Research Articles (Obstetrics and Gynaecology)
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Item Suction tube uterine tamponade versus uterine balloon tamponade for treatment of refractory postpartum hemorrhage : a randomized clinical feasibility trial(Wiley, 2025-07) Singata-Madliki, Mandisa; Nieto-Calvache, Albaro J.; Rivera Torres, Luisa F.; Abdul, Hazmath; Batting, Joanne; Cebekhulu, Sylvia N.; Chauke, Lawrence; Soma-Pillay, Priya; Fawcus, Susan; Govender, Logie; Majeke, Busiwe; Mbongozi, Xolani; Middleton, Katrin; Naidoo, Poovangela; Ndaba, Sanele; Spence, Trevi; Balie, Gaynor M.; Monroy, Angelica; Cantor, Monica; Hofmeyr, G. JustusOBJECTIVE : To compare low-cost “Suction Tube Uterine Tamponade” (STUT) treatment for refractory postpartum hemorrhage (PPH) with uterine balloon tamponade (UBT) using a randomized feasibility study. METHODS : After verbal assent, we allocated participants with refractory PPH by randomly ordered envelopes to STUT or routine UBT at 10 hospitals in South Africa and one tertiary referral center in Colombia between January 10, 2020, and May 3, 2024. In the STUT group, we inserted a 24 FG Levin stomach tube into the uterine cavity and applied suction. The control group received standard UBT, mainly the Elavi free-flow balloon or the Bakri fixed volume balloon. There were fundamental differences between the South African and the Colombian sites, so the pre-specified analysis combined data from the two countries by meta-analysis. RESULTS : We enrolled 59 participants. The rate of the primary outcome (blood loss >1000 mL or laparotomy or death) was 8/27 (30%) in the STUT group versus 14/27 (52%) in the UBT group (risk ratio [RR] 0.56, 95% confidence interval [CI] 0.30–1.05, P = 0.07). Per protocol analysis was 7/26 (27%) versus 15/28 (54%) (RR 0.49, 95% CI 0.25–0.96, P = 0.04). Reporting severe pain during the procedures was less frequent in the STUT group (RR 0.46, 95% CI 0.25–0.86, P = 0.01). Most secondary outcomes favored the STUT group, with low certainty. CONCLUSIONS : STUT was experienced as less painful than UBT. Results were consistent with reported observational findings and one other randomized trial evidence of greater effectiveness for suction than balloon tamponade.Item Pregnancy after cancer : FIGO Best practice advice(Wiley, 2025-06) Maxwell, Cynthia; Adam, Sumaiya; Bergman, Lina; Nanda, Surabhi; Guinto, Valerie Tiempo; Popovits-Hadari, Noa; Al-Bakri, Maisah; Nwokoro, Ifeyinwa; McAuliffe, Fionnuala; Peters, Inge; Nelson-Piercy, Catherine; Amant, Frederic; Nana, Melanie; Smith, Graeme; Berek, Jonathan; McNally, Orla; Nguyen-Hoang, Long; Medina-Palmezano, Virna P.; O'Reilly, Sharleen; Ruiloba, Francisco; O'Brien, Pat; Jacobsson, Bo; Wilailak, Sarikapan; Poon, Liona C.Advances in cancer care have led to a growing number of cancer survivors globally. As cancer increasingly affects women and people of reproductive age, more individuals will be experiencing pregnancy after completing cancer treatment. This Best Practice Advice manuscript describes the epidemiology of pregnancy after cancer, recommended clinical evaluation before pregnancy, key components of pregnancy care for cancer survivors, considerations for delivery planning and postpartum care, and suggested steps for future health and prevention.Item Informed consent and ethical issues pertaining to female sterilization-scoping review(Wiley, 2025-06) Maila, Sharol Malekobane; Castelyn, Camille De Villebois; Adam, Sumaiya; sumaiya.adam@up.ac.zaBACKGROUND : Female sterilization, a safe, permanent method of contraception that blocks the fallopian tubes, has been in use since the 19th century. The procedure necessitates informed consent, a critical step that has been marred by reports of forced sterilization since World War II. These incidents often stem from inadequate consent processes where ethical principles are overlooked or deliberately flouted. The persistent issue of forced sterilization, primarily attributable to a flawed informed consent process, highlights significant ethical concerns. OBJECTIVES : This scoping review aimed to identify the ethical challenges associated with the informed consent process for female sterilization, including instances of forced sterilization. SEARCH STRATEGY : The review employed a comprehensive electronic search across multiple databases, including PubMed, Scopus, Web of Science, Google Scholar, and ProQuest Central, targeting literature published in English between January 2000 and December 2021. The search strategy utilized key terms related to informed consent, ethical issues, and female sterilization, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) methodology for database search and screening. SELECTION CRITERIA : The search resulted in the inclusion of 55 published articles for this review. Studies were selected if they focused on informed consent for female sterilization and reported on forced or coerced sterilization involving mentally competent women aged 18 years and older. Exclusions were made for studies on women younger than 18 years, those related to emergency procedures, and non–English language publications. DATA COLLECTION AND ANALYSIS : A two-stage screening process was used to assess the relevance of the identified studies, with independent reviewers evaluating titles, abstracts, and full texts. Data were extracted using a predefined