South African Journal of Obstetrics and Gynaecology https://www.ajol.info/index.php/sajog The <em>South African Journal of Obstetrics and Gynaecology</em>is published by the South African Medical Association and publishes papers related to obstetrics and gynaecology. <p>Other websites related to this journal: <a title="http://www.sajog.org.za/index.php/SAJOG" href="http://www.sajog.org.za/index.php/SAJOG" target="_blank">http://www.sajog.org.za/index.php/SAJOG</a></p> Health & Medical Publishing Group en-US South African Journal of Obstetrics and Gynaecology 0038-2329 Material submitted for publication in the South African Journal of Obstetrics and Gynaecologyl (SAJOG) is accepted provided it has not been published elsewhere. Copyright forms will be sent with acknowledgement of receipt and the SAJOG reserves copyright of the material published. The SAJOG does not hold itself responsible for statements made by the authors. Does perineal body thickness affect faecal incontinence in multiparous patients? https://www.ajol.info/index.php/sajog/article/view/183945 <strong>Background</strong>. Obstetric trauma is the most common cause of faecal incontinence in multiparous women. The literature has shown that women with obstetric trauma to the anal sphincter have decreased perineal body thickness (PBT).<br /><strong>Objective</strong>. To determine the role of PBT in the assessment of this type of faecal incontinence in multiparous patients.<br /><strong>Methods</strong>. Forty-four women with faecal incontinence, and 36 asymptomatic women who had had two or more previous deliveries, were investigated with endoanal ultrasonography from January to December 2016. The patients were divided into three groups on the basis of PBT: &lt;10 mm, 10 - 12 mm and &gt;12 mm. The degree of faecal incontinence was measured using the Wexner faecal incontinence score. Sphincter angle defect was separately measured for each patient.<br /><strong>Results</strong>. The mean (standard error) age of all of our 80 patients was 46.9 (1.3) years (range 26 - 77 years), and the mean PBT in incontinent patients was 8.78 (2.84) mm, and 12.65 (16.76) mm in asymptomatic subjects (p&lt;0.001). The mean Wexner score was 8.6 (range 2 - 20) in incontinent patients. External anal sphincter defect angles were negatively correlated with PBT (p=0.045). For 89% of the patients, there was a history of vaginal delivery, and 62.5% had undergone one or more prior episiotomies during delivery. A PBT &lt;10 mm was associated with sphincter defect in most incontinent patients.<br /><strong>Conclusion</strong>. PBT plays a significantly important role in faecal incontinence, so it is recommended that it should be one of the factors involved in anal incontinency evaluations. AMAH Alhurry MA Akool SV Hosseini H Khazraei L Moosavi S Pourahmad Copyright (c) 2019-02-27 2019-02-27 24 3 28 31 Thoracic endometriosis syndrome https://www.ajol.info/index.php/sajog/article/view/183946 A 35-year-old nulliparous patient with secondary infertility presented to a tertiary hospital in Johannesburg with abnormal uterine bleeding, and a history of two previous right-sided haemopneumothoraces. The second episode had been related to her menstruation, and required the insertion of an intercostal drain in order to treat the large haemothorax. A pleural biopsy revealed pleural endometriosis. She was treated with dienogest (Visanne) on discharge, and was awaiting follow-up with the cardiothoracic surgeons for continued and definitive management. D Guidozzi E Rockson Copyright (c) 2019-02-27 2019-02-27 24 3 A rare case of ovarian lymphangioma with elevated CA-125 causing pseudo-Meigs’ syndrome https://www.ajol.info/index.php/sajog/article/view/183947 Lymphangiomas are benign congenital malformations of the lymphatic system, thought to occur as a result of obstruction of the local lymph flow system. They can occur anywhere in the skin and mucous membranes. The most common sites are the head and neck, but sometimes they are found in the intestines, pancreas and mesentery. Lymphangioma of the ovary is an extremely rare lesion. It was first described in 1908. Clinical manifestations can vary, from an asymptomatic ovarian mass to an acute abdomen. These may be confused with malignant ovarian masses, resulting in extensive surgery. A 34-year-old woman presented with dull aching pain localised to the lower abdomen, present for the previous 6 months. Ultrasound and a contrast-enhanced computed tomography scan of the abdomen were suggestive of an enlarged right ovary with massive ascites. The cancer antigen 125 (CA-125) level was 685 units/mL. Diagnostic laparoscopy revealed chylous ascites, and further, a frozen section revealed a few atypical cells, additionally strengthening the diagnosis of a malignant tumour. Staging laparotomy with total abdominal hysterectomy and salpingo-oophorectomy was finally performed. Histopathology revealed lymphangioma, with no evidence of malignancy. CA-125 also showed a rapid decline following surgery. Lymphangiomas should be included in the differential diagnosis of ovarian cystic masses, especially in patients with chylous ascites. It is very important to discriminate such cases from other malignant tumours in order to avoid overtreatment. However, a careful follow-up for at least 2 years is needed for patients with lymphangioma of the ovary, to exclude recurrence. M Mangla R Nautiyal D Prasad N Shirazi Copyright (c) 2019-02-27 2019-02-27 24 3 Is pelvic floor morphology a predictor of successful pessary retention? Original research and review of the literature https://www.ajol.info/index.php/sajog/article/view/183948 <strong>Background</strong>. Vaginal pessaries are known to be an effective treatment modality for pelvic organ prolapse (POP). Pessaries form an important part of the physician’s armamentarium in the treatment of POP, but currently many of the factors affecting their successful use are poorly understood.