Includes abstract. Includes bibliographical references (leaves 53-57).

Includes bibliographical references (leaves 107-119).

Incluedes abstract. / Includes bibliographical references (leaves 52-58). / The aim of this study was to explore the nature of fear experienced by a group of pregnant women utilizing the Cape Town public obstetric service who reported having severe fear of childbirth. The study was undertaken at antenatal clinics within the Peninsula Maternal and Neonatal Service in Cape Town. The subjects included fifteen pregnant women, 21 years and older, irrespective of gestation, who previously carried one pregnancy to at least 28 weeks gestation regardless of pregnancy outcome and who reported severe fear of childbirth in their current pregnancy (defined for the purpose of this study as a score of 7 or more on a visual analogue scale for fear).

Includes abstract. / Includes bibliographical references (leaves 64-71). / Aim: To determine whether HIV-positive patients have a longer time to healing, more complications and poorer functional outcomes after Obstetric Anal Sphincter Injury (OASI) than an HIV-negative control group.

Includes abstract. / Includes bibliographical references (leaves 70-75). / Pre-eclampsia is a leading cause of maternal mortality and morbidity in South Africa. At present this disease cannot be prevented and many interventions to reduce the incidence of pre-eclampsia have been investigated. Calcium supplementation of pregnant women at high risk of developing pre-eclampsia has been shown to be of some benefit in reducing the incidence of the disease, with the greatest benefit seen in low dietary calcium settings. While serum calcium is an unreliable indicator of chronic calcium status, hair analysis is an accurate and well documented method of determining long-term micronutrient status.

Includes abstract. / Includes bibliographical references (leaves 58-67). / Miscarriage is the commonest complication of pregnancy and affects 12-31% of all conceptions. About 1% of all couples trying to conceive will have recurrent pregnancy loss (RPL). Several causes for RPL have been documented and these include chromosomal abnormalities, peas, thrombophilias and anatomical anomalies such as cervical incompetence. In many couples the aetiology of the pregnancy loss is often not defined but nutritional deficiencies have been postulated as possible causes. In particular selenium deficiency is associated with reproductive failure in animals and, more recently, in some human studies. This study was undertaken to assess the selenium levels in women with RPL without an identified cause.

Abstract Over the last 50 years botulinum toxin has become an effective medical therapy, used in a variety of specialities for different indications. A growing body of evidence indicates its beneficial effects in treating medication refractory detrusor over activity. This modality of treatment has been offered at Groote Schuur Hospital (GSH) in South Africa since 2012. Therefore, a review of our outcomes is necessary. Objective: Primary: 1. Determine the subjective success following intravesical Botox injections for the treatment of OABS. Secondary: 1. Describe the population of patients receiving intravesical Botox injections for the treatment of refractory OABS 2. Determine the rate and type of complications associated with intravesical Botox injection and the duration of treatment success. 3. Determine any patient factors associated with shorter duration of treatment success following the treatment of refractory OABS with intravesical Botox injections Methods: We conducted a quantitative, descriptive, retrospective study. The data collection sheet included the following details from the participants: demographic details, pre-existing medical conditions, method of diagnosis, and any previous treatment, the reason for stopping previous treatment, intra operative details and early complications at 1-6 weeks. Also included were details of any symptoms at follow up visits at 6- and 12-months post procedure. Subjective success was defined as the patients reporting improvement of symptoms at the first follow up visit. Duration of treatment success was defined as the time that lapsed between the date of Intravesical Botox injections and when the patient requested repeat treatment. Inclusion and exclusion criteria: We included patients who received intravesical Botox injections for OABS from 1 January 2016 - 31 December 2018. We excluded those who received intravesical Botox treatment for reasons other than OABS. Statistical analysis: A sample of 50 subjects was used. Summary statistics for age were reported as mean and standard deviation. Categorical variables were reported as simple frequencies and percentages. Associations between categorical variables were evaluated using the Fisher's exact test. Groups were compared in terms of age using the Tow-sample Mann-Whitney test. Analyses were performed using Stata Version 16. Results: The age of our participants ranged from 25 to 85 years (m = 54.72, ds = 14.74). 36% were post- menopausal, 92% were para 1 or more, 52% had a BMI of more than 30 kg/m2 , 30% were smokers, 40% were hypertensive and 10% had diabetes mellitus. All the patients reported improvement of symptoms at the 2-6 weeks' follow-up review. At the 6 months follow up visit less than a third of the participants complained of overactive bladder symptoms with only four (8%) patients requesting repeat intravesical Botox treatment. At the 12 months follow up visit just over half of the patients were experiencing overactive bladder symptoms with 21 (42%) requesting repeat intravesical Botox injections. There were few complications related to the intravesical Botox injection procedure. All the procedures were performed under local anaesthesia none of which needed to be abandoned due to pain of bleeding. Seven (14%) patients required temporary clean intermittent catheterisation (CIC). Eight (16%) patients had experienced a UTI (urinary tract infection) by the six weeks follow up visit. We found that hypertensive patients were significantly more likely to request repeat Botox at six months compared to non-hypertensive patients. Fisher's exact of 0,020. No other patient related factors showed any significant association in relation with repeat Botox injections at 6 months and 12 months. Conclusion: Our findings confirmed the benefit of intravesical Botox injection treatment in patients with OABS with minimal complications.