tool, and discrepancies were resolved through discussion. The analysis focused on summarizing the ethical issues identified and recommendations for improving the consent process. MAIN RESULTS : The review identified vulnerable populations, particularly women reliant on the state or government for health care, as being at higher risk of forced sterilization. Cases of sterilization without consent, under coercion, sedation, or through inducements/incentives have been reported. Recommendations from international obstetrics and gynecology societies, health organizations, human rights bodies, and local governments have been issued in an attempt to improve the consent process. Notably, the United States implemented a Medicaid consent form in the 1970s, which has yet to be revised, attracting significant criticism for some of its components. Meanwhile, low- and middle-income countries lack standardized tools to address complaints related to this issue. CONCLUSION : This review identifies persistent ethical challenges in the informed consent process for female sterilization globally, with forced sterilization disproportionately affecting vulnerable populations. The review underscores the urgent need for the development and implementation of standardized consent tools, with ongoing review, to protect women's autonomy and prevent unethical practices, especially in low- and middle-income countries.Item Improved cervical screening using HPV type restriction and cycle threshold limit setting with the AmpFire assay : a prospective screening cohort of women with and without HIV in Botswana(Wiley, 2025-08) Luckett, Rebecca; Ramogola-Masire, Doreen; Moyo, Sikhulile; Gompers, Annika; Modest, Anna; Moraka, Natasha; Kashamba, Thanolo; Tawe, Leabaneng; Noubary, Farzad; Kuhn, Louise; Grover, Surbhi; Dryden-Peterson, Scott; Dreyer, Greta; Makhema, Joseph; Botha, Matthys H.; Hacker, Michele R.; Shapiro, RogerOBJECTIVE : The aim of this study was to evaluate the performance of HPV type restriction and cycle threshold (Ct)-limit setting to optimize detection of cervical intraepithelial neoplasia (CIN) with primary HPV testing. METHODS : Baseline cervical screening at time of entry into a prospective longitudinal cohort of women with and without HIV was conducted from February 2021 to July 2022 in Botswana. All women underwent HPV testing of 15 individual types using the AmpFire assay; all HPV-positive and a random subset of HPV negative had histopathology collected. Performance parameters of HPV type restriction groupings were calculated, and sensitivity by individual HPV type Ct-value limits were plotted. RESULTS : Among 2964 women who underwent primary HPV screening, 1293 (43.6%) tested HPV-positive. Among women with HIV (WWH), HPV types 16/18/33 were associated with the greatest burden of CIN2+/CIN3+ (53%/56%). In WWH, grouping by HPV types separately reported in commercial assays (16/18/45) had low sensitivity (44% [CI: 36%–52%]) but high specificity (86% [CI: 84%–88%]) for CIN2+; 8-type HPV restriction (16/18/31/33/35/45/52/58) improved sensitivity (79% [CI: 72%–86%]) and maintained reasonable specificity (67% [CI: 65%–70%]) for CIN2+. Similar results were seen in women without HIV. Ct-limit setting for medium oncogenic HPV types (31,33,35,52,58) maintained a sensitivity of 72% in WWH while reducing over-detection of non-pathogenic HPV. CONCLUSION : Eight-type HPV restriction and Ct-limit setting are promising strategies for improving the performance of primary HPV screening. A potential strategy to improve 8-type HPV restriction would be to treat all with HPV 16/18/45; treat HPV 31/33/35/52/58 if below the type-specific Ct limit and repeat HPV testing in 1-year for other positive HPV results.Item FIGO guideline on liver disease and pregnancy(Wiley, 2025-07) Nana, Melanie; Medina, Virna; Maxwell, Cynthia; McCormick, Ciara; Taliani, Gloria; Beuers, Ulrich; Money, Deborah; Jacobsson, Bo; Kapur, Anil; Beyuo, Titus; Ruiloba, Francisco; Smith, Graeme; Bergman, Lina; O'Reilly, Sharleen; O'Brien, Patrick; Hanson, Mark; Rosser, Mary; Sosa, Claudio; Adam, Sumaiya; Guinto, Valerie; Poon, Liona; McAuliffe, Fionnuala; Williamson, Catherine; FIGO Committee Impact pregnancy Long term Health; FIGO Committee Infections Pregnancy; FIGO Division Maternal Newborn HealthThe number of women entering pregnancy with chronic liver disease is rising. Gestational liver disorders affect 3% of the pregnant population. Both can be associated with significant maternal and fetal morbidity and mortality. European guidance has recently been published to inform management. This FIGO (the International Federation of Gynecology & Obstetrics) guideline aims to use the latest evidence to inform practice relevant to a global population. The immediate past and present chairs of FIGO's Committee on the Impact of Pregnancy on Long-term Health invited the Chair of the European guideline, alongside two trainees with an interest in liver disorders in pregnancy, to develop a guideline relevant to a global audience, thus serving the real-world population and fulfilling FIGO's ambition to enhance their global voice for women's health. Experts in the field with experience in managing liver disorders in pregnancy from a diverse selection of continents helped to develop a guideline. The guideline includes the most common pre-existing and gestational liver