Masters Degrees (Obstetrics and Gynaecology)

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An aetiological study of white vulval skin lesions amongst patients attending the gynaecological clinic at R.K. Khan Hospital, Durban.
(1998) Moodley, Manivasan.; Moodley, Jagidesa.
BACKGROUND White vulva! skin lesions may be due to various conditions, including benign and non-benign causes. The dilemma faced by the clinician with such a patient is the aetiology of the lesion, as well as the approach to management. AIM To establish the aetiology of white vulva! skin lesions in patients attending the gynaecology clinic and to evaluate the role of Collin's test and vulvoscopy. SETTING R. K. Khan Hospital, which is a secondary level hospital in Durban, KwaZulu Natal. METHOD Sixty-two patients with white vulva! skin lesions whom consented to the study were recruited. The investigations consisted of Pap smear, colposcopy of the vulva [Vulvoscopy], perineum and where appropriate, vaginoscopy and colposcopy; Collin's test and biopsy of all abnormal areas detected by these tests. RESULTS Pruritus vulvae was the commonest presenting symptom [70%1. No vulvoscopic abnormalities were detected in 97% of patients, whilst 3% had acetowhite areas indicative of Human papilloma virus infection. Collin's test was positive in 40% of patients, although, histologically these areas were benign. All patients in the study had benign lesions on histology. CONCLUSION All patients in this study had benign causes of white vulval skin lesions. However, this cannot lead us to conclude that there is no role for doing Vulvoscopy and Collin's test, as premalignant and malignant lesions should be detected by these tests had they been present.
Apoptosis - a comparative study of its role on the trophoblast cell in normotensive and hypertensive placental bed.
(2006) Dorsamy, Enbavani.; Moodley, Jagidesa.; Naicker, Thajasvarie.
Abstract available in PDF.
An audit of couples attending the infertility unit at Inkosi Albert Luthuli Central Hospital (IALCH), Durban.
(2011) Jogessar, Jithesh Vinod.; Bagratee, Jayanthilall Sarjoo.
An audit of Couples attending the Infertility Unit at Inkosi Albert Luthuli Central Hospital (IALCH), Durban Objectives To determine the patient profile, causes of infertility and the success rates of medical and surgical treatment of infertility thus emphasizing the need for assisted reproductive treatment Methods Data was obtained retrospectively from the medical records of 281 couples that presented to Inkosi Albert Luthuli Central Hospital Infertility Unit between January 2004 and December 2006. Information was recorded on a structured proforma and data analysed using SPSS version 15.0 Results The causes of infertility were anovulation (32.7%), tubal factor (30.3%), male factor (11.7%), endometriosis (7.8%), uterine factor (4.3%) and unexplained infertility in 7.1% of cases. Couples with both male and female factors contributed to 6.1% of infertility cases. Twenty two percent of patients with severe male factor and tubal infertility could not be offered any treatment because of the unavailability of assisted reproductive technology (ART). The pregnancy rate was 24.3% after medical treatment and 14.3% after surgery. When both modalities were employed, the pregnancy rate was 26%. The overall pregnancy rate was 16% with 84% of couples requiring further treatment. Conclusion Anovulation and tubal factors were the major causes of infertility. This audit illustrates that the majority of couples (84%) require gonadotrophins and / or assisted reproductive services to achieve conception. A dedicated infertility unit should provide a full range of services including ART. A significant proportion of couples are denied this health service in the public sector in KwaZulu Natal.
An audit of peripartum hysterectomy at the Pietermaritzburg complex of hospitals.
(2012) Uzoho, Nathan N.; Moodley, Jagidesa.
RATIONALE OF THE STUDY. To carry out a retrospective chart review of all patients who had a peripartum hysterectomy in hospitals at different levels of health care in the Pietermaritzburg Hospital Complex to examine the incidence and indications for peripartum hysterectomy. METHODS. The charts of 120 cases of peripartum hysterectomy operations performed between January 2003 and January 2008 in the Pietermaritzburg hospital complex of University of KZN were analysed retrospectively. The total number of deliveries were 48 964. The traditional indications, risk factors and associated complications were revisited to determine if there have been changes in current obstetric practice. RESULTS. The overall incidence of peripartum hysterectomy at the Pietermaritzburg complex of hospital was 0.25/1000 deliveries (95% C1 0.2 – 2.9). Uterine atony, bleeding abruption placentae, placentae praevia, uterine rupture following induction and extension of uterine incision into the uterine arteries comprised 87.9% of the indications for peripartum hysterectomy. By far, the most common complications were wound infection and haemorrhage due to difficult haemostasis. Both comprised 61% of complications, others were bladder injury and renal failure. Coagulopathy occurred in 16.7% of cases of whom 2 died due to massive uncontrollable haemorrhage and 26.7% cases had relaparatomy. There were 13.3% of haemorrhagic shock and 5% developed septic shock. All the patients had blood transfusion, 13.3% of patients received platelets in addition to blood. The results showed that 55.8% had previous caesarean sections while 12.5% had VBAC. There were 75.8% live babies. CONCLUSION. The review noted that there has not been a significant change in the incidence and indications for peripartum hysterectomy. The incidence of peripartum hysterectomy in the study 0.25/1000 compared favourably with the findings from similar studies in different parts of the world. Worldwide the incidence of PH ranges from 0.2 to 5.09/1000 deliveries, in our study the incidence was 0.25/1000.
