Masters Degrees (Obstetrics and Gynaecology)

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The accuracy of non-invasive blood pressure monitoring when compared to intra-arterial blood pressure monitoring in patients with severe pre-eclampsia during an acute hypertensive crisis
(Stellenbosch : University of Stellenbosch, 2010-12) Dalla, Sangita; Langenegger, Eduard; Petro, Gregory; University of Stellenbosch. Faculty of Health Sciences. Dept. of Obstetrics and Gynaecology.
ENGLISH ABSTRACT: OBJECTIVE: The aim of this study was to compare the accuracy of non-invasive blood pressure measurements, using automated and manual devices, against invasive intra-arterial blood pressure measurements in patients with pre-eclampsia, during a hypertensive blood pressure peak. STUDY DESIGN: In this prospective study, women admitted to the Obstetrics Critical Care Unit, with confirmed pre-eclampsia and acute severe hypertension, who had an intra-arterial line in situ, were asked to participate. During an intra-arterial blood pressure peak, both an automated oscillometric and a blinded manual aneroid sphygmomanometric blood pressure was recorded. These two methods of blood pressure measurements were compared to intra-arterial blood pressure measurements. The accuracy of a mean arterial pressure (MAP) ≥ 125mmHg in detecting a systolic blood pressure (SBP) ≥ 160mmHg, using all three methods, was also determined. RESULTS: There was poor correlation between intra-arterial SBP and automated and manual SBP (r = 0.34, p < 0.01; r = 0.41, p < 0.01 respectively). The mean differences between automated and manual SBP compared to the intra-arterial SBP was 24 ± 17mmHg (p < 0.01) and 20 ± 15 mmHg (p < 0.01) respectively. There was better correlation between intra-arterial diastolic blood pressure (DBP) and automated and manual DBP (r = 0.61, p < 0.01; r = 0.59, p < 0.01 respectively). The mean differences of the automated and manual DBP was not statistically significant when compared to the intra-arterial DBP. There was poor correlation between the intra-arterial MAP and the automated MAP (r = 0.44, p < 0.01) and good correlation with the manual MAP (r = 0.56, p < 0.01). The mean differences of the automated and manual MAP were statistically significant (5 ± 13mmHg, p < 0.01; 8 ± 11mmHg, p < 0.01 respectively). The sensitivity of automated and manual methods in detecting a SBP ≥ 160mmHg was 23.4% and 37.5% respectively. A MAP ≥ 125mmHg in detecting a SBP ≥ 160mmHg, when using intra-arterial, automated and manual methods of blood pressure measurements showed low sensitivity (35.9%, 21.9% and 17.2% respectively). CONCLUSION: This study demonstrated that both the automated and manual methods of blood pressure measurements were not an accurate measure of the true systolic intra-arterial blood pressure, when managing pre-eclamptic patients with acute severe hypertension. In such situations, intra-arterial blood pressure monitoring should be used when possible. When this is not possible, manual aneroid sphygmomanometry is recommended. Underestimating blood pressure, particularly SBP, may lead to severe maternal morbidity and mortality.
Audit of term elective caesarean section outcomes at Tygerberg Academic Hospital
(Stellenbosch : Stellenbosch University, 2021-12) De Jager, Kobie; Geerts, Lutgart Therese Gaston Maria; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.
ENGLISH ABSTRACT: Aim The aim of this study was to determine the proportion of patients intended for elective caesarean section (ELCS) at  39+0 weeks who are converted to emergency caesarean sections (EMCS) or normal vaginal delivery (NVD) and risk factors associated with these. Materials and Methods This retrospective observational study was conducted at Tygerberg Academic Hospital (TAH) which is a secondary and tertiary level hospital. Data was collected for all patients eligible for ELCS at  39+0 weeks with certain gestational age (GA). Data was collected on antenatal, peri- partum and post-partum information on maternal and neonatal outcome. Results Of the 307 patients who were eligible for ELCS at ≥ 39 weeks, 76 (24.8%) went into labour before their planned surgery date, 110 (35.8%) had their surgery postponed, 99 (32.2%) ended their pregnancy with an EMCS and 2 (0.7%) with NVD. There was no significant difference in the mean GA at delivery for patients in labour (39+1, SD 4 days) and patients who did not go into labour (39+1, SD 4 days) (p = 0.4). There was no significant difference in maternal or neonatal outcomes between groups who delivered < 39+0 weeks and  39+0 weeks. Conclusion ELCS theatre list over-run is a common problem in obstetric units and our setting is no exception. Considering there was no significant difference in maternal or neonatal outcome between groups that delivered at < 39+0 weeks and  39+0 weeks we could consider booking ELCS at a marginally earlier gestational age to reduce the rate of conversion to EMCS.
Bone involvement in patients with cervical carcinoma – a single institution cohort study
(Stellenbosch : Stellenbosch University, 2019-04) Butt, Jennifer Leigh; Botha, Matthys Hendrik; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.
Introduction Bony metastases in cervical carcinoma are rare, occurring on average in 4.6% of patients. Autopsy studies indicate that it is underdiagnosed. It is important to recognise bony infiltration as palliative radiotherapy can relieve pain and prevent pathological fractures. As survival after the diagnosis of bone involvement is short, an appropriate palliative care plan should be tailored according to the patients’ limited prognosis. Methods A retrospective cohort analysis of women with cervical cancer, diagnosed between January 2014 and December 2015, was undertaken. Demographic, treatment and follow up data were collected for all women with bone metastases confirmed by imaging. Descriptive statistics were generated. Results The cohort study identified 642 patients with cervical carcinoma, of which 25 (3.89%) were diagnosed with bone involvement. Ten patients had bone involvement at diagnosis of cervical cancer and 15 had bone metastases at recurrence, occurring a median of 286 days after primary treatment. Survival after the diagnosis of bone metastases was short, with 88% of patients dying within the first 6 months. Women with a low WHO performance status at diagnosis of bone metastases had a significantly shorter survival (p=0.024). When a previously described prognostic score was applied, those with a high score had a significantly shorter survival (median 61 days) than those with a low score (median 158 days) (p=0.0065). Conclusions Although bone metastases are rare in women with cervical cancer, they are important to recognise as radiotherapy is a useful modality for palliating bone pain and reducing pathological fractures. Health care workers should be vigilant, especially during the first 2 years of follow up, to increased analgesic use and chronic pain as these may indicate bone involvement. Use of a prognostic score is valuable in tailoring treatment and counselling patients and their families with regard to survival. Survival after the diagnosis of bone involvement is short and a patient’s quality of life may be greatly improved by an appropriate radiotherapy and palliative care plan.
