification system for caesarean sections with 10 totally inclusive and mutually exclusive groups. Horak made use of the ten group classification system (TGCS) to calculate the CSR at Mowbray Maternity Hospital (MMH) and its referring midwife obstetric units (MOU) for 2009, and reported it as 20.7%. Since the completion of her study, the referral routes to MMH have changed and the management of HIV-associated illnesses has markedly improved. A period of 7 years has elapsed and it was thought to be an optimal time to repeat a review of the CSR and compare it with the rates from 2009. Objectives The study aims to calculate the CSR for MMH from January 2016 to June 2016. Analyses of the CSR within each Robson group will be done and compared to the rates from 2009. This will allow us to make recommendations, if appropriate, aimed at reducing the CSR.
Methods
A retrospective, observational study was performed at MMH in Cape Town. Data was collected from birth registers for January 2016 – June 2016. All women who delivered, including all caesarean sections and vaginal births, were entered into the study, provided the newborn was viable with a birth weight >500g. Parameters were recorded onto an electronic and password-protected Microsoft Excel® spreadsheet and were used to classify deliveries according to the Robson Classification system. To allow for comparison with Horak’s study, deliveries at MMH for January 2009 – June 2009 were selected and analyzed. All the data was analyzed with STATA software and presented in various graphical formats. Ethics approval was obtained from University of Cape Town’s Human Research Ethics Committee (HREC Ref: 539/2016).
Results
There were 4727 deliveries from January to June 2016, of which 2472 were vaginal births and 2255 were caesarean sections, giving rise to a CSR of 47.70% (95% CI 46.28- 49.13). Of all the caesarean sections performed, 62.7% were primary caesarean sections and 37.3% were repeat caesarean sections. Nulliparous women, compared to multiparous women without a history of a prior CS, were at higher risk for a CS if in spontaneous labour (OR 2.02; 95% CI 1.71-2.38) and if induced (OR 2.75; 95% CI 2.13- 3.53). Group 5 (women with a previous CS), with a CSR of 85.34% (95% CI 82.82-87.61) made the greatest contribution to the overall CSR. The overall CSR from January to June 2009 was 44.10% (95% CI 42.63-45.57), calculated from 4379 deliveries. There was a statistically significant increase in the CSR of 3.60% from 2009 to 2016. A similar significant increase was observed in the respective CS rates of Group 1 (5.59%), Group 2 (11.63%) and Group 10 (8.73%). Group 4 was the only group with a statistically significant decrease of 4.48% in its CSR. An additional 308 labour inductions were performed in 2016, however, women in 2016 were statistically significantly less likely to be successful in a vaginal delivery (OR 0.67; 95% CI 0.55-0.81 p<0.001) compared to women in 2009.
Conclusion
A CSR of 47.70% is acceptable for a secondary level hospital such as MMH. This figure is elevated, but appropriate, as the referral units that perform only low risk vaginal deliveries are excluded. A surge in the number of repeat caesarean sections performed and lower success rates for labour inductions were mostly responsible for the rise. Primary caesarean sections performed on patients directly result in a higher risk patient profile in the future, coupled with more repeat caesarean sections in subsequent pregnancies. This is supported by a 17.5% prevalence of previous CS in women in 2009 as opposed to the 20.79% of women with a prior CS in 2016. This study shows that a CS in the index pregnancy has sizeable effects on the care of a woman in subsequent pregnancies. This places more strain on the health system and ultimately affects service delivery to all patients. Theoretically it is possible to explore changes in management to curb the ever-increasing CSR, but one has to consider if such changes is acceptable and appropriate to the setting of MMH and the population it serves.
41
Matthews, Louise S. "Fetal alcohol syndrome : prenatal ultrasound assessment of fetuses at high risk". Master's thesis, University of Cape Town, 2006. http://hdl.handle.net/11427/3049.
Testo completo
42
Jere, Khumbo. "Knowledge and utilisation of family planning 6 to 14 weeks postpartum in the Metro West region of the Western Cape Province". Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20839.
