Masters Degrees (Obstetrics and Gynaecology)

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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.
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    Polycystic ovarian syndrome (PCOS) : an audit of how many PCOS patients struggle to lose weight with recommended diet management in a Tygerberg Hospital population
    (Stellenbosch : Stellenbosch University, 2022-12) Alwakwak, Asma Ahmed E.; Matsaseng, T.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.
    ENGLISH SUMMARY: Introduction: Polycystic ovarian syndrome (PCOS) is a common endocrine disorder of women in the reproductive eage (Matsaseng, 2017). It has a variable clinical appearance, with manifestations that include menstrual irregularities, hirsutism, acne, obesity, infertility, impaired glucose tolerance, diabetes, and a significant cardiovascular risk profile (Teedeetal., 2010). Globally, the prevalence of PCOS is 5% to 10% of women in the reproductive age. Insub-Saharan Africa, studies on the prevalence of PCOS are scarce and values range from 16% to 32% (Pembe & Abeid, 2009). Materials and Methods: Aim of the study: To evaluate how many PCOS patients struggle to lose weight with recommended diet management in a Tygerberg Hospital population. Study design: This is a retrospective observational study. Setting: The setting of the study is the Reproductive Medicine Unit of the Department of Obstetrics and Gynaecology at the Tygerberg Academic Hospital. Results: A total of 73 women were recruited for the study between June and December 2021. The average age of the study participants was 29.3years. All of the study participants (100 %) struggled to lose there commended weight. Average BMI was 38.1kg/m2 and 37.7kg/m2 at first and last visit, respectively. We created two BMI category variables, each with four levels, namely pre-obese, obese class 1, obese class 2, and obese class 3. Most of the participants were obese class 2 at both the first and last visits. The classification was pre-obese (25 to 29.9), class 1 (30 to 34.9), which is associated with a mildly increased risk of co-morbidities, class 2 (35 to 39.9), which is associated with a moderately increased risk of co-morbidities, and class 3 (≥40), which is associated with a severe risk of co-morbidities. Conclusion: Inconclusion, our study shows that 38 % of patients with PCOS at Tygerberg Academic Hospital are obese, and none of the patients succeeded in losing the recommended weight following the initial standard therapy offered.
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    A retrospective study of the effect of endometriosis on reproductive outcomes in assisted reproductive treatment
    (Stellenbosch : Stellenbosch University, 2023-03) Pfeiffer, Nadine; Erasmus, Evelyn; Burger, Riana; Matsaseng, T.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.
    ENGLISH SUMMARY: Background: One of the leading causes of female infertility is a chronic condition known as endometriosis. There are four stages of endometriosis, and 25 to 50% of affected women experience endometriosis-related infertility. Endometriosis is suggested to impair the pelvic environment, ovaries (oocyte quality and quantity), and the uterus. Endometriosis is a frequent indicator for Assisted Reproductive Treatment (ART). However, there is a lack of consensus regarding the impact of this disease and its subsequent stages on outcomes achieved in ART. With the optimisation of ART, it is necessary to further evaluate the effect endometriosis may have on reproductive and embryological outcomes. Objectives: Primary objective: To retrospectively evaluate the reproductive outcomes (post-embryo transfer) of endometriosis patients (EE group) compared to the success of tubal factor infertility patients (TF group) by calculating implantation rate (IR), clinical pregnancy rate (CPR), live birth rate (LBR), and miscarriage rate (MR). Secondary objective: To retrospectively evaluate the pre-embryo transfer outcomes of the EE group and TF group by calculating fertilisation rate (FR), number of oocytes retrieved, percentage of good quality day 3 embryos (GQE), and blastulation rate (BR). Tertiary objective: To retrospectively evaluate whether the stage of endometriosis affects BR, IR, CPR, LBR, and MR. Materials and Methods: This retrospective study (2017 to 2020) used anonymised data from the Tygerberg and Aevitas Fertility Clinics. It included a study group, the EE group (N = 101) and a control group, the TF group (N = 110). The EE group were subdivided, if the stage of endometriosis (ES) was known, as stage I and II (ES1-2 group [n=13]) and stage III and IV (ES3-4 group [n=65]). The data was submitted for statistical analysis, with statistical significance defined as P < 0.05. Results: Compared to the TF group, the EE group had a higher, but non-significant (p>0.05) number of metaphase II (MII) oocytes retrieved (6.02 MII oocytes vs 5.6 MII oocytes), IR (23.27% vs 19.6%), CPR (32.67% vs 32.11%), MR (28.13% vs 25.00%), and LBR (78.13% vs 75.00%). However, the EE group had a significantly reduced FR compared to the TF group (82.19% vs 87.46%, P = 0.04). Nonetheless, the GQE (77.66% vs 75.73%) and the BR (58.7% vs 63.79%) of the two groups were similar. No statistically significant differences (p>0.05) were found between the ES1-2 group and the ES3-4 group regarding BR (62.11% vs 57.63%), IR (26.92% vs 20.77%), CPR (38.46% vs 29.23%), and LBR (100% vs 66.67%). The MR of the ES3-4 group was significantly higher than the ES1-2 group (38.89% vs 0%, P = 0.04), however, the small sample size queries the validity. Conclusions: The current study found that endometriosis does not have a negative impact on post-embryo transfer reproductive outcomes, during ART. Similarly, the disease does not have a negative effect on the number of MII oocytes retrieved, GQE, and BR. However, a significantly reduced FR in the EE group was indicated, which may be a result of oocyte abnormalities in endometriosis patients. Furthermore, the study found that the reproductive outcomes and BR were lower in ES3-4 group, although it was not significant.