Breech deliveries in Tygerberg Academic Hospital : maternal and neonatal outcomes of vaginal and abdominal deliveries - a case-controlled study
(Stellenbosch : Stellenbosch University, 2011-12) Lindeque, L. X.; Theron, G. B.; Stellenbosch University. Faculty of Health Sciences. Dept. of Obstetrics and Gynaecology.
ENGLISH ABSTRACT: The Objective: To review the difference in short term neonatal and maternal outcomes among singleton infants with breech presentation delivered by vaginal or elective caesarean section route at term, at Tygerberg Academic Hospital (TBH) in Cape Town. The study design was a retrospective case control study. Method: Part I A total of 120 patients were selected. 60 vaginal breech deliveries and 60 elective caesarean sections for breech presentation (comprising the control group). 60 cases of vaginal deliveries were collected and 60 control cases of planned elective caesarean sections, where the indication for CS was breech presentation, were collected in the same manner. Part II Nineteen registrars completed a questionnaire regarding their subjective experiences of vaginal breech deliveries at Tygerberg Academic Hospital. Results: Part I An analysis of the results found statistically significant differences in maternal ages between the two groups, with younger women delivering by CS; gravidity and parity was lower in the CS group; blood loss was observed to be higher in the CS group with more women requiring a blood transfusion when compared to vaginal delivery; there were more neonatal admissions in the vaginal delivery group as well as more birth trauma, neonatal seizures and death in this group; Apgar scores were higher in the CS group and finally, neonates born by CS were more commonly discharged at the same time as their mothers in the CS group. Part II When analyzing the registrar questionnaire it can be noted that although clinicians are performing an adequate number of breech vaginal deliveries, with an average of 10 deliveries per year, the skills training for clinicians is invaluable. Not all registrars learned skills from a senior clinician and skills training in skills labs are essential for initial and even continual training of these clinicians. It is suggested that these skills training programs be made compulsory for all registrars and that a biyearly attendance and completing of such a course be mandatory for those wishing to work in the labour ward. Conclusions: Although not statistically significant, there was more morbidity and mortality associated with vaginal breech delivery.
A comparative review of the outcomes of two different perinatal mortality classification systems at an Obstetric unit in Cape Town, South Africa
(Stellenbosch : Stellenbosch University, 2012-12) Siebritz, Mark; Steyn, Daniel Wilhelm; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.
ENGLISH ABSTRACT: Background The annual burden of stillbirths is estimated to be more than 3 million deaths globally. Depending on the perinatal classification used, up to two thirds of deaths are reported as unknown.Gardosi, et al (2006) developed the ReCoDe system, which identified the relevant condition at the time of death in utero. The system aims to identify what went wrong in utero, without necessarily indentifying why fetal demise occurred. With comparison to the conventional Wigglesworth classification, the authors were able to reduce the number of unexplained stillbirths from 66.2% to 15.2%. The Perinatal Problem Identification Program (PPIP) is the nationally implemented perinatal classification system in South Africa. The PPIP database recorded approximately 660 000 births from the 1st January 2006 until 31st December 2007. This reflects approximately 40% of all births in health institutions in South Africa during this time period. There were 11742 stillbirths recorded in on the PPIP database for this two year period.Unexplained stillbirths formed 24% of the total perinatal deaths. The Saving Babies Report 2006-2007 has suggested that funding andresearch resources be directed to identifying the causes of deaths in this group. Objective: Our primary objective was to compare the outcomes of the PPIP to the ReCoDe classification system developed by Gardosi, with special attention as to reducing the number of unexplained stillbirths. Methods: We conducted a retrospective descriptive study on the perinatal deaths occurring at or presenting to the Department of Obstetrics and Gynaecology at Tygerberg Hospital, Cape Town, South Africa, for the time period extending from 01 January 2008 to 31 December 2008. A weekly Perinatal Mortality Audit meeting (PNM) is held at Tygerberg Hospital. In attendance at these meetings are General obstetricians, Fetal-maternal specialists, Neonatologists, Pathologists, a Geneticist, Obstetric and Paediatric Registrars. Relevant clinical details are summarised from clinical notes and Perinatal Losses data forms. These forms are specific to Tygerberg Hospital and completed by the attending doctor at first consultation. Placental histology and post-mortem examination would have been performed in certain cases as per the departmental protocol. All perinatal deaths, both stillborn and neonatal deaths weighing more than 499g, are discussed at this forum and consensus then reached on a primary and final cause of death. This information is then entered into the PPIP database, along with any identifiable avoidable factors.The investigators separately reviewed the information available from the Perinatal Losses and the PIPP V2.2 data capture forms and then reclassified each stillbirth according to the ReCoDe hierarchal system Results: We studied the data sheets of 406 stillbirths of babies of whom the deaths had been previously classified according to the PPIP classification. The median maternal age was 25.65 years (range 14 – 45) while the median birth weight was 1127 grams (range 500 – 4100).The vast majority of these stillbirths occurred in singleton pregnancies and are also classified as extremely low birth weight. The three major causes of stillbirth over the study period were antepartum haemorrhage (24.4%), hypertensive disorders (22.4%) and spontaneous preterm labour (11.1%). Within the ReCoDe classification, the leading categories were in the placental group (33.2%), fetal group (21.6%) and the maternal group (20%). The unexplained group (PPIP IUD group), from the index study constitutes 8.1% (33 of 406) of cases, while the number of unclassified stillbirths in the primary ReCoDe classification accounted for 15% (60 of 406) of the total. The main reasons for this difference is that ReCoDe does not incorporate preterm labour as a cause, and uses customised growth charts for identifying fetal growth restriction. Conclusion: PPIP remains the gold standard in Perinatal Audit in South Africa.We would recommend that ReCoDe be evaluated prospectively, alongside the established PPIP system, to better compare their performance outcomes. The development of customized fetal growth potential charts relevant to the local population should be explored. The Perinatal Losses data capture form should be revised to be more comprehensive and relevant.
The comparison of non-invasive blood pressure monitoring with brachial intra-arterial blood pressure monitoring in patients with severe pre-eclampsia
(Stellenbosch : Stellenbosch University, 2014-12) Jacobs, Samier; Langenegger, Eduard; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.
