OpenUCT :: Browsing by Author "van der Spuy, Zephne Margaret"

Browsing by Author "van der Spuy, Zephne Margaret"

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Open Access
A comparison of calcium levels in pre-eclamptic and normotensive pregnancies in a low dietary calcium setting
(2011) Richards, Dominic G D; van der Spuy, Zephne Margaret
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.
Open Access
Effects of a short interpregnancy interval on pregnancy outcomes
(2017) Kisuule, Castro; van der Spuy, Zephne Margaret; Steyn, Petrus S; Petro, Gregory
The interval between one pregnancy and the next may affect the outcome of pregnancy. Both short and long interpregnancy intervals (IPI) have been associated with adverse pregnancy outcomes and most of these occur with a short IPI. Our primary objective was to determine the effects of a short IPI (< 24 months) compared with a long IPI (≥ 24 months) on the subsequent potentially viable pregnancy in women who received antenatal care (ANC) in the secondary level hospitals in the Metro-West area of Cape Town. The secondary objective was to review possible determinants of a short IPI. Methods: This was a pilot descriptive cross-sectional study conducted between 1st September 2016 and 28th November 2016. One hundred and thirty women who were Para 2 were recruited to the study in the early postnatal period. Sixty women were recruited into the short IPI group (<24 months) and 70 to the long IPI group (≥24months). Questionnaire-based interviews were conducted and data were entered using Microsoft Excel 2012 spread sheets. Statistical analysis was done using Stata® Edition 13. Results: We analysed the data for both short and long IPI and found that there were no significant differences in preterm birth, abruptio placentae, preterm prelabour rupture of membranes (PPROM) and low birth weight. There was however a significant difference in the number of small-for-gestational- age (SGA) babies. In the short IPI group, 19 women (31.7%) had SGA babies in comparison to the long IPI group where 7 women (10%) had SGA babies( p = 0.015). Of the 130 respondents, 79 women (60.8%) had unintended pregnancies, 44 (73%) with a short IPI vs 35 (50%) with a long IPI (p = 0.017). Women with a long IPI were more likely to have a different partner for the subsequent pregnancy (p= 0.002). Women in relationships longer than 5 years were more likely to have a long IPI (p = 0.049). Thirty-eight women (63.3%) with a short IPI would have preferred the pregnancy later compared to 11 women (15.7%) with a long IPI (p<0.001). There were 27 (38%) women who supported themselves financially in the long IPI group compared with 8 (13%) with a short IPI (p=0.001). A long IPI was associated with more formal employment and professional careers compared to a short IPI (p= 0.002). In the long IPI group 10 women (7%) had professional positions compared with none in the short IPI group (p=0.002). There were no significant differences in breastfeeding duration, contraception use and knowledge, social habits, previous obstetric history, educational status or emotional support between the two groups. Conclusion: In our study, of all the pregnancy outcomes investigated, small-for-gestational age was the only clinical outcome significantly associated with a short IPI. There were differences in pregnancy intendedness, duration of relationships, financial support and employment between the two groups. The majority of women with a short IPI (63.3%) would have preferred the index pregnancy to have occurred later.
Open Access
Familial association of polycystic ovary syndrome (PCOS) in women attending the gynaecological endocrinology clinic at Groote Schuur Hospital
(2010) Edelstein, Sascha; van der Spuy, Zephne Margaret
Polycystic ovary syndrome (PCOS) is the commonest endocrinopathy in women of reproductive age, affecting 5-10% of women in the general population. Patients present with menstrual disturbances, infertility and clinical hyperandrogenism. While the pathophysiology is not completely delineated, a strong familial association has been demonstrated, suggesting a genetic component. From January 2007 until February 2009, a total of 83 probands were recruited from the Gynaecological Endocrinology Clinic (GEC) at GSH. These were all women with PCOS according to the Rotterdam criteria who presented for management at the GEC. With their consent, first degree female family members were contacted and 57 mothers, 108 sisters and 8 daughters agreed to participate in the study.
Open Access
Hysterectomy at a tertiary hospital in South Africa : indications, pathology and complications
(2009) Butt, Jennifer Leigh; van der Spuy, Zephne Margaret; Jeffery, ST
Includes abstract. Includes bibliographical references (leaves 50-55).
Open Access
The impact of body mass index (BMI) on metabolic and endocrine parameters in women with the polycystic ovary syndrome (PCOS)
(2008) Edelstein, Sascha; van der Spuy, Zephne Margaret
Includes abstract. Includes bibliographical references (leaves 56-64).
