Masters Degrees (Obstetrics and Gynaecology)

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    Intact neurological survival after emergency caesarean delivery for pathological fetal heart rate tracings at term- is it time to rethink ‘fetal distress’ interpretation of cardiotocography in South African cerebral palsy lawsuits?
    (Stellenbosch : Stellenbosch University,, 2023-03) Van Rooyen, Donée; Gebhardt, Gabriel Stephanus; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. Obstetrics and Gynaecology.
    ENGLISH ABSTRACT: Objective: The aim of this descriptive study was to critically review the CTG tracings that informed the decision to do an urgent Caesarean delivery (CD) in cases where there was a good neonatal outcome. Method: This was an observational cross-sectional study using data collected from records at Tygerberg Academic Hospital reviewing women >36 weeks gestation who delivered by emergency caesarean section with the indication of “fetal distress” or “pathological CTG” and had normal neonatal outcomes. Results: The mean time from decision to do a CS to the delivery of the baby was 113 minutes and the mean time from the removal of the CTG from the patient (or the last CTG available to review in the folder) to the start of surgery was 46 minutes. The mean duration of abnormal tracings (from diagnosis to recovery or last CTG taken if there was ongoing abnormal CTG) was 72 minutes, ranging from 30 to 355 minutes. Eighty percent of women still had pathological changes on the CTG at the time of transport to theatre. Conclusion: This audit showed that in most babies with pathological CTG tracings, neither prolonged periods of abnormal tracing nor delays in delivery necessarily leads to a bad outcome. In litigation cases for term hypoxic brain injury, there are other underlying conditions of the fetus and mother that needs to be considered and not only a focus on CTG interpretation and management, before negligence is inferred.
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    Uterine balloon volume shifts using a free-flow uterine balloon in the management of refractory postpartum haemorrhage
    (Stellenbosch : Stellenbosch University, 2023-12) Hassim, Tasleem; Kidd, Martin; Theron, Gerhardus Barnard; Langenegger, Eduard Jacobus; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. Obstetrics and Gynaecology.
    ENGLISH ABSTRACT: Background Uterine balloon tamponade (UBT) is used as part of the postpartum haemorrhage (PPH) algorithm for the treatment of PPH. Objectives The free-flow Ellavi uterine balloon controls the pressure in the uterine balloon by adjusting the height of the supply bag above the patient and allows for expulsion of water from the balloon. The study quantified the volume shifts in the supply bag and assessed the optimal use of the Ellavi UBT by reducing the intrauterine pressure at regular intervals. Methods A prospective descriptive study of consecutive patients with refractory PPH was conducted. For Group A, the supply bag was weighed every 30 minutes with a sensitive digital scale. Additionally, for Group B the supply bag was lowered by 50% and the uterus gently massaged for 30 seconds. Results Thirteen patients were included in the study. The mean volume was 23.5ml for Group A and 132.7ml for Group B. The difference in the means of Groups A and B was borderline significant (P = 0.06). Conclusion The study did find volume shifts in the free-flow system, and this may be enhanced by lowering the supply bag halfway at regular intervals.
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    The utility and acceptability of a Brass V-drape versus a Maternawell tray for the collection of postpartum blood loss in low-risk term vaginal deliveries: a prospective parallel randomized trial
    (Stellenbosch : Stellenbosch University, 2023-12) Esau, Jade Monique; Morris, T; Muller, CJB; Els, Hester Christine; De Waard, Liesl; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.