ENGLISH ABSTRACT: OBJECTIVE: The aim of this study was to compare the accuracy of non-invasive brachial blood pressure measurements, using automated and manual devices, to invasive brachial intra-arterial blood pressure measurements in patients with preeclampsia, during acute severe hypertension. STUDY DESIGN: A prospective descriptive cross sectional study was conducted in the Obstetrics Critical Care Unit (OCCU) of Tygerberg Hospital. Pre-eclamptic patients with acute severe hypertension, who required the placement of brachial intra-arterial lines due to failed radial intra-arterial line placement, were included in the study. Both automated oscillometric and blinded manual aneroid sphygmomanometric blood pressures were recorded during hypertensive peaks and after stabilization of BP using intravenous Labetalol or Nepresol. These two noninvasive methods of blood pressure measurements were compared to brachial intraarterial blood pressure measurements. RESULTS: There was weak correlation between manual and intra-arterial SBP (r = 0.27, p = 0.048) for SBP≥160mmHg. The calculated mean difference between manual SBP compared to the intra-arterial SBP in this group was -23.19mmHg (+/- 19.40). There was moderate correlation between automated and intra-arterial SBP (r = 0.69, p < 0.05). The calculated mean difference between automated SBP compared to the intra-arterial SBP in this group was -16.85mmHg (+/- 11.58). CONCLUSION: This study of pre-eclamptic women demonstrated that both non-invasive methods of BP measurement were inaccurate measures of the true systolic intra-arterial BP and significantly underestimated SBP≥160mmHg when compared to brachial intra-arterial measurements. The SBP was also underestimated, to a lesser degree, for mild moderate hypertension. This study also demonstrated that direct invasive BP monitoring using the brachial artery is a safe method for accurate haemodynamic monitoring. We recommend the use of intra-arterial BP monitoring in pre-eclamptic women with acute severe hypertension. Radial arterial cannulation should be used as the first option and the brachial artery should be used if the first option fails.
A comparison of the effect of Polyvinylpyrrolidone (PVP) and SpermSlow on human spermatozoa
(Stellenbosch : Stellenbosch University, 2015-03) Nel, Marlize; Windt De Beer, Marie-Lena; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.
ENGLISH ABSTRACT: Intracytoplasmic sperm injection (ICSI), as well as other micromanipulation assisted reproductive technology methods, such as physiologic ICSI (PICSI) and intracytoplasmic morphologically selected sperm injection (IMSI), are routinely used in many fertility laboratories around the world. An integral part of these methods is the manipulation of spermatozoa in preparation of the injection into the oocyte. It is common practice to place prepared spermatozoa in a viscous holding medium to facilitate the handling, manipulation and slowdown of spermatozoon movement during the immobilization and injection processes of ICSI. The possible effect of these holding mediums on basic semen parameters, as well as the sperm deoxyribonucleic acid (DNA) and structural integrity of spermatozoa, is of importance. Hamilton Thorne IVOS® developed an automated software solution for live sperm morphology evaluation under high magnification, called IMSI StrictTM. It combines Tygerberg Strict Criteria morphological classification of human spermatozoa with motile sperm organelle morphology examination (MSOME) and provides software-based categorization. The IMSI StrictTM software was developed to aid in the IMSI spermatozoon selection process that enables objective classification of spermatozoa to remove inter-technician variation. For good optics and spermatozoon evaluation in IMSI StrictTM, spermatozoa need to be moving very slowly or be immotile, but still viable. This can be achieved by placing spermatozoa in a viscous holding medium, either polyvinylpyrrolidone (PVP) or SpermSlowTM, sometimes for a substantial time period. Before marketing the clinical use of IMSI StrictTM, the possible toxicity or deleterious effect of PVP and SpermSlowTM on spermatozoa needs to be excluded. The primary objective of this study was to evaluate the effect of PVP and SpermSlowTM on human spermatozoa after different exposure times using a viability stain, CASA motility and kinetic parameters, chromatin packaging analysis (CMA3 staining analysis) and DNA fragmentation analysis (TUNEL analysis). The secondary objective was to evaluate the effect of PVP and SpermSlowTM on human spermatozoa‟s ultrastructure with Transmission Electron Microscopy. This prospective analytical study was conducted at Drs Aevitas Fertility Clinic (Vincent Pallotti Hospital, Cape Town, South Africa) as well as the Fertility Unit at Tygerberg Hospital (Cape Town, South Africa) between July 2013 and October 2014. A total of 90 separate (no duplication) semen samples were analysed for the quantitative analysis (primary objective) and 1 sample for the descriptive analysis (secondary objective). Results showed that although PVP and SpermSlowTM treated sperm outcomes often differed significantly after typical statistical analysis, clinically these two mediums were shown to be equivalent (using a specific statistical test for equivalence) for the tested outcomes. PVP and SpermSlowTM had no detrimental effect clinically on sperm viability, motility parameters, chromatin packaging and DNA fragmentation rate. The secondary investigation indicated that SpermSlowTM might exert a disintegrating effect on various sperm membranes, and as a secondary consequence of the eventual necrotic process, alteration of chromatin and cytoskeletal components. PVP medium on the other hand did not show these disintegrating effects. This finding needs to be further investigated since only one semen sample was evaluated. Based on this study‟s results, either PVP or SpermSlowTM can be used for IMSI StrictTM purposes. However, the study did not include the technical aspects of the usage of PVP and SpermSlowTM.
The context of fetal ventriculomegaly in a developing country : a retrospective review
(2019-12) Pretorius, Cornelius Hermanus Zacharias; Van der Merwe, J. L.; Geerts, L. T. M.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.
AIM: The goal of this study is to describe fetal ventriculomegaly (VM) in a developing country population with regards to clinical presentation, associated findings, natural history and outcome. Materials and methods This retrospective observational study was conducted at Tygerberg Academic Hospital, a secondary and tertiary referral centre in the Western Cape Province. Data was collected from all pregnancies with a prenatal diagnosis of ventriculomegaly from 2013 to 2015. The initial presentation and associated findings with the natural history of VM was studied and a selection of perinatal outcomes was measured. Results A final cohort of 252 cases was analysed: 168 mild, 42 moderate and 42 severe cases of VM. The median gestational age at diagnosis was 23w4d, with 48,8% diagnosed after 24w0d. Mild VM was more likely to be unilateral (p<0,001) and isolated (p=0,006) when compared to moderate and severe VM. Mild VM was associated with multiple soft markers in up to a third of the cases and over half of the cases normalized during pregnancy; severe VM was associated with multiple major anomalies in 31,0% of the cases. The majority of major anomalies in all 3 groups were CNS defects in 25,8% and cardiac anomalies in 10,3%. Termination of pregnancy was opted for in 12,5% of mild, 35,7% of moderate and 59,5% of severe VM cases. Conclusion VM is a common prenatal finding but, in this setting, was often diagnosed late, which limits options for investigation and management. Associated findings included cardiac and other CNS abnormalities and increased with increasing severity of VM. Aneuploidies were encountered within all groups. In this cohort, unilateral VM was more associated with mild VM and may have been due to the inclusion of borderline VM, which was shown not to be a benign finding. Uptake of invasive testing and of TOP was low in this community and the late diagnosis may have contributed to that.
