Obstetrics and Gynaecology Forum 2021-07-30T07:22:32+00:00 Prof Great Dreyer Open Journal Systems <p style="font-weight: 400;"><em>OBSTETRICS &amp; GYNAECOLOGY FORUM&nbsp;</em>is written by specialists in the field. It aims,&nbsp;primarily, to present articles on the practice of&nbsp;Obstetrics and Gynaecology in South Africa&nbsp;and is distributed to GP’s and Specialists&nbsp;concerned with the rendering of healthcare to&nbsp;women.</p> <p style="font-weight: 400;">The views expressed in individual articles are&nbsp;the personal views of the Authors and are&nbsp;not necessarily shared by the Editors, the&nbsp;Advertisers or the Publisher. No articles may&nbsp;be reproduced in any way without the written&nbsp;consent of the Publisher.</p> The consequences of the consequences: Can higher-order thinking skills help us reconsider the criminalization of cases of alleged medical negligence? 2021-07-30T07:12:12+00:00 M. Malebane <p>No Abstract.</p> 2021-07-30T00:00:00+00:00 Copyright (c) The accuracy of spot urine protein-to-creatinine ratio in diagnosis or exclusion of signifi cant proteinuria in pre-eclampsia 2021-07-30T07:13:40+00:00 B.S. Mdunge S.M. Baloyi <p><strong>Background:</strong> Proteinuria is a major component of preeclampsia. Urine protein measurement after 24-hour urine collection is the traditional standard method for the detection of proteinuria. It is time- consuming and costly. Prompt diagnosis of preeclampsia is necessary to prevent fatal maternal and foetal complications. As an alternative, random spot urine protein to creatinine ratio (PCR) has been investigated.</p> <p><strong>Objectives</strong>: To assess if spot urine protein-creatinine ratio can be used as an alternative diagnostic test to the traditional quantitative 24-hour urine protein excretion for signifi cant proteinuria in pre-eclampsia.</p> <p><strong>Methods</strong>:</p> <p><strong>Study Design</strong>: Case-control study. Prospective cross-sectional study was conducted on pregnant women with equal to or more than 20 weeks’ gestation, admitted for pre-eclampsia work-up at Pelonomi Regional Hospital from July 2020 to December 2020.Results: In total, 99 patients were included. There was a high correlation rate (r=0.74, P&lt;0.001.) between the two tests. The area under the curve (ROC) was 0.8506. The optimal PCR cut-off found was 30mg/mmol (sensitivity=81.45%, specifi city=77.7 8%). The PPV was 81,48 % and the NPV was 77,78 %. The LR+ was 3.67 and LR- was 0.24.</p> <p><strong>Conclusion</strong>: The random urine spot protein-creatinine ratio is a good alternative diagnostic test for signifi cant proteinuria in pre-eclampsia because of its high correlation rate (r=0.74, P&lt;0.001.) with 24-hour urine protein. It is a cost-effective, easy, non-invasive, and faster test. This will reduce the patient’s stay in hospital, prevent complications associated with pre-eclampsia and will shorten diagnosis-treatment interval.</p> 2021-07-30T00:00:00+00:00 Copyright (c) Factors aff ecting VBAC success at a Tertiary Level Hospital in Pretoria, South Africa 2021-07-30T07:19:55+00:00 T. Masina P. Soma-Pillay <p>There is growing concern about rising global caesarean delivery (CD) rates. One of the strategies to overcome this problem is to reduce primary caesarean section. A trial of labour following a previous CD is another option that may be explored.<br><strong>Aim</strong>: The aim of the study was to determine the success rate and risk factors for women attempting vaginal birth after a prior caesarean delivery (VBAC).<br><strong>Methods</strong>: This was a retrospective analysis from 2013-2018 of women attempting a vaginal birth after caesarean section at a tertiary level hospital in Pretoria, South Africa.<br><strong>Results</strong>: The VBAC success rate was 36%. Factors that were associated with a successful VBAC were a third pregnancy, previous successful VBAC (61%), presentation in the active phase of labour and a neonatal birthweight of less than 3kg.<br><strong>Conclusion</strong>: Pregnant women with a CD in a prior pregnancy should be appropriately counselled regarding delivery options. Risks and benefi ts of elective repeat caesarean delivery versus trial of labour should be clearly explained to expectant mothers.</p> 2021-07-30T00:00:00+00:00 Copyright (c) Knowledge about human papilloma virus (HPV) disease and vaccination among primary health care nurses at Nelson Mandela Bay clinics 2021-07-30T07:20:14+00:00 L. Tangayi M. Mabenge <p><strong>Background</strong>: Primary prevention of cervical cancer is recommended by prophylactic HPV vaccine administration to girls before sexual debut. Vaccination coverage can be increased by nurses’ counselling and recommendations to parents.</p> <p><strong>Objectives</strong>: Our aim was to investigate the knowledge of nurses working in primary health care clinics in the Nelson Mandela Bay (NMB) area, Port Elizabeth, on HPV disease and vaccine. We also explored the attitudes and perceptions of the nurses on HPV vaccine.</p> <p><strong>Methods:</strong> We conducted a cross-sectional descriptive study by means of self-administered questionnaires, completed anonymously by nurses in primary health care clinics in NMB. Data were collected on participants’ demographics, knowledge of HPV infection and – vaccine as well as their attitude and perception regarding the HPV vaccine.</p> <p><strong>Results</strong>: The mean age of participating nurses was 46.9 years, and about 75% had more than fi ve years’ work experience. Knowledge on HPV transmission and its prevention was good, but was lacking on HPV vaccine and vaccination. Respondents showed a positive attitude and perception towards the HPV vaccine.