Open Access
Infertility in the public health care system in South Africa : patients' experiences, reproductive health knowledge and treatment-seeking behaviour
(2006) Dyer, Silke Juliane; van der Spuy, Zephne Margaret
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.
Open Access
Knowledge of contraception and barriers to contraceptive use in women undergoing repeat termination of pregnancy
(2013) Essel, Kwabena; van der Spuy, Zephne Margaret
Includes abstract. Includes bibliographical references.
Open Access
A longitudinal study of hormonal and semen profiles in a marathon runners
(1993) Jensen, Carl Edward; van der Spuy, Zephne Margaret
Over the past decade long distance marathon running has become an important recreational activity. There is evidence that males with high levels of physical activity have some impairment of fertility. In order to investigate this further, 24 male marathon runners were studied over a period of a year. Each runner was assessed at regular intervals using hormonal profiles, anthropomorphic indices and semen evaluation. The training time and distance run increased progressively over the first five months of the study as the runners prepared for the Two Oceans marathon. Analysis of the serum hormonal profiles in this longitudinal study showed that the prolactin level increased when comparing the initial study month with the rest of the year and the progesterone level decreased. However the luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone and estradiol (E2) levels remained unchanged. When the runners were divided into a high and low training group according to the distance run in the preceding week, the only significant difference was the lower mean serum FSH level in the high training group. A decrease in semen volume was demonstrated as the training time increased. This trend was reversed as the runners' training decreased after the Two Oceans marathon. The percentage of morphologically normal spermatozoa showed an initial significant decrease in the first month of training. However, no significant difference was observed throughout the rest of year. An overall downward trend in semen motility in the first 5 months of the study was shown but this was only significant if the first and fifth study months were compared. The decrease in semen motility coincided with the period of maximum training. Since patients with an adequate sperm count but decreased motility have impaired fertility this finding is of considerable importance. In addition to the decrease in motility, there was a decrease in the percentage of morphologically normal spermatozoa when the initial month of low physical activity (December) was compared to all of the subsequent months analysed. This, too, is an important finding as the percentage of morphologically normal spermatozoa correlates directly with fertilisation and pregnancy rates. When the results were analysed in the high and low training months there was a significant difference in mean semen count and semen morphology. The mean count was higher in the high training group and this group also had a significantly higher normal morphology. However, there was no significant difference in semen volume and motility in the high and low training groups.
Open Access
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
(2015) Morrison, Candice Jane; van der Spuy, Zephne Margaret
PCOS is the commonest endocrinopathy occurring in women of reproductive age. This study aimed at comparing the presentation of adolescents to that of women â‰¥ 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.
Open Access
Polycystic ovary syndrome : the effect of weight loss on intravenous triglyceride clearance and lipid profile
(2006) Olarogun, J O; van der Spuy, Zephne Margaret
The aim of this study was to investigate the effects of weight loss on markers of insulin resistance, triglyceride clearance rate and lipid profile in obese patients with PCOS.
Open Access
Psycho-social apsects of Turner Syndrome : a qualitative study
(2008) Matebese, Nomathamsanqa Thandeka; van der Spuy, Zephne Margaret; Dyer, Silke
Includes abstract. Includes bibliographical references (leaves 53-57).
Open Access
Pubertal development in urban Xhosa schoolgirls
(1995) Largier, Damian Douglas Christopher; van der Spuy, Zephne Margaret
The present study was performed in order to update available data on puberty in South African women gathered from studies among a variety of South African population groups and to compare our findings with these previous studies in order to identify any change. In addition, the children's social environment was evaluated to see if it had any influence on the timing of puberty. This study is important because a decrease in the age of onset of the various stages of puberty would be expected as the socio-economic status of the population increases. We would expect that once socio-economic and therefore nutritional equality between different communities exists, there would be little difference between the age at which children attain puberty. An absence in the trend toward a younger onset of puberty would be a cause for concern as this would imply that there has been no improvement in living conditions from the time of the original study. A relationship has also been shown to exist between an earlier age at menarche and an increased risk of breast cancer (Pike 1983), an increased risk of coronary heart disease (Colditz 1987), shorter adult height (Shangold 1989), earlier initiation of sexual activity (Soefer 1985), earlier first pregnancy, (Sandler 1984) and larger family size (Frisch 1978). This implies that as the age at which children pass through puberty decreases, it becomes increasingly important to introduce both sexual education and the availability of contraception at a correspondingly earlier age in order to avoid the tragedies of teenage pregnancies.