Contributory factors to burnout syndrome in Obstetrics and Gynaecology at Tygerberg Hospital
(Stellenbosch : Stellenbosch University, 2024-03) Ali, Saida; Masimila, Davinia Alpharita Helene; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. Obstetrics and Gynaecology.
ENGLISH SUMMARY: Burnout has been widely recognised as a debilitating psychological condition that develops over time leading to increasing misalignment between an individual’s intentions and the realities of their environment. Burnout leads to feelings of exhaustion, distress, overwhelming emotions and negative attitudes towards the environment, and this leads to increasing in lack of interest, impersonal engagement, emotional detachment and inability to be efficient and deliver good service. The World Health Organisation recognizes burnout as a risk to the healthcare sector and may negatively impact healthcare outcomes, especially in developing countries. This study aimed to evaluate the prevalence of burnout syndrome and factors leading to its development in a cohort of doctors in Obstetrics and Gynaecology at the Tygerberg Hospital, South Africa. Using the Maslach Burnout Toolkit, 73 participants, which consists of medical officers, junior and senior registrars, and specialists, were surveye. The Maslach Burnout Toolkit combines the Burnout inventory dimensions and the areas of Worklife Survey which assess the perceptions of worklife areas. The survey showed that 80.8% of the participants reported a moderate to high prevalence of emotional exhaustion, as well as 69.9% moderate to high levels of depersonalisation and low personal achievement respectively. There were no differences in burnout syndrome reported between genders. However, those who were in the organisation and in the position for less than 5 years reported high levels of burnout while those who were in the organisation and held a senior position for more than 20 years reported low burnout. Participants with under 5 years in the organisation and position reported less alignment on all Areas of Worklife assessed, especially for workload. Workload and fairness alignment contributed significantly to development of burnout. For every increase in workload alignment there was a resulting 8.31 times decrease in emotional exhaustion, and 3.30 times decrease in depersonalisation. Increased alignment with fairness resulted in a decrease in emotional exhaustion. Workplace characteristics are crucial to the wellbeing of healthcare workers and human resource practices need to ensure these are aligned and supportive. Increased burnout will likely cause a decrease in job satisfaction and promote the feeling to leave the healthcare sector or specific position held among the healthcare workers (Payne et al 2020). Young doctors need more time to learn theory and practical applications, aiding the need for continued support and mentorship, as well as enough resting time to ensure their mental health and wellbeing is looked after. This research highlights the importance of creating a supportive work environment for healthcare workers to prevent burnout and optimise healthcare delivery.
A controlled randomised study to compare the IUI biochemical pregnancy outcome between a routine swim-up and the Sep-D Kit semen preparation method
(Stellenbosch : Stellenbosch University, 2013-03) Gentis, Roxanne; Windt De Beer, Marie-Lena; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.
ENGLISH ABSTRACT: Male factor infertility is a general term that describes couples in which an inability to conceive is associated with a problem identified in the male partner. Intrauterine insemination (IUI) together with ovulation induction has been shown to be an effective treatment method for male factor infertility. Oocyte production by the ovaries is stimulated by the use of fertility drugs. A prepared sperm sample is then injected into the uterus through the vagina using an IUI catheter which brings the oocytes and spermatozoa into close proximity. Semen preparation is an integral part of an IUI cycle. In a developing country, a simple inexpensive semen preparation method for IUI procedures, not necessitating a lot of equipment, is essential. An example of such a method, the Sep-D Kit (Surelife Sep-D Kit, Surelife Media Technologies Pty Ltd, Singapore) has been proposed as a possible preparation method. In a pilot study performed by the principal investigator (Roxanne Gentis), comparing the Sep-D Kit and standard swim-up preparation methods, it was found that the Sep-D Kit compared very well with the swim-up method regarding most pre- and post-preparation semen parameters. The Sep-D Kit method, however, still needed further testing to see whether or not pregnancy rates resulting from the method are comparable with that resulting from the standard swim-up method, as this ultimately is the required result of an IUI. The primary aim of this study was to compare the Sep-D Kit method to the standard swim-up method with regards to biochemical pregnancy outcome, post-preparation sperm count, motility, total motile count (TMC), morphology, DNA compaction and fragmentation (CMA3 and TUNEL). The secondary aim was to evaluate which variables, male and female, affect biochemical pregnancy outcome. The study took place at Drs Aevitas Fertility Clinic, Vincent Pallotti Hospital, Pinelands. The study was a prospective analytical study and was conducted from December 2010 until October 2012. A total of 473 IUI cycles were evaluated. Results showed that the Sep-D Kit semen preparation method was non-inferior to the standard swim-up method with regards to biochemical pregnancy rates, post-preparation count and TMC. The swim-up method produced samples with a significantly higher post-preparation motility compared to the Sep-D Kit method, however both methods still managed to produce similar biochemical pregnancy rates (10.39% for the swim-up group versus 11.57% for Sep-D Kit group). For the total cohort of cycles analysed the only female parameter which significantly predicted biochemical pregnancy outcome in this study was age. Sperm motility (post-preparation) was the only male parameter that significantly affected biochemical pregnancy outcome. The Sep-D Kit method is more cost effective and also time saving compared to the swim-up method. There is also no need for expensive laboratory equipment or a trained embryologist using the Sep-D Kit preparation method. The Sep-D Kit may therefore be used with confidence as a standard semen preparation method, and may be implemented in developing countries for use in routine IUI procedures.
Description of fetal heart rate patterns at 20 to 24 weeks gestation
(Stellenbosch : Stellenbosch University, 2012-12) Hofmeyr, Franelise; Odendaal, H. J.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.
