Obstetrics and Gynaecology

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Browsing Obstetrics and Gynaecology by Subject "Dissertation (M.Med. (Obstetrics and Gynaecology))--University of the Free State, 2019"

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    Normal platelet count in the HIV positive pregnant patient
    (University of the Free State, 2019-04) Van Wyngaard, Bianca; Zondagh, Inge
    Background. Thrombocytopenia complicates 6.6% – 11.6% of all pregnancies. Gestational Thrombocytopenia accounts for the majority of cases, it is usually mild with spontaneous resolution postpartum. It is estimated that more than 25% of pregnant South African patients are HIV positive. Objectives. The objective of the study was to determine the platelet count for HIV positive pregnant patients. This will lead to minimizing unnecessary invasive testing and workup for other pathologies. Method. This was a prospective descriptive study in which low and mild risk pregnant patients with WHO stage 1 HIV disease were recruited for participation. In patients that needed routine blood tests drawn, a platelet count was added. Patients were either first visit patients or following up for routine antenatal care. Results. For all participants (n = 120), the mean platelet count was 270.9 x 10 ⁹/L (range 91 –488). For first trimester participants (n = 37), the mean platelet count was 282.3 x 10 ⁹/L (range 103 – 441). For the second trimester participants (n = 28), the mean platelet count was 263.7 x 10 ⁹/L (range 91 - 470). For the third trimester participants (n = 34), the mean platelet count was 260.2 x 10 ⁹/L (range 99 - 488). For the participants where no trimester was indicated (n = 21), the mean platelet count was 278.1 x 10 ⁹ /L (range 181 - 426). Discussion and Conclusion. Stage 1 HIV does not have a clinical significant impact on the platelet count in pregnant patients.
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    Profile of cardiac patients who delivered at Universitas Academic Hospital (UAH) in Bloemfontein South Africa: 2012 – 2017
    (University of the Free State, 2019-09) Makgato, C. M.; Baloyi, S. M.; Nondabula, T.
    INTRODUCTION: Maternal deaths related to cardiac disease in pregnancy is rising globally. Cardiac disease remains the leading cause of mortality and morbidity in women with medical and surgical conditions in South Africa. Prevalence of cardiac disease in pregnancy ranges between 0.10.9% in South Africa. Pre-existing cardiac disease also contributes to significant perinatal morbidity and mortality. OBJECTIVES: To assess the profile of women with cardiac disease who delivered at UAH, taking into account maternal and perinatal outcomes, and to identify underlying risks. METHODS: A retrospective analysis of 148 files of pregnant women with cardiac disease who delivered at UAH between January 2012 and December 2017 was carried out. Frequencies and percentages were used to summarise categorical data. Medians and percentiles were used to summarise numerical data. The data analysis was generated using the SAS statistical software. RESULTS: There were 3 154 deliveries at UAH during the study period. The prevalence of cardiac disease in pregnancy was 4.7% (n=148), with black women most affected (89.7%). The average age was 27.0 years. The youngest parturient was 16 years old and the oldest 43 years old. The majority of the patients (71.6%) booked antenatal care in the second trimester, with average gestational age at 19.5 weeks. One hundred and six women (71.6%) tested negative for HIV. The study population had an average BMI of 27. The average gestational age at delivery was 36.7 weeks, with 27.3% of the babies born preterm. Twenty-one (15.3%) of these neonates were admitted to the neonatal intensive care unit. There were eight stillborn deliveries with no neonatal deaths reported. The Caesarean section rate was 67.6%. Vaginal deliveries were 32.4% of all deliveries, and 31.9% (15) of these were assisted deliveries. Of the patients with cardiac disease, 85% were New York Heart Association class (NYHA) I and II. Rheumatic heart disease (RHD), congenital heart disease (CHD) and cardiomyopathy was diagnosed in 48.6% (n=72), 24.3% (n=36) and 18.9% (n=28) of cases respectively. Cardiac failure and pulmonary oedema contributed 56% of maternal morbidity. Cardiac failure was indication for 43.8% of intensive care unit admissions. Six deaths were reported, with a case fatality rate of 4.05%. Peripartum cardiomyopathy was the cause of death in five deaths and valve thrombosis in one death respectively. All deaths were NYHA functional class III and IV. CONCLUSION: The prevalence of cardiac disease among pregnant women is increasing, with rheumatic heart disease (RHD) being the leading aetiology. The most significant increase was that of congenital heart lesions. Pregnancies complicated by underlying cardiac disease are associated with maternal and perinatal morbidity.
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    Profiles of women presenting with obstetric fistulae at Universitas Academic Hospital, Free State province, South Africa
    (University of the Free State, 2019-07) Marokane, Masekhokho M. P.; Baloyi, Shisana
    Background: Obstetric fistula is a serious consequence of prolonged and obstructed labour, common in low income countries were accessibility to emergency obstetric care may be limited. Most common cause is ischemia and necrosis of the soft tissues of the birth canal caused by the compression of the foetal presenting part against the bony pelvis. This results in abnormal communication between the vagina, bladder and/or rectum with resultant leakage of stools or/and urine through the vagina. Other causes may be tearing of those tissues or iatrogenic injury during abortions. Objectives: Primary objective To determine the prevalence of obstetric fistula at Universitas Academic Hospital urogynaecology clinic Secondary objective To determine the demographic characteristics of the women presenting with obstetric fistulae. Study design and methods: Retrospective descriptive-analytical study. Medical records and demographic characteristics of all patients referred to Universitas Academic Hospital's urogynaecology clinic with obstetric fistulae from 01 January 2013 to 31 December 2017. A 21- item data sheet was used to collect data and the latter was analysed on the Microsoft excel spreadsheet. Limitations: Small sample size, only 46 patients met the inclusion criteria over the 5 year study period. Results: The prevalence of obstetric fistula at UAH urogynaecology clinic was found to be 1% which correlates with the global estimates in the literature. The most common type of fistula was found to be rectovaginal fistula (63.04%) and mostly they developed as a result of soft tissue lacerations not necessarily ischemia and necrosis. Only 5(10.87%) patients in our population group delivered before the age of 20 though it is reported globally that this condition is the most in teenagers. Fifty percent of the study population were not married and only 2(4.35%) of the married ones were divorced. 63.04% of the study population had high school level education and only 8.7% of them were employed. Out of 46 participants only 2 (4.35%} did not seek antenatal care, the median number of follow-up in this group was 4 antenatal visits. Almost all of them {91.3%) delivered normally and only 4 had episiotomies. The perineal (71.74%) tears were common in this study group and some remained not sutured. Most of them delivered at a level 2 health care facility. Conclusion: The prevalence of obstetric fistula in our setting although shown to be low, like in the rest of the world, more attention should be paid to maternal health services as this complication of child birth is the indicator of poor/inadequate health service. Although the level 2 facilities are regarded as well equipped to deal with obstetric emergencies authorities are urged to pay more attention to skill development of the personnel rendering the maternity care as most of these cases were not appropriately managed during the intrapartum period, use of partogram during labour during be encouraged so that those patients who will end up with obstructed labour can be identified timeously.