    ENGLISH ABSTRACT: Objective To assess the perceived usefulness and ease of use of a Brass V-drape versus a Maternawell tray for the collection of postpartum blood loss. Design Prospective parallel randomised controlled trial Setting Site B Midwife and Obstetric Unit, Khayelitsha, Cape Town, South Africa Methods The study was approved by the Health Research and Ethics Committee of Stellenbosch University (S21/10/191). Informed consent was obtained, and participants were randomised to either the Brass-V drape or Maternawell tray, the birth attendant placed these after the delivery of the baby. The birth attendant and participant completed a questionnaire and clinical data was collected. Main Outcome Measures To assess and compare the perceived usefulness and ease of use of a Brass V-Drape versus the Maternawell tray for the collection of post-delivery blood loss by the birth attendant as well as the participant. Additionally, secondary outcomes included describing the characteristics of the study participants, measuring the blood loss for each participant, analysing the details of participants with blood loss exceeding 500ml, and identifying potential risk factors for postpartum haemorrhage Stellenbosch University Results There were 63 participants, 33 assigned to the Maternawell tray and 30 to the BrassV drape. The mean delivery gestation was 39[37-43] weeks. Birth attendants were keen to use the Maternawell tray 30/33(90%) or Brass-V drape 26/30(87%) for future deliveries. The participants 33/33(100%) delivering with the Maternawell tray and 28/30(93%) with the Brass-V drape would be keen to use it in future. There were five (8%) cases of postpartum haemorrhage, two with the Maternawell tray and three with the Brass-V drape, one required hospital transfer. Conclusion The response to the Maternawell tray and the Brass-V drape were positive and accepted by the birth attendants and participants. With the option of reuse and lower cost, the Maternawell tray appears to be an acceptable alternative, and could provide a solution for early recognition of postpartum haemorrhage.
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    Retrospective audit on outcomes of post caesarean section sepsis after additional azithromycin to the standard antibiotic at Tygerberg hospital, Cape Town
    (Stellenbosch : Stellenbosch University, 2023-12) Matabata, Thembani; Mbungu, Nomaphelo; Singini, Isaac; Gebhardt, Gabriel Stefanus; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. Obstetrics and Gynaecology.
    ENGLISH ABSTRACT: Background Surgical site infections (SSI) and endometritis are important causes of post caesarean delivery (CD) morbidity and mortality. They lead to prolonged hospital stay and increase in hospital expenditure. The global rate of SSI is 3-15% with the change in incidence being attributed to changes in population traits, risk factors, perioperative practices and time taken from the procedure. There is currently little clinical data on the incidence of post CD in the South African setting. The commonest organisms associated are Staphylococcus aureus, E. coli, Pseudomonas, Proteus mirabilis and Mycoplasma species. Some of the identifiable risk factors are prolonged labour, emergency CD, multiple vaginal examinations during labour, diabetes mellitus or high Body Mass Index (BMI). With the use of the standard antibiotic prophylaxis, the incidence of post CD sepsis remains high. With dual antibiotic prophylaxis (azithromycin 500mg IV in addition to the standard cephazolin) there is a 60% reduction in post CD sepsis with no adverse neonatal outcomes. Single agent pre-operative prophylaxis with a first-generation cephalosporin (e.g. cefazolin) was the standard of care during 2017, when a retrospective folder review showed a cumulative incidence for post-CS sepsis to be 4.69%. Dual prophylaxis became the standard of care during 2019 with its inclusion in the National Essential Medicine List. This was introduced at Tygerberg Hospital in September 2020. Aim To perform an audit of post caesarean section sepsis after implementation of the additional azithromycin to standard antibiotic protocol at Tygerberg hospital, Cape Town; to monitor adherence to this new protocol as well as to determine the incidence of post-CD sepsis. Methods 3 | Page A retrospective study was conducted on all pregnant women undergoing CD at Tygerberg hospital in from 01 September 2021- 30 November 2021. Records of the cases of the patients were retrieved from the Electronic Content Management (ECM) and followed up to 30 days after delivery to determine the rate of post-CD sepsis. Results A total of 457 records were audited, with 16 women identified with post CD sepsis (a hospital rate of 3.5%). This was 18% lower than the rate reported prior to dual prophylaxis (4.69%). The risk factors identified to be significantly associated with post CD sepsis were number of vaginal examinations >5 (p = 0.007), duration of active labour (p = 0.011), labour mechanism (p = 0.009) and noticeable intra-operative findings including difficult haemostasis and adhesiolysis (p= 0.003). Conclusion Addition of azithromycin to the standard antibiotic reduces the rate of post CD sepsis. Multiple vaginal examinations, duration of active labour, emergency CD and specific intraoperative findings were identifiable risk factors for post CD sepsis.