ENGLISH ABSTRACT: Introduction - Accurate computerized analysis of the fetal heart rate (FHR) pattern has become more feasible and clinically relevant in recent years. Taking into account advances in neonatal care resulting in a declining lower limit for fetal viability as well as research into fetal effects of maternal high risk behaviour and escalating intra-uterine exposure to harmful toxins and drugs, fetal heart rate patterns need to be more accurately described in earlier gestations than what is currently available in literature. With advancing technology it is becoming possible to accurately record and interpret the FHR patterns from gestations as early as 20 weeks' gestation. By using the Monica AN24 transabdominal electrocardiographic fetal monitor and product specific software, we analysed early FHR patterns according to the Dawes-Redman criteria, as used in later gestations. Methods - The aim of our study was to describe patterns of FHR (short-term variability, basal heart rate, accelerations and decelerations) at 20-24 weeks' gestation. Physiological data were obtained from the routine second trimester fetal assessment by the Monica AN24 monitor as used in the Safe Passage Study. As of December 31, 2009, 411 participants completed their first fetal assessment and met our inclusion criteria. Because our aim was the description of patterns in pregnancies with a normal outcome, we excluded all adverse neonatal outcomes, preterm deliveries, babies with low birth weights as well as cases where delivery data were lost. After recordings of poor technical quality were also removed from our data pool, 281 recordings remained for analysis. Results - Distinct FHR patterns and quantifiable parameters of heart rate variability were consistently observed. In contrast to what has previously been published, accelerations of the FHR and reassuring baseline variation are present from as early as 20 weeks. Conclusion - Information from this study provides an important foundation for further studies of early FHR patterns and it will help us better assess the fetus at a crucial age for indicators of good outcome at early delivery.
A Descriptive study of low risk women presenting in suspected preterm labour at Tygerberg hospital
(Stellenbosch : Stellenbosch University, 2018-12) Abraham, Kevin Thomas; Vollmer, Linda; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.
Introduction: Preterm birth refers to delivery before 37 completed weeks’ gestation and is often, but not always, preceded by spontaneous preterm labour. Prematurity due to preterm birth is the leading cause of direct neonatal mortality worldwide, as well as a cause for significant neonatal morbidity and long-term sequelae. The estimated preterm birth rate varies worldwide and represents 5-18% of all live births with approximately 15 million babies born preterm annually worldwide. Early identification and adequate management of preterm labour and subsequent preterm birth is paramount. However, the signs and symptoms of preterm labour are non-specific, and can lead to over diagnosis and over treatment with unnecessary interventions and medications, which could be harmful to both the mother and the foetus. Thus, there remains a great challenge in clinical practice to be able to differentiate true preterm labour from false labour and to be able to risk stratify high risk women with features necessitating admission and intervention, and low risk women with features that make conservative, non-interventional management safe. Aims and Methods The study was a retrospective descriptive audit of all women presenting to TBH with suspected preterm labour between 24 and 34 weeks gestation in a predetermined 6-month period from 01/01/2015 to 30/06/2015. The primary aim was to determine the incidence of preterm birth in women who present in suspected preterm labour between 24 and 34 weeks at Tygerberg Hospital. Secondary aims were to identify the demographic and obstetric characteristics, evaluate the management performed, assess the obstetric and neonatal outcomes, and to determine risk factors for preterm delivery in women presenting in suspected preterm labour between 24 and 34 weeks at Tygerberg Hospital. Results Of the 5103 women triaged in Tygerberg Hospital during the 6-month study time- period, a total of 102 low risk women (42 women included in the study, 60 women in active labour at presentation) presented with suspected preterm labour had subsequently delivered at a preterm gestation less than or equal to 34 weeks. The total number of babies delivered in this time period was 3940. Thus, the incidence of preterm birth from suspected preterm labour for the study period was 2.59%. One hundred (100) low risk women were included in the study and 48% of the women were in their first or second pregnancies. This precluded them from routine screening for risk of preterm labour as they were not identified as high-risk patients with 2 or more previous trimester two losses or preterm births. The correct use of clinical obstetric criteria that fulfil the diagnosis of preterm labour is essential in correctly diagnosing true preterm labour and differentiating it from false preterm labour. Less than a third (32%) of the women included in the study presented with both pain and a show. Only 19% of patients had a cervical dilatation greater than 2cm and in addition to this, only half (50%) had a cervical length less than 20mm. Sixty eight percent (68%) of women, though, were admitted and interventions such as suppression, antibiotics and steroids were given. Risk factors identified for preterm birth (with an interval to delivery from presentation of less than one week), include pain and show as presenting symptoms (P<0.001), cervical dilatation >2cm (P0.001), cervical length <20mm (P0.006), clinical presence of a show (P<0.001), and when objective criteria are met for preterm labour according to set protocols (P<0.001). Conclusion The incidence in the index study of 2.59% is a population-based reflection of risk of preterm birth in low risk women that present with suspected preterm labour. The risk factors for preterm birth that were identified are thus invaluable in understanding this condition that is still of global concern. Risk factor identification and correct clinical diagnosis of true preterm labour is essential to correctly admit and provide management for only those at high risk of preterm birth. This would prevent increasing the workload of an already overburdened health system. Vigilance with these factors will aid in decreasing the morbidity and mortality related to preterm labour and preterm births.
A descriptive study of patients at high risk for mother-to-child transmission (MTCT) of HIV at Tygerberg Hospital: a retrospective review
(Stellenbosch : Stellenbosch University, 2016-12) Parker, Liaquat Ali; Theron, Gerhardus Barnard; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.
ENGLISH ABSTRACT: AIM This is a sub study of a main study with the primary aim of early identification of infants at high risk for HIV transmission, starting them on ARVs to prevent seroconversion and also possibly reverse early seroconversion. A secondary aim of the main study and our main focus is to identify the characteristics of mothers who are at a high risk of transmitting their HIV infection to their infants in the antepartum and intrapartum period. METHODS This was a retrospective study conducted at Tygerberg Hospital (TBH). A review of files spanning a 21 month period from the period 1 January 2011 till 30 September 2012 was performed. The selection criteria included pregnant HIV patients who were: exposed to AZT monotherapy for PMTCT for 4 weeks or less, exposed to combination ART for 4 weeks or less without preceding AZT monotherapy, with a measured plasma HIV viral load of ≥1000 copies/ml ≤8 weeks before birth, defaulted ART during pregnancy, first presented as HIV-seropositive at delivery or early in the postpartum period and delivered before 37 weeks gestational age. RESULTS During the study period a total number of 301 patients and their children were included in the study. These patients all came from a low to middle income resource setting. The mean age at delivery was 26.9 years. The median gravidity and parity was 3 and 1 respectively. The median gestational age at initiating antenatal care was 26 weeks. The mean gestational age at booking was 24.8 weeks. 35 patients were on ARVs during pregnancy. Of the remaining 266 patients: 143 patients were started on AZT prophylaxis during pregnancy, and 123 patients were never initiated on AZT prophylaxis. The mean gestation of AZT initiation was 27 weeks. A total of 108 patients never initiated any antenatal care at all. A total of 7 patients presented with antepartum haemorrhage and 21 mothers were grouped as having infections during pregnancy. The total number of deliveries was 301. 49.5% of all the deliveries were normal vertex deliveries. A total of 187 patients received AZT in labour. 115 patients received no AZT prophylaxis at all. More than half of the patients (188) in the study were seen with either medical complications or pregnancy related complications. 114 patients (37.8%) had hypertensive disease in pregnancy. 224 patients (74%) were diagnosed with HIV during the index pregnancy and 3.1% were diagnosed with HIV during labour. CONCLUSION It is clear that patients who do not initiate antenatal care have an increased risk of transmission in a population with an increased prevalence of HIV disease. Additional factors are the lack of initiation of ARV drugs at antenatal clinics and preterm labour and preterm deliveries.
