Made available in DSpace on 2014-06-11T19:27:44Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-04-26Bitstream added on 2014-06-13T18:56:25Z : No. of bitstreams: 1 malini_gmv_me_botfm_prot.pdf: 1634811 bytes, checksum: c4c3c52a8699b198de4e1ccc994f6b1f (MD5) / Financiadora de Estudos e Projetos (FINEP) / Ses - Secretaria Estadual da Saúde / Medidas seriadas da altura uterina e do peso materno são métodos de rastreamento de restução ie cresctmei mtta-utetmo C1X3 K ï uestio a ac as diferentes curvas de altura uterina e traz poucos relatos sobre o peso materno. Objetivo: avaliar a acurácia de curvas de altura uterina e de peso materno como método de rastreamento de RCIU. Sujeitos e métodos: foi realizado estudo retrospectivo de 453 primigestas, com gestação única e sem intercorrências clínicas ou obstétricas, acompanhadas desde o primeiro trimestre de gestação no Serviço de Obstetrícia do Hospital das Clínicas da Faculdade de Medicina de Botucatu - UNESP, no período entre janeiro de 2001 e dezembro de 2003. Foram avaliadas, isoladamente, a curva de altura uterina e as curvas de peso (Rosso) e ganho de peso (CLAP) materno, e também a associação da curva de altura uterina com as curvas de peso e ganho de peso materno. Nos programas estatísticos EPI-INFO e SPSS foram calculados sensibilidade, especificidade, valores preditivos positivo e negativo e, acurácia das curvas analisadas. Foi considerado intervalo de confiança de 95%. Resultados: a incidência de recém-nascidos com RCIIU foi de 22,5%. A sensibilidade da curva de altura uterina em rastrear RCIU foi de apenas 1% (1C95% 0,0 - 2,8). As curvas de peso (Rosso - 55,9% - 1C95% 46,9 - 64,8) e de ganho de peso (CLAP - 26,5% - 1C95% 18,5 - 34,4) apresentaram baixa sensibilidade. A associação da curva de altura uterina às curvas de peso e de ganho de peso não modificou a sensibilidade apresentada quando analisadas isoladamente. Conclusões: em pnmigestas, sem intercorrências clínicas ou obstétricas, a medida seriada da altura uterina não é um bom método de rastreamento de RCIU. As medidas seriadas do peso e do ganho de peso materno apresentaram baixa sensibilidade como fator de rastreamento... / Sena! measures of uterine height and of maternal weight are methods for investigating the restnction of intra-uterine growth (RCIU). Literature questions the accuracy of the different curves of uterine heights and brings few reports concerning maternal weight. Objective: Evatuate the accuracy of the curves of uterine height and of maternal weight as a method of investi gating the RICU. Subjects and Methods: A restropective study of 453 women that were pregnant for the first time, with only one pregnancy and with no clinical or obstetric incidents, was conducted. They were assisted since their first three months of pregnancy at the Serviço de Obstetrícia do Hospital das Clínicas da Faculdade de Medicina de Botucatu - UNESP , between January 2001 and December 2003. The curves of utenne height and weight (Rosso) and the gain of maternal weight (CLAP) were analysed separately, as well as the association of the curve of uterine height with the curves of weight and the gain of maternal weight. In the Statistics programs EPI-INFO and SPSS, it was calculated sensibility, speciflcation, expected positive and negative values, and the accuracy of the curves that were analysed. A trustable interval of 95% was considered. Results: The incidence of new-born babies with the RCIU was of 22.5%. The sensibility of the curve of uterine height for investigating the RCIU was only of 1% (1C95% 0.0 - 2.8). The curves of weight (Rosso - 55.9% - 1C95% 46.9 - 64.8) and ofthe gain ofweight (CLAP - 26.5% - IC 95% 18.5 - 34.4) showed low sensibility. The association of the curve of uterine height with the curves of weight and of the gain of weight did not modify the sensibility showed when they were analysed separately. Conclusion: Iii women that are pregnant for the firs time with no clinical or obstetnc incidents, the sena! measure of the uterine height is not a good... (Complete abstract click electronic access below)

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.

