Masters Degrees (Obstetrics and Gynaecology)

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    Outcomes of laparoscopic abdominal cerclage in Aevitas Fertility Clinic in South Africa from 2018-2022 : a retrospective study
    (Stellenbosch : Stellenbosch University, 2024-03) Mbungu, Nomaphelo; Siebert, Thomas Ignatius; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. Obstetrics and Gynaecology.
    ENGLISH SUMMARY: BACKGROUND: Cervical insufficiency (CI) is an important cause of recurrent miscarriages and spontaneous preterm delivery. Preterm delivery is associated with significant neonatal morbidity and mortality. CI and its associated devastating pregnancy outcomes can be treated by cervical cerclage, a surgical reinforcement of cervical competency. Transabdominal cerclage (TAC) has emerged as a superior approach to the conventional transvaginal cerclage (TVC), particularly after previous failed TVC. In TAC, laparoscopic approaches offer several advantages that may contribute to improved outcomes. OBJECTIVES: The primary objective of this study was to evaluate surgical complications following laparoscopic abdominal cerclage (pre and post conception) at Aevitas Fertility Clinic. Secondary objectives were to assess pregnancy outcomes at 24 to 34 weeks of gestation and beyond 34 weeks of gestation, and to evaluate pregnancy complications following laparoscopic abdominal cerclage. METHODS: A retrospective cohort study was performed of all women who underwent either pre-conception or post-conception laparoscopic TAC at Aevitas Fertility Clinic over a period of 3 years. The charts of all patients (n= 18) who had laparoscopic TAC were retrieved from Aevitas Health ONE (electronic hospital data system) for evaluation and telephone interviews were conducted using a questionnaire for further information. RESULTS: The mean age at the time of presentation was 34.5 ± 3.7 years and BMI was 31.4 ± 6.5 kg/m2. More than half the patients had a previous TVC, 55.6% (10/18) . The majority of patients had successful laparoscopic TAC , 94.4 % (17/18) and only one case had a conversion to laparotomy due to large uterine size. The majority of women had preconception transabdominal cerclage, 83.3% (15/18) and 16.7% (3/18) had postconception TAC. There were no surgical complications in the pre-conception group and only one patient had a surgical complication in the post-conception group. None of the women had obstetric complications in the post- conception group and one patient had a 2nd trimester miscarriage in the pre-conception group. In pregnancy outcomes, 20% (3/15) had spontaneous pregnancy and 20% (3/15) conceived through assisted reproductive therapy (ART) and the remainder, 46.6% (7/15) were still in progress (either awaiting spontaneous pregnancy or undergoing assisted reproductive therapy), while 13,3% (2/15) decided to be child free (discontinued), respectively. Of the 6 pregnant patients, 4 patients (66.7%) delivered successfully, one patient (16.7%) had an intra-uterine death at 32 weeks and one (16.7%) had a miscarriage at 16 weeks’ gestation. Of the 4 successful deliveries, 3 deliveries (75%) were at term (37, 39 and 39+ weeks gestation), and one (25%) was a preterm delivery at 28 weeks gestation, due to preterm labour. CONCLUSION: In this small cohort, laparoscopic TAC by an experienced surgeon was feasible and safe. The very low rate of surgical and obstetric complications and encouraging obstetric outcomes reinforce the value of laparoscopic TAC. More robust evidence with prospective studies is required to properly define the effectiveness of laparoscopic TAC.
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    Sacrospinous ligament fixation surgical outcoms after hysterectomy for apical support in a local population at a tertiary hospital - a retrospective descriptive study
    (Stellenbosch : Stellenbosch University, 2024-03) Mokete, Gaone Gosego; Van Rensburg, Jacobus Albertus; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. Obstetrics and Gynaecology.
    ENGLISH SUMMARY: Introduction: Sacrospinous ligament fixation (SSLF) is a surgical procedure designed to restore support of the uterus or vaginal vault, often performed post hysterectomy. It involves attaching upper most lateral aspect of the vaginal vault to the sacrospinous ligament. Complications can include 5-10% failure rate, <1% risk of bleeding requiring blood transfusion, <1% risk of deep venous thrombosis and 1-5% risk of urinary tract infections, as well as potential dyspareunia. However, there is limited research on SSLF success and failure rate in the local population. Aims and Objectives: This study aimed to evaluate the surgical outcomes of sacrospinous ligament fixation for level 1 and apical support of the vagina in pelvic organ prolapse (POP) repair. Methods: A Retrospective chart review was conducted on 86 women with pelvic organ prolapse who underwent clinical examination and sacrospinous ligament fixation after hysterectomy at Tygerberg Hospital between January 2014 and December 2019. POP was clinically evaluated and graded using POP-Q system. Preoperative and postoperative clinical assessment included the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Retrospective data analysis extended up to 3 years post-operation. Microsoft™ Excel software was used for data entry, cleaning and analysis. Results: Patient ages ranged from 38 to 79 years with a mean of 59 years. Eighty percent of patients were overweight or obese, and 75% had parity between 2 and 5. Symptomatic POP was present in 97% of cases, with grade 3 and 4 POP accounting for 93% of the diagnoses. Initial surgery resulted in no recurrence in 88% of patients. Site specification for SSLF was lacking in 23.2% of cases, without reasons provided for the omission. The PGI-I combined with post operation ICIQ-SF revealed that ninety-six percent of patients reported 100% satisfaction with treatment while clinical evaluation showed that anatomical success was achieved in 87.2% of the cases. Complications related to the surgery were reported by only 3.6% of patients. Regarding incontinence, 49% experienced improvement, 9% reported no change in symptoms ,1% had new symptoms, and 40% remained incontinent before and after the operation. Conclusion: SSLF demonstrated excellent anatomical support and high patient satisfaction rates.
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    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.
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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.