Includes bibliographical references / This study aims to address the lack of data on the link between BMI and infertility in the South African population by describing the prevalence of male overweight and obesity in a group of men undergoing infertility investigation, as well as assessing any semen analysis abnormalities in these groups. It also aims to describe how well men can predict their BMI category and determine whether weight loss would be an acceptable part of infertility management in overweight or obese male partners. Beliefs surrounding healthy weight and fertility will also be addressed.

OBJECTIVE: To compare the efficacy and safety of misoprostol (Cytotec) with prostaglandin E2 (prandin gel) in cervical ripening and induction of labour at term. STUDY DESIGN: Two independent studies were performed. The first was to evaluate misoprostol as a cervical ripening agent when compared to prandin gel and the second to compare their ability to induce labour. Two hundred and forty patients requiring cervical ripening prior to induction of labour were recruited to the cervical ripening arm of the trial. Patients were randomly assigned to receive either 100 μg of misoprostol (half a 200 μg tablet) in the posterior fornix or 1mg prandin gel similarly inserted. A Bishop's score of the cervix was performed prior to drug insertion and repeated by the same clinician 24 hours thereafter if labour or delivery had not ensued. If labour commenced it were managed according to standard labour ward protocols. Three hundred and forty patients who required induction of labour for maternal or fetal reasons at term were recruited to the induction of labour arm of the trial. Half were randomly allocated to receive 100 μg misoprostol (half a 200 μg tablet) in the posterior fornix and half, 1mg prandin gel in the posterior fornix. If after 4 hours the labour had not ensued or the cervix remained too unfavourable for amniotomy, then a second dose of the drug was used. Labour and delivery was managed according to standard labour ward protocols. RESULTS: In the cervical ripening trial, data was analysed on 113 patients in the misoprostol arm and 116 in the prandin arm. The demographic characteristics were similar in both groups. Significantly more patients delivered within the 24-hour ripening period with misoprostol (88 (77.9%)) than with prandin gel (47 (40.5%)) (P < 0.001). In those patients delivered within 24 hours, the induction of labour to delivery interval was similar at, 9 hours 30 minutes (SD = 5h30) for misoprostol and 10 hours 51 minutes (SD = 5h09), with prandin gel. Significantly more patients in the prandin gel arm required oxytocin augmentation (25.5% versus 12.5% with misoprostol) but the caesarean section rate (13.6% with misoprostol and 12.7% with prandin gel) and analgesic usage were similar. Maternal side effects were similar in the two groups but tachysystole was significantly more common at 12.4% with misoprostol and 1.7% with prandin gel (P<0.01). In those patients undelivered at 24 hours, there was a significant improvement in the number of patients with a Bishop's score of > 4 with both drugs. Neonatal outcomes, including Apgar score and admission to the neonatal intensive care unit were not significantly different. In the induction of labour arm of the trial the demographic characteristics of both groups were similar. The use of misoprostol resulted in a significantly higher number of patients delivering within 12 hours of drug insertion than with prandin gel (136 (80%) with misoprostol versus 91 (66,9%) with prandin gel, P < 0.001). There was also a significantly shorter insertion to delivery interval with misoprostol (9hr13 (SD = 5hr 53)) than with prandin gel (12hr18 (SD = 6h22)), (P < 0.001). Thirty nine patients in the misoprostol group required a second dose of the drug versus 55 patients in the prandin gel group (P<0.05). Although the caesarean section rate was similar with the two drugs (30.6% with misoprostol and 34.1 % with prandin gel) significantly more patients had a caesarean section for fetal distress in the misoprostol group (21.8% vs 10.6%) (P < 0.05). Neonatal outcome, as assessed by Apgar score and admission to the neonatal intensive care unit, was however not different with either drug. Four patients had abruptio placentae in the misoprostol group and the incidence of tachysystole was significantly higher at 28.2% vs 15.3% with prandin gel (P< 0.01). Oxytocin was used for labour augmentation in 52.9% of patients with prandin gel and 27% with misoprostol (P < 0.05). Analgesic usage and other maternal side effects were similar with both drugs. CONCLUSION: Misoprostol is an effective cervical ripening and induction of labour agent when compared to prandin gel. However, it results in a higher incidence of tachysystole, caesarean section for fetal distress and abruption placentae and cannot yet be recommended for general use until the concern over adverse fetal and maternal outcome is addressed in larger trials.