Testo completoAbstract (sommario):
Postpartum family planning (PPFP) is the initiation and use of contraception during the first year after delivery. Following delivery mothers are encouraged to attend local Baby Clinics where infant follow up and immunization services and contraceptive advice should be available. The general understanding and importance of contraceptive use of postpartum mothers in this period has not been fully explored within our services. The aim of this study was to assess the current knowledge and the utilisation of contraception at the primary level of care among women who delivered 6 to 14 weeks earlier. We also hoped to identify possible obstacles to accessing family planning services. Methods This was descriptive cross-sectional study that was conducted between March and September 2014, in the Metro West of Cape Town. The study included five Baby Clinics in local health centres. Ethics committee approval was granted by the Human Research Ethics Committee of the Faculty of Health Sciences of UCT (HREC REF: 544/2013) and further permission was granted for study sites by the Provincial Health Research Council of the Western Cape Government (RP 004/2014). A total of 228 mothers, who were 6-14 weeks postpartum and attended a Baby Clinic during the study period were recruited. Questionnaire based interviews were conducted and data were entered using Microsoft Excel 2012 spreadsheets and were analysed using SPSS version 22.
43
Brink, Derek Montagu. "Clinical and ultrasonic estimation of fetal weight". Master's thesis, University of Cape Town, 1994. http://hdl.handle.net/11427/26563.
Testo completoAbstract (sommario):
Several clinical situations occur in obstetrics where it is useful to make an accurate assessment of fetal weight prior to delivery. A foreknowledge of the mass of the fetus can influence management in circumstances complicated by, for example, a previous caesarean section, a breech presentation, a compromised fetus of borderline viability and a diabetic pregnancy at term. Researchers have attempted to estimate fetal weight by assaying oestriol, human placental lactogen, and pregnanediol. These parameters have been found to be of limited value because of the indirect measurement of fetal mass. Since the introduction of ultrasound scanning techniques to obstetrics in the mid- 1960's, it has become possible to visualise the fetus and to make direct measurements of fetal anatomy. By using ultrasound, workers have tried to predict fetal weight by measuring fetal heart volume, hourly urine production, trunk diameter, circumference and placental volume. At present various combinations of head circumference (HC), biparietal diameter (BPD), femur length (FL), and abdominal circumference (AC) are the most commonly used measurements which, when used in different formulas and read off tables estimate fetal weight. Recently the gestational age (GA) has been incorporated into formulas specifically applied to small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA) fetuses. A sonographic estimation of fetal weight based on a model of fetal volume has also been developed. It was generally believed that with the refining of ultrasonic estimation of fetal weight an accurate assessment of fetal mass could, at last, be made. Some investigators believe that the ultrasound estimation of fetal mass is more accurate than clinical assessment. In contrast other workers have shown that the accuracy of clinical examination is comparable to ultrasound determination in estimating fetal weight.
44
Rogers, Linda Joy. "Chemoradiation in advanced vulval carcinoma". Master's thesis, University of Cape Town, 2008. http://hdl.handle.net/11427/3054.
Testo completoAbstract (sommario):
Includes abstract.Includes bibliographical references (leaves 68-74).
Vulval carcinoma is uncommon, affecting approximately 2 per 100 000 women annually. The treatment of choice is radical vulvectomy and inguinal lymph node dissection. ‘Advanced’ vulval carcinomas involve midline structures (such as clitoris, urethra or anus) and/or adjacent pelvic organs or bone, and adequate excision may require urinary diversion, colostomy or pelvic exenteration. Less morbid and less mutilating therapeutic alternatives have been investigated, particularly chemoradiation, which has shown significant success in the management of anal carcinomas. Primary chemoradiation has been used, instead of primary radical surgery, to treat advanced vulval carcinomas at Groote Schuur Hospital (GSH) since1982. Aims: 1) To assess the survival of women with advanced vulval carcinoma treated with primary chemoradiation. 2) To examine the role of surgery after treatment with primary chemoradiation.
45
Adams, Tracey. "A quality of care assessment of the management of obstetric haemorrhage in the Peninsula Maternal and Neonatal Services". Master's thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/3058.
Testo completoAbstract (sommario):
Includes bibliographical references (leaves 64-68).In South Africa obstetric haemorrhage is the third most common cause of maternal deaths. In addition to maternal mortality audits, quality of care audits using criterion based audit methodology provides useful information. The aim of this study was to audit the management of all women with severe obstetric haemorrhage in the Peninsula Maternal and Neonatal Services in order to improve management. A descriptive retrospective audit was conducted during the period August 2006 to August 2007 using a criterion based audit methodology. Cases of severe obstetric haemorrhage were identified prospectively. Folders were reviewed and data collection sheets utilized to: 1. Describe the demographics and causes of obstetric haemorrhage in the Peninsula Maternal and Neonatal Services, 2. Measure the case fatality ratio, 3. Describe the management of women with severe obstetric haemorrhage with reference to that prescribed in the South African National Guidelines (2002-2004), 4. Score the management provided by the Peninsula Maternal and Neonatal Services using a shorter checklist devised from the National Guidelines.