disorders. Evidence-based best practice recommendations are summarized in addition to pragmatic recommendations. Printable tables/figures are included in the guideline for ease of use. These include a table of normal ranges of commonly used blood tests, a table outlining safety of investigations, and a table of delivery considerations relevant to a global audience. Figures designed to summarize each section of the guideline and the multidisciplinary approach to managing liver disorders in pregnancy are also included. This guideline incorporates guidance for a global audience aimed at improving the management of women with pre-existing and new liver disease in pregnancy.Item Cancer in pregnancy : FIGO best practice advice and narrative review(Wiley, 2025-10) Nanda, Surabhi; Nana, Melanie; Nguyen-Hoang, Long; Adam, Sumaiya; McAuliffe, Fionnuala; Bergman, Lina; Wilailak, Sarikapan; McNally, Orla; Maxwell, Cynthia V.; Purandare, Nikhil; Jacobsson, Bo; Medina, Virna P.; Kapur, Anil; Beyuo, Titus; Ruiloba, Francisco; Castelazo, Ernesto; Smith, Graeme N.; O'Reilly, Sharleen L.; O'Brien, Patrick; Hanson, Mark; Rosser, Mary L.; Sosa, Claudio; Guinto, Valerie; Berek, Jonathan; Nelson-Piercy, Catherine; Amant, Frederic; Poon, LionaCancer during pregnancy is relatively rare. The incidence is underestimated due to the lack of international registries covering both high-income and low- and middle-income countries, and is expected to rise with increasing maternal age and increasing global adoption of cell-free DNA testing for aneuploidy. Physiological changes during pregnancy often make the diagnosis challenging and delayed. Lack of experience and knowledge about this condition may also contribute to late diagnosis, suboptimal management, and occasionally inadvertent fetal and/or maternal harm. The principles of cancer management in pregnancy for most cancer types do not differ significantly from the non-pregnant population. The impact of investigations for diagnosis and staging, risks of surgery, systemic chemotherapy, and/or radiotherapy on fetal well-being and preterm birth need to be considered for treatment and management planning, in addition to maternal wishes. Working in a multidisciplinary setting, ideally with medical and radiation oncologists, surgeons, radiologists, cancer specialist nurses, geneticists, psychologists, teratologists, and clinical pharmacologists, obstetricians, obstetric physicians, neonatologists, and experienced nursing and midwifery staff helps provide optimal care for the woman. This best practice advice aims to provide recommendations on the diagnosis and management of cancer in pregnancy, which can be adopted in all resource settings.Item Large adnexal tumour in a young woman presenting with cardiac-related signs and symptoms(In House Publications, 2025-08) Matlou, Thapelo; Snyman, Leon Cornelius; Bothma, Salome; leon.snyman@up.ac.zaAdnexal tumours constitute a wide range of conditions that are frequently faced in gynecological practice, and this include benign cysts, as well as malignant tumours. Although the majority of ovarian tumours are asymptomatic or have localized symptoms, very large adnexal tumours may have systemic effects because of their size and location. This report describes a rare case of a young woman with a very large adnexal tumour presenting with predominantly cardiovascular-related symptoms. A 21 year old nulligravid woman presented to our emergency department with progressive history abdominal distension, swelling of the lower limbs, and cardiorespiratory distress due to an adnexal tumour noted intra op to be measuring 30 x 40 cm. Initial investigations revealed a tumour originating from the pelvis extending to the epigastrium. Further investigations revealed cardiovascular compromise tumour with an ejection fraction of 43% on echocardiogram. A multidisciplinary team consisting of gynaecological oncologists, physicians and anaesthetists were involved in the management of the patient. Fertility sparing surgery was performed and serial echocardiograms post-operatively showed improvement in the patient’s cardiovascular status.Item Artificial intelligence applications in obstetrics and gynaecology(In House Publications, 2025-08) Abdool, Zeelha; Snyman, Leon CorneliusThe idea of artificial intelligence (AI) initially stemmed from philosophical ideas based on ‘thinking machines that mimic human intelligence.’ The term was first coined in 1956, and Warren McCulloch, a neurophysiologist and cybernetician, is credited as the founder of AI. He was the first to propose artificial neural networks in 1944, which is a model based on the structure and function of the human brain.Item Regional adiposity and insulin sensitivity-interactions with menopause and HIV in middle-aged black African women(Oxford University Press, 2025-01) Masemola, Maphoko; Mendham, Amy E.; Micklesfield, Lisa K.; Pheiffer, Carmen; Hawley, James; Kengne, Andre Pascal; Chikowore, Tinashe; Kufe, Clement Nyuyki; Crowther, Nigel J.; Norris, Shane; Storbeck, Karl-Heinz; Olsson, Tommy; Karpe, Fredrik; Goedecke, Julia H.OBJECTIVE : To explore depot-specific functional aspects of adipose tissue, examining the putative role for menopause and HIV status on insulin sensitivity (SI) and beta-cell function in Black South African women. METHODS : Women (n = 92) from the Middle-Aged Soweto Cohort, including premenopausal