Includes bibliographical references. / Background External Cephalic Version (ECV) is the manipulation of the baby, through the mother’s abdomen to a cephalic presentation. ECV is typically performed antenatally, in women with a breech presentation who are not in labour, at or near term, to improve their chances of having a normal vaginal delivery. ECV is one of the few obstetric interventions for which there is evidence that its use leads to a fall in caesarean section rates. ECV is an intervention that gives women another option, prior to considering caesarean section. Objective: To evaluate whether there were missed opportunities for performing ECV in women that had caesarean sections for breech presentation at term, and to determine the reasons why ECV was not offered or attempted for women with breech presentation, who had a caesarean section for that reason.

Includes bibliographical references. / Background: The Lesbian, Gay, Bisexual and Transgender (LGBT) community has historically been marginalised. Increased international awareness of the LGBT profile has led to the recognition that the medical profession has overlooked the health needs of lesbian women, with a resultant paucity of data regarding lesbian women’s health risks. International literature has shown that lesbians remain at risk of sexually transmitted infections and HIV; are at significant risk of mental health disorders; exhibit a high-risk profile for cardiovascular disease, diabetes, as well as cancer, and underutilise health care services due to experiences of homophobia. South African data is almost non-existent. Objective: To explore Cape Town wsw’s (women who have sex with women) experiences with, and trends of utilisation of Reproductive Healthcare Services. Study Design: Cross Sectional Survey. Methods: A sample of self-identified wsw was recruited using a snowball sampling method to complete an anonymous, self-administered online questionnaire during February 2013. Outcome Measures: Predominantly descriptive, with an aim to validate the study questionnaire for the South African context. Results: A total of 116 responses were analysed. The mean age of the population was 37 years of age, with the majority identifying as lesbian. The population comprised predominantly of Caucasian, middle class suburban residents, with most having medical aid, and accessing private health care. A significant proportion of respondents reported previous intercourse with a male sexual partner. Barrier contraception was not always used during intercourse with men and almost never during sex with women. There were a significant number of sexually transmitted infections in women with no previous male sexual partners. Most respondents considered themselves to be at low risk of contracting HIV, and at intermediate risk of cervical and breast cancer, and showed higher than average utilization of cervical screening practices for 4 this population, despite a general perception that screening is unnecessary in lesbian women. A general trend towards disclosure of sexual orientation was noted; however users of private healthcare were significantly more likely to have disclosed their orientation to their physician than users of public and NGO services. Respondents held a preference for practitioners that were themselves gay/lesbian.The study tool was validated for use in the South African context; however redundancy could not be formally excluded from the questionnaire. Conclusions: Wsw from Cape Town experience internationally comparable exposures and risks of gynaecological problems. Further research is required to fully understand the healthcare needs of lesbian women living in lower socio-economic conditions.

Background: The management of late preterm prelabour rupture of membranes (PPROM) is associated with an increased risk of neonatal prematurity related morbidity due to many obstetric care guidelines which favour delivery at 34 weeks or immediately upon diagnosis of ruptured membranes after 34 weeks gestation. However, expectant management of this group of patients (i.e delayed delivery) between 34+0 and 36+6 weeks of gestation is associated with an increased risk of neonatal and maternal infectious morbidities. Aim of Study: The aim of this study was to evaluate the impact of the latency period on maternal and neonatal outcomes in late preterm prelabour rupture of membranes in a regional perinatal service in Cape Town, South Africa. The latency period was defined as the time from rupture of membranes to the time of delivery. In addition, we sought to investigate whether immediate induction of labour in the absence of overt signs of infection or fetal compromise should be prioritised in women who present with late preterm prelabour rupture of membranes. Methods: This was a retrospective cohort study carried out over a period of two years in two secondary level hospitals of the Metro West area of Cape Town. The subjects were low risk HIV negative women with singleton pregnancies with ruptured membranes in the late preterm period. Maternal and neonatal outcomes were studied between two latency periods, namely short latency (< 48 hours) and long latency period (≥ 48 hours) after ruptured membranes. Results and Conclusion: There were no significant differences in maternal and neonatal outcomes between the two groups of latency periods when latency was defined as the time from ruptured membranes to delivery. The study favoured a delayed induction thereby improving neonatal outcomes by decreasing the complications of prematurity. There were more adverse maternal outcomes, including an increase likelihood of augmentation of labour and more operative delivery along with its major risk, that of obstetric haemorrhage, were noted in the short latency period group. Therefore, a delayed induction policy appeared to be more appropriate. Preterm delivery places the newborn at risk of prematurity. Therefore, the risk of prematurity must be balanced with the risks of intrauterine infection and antepartum haemorrhage, the two major complications of expectant management if delayed induction is to be adopted. Proper monitoring of both the pregnant woman and fetus is essential when expectant management is carried out to avoid these adverse maternal and neonatal outcomes.

Includes bibliographical references. / Objective: To compare the analgesic efficacy of Paracervical Block (1% lidocaine) with procedural sedation (Midazolam/Fentanyl) in the surgical management of incomplete/ missed miscarriages. Study design: An efficacy trial with a naturally occurring control group who received what is standard practice. The study compared two methods of analgesia. The study group received paracervical block and the control group received procedural sedation. The study ran over two consecutive months (December 2012/January 2013). Setting: Groote Schuur Hospital, a level three hospital situated in Cape Town, South Africa. Population: All women between 18 and 55 years of age that were admitted to Groote Schuur Hospital requiring a uterine evacuation following either a spontaneous incomplete or a missed miscarriage that were not excluded by any of the exclusion criteria. Methods: Over the two month period recruited participants (those patients who fit the inclusion criteria and were agreeable to participate) were allocated to either the control group (month 1) or the intervention group (month 2), depending on which month they had the uterine evacuation. Data was collected from the uterine evacuations of the recruited participants over the two month study period. Main outcome measure: The participants perceived pain during and after uterine evacuation (10 minutes and two hours), scored by the participant on an eleven point numerical pain scale. Secondary outcomes were the surgeons’ satisfaction with the analgesia, duration of procedure and complications/ side effects of the two methods of analgesia under study. Results: A total of 111 participants were recruited over the study period, 57 in the control group and 54 in the intervention group. The average pain score during the procedure was lower in the Paracervical block group compared with the procedural sedation group, but this difference was not statistically significant at a 5% level (t=-1.8495, p=0.0671). For the Paracervical block group, the ‘’pain during” mean and the standard deviation (SD) were 5.56 and 2.50 respectively, whilst for the Procedural sedation group, the mean and SD were 6.49 and 2.81 respectively. Conclusion: Paracervical block using 1% lidocaine is an effective and safe alternative to procedural sedation in the surgical management of incomplete/missed miscarriages.