46
Richards, Dominic G. D. "A comparison of calcium levels in pre-eclamptic and normotensive pregnancies in a low dietary calcium setting". Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/11528.
Testo completoAbstract (sommario):
Includes abstract.Includes bibliographical references (leaves 70-75).
Pre-eclampsia is a leading cause of maternal mortality and morbidity in South Africa. At present this disease cannot be prevented and many interventions to reduce the incidence of pre-eclampsia have been investigated. Calcium supplementation of pregnant women at high risk of developing pre-eclampsia has been shown to be of some benefit in reducing the incidence of the disease, with the greatest benefit seen in low dietary calcium settings. While serum calcium is an unreliable indicator of chronic calcium status, hair analysis is an accurate and well documented method of determining long-term micronutrient status.
47
Annor, Charlene Adjoa Adobea. "Antenatal AVSD diagnosis at Groote Schuur Hospital A retrospective cohort study". Master's thesis, Faculty of Health Sciences, 2019. https://hdl.handle.net/11427/31669.
Testo completoAbstract (sommario):
The antenatal diagnosis of a fetal atrioventricular septal defect (AVSD) impacts the prognosis of an unborn child, and may have psychosocial and financial implications for mothers receiving this diagnosis. Outcomes relevant to our local population may be used to improve counselling for parents receiving this diagnosis. During a literature review, there was a lack of existing published data on antenatal AVSD outcomes from the developing world. To ascertain the outcomes of antenatal AVSD diagnosis in fetal, neonatal and infant life, we performed a retrospective study of all AVSD's diagnosed at a tertiary referral hospital in Cape Town (Groote Schuur Hospital) between 1 January 2010 and 31 December 2016. We examined ultrasound records and case folders from the antenatal, neonatal and infancy periods, up to a year of life or demise. The resultant cohort had a total of 55 cases. We found that fetal outcomes in Cape Town, South Africa are similar to those in developed countries. Pregnancies were terminated in just over a third of cases and similarly, the over-all survival to one year of life excluding termination of pregnancy was 29,73%. The bulk of these fetuses demised in the antenatal period, and the rate of demise positively correlated with the presence of associated organ abnormalities and aneuploidies. In those born alive, the correlation between an antenatal AVSD diagnosis and the same diagnosis during postnatal echocardiography was 59,09%, with the remaining 40,91% having other complex cardiac abnormalities diagnosed. Corrective cardiac surgery in the neonatal period or infancy occurred in 46,15% of those born alive, with good outcomes. This study shows similarity between survival of fetuses diagnosed with antenatal AVSD in the developing and developed world. It will be instrumental in appropriately counselling South African parents who receive the diagnosis. In order to assess if prenatal AVSD diagnosis improves neonatal and infant outcomes, a further study comparing this group to the outcomes of infants with postnatally diagnosed AVSD is necessary. More research is needed in an African context regarding the outcomes of babies diagnosed with antenatal anomalies.
48
Ncube, Nkosinathi. "Validation of the polycystic ovary syndrome health-related quality of life questionnaire (PCOSQ) in the clinical community in our gynaecological endocrine clinic". Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/23400.
Testo completoAbstract (sommario):
Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age and impacts negatively on their health related quality of life (HRQoL). The Polycystic Ovary Syndrome Questionnaire (PCOSQ) is a disease specific questionnaire used to measure HRQOL in affected women. This questionnaire has not been validated for use in the clinical population of South Africa. This study aimed to assess the psychometric properties of the PCOSQ in our population and to compare findings with those from the WHOQOL-BREF, a generic questionnaire that measures HRQoL. Methods: This was a cross sectional analytical study of women with PCOS as defined by the Rotterdam criteria attending the Gynaecological Endocrine Clinic at Groote Schuur Hospital in Cape Town. The PCOSQ and WHOQOL-BREF were administered at the first interview and a repeat PCOSQ interview was conducted telephonically within a period of 2 to 7 days. The clinical data of the participants at initial diagnosis were obtained from the clinical records. Results: A total of 105 consenting women were recruited over a period of 8 months from November 2013 to July 2014. Sixty-seven participants responded to the second follow up interview for test-retest reliability. The test-retest reliability was good with intra-class correlation coefficients from all domains being above 0.8 (0.820-0.929, P<0.001). The Cronbach's alpha coefficients of internal consistency were above 0.7 in all domains with the exception of the menstrual domain, which scored 0.65. Construct validity was demonstrated by a statistically significant correlation between the corresponding domains of the WHOQOLBREF (P<0.05). Secondary factor analysis confirmed the domain structure of the PCOSQ. The scores from all domains were reflective of an impaired quality of life. Weight had the most impact on the HRQoL. The WHOQOL-BREF demonstrated a poor internal consistency in the study population. Conclusions: The PCOSQ is a valid questionnaire for measuring the HRQoL in our clinical population and is preferred above the WHOQOL-BREF. The incorporation of the domain on acne and further exploration of the domain of menstrual problems could be undertaken to strengthen its factor structure. PCOS has an adverse effect on the HRQoL. Weight has the biggest impact on the HRQoL. The WHOQOL-BREF is suboptimal in measuring HRQoL in women with PCOS, as it is not specific to the condition.
