Browsing by Author "Kadwa, Khatija"

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    Hygiena Study: audit of women managed with Cone Biopsy at Groote Schuur Hospital from 1st April 2013 to 31st October 2015
    (2017) Kadwa, Khatija; Denny, Lynette; Mbatani, Nomonde
    INTRODUCTION: Cervical cancer is the second commonest cancer in South Africa and the commonest amongst Black females with a Lifetime Risk (LR) of 1:35. In South Africa the problem has been compounded by the HIV epidemic as well as a lack of resources and infrastructure to offer an adequate screening and treatment programme. Cone biopsies are one of the diagnostic and sometimes therapeutic modalities used to assess and treat cervical precursors and cervical cancer. Unfortunately, cone biopsy of the cervix remains a morbid procedure often performed on young women in the reproductive age group and has resultant complications. OBJECTIVE: To audit the demographics, indications, histology and post cone management and outcome of women requiring cone biopsies of the cervix, at Groote Schuur Hospital Colposcopy Clinic between 1st April 2010 and 31st October 2013. METHODS: A group of women attending the colposcopy clinic, and requiring cone biopsies between 1st April 2010 and 31st October 2013 were identified from a computerized database, known as the Hygiena Database. Women who had an incomplete dataset were excluded. Folder review and review of the National Health Laboratory Services was also conducted. Patient demographics, indications, cone histology and follow up at 4-6 months, 10-12 months and > 12 months were analysed. Age, parity, HIV status, CD4 count, ARV status and cone margin involvement were included in the univariate and multivariate analysis to determine predictors of persistent disease RESULTS: Three hundred and seventy six cone biopsies were performed during the study period, with a mean age of 42.3 years, mean parity of 2. The majority of women [56,7% (213/376)] were HIV positive. The final histology indicated that 65,2% (246/376) of the women had high-grade disease (CIN 2/3 or HSIL) and 12,5% (47/376) had microinvasion. Ectocervical margins were clear in 57,6% (212/368) of cases and endocervical margins were clear in 54,6% (201/368) of specimens. Fifty-one cancers were detected during the study period. In the multivariate analysis age 40-49yrs (RR 1.4, 95% CI 1.01-2.0: p=0,043), ectocervical margin involvement with CIN 2/3 (RR 1.8, 95% CI 1.1-3.0: p-0.017) and endocervical margin involvement with CIN 2/3 (RR 1.5, 95% CI 1.04-2.3; p=0,031) and microinvasion ( RR 2.4, 95% CI 1.4-4.3; p=0.003) were all predictors of persistent disease. CONCLUSION: The use of cone biopsy is a valid diagnostic and sometimes therapeutic procedure at Groote Schuur Hospital with significant detection of high grade disease and cervical cancer. Women aged 40-49 years and positive cone margins are strong predictors of persistent disease. Improved compliance and a reduction in positive margins are two areas that need to be addressed to improve the current treatment programme. Use of cone biopsy as surgical therapy for early stage cancer appears promising but needs further study.
