NC Ngene

• PhD, MMed (O&G), FCOG, MMed (Fam Med), Dip HIV Man, Dip Obst, MBBS
• Specialist obstetrician and Gynaecologist at University of the Witwatersrand South Africa

A 16-year-old primigravida at term developed fetal compromise in the second stage of labour and had a delayed caesarean delivery (CD) because she declined the procedure after the medical manager had consented on her behalf following the unavailability of her parents. The baby that was delivered suffered neonatal encephalopathy. This report provides...

Background Sociodemographic characteristics can influence the burden of caring for patients with mental illnesses such as schizophrenia. Aim The aim of this study was to ascertain the sociodemographic characteristics implicated in severe caregiver burden among family caregivers of patients with schizophrenia. Methods Over 3 months, 300 caregivers...

Amongst the indications for caesarean delivery (CD) in pregnant women presenting with placental abruption (PA), fetal demise near term, and a previous major uterine surgery are peritonitic abdomen and severe vaginal bleeding. When the presence of these two indications is equivocal, deciding on the mode of delivery becomes challenging, as uterine ru...

Background Poor wound healing may limit body functionality and is an indication for clinical intervention. Excessive formation of granulation tissue above the edge of the skin surrounding a wound without re-epithelization is termed exuberant granulation, or proud flesh. It is uncommonly reported as a complication of an episiotomy wound. Aim This s...

Background Burkitt’s lymphoma (BL) affecting the female genital tract is rare. Objective The aim of this paper is to report BL of the cervix in an HIV-positive patient to discuss the fatality of the condition and ways to mitigate it through advocacy for improved health care delivery in resource limited settings. Methods The patient was a 29-year-...

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Background: Chronic mental illnesses such as schizophrenia affect patients’ functioning, making caregiving necessary although burdensome. Aim: This study aimed to determine caregiver burden and its sociodemographic determinants in family caregivers of patients with schizophrenia attending a Psychiatric Outpatient Department (POD). Setting: Tertiary...

Poor quality of life and increased burden of diseases caused largely by socio-economic conditions are the bane of obstetric and gynecological services in many low resource settings (LRS). These unpleasant conditions make it difficult to adopt many popular clinical guidelines, as there are inadequate resources to ensure their implementation. This ca...

Objective: To determine the pregnancy outcomes of women who had 2017 American College of Cardiologists stage 1 hypertension during the first prenatal clinic visit before 20 gestational weeks in a tertiary hospital in South Africa. Study design: A retrospective cohort study involving the review of medical records of 127 participants with stage 1 hyp...

Preeclampsia (PE) is a complex heterogeneous disorder with overlapping clinical phenotypes that complicate diagnosis and management. Although several pathophysiological mechanisms have been proposed, placental dysfunction due to inadequate remodelling of uterine spiral arteries leading to mal-perfusion and syncytiotrophoblast stress is recognized a...

Early recognition and treatment of surgical site infection (SSI) may prevent devastating consequences of wound infections complicating caesarean delivery (CD). SSI complicates 3–15% of CDs; among the severe forms are necrotising fasciitis (NF) and clostridial gas gangrene, with the latter being the most rapidly spreading and fatal. The aim of this...

https://doi.org/10.1016/j.crwh.2023.e00567

Background Teaching philosophy defines the beliefs and ideas that guide practices in teaching and learning. Writing teaching philosophy statements for promotion or employment is daunting for inexperienced new faculty members. Aim This article aims to discuss the principles of relevant educational domains that academics need to know to be well info...

Background Several schoolgirls attain reproductive age with undiagnosed gynaecological problems which pose challenges in their livelihood. These conditions include precocious puberty, congenital reproductive tract abnormalities, and delayed sexual development. Many children with these conditions face additional challenges including physical pain, p...

