Browsing by Subject "gynaecology"
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- ItemOpen AccessAdvanced abdominal pregnancy: diagnosis, evaluation and surgical management in a resource constrained setting(2022) Elijah, Regis; Fawcus, Susan; Moja, Letticia M; Godi, Nthandho PIntroduction Advanced abdominal pregnancy (AAP) is a pregnancy of over 20 weeks gestation, with a foetus living, or showing signs of having once lived and developed, in the mother's abdominal cavity. It is a rare obstetric complication associated with high maternal and perinatal morbidity and mortality. The question of whether to leave the placenta in or to remove it has been the subject of debate. When such cases present outside high resource settings, where a multi-disciplinary approach may not be possible, there are many challenges to effective treatment. The management of this rare but serious complication of pregnancy at Rob Ferreira Hospital (RFH), a rural provincial tertiary hospital, in Mpumalanga, was investigated. Methods This was a retrospective observational study of patients with AAP identified from theatre registers from January 2011 to January 2018 at RFH. Data was collected on patient demographics, diagnostic challenges, preoperative evaluation, and surgical management particularly of the placenta, and outcomes. Delivery data for RFH was retrieved from the provincial database. Results There were 26 cases of AAP identified, for which 21 folders could be retrieved from the registry. The incidence of AAP was 66.2 per 100, 000 deliveries. Abdominal pain was a presenting complaint in 100% of patients. Ultrasound scan (USS) accuracy, prior to surgery, was eventually 90.5%. However, for 61.9% the diagnosis of AAP was missed at initial USS and for 33% of these, AAP was only diagnosed after failed attempts at induction of labour (IOL). AAP was diagnosed intra-operatively in 9.5%, for a supposed caesarean delivery and 19 (94.7%) were diagnosed pre-operatively. Intra-operatively, 36.8% patients had placental site bleeding for which partial placental removal was 2 necessary in 71.4%. This group had more adverse maternal outcomes. For 73.7% of patients there was no bleeding from placental bed and the placenta was left in situ; but 7.1% required relook laparotomy for haemorrhage. There was one maternal death. Overall neonatal survival rate was 14.3% and pregnancy loss rate was 71.4%. Conclusion This study shows that planned management of AAP in a resource constrained setting with tailored approach and management, can be performed without compromising maternal outcomes. However, poor outcomes occurred when pre-operative diagnosis was not made and AAP was discovered during emergency CS, emphasising the importance of antenatal diagnosis. USS and a high index of suspicion remains the best diagnostic tool. From this study it appears safe to leave the placenta undisturbed unless it can be safely removed, or the patient is already bleeding from the placental site. There were very low neonatal survival rates, and this needs to inform counselling of patients with AAP.
- ItemOpen AccessMedicine and the Arts Week 4 - Birth and creativity(2015-01-21) Dyer, SilkeIn this video, gynaecologist and fertility specialist Silke Dyer speaks about the physiological processes of human reproduction, and some of the creative solutions in assisted reproductive technology (ART) to help infertile couples conceive. This is the fourth video in Week 4 of the Medicine and the Arts Massive Open Online Course.
- ItemOpen AccessMenopause and its management the physiopathologic foundation(2007) Utian, Wulf HesselAn historical survey of all issues relating to the menopause was considered integral to understanding attitudes and the existing state of knowledge at the time of my planning and designing my initial investigations. While the research literature up to late 1966 was essentially narrative in nature, there were many indirect areas of research that could help define both the level of existing knowledge as well as attitudes and perceptions at that time. Above all, by understanding and documenting a comprehensive historical survey, it became possible to define the pertinent questions that needed answers. Key papers in which I documented the history and summarized the state of the art at that time are references 1-5, 107, 109, and my monograph, “Menopause in Modern Perspective (Appleton, Century, Crofts, New York, 1979). I can best summarize the background to my future studies by quoting from my first published analysis of the literature in 1968.107 The critical review opened with the observation that “most of what is published is based on emotional and philosophical premises; the 'change of life' is an emotional subject not only to women, but to men and doctors.” The purpose of the review was then listed as: “1. To analyse the current thoughts regarding the menopause. 2. To draw attention to the paucity of authoritative research and published data. 3. To serve as an indication for the urgent need for research, particularly into the nature of the menopause and the methods for the relief of menopausal symptoms and disorders; the process of 'ageing' and, in particular, the occurrence of osteoporosis and atherosclerosis in postmenopausal women; and the metabolic and vascular changes following acute hormone withdrawal, e.g. after bilateral oophorectomy in the pre- and postmenopausal female.” The conclusions of that 1968 critical review determined my future career path: “Several questions urgently require answers: 1. Is the climacteric a normal physiologic stage in the life of the human female, or is it a simple result of ovarian failure and oestrogen deficiency? 2. Are the manifestations of ageing directly related to diminution of circulating sex hormones? 3. Can the administration of exogenous oestrogen or other sex hormones prevent the manifestations of ageing? 4. Are the oestrogens at present available for administration equivalent in effect to circulating endogenous oestrogens? 5. Does long-term oestrogen administration result in an increased incidence of breast or uterine carcinoma? 6. Do oestrogens have a direct effect on the psychological state and sense of well-being in the postmenopausal patient? To these ends the development of more precise diagnostic techniques and methods of evaluation is vital.
