Includes bibliographical references / Aims and Objectives : To identify risk factors affecting rates of progression and regression of LSIL To determine the rates of progression and regression of disease in women with LSIL To compare the natural history of LSIL in HIV positive and negative women to determine patient adherence to colposcopy clinic in women with LSIL Methods: This is a retrospective, descriptive, cohort study of women who were referred to the colposcopy clinic with a cytological diagnosis of LSIL and followed for a minimum period of 2 years. Data was extracted from the colposcopy clinic data. Women who were referred and attended the clinic between 1st January 2009 and 31st December 2013 were included in the analysis. Statistical analysis was performed using Stata version 13.1 (StataCorp LP, 4905 Lakeway Drive, College Station, TX 77845, USA). All p-values <0.05 were deemed statistically significant. Results: The study population was 154 women with LSIL (N=154). Of these, 27 (17%) women were HIV negative, 106 (69%) were HIV positive and 18 had an unknown HIV status. The overall regression rate from LSIL to normality was 88.5% [95% CI = 83.9 - 92.1%], with 128 of the 154 women having had regression of disease. The overall progression to higher grade lesions included 31 women, giving a progression rate of 17.7% [95% CI = 15.4 -22.8%]. None of these women progressed to invasive cancer. HIV positive women made up 69% of the study population but there was no significant difference in regression and progression between the HIV positive and negative women. The mean age of the group was 37.8 years with 60% of women screened at this clinic falling between 30-49 years of age. All age groups had similar trends of regression and progression, but those over 60 years of age were 12 times more likely to regress and none of them progressed to HSIL [p=0.002]. Those using an IUCD made up 141 person-months studied, they were shown to have a 6 times greater likelihood to result in regression (p=0.01) compared to women on no contraception. Conclusion: The high regression and low progression rates of LSIL are in keeping with global data and substantiate the need for surveillance rather than surgical intervention i.e. LSIL is a risk factor rather than a precursor for cervical cancer. The lack of difference in regression-progression rates despite HIV status means we can follow-up positive and negative women similarly (12 monthly). Older women (60+) are most likely over-called during diagnosis due to genital atrophy and thus follow-up interval can be longer than 12 months. More research is required to assess IUCDs' effect on LSIL regression and to ascertain the possible reasons for patient adherence.

Includes abstract. / Includes bibliographical references. / Almost four million babies die in the first four weeks of life per year worldwide, most from preventable causes. In addition a million babies die during labour and delivery (Lawn J et al., 2005). In South Africa, ‘intrapartum hypoxia and birth trauma’ are among the top three causes of perinatal deaths. Severe intrapartum hypoxia is often preventable with appropriate maternal and fetal monitoring in labour. However, this remains a challenge in under-resourced settings, due to difficulties that accompany the use of a Pinard Fetal Stethoscope (PFS) which include user-dependence and lack of evidence based standardisation in taking measurements with it. Although intermittent fetal heart monitoring is as effective as continuous electronic monitoring in low risk labours (Banta DH and Thacker, 2001), the search is for reliable, robust and cheaper fetal monitoring devices. The innovative crank powered Doppler Ultrasound Fetal Heart Rate Monitor (DUFHRM) developed by Power-free Education and Technology is robust, cheaper and designed for use even in settings with no or erratic access to mains electricity and replaceable batteries, and overcomes some of the challenges that come with the use of PFS (Banta DH and Thacker, 2001). The aim of the study was to assess the accuracy of Fetal Heart Rates (FHRs)taken with the DUFHRM compared to FHRs taken with a PFS using a Cardiotocography (CTG) as a standard fetal heart rate monitoring device. This was a comparative diagnostic study conducted at Mowbray Maternity Hospital, a public sector maternity hospital in Cape Town during 2012. Women with singleton pregnancies in the active phase of the first stage of labour, who had consented to participation, were enrolled in the study. Paired readings of FHRs were taken with a DUFHRM and a PFS, by two midwives and also with a CTG during the active phase of the first stage of labour before and after two preferably consecutive uterine contractions. The midwives were blinded to the CTG measurements by silencing the CTG and turning it away from their view. The FHRs taken with a PFS were done over a 60 second period in accordance with the guidelines from professional bodies (ACOG, 1995, RANZCOG, 2002, RCOG, 2001a, Liston R et al., 2002) The DUFHRM and CTG readings were made at the start and end of each 60 second period of PFS monitoring. The proportion agreement of FHRs taken with a DUFHRM to FHRs recorded with a CTG, and the proportion agreement of FHRs taken with a PFS to FHRs recorded with a CTG were determined and compared using McNemar Exact Significance Probability test (mcc).