Introduction: The cost of ART remains amongst the most prevalent barriers to treatment, especially in resource limited countries where many people are poor and inadequately covered by private and public health insurances. This study aims to assess the financial consequences of out of pocket payment for ART in the South African setting and the ability of couples to financially recover. Methods: A prospective follow-up study was carried out at the Infertility Clinic of the Reproductive Medicine Unit, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town. All 135 participants from the original study were invited to participate with no exclusion criteria. A six part questionnaire, developed for the original study, was adjusted to assess recovery from out of pocket expenditure for ART. Indicators of recovery included the recuperation of savings, settlement of debt and reacquisition of sold assets. Persistence of coping strategies such as reduction in spending and additional work was also assessed. Results: A follow-up rate of 54% percent was achieved. The minimum and maximum follow up period was three and five years respectively. Nineteen percent of couples reported complete financial recovery, assessed as the recovery of savings, repayment of all debt and recovery of a sold asset. Forty percent of couples were unable to settle their debt incurred during the original study. The average amount still owed was R 7 750 (SD R5 140). At follow up, 75% of couples who had reduced expenditure to offset the original cost of ART were still reporting a reduction in expenditure while 39% were still engaged in additional work. The majority of couples reporting difficulties at the time of follow up in paying bills or for basic amenities and healthcare were from the poorest socioeconomic tertiles with 64% of all couples indicating that they were not coping financially at the time of follow up. Conclusion: This study documented a long-lasting impact of OPP for ART among all HH but especially among the poorest. Given the high prevalence of infertility, its impact on individuals, couples and communities, the associated mental, emotional and financial consequences, and existing barriers to adequate and affordable treatment should be minimised as South Africa is moving towards the implementation of a national health system.

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.

Background The United Nations (UN) aims to reduce the maternal mortality ratio (MMR) and improve access to reproductive health services. Caesarean sections (CS) are known to be associated with a raised mortality rate by a factor of 2.8 in addition to the raised morbidity rate (OR 3.1; 95% CI 3.0-3.3) compared to vaginal deliveries (VD). Globally, there has been a concerning trend in the caesarean section rate (CSR), rapidly increasing since the 1970’s, with some countries reporting CS rates as high as 40.5%. South Africa has a CSR of 25.7%, which is higher than the suggested rate by the World Health Organization (WHO) of 15%; a rate above which the WHO suggests no maternal and fetal benefit exists. Robson introduced a universal classification system for caesarean sections with 10 totally inclusive and mutually exclusive groups. Horak made use of the ten group classification system (TGCS) to calculate the CSR at Mowbray Maternity Hospital (MMH) and its referring midwife obstetric units (MOU) for 2009, and reported it as 20.7%. Since the completion of her study, the referral routes to MMH have changed and the management of HIV-associated illnesses has markedly improved. A period of 7 years has elapsed and it was thought to be an optimal time to repeat a review of the CSR and compare it with the rates from 2009. Objectives The study aims to calculate the CSR for MMH from January 2016 to June 2016. Analyses of the CSR within each Robson group will be done and compared to the rates from 2009. This will allow us to make recommendations, if appropriate, aimed at reducing the CSR. Methods A retrospective, observational study was performed at MMH in Cape Town. Data was collected from birth registers for January 2016 – June 2016. All women who delivered, including all caesarean sections and vaginal births, were entered into the study, provided the newborn was viable with a birth weight >500g. Parameters were recorded onto an electronic and password-protected Microsoft Excel® spreadsheet and were used to classify deliveries according to the Robson Classification system. To allow for comparison with Horak’s study, deliveries at MMH for January 2009 – June 2009 were selected and analyzed. All the data was analyzed with STATA software and presented in various graphical formats. Ethics approval was obtained from University of Cape Town’s Human Research Ethics Committee (HREC Ref: 539/2016). Results There were 4727 deliveries from January to June 2016, of which 2472 were vaginal births and 2255 were caesarean sections, giving rise to a CSR of 47.70% (95% CI 46.28- 49.13). Of all the caesarean sections performed, 62.7% were primary caesarean sections and 37.3% were repeat caesarean sections. Nulliparous women, compared to multiparous women without a history of a prior CS, were at higher risk for a CS if in spontaneous labour (OR 2.02; 95% CI 1.71-2.38) and if induced (OR 2.75; 95% CI 2.13- 3.53). Group 5 (women with a previous CS), with a CSR of 85.34% (95% CI 82.82-87.61) made the greatest contribution to the overall CSR. The overall CSR from January to June 2009 was 44.10% (95% CI 42.63-45.57), calculated from 4379 deliveries. There was a statistically significant increase in the CSR of 3.60% from 2009 to 2016. A similar significant increase was observed in the respective CS rates of Group 1 (5.59%), Group 2 (11.63%) and Group 10 (8.73%). Group 4 was the only group with a statistically significant decrease of 4.48% in its CSR. An additional 308 labour inductions were performed in 2016, however, women in 2016 were statistically significantly less likely to be successful in a vaginal delivery (OR 0.67; 95% CI 0.55-0.81 p<0.001) compared to women in 2009. Conclusion A CSR of 47.70% is acceptable for a secondary level hospital such as MMH. This figure is elevated, but appropriate, as the referral units that perform only low risk vaginal deliveries are excluded. A surge in the number of repeat caesarean sections performed and lower success rates for labour inductions were mostly responsible for the rise. Primary caesarean sections performed on patients directly result in a higher risk patient profile in the future, coupled with more repeat caesarean sections in subsequent pregnancies. This is supported by a 17.5% prevalence of previous CS in women in 2009 as opposed to the 20.79% of women with a prior CS in 2016. This study shows that a CS in the index pregnancy has sizeable effects on the care of a woman in subsequent pregnancies. This places more strain on the health system and ultimately affects service delivery to all patients. Theoretically it is possible to explore changes in management to curb the ever-increasing CSR, but one has to consider if such changes is acceptable and appropriate to the setting of MMH and the population it serves.

Thesis (MMed (Obstetrics and Gynaecology))--University of Stellenbosch, 2010. / Please refer to full text for abstract.

Thesis (MMed)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Objective: The aim of the study was to determine whether Beta-hCG levels at various time intervals during the follow-up period after primary treatment of molar pregnancies could be used to predict progression of the disease later, in an attempt to shorten the period of surveillance. Furthermore an assessment of the demographic details and risk factors for the development of persistent trophoblastic disease was examined. Levels of compliance to the current surveillance protocol were evaluated. Method: A retrospective analysis of all patients diagnosed with molar pregnancies at Tygerberg Hospital, Cape Town from January 2000 to December 2010. Results: Among the 120 patients, 13 (19.7%) of complete moles and 10 (20%) of partial moles developed persistent trophoblastic disease. There was no statistical significance of the demographic data when comparing the two types of moles. 