Obesity is a major determinant of health outcomes and is on the increase in women world-wide. It predisposes to surgical site infection (SSI). Risk factors for the SSI include extremes of age, smoking, comorbidities such as hypertension and diabetes, inappropriate vertical abdominal and or uterine wall incisions, increased operating time, subcutane...

Racial disparities exist in the prevalence of preeclampsia (PE), with women of African ancestry suffering the highest rates of morbidity and mortality. Genetic changes may play a role in the preponderance of PE among women of African ancestry. This review discusses 30 genes with variants that have been studied in PE in women of African ancestry. Th...

In low- and middle-income countries, urban and rural settings are distinct communities with the latter being more likely to have limited resources, particularly in health care services. We assessed the inequality in health care services in urban and rural settings in South Africa, highlighting the disparities between public and private health servi...

An obstetric rectal buttonhole tear (ORBT) is a rare obstetric complication with only 21 cases reported in the literature. The choice of two- or three-layer repair of ORBT is controversial. In this case, the author describes (with high-quality images) an ORBT repaired in three layers in order to provide clinical lessons to healthcare professionals...

Background Preeclampsia is currently defined as new-onset hypertension occurring with significant proteinuria, maternal organ dysfunction, and/or placental insufficiency at or after 20 weeks of gestation. In the majority of cases, it occurs before 48 h postpartum. Therefore, preeclampsia occurring before 20 weeks of gestation or after 48 h postpart...

Background: The proximity of the uterus and the cervix to the urinary tract predisposes the latter to injury during obstetrical and gynaecological surgical procedures. Following a difficult surgical procedure on the lower uterine segment and or adnexa, urinary tract injury should be excluded. Methods: A booked 39-year-old G3P2 lady who suffered...

Cardiac disease is one of the commonest causes of indirect maternal deaths globally. This brief report is a reminder that isolated maternal tachycardia at rest is a clinical alert and warrants a detailed history in relation to cardiac disorders, thorough clinical examination of all organ systems, relevant investigations such as imaging, and expert...

This case report is on cervical spindle cell neoplasm and complications of its excision. A 34-year-old multiparous woman presented with a one-year history of mild to moderate non-radiating lower abdominal pain and a sensation of a mass in the vagina when urinating. These symptoms were associated with a recurrent foul-smelling yellow vaginal dischar...

Background: The risk of uterine perforation during manual vacuum aspiration (MVA) is reduced by using Karman cannula (which has a rounded tip) during the procedure. Methods: A 35-year-old multigravida at 13 gestational weeks presented with vaginal bleeding of a day duration and ultrasound evidence of retained products of conception suggestive of...

Assigning a primary cause of death to a deceased patient who had multiple principal diagnoses including coronavirus disease 2019 (COVID-19) is challenging because of the difficulty in selecting the most appropriate cause. To proffer a solution, the authors reviewed the literature on assigning a primary cause of death. In 2015, the Nnabuike-Jagidesa...

Background We report on childbirth trauma resulting in a rare stretching and prolapsing of the anterior lip of the cervix beyond the vaginal introitus, and describe the management. Case Presentation A 17-year-old primigravida who had normal antenatal care delivered a live normal male baby weighing 3600 g at 39 weeks of gestation. The patient susta...

Background: Hypertension is a major cause of morbidity and mortality and its control has important clinical and socio-economic benefits to the family and community. Unfortunately, the extent of blood pressure (BP) control and its potential predictors in hypertensive patients in many rural communities in low-resource settings are largely unknown. T...

Pre-eclampsia complicated by pulmonary oedema, severe hypertension, tachycardia and desaturation is a devastating condition. A comprehensive understanding of the aetiopathogenesis during such an emergency is challenging in the absence of functional and responsive point-of-care imaging, and laboratory and other critical-care services. An unbooked 26...

Objective To determine if any of maternal pre‐delivery soluble fms‐like tyrosine kinase‐1 (sFlt‐1), placental growth factor (PIGF), or sFlt‐1/PIGF ratio correlate with either perceived stress scale (PSS) or verbal numeric rating scale (VNRS) pain scores. Methods Among 50 pregnant women with severe pre‐eclampsia and 90 normotensive pregnant women o...