Objective: Lynch syndrome, previously called hereditary non-polyposis colorectal cancer (HNPCC), is one of the most common hereditary cancer syndromes with an association with gynaecological cancers. Members of affected families have an increased risk for colon cancer as well as extra colonic sites; in particular endometrial and ovarian cancer. A cohort of patients with Lynch syndrome in the Northern Cape, South Africa has been identified and followed up. According to recommendations by the International Collaborative Group on HNPCC (ICGHNPCC); women affected with the gene mutation warrant full gynaecological assessment to exclude endometrial and ovarian cancer. Thus far the recommended screening has not been possible and the apparent prevalence of gynaecological cancer or premalignancies among this high risk group has not been established. The aim of this study was to determine the actual apparent prevalence of gynaecological pathology in this cohort of patients; by way of screening. Methods: Women with a known gene mutation, or close relatives of affected family members, utilising the annual colorectal service in the Northern Cape, who fulfilled the inclusion criteria, were recruited to undergo gynaecological evaluation. The participants had a gynaecological examination which included a Papanicolaou smear, a pelvic ultrasound and endometrial sampling. The resultant data was captured on an Excel spread sheet and a descriptive analysis was done. Results: In total 43 women were recruited, of which 18 were postmenopausal and 25 premenopausal. 35 of these women had a known hMLH1 gene mutation. The eight remaining women had either normal genotyping (n=7) or were awaiting molecular test results (n=1). Only twenty-one of these participants agreed to endometrial sampling, in addition to pelvic ultrasound and gynaecological examination. Histological results were therefore available for the 21 participants. One patient was diagnosed with a grade-2 endometroid adenocarcinoma. No cases of endometrial hyperplasia were found. Thirty pelvic ultrasound scans were performed. Of these, one patient had an enlarged adnexal mass. No cervical premalignancies were diagnosed on cervical smears, with one abnormal smear of atypical cells of unknown significance (ASCUS) diagnosed. Conclusion: The apparent prevalence of gynaecological disease in this study population was lower than expected. We conclude however that this high risk group of women should still undergo regular gynaecological screening which should include history taking and clinical examination. Screening using routine endometrial sampling and pelvic ultrasound in asymptomatic women did not appear to be beneficial.