49
Ndovie, Lughano. "Maternal and fetal outcomes of induction of labour using oral misoprostol at New Somerset Hospital". Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/28074.
Testo completoAbstract (sommario):
Introduction: Induction of labour is commonly performed in clinical practice. Increasing rates of induction of labour worldwide has led to debate on whether elective induction improves the outcomes or simply leads to increased complications and healthcare costs. Maternal and neonatal complications and increased caesarean section (CS) rates associated with induction of labour are related to a variety of factors influencing the methods of induction. Misoprostol has been the drug of choice for induction of labour in developing countries for almost a decade. Different misoprostol regimens are used for induction of labour in different health facilities. New Somerset Hospital uses the standard protocol for induction of labour using misoprostol that the Western Cape Government adopted. This protocol has however not been audited. The main objective of the study was to determine the maternal and fetal outcomes of inductions of labour performed at New Somerset Hospital. Methods: This was a retrospective study conducted at New Somerset Hospital. We reviewed a random sample of medical records of patients who underwent induction of labour from 01 January 2014 to 31 December 2014. Ethics committee approval was granted by the Human Research Ethics Committee of the Faculty of Health Sciences of UCT. A total of 88 folders were sampled from 1029 women who had induction of labour. Results: There were a total of 6514 deliveries in 2014 of which 1029 had induction of labour, giving an induction rate of 15.8%. A total of 86 patients were included in the study. The mean age of the patients was 28.9 years (SD±6.586) with an age range of 16 to 44 years. The average gestational age at the time of induction of labour was 39.5 weeks with a range 35 to 42.6 weeks and 14.0% of the patients were HIV positive. The three main indications of induction of labour were hypertension in pregnancy (40.7%), prolonged pregnancy (27.9%) and pre-labour rupture of membranes (8.1%). Overall, 50 patients (58.1%) had vaginal delivery and 36 patients (41.9%) had caesarean delivery. There was a significant association between mode of delivery and time to delivery. Patients who delivered within 24 hours of commencement of induction of labour were more likely to have had a vaginal delivery (p = 0.005). The three main indications for caesarean delivery were fetal heart rate changes (n=30; 72.0%) followed by failed induction of labour (n=9; 21.0%) and cephalopelvic disproportion (n=3; 7.0 %). In terms of maternal outcomes, 2 patients (2.3%) had hyperstimulation of the uterus, 6 patients (7.0%) had postpartum hemorrhage, 8 patients (9.3%) had vaginal tears and 5 patients (5.9%) had an episiotomy performed during delivery. The mean birth weight was 3262.1g (SD±503.77) with a range of 1925 to 4515 grams. At five minutes the means Apgar score was 9.8(SD ± 0.62) with range of 6 to 10. A total of 38 babies (44.3%) had meconium stained liquor documented at delivery, three babies (3.4%) required neonatal resuscitation upon delivery. There were 10 (11.6%) babies that were admitted to NICU. Conclusion: In this study we found that the prevalence of induction of labour was 15.8%. Hypertension in pregnancy, prolonged pregnancy and pre-labour rupture of membranes are the three common indications for induction of labour. Successful vaginal delivery was achieved in 51.0% of the study population. The caesarean delivery rate was high, mostly due to CTG changes The current induction of labour protocol using oral misoprostol is associated with acceptable maternal and fetal outcomes.
50
Butt, Jennifer Leigh. "Hysterectomy at a tertiary hospital in South Africa : indications, pathology and complications". Master's thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/3033.
Testo completo