Browsing by Subject "Gynaecology"

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    An audit of the management of women with Borderline Ovarian Tumours treated at Groote Schuur Hospital between 1984-2008
    (2017) Hendricks, Aneeqah; Denny, Lynette; van Wijk, Leon
    Background: Borderline ovarian tumours (BOT) are an intermediate form of neoplasia, between benign and malignant and have been classified as epithelial tumours of low malignant potential. These particular tumours affect a younger age group than their invasive counterparts with an overall survival of 90 - 100%. The present study aims to document the experience of a single centre on the management of women with borderline ovarian tumours (BOT). Methods: Two hundred and thirteen patients diagnosed and treated with BOT between 1984 and 2008 were identified through the Gynaecology Oncology database that has been in existence since 1984. Details of management, outcome and survival were retrieved and data were analysed descriptively and for survival. Results: The median age at diagnosis was 45 years old, with 34 % of patients > 40 years old. The incidence of serous BOT (SBOT) was 47.9% (102/213) and 49.3 % (105/213) were mucinous BOT (MBOT). Most of the patients were diagnosed in Stage I 83.6% (178/213), 6.1%( 13/213) were in stage II and 10.0% (22/213) were stage III. There were no patients in stage IV. At the end of the study period 73% (156/213) of the women were alive with no evidence of disease. Univariate analysis, indicated that the histological subtype of tumour, the type of surgery, the presence of residual disease, advanced stage disease, the presence of ascites were all statistically significant in affecting survival. Multivariate analysis, however, revealed that only the presence of residual disease was statistically significant as a prognostic predictor of poor outcome.
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    “Foreign migrant women's perceptions of obstetric care in the Cape Town metro pole.”
    (2024) Hendricks, Fahad; Gordon, Chivaugn
    This study explores the maternal healthcare experiences of nine foreign migrant women who received obstetric care in the Cape Town metropole. The Republic of South Africa's legislation enshrines the right to health for all who live within the country's borders, regardless of residency status. In practice however, foreign migrants can experience significant challenges and, in the Cape Town metropole how these women experience obstetric care has not been a focus of scholarly interrogation. With this study I hope to establish the factors that influence migrant women's experiences positively or negatively and to utilise the knowledge gained from their experiences to enhance pregnancy care of migrant women in the longer term. A literature review was performed covering the areas of migration to South Africa, migrant women's health, migrant's health challenges and official South African health care policies. Data was collected by doing one on one, open-ended and semi-structured interviews with nine foreign migrant women from seven different countries and with two key stakeholders employed at two of Cape Town's largest refugee centres. The interviews were recorded, professionally transcribed and then data inductively coded using thematic analysis. Thematic analysis was used since it is a way to extract descriptive information concerning the experiences of migrant women in Cape Town and to construct meaning, in order to understand their perceptions about the obstetric care. The findings indicate that the attitudes & behaviours of staff, language, prior traumatic experiences, degree of assimilation and healthcare systemic issues are some of the chief factors that influence perception of care. Xenophobia and dismissive behaviour were the main issue with staff but that was juxtaposed against some excellent and compassionate care received. Some of the women struggled to communicate the nature of their problems and being understood but also found understanding local staff a significant barrier. Having had to endure staff attitudes and behaviours can reasonably be agreed to have delayed monitoring or intervention. Language barriers resulted in adherence issues with medications, potential missed appointments, issues around informed consent and missed opportunities at health promotion. The women had a poor understanding of the local healthcare system's design and had expecta tions in relation to their own experience of the system in origin countries. When these expectations were not met, it was perceived as poor. A key challenge was the failure of the facilities to recognise the asylum documentation and the rights afforded to those who had them. The reasons for fleeing their countries included warfare, geno cide, political turmoil and economic deprivation. The journeys to Cape Town were fraught with further trauma and this made the women vulnerable to mental health is sues which also impacted their perceptions of care. Further, a traumatic birth in Cape Town carried significant sway over how further births in Cape Town were viewed. It is clear from this study that multiple, complex factors influence the way foreign mi grant women perceive their care. These factors are personal and unique to each indi vidual but there were commonalities. Trained interpreters, cultural sensitivity training, education surrounding documentation, allowing birth partners to be present during visits and births, extra safety checks on perinatal mental health for first time births in Cape Town and a more robust, confidential and accountable complaints system were recommendations by this cohort.
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    Gynaecological case book.
    (1957) Du Toit, Pierre Francois Mulvihal
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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.
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    The Caesarean Section rate at Mowbray Maternity Hospital: Applying Robson's Ten group classification system
    (2018) Venter, Eben Kruger; Horak, T A; Fawcus, S R; Petro, G A
    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.