</p> <p><strong>Conclusion:</strong> Our study showed that the nurses at Nelson Mandela Bay clinics have limited knowledge about HPV and had poor knowledge about the HPV vaccine itself and to whom and when to administer it.</p> 2021-07-30T00:00:00+00:00 Copyright (c) Tubal Ectopic Pregnancy 4 years after hysterectomy: A case report 2021-07-30T07:20:41+00:00 B. Magagula L. Malahlela G. Dreyer <p><strong>Background: </strong>Ectopic pregnancy after hysterectomy is a rare event. To date there are 73 defi nitive cases of post-hysterectomy ectopic pregnancy. The fi rst case was reported by Wendler in 1895.<br><strong>Case:</strong> A 31 year old P2G4 (one miscarriage) presented with a history of severe lower abdominal pain of three days duration. She previously had a subtotal hysterectomy four years prior her current presentation for a septic miscarriage with multiple organ dysfunction. She had a background history of being HIV reactive on antiretroviral therapy initiated two days before her presentation. Her CD4 count was 54 cells/uL, negative cryptococcal latex test. She was fi rst diagnosed with HIV in 2015, however had not been on antiretroviral therapy since then. On clinical examination she was hemodynamically stable, normal blood pressure and pulse, afebrile and no stigmata of AIDS. She had an acute abdomen and on pelvic examination a cervical stump was palpable with no blood from the cervical os. Her haemoglobin was 13.4g/dl. Urine pregnancy test was positive. Her quantitative beta-HCG of 3979 IU/L. Pelvic ultrasound showed fl uid collection in the pelvis, no defi nite masses seen, no uterus seen and ovaries could also not be visualised. Abdominal ultrasound did not show any abnormalities in the rest of the abdomen. The patient was counselled for surgery. Preparation with multidisciplinary consultation was done. Intraoperatively, 100ml haemoperitoneum was found. There were dense pelvic adhesions. Adhesiolysis was done and a bleeding right fallopian tube ampullary pregnancy was found. The right ovary was grossly normal. The contralateral adnexa could not be identifi ed. A right salpingectomy was done. Total blood loss was 100ml. She recovered well post operatively and was discharged three days later to continue her antiretroviral therapy.<br><strong>Discussion</strong>: A rare case of tubal ectopic pregnancy after hysterectomy is presented. Access to the peritoneal cavity and fallopian tube&nbsp; through the cervical canal, we postulated as the mechanism in this case. Ectopic pregnancies after hysterectomy are classifi ed into early and late. The former being associated with a pregnancy (or viable gametes) that was present at the time of hysterectomy. These present soon after the hysterectomy. The latter present long after the hysterectomy. Conception can occur after hysterectomy through access via a prolapsed fallopian tube, a fi stula or defect in the vault. Cervical stump pregnancy is also described. Surgical intervention is the most common intervention described amongst the case reports.<br><strong>Conclusion:</strong> Pregnancy after a hysterectomy is a rare possibility with possible adverse outcomes. Clinicians must have a strong index of suspicion for a possible ectopic pregnancy in patients that present with abdominal pain after hysterectomy.</p> 2021-07-30T00:00:00+00:00 Copyright (c) Three cases of heterotopic pregnancy at a tertiary hospital in Port Elizabeth, South Africa 2021-07-30T07:21:02+00:00 M. Mabenge E. Hancke Z. Sipuka <p>Heterotopic pregnancy is defi ned as the coexistence of intrauterine and extra uterine pregnancy. A high index of suspicion is needed for early and timely diagnosis and intervention. Clinicians should remain alert to the possibility of heterotopic pregnancy even when an&nbsp; intrauterine pregnancy is confi rmed. Management options for heterotopic pregnancy includes expectant management, surgical&nbsp; intervention, medical management as well as transabdominal sonographic guided aspiration of the ectopic gestational embryo.With early diagnosis and treatment, 70% of the intrauterine pregnancies will reach viability</p> 2021-07-30T00:00:00+00:00 Copyright (c) Amniotic Band Destruction Syndrome causing Umbilical cord strangulation in a pregnancy with diabetes: A case report 2021-07-30T07:21:44+00:00 Shah Krupa Sangha Surabhi A.P. Ashwini Bhat Shashikala Vinod Vinutha <p>Amniotic band destruction syndrome is rare. It is a constellation of major and minor abnormalities, which arises from lacerated amniotic band. The amniotic band syndrome involving umbilical cord constriction is even rare. We describe a case of umbilical cord constriction resulting in fetal demise and limb defects in second trimester.</p> 2021-07-30T00:00:00+00:00 Copyright (c) Marketing novel devices in medicine with reference to gynaecological innovations: Ethical dimensions 2021-07-30T07:22:11+00:00 Z. Abdool M. de Roubaix <p>New scientific and technological discoveries in all spheres of Medicine continuously challenge the boundaries of healthcare. To this end, the discipline is considered progressive and accomplished. The birth of this heavily professionalized discipline has leveraged the potential for the healthcare industry to innovate, regulate and disseminate proprietary products with relative ease. The rise and fall of four novel&nbsp; gynaecological devices represent excellent examples of ethical dilemmas in clinical medicine. This paper aims to deconstruct the power versus knowledge conflict, and suggest that reappraisal and recourse to Aristotelian virtue ethics will assist in shifting the decisional power balance primarily towards the physician.</p> 2021-07-30T00:00:00+00:00 Copyright (c)