HIV-negative women (n = 21); premenopausal women living with HIV (LWH; n = 11); postmenopausal HIV-negative women (n = 42); and postmenopausal women LWH (n = 18) underwent the following tests: body composition (dual-energy x-ray absorptiometry); fasting bloods for sex hormones, inflammation, and adipokines; frequently sampled intravenous glucose tolerance test for SI and beta-cell function (disposition index, DI); abdominal (aSAT) and gluteal subcutaneous adipose tissue (gSAT) biopsies for cell size, and mRNA expression of adipokines, inflammation, and estrogen receptors (ER). RESULTS : Depot-specific associations between gene expression and insulin parameters did not differ by HIV or menopause status. Pooled analysis showed significant models for SI (P = .002) and DI (P = .003). Higher SI was associated with lower leptin and CD11c expression in aSAT and higher adiponectin in gSAT. Higher DI was associated with higher aSAT and gSAT expression of adiponectin, lipoprotein lipase, ERα, and PPARγ, and lower leptin in aSAT. Women LWH had higher expression of adiponectin and lower expression of leptin in both aSAT (P = .002 and P = .005) and gSAT (P = .004 and P = .002), respectively, and a larger proportion of smaller cells in aSAT (P < .001). CONCLUSION : Insulin sensitivity and beta-cell function were distinctively associated with aSAT and gSAT. While menopause did not influence these relationships, HIV had a significant effect on adipose tissue, characterized by variations in cell size distribution and transcript levels within the depots.Item Integrated profiling of adiponectin and cytokine signaling pathways in high-fat diet-induced MASLD reveals early markers of disease progression(Nature Research, 2025-06) Johnson, Rabia; Shabalala, Samukelisiwe; Mabasa, Lawrence; Kotze-Hoerstmann, Liske; Sangweni, Nonhlakanipho; Ramharack, Pritika; Sharma, Jyoti; Pheiffer, Carmen; Arowolo, Afolake; Sadie-Van Gijsen, HanelMetabolic dysfunction-associated steatotic liver disease (MASLD), which affects a significant portion of the global population, is linked to high-fat diets (HFD) and characterized by abnormal lipid accumulation and activation of inflammatory pathways in hepatocytes. The precise mechanisms underlying MASLD, especially the involvement of inflammatory cytokines in its pathophysiology, remain unclear. This study evaluated the changes and interactions of steatotic liver and inflammatory markers in an animal model of MASLD by feeding male Wistar rats a high-fat diet (HFD) for 17 weeks. After this period, the serum lipid profiles were assessed, along with liver enzymes, including aspartate aminotransferase (AST) and alanine aminotransferase (ALT). The changes in liver morphology and triglyceride levels were determined by histology and a colorimetric assay, respectively. Steatotic liver and inflammatory markers were measured using a RT2 ProfilerTMPCRArray and validated with quantitative real-time PCR (qRT-PCR). Histological evaluations indicated that HFD livers exhibited macrovesicular steatosis and lobular inflammation. The HFD-fed group had significantly higher hepatic triglyceride levels than the controls (383 ± 23 mg/dL vs. 100 ± 9 mg/dL) and elevated serum lipid levels (p < 0.0001), along with increased liver aminotransferase levels. Gene expression analysis showed decreased adiponectin signaling (AdipoR2, p < 0.001) and upregulated de novo lipogenesis (Srebf1, p < 0.05). Notably, pro-inflammatory cytokines (Cxcl10, Ccl2, Ilβ, p < 0.001; TNF-α, p < 0.01) were significantly elevated, correlating with reduced hepatic glucose transporter Glut2 expression (p < 0.05), as confirmed by STRING analysis. These findings demonstrate that HFD consumption alters key genes and pathways involved in adiponectin and insulin signalling, lipogenesis, and inflammatory responses, thereby contributing to the pathogenesis of MASLD. Additionally, it identifies a comprehensive chemokine expression profile, highlighting potential therapeutic targets for MASLD.Item Brief communication : targeted serum proteomics in postpartum South African women living with and without HIV, correlations with anthropometry and adiposity(BioMed Central, 2025-08) Madlala, Hlengiwe P.; Chen, Junyu; Jao, Jennifer; Myer, Landon; Mendham, Amy E.; Pheiffer, Carmen; Bell, Liam; Dugas, Lara R.; Goedecke, Julia H.; Sun, Yan V.; Bengtson, Angela M.Postpartum adiposity is associated with long-term risk of cardiovascular disease (CVD), which may be influenced by HIV infection. We investigated cross-sectional correlations between postpartum adiposity measures, and circulating proteins linked to CVD in women living with and without HIV. Irrespective of HIV status, adiposity was positively correlated with fatty acid binding protein 4, leptin and galectin 9; and negatively correlated with insulin-like growth factor binding protein 2 and V-set immunoglobulin domain containing 2. The link between adiposity and CVD-linked circulating proteins underscores the role of protein markers in understanding the cardiometabolic health of postpartum women living with and without HIV. Clinical trial number: Not applicable.Item International Urogynecology Consultation Chapter 3 Committee 1-pessary management(Springer, 2025-03) Rantell, Angie; Abdool, Zeelha; Fullerton, Morgan E.; Gedefaw, Abel; Lough, Kate; Miotla, Pawel; Mukhtarova, Narmin; Neumann, Patricia; Spencer, Jordan; Warner, Kristina