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.

Introduction: Induction of labour is commonly performed in clinical practice. Increasing rates of induction of labour worldwide has led to debate on whether elective induction improves the outcomes or simply leads to increased complications and healthcare costs. Maternal and neonatal complications and increased caesarean section (CS) rates associated with induction of labour are related to a variety of factors influencing the methods of induction. Misoprostol has been the drug of choice for induction of labour in developing countries for almost a decade. Different misoprostol regimens are used for induction of labour in different health facilities. New Somerset Hospital uses the standard protocol for induction of labour using misoprostol that the Western Cape Government adopted. This protocol has however not been audited. The main objective of the study was to determine the maternal and fetal outcomes of inductions of labour performed at New Somerset Hospital. Methods: This was a retrospective study conducted at New Somerset Hospital. We reviewed a random sample of medical records of patients who underwent induction of labour from 01 January 2014 to 31 December 2014. Ethics committee approval was granted by the Human Research Ethics Committee of the Faculty of Health Sciences of UCT. A total of 88 folders were sampled from 1029 women who had induction of labour. Results: There were a total of 6514 deliveries in 2014 of which 1029 had induction of labour, giving an induction rate of 15.8%. A total of 86 patients were included in the study. The mean age of the patients was 28.9 years (SD±6.586) with an age range of 16 to 44 years. The average gestational age at the time of induction of labour was 39.5 weeks with a range 35 to 42.6 weeks and 14.0% of the patients were HIV positive. The three main indications of induction of labour were hypertension in pregnancy (40.7%), prolonged pregnancy (27.9%) and pre-labour rupture of membranes (8.1%). Overall, 50 patients (58.1%) had vaginal delivery and 36 patients (41.9%) had caesarean delivery. There was a significant association between mode of delivery and time to delivery. Patients who delivered within 24 hours of commencement of induction of labour were more likely to have had a vaginal delivery (p = 0.005). The three main indications for caesarean delivery were fetal heart rate changes (n=30; 72.0%) followed by failed induction of labour (n=9; 21.0%) and cephalopelvic disproportion (n=3; 7.0 %). In terms of maternal outcomes, 2 patients (2.3%) had hyperstimulation of the uterus, 6 patients (7.0%) had postpartum hemorrhage, 8 patients (9.3%) had vaginal tears and 5 patients (5.9%) had an episiotomy performed during delivery. The mean birth weight was 3262.1g (SD±503.77) with a range of 1925 to 4515 grams. At five minutes the means Apgar score was 9.8(SD ± 0.62) with range of 6 to 10. A total of 38 babies (44.3%) had meconium stained liquor documented at delivery, three babies (3.4%) required neonatal resuscitation upon delivery. There were 10 (11.6%) babies that were admitted to NICU. Conclusion: In this study we found that the prevalence of induction of labour was 15.8%. Hypertension in pregnancy, prolonged pregnancy and pre-labour rupture of membranes are the three common indications for induction of labour. Successful vaginal delivery was achieved in 51.0% of the study population. The caesarean delivery rate was high, mostly due to CTG changes The current induction of labour protocol using oral misoprostol is associated with acceptable maternal and fetal outcomes.

Includes abstract. Includes bibliographical references (leaves 50-55).

INTRODUCTION: Cervical cancer is the second commonest cancer in South Africa and the commonest amongst Black females with a Lifetime Risk (LR) of 1:35. In South Africa the problem has been compounded by the HIV epidemic as well as a lack of resources and infrastructure to offer an adequate screening and treatment programme. Cone biopsies are one of the diagnostic and sometimes therapeutic modalities used to assess and treat cervical precursors and cervical cancer. Unfortunately, cone biopsy of the cervix remains a morbid procedure often performed on young women in the reproductive age group and has resultant complications. OBJECTIVE: To audit the demographics, indications, histology and post cone management and outcome of women requiring cone biopsies of the cervix, at Groote Schuur Hospital Colposcopy Clinic between 1st April 2010 and 31st October 2013. METHODS: A group of women attending the colposcopy clinic, and requiring cone biopsies between 1st April 2010 and 31st October 2013 were identified from a computerized database, known as the Hygiena Database. Women who had an incomplete dataset were excluded. Folder review and review of the National Health Laboratory Services was also conducted. Patient demographics, indications, cone histology and follow up at 4-6 months, 10-12 months and > 12 months were analysed. Age, parity, HIV status, CD4 count, ARV status and cone margin involvement were included in the univariate and multivariate analysis to determine predictors of persistent disease RESULTS: Three hundred and seventy six cone biopsies were performed during the study period, with a mean age of 42.3 years, mean parity of 2. The majority of women [56,7% (213/376)] were HIV positive. The final histology indicated that 65,2% (246/376) of the women had high-grade disease (CIN 2/3 or HSIL) and 12,5% (47/376) had microinvasion. Ectocervical margins were clear in 57,6% (212/368) of cases and endocervical margins were clear in 54,6% (201/368) of specimens. Fifty-one cancers were detected during the study period. In the multivariate analysis age 40-49yrs (RR 1.4, 95% CI 1.01-2.0: p=0,043), ectocervical margin involvement with CIN 2/3 (RR 1.8, 95% CI 1.1-3.0: p-0.017) and endocervical margin involvement with CIN 2/3 (RR 1.5, 95% CI 1.04-2.3; p=0,031) and microinvasion ( RR 2.4, 95% CI 1.4-4.3; p=0.003) were all predictors of persistent disease. CONCLUSION: The use of cone biopsy is a valid diagnostic and sometimes therapeutic procedure at Groote Schuur Hospital with significant detection of high grade disease and cervical cancer. Women aged 40-49 years and positive cone margins are strong predictors of persistent disease. Improved compliance and a reduction in positive margins are two areas that need to be addressed to improve the current treatment programme. Use of cone biopsy as surgical therapy for early stage cancer appears promising but needs further study.