- ItemOpen AccessMenopause And Its Management The Physiopathologic Foundation(2007) Utian, Wulf HesselAn historical survey of all issues relating to the menopause was considered integral to understanding attitudes and the existing state of knowledge at the time of my planning and designing my initial investigations. While the research literature up to late 1966 was essentially narrative in nature, there were many indirect areas of research that could help define both the level of existing knowledge as well as attitudes and perceptions at that time. Above all, by understanding and documenting a comprehensive historical survey, it became possible to define the pertinent questions that needed answers. Key papers in which I documented the history and summarized the state of the art at that time are references 1-5, 107, 109, and my monograph, “Menopause in Modern Perspective (Appleton, Century, Crofts, New York, 1979). I can best summarize the background to my future studies by quoting from my first published analysis of the literature in 1968.107 The critical review opened with the observation that “most of what is published is based on emotional and philosophical premises; the 'change of life' is an emotional subject not only to women, but to men and doctors.” The purpose of the review was then listed as: “1. To analyse the current thoughts regarding the menopause. 2. To draw attention to the paucity of authoritative research and published data. 3. To serve as an indication for the urgent need for research, particularly into the nature of the menopause and the methods for the relief of menopausal symptoms and disorders; the process of 'ageing' and, in particular, the occurrence of osteoporosis and atherosclerosis in postmenopausal women; and the metabolic and vascular changes following acute hormone withdrawal, e.g. after bilateral oophorectomy in the pre- and postmenopausal female.” The conclusions of that 1968 critical review determined my future career path: “Several questions urgently require answers: 1. Is the climacteric a normal physiologic stage in the life of the human female, or is it a simple result of ovarian failure and oestrogen deficiency? 2. Are the manifestations of ageing directly related to diminution of circulating sex hormones? 3. Can the administration of exogenous oestrogen or other sex hormones prevent the manifestations of ageing? 4. Are the oestrogens at present available for administration equivalent in effect to circulating endogenous oestrogens? 5. Does long-term oestrogen administration result in an increased incidence of breast or uterine carcinoma? 6. Do oestrogens have a direct effect on the psychological state and sense of well-being in the postmenopausal patient? To these ends the development of more precise diagnostic techniques and methods of evaluation is vital.
- ItemOpen AccessPain and fertility outcomes post endometriosis surgery at Groote Schuur hospital(2023) Kalwiba, Christian; Kadwa, Khatija; Olarogun, Olufemi; Jere, KhumboBackground 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.
- ItemOpen AccessProcedures in obstetrics and gynaecology(2010) Jeffery, StephenBook providing practical approach to broad range of procedures in obstetrics and gynaecology. Textbook relevant to fourth through six year medical students.
- ItemMetadata onlyTeaching and Learning for Obstetrics and Gynaecology(2022-09-08) Gordon, ChivaugnThis collection of teaching resources for medical undergraduate students is radically different to conventional teaching. It was specifically created for emergency remote teaching through months of COVID-19 lockdown in 2020, to help students in their learning. My aim was to engage and enthuse students during an exceptionally difficult time, using out-of the box teaching methods. The intensely positive feedback from the majority of students encouraged me to create this website for wider access to facilitate learning beyond my own classroom.
- ItemOpen AccessTextbook of urogynaecology(2010) Jeffery, Stephen; De Jong, PeterMulti-authored textbook by multi-disciplinary team of experts summarising the most up-to-date concepts and management strategies in urogynaecology. Used to teach physiotherapists and nurses working in the field of Urogynaecology.