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    Incidence, management, and outcomes of pregnancies complicated by major placenta praevia at Tygerberg Hospital: A two-year review
    (Stellenbosch : Stellenbosch University, 2022-11-21) Indongo, Justine Nalimanguluke; Gebhardt, Gabriel Stefanus; Swart, Hester Alida; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. Obstetrics and Gynaecology.
    ENGLISH ABSTRACT: Introduction Obstetric haemorrhage is the third most important cause of direct maternal death (19,1% of all deaths) in South Africa. Although most of these deaths are due to postpartum haemorrhage, antenatal haemorrhage also contributes significantly. Placenta praevia is a major source of obstetric haemorrhage as it carries risks for both antepartum haemorrhage, intrapartum haemorrhage, and postpartum haemorrhage. Massive obstetric haemorrhage is also a major cause of perinatal morbidity and mortality. Placenta praevia represents a complex clinical challenge due to the prolonged in-patient monitoring that is often advised. Additionally, patients are at increased risk for hysterectomy and blood transfusions as well as perinatal morbidity and mortality mainly due to premature delivery. Methods This is a retrospective audit including all women with major placenta praevia during a twoyear period (1st January 2016 until 31st December 2017) at Tygerberg Hospital, a large regional and tertiary referral centre in the Western Cape province of South Africa. It was conducted as a retrospective folder review. Results The total number of deliveries during the study period was 15 780, of which 121 were diagnosed with major placenta previa, giving an incidence rate of 0.4%. Of the 121 patients in the study, complete data was available for 119 patients (98%) of which 31% (n=38) had a previous delivery by caesarean section. Of all the patients with major placenta praevia (MPP), 19.8% (n=24) had a morbidly adherent placenta (MAP). Intraoperative interventions used to control bleeding were multiple haemostatic sutures in 11.6% (n=14), followed by compression sutures 5.8% (n=7) and uterine artery ligation 2.5% (n=3). The hysterectomy rate was 16.5% (n=20). Of all the mothers, 24.8% (n=30) required a high dependency unit (HDU) of which 1.7% (2) went to the intensive care unit (ICU), 8.6% (n=8) to a step-down acute post-natal ward (APN) and the majority 16.5% (n=20) went to the obstetric critical care unit (OCCU). Relook laparotomy was required in 2.5% (n=3) of the cases. There were no maternal deaths. Of all the deliveries 62.8% (n=76) were preterm and 5.8% (n=6) required admission to neonatal intensive care unit (NICU), and 78.8% (n=93) had good APGAR scores (5-minute score ≥6), while 21,2% (n=25) had poor APGAR scores (5-minute score 5 or less). The overall hospital still birth rate (SBR) during the study period was 63 per 1000 births, and major placenta praevia accounted for 0.2% (16 per 1000 births) of all the still births. Conclusion The incidence of MPP was 0.4% which is comparable to other studies. MPP is one of the leading causes of feto-maternal mortality and significant morbidity. The prematurity rate was very high, however the majority (78.8%) of the babies had good 5-minute APGAR scores. Effective management protocols may help to identify high risk patients, thus improving management and outcomes of both the mother and the neonate.
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    Outcomes of monoamniotic twin pregnancies at Tygerberg Hospital : a ten-year review
    (Stellenbosch : Stellenbosch University, 2022-11) Mkoka, Siphelele Augastine; Swart, Hester Alida; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.
    ENGLISH ABSTRACT: Background: Monoamniotic twin pregnancies (MATPs) are at high risk of antenatal and perinatal complications including fetal loss. There is still no consensus regarding the optimal management strategies, incorporating antenatal monitoring and the mode and timing of delivery. Aim: Little is known regarding the management and outcomes of MATPs in low-and middle-income countries. We aim to assess and describe the management and shortterm outcomes of MATPs at Tygerberg Hospital (TBH), a South African university hospital and compare it with the available literature. Methods: This retrospective audit includes all MATPs managed from 2011-2020 at TBH. Primary aims were to review the fetal and neonatal outcomes as well as the mode and gestational age (GA) at delivery. Secondary aims included a composite of maternal and perinatal outcomes. Results: The study includes 62 MATPs. Miscarriage rate < 22 weeks GA was 13.1% and the risk of intra-uterine fetal demise (IUFD) was 27.2% of which most of those (73.7%) were double IUFD. Overall live birth rate was 72.5%. The overall perinatal mortality was 12.2% and 6.7% when fetal anomalies (FA) were excluded. The overall survival rate until discharge was 65% of which 56.7% were double survivors and 16.7% single survivors. Neonatal death rate was 5.8% and FA occurred in 27% of all MATPs. There was a birthweight discordance of 10.3  12.2% when considering all fetuses and 6.8%  6.5% in viable fetuses without FA. The average GA at delivery for pregnancies reaching viability without FA was 32  1.9 weeks. Normal vertex delivery occurred in 28% (only non-viable pregnancies) and 62.9% had caesarean sections. Neonatal admission was on average 3 weeks with significant morbidity occurring in 54.5% of the live births. Conclusion: MATPs remain a high-risk group and consensus on management strategies is yet to be reached. This study demonstrates that with increased surveillance and early delivery, the survival rate of MATPs is high, especially once severe FA are excluded. The Fetal Medicine team of TBH remains in support of inpatient care from viability onwards and delivery at 32 weeks GA via caesarean section. Additionally, delivery before 32 weeks must be preceded by fetal preparation with antenatal corticosteroids and magnesium sulphate.