Introduction: Preterm births are common in all obstetric hospitals and present multiple challenges to both the obstetrician and the paediatrician. Preterm delivery is an important cause of perinatal morbidity and mortality, and places significant psychosocial stress on all involved. Late Preterm Birth (LPTB) is an important topic with many consequences for mother, child and society. It would be of interest to quantify the problem of late preterm birth at Mowbray Maternity Hospital (MMH); quantifying the deliveries into spontaneous versus medically indicated, and to explore the reasons and outcomes for each category. Aims and Objectives: To review the causes, indications for, and outcomes (maternal and neonatal) of all late preterm births delivered at Mowbray Maternity Hospital. Methods: This was a retrospective descriptive study, conducted at Mowbray Maternity Hospital, between January 1 st 2016 and March 31 st 2016. The study population, consisting of 231 patients, includes all deliveries at MMH during the above time period, which fit the inclusion criteria of a gestational age (GA) of between 34⁺⁰ and 36⁺⁶ weeks. All data pertaining to the patient’s previous history, risk factors and current pregnancy were captured and analyzed using Stata. This study was approved by the UCT Ethics Committee (HREC) and institutional approval was obtained from Mowbray Maternity Hospital. All information was treated with confidentially and in accordance with the Helsinki Declaration. Results: During the study period, 1st January 2016 and 31st March 2016, there were a total of 2342 deliveries. Of these deliveries 36 (1.5%) were found to have a GA < 28 weeks (these included those that were categorised as miscarriages); 24 (1%) were between 28 – 31⁺⁶ weeks; 56 (2.4%) were between 32 – 33⁺⁶ weeks and 1833 (78.2%) had a GA above 37 weeks. 162 (6.9%) folders were missing and therefore GA was not calculated, leaving 231 (9.9%) deliveries of late preterm infants. Of the 231 patients included, 64 (27.7%) were noted to have a poor obstetric history, 38 (16.5%) had a history of a previous preterm delivery. Gestational age was calculated by Early Ultrasound Scan (EUS) in 44.2% of cases; Late Ultrasound Scan (LUS) in 36.4 % of cases; Last Normal Menstrual Period (LNMP) in 14.3% of cases and booking palpation in 5.12% of cases. At least one maternal characteristic associated with preterm labour was seen in 131 (56.7%) of the included patients. There were 20 (8.7%) sets of twins. Of the 231 patients, 129 (55.8%) presented in spontaneous labour and 102 were delivered late preterm for medical reasons; this included 70 (30.3% of 231) who had labour induced and 32 (13.9% of 231) who were delivered via caesarean section despite not being in labour for reasons that prevented an Induction of Labour (IOL)/vaginal birth. There were 251 babies delivered in the late preterm category, and of these, 250 (99.6%) were born alive, with 1 Early Neonatal Death (ENND) and 1 macerated stillborn. Of the 251 newborns, 63 (25.1%) were admitted to at least one of the neonatal wards during their hospital stay. Of these, 64.1% spent time in the High Care Unit (HCU), 28.1% spent time in the Neonatal Intensive Care Unit (NICU) and 68.8% spent time in Kangaroo Mother Care (KMC) unit (majority of these newborns had been in either HCU or NICU prior to KMC). Of the 63 neonates admitted to a neonatal ward; there were 37 (36.3%) from the 102 mothers delivered for medical reasons and 26 (20.2%) from the 129 mothers who had presented in spontaneous labour. The overall correlation between gestational age calculated by EUS/LUS/LMNP and Ballard score was calculated as 37%. The average length of stay in the hospital for the newborns, whether admitted or with mom, was 4.96 days. Discussion and Conclusion: Late Preterm Birth accounts for 9.9% of all births and 66.6% of all preterm births at Mowbray Maternity Hospital. This is a substantial proportion of MMH deliveries, putting pressure on already strained resources. This pressure is confounded by the fact that 25.1% of these neonates are admitted to a neonatal ward. 44.2% of these births are medically initiated and this should give cause for thought as to whether our protocols that govern certain medical conditions in pregnancy could possibly be altered to prolong pregnancies and reduce the incidence of Late Preterm Birth.