Jayanthilall S. Bagratee

Medical vs. surgical evacuation of first-trimester spontaneous abortion

Objective: To determine whether management of incomplete first‐trimester abortion with vaginal misoprostol in an under‐resourced setting is a viable treatment option. Methods: A total of 94 women were randomized to 600 μg of misoprostol intravaginally or to surgical curettage. The women receiving misoprostol were administered a second dose if the abortion was incomplete; and if still not complete after a week, evacuation of retained products of conception was performed. All women had a follow‐up visit 2 weeks following complete abortion. Results: The overall success rate of medical management was 91.5%, with 15 of 47 successful cases after 1 dose of misoprostol; 8.5% of the 47 women required evacuation of retained products of conception after 1 week because of treatment failure. The success rate in the surgical arm was 100%. Patients in the medical arm had a longer duration of bleeding and a greater need for analgesia. There were no differences in hemoglobin levels, white blood cell count, adverse effects, pain score, and satisfaction with treatment at the follow‐up visit. However, more women who received the medical treatment would recommend it or choose it in the future. Conclusion: Medical management using 600 μg of misoprostol in 2 doses is effective to treat incomplete first‐trimester abortions in an under‐resourced setting when there is no evidence of uterine sepsis.

Awareness of and attitudes toward menopause and hormone replacement therapy in an African community

Menopausal symptoms can be perceived as unpleasant yet avoidable manifestations of the aging process in women. In particular Black African women may not be aware that the symptoms can be relieved. This study determined how perimenopausal urban African women experience menopause and what their attitudes are toward hormone replacement therapy (HRT). A total of 102 women age 45 years or above in Durban South Africa were interviewed. Demographic data were collected as well as gynecological medical family and social histories and their employment status. The mean age for menopause was 49 years. Most women knew of menopause. Half obtained their information from family or friends and the rest from their general practitioner hospital or local clinic. Actual menopausal symptoms were commonly experienced yet they had a poor understanding of them. Attitude was positive in that the women who were aware of the existence of menopause said it was culturally and socially acceptable. However very few women were aware of HRT.

Use of the myocardial performance index as a prognostic indicator of adverse fetal outcome in poorly controlled gestational diabetic pregnancies

The aim of this study was to determine whether there are any changes in cardiac function in fetuses of poorly controlled gestational diabetics and whether these changes influence perinatal outcome.

Anaemia in pregnancy is associated with advanced HIV disease.

Background Anaemia is a common clinical finding in HIV infected women and has been associated with advanced disease. The use of antiretroviral drugs such as Zidovudine (ZDV) either for prevention of mother to child transmission (MTCT) of HIV or used in combination with other antiretrovirals have been implicated in the development or increased severity of anaemia. We report the prevalence, type, severity and incidence of anaemia in a cohort of HIV infected women who initiated antiretroviral prophylaxis or treatment during pregnancy. Methods and Materials This is a retrospective cohort data analysis of 408 HIV infected pregnant women who participated in a breastfeeding intervention study (HPTN 046 Study, ClinicalTrials.gov NCT 00074412) in South Africa. Women initiated zidovudine prophylaxis for PMTCT or triple antiretroviral treatment in pregnancy according to the standard of care. Laboratory and clinical data in pregnancy, <72 hours and 2 weeks postdelivery were extracted from the main database and analysed. Results The mean Hb concentration was 10.6 g/dL at baseline and 262/408 (64.2%) women were diagnosed with anaemia (Hb<11 g/dL) in pregnancy, 48/146 (32.9%) subsequently developed anaemia intrapartum or postpartum and 89/310 (28.7%) of all cases of anaemia remained unresolved by 2 weeks postdelivery. In a univariate analysis, CD4 count and gravidity were significant risk factors for anaemia in pregnancy, RR 1.41; 1.23–1.61 (p<0.001) and 1.10; 1.01–1.18 (p = 0.02) respectively. After adjusting for antiretroviral regimen, age and gravidity in a multivariable analysis, only the CD4 count remains a significant risk factor for anaemia in pregnancy and postdelivery. Conclusion In conclusion, anaemia was most common among women in the advanced stage of HIV infection (CD4<200 cells/mm3). There was no evidence of an association between ZDV or triple ARVs and anaemia.

Classification of the lesions observed in female genital schistosomiasis

Authors version of an article in the journal: International Journal of Gynecology and Obstetrics. Also available from the publisher at: http://dx.doi.org/10.1016/j.ijgo.2014.07.014

Determination of the myocardial performance index in deteriorating grades of intrauterine growth restriction and its link to adverse outcomes

The aim of this study is to determine the fetal modified myocardial performance index (Mod‐MPI) and E‐wave/A‐wave peak velocities (E/A ratio) in deteriorating grades of intrauterine growth restriction (IUGR) and its link to adverse outcomes defined as perinatal death, hypoxic ischemic encephalopathy, neonatal resuscitation, neonatal cord pH <7.15, intraventricular hemorrhage and bronchopulmonary dysplasia.

The colposcopic atlas of schistosomiasis in the lower female genital tract based on studies in Malawi, Zimbabwe, Madagascar and South Africa

Background Schistosoma (S.) haematobium is a neglected tropical disease which may affect any part of the genital tract in women. Female genital schistosomiasis (FGS) may cause abnormal vaginal discharge, contact bleeding, genital tumours, ectopic pregnancies and increased susceptibility to HIV. Symptoms may mimic those typical of sexually transmitted infections (STIs) and women with genital schistosomiasis may be incorrectly diagnosed. An expert consensus meeting suggested that the following findings by visual inspection should serve as proxy indicators for the diagnosis of schistosomiasis of the lower genital tract in women from S. haematobium endemic areas: sandy patches appearing as (1) single or clustered grains or (2) sandy patches appearing as homogenous, yellow areas, or (3) rubbery papules. In this atlas we aim to provide an overview of the genital mucosal manifestations of schistosomiasis in women. Methodology/Principal findings Photocolposcopic images were captured from women, between 1994 and 2012 in four different study sites endemic for S. haematobium in Malawi, Zimbabwe, South Africa and Madagascar. Images and specimens were sampled from sexually active women between 15 and 49 years of age. Colposcopic images of other diseases are included for differential diagnostic purposes. Significance This is the first atlas to present the clinical manifestations of schistosomiasis in the lower female genital tract. It will be freely available for online use, downloadable as a presentation and for print. It could be used for training purposes, further research, and in clinical practice.

Amebiasis cutis revisited

Background:  Amebiasis cutis (AC) is reported infrequently. This study assesses the clinicopathological spectrum, co‐existent visceral involvement and impact of human immunodeficiency virus (HIV) co‐infection on AC.

Gestational age-adjusted trends and reference intervals of the Modified Myocardial Performance Index (Mod-MPI) and its components, with its interpretation in the context of established cardiac physiological principles.

The objective of this study is to establish gestational age‐adjusted reference intervals and trends of the modified myocardial performance index (Mod‐MPI), isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT), and ejection time (ET) in pregnancy

Pregnancy outcomes in patients with previous history of abruptio placentae

Abruptio placentae (AP) is a major cause of adverse obstetric outcome. Recurrence rates of 10% after 1 episode and 25% after 2 episodes have been reported. The present study evaluated obstetric outcome in women who were from a low socio-economic population and had a history of AP. A retrospective study of 6054 deliveries performed over 9 months was carried out. The inclusion criteria were (1) a pregnancy duration greater than 24 weeks based on menstrual history palpation and ultrasonography; (2) a history of antepartum hemorrhage with demonstration of retroplacental hemorrhage; and (3) the possibility of placenta previa was excluded. (excerpt)