Background: In the past few decades, an increasing number of women have been participating in high-impact sports which involves jumping, landing and/ or running activities. Recent data have shown, however, that this kind of activity might be associated with adverse effects, including pelvic floor disorders. Nevertheless, there is very little in the literature about pelvic floor effects associated with endurance sports where high-impact exercise is performed at submaximal intensity for prolonged periods of time. Objective: The primary objective of the present paper is to describe the prevalence of pelvic floor dysfunction (PFD) in a female triathlete population. Methods: An anonymous on-line survey was administered from September 2015 to March 2016 to women who self-identified as triathletes. We used two validated questionnaires: the Pelvic Floor Distress Inventory Questionnaire short form (PFDI) and the Pelvic Floor Impact Questionnaire short form (PFIQ). In addition, respondents were asked for demographics (age, height, weight, occupation), general health status (medical history, pelvic/abdominal surgical history, pregnancy and birth history) as well as sport practice characteristics (duration of training, level of competition, number of hours spent per week swimming, cycling, and running), so as to characterise these female triathletes. The survey remained active online for seven months, during which time the majority of responses were obtained from having our survey on the IRONMAN December 2015 newsletter. The balance of responses came from various triathlon clubs which we had approached within Western Cape Province. Results: Sixty-seven female triathletes responded to the online survey which we designed on SurveyMonkey. The respondents were between the ages of 22 and 56 years, the mean being 37 years. They had a mean BMI of 22.6 kg/m2. None of them had any medical conditions known to increase the risk of PFD. Of the known surgical history risk factors, 74.6% had had no previous pelvic or abdominal surgery. In the cohort, 69.2% were nulliparous and 30.8% parous. Most of the respondents competed in the recreational age group (70.4%), compared with 29.6% who described themselves as being in the competitive age group. Over 94.4% of the participants had been involved in triathlon training for a period of more than 6 months. At the peak of their training, athletes described their weekly training regime as comprising a mean of 5.4 hours running, 3.9 hours swimming and 9.1 hours cycling. Of those who performed any form of 'core exercises', 29.6% performed pelvic floor exercises, 16.7% yoga, and 25.9% Pilates as part of their routine training. Eighty-two per cent of the triathletes had competed in the half IRONMAN and 37.8% in at least one full IRONMAN competition. The PFDI revealed a number of commonly occurring pelvic floor symptoms. The most reported urinary symptoms were urinary frequency, stress urinary incontinence (SUI) and urge urinary incontinence (UUI) (45.8%, 33.3% and 37.5%, respectively). The most reported colorectal symptoms were incomplete bowel emptying (41.7%), faecal urgency (43.8%), and flatal incontinence (41.7%). Pelvic organ prolapse symptoms were least reported, but those who had symptoms mostly experienced heaviness or dullness in the pelvic area (33.3%), pressure in the lower abdomen (31.3%) and a need for vaginal/rectal digitation in order to have or complete a bowel movement (25%). It was noteworthy to find that the nulliparous triathletes had more pelvic floor symptoms than the parous group. A higher prevalence of colorectal/rectal symptoms were reported by those who had had forceps deliveries. Colorectal symptoms were found to be slightly more prevalent in those who performed any pelvic floor exercises (PFE), yoga or Pilates than amongst those who did not. Even with the myriad symptoms reported, these women were not significantly bothered by their symptoms. Conclusion: It is apparent that PFDs are prevalent in the population reviewed, although the majority of individuals did not seem to be bothered by the symptoms that also did not appear to interrupt training or quality of life. For those who are concerned or troubled by the symptoms, it would be beneficial for them to be identified early so that management options can be offered to relieve the symptoms.