Awareness, knowledge and utilization of the human papillomavirus vaccine.
(2012) Allie, Naseera.; Moodley, Mathew.
OBJECTIVES To determine if health care workers are aware of the HPV vaccine and its availability, uptake of the vaccine and prescribing practices and reasons for non – uptake of the vaccine . METHODS Health care providers working in the private sector, in the Ethekweni health district in Kwazulu Natal, were interviewed. Health care workers included: 100 general practitioners, 50 gynaecologists, 50 paediatricians, 50 medical staff and 50 nursing staff. A questionnaire was designed for purpose of this study. Visits were be made to health care providers. All heath care providers who were willing to participate were interviewed. STATISTICS Comparisons of awareness among subgroups of health care providers was analysed using Chi-square tests. If significant, pairwise comparisons were made using a Bonferroni adjustment for multiple comparisons. Associations between awareness and other factors, such as demographic, uptake and beliefs were tested using a chi square test. Analysis was done by Stata v11 (StataCorp, 2009) i RESULTS Three hundred health care workers were interviewed - 50 gynecologists (16.7%), 52 pediatricians (17.3%), 99 general practitioners (33%), 49 other medical doctors (16.3%) and 50 (16.7%) nurses. Two hundred and sixty seven health care workers (89%) were aware of the HPV vaccine and one hundred and eighty eight health care workers (70.4%) informed patients of the availability of the HPV vaccine. Most (77.9%) practitioners have only prescribed the vaccine less than ten times. Gardasil® was prescribed by 46%, Cervarix® by 6.5% and prescription of either vaccine of health care workers was 50.2%. Practitioners were generally unaware that Gardasil® could be prescribed to males (62.9%). CONCLUSION Health care workers were aware of the HPV vaccine and prescribed the vaccine on request. However even though practitioners were aware of the vaccine, most have prescribed the vaccine less than ten times since licensing in 2008. Knowledge with regards to the licensed use of the HPV vaccines is deficient.
The cardio-metabolic profile and bone mineral density in African and Indian postmenopausal women.
(2013) Moodley, Jayeshnee.; Bagratee, Jayanthilall Sarjoo.
AIMS. To determine the cardio-metabolic risk profile and incidence of low bone mineral density in African and Indian postmenopausal women attending the IALCH menopause clinic and to determine whether there is a correlation between cardio-metabolic parameters and low bone mineral density. METHODS. A retrospective, descriptive study involving all Indian and African postmenopausal women, above the age of 40, referred to the menopause outpatient clinic at IALCH from 01 July 2009 to 31 December 2010 was conducted. Data was collected from the medi-com database using a structured questionnaire. Cardio-metabolic data was analysed as continuous variables and summarized using means and standard deviations. Bone mineral density was treated as a quantitative variable and correlation analysis was used to assess relationships between the variables. This was done for each race group separately. The Students T-test was used to compare cardio-metabolic variables between the two ethnic groups. SPSS version 18.0 was used to analyse data. RESULTS. The records of 106 women were analysed (51 African and 55 Indian). In African and Indian women, the prevalence of hypertension was 54.9% vs 65.5%, the prevalence of diabetes was 31.4% vs 56.4%, the prevalence of dyslipidaemia was 17.6% vs 32.7% and the prevalence of ischaemic heart disease was 5.9% vs 14.9% respectively. The prevalence of low bone mineral density was higher in Indian women (40%) compared to African women (23.5%). The mean body mass index (BMI) of African women was significantly higher than Indian women, (33 vs 29). There were no significant differences between African and Indian postmenopausal women regarding their lipid profile, fasting glucose, fasting insulin and thyroid profile. The mean bone mineral density (BMD) in the hip and spine was lower in Indian women compared to African women, however the prevalence of osteopaenia and osteoporosis, as defined by T-scores, was not statistically significant. Statistically significant positive correlations were observed between an increasing BMI and BMD (p<0.001) and increases in weight and BMD (p<0.001). A statistically significant correlation were observed between serum LDL-cholesterol values and BMD (p=0.03), where serum LDL-cholesterol values were inversely proportional to BMD. There were no significant correlations between BMD and the remaining cardio-metabolic variables (ie blood pressure; waist-hip ratio; clinical stigma of dyslipidaemia; clinical stigma of insulin resistance; cholesterol; HDL; triglycerides; fasting glucose; fasting insulin and thyroid function). CONCLUSIONS. There is a high prevalence of cardiovascular risks and low BMD amongst the local menopausal population, irrespective of ethnicity. African and Indian postmenopausal women had a high prevalence of hypertension (60%), diabetes (44%), dyslipidaemia (25%) and obesity (54%). In African women, the incidence of low BMD was 35% in the hip, 53% in the neck of femur and 55% in the lumbar spine. In Indian women, the incidence of low BMD was 55% in the hip, 67% in the neck of femur and 69% in the lumbar spine. BMI and weight showed a positive correlation with bone mineral density. Regarding the cardio-metabolic variables, an increasing LDL value was negatively correlated with bone mineral density. It thus is apparent that a screening lipid profile during the peri-menopausal years, coupled with early and appropriate lifestyle management regarding body mass index/ weight may limit the burden of morbidity in later life.