Objective To describe risk factors and outcomes of pregnant women infected with SARS‐CoV‐2 admitted to South African healthcare facilities. Methods A population‐based cohort study was conducted utilizing an amended International Obstetric Surveillance System protocol. Data on pregnant women with SARS‐CoV‐2 infection, hospitalized between April 14,...

Due to the disparity in resource availability between low- and high-resource settings, practice recommendations relevant to high-income countries are not always relevant, and often need to be adapted to low-resource settings. The adaptation applies to induction of labour (IOL) which is an obstetric procedure that deserves special attention because...

https://doi.org/10.1016/j.crwh.2021.e00314

In view of the continuing worldwide spread of COVID-19 infection, the increased morbidity and mortality from the disease during pregnancy, and the current efficacy and safety of vaccines in non-pregnant individuals, vaccines should not be withheld from women simply because of pregnancy or lactation. All pregnant women, especially healthcare profess...

Transient gestation hypertension is a contributor to adverse pregnancy outcomes particularly when it progresses to pre-eclampsia (PE). This requires frequent monitoring. We illustrate the need for stringent monitoring of gestational hypertension, transient gestational hypertension (TGH) and PE without severe features and conducted a brief rapid rev...

Background: It is uncommon to find ampullary tubal pregnancy in the second trimester. Methods: A 35-year-old G4P3 at 16 gestational weeks presented with a day history of sudden severe lower abdominal pain and no vaginal bleeding. The patient had a normal pulse of 82/minutes, haemoglobin concentration of 6.3 g/dl and ultrasonography showed an emp...

Obstetric emergencies refer to clinical conditions that require immediate interventions to prevent mortality or morbidity to a mother and or her baby. Easy access to an appropriate healthcare facility, problem recognition and provision of the best possible standard of care is the sine qua non to 'successful' management. The bane of success is usual...

Background: Induction of labour (IOL) is an obstetric procedure that should be conducted in a healthcare facility with the capacity to provide optimal care based on the patient risk status. Inadequate monitoring, untimely procedure and lack of readily available and experienced medical staff to participate in the care of the patient undergoing indu...

Introduction: there is variance in both the types and combinations of antihypertensive drugs used for managing pre-eclampsia in the postpartum period. Knowledge of the most common and suitable single or combination antihypertensive drug therapies in the postpartum period will minimize harmful effects, promote adherence to medications, overcome any...

Labor induction in low‐resource settings has challenges that may be resolved by using a 20‐point toolkit.

In South Africa, large numbers of individuals with medical emergencies initially visit a general practitioner or family physician. In the case of maternity care, this may occasionally involve acute onset of severe hypertension during the antenatal period. Primary care providers (PCPs) are therefore faced with the conundrum of treating and stabilisi...

Background: Eclampsia remains a major cause of maternal mortality, particularly in teenage pregnancies. Healthcare professionals providing antenatal must regard teenagers as a high risk group for the pre-eclampsia-eclampsia syndrome. Setting: Data extracted from the South African Saving Mothers Report: 2014–2016. Aim: To establish the clinical de...

Background Prenatal ultrasonography for the detection of fetal structural anomaly is an important component of antenatal care. During the assessment, proximal limb deformities are readily diagnosed. Distal limb, especially digit, abnormalities, however, may be difficult to detect, particularly if the ultrasonography is performed in the third trimes...

The placenta accreta spectrum (PAS) describes invasion and adherence of the placenta onto or beyond the myometrium. Prenatal imaging improves management outcomes. In low- and middle-income countries (LMIC), however, the unavailability of ultrasonography in some health facilities delays the diagnosis, particularly if the prenatal period is asymptoma...