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    Pain and fertility outcomes post endometriosis surgery at Groote Schuur hospital
    (2023) Kalwiba, Christian; Kadwa, Khatija; Olarogun, Olufemi; Jere, Khumbo
    Background Endometriosis is characterized by the development of endometrial-like tissue outside of the uterus, which results in a persistent inflammatory response . It is an estrogen-dependent chronic disorder and affects millions of women in their reproductive age. The true incidence is not well known but it is around 6% or more. The clinical presentation of endometriosis varies. Most women will present with secondary dysmenorrhea, dyspareunia, pelvic pain, and infertility. Laparoscopy is the gold standard diagnostic tool for endometriosis, with surgical management being the mainstay in the treatment of endometriosis. Objectives The study's primary objective was to determine the effect of surgery on pain and infertility in women with endometriosis. Secondly, to determine the demographics, severity of endometriosis and laparoscopic complications, recurrence of symptoms and need for repeat surgery. Methodology To achieve the objectives of this research, the study design was a retrospective study. Seventyfive women with endometriosis who attended the reproductive Medicine Unit at Groote Schuur Hospital in Cape Town from January 2016 to December 2018 were analysed. Results Eighty-seven patients were identified with endometriosis from January 2016 to December 2018. Twelve folders could not be retrieved, therefore 75 patients out of the 87 were included in and analysed for this study. Some of the 75 patient files had missing information regarding some of the variables. Post laparoscopic surgery, the pain improved in 90%, 82%, 85% and 61% of patients with a P value < 0.05 at 6 weeks, 6 months, 1 year and 2 years, respectively. Thirty percent of women operated primarily for infertility conceived spontaneously within 2 years. Nine point three percent of patients were reoperated with a mean duration from primary to second surgery of 3 years ± 1.3. More than six percent (6.6%) had intraoperative complications with two patients having ureteric injuries, another two with bowel injuries, and one who had vascular injuries. The prevalence of endometriosis among women undergoing laparoscopic surgeries was 30.6% over the 3-year period. Chronic pelvic pain was the most common symptoms in 86.6% of patients. Dysmenorrhea was reported in 72,6%, 36.5% had dyspareunia, 50% had heavy menstrual bleeding and 53% had primary or secondary infertility. Chronic pelvic pain and infertility were found in 42.67%. Conclusion This study has shown a great improvement in pain post laparoscopic surgery varying from 90% at 6 weeks to 61% at 2 years. About one-third of patients operated on for primarily infertility will conceive spontaneously post-surgical intervention. We recommend a new study with a large sample size in order to determine the improvement and fertility according to the stages of endometriosis.
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    Pregnancy intendedness in a high-risk obstetric population in a regional hospital
    (2024) Akpakan, Akanimo; Van Der Spuy, Zephne; Kadwa, Khatija; Petro, Greg; Firmin, Carl
    Unintended pregnancies (UIP) are those that are mistimed, unplanned, or unwanted at the time of conception. It is estimated that, worldwide, 40% of pregnancies were unplanned in 2012 and this carries increased risks for both mothers and babies. This study was designed to utilise the London Measure of Unplanned Pregnancy (LMUP) to assess pregnancy intendedness in a high-risk obstetric population of women who were accessing care at a large regional hospital. Methods: This was a cross-sectional descriptive study. Women attending the High-Risk clinics or admitted with medical problems were recruited at George Regional Hospital. Once they consented to the study, the LMUP was administered by a single research team member. The LMUP is a psychometrically validated measure of pregnancy intention for a current or recent pregnancy. Questions enquire about the intention and timing of pregnancy, preconception behaviour, contraception usage, and partner's input and a score is obtained which indicates intendedness. It has been validated in our department in the 3 local languages. Results: A total of 200 women were recruited for the study. No potential participant declined to be interviewed. The mean age was 30.4+/- 6.3 years and the majority of participants were of mixed ancestry (n=135). HIV status was positive for 23 participants and unknown for 29. All participants completed the Perinatal Mental Health Score and 4 required referrals for supportive assistance. The LMUP indicated that 76 women had unintended pregnancies, 58 were ambivalent about their pregnancies and 66 had an intended pregnancy. Pre-pregnancy discussion and preparation were lacking for most of the participants despite pre-existing risk factors. Pregnancy intendedness was affected by several factors. Age (P = 0.02), relationship status (P = 0.001) and financial support (P = 0.005) were associated with intendedness. Employment, parity, language group, educational level, booking gestation, HIV status, and multiple comorbidities did not affect pregnancy intendedness. Other factors that had no influence were Perinatal Mental Health Score, preconceptual counselling/health improvement, and habits. Poor partner communication was common. Women at extremes of reproductive life had more unplanned pregnancies (P = 0.02). i There was good unprompted contraceptive knowledge but poor information about emergency contraception. Conclusion: In this high-risk group of obstetric patients, there was little preconception discussion or preparation and inadequate use of contraception among women who did not plan a pregnancy.