PCOS is the commonest endocrinopathy occurring in women of reproductive age. This study aimed at comparing the presentation of adolescents to that of women ≥ 35 years presenting to the gynaecological endocrine clinic with a diagnosis of PCOS. This was a descriptive cohort study. Since 1996 all women with PCOS have their clinical, metabolic and endocrine data entered into a database. We compared the initial presentation of adolescents and women aged 35 and above.

Includes abstract. / Includes bibliographical references (leaves 48-53). / Clinical officers perform much of major emergency surgery in Malawi, in the absence of medical officers. The aim of this study was to validate the advantages and disadvantages of delegation of major obstetric surgery to non-doctors.

Postpartum family planning (PPFP) is the initiation and use of contraception during the first year after delivery. Following delivery mothers are encouraged to attend local Baby Clinics where infant follow up and immunization services and contraceptive advice should be available. The general understanding and importance of contraceptive use of postpartum mothers in this period has not been fully explored within our services. The aim of this study was to assess the current knowledge and the utilisation of contraception at the primary level of care among women who delivered 6 to 14 weeks earlier. We also hoped to identify possible obstacles to accessing family planning services. Methods This was descriptive cross-sectional study that was conducted between March and September 2014, in the Metro West of Cape Town. The study included five Baby Clinics in local health centres. Ethics committee approval was granted by the Human Research Ethics Committee of the Faculty of Health Sciences of UCT (HREC REF: 544/2013) and further permission was granted for study sites by the Provincial Health Research Council of the Western Cape Government (RP 004/2014). A total of 228 mothers, who were 6-14 weeks postpartum and attended a Baby Clinic during the study period were recruited. Questionnaire based interviews were conducted and data were entered using Microsoft Excel 2012 spreadsheets and were analysed using SPSS version 22.

Several clinical situations occur in obstetrics where it is useful to make an accurate assessment of fetal weight prior to delivery. A foreknowledge of the mass of the fetus can influence management in circumstances complicated by, for example, a previous caesarean section, a breech presentation, a compromised fetus of borderline viability and a diabetic pregnancy at term. Researchers have attempted to estimate fetal weight by assaying oestriol, human placental lactogen, and pregnanediol. These parameters have been found to be of limited value because of the indirect measurement of fetal mass. Since the introduction of ultrasound scanning techniques to obstetrics in the mid- 1960's, it has become possible to visualise the fetus and to make direct measurements of fetal anatomy. By using ultrasound, workers have tried to predict fetal weight by measuring fetal heart volume, hourly urine production, trunk diameter, circumference and placental volume. At present various combinations of head circumference (HC), biparietal diameter (BPD), femur length (FL), and abdominal circumference (AC) are the most commonly used measurements which, when used in different formulas and read off tables estimate fetal weight. Recently the gestational age (GA) has been incorporated into formulas specifically applied to small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA) fetuses. A sonographic estimation of fetal weight based on a model of fetal volume has also been developed. It was generally believed that with the refining of ultrasonic estimation of fetal weight an accurate assessment of fetal mass could, at last, be made. Some investigators believe that the ultrasound estimation of fetal mass is more accurate than clinical assessment. In contrast other workers have shown that the accuracy of clinical examination is comparable to ultrasound determination in estimating fetal weight.

Includes abstract. / Includes bibliographical references (leaves 68-74). / Vulval carcinoma is uncommon, affecting approximately 2 per 100 000 women annually. The treatment of choice is radical vulvectomy and inguinal lymph node dissection. ‘Advanced’ vulval carcinomas involve midline structures (such as clitoris, urethra or anus) and/or adjacent pelvic organs or bone, and adequate excision may require urinary diversion, colostomy or pelvic exenteration. Less morbid and less mutilating therapeutic alternatives have been investigated, particularly chemoradiation, which has shown significant success in the management of anal carcinomas. Primary chemoradiation has been used, instead of primary radical surgery, to treat advanced vulval carcinomas at Groote Schuur Hospital (GSH) since1982. Aims: 1) To assess the survival of women with advanced vulval carcinoma treated with primary chemoradiation. 2) To examine the role of surgery after treatment with primary chemoradiation.

