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 3  I August 2017

Introduction
A 17-year-old woman at 20 weeks gestation is referred for a detailed anomaly scan. The fetus is diagnosed with anencephaly. How should this woman be counselled? The reflex answer is that it should be non-directive counselling. She should be provided with enough information about the condition and the management options in order to make a decision

S Adam, G Lindeque

Introduction
Obtaining valid informed consent is central to the ethical and legal duties of a doctor. In South Africa obtaining informed consent for all medical and surgical procedures has been a legal requirement since 1923 (Stoffberg Elliot). Failing to obtain informed consent breaches a patient’s constitutional right and can lead to a complaint at the Health Professions Council of South Africa (HPCSA), a civil case or even criminal proceedings for assault or battery. Ethical medical practice is based on four principles: beneficence, non-maleficence, distributive justice and autonomy. Informed consent falls under the last mentioned principle. It is important to note that informed consent for all procedures not only protects the rights of the patient, but the rights of the doctor as well, since both parties have an obligation to protect the integrity of the doctor-patient relationship.

E Wethmar

Introduction
Advances in science and technology have made it possible for women, men and couples who ordinarily would not have been able to have children, to conceive through assisted reproductive technology. Third party reproduction or donor-assisted reproduction is a form of reproduction in which DNA or gestation is provided by a third party or donor other than the two intended parents who will raise the resulting child. It includes donor sperms, donor eggs, donor embryos and surrogacy. The indications for gamete donation include patients with primary ovarian insufficiency, those who carry genetic diseases, same sex couples and those of advanced age. It is a journey that involves psychological preparation, legal issues, sociocultural issues and ethical issues. The gestational carriers are always known to the intended parents but the sperm, egg or embryo donors may be anonymous

J Biko, Z Nene

Introduction
The World Health Organisation (WHO) defines palliative care as care aimed at improving the quality of life of patients and their families confronted with
the challenges associated with a terminal illness, by way of preventing and relieving suffering through early recognition and dealing with physical,
psychosocial and spiritual difficulties. The current WHO definition is given in Box 1. While care provided by hospice is regarded as palliative care, not all palliative care provided is in a hospice. Palliative care can be delivered to patients at any point during the course of a life-threatening illness, even simultaneous with curative or lifeprolonging therapies. Palliative care can be offered in any setting and is not dependant on high-level equipment, classy buildings or technology.

MC van Aardt

Mental retardation is characterized by significantly sub-average intellectual functioning (IQ of approximately 70 or below), with onset before age 18 years and concurrent deficits of impairment in adoptive functioning in at least two of the following skills areas: communication, self-care, home living, social/interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health and safety. Young women with
mental retardation present a unique set of reproductive health concerns to both the physician and caregiver. They have varying levels of understanding of reproduction, contraception and sexuality and varying levels of ability to care for themselves and to make informed decisions.

A Mouton

Cerebral palsy(CP) cases are some of the primary reasons for litigation of high quantum amounts against obstetricians both in the public and private sector, on the basis of acute intrapartum hypoxia resulting in hypoxic ischaemic foetal brain damage and by extension invoking “negligent intrapartum care”. This has resulted in a steep rise of insurance premiums1 placing service delivery in both the public and private sector under a serious threat. This is a worldwide phenomenon and MacLennan already expressed his concerns in 2005 by asking: ‘Who will deliver our grandchildren?’. It has widely been believed that CP is the direct result of an adverse event at birth and that it could have been prevented, but <10% of CP is caused by “birth asphyxia”. There are multiple risk factors and causes now identified to be associated with CP.

I Bhorat, L Pistorius, P Soma-Pillay, I Smuts

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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