J.; Brown, Heidi W.INTRODUCTION AN HYPOTHESIS : This manuscript is part of the International Urogynecological Consultation (IUC) on Pelvic Organ Prolapse (POP), Chapter 3, Committee 1 focusing on pessary management of POP. METHODS : A narrative review was conducted by an international, multi-disciplinary group of clinicians working in the field of pelvic health following a search of the literature using the MeSH terms “pelvic organ prolapse” OR “urogenital prolapse” OR “vaginal prolapse” OR “uterovaginal prolapse” AND “pessary” OR “support device” OR “intravaginal device.” Relevant studies, as determined after review using the Covidence manuscript review platform, were included. RESULTS : A total of 540 articles were reviewed, of which 313 were included for this narrative review. The reported pessary fitting success rate ranges from 41% to 96.6%, and the continuation of successful use rate varied from 21% to 97.7%. The most likely predictors of unsuccessful fitting trials were previous POP surgery, previous hysterectomy, short vaginal length, wide genital hiatus, and posterior compartment involvement. Following successful pessary placement in individuals with POP, vaginal bulge and pressure resolved in over 90%. A significant improvement in obstructive voiding was reported in 40–97% of participants, urinary urgency in 38%, urgency urinary incontinence in 29–77%, and stress urinary incontinence in 9–45%. Older age and women who can self-manage the pessary care or had family support were factors associated with pessary continuation. Common reasons reported for discontinuation included expulsion, vaginal pain/discomfort, unwillingness to continue, erosions, desire for surgery, bleeding, symptoms not improved with pessary, and incontinence. More serious complications (fistula, bowel obstruction, pessary impaction, and vaginal cancer) are rare, and occur usually in older women in whom pessary maintenance has been neglected. There is no high-quality evidence to guide pessary choice. The current literature lacks studies specifically focused on determining the role of preventative measures, i.e., estrogen, pessary type/material as regards to pessary-associated complications (PACs). The review identified a lack of information about the relevant and required training and education (for healthcare professionals and patients) for pessary provision, use, and management. CONCLUSIONS : There is a considerable body of published work on the use of pessaries for POP, including effectiveness, factors associated with success and failure, and complications. However, there is a dearth of published literature regarding how pessary types are selected by providers, how providers are trained, what defines competency in pessary provision, and what constitutes appropriate patient education related to pessary use and management.Item Fertility care in low- and middle income countries : public sector access to medically assisted reproduction in South Africa : a case study(Bioscientifica Ltd., 2025-07) Boshoff, Gerhardus Marthinus; Ombelet, Willem; Huyser, Carin; gerhard.boshoff@up.ac.zaIn South Africa, approximately 10% of the calculated need for medically assisted reproduction is being met due to limited access and unequal availability of these services. To facilitate understanding of challenges associated with access to assisted reproduction, a retrospective case study spanning 6 years was performed at one public sector hospital in South Africa offering these services. Demographic profiles, including income, region of residency and access to medical insurance, of patients seeking assistance to become pregnant were investigated. Patients were categorised as those who underwent diagnostic investigations only vs those who returned for therapeutic procedures, and the difference in demographic profiles between the two groups was determined. This investigation showed that patients from the lower-income classification group, without medical insurance, tend to return for therapeutic procedures less often than those with a higher income and medical insurance, even though these low-income patients qualify for a therapeutic procedure subsidy. An inverse relationship existed where patient numbers decreased as their travel distance increased, but patients who were required to travel further for assisted reproductive therapy tended to return for these procedures more often than patients who resided closer to the medical facility. In conclusion, access to medically assisted reproduction facilities is critically undersupplied and limited in the region. In order to ease the travel distance of patients, alternative primary diagnostic routes with accessible clinics are needed. In addition, costs of therapeutic procedures in the public sector should be re-evaluated to be offered at affordable rates for marginalised patients.Item What do women with epilepsy know about pregnancy?