Challenges facing refugee women while accessing antenatal care in public health institutions in Durban, South Africa.
(2014) Kibiribiri, Edith Tuyisenge.; Moodley, D.
Background Findings from international studies claim that pregnant refugee women are at increased risk of obstetric complications due to preexisting health conditions, nutritional deficiencies and increased vulnerability to infectious diseases. All these factors are related to their poor socio-economic status, poor living conditions, limited access to essential reproductive health services and substandard antenatal care. A recent report estimated a total number of recognized refugees in South Africa reaching approximately 1 per 1000 and there are no formal published studies but newspaper reports of healthcare services in South Africa not being responsive to refugees’ needs, particularly when pregnant. This study will provide a South African perspective to the current status of the antenatal care services received by pregnant refugee women in an urban District. The quality of antenatal service rendered to refugees will be compared to that received by the local South African women to establish if refugees are indeed vulnerable to substandard care. Methods: Through administering a questionnaire to women who delivered in the past 6 months, we estimated the percentage of refugees who sought antenatal care at 4 primary health care clinics (Lancers Road, Overport, Sydenham and Clare Estate) in Durban and explored the quality of antenatal care received. The questionnaire included demographic characteristics, medical history, obstetric history and experiences with accessing antenatal care at the clinic. Using a maternity chart audit, we further conducted a quantitative comparative assessment of antenatal care received by refugees and South African women as prescribed by the National Maternity Guidelines. Health care workers who provided antenatal services at the selected clinics were also invited to participate in in-depth interviews. These health care workers were asked to share their experiences with providing antenatal care to refugees. Results: Among 200 women sequentially enrolled 39% (78/200) were refugees and 61% (122/200) South Africans. The majority among the refugees were from Zimbabwe (24.4%) and Malawi (11.5%). The remaining refugees primarily came from the Democratic Republic of the Congo (29.5%), Rwanda (5.1%), Burundi (14.1%) and Somalia (1.5%) following war and political conflict in their countries. Refugee antenatal attendees tended to be older than their South African counterparts and significantly more likely to be married. While the majority (81%) of the South African antenatal attendees understood IsiZulu, a language spoken by all health workers at the 4 clinics, only 27% of refugee antenatal attendees understood IsiZulu (p<0.0001). A review of the medical records of 68 participants (45.6% refugees and 54.4 % SA citizens), an average of 70% of women had a complete history taken, and a lower but not statistically significant proportion of refugees had a complete history taken (62.5% vs 77.4% p=0.18) when compared to their SA counterparts. Generally, antenatal services rendered were similar in both groups of participants and overall provision of health information, planning and advising pregnant women were substandard for all antenatal attendees. In comparison to South African women, refugees were not advised on maintaining their general health (p=0.018), purpose of laboratory investigations (p=0.025) and indications for treatment with accompanying dosing instructions (p=0.014). In addition, refugees were uninformed of the expected labour process or identifying labour signs (p=0.03); and were not advised on infant feeding options (p=0.003) and contraception (p<0.0001). Health care workers also expressed that the most significant challenge while providing antenatal care to refugees was the language barrier. All health care workers interviewed mentioned that they were frustrated when obtaining history of a refugee. Refugees elaborated on the language-barrier, expressed client dissatisfaction and perceived intimidation when accessing antenatal care. Conclusion: Disparities in antenatal care were noted when procedures involved verbal communication between pregnant refugees and the Health Care Worker. It has been clearly demonstrated that while there were no disparities in the antenatal management of refugees when compared to their SA counterparts, inadequate history taking and relevant health information and education not being provided because of the language barrier, would need to be addressed to prevent adverse pregnancy outcomes among refugees.
