Background. Cervical cancer is the second most common malignancy in women, particularly in developing countries. Endocervical adenocarcinoma (ECA) is less common than cervical squamous cell carcinoma (SCC), but its incidence is increasing globally, particularly in young women. The decline in the incidence of SCC is attributed to effective screening programmes. Objectives. To assess the prevalence of ECA and its subtypes and to describe the clinicopathological characteristics of patients with these tumours at a tertiary South African institute between 2017 and 2019. Methods. This was a cross-sectional, descriptive study of 156 ECA patients. Following ethical clearance, demographic data, clinical information and disease characteristics were obtained from departmental histopathological reports. Descriptive statistics were used to calculate the prevalence of ECA. We analysed the association between age, Papanicolaou (Pap) smear results, human papillomavirus (HPV) status, and HIV status with ECA. Results. The prevalence of ECA was 6.8% and it was more commonly diagnosed in younger women. HPV-associated subtypes were the most common variants. The usual type of ECA accounted for 24.4% of cases. HIV status was documented in 64.0% of cases, of which 34.0% were positive. There were no statistically significant associations between ECA subtype and HIV status (p=0.81) or between ECA subtype and Pap smear results. Conclusion. In South Africa, the prevalence of ECA is lower compared with Western countries, reflecting inadequacies in screening modalities of ECA at primary healthcare facilities. HPV prevails as a cause of endocervical carcinoma. HPV morphologic hallmarks serve as a practical guide in classifying ECAs according to their HPV status.
Background. Changes in the fibrinolytic system that support haemostasis are seen in the third trimester of pregnancy. An imbalance between coagulation and fibrinolysis could increase either thrombotic episodes or haemorrhagic risk. Objective. To assess plasma D-dimer and plasmin-a2-antiplasmin (PAP) complex levels as indication of plasmin generation during late pregnancy. Methods. A sample of 41 healthy pregnant women in their third trimester participated in the study. Data on obstetric history, body mass index (BMI) and other demographic variables were recorded. Haematological analysis involved enzyme-linked immunosorbent assaying of venous blood samples. Statistical analysis was performed using SPSS version 21. Results. Mean maternal and gestational age, with associated standard deviations (SD), were 30.68 (4.69) years and 34.78 (3.34) weeks, respectively. Haematological analysis showed mean (SD) values of D-dimer and PAP complex to be 194 (24 ng/mL) and 175 (11 ng/mL), respectively. Both indicators were positively correlated with maternal age, gestational age and BMI grouping, although significantly only for maternal age. Multiple linear regression analysis showed that with every increasing year of maternal age, D-dimer levels increased by 2.0 ng/mL (95% confidence interval (CI) 0.4 - 3.6 ng/mL). PAP complex levels similarly increased by 0.8 ng/mL (95% CI 0.1 - 1.5 ng/mL), after controlling for gestational age and BMI. Conclusion. D-dimer and PAP levels increased with increasing maternal age, suggesting it to be an independent determinant of plasmin generation in the third trimester of pregnancy. If this finding is confirmed in larger studies, age should be considered when interpreting these indicator values during pregnancy.
Background. Sickle cell disease (SCD) is a common genetic disease in sub-Saharan Africa. The condition affects more than 7% of pregnant women worldwide, with complications including severe infections, vital organ damage, respiratory problems, bone marrow suppression and a high rate of maternal or fetal death. Objective. To evaluate the prevalence, management and maternal–fetal prognosis of pregnancies in women with major SCD. Methods. A prospective and descriptive study was conducted in the gynaecology and obstetrics department of the university hospital of Cocody, Abidjan, in Cote d’Ivoire over two years. Records of all pregnant women with homozygous SCD who had given birth or were followed up in the unit were reviewed. Women with an HbAA or HbAS genotype or any other normal electrophoretic profile or history of renal disease were excluded. Results. Out of 14 819 delivery records, 118 (0.8%) women presented with an abnormal haemoglobin profile; 75 were classified as having major SCD (0.51%). The majority of women (82.7%) were younger than 35 and 68% worked in the informal sector. About a third (37.3%) had no formal education. Heterozygous HbSC profiles were the predominant (88%) presenting form; HbSS genotypes were found in 12% of cases. The occurrence of complications during pregnancy was significant (44%). Conclusion. SCD in pregnancy is associated with an increased risk of maternal and fetal complications. Accurate and rigorous monitoring of these pregnancies by a multidisciplinary team, together with improved patient awareness and education, is required to reduce maternal and fetal health risks.
Background. Information about current gynaecological surgical practices and patient outcomes is integral to the provision of quality gynaecological care. An audit of surgical complications can provide important information needed for an assessment of current surgical practices and outcomes. Objective. To describe the cohort of patients undergoing gynaecological surgical procedures at Tygerberg Hospital, their complication rates and identify associated risk factors. Methods. We conducted a retrospective review of adult patients having emergency and elective gynaecological surgical procedures between 1 January and 31 December 2019. A total of 970 patients were included. We summarised categorical data as counts and percentages. We performed logistical regressions to assess factors associated with complications. Odds ratios (ORs) were reported as measures of association with the corresponding 95% confidence interval (CI). Statistical significance was set at a p-value <0.1 and p-value <0.05 in the bivariate and multivariate analysis, respectively. Results. Overweight and obese patients accounted for 60% of patients. The most common indication for surgical intervention was benign gynaecological conditions (23.3%). Total abdominal hysterectomy was the single most common procedure performed (23.7%). Intraoperative or postoperative complications occurred in 12.7% of patients, while 1.2% sustained both intraoperative and postoperative complications. The most common complications were infection-related (7.5%) and bowel injury (1.8%). Oncological surgery did not increase the likelihood of complications compared with non-oncological surgery (OR 1.14; 95% CI 0.66 - 1.97; p=0.63). Conclusion. The provision of quality gynaecological care requires information on gynaecological surgical practices and patient outcomes. The rates of surgical complications at our facility appear to be higher than local and international studies, with our main contributors being infection-related complications and bowel injuries. An extended course of prophylactic antibiotics could be considered, as well as auditing infection control measures. Patients who are at a higher risk of bowel injury should be identified preoperatively and the surgery approached with care.
Background. Large for gestational age (LGA) refers to a newborn birthweight equal to or greater than the 90th percentile for a given GA. Delivering an LGA newborn poses a high risk of morbidity and mortality for both mother and baby. Objectives. To describe the prevalence of term LGA newborns and identify the factors and pregnancy-related outcomes associated with delivering term LGA newborns at Chris Hani Baragwanath Academic Hospital (CHBAH), a tertiary hospital in Johannesburg, South Africa. Methods. We conducted a retrospective, institution-based cross-sectional study from 1 October 2020 to 31 March 2021, in which 275 LGA singleton term deliveries were reviewed. Patient demographics, medical factors and clinical outcomes were recorded and statistically analysed. Results. The prevalence of LGA newborns in singleton-term deliveries at CHBAH was 3.92%. Associated factors included maternal obesity, multiparity, prolonged pregnancy with a GA >40 weeks, previous LGA delivery and (newborn) male gender. Maternal complications included prolonged labour, increased caesarean delivery, postpartum haemorrhage, obstetric anal sphincter injuries and uterine rupture. Fetal and neonatal complications included shoulder dystocia, neonatal hypoglycaemia, and neonatal respiratory distress syndrome. Conclusions. LGA singleton term deliveries at CHBAH were associated with both maternal and neonatal morbidity. The presence of associated factors should alert maternity caregivers to closely monitor these pregnancies and plan for an appropriate mode of delivery. LGA newborns should be routinely screened and appropriately managed for hypoglycaemia.