Includes bibliographical references (leaves 64-68). / In South Africa obstetric haemorrhage is the third most common cause of maternal deaths. In addition to maternal mortality audits, quality of care audits using criterion based audit methodology provides useful information. The aim of this study was to audit the management of all women with severe obstetric haemorrhage in the Peninsula Maternal and Neonatal Services in order to improve management. A descriptive retrospective audit was conducted during the period August 2006 to August 2007 using a criterion based audit methodology. Cases of severe obstetric haemorrhage were identified prospectively. Folders were reviewed and data collection sheets utilized to: 1. Describe the demographics and causes of obstetric haemorrhage in the Peninsula Maternal and Neonatal Services, 2. Measure the case fatality ratio, 3. Describe the management of women with severe obstetric haemorrhage with reference to that prescribed in the South African National Guidelines (2002-2004), 4. Score the management provided by the Peninsula Maternal and Neonatal Services using a shorter checklist devised from the National Guidelines.

The antenatal diagnosis of a fetal atrioventricular septal defect (AVSD) impacts the prognosis of an unborn child, and may have psychosocial and financial implications for mothers receiving this diagnosis. Outcomes relevant to our local population may be used to improve counselling for parents receiving this diagnosis. During a literature review, there was a lack of existing published data on antenatal AVSD outcomes from the developing world. To ascertain the outcomes of antenatal AVSD diagnosis in fetal, neonatal and infant life, we performed a retrospective study of all AVSD's diagnosed at a tertiary referral hospital in Cape Town (Groote Schuur Hospital) between 1 January 2010 and 31 December 2016. We examined ultrasound records and case folders from the antenatal, neonatal and infancy periods, up to a year of life or demise. The resultant cohort had a total of 55 cases. We found that fetal outcomes in Cape Town, South Africa are similar to those in developed countries. Pregnancies were terminated in just over a third of cases and similarly, the over-all survival to one year of life excluding termination of pregnancy was 29,73%. The bulk of these fetuses demised in the antenatal period, and the rate of demise positively correlated with the presence of associated organ abnormalities and aneuploidies. In those born alive, the correlation between an antenatal AVSD diagnosis and the same diagnosis during postnatal echocardiography was 59,09%, with the remaining 40,91% having other complex cardiac abnormalities diagnosed. Corrective cardiac surgery in the neonatal period or infancy occurred in 46,15% of those born alive, with good outcomes. This study shows similarity between survival of fetuses diagnosed with antenatal AVSD in the developing and developed world. It will be instrumental in appropriately counselling South African parents who receive the diagnosis. In order to assess if prenatal AVSD diagnosis improves neonatal and infant outcomes, a further study comparing this group to the outcomes of infants with postnatally diagnosed AVSD is necessary. More research is needed in an African context regarding the outcomes of babies diagnosed with antenatal anomalies.

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age and impacts negatively on their health related quality of life (HRQoL). The Polycystic Ovary Syndrome Questionnaire (PCOSQ) is a disease specific questionnaire used to measure HRQOL in affected women. This questionnaire has not been validated for use in the clinical population of South Africa. This study aimed to assess the psychometric properties of the PCOSQ in our population and to compare findings with those from the WHOQOL-BREF, a generic questionnaire that measures HRQoL. Methods: This was a cross sectional analytical study of women with PCOS as defined by the Rotterdam criteria attending the Gynaecological Endocrine Clinic at Groote Schuur Hospital in Cape Town. The PCOSQ and WHOQOL-BREF were administered at the first interview and a repeat PCOSQ interview was conducted telephonically within a period of 2 to 7 days. The clinical data of the participants at initial diagnosis were obtained from the clinical records. Results: A total of 105 consenting women were recruited over a period of 8 months from November 2013 to July 2014. Sixty-seven participants responded to the second follow up interview for test-retest reliability. The test-retest reliability was good with intra-class correlation coefficients from all domains being above 0.8 (0.820-0.929, P<0.001). The Cronbach's alpha coefficients of internal consistency were above 0.7 in all domains with the exception of the menstrual domain, which scored 0.65. Construct validity was demonstrated by a statistically significant correlation between the corresponding domains of the WHOQOLBREF (P<0.05). Secondary factor analysis confirmed the domain structure of the PCOSQ. The scores from all domains were reflective of an impaired quality of life. Weight had the most impact on the HRQoL. The WHOQOL-BREF demonstrated a poor internal consistency in the study population. Conclusions: The PCOSQ is a valid questionnaire for measuring the HRQoL in our clinical population and is preferred above the WHOQOL-BREF. The incorporation of the domain on acne and further exploration of the domain of menstrual problems could be undertaken to strengthen its factor structure. PCOS has an adverse effect on the HRQoL. Weight has the biggest impact on the HRQoL. The WHOQOL-BREF is suboptimal in measuring HRQoL in women with PCOS, as it is not specific to the condition.