66% of complete and 50% of partial moles were lost to follow-up within the first six months of surveillance. A potential Beta-hCG cut-off value of 148mIU/ml at week 6 offered a sensitivity of 0.89 and specificity of 0.88 that surveillance could be terminated. Conclusions: Patient compliance is a limiting factor in the evaluation of molar pregnancy surveillance. However, based on our results, the suggestion that termination of surveillance after primary evacuation could occur at 6 weeks if the Beta-hCG level was 148 mIU/ml or lower remains undecided, and it is our opinion that higher sensitivities and specificities are required. Further research is needed to solidify this claim. The acquisition of demographic information of our population remains a priority, in order for more informed decisions to be made. / AFRIKAANSE OPSOMMING: Doel: Die doel van die studie was om te bepaal of Beta-mCG vlakke of verskillende intervalle, gedurende die opvolg periode na primêre behandeling van mola swangerskappe gebruik kan word om siekte progressie te voorspel, en sodoende die tydperk van opvolg te verminder. Verder was die demografiese besonderhede en risiko faktore vir die ontwikkeling van persisterende trofoblastiese siekte ondersoek. Die nakoming tot die huidige toesighouding protokol was geevalueer. Metode: ‘n Retrospektiewe analise van al die pasiënte wat gediagnoseer is met ‘n mola swangerskap by Tygerberg Hospitaal, Kaapstad vanaf Januarie 2000 tot Desember 2010. Resultate: Van die 120 pasiënte het 13 (19.7%) van die volledige molas en 10 (20%) van die gedeeltelike molas persisterende trofoblastiese siekte ontwikkel. Daar was geen statistiese belang in die demografiese data, wanneer die twee tipe molas met mekaar vergelyk is nie. 66% van die volledige en 50% van die gedeeltelike molas was verlore met opvolg binne die eerste ses maande van opvolg. ‘n Potensiële Beta-mCG afsnywaarde van 148mIU/ml op ses weke het ‘n sensitiwiteit van 0.89 en spesifisiteit van 0.88 gewys dat toesighouding getermineer kan word. Opsomming: Pasiënt nakoming is ‘n beperkende faktor in die opvolg van mola swangerskappe. Alhoewel, gebaseer op ons resultate, ons kan voorstel dat terminasie van “surveillance/toesighouding” na primêre lediging, kan plaasvind op 6 weke indien die Beta-mCG vlak 148mIU/ml of minder is, bly dit onbeslis. Dit is ons opinie dat hoër vlakke van sensitiwiteit en spesifisiteit nodig is. Verdere navorsing is nodig om hierdie voorstelling te staaf. Die invordering van demografiese inligting van ons populasie bly ‘n prioriteit, om sodoende meer ingeligte besluite te neem.

Thesis (MMed)-- Stellenbosch University, 2013. / ENGLISH ABSTRACT: Aims of the study Urodynamic studies (UDS) have been suggested to be performed as part of the pre-operative work-up of patients undergoing prolapse surgery. Some women with POP have occult stress urinary incontinence (OSUI) and even if subjectively continent, have a higher incidence of developing de novo stress urinary incontinence (SUI). The aim of this study was to describe the outcome of a group of patients who had pre-operative UDS and manual prolapse reduction. Methods This was a retrospective descriptive study including all women who had prolapse surgery during the period January 2006 to December 2011. Patients received routine pre-operative UDS and manual reduction of prolapse, performed at maximum bladder capacity determined by UDS. Patients demonstrating urodynamic SUI or OSUI were offered a concomitant anti-incontinence procedure. Post-operative follow-up data included symptoms of SUI and clinical evidence of SUI. Results The final group consisted of 131 women. The mean age of the patients was 57 years (range 33 to 79) and parity 3.6 (range 0 to 7). The mean body mass index was 32 (range 19 to 53). Twenty-four (18.3%) women had demonstrable SUI on clinical examination at initial presentation in the clinic. At the time of urodynamic studies, forty patients (30.5%) had evidence of SUI determined by either UDS and/ or cough test in the standing position at maximum bladder capacity. Ninety-one women (69.5%) had no evidence of UI on UDS, of which 20(15.3%) demonstrated OSUI (SUI on manual reduction of prolapse at maximal bladder capacity determined by UDS). Of the 40 women with UI on UDS, 36 had 1-step surgery (combination of anti-incontinence procedure and prolapse repair) and 4 had prolapse surgery alone. Of the 20 women with OSUI on UDS, 16 had 1-step (combined) surgery and 4 prolapse surgeries only. Of the 4 who had prolapse surgery alone, 3 complained of post-operative SUI. In the group with no SUI on UDS and manual reduction of POP, 69 