A clinical audit of laparoscopic surgery for recto-vaginal endometriosis at a tertiary referral centre in KwaZulu-Natal.
(2012) Mchunu, Makaya.; Ramphal, Surandhra Roopnarain.
Aim: The aim of the study was to evaluate the operative and post-operative complications, and outcomes of laparoscopic surgery using the Harmonic scalpel in patients with recto-vaginal endometriosis (RVE). Furthermore, pre-operative work up and referral patterns were evaluated. Design: Retrospective chart review. Method: Following ethical (BREC No. BE O42/11) and hospital regulatory approvals, a retrospective chart review of the hospital case records of all patients who underwent laparoscopic surgery for RVE using the Harmonic scalpel from January 2004 to December 2010 was performed. All relevant clinical information was captured on structured data sheets which were kept confidential and used strictly for the purposes of the audit. Results: The case records of 105 women who had laparoscopic surgery for endometriosis between January 2004 to December 2010 were identified Thirty-three (31.4%) patients with RVE were treated using the Harmonic scalpel as the main energy source. From this cohort of patients, there was one case which required conversion to laparotomy for rectal injury which was successfully repaired; one case required re-laparoscopy for suspected intra-operative bleeding and another required cystoscopy and double J stenting due to anuria of 21 hours post- surgery. The mean hospital stay was 4 days. 76% of women had improvement of pain after surgical intervention and concomitant adjuvant medical therapy was used in 30.3%. Conclusion: The usage of Harmonic scalpel as the energy source in the management of RVE appears to be safe and the morbidity is comparable to other energy sources reported in literature.
Clinical profile and management of women treated for endometrial carcinoma in Durban.
(2017) Augustine, Leon.; Bagratee, Jayanthilall Sarjoo.
Abstract available in PDF file.
A comparison of depressive scores amongst newly diagnosed HIV-infected and uninfected pregnant women using the Edinburgh Depression Scale.
(2016) Nydoo, Puvashnee.; Moodley, Jagidesa.
Objective Prevalence rates of HIV infection in KwaZulu-Natal are high, with a significant amount of those infected being women of reproductive age. A diagnosis of HIV infection has been associated with an increased risk for the development of depression. Antenatal depression is a serious health concern, as it has the potential to cause wide-reaching adverse consequences for both mother and unborn child. Thus the objective of this study is to compare depressive scores between newly diagnosed HIV-infected and uninfected pregnant women in KwaZulu-Natal to elucidate any association between a new diagnosis of HIV infection and the development of antenatal depression. Methods 102 newly HIV tested Black African pregnant women were recruited from antenatal clinics at two regional hospitals; further stratified into two cohorts based on HIV status (HIV-infected: n=40; HIV-uninfected: n=62). Women’s sociodemographic and clinical data were recorded, before being assessed for depression using an IsiZulu version of the Edinburgh Depression Scale. Results Of the sample, 9.8% suffered from depression. Prevalence rates of antenatal depression did not differ significantly between the HIV-infected and uninfected cohorts (p=0.79). A diagnosis of HIV infection (p<0.0001) and maternal age (p=0.03) are risk factors for antenatal depression. Unemployment (p=0.09) is a borderline risk factor for the development of antenatal depression. Conclusion Prevalence rates of depression are low in our sample. A new diagnosis of HIV infection in pregnancy places women at an increased risk for the development of antenatal depression. Younger age and unemployed status may also influence depression.
A descriptive analysis of patients presenting with ectopic pregnancies at King Edward VIII hospital, Durban.
(2011) Singh, Nikhil.; Bagratee, Jayanthilall Sarjoo.
