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 2  I May 2017

This edition of the O and G Forum does not have a theme but attempts to provide practical advice on common clinical matters affecting pregnant women and their
families. Hypertensive disorders of pregnancy (HDP) remain the commonest direct cause of maternal mortality in South Africa (Saving Mothers Report 2011-2016). Attempts so far to decrease deaths from HDP have not been successful, mainly because health care workers do not make themselves familiar with guidelines on the prevention and management of these disorders. Osman and Anthony outline the management of Acute Pulmonary Enema, which accounts for about 30% of all deaths due to HDP. This paragraph should read:

J Moodley

Introduction
Pulmonary oedema (PE) may complicate both hypertensive and heart disease in pregnancy. Maternal mortality due to hypertensive disorders of pregnancy is common and largely preventable.1 The National Confidential enquiry into maternal deaths consistently shows that hypertensive deaths rank among the three leading causes of death and more than 50% of the deaths are assessed to be avoidable. The reasons cited for mortality in hypertensive parturients include cerebrovascular hemorrhage and PE. The latter entity can be inferred from a combination of organ systems described to be failing in hypertensive patients. These categorized organ failures include heart failure, respiratory failure and renal failure, all of which manifest with varying degrees of fluid overload or oedema including PE.

A Osman, J Anthony

A critique of standard fetal monitoring models shows that in many areas of high risk obstetrics, our present standard fetal monitoring models are inadequate or inappropriate in detecting fetal compromise and makes the case for additional monitoring methods to assist the clinician in the decision- making process and for timeous delivery. The problem is that inflexible standard monitoring models are used to detect fetal compromise from differing pathophysiological mechanisms in these high risk obstetric conditions. An example would be gestational diabetes where the primary pathophysiology is abnormal metabolism, yet the present monitoring tools to detect fetal compromise in diabetes revolve around placental insufficiency rather an abnormal metabolic state. In this respect can the addition of fetal cardiac function monitoring improve our prediction and detection capabilities of fetal compromise, where this could become part of the clinical work-up? A number of high risk obstetric conditions in particular gestational diabetes, intra-uterine growth restriction (IUGR), and pre-eclampsia have a significant impact on the fetal heart.

I Bhorat

Introduction
An estimated 36.7 [34.0 –39.8] million people worldwide were living with HIV infection by the end of 2015. Among these individuals, 7.0 [6.7 – 7.4] million were living in South Africa (SA).2 These individuals were infected through a number of means. Of the various routes of HIV transmission, sexual contact is the commonest.3,4 In SA, 98% of HIV infections are estimated to be transmitted sexually.5 There is a concerted effort to zero HIV transmission through various measures.6-8 One of these measures is the provision of pre- exposure antiretroviral prophylaxis (PEP) service is provided routinely to specific groups of people in the public health sectors in SA.

NC Ngene, SC Onwukwe

Introduction
Caesarean section (CS) is the most common reason for laparotomy in South Africa and worldwide. The need to improve the safety of CS has recently come under the spotlight in South Africa, in view of the large number of maternal deaths related to CS that have recently been notified to the South African confidential enquiry into maternal deaths. For every CS-related maternal death, it is likely that there are several cases of severe morbidity related to CS. Such morbidity includes severe haemorrhage and severe sepsis (both of which may necessitate hysterectomy and intensive care unit admission), injuries to the urinary tract or the bowel as well as anaesthetic complications.

NF Moran

Introduction
Since 1997, abortion has been legal in South Africa in the first trimester under all circumstances. Between 13-20 weeks’ gestation abortion is legal in cases of socioeconomic hardship, rape, incest and for reasons related to the health of the pregnant woman or fetus. Despite the progressive law, however, access to abortion is challenging for many women for a host of reasons including a lack of willing providers and stigma surrounding abortion services, providers and clients. Two new articles on medication abortion by researchers from Ibis Reproductive Health, Ipas, the University of Cape Town, King Dinuzulu Hospital, and the University of KwaZulu-Natal add to the growing body of evidence around women’s use of medication abortion as well as estimating the costs to women and the health system.

T Fetters, N Lince-Deroche, J Moodley

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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