(AOSIS, 2024-08-16) Baloyi, Miyalani G.; Khalema, Rethabile; Adam, Sumaiya; sumaiya.adam@up.ac.zaBACKGROUND : Understanding the intersection of epilepsy and pregnancy, including knowledge gaps and healthcare access for women with epilepsy (WWE), is critical. This study evaluated WWE knowledge gaps and information needs concerning epilepsy’s impact on their sexual and reproductive health during pregnancy and examined healthcare system factors affecting their access to information, aiming to identify areas for improvement in educational and healthcare strategies to enhance health management for WWE. METHODS : From July 2022 to June 2023, 111 WWE aged 18 to 40 years were recruited from the family medicine and internal medicine outpatient departments at Steve Biko Academic Hospital, Tembisa Tertiary Hospital (TTH), and Kalafong Hospital. Interviews assessed various aspects related to epilepsy in pregnancy and contraceptive use. RESULTS : The study found strong links between WWE, their demographics, and their awareness of pregnancy-related epilepsy issues. Participants from TTH showed notably higher awareness (85.5%) of risks from epilepsy and AED during pregnancy (p < 0.05). Age and education significantly influenced pregnancy planning and understanding of medication risks. Younger women (20–25 years) were more inclined towards future pregnancies, and those with more education were better informed about medication risks (p < 0.05); and 68.5%had received counselling on AED and contraceptive interactions, yet only 16.2% knew AED could reduce contraceptive effectiveness. CONCLUSION : The study reveals significant knowledge gaps in WWE regarding the impact of epilepsy and AED on pregnancy, suggesting tailored educational and counselling initiatives to improve WWE health outcomes and quality of life, advancing chronic disease management and public health objectives. CONTRIBUTION : The study highlights substantial knowledge gaps in epilepsy during pregnancy among WWE, urging tailored counselling and information to empower informed decisions.Item Sociodemographics, behaviour and knowledge of first South African HPV-vaccine recipients(AOSIS, 2024-04-24) Adams, Robyn A.; Visser, Cathy; Dreyer, Greta; Snyman, Leon Cornelius; Van der Merwe, Frederick; Botha, Matthys H.BACKGROUND : Infection with the human papillomavirus (HPV) is a necessary cause of cervical cancer and is one of the most prevalent sexually transmitted infections worldwide. Primary prevention strategies target reducing HPV acquisition through vaccination, limiting exposure (e.g. delayed sexual debut, barrier contraception) and health education focusing on sexual behaviour and tobacco use. METHODS : The ImmunoVACCS study, conducted from 2019 to 2022 in two provinces in South Africa, examined sociodemographic characteristics, sexual practices, and knowledge of cervical cancer and the HPV vaccine among young female vaccine recipients. It encompassed participants from the previously conducted vaccine implementation trials, VACCS 1 and VACCS 2 (2011–2014). Recruitment involved telephonic contact with eligible potential participants. Data were collected through self-administered questionnaires. RESULTS : One hundred and eleven participants took part in the current study (median age: 20years; age range: 16–22 years). Most sexually active participants had their first engagement in secondary school (96.2%), and 77.2% used contraception during their last sexual activity. Knowledge gaps were evident, with only 13.5% recognising cervical cancer’s cervix origin and 3.6% attributing it to a virus. Despite this, 70.3% had heard of a vaccine for cervical cancer. Less than half knew about the importance of regular Pap smears (49.5%), vaccine protection (44.1%) or condom use (20.7%) against HPV and cervical cancer. CONCLUSION : The current study demonstrates that young women still lack complete information on cervical cancer and its risk factors even after receiving health education linked with vaccination. CONTRIBUTION : This study underscores the necessity of ongoing education about HPV, its risks and preventive measures among young women to combat cervical cancer.Item Diagnosis of female genital schistosomiasis and other genital infections in young South African women : challenges in the syndromic approach(Frontiers Media, 2024-04-09) Søfteland, Solrun; Sebitloane, Motshedisi; Galappaththi-Arachchige, Hashini Nilushika; Kleppa, Elisabeth; Holmen, Sigve; Pillay, Pavitra; Ndhlovu, Patrica Doris; Taylor, Myra; Vennervald, Birgitte Jyding; Naidoo, Saloshni; Staff, Anne Cathrine; Makua, Manala; Gundersen, Svein Gunnar; Kjetland, Eyrun FloereckeINTRODUCTION : Female genital schistosomiasis is a common but neglected disease, which results in symptoms similar to sexually transmitted infections in Schistosoma haematobium-endemic areas of Africa and Middle East. In primary healthcare of low-income countries, healthcare professionals use syndromic management protocols for guidance when treating symptoms of genital infection, due to lack of laboratory resources. These protocols do not include treatment for female genital schistosomiasis, despite the overlap of symptoms. Women are at risk of not receiving the appropriate treatment. The aim of this study was to investigate challenges and missed opportunities when using syndromic management protocols for sexually transmitted infections in female genital schistosomiasis-endemic areas. METHODS : This is a secondary analysis of data from a large cross-sectional prevalence study conducted in 2011 in KwaZulu-Natal, South Africa. Young women in schistosomiasis-endemic areas were asked about genital symptoms and underwent laboratory testing and gynecological examinations to look for common genital infections including female genital schistosomiasis. We used the current South African