OBJECTIVE: To describe the patient profile, clinical features, risk factors, management options and complications in women with ectopic pregnancy. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: King Edward VIII Hospital, Congella, Durban from July 2005 – June 2006. MATERIALS AND METHODS: 130 case notes of women with the final diagnosis with ectopic pregnancy were examined retrospectively. Data was retrieved through a structured proforma. The variables studied included age, parity, signs and symptoms, treatment, management, complications and associated maternal morbidity and mortality. RESULTS: One hundred and twenty women diagnosed with ectopic pregnancy were included in this study. Ten patients were excluded due to failure to obtain clinical records. Women’s ages ranged from 17-40 years with 32 patients (26.7%) being nulliparous and 88 patients (73.3%) between parity 1-4. Twelve patients (10%) had a history of previous ectopic pregnancy. The commonest presenting symptom was abdominal pain in 106 (88.3%) patients whereas amenorrhoea and vaginal bleeding were found in 88 (73.3%) and 84 (70%) patients respectively. The most common physical sign was tenderness: Adnexal tenderness in 99 (82.5%) and pelvic tenderness in 91 (75.8%) of women. Fourteen women (11.7%) presented to the gynaecological outpatient’s department in acute shock with a blood pressure < 90/60 mmHg. The commonest ultrasound findings were the presence of an adnexal mass and an empty uterus in 82 (68.3%) and 80 (66.7%) women respectively. The most frequent risk factors were previous genital infection in 34 patients (28.3%) and multiple sexual partners in 32 patients (26.7%). One hundred and eleven 92.4%) women were managed by laparotomy: One hundred and four (87.4%) women via emergency laparotomy and 6 women (5%) had an elective laparotomy. One patient (0.8%) had a diagnostic laparoscopy which was converted to laparotomy. Only 8 patients (6.7%) were managed laparoscopically. Surgical treatment consisted of salpingectomy 101/120 (84.9%) and salpingotomy in 4 (3.4%) patients. Post- operation complications were minimal however the one maternal death was probably due to a pulmonary embolus. CONCLUSION: Risk factors may not always be present, hence ectopic pregnancy should be suspected in every women of reproductive age who present with unexplained abdominal pain, amenorrhoea and vaginal bleeding. Most women presented with ruptured ectopic pregnancies at King Edward VIII Hospital warranting emergency laparotomy.
Evaluation of haematological parameters and immune markers in HIV-infected and non-infected pre-eclamptic Black women.
(2007) Naidoo, Kalendri.; Moodley, Jagidesa.
This study focuses on women with both pre-eclampsia and Human Immunodeficiency Virus (HIV). Pre-eclampsia is a pregnancy-specific syndrome that occurs after 20 weeks gestation. Thrombocytopenia is the most common haematological abnormality in pre-eclampsia. Further, studies suggest that the immunological mechanism plays some role in the aetiology of pre-eclampsia. The immunological hallmark of HIV infection is a progressive decline in the number of CD4 T lymphocytes and significant haematological abnormalities are also common in HIV-infected individuals i.e. anaemia, thrombocytopenia and leukopenia. The study population comprised of two groups i.e., pre-eclamptic HIV-positive African women and preeclamptic HIV-negative African women as the control group. Samples were analysed for haematological parameters (full blood count) and immunological markers (flow cytometry). There was no statistical significance in the following parameters: RBC, Hb, haematocrit, MCV, MCH, MCHC, platelets, MPV, WBC, lymphocytes, neutrophils, eosinophils, monocytes, basophils and CD8. There was a statistical difference in the CD3 and CD4 counts between both the groups. However, the CD3 and CD4 counts were within the normal range in the HIV-negative pre-eclamptic group and even though CD3 decreased, it was still within the normal range in the HIV-positive pre-eclamptic group, with CD4 decreasing below the normal range in the HIV-positive pre-eclamptic group. This suggests that immune mechanisms involving CD estimations do not play a role in pre-eclampsia since the decrease in the counts can be solely attributed to HIV infection. Results obtained in this study do not show any severe haematological or immunological abnormalities when women have both pre-eclampsia and HIV infection.
An evaluation of outcomes and complications of patients undergoing mid-urethral tapes insertion for stress urinary incontinence at a tertiary institution.
(2016) Maistry, Charlene.; Ramphal, Surandhra Roopnarain.
Abstract available in PDF file.
The frequency of insulin resistance and hyperlipidaemia in women with polycystic ovarian syndrome (PCOS) attending Inkosi Albert Luthuli Central Hospital .
(2010) Magan, Nitasha.; Bagratee, Jayanthilall Sarjoo.