of the 71 women had follow-up data. Only 1 had demonstrable SUI on examination. The manual reduction test had a sensitivity of 42.9% and a specificity of 98.5% (95% CI, 92.0-99.9%). The positive predictive value was 75.0% (95% CI, 19.4-99.3%), with a high negative predictive value of 94.4% (95% CI, 86.2-98.8%). Conclusion The numbers in our study are too small to determine sensitivity and positive predictive value of UDS and manual prolapse reduction for the detection of OSUI. However, our data shows promise in identifying POP patients without OSUI, which is a complement of the hypothesis. We recommend that UDS can be performed pre-operatively in women undergoing prolapse surgery, to identify patients with urodynamic stress incontinence. Manual reduction of the prolapse at maximum bladder capacity can then be done to identify a subgroup of patients without OSUI. Future research is needed on the true predictive value of reduction stress testing with larger numbers. / AFRIKAANSE OPSOMMING: Doel van die studie Urodinamiese studies (UDS) word voorgestel as deel van die pre-operatiewe ondersoeke voor prolaps chirurgie gedoen word. Sommige vroue met genitale prolaps het verborge druklek, en selfs as hulle subjektief kontinent is, het hulle ‘n groter insidensie van de novo druklek. Die doel van die studie was om die uitkoms van ‘n groep pasiënte wat pre-operatiewe UDS en manuele prolaps reduksie gehad het, te beskryf. Metodes Die studie was ‘n retrospektiewe beskrywende studie. Al die pasiënte wat prolapse chirurgie in die tydperk Januarie 2006 tot Desember 2011 gehad het, is ingesluit. UDS en manuele prolaps reduksie tydens maksimale blaaskapasiteit, bepaal deur UDS, was deel van die roetine pre-operatiewe ondersoeke. In die gevalle waar urodinamiese druklek of verborge druklek demonstreer is, is die opsie van ‘n meegaande prosedure vir kontinensie tydens prolaps chirurgie aangebied. Post-operatiewe opvolg inligting het simptome van druklek en kliniese bewys van druklek ingesluit. Resultate Die finale groep was 131 vroue reikwydte. Die gemiddelde ouderdom van die pasiënte was 57 jaar (reikwydte 33 - 79) en pariteit 3.6 (reikwydte 0 - 7). Die gemiddelde liggaamsmassa indeks was 32 (reikwydte 19 - 53). Vier-en-twintig (18.3%) vroue het aantoonbare druklek gehad met kliniese ondersoek tydens die eerste kliniek afspraak. Tydens UDS het 40(30.5%) pasiënte druklek getoon tydens UDS en/ of hoestoets in die staande posisie teen maksimale blaaskapasiteit. Een-en-negentig (69.5%) het geen tekens van urinêre inkontinensie tydens UDS demonstreer nie, waarvan 20(15.3%) verborge druklek demonstreer het (druklek met reduksie van prolapse tydens maksimale blaaskapasiteit, bepaal deur UDS). Veertig pasiënte het urodinamiese druklek gehad, waarvan 36 een-stap chirurgie (‘n kombinasie van prolaps herstel en meegaande kontinensie prosedure) en 4 prolaps chirurgie alleenlik gehad het. Uit die 20 vroue met verborge druklek tydens UDS, het 16 een-stap (kombinasie) chirurgie en 4 prolaps chirurgie alleen gehad. Uit die 4 wat prolaps chirurgie alleen gehad het, het 3 post-operatiewe klagtes van druklek gehad. In die groep wat geen inkontinensie tydens UDS en manuele prolaps reduksie gehad het nie, het 69 van die 71 vroue opvolg data gehad. Druklek kon net by een pasiënt met ondersoek demonstreer word. Die manuele reduksie toets het ‘n sensitiwiteit van 42.9% en ‘n spesifisiteit van 98.5% (95% CI, 92.0-99.9%) gehad. Die positiewe voorspellingswaarde was 75.0% (95% CI, 19.4-99.3%), en die negatiewe voorspellingswaarde was 94.4% (95% CI, 86.2-98.8%). Gevolgtrekking Die getalle in ons studie was te min om te bepaal wat die sensitiwiteit en positiewe voorspellingswaarde van UDS and manuele prolaps reduksie is om verborge druklek te demonstreer. Die belowende data om pasiënte te identifiseer met genitale prolaps sonder verborge druklek (‘n kompliment van die hipotese). UDS kan pre-operatief gedoen word in pasiënte wat prolapse herstel chirurgie benodig, om pasiënte met urodinamiese druklek te identifiseer. Manuele reduksie van die prolaps tydens maksimum blaas kapasiteit kan dan volg, om ‘n subgroep van pasiente sonder verborge druklek, uit te ken. Verdere navorsing, met groter getalle word benodig om die werklike voorspellende waarde van die reduksie toets te ondersoek.