Pregnancy is associated with complications ranging from minor ailments to major morbidity and mortality. To prevent such complications, some women, including some in South Africa, resort to the use of traditional medicines. These are meant to either supplement or replace conventional medicines that are offered by their healthcare facilities. Some o...

Background The imbalance between circulating concentrations of anti- and pro-angiogenic factors is usually intense in preeclampsia with severe features (sPE). It is possible that pre-delivery circulating levels of angiogenic factors in sPE may be associated with postpartum antihypertensive drug requirements. Objective To determine the predictive a...

Statistically significant difference in the pre-delivery serum concentration of angiogenic factors between normotensive pregnancy and preeclampsia with severe features. (DOCX)

The 2015 STARD (Standards for Reporting of Diagnostic Accuracy) 30-item checklist. (DOCX)

Antenatal or prenatal care is a well-intentioned health-care programme for utilization by all pregnant women to improve the outcomes of their pregnancies. Unfortunately, a number of factors militate against the programme and occasionally lead to incomplete utilization of the services, and sometimes result in blatant refusal of care. This editorial...

Objective: To determine blood pressure (BP) patterns in the immediate postpartum period in preeclampsia with severe features (sPE) and normotensive pregnant women who had cesarean deliveries (CD). Study design: The BP levels of two groups comprising 50 sPE and 90 normotensive pregnant women who had CD were measured before delivery and on days 0–3 p...

Measurement of blood pressure is essential for clinical management of patients. To obtain an accurate blood pressure reading, the use of a validated device and an appropriate technique are required. This is of particular importance in pregnancy where the physiological changes affect vessel wall compliance. Moreover, currently it is difficult to pre...

Hypertension, including chronic hypertension and gestational hypertension, is the most common medical complication in pregnancy. Chronic hypertension is associated with up to 5% of all pregnancies and accounts for a significant number of adverse complications, such as superimposed pre-eclampsia, abruptio placentae, iatrogenic preterm labour, stillb...

Spontaneous rupture of liver haematoma is a complication of pre-eclampsia (PE) that results in maternal mortality, particularly in the absence of an early diagnosis and appropriate interventions. The aim was to describe cases of maternal deaths due to spontaneous rupture of liver haematoma associated with PE to raise awareness of clinical features...

Objective The baseline blood pressure (BP) readings of an automated device that have not been validated in pregnancy require comparison with those from a reference standard before the device is utilized in pregnancy. We aimed to perform a baseline check of BP readings of an automated device, Mindray iMEC12 patient monitor, in severe pre-eclampsia a...

The cause of pre-eclampsia is unknown. Different postulates have been developed to explain its pathogenesis. The two-stage theory and angiogenic imbalance are two notable postulates of the disease. Together, they propose that there is a lack of cytotrophoblastic invasion of the uterine spiral arteries in pre-eclampsia. The lumen of these arteries r...

Purpose: Pregnancy causes physiological changes in maternal organ systems, and blood pressure (BP) is one of the variables affected. This review is focusing on the physiology of BP relevant to the management of hypertension in pregnancy. Materials and methods: A detailed literature search was performed using electronic databases (including WorldCat...

Available at: http://ihpublishing.co.za/obstetric-gynaecology-forum/#1480416497920-391146a3-942b Abstract A significant number of individuals present to public health facilities in South Africa requesting HIV post-exposure antiretroviral prophylaxis (PEP) after consensual intercourse. Unfortunately, there is no comprehensive guideline in many of t...

Background. Identification and prevention of any avoidable factor (AVF) associated with pregnancy may reduce critical illnesses and the need for intensive care unit (ICU) admission. Objectives. To determine AVFs that occurred prior to the admission of pregnant and postpartum patients to two ICUs in South Africa (SA) and the resulting maternal outco...

Women with persistent vomiting during pregnancy need early referral to appropriate health facilities. Delayed referral and inappropriate management may lead to metabolic encephalopathy from a variety of causes, including electrolyte derangements or thiamine deficiency (Wernicke’s encephalopathy) (WE). We present a case of persistent vomiting in pre...