BACKGROUND. Polycystic ovarian syndrome is one of the commonest endocrinopathies in women of reproductive age. The prevalence of the disease is estimated to be around 5 % in general population (Azziz, 2004). Literature on the prevalence of PCOS in Black women is limited (Knochenhauer, 1998). This syndrome is a diagnostic conundrum due to the phenotypic variability of these women. The PCOS woman also has a greater disposition for impaired glucose homeostasis as well as hyperlipidaemia. OBJECTIVE. The hormonal and metabolic profiles of South African women with PCOS have not been described. Ethnic differences in the prevalence of PCOS have also not been well explored. Our study aims to describe and compare the phenotypic profile of African and Indian women with PCOS and to determine the frequency of insulin resistance and hyperlipidaemia in these women. METHODS. A retrospective audit of all patients attending gynaecology endocrine and infertility clinics over the period June 2005 to June 2009 was carried out. The biochemical and clinical profiles were analysed and a comparative analysis between the two largest groups, Indian and Black women were done. All women that attended these clinics were subjected to a fasting lipogram and fasting serum glucose. An abnormal fasting serum glucose would have necessitated a full glucose tolerance test. RESULTS. A total of 110 patients were analysed in this study. There were 87 Indian patients, 16 Black patients, 5 Coloured patients and 2 White patients. Eighty nine percent of PCOS women studied had an increased body mass index (>25). There was an increased LH:FSH in 66 (75.9%) of Indian women and 13 (81.3%) of Black women. Increased androgens were present in 26 (30.2%) in Indian women and 6 (37.5%) of Black women. An increase in fasting insulin was found in 48 (55.2%) of the Indian women and 5 (31.3%) of the Black women. Twenty five (29.1%) Indian women had an increase in fasting serum glucose compared to 1 (6.3%) in Black women. In the Indian population, 13 (14.9%) were found to have Diabetes Mellitus, and 9 (10.3%) had an impaired glucose tolerance test. In the Black population only 1 patient had impaired glucose tolerance. There were no Black patients with Diabetes Mellitus. No Black women were found to have hyperlipidaemia, however 12 (14.3%) Indian women were affected. None of these differences between the races were statistically significant. The major limitation of the study was the sample size of Black women. This is an ongoing study, and aims to recruit more Black women. This will be able to adequately address the correct perspective regarding the metabolic and cardiovascular abnormalities in these women. CONCLUSION. The prevalence of insulin resistance and hyperlipidaemia in local women with PCOS was 50.9%.and 11.3% respectively. Menstrual irregularities and infertility are the most frequent presenting complaints of women with PCOS. Features of hyperandrogenism are not common presenting complaints in South African women. There are no differences in the hormonal and clinical profile of South African Indian and Black women with PCOS, however, there is a trend toward Indian women having a greater prevalence of glucose abnormalities than Black women. We recommend further studies in the management of the metabolic abnormalities in local women with PCOS, in an attempt to develop a protocol to manage the metabolic complexities of PCOS.
The impact of pneumonia in human immunodeficiency virus (HIV-1) infected pregnant women on perinatal and early infant mortality.
(2007) Khan, Munira.; Moodley, Jagidesa.
Background: Although the prevalence of pneumonia in pregnancy is reported to be less than 1%, the pregnant state and risk factors associated with the development of pneumonia adversely influence the outcome of pregnancy. KwaZulu-Natal is at the epicenter of the dual epidemics of tuberculosis and HIV-1 and the impact of these diseases occurring concurrently in pregnant women at King Edward VIII hospital (KEH), South Africa have been described previously. The impact of antenatal pneumonia in HIV-1 infected and uninfected women however has not been described in the study population and was investigated. Methods: Pregnant women with clinical and radiological evidence of pneumonia were recruited from the antenatal clinic and labour ward at KEH. The study was conducted prospectively between January and December 2000. The clinical profile of these women and the causative organisms were determined. In addition the impact of HIV-1 infection, maternal immunosuppression and maternal pneumonia on obstetric and perinatal outcomes were evaluated. Mothers diagnosed with tuberculosis and multi drug resistant tuberculosis were hospitalised at King George V hospital until delivery. Results: Twenty nine women were diagnosed with antenatal pneumonia (study arm) with Mycobacterium tuberculosis the only causative organism isolated. A control arm of 112 pregnant women was also studied. Maternal and perinatal mortality was restricted to the study arm with a maternal mortality ratio of 99 per 100 000 live births and a perinatal mortality rate of 240 per 1000 births. Pneumonia was significantly associated with a negative overall obstetric outcome in the presence of HIV- l infection, antenatal care, anaemia and second trimester booking status. In addition, the presence of pneumonia was significantly associated with maternal mortality. There was a highly significant association between exposure to pneumonia and poor neonatal outcome. Maternal pneumonia, maternal HIV infection and the presence of medical and obstetric conditions were significantly associated with low birth weight and neonatal pneumonia. Further, maternal pneumonia (p <0.001) and concurrent HIV infection (p=0.002) was significantly associated with neonatal death. Conclusion: The presence of pneumonia in the antenatal period impacts negatively on maternal and neonatal morbidity and mortality. Health care providers must maintain a high degree of suspicion when managing a pregnant woman with unresolving upper respiratory tract symptoms and refer timeously for further investigation. Pneumonia and in particular pulmonary tuberculosis associated with HIV co- infection in pregnancy is a threat to mother and baby. Therefore in areas endemic for TB and HIV infection, it may be prudent to screen HIV positive pregnant women for symptoms suggestive of pneumonia and thereby identify women requiring further investigations such as sputummicroscopy and cultures, and a screening chest radiograph.