Open Access
Pubertal development in white and coloured urban schoolgirls
(1994) Thomas, Carol Ann; van der Spuy, Zephne Margaret
The aim of this study was to compare pubertal development between the two main ethnic groups in the Cape, controlling for social class. This study aimed to investigate: 1. The age of menarche and other stages of pubertal development of white and coloured school girls living in greater Cape Town. 2. The relationship between the age of menarche and the other stages of pubertal development, social class and race. 3. The influence of home environment (childminder, sibling number, maternal education) on onset of menarche and breast development. This data further contributes to a larger study on pubertal development of all representative ethnic groups and social classes in the Cape. Our hypothesis is that social class, and not race, is a major determinant of pubertal development.
Open Access
Reproductive and contraceptive knowledge among women with hypertensive and cardiac disease
(2014) Giyose, Nwabisa; van der Spuy, Zephne Margaret
Introduction: This study aimed to assess reproductive knowledge and use of contraception in women of reproductive age with cardiac disease or chronic hypertension attending outpatient clinics. Methods: This was a prospective descriptive study. Women aged between 18 and 45 years attending cardiac or hypertension clinics at Groote Schuur Hospital, Khayelitsha and Mitchells Plain Day Hospitals were recruited. The study tool was an administered questionnaire which included social, demographic and medical information, knowledge about their condition and the contraceptive history. Results: Two hundred women were interviewed, 100 with cardiac disease and 100 with chronic hypertension. Among the 84 cardiac and 90 hypertensive women who had previously been pregnant, there were 193 and 262 pregnancies respectively. Of these participants, 72% cardiac and 70% hypertensive women reported at least one unplanned pregnancy. Unemployed hypertensive women were more likely to have unplanned pregnancies (81%), than their employed counterparts (65%) (p<0.03). In the cardiac group employment did not affect planning of pregnancies. Forty cardiac and 46 hypertensive women were married. Married women in both groups had more planned pregnancies (46% cardiac, 43% hypertensive) in contrast to 10 Out of 200 women, only 2 were unaware of any contraceptive methods. One hundred and fifty eight participants were using modern contraceptive methods. None of the women accessed contraception at their routine medical clinics and less than half had received contraceptive advice there. Conclusion: This study showed that many pregnancies among participants with medical conditions were unplanned, and there was poor knowledge about the impact of their medical condition on pregnancy. There is an unmet need for reproductive health education in women with medical conditions, and ideally this should be part of the holistic care of any woman with a significant medical condition.
Open Access
Reproductive and contraceptive knowledge among women with hypertensive and cardiac disease
(2014) Giyose, Nwabisa; van der Spuy, Zephne Margaret
Introduction: This study aimed to assess reproductive knowledge and use of contraception in women of reproductive age with cardiac disease or chronic hypertension attending outpatient clinics. Methods: This was a prospective descriptive study. Women aged between 18 and 45 years attending cardiac or hypertension clinics at Groote Schuur Hospital, Khayelitsha and Mitchells Plain Day Hospitals were recruited. The study tool was an administered questionnaire which included social, demographic and medical information, knowledge about their condition and the contraceptive history. Results: Two hundred women were interviewed, 100 with cardiac disease and 100 with chronic hypertension. Among the 84 cardiac and 90 hypertensive women who had previously been pregnant, there were 193 and 262 pregnancies respectively. Of these participants, 72% cardiac and 70% hypertensive women reported at least one unplanned pregnancy. Unemployed hypertensive women were more likely to have unplanned pregnancies (81%), than their employed counterparts (65%) (p<0.03). In the cardiac group employment did not affect planning of pregnancies. Forty cardiac and 46 hypertensive women were married. Married women in both groups had more planned pregnancies (46% cardiac, 43% hypertensive) in contrast to 10 Out of 200 women, only 2 were unaware of any contraceptive methods. One hundred and fifty eight participants were using modern contraceptive methods. None of the women accessed contraception at their routine medical clinics and less than half had received contraceptive advice there. Conclusion: This study showed that many pregnancies among participants with medical conditions were unplanned, and there was poor knowledge about the impact of their medical condition on pregnancy. There is an unmet need for reproductive health education in women with medical conditions, and ideally this should be part of the holistic care of any woman with a significant medical condition.