The development, implementation and evaluation of a short course in Objective Structured Clinical Examination (OSCE) skills
(Stellenbosch : University of Stellenbosch, 2011-03) De Villiers, Adele; Archer, Elize; University of Stellenbosch. Faculty of Health Sciences. Dept. of Obstetrics and Gynaecology. Centre for Health Sciences Education.
Introduction: Objective Structured Clinical Examination (OSCE) examiner training is widely employed to address some of the reliability and validity issues that accompany the use of this assessment tool. An OSCE skills course was developed and implemented at the Stellenbosch Faculty of Health Sciences and the influence thereof on participants (clinicians) was evaluated. Method: Participants attended the OSCE skills course which included theoretical sessions concerning topics such as standard-setting, examiner influence and assessment instruments, as well as two staged OSCEs, one at the beginning and the other at the end of the course. During the latter, each participant examined a student role-player performing a technical skill while being video recorded. Participants‟ behaviour and assessment results from the two OSCEs were evaluated, as well as the feedback from participants regarding the course and group interviews with student role players. Results: There was a significant improvement in inter-rater reliability as well as a slight decrease in inappropriate examiner behaviour, such as teaching and prompting during assessment of students. Furthermore, overall feedback from participants and perceptions of student role-players was positive. Discussion: In this study, examiner conduct and inter-rater reliability was positively influenced by the following interventions: examiner briefing; involvement of examiners in constructing assessment instruments as well as viewing (on DVD) and reflection, by examiners, of their assessment behaviour. Conclusion: This study proposes that the development and implementation of an OSCE skills course is a worthwhile endeavour in improving validity and reliability of the OSCE as an assessment tool.
Double blind, randomised, placebocontrolled trial to evaluate the efficacy of esomeprazole to treat early onset pre-eclampsia (PIE Trial) : a study protocol
(BMJ Publishing Group, 2015) Cluver, Catherine Anne; Walker, Susan P.; Mol, Ben W.; Theron, Gerard B.; Hall, David R.; Hiscock, Richard; Hannan, N.; Tong, S.
Introduction: Pre-eclampsia is a major complication of pregnancy, globally responsible for 60 000 maternal deaths per year, and far greater numbers of fetal losses. There is no definitive treatment other than delivery. A drug that can quench the disease process could be useful to treat early onset pre-eclampsia, as it could allow pregnancies to safely continue to a gestation where fetal outcomes are significantly improved. We have generated preclinical data to show esomeprazole, a proton pump inhibitor used for gastric reflux, has potent biological effects that makes it a worthwhile therapeutic candidate. Esomeprazole potently decreases soluble fms-like tyrosine kinase 1 (sFlt-1) and soluble endoglin secretion from placenta and endothelial cells, and has biological actions to mitigate endothelial dysfunction and oxidative stress. Methods and analysis: We propose undertaking a phase II, double blind, randomised controlled clinical trial to examine whether administering 40 mg esomeprazole daily may prolong gestation in women with early onset pre-eclampsia. We will recruit 120 women (gestational age of 26+0 to 31+6 weeks) who will be randomised to receive either esomeprazole or an identical placebo. The primary outcome will be the number of days from randomisation to delivery. Secondary outcomes include maternal, fetal and neonatal composite and individual outcomes. Maternal outcomes include maternal death, eclampsia, pulmonary oedema, severe renal impairment, cerebral vascular events and liver haematoma or rupture. Neonatal outcomes include neonatal death within 6 weeks after the due date, intraventricular haemorrhage, necrotising enterocolitis and bronchopulmonary dysplasia. We will examine whether esomeprazole can decrease serum sFlt-1 and soluble endoglin levels and we will record the safety of esomeprazole in these pregnancies. Ethics and dissemination: This study has ethical approval (Protocol V.2.4, M14/09/038, Federal Wide assurance Number 00001372, IRB0005239), and is registered with NHREC (ID 3649) and the Pan African Clinical Trial Registry (PACTR201504000771349). Data will be presented at international conferences and published in peer-reviewed journals.
Early human follicle ultrastructure comparison after slow cryopreservation in two different cryoprotectants
(Stellenbosch : Stellenbosch University, 2008-03) Els, Cecilia Lydia; De Beer, Marie-Lena (Windt); Stellenbosch University. Faculty of Health Sciences. Dept. of Obstetrics and Gynaecology.
