OBSTETRICS & GYNAECOLOGY FORUM is written by specialists in the field. It aims, primarily, to present articles on the practice of Obstetrics and Gynaecology in South Africa and is distributed to G.P’s and to Specialists concerned with the rendering of healthcare to women.

The views expressed in individual articles are the personal views of the Authors and are notnecessarily shared by the Editors, the Advertisers or the Publisher. No articles may bereproduced in any way without the writtenconsent of the Publisher.

VOLUME 27  I ISSUE 1  I March 2017

During the pre-antiretroviral era 50% of transmissions occurred during labour and delivery. Elective Caesarean sections prior to the onset of labour in low and most middle income countries were not a feasible option. The success of the landmark 076 study conducted in the USA in reducing perinatal mother to child transmission (PMTCT) of HIV to 8.3% compared to 25,5% in the control group was published in 1994.1 The significant reduction in MTCT left health workers in high HIV prevalence countries in sub-Sahara Africa despondent. The intrapartum use of intravenous zidovudine (AZT) was not available and affordable. The HIVNET012 study conducted in Uganda and published in 1999 compared intrapartum single dose (sd) nevirapine (NVP) to the mother and new born infant to oral AZT used 3 hourly intrapartum and administered twice daily for 7 days to the infant.2 A 47% reduction in MTCT in the sdNVP arm compared to the AZT arm of the study was found. A reduction in HIV transmission from the estimated 21% to 43% in lesser resourced countries at that time to 12% at 6 to 8 weeks of age by using sdNVP was achieved. Intrapartum and neonatal sdNVP was both feasible and affordable in high HIV prevalence countries in sub- Sahara Africa and was embraced by most of these countries.

GB Theron

Introduction
First described by Horney and Frank in 1931 as “premenstrual tension”1, Premenstrual Tension Syndrome (PMS) is a “cluster of predictable physical, psychological and behavioral symptoms”2 usually confined or worsened in the luteal phase, relieved with the onset of, or shortly after, menstruation followed by a symptom free week. A more severe form of PMS, Premenstrual Dysphoric Disorder (PMDD) has been included in the Diagnostic and Statistical Manual of Mental Disorders (DSM–V) manual and should be regarded as the extreme end of a clinical spectrum.

C Marais

Introduction
Polycystic ovary syndrome (PCOS) can be a challenging and frustrating condition for both treating clinician and patient alike. It is a common endocrine disorder occurring in 5-10% of women in the reproductive age.1 The aetiology is multifactorial and is still not very well understood.2 Despite diagnostic controversies3,4, the Rotterdam criteria is the universally adopted and practiced.5 It describes the diagnosis of PCOS by the presence of at least two of three (chronic anovulation, clinical and/or biochemical hyperandrogenism and polycystic ovaries on ultrasound) [Figure 1].5 For comprehensive and holistic care of patients with PCOS, one has to understand the (short and long term) complications associated with the disorder. For the purpose of this article, however, we will address only the challenges in the reproductive age and they include menstrual irregularities, hirsutism and/or acne, infertility,

T Matsaseng

Introduction
Exclusive breastmilk is the optimal feeding for infants up to six months of age. Established short-term benefits of exclusive breastmilk include providing a child’s first immunity and thereby decreasing morbidity and mortality associated with infections. Long-term benefits include a lower mean blood pressure and total cholesterol in adults and improved performance in intelligence tests. The World Health Organization (WHO) recommends exclusive breastfeeding up to 6 months of age, and the continuation of breastfeeding up to 2 years of age. Mothers however struggle to achieve exclusive breastfeeding and South African breastfeeding rates represent some of the lowest rates in the world. The exclusive breastfeeding rate in South Africa is 11.6% in infants younger than 4 months and 8.3% in infants up to the age of 6 months compared to a global rate of 38%.

N Steyn, EH Decloedt

Introduction
In this era of information overload, pregnancy can be quite daunting for the new mother and often, more so, her doctor who needs to advise her on safe practices and a healthy life style during her pregnancy. It is often the case that women turn to family, friends and social media for advice, ultimately being presented with conflicting information. This article therefore serves to explore some pregnancy “dos and don’ts” and provide evidence based advice and expert opinion based on established international guidelines where available. Well proven and dangerous habits such as alcohol use and smoking have not been covered by this article.

DL Prince, LR Vollmer

Introduction
The oral contraceptive has been available for nearly 60 years. The remarkable story of its development features Gregory Pincus, John Rock and Margaret Sanger.1 Progesterone and the synthetic progestin ethisterone were known to inhibit ovulation but were weakly orally active, and thus not really suitable to act as ovulation inhibiting
agents. It was the synthesis of the orally active progestins, nor-ethisterone and nor-ethynodrel in the early 1950’s which made oral contraception feasible. These progestins enabled Pincus, Rock and Sanger to clinically test the birth control pill. Numerous other progestins followed (Table 1). Initially these progestins were combined with 75-100μg of mestranol or ethinyl-estradiol (EE2). The first generation
estranes (Table1) are testosterone derivatives (19 carbon atoms) and are partially metabolised (~5%) to estrogens. Second generation progestins (gonanes) are not partially metabolised to estrogen. While the third generation gonanes are similar but generally more active (potent-see explanation further on). The pregnanes (Table1) are progesterone derivatives (21 carbon atoms) but initially were less used. They are surprisingly coming back into favour and being used in new formulations..

ND Goldstuck, J Kluge

Zane Wilson Founder SADAG

  • Neil Amoore,
  • Psychologist, Johannesburg
  • Kevin Bolon,
  • Psychologist, Johannesburg
  • Dr Jan Chabalala,
  • Psychiatrist, Johannesburg
  • Dr Lori Eddy,
  • Psychologist, Johannesburg
  • Lee-Ann Hartman,
  • Psychologist, Johannesburg
  • Dr Frans Korb,
  • Psychiatrist/Psychologist, Johannesburg
  • Professor Crick Lund,
  • Psychiatrist, Cape Town
  • Dr Rykie Liebenberg,
  • Psychiatrist, Johannesburg
  • Dr Colinda Linde,
  • Psychologist, Johannesburg
  • Zamo Mbele,
  • Psychologist, Johannesburg
  • Nkini Phasha,
  • SADAG Director, Johannesburg
  • David Rosenstein,
  • Psychologist, Cape Town
  • Professor Dan Stein,
  • Psychiatrist, Cape Town
  • Professor Bernard van Rensburg,
  • Johannesburg
  • Dr Sheldon Zilesnick,
  • Psychiatrist, Johannesburg
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