Open Access
Retrospective review of women diagnosed with premature ovarian insufficiency
(2018) Chirwa, Nyatozi; van der Spuy, Zephne Margaret
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.
Open Access
The role of kisspeptin and its cognate receptor GPR54 in normal and abnormal placentation
(2015) Matjila, Mushi Johannes; van der Spuy, Zephne Margaret; Katz, Arieh; Millar, Robert
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.
Open Access
Selenium levels and recurrent pregnancy loss : is there an association?
(2010) Thomas, Viju; van der Spuy, Zephne Margaret
Miscarriage is the commonest complication of pregnancy and affects 12-31% of all conceptions. About 1% of all couples trying to conceive will have recurrent pregnancy loss (RPL). Several causes for RPL have been documented and these include chromosomal abnormalities, peas, thrombophilias and anatomical anomalies such as cervical incompetence. In many couples the aetiology of the pregnancy loss is often not defined but nutritional deficiencies have been postulated as possible causes. In particular selenium deficiency is associated with reproductive failure in animals and, more recently, in some human studies. This study was undertaken to assess the selenium levels in women with RPL without an identified cause.
Open Access
Strategies to improve artificial insemination by donor
(1997) Dyer, Silke Juliane; van der Spuy, Zephne Margaret
Artificial insemination with donor sperm is a widely accepted form of treatment for severe male factor infertility. The introduction of quarantined, cryopreserved semen and the associated reduction in cycle fecundity when compared to fresh semen necessitated the development of strategies to improve the performance of frozen sperm. A prospective randomised clinical trail was undertaken in the Reproductive Medicine Unit at Groote Schuur Hospital to compare intrauterine insemination with intracervical insemination in a therapeutic donor insemination program with cryopreserved semen. The method of insemination was alternated in successive cycles in each patient after intitial randomised selection. Forty three patients underwent 61 intracervical insemination cycles and 48 intrauterine insemination cycles. Strict cycle control was exercised and the timing and frequency of insemination followed a specific protocol. Eighteen clinical pregnancies occurred following eleven intrauterine insemination cycles (22.9% per cycle) and seven intracervical insemination cycles (11.5% per cycle). Treatment outcome was influenced by patient age, the severity of the male factor and endometriosis. Most pregnancies followed insemination with 15 to 25 million motile sperm. Sperm fecundity differed amongst donors. The findings of our study and the current literature suggest that intrauterine insemination improves cycle fecundity in therapeutic donor insemination cycles with frozen donor sperm.
Open Access
A survey to assess knowledge and acceptability of intrauterine devices (IUD) among family planning clients and providers in the Family Planning services in Cape Town
(2007) Van Zijl, Shelsley; van der Spuy, Zephne Margaret
[Background]The IUD is a highly effective, reliable, and safe contraceptive method that is under-utilised in many countries due to persistent fears that it causes pelvic infection. Reliable evidence of the safety of this contraceptive method has not been enough to effect a change in use. The aim of this study was to assess the knowledge and acceptability of the IUD among clients and providers in the Family Planning services in Cape Town and to attempt to identity obstacles to use. [Methods] A descriptive cross-sectional survey was conducted at eight Family Planning clinics in Cape Town. Two hundred and sixteen clients aged between 18 and 50 years, and 30 providers from the same clinics, were interviewed using structured questionnaires. [Results] Awareness of the IUD among clients was low - 81 women (41%) had heard of this contraceptive method. Ever and current use were very low. Only 9 women (4%) had ever used an IUD and 3 women were still using this method. Both the women who were interested in using this method in the future (n=77; 36%) and the women who were ambivalent or not interested in future use (n=139; 64%) cited a lack of knowledge as an obstacle to use. Although most providers were aware of the availability of the IUD (n=26; 87%). their factual knowledge was limited. Infection (n=14; 47%) and increased menstrual bleeding (n=12; 40%) were frequently mentioned as disadvantages. Referrals for and insertions of the IUD were low, and this method was often not discussed with women considering tubal ligation. Providers identiﬁed lack of client knowledge, myths and rumours among clients, lack of skilled providers to insert the device, and lack of promotion of the IUD, as signiﬁcant obstacles to greater use of this method. [Conclusion] Although the IUD is available in the public sector services, it is not being utilized. Better education of both clients and providers is essential in order to improve accessibility and acceptability of this highly effective and cost effective contraceptive method.