BACKGROUND: The cryopreservation and transplantation of ovarian tissue have been shown to restore ovarian function temporarily and may also preserve the fertility of young female cancer patients until after their sterilizing cancer treatment. Since tissue samples are large and morphologically complex, the cryopreservation methodology is difficult to optimize and standardise. Ovarian tissue cryopreservation is therefore, still in its experimental stages and is not a routine option offered to cancer patients. OBJECTIVES: Our main aim was to initiate, develop and implement a practical ovarian tissue cryopreservation and re-transplantation protocol which would restore ovarian function, and possibly fertility, in young female cancer patients undergoing sterilizing cancer therapies in South Africa. The objective of this study was to improve the slow cryopreservation protocol for human ovarian tissue. The ultrastructural effects after cryopreservation with two well-known cryoprotectants, dimethyl sulfoxide (DMSO) and 1,2-propylene glycol (PROH), on early human follicles were investigated and compared to identify and the better cryoprotectant. MATERIALS AND METHODS: A single group experimental study design was used. The participants consisted cancer patients of the Gynaecological Oncology Unit of Tygerberg Hospital who entered on a basis of voluntary informed consent. Ovarian tissue was obtained by laparoscopic oophorectomy. After dissection of the ovary(ies), some fresh cortical tissue was sent for metastatic analysis and a few strips taken as fresh control. Remaining dissected ovarian cortical tissue sections of each patient were equally divided into the two cryoprotectant groups. Five resulting groups could be compared: i) fresh tissue (control group); tissue equilibrated in ii) DMSO; or iii) PROH and tissue equilibrated and cryopreserved in iv) DMSO or v) PROH. Five tissue samples per patient were therefore fixed for standard histological haematoxylin and eosin (HE) staining and transmission electron microscopy (TEM). Tissue samples showing early follicles on HE slides were sent for TEM processing. Ultrastructural studies on micrographs of primordial and primary follicles were assessed according to a scoring system which gave an indication of follicular health. Appropriate statistical tests were applied to analyse the mean scores where P≤0.05 was considered as statistically significant. RESULTS: No significant overall cryopreservation treatment effect was evident in any of the follicular ultrastructures evaluated. This result indicated that the cryopreservation protocol used did not induce significant damage to the cortex tissue compared to the fresh control group. Comparison of the effect of PROH and DMSO on the follicular ultrastructures showed that PROH tend to induce more extensive damage, especially after cryopreservation. Correlation studies showed significant positive relationships between the majority of the evaluated ultrastructures, especially between the oocyte and granulosa cell layer and basal membrane. The stromal cells and extracellular matrix did not correlate well with other structures. Correlations indicated that the granulosa cells, oocyte and basal lamina are affected similarly and that the damage in one of these structures may be representative of the damage in the other structures. CONCLUSION: The main aim of the study was achieved since results showed that no significant damage was induced by the cryopreservation protocols. Ovarian tissue cryopreserved in this study has shown to restore endocrine function temporarily after heterotopic autotransplantation in menopausal patients. From the electron microscopy evaluations, DMSO showed better cryopreservation results. The DMSO cryopreservation protocol was also more time efficient and has shown the most successful outcomes in the literature. The stromal tissue seemed to be affected differently by cryopreservation compared to the primordial follicle ultrastructures. Younger patients are needed for future studies since a larger initial follicular reserve may allow for larger follicle sample sizes.
Early onset pre-eclampsia with severe features necessitating fetal delivery: outcome of pregnancies with birthweight 1000-1800g at Tygerberg Hospital 2017
(Stellenbosch : Stellenbosch University, 2021-12) Adlam, Jan Andries; Gebhardt, Gabriel Stefanus; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.
Introduction: Expectant management of early onset pre-eclampsia (EOPE) is an established practice at Tygerberg Hospital and some other tertiary institutions in South Africa. Its outcome has been documented in several studies. However, neonatal care has improved since many of these studies were done, e.g., nasal continuous positive airway pressure (NCPAP) plus intubation, surfactant, and extubation (InSurE) (introduced in 2006 at Tygerberg) and therapeutic hypothermia introduced in 2008. It is plausible that an interventionist approach (delivery after 48 hours of optimal maternal and fetal preparation, stabilisation of mother, antenatal corticosteroids and MgSO4 for neuroprotection, fetal evaluation with ultrasound, Doppler and electronic fetal monitoring) with access to good neonatal care can yield the same outcome without subjecting the mother to the additional dangers of expectant management. The women who do not qualify for expectant management (due to maternal or fetal contra- indications) can be a good proxy for an interventionist approach to EOPE. The outcome of ELBW (<1000g) babies at Tygerberg has been described previously. Methods: This was an observational cross-sectional study using data from the routinely collected PPIP database, electronic labour ward register and clinical data from patient folders. All pregnancies complicated by pre-eclampsia with a birthweight of 1000-1800g born at least 24 hours after admission in 2017 at Tygerberg Hospital were identified. Patients admitted for formal expectant management were excluded. By folder review, routine provincial admission and discharge data and mortality data, clinical outcome and neonatal survival were investigated. Findings: 139 Women were identified by total population sampling. The presenting diagnosis was EOPE (122 women, [88%]) LOPE (14 women [10%]) or eclampsia (3 women [2%]). Intra-uterine growth restriction (IUGR) was diagnosed in 41% of cases before delivery. The time to delivery was on average 81 hours. In total, 65 (46.7%) of deliveries were due to fetal indications. Maternal indications for early delivery in the remaining 74 women were: pregnancy that reached 34 weeks (n=28), specialist opinion (n=13), HELLP syndrome (n=7), pulmonary oedema (n=7), severe maternal ascites (n=6), uncontrollable hypertension (n=5), maternal request (n=3), eclampsia (n=3) or acute renal injury (n=2). There were no intrapartum deaths and only two neonatal deaths. The rest of the babies were discharged alive from hospital. For 22 babies, there were no accounts of follow-up visits in the province. Thirty babies iii attended the neurodevelopmental clinic for follow-ups. Of these, three had spastic cerebral palsy and two had fine or gross motor delay. The rest had no major disabilities noted. The remaining 84 babies all had contact with health services during the months after discharge, with minor problems. The mean number of neonatal days in hospital was 20 and ranged from 2 days to 116 days. Conclusion: Neonatal outcomes were acceptable and overall survival was better than the initial study done at Tygerberg Hospital (with 12 neonatal deaths in babies >1000g in the group of 340 women managed expectantly in 1992-1997). With these findings, a rethink of management strategies for pregnancies complicated by severe early onset pre-eclampsia is warranted and a randomised trial is recommended as the next step.
Effect of human male patient diagnosis on syngamy timing and blastulation using time-lapse technology
(Stellenbosch : Stellenbosch University, 2019-04) Steyn, Cheyenne; Windt De Beer, Marie-Lena; Els-Smit, Lydia; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.