syndromic management protocols as the basis and analyzed the associations between the reported genital symptoms and the differential diagnoses with logistic regression. RESULTS : By use of the syndromic approach the conditions gonorrhea, trichomoniasis and herpes could be identified. The symptom “lower abdominal pain” was significantly associated with documented female genital schistosomiasis. However, the same association was not found with gonorrhea or chlamydia. We found no significant association between reported vaginal discharge syndrome and female genital schistosomiasis or between genital ulcer syndrome and female genital schistosomiasis. DISCUSSION : Female genital schistosomiasis frequently co-exists with, and mimics other genital infections in rural areas of Sub-Saharan Africa. The management protocols in schistosomiasis endemic countries should include advice on how to diagnose and manage this chronic, waterborne genital condition. There is an urgent need to upscale laboratory and diagnostic resources in low-and middle-income countries and specifically schistosomiasis-endemic areas, to diagnose these common genital infections more accurately and to treat affected women accordingly.Item Resilience in the time of crisis : a review of the maternal, perinatal and reproductive health effects of COVID-19 in South Africa(South African Medical Association, 2024-05) Fawcus, S.; Gebhardt, S.; Niit, R.; Pattinson, Robert CliveBACKGROUND : The COVID-19 pandemic had a profound effect on the health sector globally and in South Africa (SA). OBJECTIVE : To review the effects of COVID-19 on maternal, perinatal and reproductive health outcomes and service utilisation in SA. METHODS : Three routine national data collection systems were sourced: the District Health Information System, the Saving Mothers reports of the National Committee on Confidential Enquiry into Maternal Deaths and the Saving Babies reports from the National Perinatal Morbidity and Mortality Committee using data from the Perinatal Problem Identification Program. RESULTS : There were 35% and 8% increases in maternal and stillbirth mortality rates, respectively, in 2020 and 2021, which correlated with the COVID-19 waves. However, in 2022, rates returned to pre-COVID levels. Antenatal visits and facility births showed little change, but there was a shift to more rural provinces. The use of oral and injectable contraceptives and termination of pregnancy services decreased markedly in 2020 and 2021, with a sustained shift to long-acting reversible contraceptives. The increase in maternal deaths was predominantly due to COVID-19 respiratory complications, but also an increase in obstetric haemorrhage. Stillbirths increased significantly (10%) for birthweights between 2 000 g and 2 499 g, categorised mostly as unexplained stillbirths or preterm labour, but no increase in neonatal deaths was observed. Administrative avoidable factors increased by 24% in the 2020 - 2022 triennium, but there was no increase in patient/community level or healthcare provider-related avoidable factors during the pandemic years. CONCLUSION : COVID-19 caused a marked increase in maternal death and stillbirth rates in 2020 and 2021 due to both direct effects of the virus and indirect effects on functioning of the health system. The continued, although modified, health-seeking behaviour of women and the rapid return to pre-COVID-19 mortality rates demonstrates enormous resilience in women and the health system.Item A randomised trial comparing preoperative administration of single-dose kefazolin to kefazolin plus metronidazole as prophylactic antibiotics at caesarean section(South African Medical Association, 2024-06) Lanfel, R.; Snyman, L.; Seopela, Louisa; Jahn, G.; Becker, Piet J.BACKGROUND : Caesarean section is a life-saving procedure which is associated with high rates of maternal and neonatal complications. It has been estimated that globally, 29.7 million births occur by caesarean section annually. The risk of postpartum infection is estimated to be five to ten times higher compared with normal vaginal delivery. Pregnancy-related sepsis was listed as a top-six cause of maternal mortality in the South African Saving Mothers report between 2017 and 2019. Multiple trials have been conducted in an attempt to optimise administration of prophylactic antibiotics in an effort to reduce postpartum infection and maternal sepsis, and current practice guidelines suggest that there is sufficient evidence that extended-spectrum antibiotics, in combination with kefazolin, result in reduction of postpartum infections OBJECTIVES : To investigate the effect of perioperative administration of kefazolin alone compared with kefazolin plus metronidazole on postpartum infection in women undergoing caesarean section at Kalafong Provincial Tertiary Hospital, Pretoria, South Africa METHOD : All patients undergoing emergency or elective caesarean section were randomised and then sequentially numbered in opaque sealed envelopes, which were placed in the caesarean section operating theatre. The intervention group received kefazolin and a sealed envelope with metronidazole. The control group received kefazolin and a sealed envelope with normal saline RESULTS : A total of 57/1 010 patients (5.64%) had surgical site infections, of which 27 (5.33%) were in the control group, and 30 (5.96%) were