<br /><strong>Objectives</strong>. To determine the association between pessary retention (PR) at 1 year, and functional pelvic floor morphology, i.e. levator hiatal distance and area, and levator avulsion.<br /><strong>Methods</strong>. This retrospective study reviewed the records of 73 patients with symptomatic POP at a tertiary urogynaecological centre. This multi-ethnic cohort had previously been studied for pelvic-floor morphology, had had 4D transperineal pelvic-floor ultrasound, and had opted for a vaginal pessary as a treatment option.<br /><strong>Results</strong>. Our population had a mean age of 59.4 (range 32 - 91) years, and mean body mass index of 29.4 (range 20 - 42) kg/m2, with a mean assessment of stage 3 in the Pelvic Organ Prolapse Quantifications System (POP-Q). The level of prolapse was found to be related to PR (p=0.077). We further explored this concept using symmetric measures of association (γ=–0.353), indicating that PR decreases with increasing prolapse severity. PR was also found to be inversely associated with prior pelvic reconstructive surgery (n=63; p=0.055; γ=–0.417). There was a strong correlation that failed, however, to achieve significance by a small margin (p=0.052) between hiatal distance on contraction and PR.<br /><strong>Conclusion</strong>. This study found an inverse relationship between PR and hiatal distance on contraction, prior pelvic surgery and the severity of prolapse. This was a pilot study with a limited number of participants, and the authors plan a prospective study to further clarify the association between long-term PR and functional pelvic floor morphology. FS Paterson Z Abdool Copyright (c) 2019-02-27 2019-02-27 24 3 Gestational outcomes of patients with multiple sclerosis: A tertiary centre experience https://www.ajol.info/index.php/sajog/article/view/183949 <strong>Background</strong>. Multiple sclerosis (MS) is a disease that predominantly affects the young female population. It is important for an obstetrician to know the effects of pregnancy on MS, and vice versa.<br /><strong>Objective</strong>. To demonstrate the impact of MS on pregnancy outcomes.<br /><strong>Methods</strong>. We retrospectively evaluated demographic features, clinical characteristics, and obstetric outcomes of 47 pregnancies in 24 patients with MS, between January 2007 and December 2016.<br /><strong>Results</strong>. Patients were divided into three groups: (i) 35 pregnancies in patients with MS who were in remission at the beginning of pregnancy; (ii) 10 pregnancies in patients with MS whose disease was exacerbated at the beginning of pregnancy; and (iii) 2 pregnancies in patients with active MS whose symptoms were relieved after becoming pregnant. The overall early pregnancy loss rate was 36.2%, whereas it was 60% and 31.4% in the exacerbation and remission groups, respectively; and the overall preterm delivery rate was 30%, while it was 29.1% and 50% in the remission and exacerbation groups, respectively.<br /><strong>Conclusion</strong>. Miscarriage and preterm delivery seem to be significant obstetric complications in pregnant women with MS. O Ozyuncu A Tanacan F Aktoz M Buyukeren R Karabudak MS Beksac Copyright (c) 2019-02-27 2019-02-27 24 3 Maternal and perinatal outcomes in women undergoing expectant management of early-onset pre-eclampsia: A retrospective cohort study https://www.ajol.info/index.php/sajog/article/view/183950 <strong>Background</strong>. Expectant management of early-onset pre-eclampsia, with the aim of improving perinatal outcomes, may increase the risk of maternal morbidity.<br /><strong>Objective.</strong> To study the maternal and perinatal outcomes and their association with various risk factors in women undergoing expectant management for early-onset pre-eclampsia.<br /><strong>Methods</strong>. A retrospective cohort study was carried out in a tertiary centre in south India between April 2014 and June 2015. We studied 201 women with singleton pregnancies with pre-eclampsia diagnosed between 28 and 34 weeks’ gestation. Demographic data, medication and treatment details, and delivery data were extracted from maternal charts. The primary outcomes were: (i) composite maternal outcomes, defined as the development of any of eclampsia, abruptio placentae, pulmonary oedema or renal failure; and (ii) perinatal mortality. Logistic regression was used to assess the independent association risk factors with primary outcomes, after adjusting for other variables.<br /><strong>Results</strong>. Sixty-nine women (34.3%) had one or more of the composite adverse maternal outcomes, and there were 74 (36.8%) cases of perinatal mortality. The presence of imminent symptoms (odds ratio (OR)=2.35) and multiparity (OR=2.31) were associated with composite adverse maternal outcomes, whereas low birth weight and breech vaginal delivery were associated with perinatal mortality. Perinatal mortality was higher in women with pre-eclampsia diagnosed between 28 and 30 weeks. Gestational age at diagnosis was not found to be associated with composite adverse maternal outcomes or perinatal morbidity.<br /><strong>Conclusion</strong>. Expectant management in early-onset pre-eclampsia can be safely considered without increasing maternal risk, after thorough counselling about outcomes, based on the available neonatal facilities in low-resource settings. N Vijayan A Keepanasseril N Plakkal V Udupa SS Raghavan Copyright (c) 2019-02-27 2019-02-27 24 3