Introduction This study aimed to investigate the time interval between the confirmation of pregnancy diagnosis and the commencement of antenatal care at the Metro West district of Cape Town, and to explore reasons for delays between the confirmation of pregnancy and the first antenatal booking. Methods A cross sectional descriptive study was conducted in September 2015 at Vanguard MOU, in which 120 pregnant women were interviewed at their first antenatal visit, using a structured questionnaire. Subjects were grouped into those with a short time interval (less than 60 days) between confirmation of pregnancy diagnosis and booking, and those with a long time interval (more than 60 days). The two groups were compared. The study hypothesis was that income would be a significant determinant of this time interval. The data were divided into descriptive and categorical variables. A logistic regression analysis was conducted to determine the association between independent variables and the dependent variable (time interval). Results The average gestational age at confirmation of pregnancy was 10.75 ± 5.88 weeks and the average gestation at booking was 18.27 ± 7.27 weeks. The mean time interval between confirmation of pregnancy diagnosis and first antenatal visit was 7.50 ± 6.63 weeks. Seventy- three (60.83%) reported a short time interval (SI) while 47 (39.17%) reported a long time interval (LI). The prevalence of late booking (defined as booking at or after 20 weeks) in the total study sample was 38.30%. There was a significant association between late attendance and LI with 70.21% of the LI group attending late, as compared to 17.81% of the SI group (OR 10.88; 95% CI 4.23-28.43). The time interval was significantly influenced by the women’s type of residence, the perception of the women regarding knowledge of the timing of antenatal care, and perception of the timing of pregnancy complications. It was not influenced by monthly income, thus refuting our hypothesis. Previous obstetric complications did not influence the time interval. Private confirmation of pregnancy by a general practitioner or home pregnancy test was significantly associated with a long interval; 37 (78.7%) in the LI group compared to 43 (59.9%) in the SI group, (p= 0.016). Reasons for the delay in booking were mostly related to poor understanding by women of the role of antenatal care and the ideal time of booking. Discussion and Conclusion Even though some women confirm their pregnancy as early as three weeks, there were notable delays in booking for their first antenatal visit, thus delaying antenatal care. However, the time delays seemed shorter than found in the previous Cape Town study, and compared to other studies in Africa. Many women perceived antenatal care to be curative rather than preventive. It is suggested that the site where women confirm their pregnancy (pharmacy, general practitioner or family planning clinic) should refer women immediately for antenatal booking. Also antenatal care sites should offer pregnancy testing services so that booking could occur after pregnancy is confirmed on the same day and at the same site.

Background: Postpartum haemorrhage (PPH) is a direct leading cause of maternal death in developing countries including South Africa, and atonic uterus is responsible for up to 80% of cases of postpartum haemorrhage. The introduction of the uterine compression suture (UCS) by C B-Lynch revolutionised the conservative surgical management of postpartum haemorrhage. Its use is simple, does not require special training and reduces the need for hysterectomy. Many small studies have been conducted in different parts of the world on its effectiveness but no published studies have been found from Africa. To understand the unique challenges in developing countries, especially those in Africa, it would be relevant to establish if uterine compression sutures are beneficial in a low resource setting for the management of PPH. Accordingly, the aim of the present study was to audit the use of uterine compression suture (UCS) in our regional hospital, with a focus on the circumstances in which it was used and its success rate in treating postpartum haemorrhage. Methods: This was a retrospective folder review study of all women who had a UCS inserted to treat obstetric haemorrhage in Mowbray Maternity Hospital during the period between January 2010 and June 2016, following ethical approval from the UCT HREC and Mowbray Maternity Hospital's management. Cases were identified from theatre registrars and a designated UCS book. Patients' records were retrieved and data collected and analyzed using the Excel spreadsheet software. Results: During the 6.5-year study period, there were 132, 612 deliveries in the population served by Mowbray maternity Hospital, of which 102,261 (78%) were by normal vaginal delivery and 30,351 (22%) by caesarean section. A total of 150 UCS cases were identified giving a rate of 0.87 UCS per 1000 deliveries (at MMH and its referral MOUs). Of the 150 cases, 115 (77%) patient files could be retrieved for further analysis. UCS was performed more commonly after ceasarean section (107; 93%) than after vaginal delivery (8; 7%) The majority were performed by obstetric registrars (73; 63.4%) compared to 21 (18.3%) performed by consultants and by medical officers. The UCS was successful in stopping haemorrhage without the need for hysterectomy in 107 (93%) of all analyzed cases. Among the 8 failures, all required a hysterectomy and one woman died. The majority of UCS (50%) were performed in cases with estimated blood loss over 1000 mls, with 20.9% having blood loss more than 2000mls. Of note, 13.9% had an estimated blood loss (EBL) less than 500 mls (the majority of which were performed by medical officers). Short term morbidity of UCS cases included blood transfusion (42%), admission to ICU (8.7%), post ceasarean section sepsis (9.6%), and prolonged hospital stay (46.1%). Discussion and conclusion: This study is one of the largest case series and the first done in an African setting. Our success rate of 93% is similar to other previously reported published studies with similar low rates of short term morbidity. Our study confirmed that the success of the UCS is achievable even in low-resource environments and that UCS can be safely performed by surgeons with different levels of surgical expertise (medical officers as well as registrars and consultants).