in the intervention group (p=0.66). Two patients in each arm (0.40% in the intervention arm and 0.39% in the control arm) underwent laparotomy procedures, while three women (0.60%) in the intervention arm and four women (0.79%) in the control arm underwent hysterectomy procedures. There were no statistically significant differences in all the measured secondary outcomes between the two groups CONCLUSION : The overall sepsis rate in this study was 5.64%. Postpartum infection is multifactorial and there are multiple factors that can be addressed in strengthening the sepsis care bundle. We do not recommend the addition of metronidazole to kefazolin as prophylaxis at caesarean section.Item Now is the time to introduce new innovative assisted reproduction methods to implement accessible, affordable, and demonstrably successful advanced infertility services in resource-poor countries(Oxford University Press, 2025-02) Ombelet, Willem; Van Blerkom, Jonathan; Boshoff, Gerhardus Marthinus; Huyser, Carin; Lopes, Federica; Nargund, Geeta; Sallam, Hassan; Vanmechelen, Koen; Campo, RudiNearly 200 million people worldwide suffer from infertility. Disparities exist between developed and developing countries due to differences in the availability of infertility care, different reimbursement policies and socio-cultural differences surrounding procreation. In low- and middle-income countries, specialized infertility centres are either scarce or non-existent, mostly in private settings, and accessible only to the fortunate few who can afford them. The success and sustainability of ARTs will depend on our ability to optimize these techniques in terms of availability, affordability, and effectiveness. A low-cost, simplified IVF system has been developed and shown to be safe, cost-effective, and widely applicable to low-resource settings. Combined with inexpensive mild ovarian stimulation protocols, this could become a truly effective means of treating infertility and performing assisted reproduction at affordable prices, but only if such programmes are sincerely desired and supported by all relevant stakeholders. A receptive political, governmental, and clinical community is essential.Item A core outcome set for future male infertility research : development of an international consensus(Elsevier, 2025-06) Rimmer, Michael P.; Howie, Ruth A.; Anderson, Richard A.; Barratt, Christopher L.R.; Barnhart, Kurt T.; Beebeejaun, Yusuf; Bertolla, Ricardo Pimenta; Bortoletto, Pietro; Bran; Brannigan, Robert E.; Cantineau, Astrid E.P.; Caroppo, Ettore; Collura, Barbara L.; Coward, Kevin; Duncan, William Colin; Eisenberg, Michael L.; Gellatly, Steven A.; De Geyter, Christian; Goulis, Dimitrios G.; Henkel, Ralf R.; Ho, Vu N.A.; Hussein, Alayman F.; Huyser, Carin; Kadijk, Jozef H.; Kamath, Mohan S.; Khashaba, Shadi; Khattak, Hajra; Kobori, Yoshitomo; Kopeika, Julia; Kucuk, Tansu; Lujan, Saturnino; Matsaseng, Thabo Christopher; Mathur, Raj S.; McEleny, Kevin; Mitchell, Rod T.; Mol, Ben W.; Murage, Alfred M.; Ng, Ernest H.Y.; Pacey, Allan; Perheentupa, Antti H.; Du Plessis, Stefan; Rives, Nathalie; Sarris, Ippokratis; Schlegel, Peter N.; Shabbir, Majid; Smiechowski, Maciej; Subramanian, Venkatesh; Sunkara, Sesh K.; Tarlarzis, Basil C.; Tuettelmann, Frank; Vail, Andy; Van Wely, Madelon; Vazquez-Levin, Monica H.; Vuong, Lan N.; Wang, Alex Y.; Wang, Rui; Duffy, James M.N.; Farquhar, Cindy M.; Niederberger, CraigENGLISH OBJECTIVE : To develop a core outcome set for male infertility trials. DESIGN : A two-round Delphi survey and consensus development workshop were undertaken with healthcare professionals, researchers and clinicians globally. SUBJECTS : 334 participants from 39 countries participated in the Delphi Survey, while 44 participants from 21 countries participated in the consensus development workshop. EXPOSURE : NA MAIN OUTCOME MEASURES : The core outcome set for male infertility trials has been developed by the inclusion of specific male-factor outcomes in addition to the general infertility core outcome set which focuses on female-factor outcomes. RESULTS : The outcomes identified include assessment of semen using the World Health Organisation recommendations for semen analysis; viable intrauterine pregnancy confirmed by ultrasound (accounting for singleton, twin and higher multiple pregnancies); pregnancy loss (accounting for ectopic pregnancy, miscarriage, stillbirth and termination of pregnancy); live birth; gestational age at delivery; birthweight; neonatal mortality; and major congenital anomaly. Although not a requirement as part of the core outcome set, other outcomes were identified as potentially useful in certain study settings. CONCLUSION : Embedding the core outcome set within RCTs and systematic reviews should ensure the comprehensive selection, collection and reporting of core outcomes, which are inconsistently reported at present. Research funding bodies, the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) statement, and over 80 specialty journals, including the Cochrane Gynaecology and Fertility Group, Fertility and Sterility and Human Reproduction, have committed to implementing this core outcome set for male infertility trials. TRIAL REGISTRATION NUMBER : Core Outcome Measures in Effectiveness Trials (COMET) initiative registration No: 1586. Available at www.comet-initiative.org/Studies/Details/1586.