Severe hypertension is a major cause of morbidity and mortality. The South African Saving Mothers report (2011 - 2013) indicates that cerebral injury due to severe hypertension is resulting in avoidable maternal deaths. This demands that management of severe hypertension in pregnancy needs to be improved. A rapid-acting antihypertensive is recommen...

The use of an inappropriate device and or technique for blood pressure (BP) measurement in pregnancy results in inaccurate BP readings. Under or over-estimation of the BP will influence clinical decisions and compromise patient safety. Additionally, severe hypertension in pregnancy may be detected during a BP measurement. In such situations, increm...

In South Africa, new drug regimens (WHO treatment Option B) used to manage HIV infection in pregnancy and the national strategic plan on HIV have resulted in improved health outcomes. Among these outcomes are reductions in the following: mother-to-child transmission (MTCT) of HIV to 2.4%;maternal deaths attributable to HIV; and adverse reactions du...

The most appropriate primary cause of death in a patient who had multiple medical conditions is that medical condition which initiated the chain of events that led to the other medical conditions that resulted in death. In clinical practice, there are deceased patients who had several medical conditions that could lead to death (primary causes of d...

Ruptured subcapsular hematoma of the liver (RSHL) can mimic ruptured interstitial pregnancy because each of these conditions occasionally presents at the same gestational period and both do manifest hemodynamic instability. The similarities between the two conditions pose a diagnostic challenge, especially in an unbooked patient. We report a case o...

The use of currently available guidelines such as the International Classification of Diseases, 10th Revision (ICD-10) and its clinical modification to assign a principal diagnosis to a patient who has multiple principal diagnoses appears unreliable. This is because these guidelines are complex and uses criteria that are highly subjective. Even whe...

Acute uterine inversion (AUI) is a rare obstetric emergency. Manual removal of placenta in such circumstances often leads to massive postpartum haemorrhage (PPH) if the procedure is performed before correction of the inversion. In the case reported, a 20 year old G3, P1+1 at term, had a spontaneous vaginal delivery in a district hospital. During th...

The incidences of hepatic masses and colon cancer in pregnancy are low. The clinical features of each can mimic those of pregnancy, thereby posing a diagnostic challenge to clinicians, particularly when the clinical scenario is complicated by HIV infection. This report illustrates such diagnostic difficulties, and the need to offer diagnostic colon...

Needlestick injury (NSI) is commonly reported among healthcare workers, but is not well documented in patients. We report a case of an NSI in an HIV-negative, gestational hypertensive patient admitted to a hospital for induction of labour at term. Owing to an insufficient number of hospital beds, patients were seated in an overcrowded corridor of t...

We present a case of spontaneous antepartum uterine rupture through a previous lower segment Caesarean section (LSCS) scar with clinical features mimicking an advanced extrauterine pregnancy (AEUP) in a twin pregnancy at 28 weeks gestation. This report illustrates the need to consider a diagnosis of a ruptured uterus in any patient with a previous...

Background: Outcomes of HIV-positive pregnant patients admitted to intensive care units (ICUs) are controversial. Objective: To determine maternal and fetal outcomes of HIV-positive patients admitted to ICUs. Methods: Pregnant patients admitted to ICUs were enrolled in the study. On admission, they were classified as having low (<50%) or high...

The authors of the commentary entitled: "Important surgical measures and techniques at cesarean hysterectomy for placenta previa accreta" (1) are to be commended for describing their departmental protocol on this important procedure. However, step 5 concerning the withholding of uterotonics is debateable. Uterotonics cause contractions which allow...

Termination of pregnancy (TOP) is requested by some women for a variety of reasons and it is plausible that profiling their characteristics might help to target selected groups for counselling. This study aimed to determine the characteristics of women having a legal first-trimester TOP at a regional hospital in KwaZulu-Natal. The medical records...