STUDY OBJECTIVE: To evaluate the diagnostic accuracy of transvaginal sonography compared to hysteroscopy in diagnosing benign endometrial pathology. DESIGN: Retrospective cross-sectional study. Canadian Task force classification II – 2 SETTING: Department of Gynaecology, Groote Schuur Hospital, Cape Town, South Africa. PATIENTS: Patients having an office hysteroscopy procedure between January 2014 and December 2016, with a record of a recent transvaginal ultrasound and endometrial histology were included in this study. All malignant cases were excluded. INTERVENTIONS: Transvaginal ultrasound, endometrial biopsy and office hysteroscopy. MEASUREMENTS AND MAIN RESULTS: A total of one hundred and forty two patients, pre- and postmenopausal, were included in this study. The most common indications for hysteroscopy were abnormal uterine bleeding and postmenopausal bleeding. Sensitivity, specificity, positive and negative predictive values were calculated for ultrasonography and hysteroscopy in diagnosing benign endometrial pathology by comparing them to histological diagnosis as gold standard. The most common pathologies identified at histology were polyps and fibroids. For those patients who had a normal endometrium at ultrasound (n=59), hysteroscopy revealed 33.9% polyps, 5.1% submucosal fibroids and 49.2% normal/atrophic endometrium. The remainder of these patients demonstrated proliferative or hyperplastic endometrium, suspicious endometrium and adhesions. For those patients who had a normal hysteroscopy (n=26), ultrasound demonstrated 7.7% polyps, 7.7% submucosal fibroids, 11.5% cystic areas, 3.9% no comment on endometrium and 69.2% normal endometrium. In diagnosing polyps, hysteroscopy had a higher sensitivity (78%) than ultrasound (37.3%). However, ultrasound had a higher specificity (85.5%), compared to that of hysteroscopy which was 71.1%. The negative predictive value of hysteroscopy for polyps was 81.9% and ultrasound, 65.7%. In the diagnosis of submucosal fibroids, ultrasound had a higher sensitivity than hysteroscopy but they both had similar specificity. Ultrasound and hysteroscopy had high negative predictive values and low positive predictive values. The combination of ultrasound and hysteroscopy did not improve sensitivity, PPV or NPV with a small decline in specificity. CONCLUSION: This study demonstrated that hysteroscopy was more accurate in the diagnosis of endometrial polyps than ultrasound with a higher sensitivity and negative predictive value. However hysteroscopy had a lower sensitivity when diagnosing submucosal fibroids.

Includes bibliographical references / Background: 33,4 Million people were living with the Human Immune Deficiency virus by the end of 2009 with sub-Saharan Africa the most affected region. Maternal HIV infection is the leading cause of maternal and child morbidity and mortality in South Africa. A meta-analysis of world literature suggests a clear association between HIV infection and perinatal mortality. Aims and Objectives: To study the effect of HIV status on perinatal outcome at Mowbray Maternity Hospital (a secondary level hospital in Cape Town, South Africa.) and its catchment MOUs. Specific aims: 1) To compare the perinatal mortality rate in the group of HIV exposed with the HIV negative group and the untested group. 2) To determine where possible, the primary obstetric cause of adverse outcome and compare this in HIV exposed to the HIV negative and the untested group. 3) To compare the incidence of Neonatal Encephalopathy in the group of HIV exposed with the HIV negative group and the untested group. Methods: The study was a retrospective descriptive and comparative audit. All deliveries at MMH and its referral midwife obstetric units from January 2008 to December 2008 were audited with respect to HIV status and other demographic data. All deliveries with perinatal mortality and or neonatal encephalopathy were identified and analyzed in detail. Results: There was a total of 18 870 deliveries at the units being studied. The number of deliveries to HIV positive mothers were 3259 (17,2 %). The stillbirth rate in the HIV positive population for the units being studied was 17,1 per 1000 deliveries. In the HIV negative population this rate was 8,3 per 1000 deliveries. The odds ratio was 2,07 [CI, 1.5-2.8] with a p-value of <0,0001. The neonatal death rate in the HIV positive population was 4,6 per 1000 deliveries, this as opposed to a rate of 3,1 per 1000 in the HIV negative population. The odds ratio was calculated as 1,46 [ CI, 0.8-2.6] with a p-value of 0,26. The perinatal mortality rate in the HIV population was 21,7 per 1000 deliveries. In the HIV negative population this rate was 11,7 per 1000 deliveries. The odds ratio was 1,91 [CI, 1.4-2.5] with a p-value of <0,0001. A comparison of the pattern of primary obstetric cause for perinatal mortality showed that infection, intra uterine growth restriction and ante partum haemorrhage were significantly more common as a cause for perinatal death in the HIV positive population. The risk of neonatal encephalopathy in the HIV exposed population was 4,9 per 1000 deliveries as opposed to 2,07 per 1000 deliveries in the HIV negative group. Comparing the two groups found an odds ratio of 2,36 [CI, 1.28- 4.35] with the p-value 0,008. The untested group of patients is shown in this study to be at particularly high risk of adverse perinatal outcome. This consists mostly of mothers who have had no antenatal care in the index pregnancy. Discussion: The perinatal mortality rate in the group of HIV exposed mothers was significantly higher than the HIV negative group due to a higher stillbirth rate. The lack of difference in neonatal death rate could be due to the high standard of neonatal care at the hospital. There was no significant difference in demographic data between the HIV positive and negative groups. Conclusion: Parturients who were infected with HIV were at significantly increased risk of perinatal mortality. Infection, intra uterine growth restriction and antepartum haemorrhage were significantly more common obstetric causes for mortality in the HIV infected population. The risk of neonatal encephalopathy was also significantly higher in the HIV positive population.