Leptin levels in the hypertensive black African parturient.
(2001) Kafulafula, George Emmanuel.
Background: Leptin is a new adipose-derived hormone discovered in 1994. It is vital in energy balance and weight regulation in humans. During pregnancy the placenta is an extra source of leptin. The role of leptin in pregnancy is not established. This has generated a lot of interest in leptin research in pregnancy. Leptin is being examined in pathological states that may have origin in adipose tissue and the placenta such as pre-eclampsia, intrauterine growth restriction and obesity. Aim and Method: This study measured concentrations of serum leptin in Black African women during late pregnancy in 68 women with pre-eclampsia, 92 healthy normotensive pregnant women and in 32 healthy non-pregnant women. In each group leptin levels were compared between obese (body mass index, BMI = or > than 30 kgm-2) and lean women. Serum leptin concentrations were measured by radioimmunoassay (RIA) technique. Results: Serum leptin levels were higher in pregnancy compared to non-pregnant women (26.66+/-16.13 ng/ml, 25.89+/-15.83 ng/ml vs 17.97+/-11.98 ng/ml, p=0.02). This is due to firstly, the extra fat accumulated as part of the maternal adaptation to pregnancy and secondlv, to the placenta-derived leptin. Other pregnancy hormones such as insulin, hcG, prolactin and oestrogen may modulate the serum levels of leptin in pregnancy. Simple anthropometric parameters (weight, BMI, circumferences of the mid upper arm (MAC), waist (WC), hip (HC), and thigh (TC) and waist-hip ratio (WHR)) were used to explore the relationship between leptin concentrations and obesity. All the parameters showed a positive correlation with serum leptin concentration in all the groups with the exception of WHR. Weight and BMI showed the greatest correlation both in pregnant (r=0.61 and r=0.58, respectively, p<0.001) and non-pregnant (r=0.74 and 0.79, respectively, p<0.001) women. However we did not find a significant difference in the concentrations of leptin between women with and those without pre-eclampsia (26.66 ng/ml vs 25.89 ng/ml, p=0.95). This probably means that adiposity is the predominant factor influencing levels of leptin in pregnancy. The other factors mentioned above play only a minor role. Indeed the mean serum leptin levels were higher in obese compared to lean women in both pregnant and non-pregnant women. Conclusion: Pregnancy is a hyperleptinaemic state. There is no difference in serum leptin levels between women with pre-eclampsia and healthy normotensive pregnant women. Serum leptin concentration is largely determined by the degree of adiposity both in and outside pregnancy.
Maternal and perinatal outcomes in triplet pregnancy : an audit over 12 years at Inkosi Albert Luthuli Central Hospital.
(2016) Parikh, Nitish Upendra.; Ramnarain, Harry.
Aim: To determine maternal and neonatal outcomes in triplet gestation. Study Design: Retrospective observational study. Place and Duration of Study: Obstetric and Gynaecological Department, Inkosi Albert Luthuli Central Hospital, Durban from January 2003 to December 2014. Patients and Methods: A retrospective analysis of all triplet pregnancies referred from nearby and outlying hospitals that were delivered at IALCH over a 12-year period was done. Results: Eighty-nine women with triplet pregnancy were studied. Eighty-eight (98.9%) of the women were conceived spontaneously while 1 (1.1%) with the use of ovulation induction. Seventy-seven (86.5%) were booked for antenatal care at the base hospital. Mean duration of gestation was 30.8 weeks. The antenatal complications were preterm delivery in 62%, hypertension in 11%, anaemia in 26 % and preterm premature rupture of membranes in 17% of patients. Nine patients (10%) suffered postpartum haemorrhage. Seventy-five sets of triplets were delivered abdominally. Mean birth weights of the 1st, 2nd and 3rd triplet were 1497, 1499 and 1427 grams respectively. The mean Apgar scores of the 1st, 2nd and 3rd triplet at 1 and 5 minutes after birth were 7.3 and 8.5, 7.2 and 8.4; and 7.0 and 8.3 respectively. Of the 258 infants, 230 (89%) required neonatal intensive care unit admission. Total perinatal mortalities were 36 (13.5%) including 9 cases of intra-uterine demise. One hundred and nine suffered respiratory distress syndrome, 39 had neonatal jaundice and 19 had sepsis. Conclusion: Triplet pregnancies had a high rate of feto-maternal complications in keeping with other retrospective studies. Risk factors in cases of premature delivery at IALCH included a birth weight of less than 1500 g, gestational age of less than 28 weeks and a maternal age between 25-39 years. Caesarean section was the MOD associated with better neonatal outcomes.
