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 28  I ISSUE 1 I Feb/Mar 2018

WHO estimates that 3 to 6% of all births will result in obstructed labour.1 Globally the annual incidence of obstetric fistula caused by prolonged obstructed labour is 100,000 and 2 million women have untreated fistulae. In the 21st century obstetric fistula are confined to Africa and South Asia.2 Obstetric fistulae could be prevented by timely intervention through Caesarean sections (CS).

GB Theron

Introduction
Sampson first described haemorrhagic endometriotic cysts in 1921 and since then many systems have been suggested to classify endometriosis.1 These systems have
utilized symptomatic, clinical, biochemical, histological, anatomical, and radiological parameters or combinations of these. While some classifications have aimed to describe the anatomical extent of disease; others have aimed to quantify pain, fertility outcomes, quality of life and prognosis. Endometriosis is estimated to affect 10- 15% of all women. The degree of affectation is not easily quantifiable, and different classification systems address different aspects of the disease. Historic classification systems were mainly focussed on fertility and more patient-centric systems that aim to address pain and quality of life have only come into existence in recent years. In this article we will review the classification systems in common use.

A Barnard, VV Thomas, IT Siebert

Introduction
Chronic pelvic pain (CPP) is a common, disabling disease present for 6 months or longer that is associated with significant morbidity, distress and reduced quality of life and may occur in both males and females. Diagnosing CPP may be a complex process as there is no single definition that comprehensively describes this condition. The International Association for Study of Pain (IASP) describes CPP as “chronic or persistent pain in pelvis-related structures; often associated with negative emotional, sexual, behavioural and cognitive consequences, as well as symptoms that suggest dysfunction in such systems. Its symptoms include cyclic or acyclic pain; however it is not necessary to show symptoms for more than six months if the patient present evidence of central sensitization”.

E Thomas

Introduction
The complication of hypotonic fluid overload has classically been described in urological literature as transurethral resection of the prostate (TURP) syndrome, but this syndrome may also occur during hysteroscopic procedures, typically those utilising monopolar instruments. The absorption of distension media may lead to significant hyponatraemia and hypo-osmolality, and result in neurological and cardiovascular complications. The incidence of severe fluid overload during hysteroscopy is up to 5% and severe morbidity occurs in up to 40% of patients with severe hyponatremia. A clear understanding of the nuances of TURP syndrome, including its prevention and complications will aid the gynaecologist to practice safe
operative hysteroscopy and optimise patient outcomes.

KT Abraham, A Barnard, VV Thomas

Introduction
Uterine leiomyoma are the most common benign gynecological tumor in reproductive aged women, affecting up to 70-80% of women by the age of 50.
Hysterectomy is regarded as the most effective form of treatment for symptomatic leiomyoma, however in patients still desiring fertility, uterine sparing surgery on
the form of a myomectomy is often indicated. Total or sub-total hysterectomy is one of the most common gynecological surgeries performed, and symptomatic uterine leiomyoma are the indication in the majority of cases for the hysterectomy. Other benign indications for hysterectomy includes, abnormal uterine bleeding (AUB), pelvic organ prolapse, adenomyosis and endometrial hyperplasia.

G Hanekom, I Siebert, L Hugo, V Thomas

Introduction
The 52mg levonorgestrel (LNG) releasing intrauterine system (IUS) also known as Mirena©, Levosert®, or Lilletta® was developed by Tapani Luukkainen at the Steroid Research Laboratory in Helsinki in the 1970’s. After many years of research it was initially marketed in Finland in 1990 and worldwide over the next decade. Schering AG, Berlin was the first pharmaceutical company to do so until it was taken over by Bayer who currently sell it as Mirena although a generic version (Levosert in Europe, Lilletta in the USA) is made by Actavis, in Iceland.

ND Goldstuck, J Kluge

In counselling expecting parents concerning prenatal screening for chromosomal abnormalities e.g. Down’s syndrome (T21), the key principle is that it should be voluntary, should be easily understood with clear and complete information that allows patients to make informed, preference–based screening and diagnostic testing decisions.

I Bhorat, L Chauke, E Coetzee, L Geerts, H Lombaard, E Nicolaou,
L Pistorius, P Soma-Pillay

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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