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    A retrospective study of the effect of testicular biopsy extracted spermatozoa in intracytoplasmic sperm injection (ICSI) on reproductive outcomes in assisted reproductive treatment (ART)
    (Stellenbosch : Stellenbosch University, 2023-03) Oosthuizen, Micke; Burger, Riana; Erasmus, Evelyn; Matsaseng, T.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.
    ENGLISH SUMMARY: Background: Azoospermia, a possible cause of male infertility, is responsible for 10–15 percent of infertility cases. Azoospermia is characterized by the absence of spermatozoa following microscopic analysis and centrifugation of the complete sperm specimen. Azoospermia patients can be divided into two categories, obstructive azoospermia (OA) and non-obstructive azoospermia (NOA). The effects of testicular spermatozoa compared to ejaculated spermatozoa on ART outcomes still remain controversial. Spermatozoa from different sources or diagnostic groups result in significantly different treatment outcomes in some studies but not in others. There are differences in the quality of sperm from patients diagnosed with OA and NOA. Due to ongoing controversy, this study was therefore conducted to establish ICSI outcomes with ejaculated spermatozoa and testicular retrieved spermatozoa under specific laboratory conditions. Aims: The primary aim was to retrospectively investigate the effect of testicular biopsy spermatozoa (TB group) compared to the effect of ejaculated spermatozoa (ES group) on ART outcomes. The secondary aim was to retrospectively evaluate whether the reason for azoospermia (NOA or OA) affects the IR, CPR, LBR, and MR. Materials and Methods: This study was retrospectively conducted on the data obtained from medical and laboratory records between 2017 and 2020 at Drs. Aevitas Fertility Clinic, Pinelands, South Africa and Tygerberg Fertility Clinic for the period of 2015 – 2020. Data was categorized and filtered based on predetermined inclusion and exclusion criteria. Data was submitted for statistical analysis (statistical significance: P < 0.05). Results: The FR (84.66% vs 82.47%), Cleavage Rate (97.15% vs 98.76%), Blastulation Rate (54.73% vs 53.82%), CPR (44.86% vs 35.94%) and MR (29.17% vs 36.28%) were not significantly different between the TB group and the ES group respectively (p>0.05). The IR (30.69% vs 23.06%) and the LBR (33.64% vs 23.96%) was significantly different between the TB group and the ES group respectively (p<0.05). The FR (86.30% vs 79.29%), Cleavage Rate (96.79% vs 98.39%), Blastulation Rate (57.19% vs 45.43%), IR (29.27% vs 35.33%), CPR (43.90% vs 48%), MR (36.11% vs 8.33%) and LBR (29.27% vs 44%) were not significantly different between the OA group and the NOA group respectively (p>0.05). Conclusion: The present study primarily compared the results of ICSI with testicular spermatozoa with those of ICSI with ejaculated spermatozoa. Sub analysis were done on the two different azoospermic groups (NOA and OA). This retrospective study indicated similar FR, Cleavage Rates, Blastulation Rates, PR and MR for the ES group and the TB group. The current study found a significant difference in the IR and LBR between these two groups. By comparing the OA and the NOA group no significant difference in the FR, Cleavage Rates, Blastulation Rates, IR, CPR, MR and LBR was found. The present study, as well as available literature, confirms that the use of testicular spermatozoa does not have a negative effect on ICSI treatment outcomes. This study can therefore provide valuable information during consultation for ICSI treatment in these patients and provide them with assurance that it is possible to achieve normal FR as well as good quality embryos, IR, CPR and lower MR with ICSI.