Peripartum hysterectomy audit at Port Shepstone Regional Hospital, South Africa : a five year review.
(2017) Phinzi, Sibusiso Blessing.; Sebitloane, Hannah Motshedisi.
Background Over the years the peripartum hysterectomy has become a life-saving procedure in cases of intractable postpartum haemorrhage or when medical and/or surgical conservative interventions have failed and in severe puerperal sepsis. Aim To audit the clinical management preceding peripartum hysterectomy and evaluate maternal and neonatal outcomes in patients who were done peripartum hysterectomy. Material and Methods The researcher developed a structured audit form based on specific types of pregnancy and delivery complications leading to peripartum hysterectomy. The medical records of 126 patients who had postpartum hemorrhage and 83 patients who had undergone peripartum hysterectomy from 1st January, 2010 to 31st December, 2014 (5 years), at Port Shepstone Hospital in Kwa-Zulu Natal were reviewed retrospectively. Maternal characteristics and details of the present pregnancy and delivery, hysterectomy indications, complications, postoperative complications, and maternal and neonatal outcomes were evaluated. A statistical package (SPSS version 24.0) was used to analyze the data. Results During the 5-year study period, a total of 17657 births occurred. There were 83 peripartum hysterectomy cases and 126 postpartum hemorrhage cases. The incidence for peripartum hysterectomy was 0.47% (4.7/1000 deliveries) and incidence for postpartum hemorrhage was 0.71% (7.1/1000 deliveries). In patients with PPH, post C/S peripartum hysterectomy incidence was 7.2/1000 C/S deliveries and post vaginal peripartum hysterectomy incidence was 0.65/1000 normal vaginal deliveries. There was a statistical significant relationship between peripartum hysterectomy and cesarean section delivery in the current pregnancy and previous cesarean delivery (p=0.0001 and p=0.01 respectively). Sixty two (49.2%) of 126 postpartum hemorrhage cases were unresponsive to conservative medical and surgical measures and required peripartum hysterectomy. Five patients with uterine rupture did not have any conservative management and proceeded to peripartum hysterectomy. Sixteen (19.3%) patients with sepsis were sent directly for peripartum hysterectomy.
Pregnancy outcome in HIV positive women on antiretroviral therapy delivering in Durban, South Africa.
(2014) Kesene, Dennis Abanum.; Bagratee, Jayanthilall Sarjoo.
Abstract available in PDF file.
Prevalence, risk factors and pregnancy outcomes of cervical cell abnormalities in the puerperium in a hyperendemic HIV setting.
(2017) Maise, Hopolane Clifford.; Moodley, D.
Objective We investigated the impact of cervical cell abnormalities detected in the puerperium in association with HIV-1 infection on pregnancy outcomes. Methods A behavioural intervention RCT enrolled 1480 pregnant women (>18years) at a peri-urban primary health clinic in South Africa during May 2008-June 2010. A pap smear was performed 14weeks postpartum and sent to the local laboratory services for cytology. We performed a secondary data analysis of pregnancy outcomes, Pap smear results (cytology), HIV results and participant demography. Results 564 women (38.1%; 95%CI35.7-40.1) were HIV-1 positive and 78(8.0%; 95%CI6.4-9.9) women tested positive for cervical cell abnormalities at the postpartum visit. Forty two (4.2%; 95%CI 3.1-5.6) women presented with LGSIL, and 7 (0.7%; 95%CI 0.3-1.4) with HGSIL. In an adjusted analysis, HIV-infected women were significantly more likely to test positive for LGSIL (p<0.001) and HGSIL (p=0.011). Premature birth, low-birth weight and non-live birth rates were similar among HIV-infected and uninfected women with abnormal cervical cytology. Low-birth weight was also significantly more common among HIV infected women with normal cervical cytology. Conclusion HIV-infected pregnant women are more likely to be diagnosed with higher grades of squamous cell abnormalities. There is no evidence of an association between squamous cell abnormalities/HIV comorbidity and adverse pregnancy outcomes. Synopsis HIV-infected pregnant women are likely to present with higher grades of cervical cell abnormalities in the puerperium but without any evidence of adverse pregnancy outcomes.

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