Includes abstract. Includes bibliographical references.

Includes abstract. / Includes bibliographical references. / Despite two decades of studies of mother to child transmission of HIV, very little data is available regarding vertical transmission in twin pregnancies. There is uncertainty whether discordance of HIV transmission exists between the first born (Twin A) and second born (Twin B) infant. Primary aim of the study was to examine if there is any discordance of HIV transmission in twin pregnancies when comparing Twin A to Twin B. Secondary objectives were to identify possible additional risk factors for HIV transmission in twin pregnancies. We assessed antenatal care, antiretroviral therapy, birth order, delivery route and feeding options as risk factors for mother to child transmission of HIV in twin pregnancies.

Bibliography: leaves 36-41. / This study was designed to identify specific patient and tumour related factors which could be used as prognostic parameters in women with stage IIIB cervial cancer, and to investigate the relationship between these factors and treatment outcome. Primary endpoints were overall survival, disease-free and pelvic recurrence-free survival rates.

The interval between one pregnancy and the next may affect the outcome of pregnancy. Both short and long interpregnancy intervals (IPI) have been associated with adverse pregnancy outcomes and most of these occur with a short IPI. Our primary objective was to determine the effects of a short IPI (< 24 months) compared with a long IPI (≥ 24 months) on the subsequent potentially viable pregnancy in women who received antenatal care (ANC) in the secondary level hospitals in the Metro-West area of Cape Town. The secondary objective was to review possible determinants of a short IPI. Methods: This was a pilot descriptive cross-sectional study conducted between 1st September 2016 and 28th November 2016. One hundred and thirty women who were Para 2 were recruited to the study in the early postnatal period. Sixty women were recruited into the short IPI group (<24 months) and 70 to the long IPI group (≥24months). Questionnaire-based interviews were conducted and data were entered using Microsoft Excel 2012 spread sheets. Statistical analysis was done using Stata® Edition 13. Results: We analysed the data for both short and long IPI and found that there were no significant differences in preterm birth, abruptio placentae, preterm prelabour rupture of membranes (PPROM) and low birth weight. There was however a significant difference in the number of small-for-gestational- age (SGA) babies. In the short IPI group, 19 women (31.7%) had SGA babies in comparison to the long IPI group where 7 women (10%) had SGA babies( p = 0.015). Of the 130 respondents, 79 women (60.8%) had unintended pregnancies, 44 (73%) with a short IPI vs 35 (50%) with a long IPI (p = 0.017). Women with a long IPI were more likely to have a different partner for the subsequent pregnancy (p= 0.002). Women in relationships longer than 5 years were more likely to have a long IPI (p = 0.049). Thirty-eight women (63.3%) with a short IPI would have preferred the pregnancy later compared to 11 women (15.7%) with a long IPI (p<0.001). There were 27 (38%) women who supported themselves financially in the long IPI group compared with 8 (13%) with a short IPI (p=0.001). A long IPI was associated with more formal employment and professional careers compared to a short IPI (p= 0.002). In the long IPI group 10 women (7%) had professional positions compared with none in the short IPI group (p=0.002). There were no significant differences in breastfeeding duration, contraception use and knowledge, social habits, previous obstetric history, educational status or emotional support between the two groups. Conclusion: In our study, of all the pregnancy outcomes investigated, small-for-gestational age was the only clinical outcome significantly associated with a short IPI. There were differences in pregnancy intendedness, duration of relationships, financial support and employment between the two groups. The majority of women with a short IPI (63.3%) would have preferred the index pregnancy to have occurred later.

Includes abstract. Includes bibliographical references.