BACKGROUND: Improving embryo selection for embryo transfer is essential in Assisted Reproductive Technologies (ART), especially in single embryo transfer settings to reduce multiple birth rate. Current selection methods are largely based on assessment of morphological characteristics. Morphological blastocyst parameters have been shown in literature to correlate with implantation and live birth success rates, while female age is well established to affect overall assisted reproductive technology outcomes. More recently, kinetic parameters from time lapse (TL) technology have also emerged as additional selection characteristics during embryo development. As of yet, the effect of certain patient factors on kinetic parameters is to be elucidated. Syngamy is the merging event of maternal and paternal deoxyribonucleic acid (DNA) during fertilization and can be accurately determined / visualized using TL. The functional centrosome within the spermatozoa contributes to chromosome alignment and combination, therefore possibly impacting syngamy. The paternal genome from the spermatozoon also possibly contributes to blastulation on day 5 of embryo development by playing a role in the embryo genome activation, which drives advanced embryo development. The kinetic time points generated by TL technology during embryo development, can be used to examine the potential effect of male fertility diagnosis on syngamy and blastulation. This may elucidate whether syngamy timing is a relevant kinetic parameter that can allow more accurate selection and prediction of good quality embryos. AIMS: Primary aim: To investigate the possible measurable direct effect of male fertility prognosis using TL, on the time duration to the syngamy fertilization event. Secondary aim: To investigate the subsequent effect of male fertility prognosis using TL, on syngamy timing and the resulting advanced embryo development and blastocyst quality. MATERIALS AND METHODS: This was a retrospective study that was conducted from 2017 to 2018 at Wijnland Fertility clinic on de-identified, aggregated TL patient embryo data from 2013 to 2016. Data was filtered according to inclusion and exclusion criteria and categorized according to defined male prognosis groups (good prognosis (GP), poor prognosis (PP), and very poor prognosis (VP)). Data was submitted for statistical analysis (statistical significance: P < 0.05). Female age was compensated for during statistical analysis. RESULTS: Results indicated that all three male prognosis groups (GP, PP, VP) had similar rates of normal fertilization (60.12%, 58.84%, and 54.29%, P = 0.19) and subsequent blastulation (64.75%, 69.61%, and 63.28%, P = 0.25). The GP group showed significantly shorter syngamy timing compared to the VP group (19.73 ± 3.69 hours vs 20.80 ± 4.71 hours, P = 0.02). Shorter syngamy timing significantly correlated with increased blastocyst expansion on day 5 of embryo development in all groups (P < 0.01). A shorter syngamy timing significantly correlated with A-grade trophectoderm epithelium (TE) quality compared to B-grade (P = 0.02). A-grade TE in the GP group (P = 0.05) and VP group showed significantly shorter syngamy timing compared to B-grade in the VP group (P =0.04). Syngamy timing did not show any significant correlation with inner cell mass (ICM) quality (P = 0.36) or between male prognosis groups (P = 0.13). CONCLUSION: Results indicated that although fertilization and blastulation rate amongst the male prognosis groups were similar, poorer male prognosis may lead to extended syngamy timing and poorer blastocysts, impacting expansion and trophectoderm epithelium quality specifically. Since these two blastocyst parameters are the most important indicators of embryo implantation potential, syngamy can therefore be an early predictive marker for blastocyst quality, irrespective of initial sperm prognosis.
The effect of incubation time and temperature on sperm motility, human sperm DNA and assisted reproductive technologies (ART) outcome
(Stellenbosch : Stellenbosch University, 2015-03) Van Zyl, Estee Alwelien; De Windt-de Beer, Marie-Lena; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology
ENGLISH ABSTRACT: In all Assisted Reproductive Technologies (ART) procedures the semen sample is handled, processed, prepared and manipulated before use in the fertilization process. During these incubation times, the sperm cells are exposed to factors that may inflict damage to the sperm structure and DNA integrity, impair its functional abilities and subsequently lead to fertilization failure and poor ART outcome. Two of the very basic, but important factors that may have an impact on the sperm quality are time and temperature exposure. The primary objective of this study was to prospectively determine the effect of different incubation times and temperatures on motility and the DNA profile of the spermatozoa. Non-processed (n=36) and processed (n=33) semen samples were incubated for different time intervals (before: 20, 40, 60 minutes; after: 30, 60, 90 minutes) and at different temperatures (room temperature [RT] and 37°C). After incubation, sperm parameters were assessed, the CMA3 assay was applied to determine chromatin maturity and compaction and the TUNEL assay to assess the level of DNA fragmentation. The results showed that in the non-processed group, incubation led to a time-dependent, significant decline in the motility. The highest motility was seen at 20 minutes (37°C) and motility declined in a time-dependent manner. Incubation time and temperature did not affect the CMA3 and TUNEL values. Incubation of the processed sample led to a significant time-dependent decrease in the motility; 90 minutes (RT) had the lowest motility. The CMA3 and TUNEL values between the different incubation groups did not differ significantly. The secondary objective was to retrospectively investigate the effect of sperm incubation time after preparation on ART outcome. A total of 901 patient ART cycles (January 2010- December 2012) were included. Fertilization rates, embryo quality and pregnancy rates were examined. The results showed that the sperm incubation time before insemination between in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) differed significantly and the incubation time had a significant negative effect on the fertilization rates in IVF, but not in ICSI. Longer incubation times led to an unexpected significant improvement in the quality of day 2 embryos and were significantly associated with pregnancy failure in IVF and ICSI. These combined findings suggest that non-processed semen samples can be incubated at RT or 37°C, but for no longer than 40 minutes and, for IVF, processed samples should not be incubated for longer than 60 minutes at RT or 37°C. The ICSI sample should not be incubated for more than 60 minutes although longer incubation times do not seem to influence the results for IVF. It can therefore also be concluded that sperm incubation time before insemination should be closely monitored, especially in IVF cycles.
The effect of misoprostol on fetal heart rate parameters during induction of labour from 38 weeks gestation : a retrospective audit
(Stellenbosch : Stellenbosch University, 2013-12) Feketshane, Anthony M.; Steyn, D. W.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.
ENGLISH ABSTRACT: Misoprostol is often used for the purpose of induction of labour. However, its effect on fetal heart rate has not been systematically studied. Objective To assess the effect of misoprostol on fetal heart rate parameters during induction of labour from 38 completed weeks in women with previous intrauterine death or postterm pregnancy. Study design A retrospective descriptive study of 127 women for a period of 18 months. Method Women who underwent induction of labour with misoprostol for either previous intrauterine death or postterm pregnancy at Tygerberg hospital were eligible. The selected process of induction of labour happened according to the departmental protocol. The primary outcomes were changes in fetal heart rate (variability, accelerations and decelerations) pre-and post-administration of misoprostol. Secondary outcomes were neonatal highcare or intensive care unit (ICU) admissions. Results There was no statistical difference in the mean fetal heart rate and baseline variability in relation to time recordings after administration of misoprostol. There were no statistically significant differences in the distribution of accelerations and decelerations in different time intervals before and after administration. There were more reactive patterns at all time intervals after the administration of misoprostol, but these differences did not quite reach statistical significance. In both study groups no neonatal complications or intensive care admissions were reported. Conclusion In the absence of contra indications, 50mcg of oral misoprostol can be given to mothers for induction of labour as no harmful fetal heart tracing abnormalities were found for 45 minutes; however large prospective randomized controlled trials are still needed to confirm effectiveness and evaluate further maternal and neonatal safety issues. Optimal dose and frequency also still need robust interrogation. Based on this thesis it does appear that misoprostol is probably not harmful to the fetus under these circumstances.

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