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Babies born at the lower limits of viability have a poor prognosis in the South African setting. Neonatal intensive and high care units are overburdened, which leads to outbreaks of resistant organisms. An equitable set of interventions, based on available resources and referral pathways is proposed for each level of care to manage pregnancies and babies around the margins of viability. It is envisaged that this will serve as a basis for each province to develop their own guideline. [ABSTRACT FROM AUTHOR]

Objective. To determine the changes in stillbirth rates in singleton pregnancies in a stable population over a period of 50 years. Methods. Stillbirth rates for singleton pregnancies where the fetus weighed ≥1 000 g were collected from 1962 to 2011. From 1972 to 2011, rates included fetuses weighing ≥500 g at birth. Results. When the birth weight was ≥1 000 g, the stillbirth rate declined from 70 to 12.6 per 1 000 births, and when the birth weight was ≥500 g, it dropped from 34.2 to 24.5 per 1 000 births. The decline was very much slower towards the end of the study period. Conclusion. To achieve further sustained reductions in stillbirth rates, healthcare workers should continue to emphasise quality of healthcare, but should also address and prevent specific conditions associated with stillbirth, such as smoking and drinking during pregnancy. [ABSTRACT FROM AUTHOR]

Oxidative stress is thought to play an important role in the pathophysiology of pre-eclampsia. A defect in certain enzymes responsible for detoxification may cause prolonged exposure to reactive by-products and contribute to maternal endothelial as well as placental damage. Two polymorphisms affecting the function of the biotransformation enzymes epoxide hydrolase and glutathione S-transferase P1 were shown previously to be associated with pre-eclampsia in a Dutch population. The aim of this study was to determine if these two polymorphisms (maternal or fetal) contribute to pre-eclampsia in an anthropologically distinct population (the Western Cape region of South Africa) with a high incidence of the disease. Genomic DNA of mother - infant pairs with severe pre-eclampsia ( n  = 144), a population control group ( n  = 156) and control mother - infant pairs with uncomplicated pregnancy outcome ( n  = 45) were analysed for the EPHX and GSTP1 polymorphisms by polymerase chain reaction amplification and restriction enzyme digestion. Each polymorphism had a similar distribution in case and control subjects (mother and infant). The Val105/Val105 genotype of GSTP1 occurred at a higher frequency than reported for other populations. Neither maternal nor fetal EPHX Tyr113His and GSTP1 Ile105Val polymorphisms appear to contribute significantly to the pathophysiology of pre-eclampsia in the Coloured population of the Western Cape region of South Africa. [ABSTRACT FROM AUTHOR]

This article discusses various issues related to collection of fetal cells in cervical secretions without ultrasound guidance. Antenatal diagnosis of fetal abnormalities remains governed by highly invasive techniques such as amniocentesis and chorionic villus biopsy. Fetal cells are probably shed into the lower uterine cavity between 7 and 13 weeks' gestational age before fusion of the deciduas basalis and parietalis when the uterine cavity is still present. They may be retrieved from the cervix using lavage under ultrasound guidance and used for diagnostic tests. The article authors utilized cervical lavage under direct visualization and a standardized depth of catheter insertion, and exclude ultrasound guidance. Their results showed insufficient fetal DNA in all of the lavage samples.

The article focuses on group A beta-haemolytic streptococcal toxic shock syndrome (STSS), which was presented as suspected ileo-femoral thrombosis in the puerperium. The syndrome is characterized by early onset and rapid progression of shock and multi-organ failure, often accompanied by myositis or necrotising fasciitis. Treatment includes massive antibiotic cover, human immunoglobulin administration and widespread debridement of affected tissue. The case study presented in the article illustrated the importance of recognizing the atypical clinical features of streptococcal pelvic infection, as well as the need to identify the organism involved in order to suspect and diagnose STSS.

Maternal and/or perinatal death review or audits aim to improve the quality of health services and reduce deaths due to causes identified. A death review audit cycle identifies causes of deaths and possible modifiable factors, these can point to potential breaks in the continuity of health care and other health systems faults and challenges. It is an important function of audit cycles to develop, implement, monitor, and review action plans to improve the service. The WHO has produced two handbooks (Making Every Baby Count and Monitoring Emergency Obstetric Care) to guide maternal and perinatal death reviews. Health worker related factors accounts for two thirds of aspects that, if done differently may have prevented the adverse outcome. This emphasises the need for skilled health care workers at every delivery and for deliveries to take place in health facilities., Competing Interests: Declaration of competing interest The authors have no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: In the latest (2011-2013) Saving Mothers report, the National Committee for Confidential Enquiries into Maternal Deaths in South Africa (SA) (NCCEMD) highlights the large number of maternal deaths associated with caesarean section (CS). The risk of a woman dying as a result of CS during the past triennium was almost three times that for vaginal delivery. Of all the mothers who died during or after a CS, 3.4% died during the procedure and 14.5% from haemorrhage afterwards. Including all cases of death from obstetric haemorrhage where a CS was done, there were 5.5 deaths from haemorrhage for every 10,000 CSs performed., Objective: To scrutinise the contribution or effect of the surgical procedure on the ultimate cause of death by a cross-cutting analysis of the 2011-2013 national data., Methods: Data from the 2011-2013 triennial review were entered into an Excel database and analysed on a national and provincial basis., Results: There were 1,243 maternal deaths where a CS was the mode of delivery and 1 471 deaths after vaginal delivery. More mothers died as a result of CS in the provinces where there is a low overall CS rate. The following CS categories were identified as specific problems: bleeding during or after CS, pre-eclampsia and eclampsia, anaesthesia-related deaths, pregnancy-related sepsis and acute collapse and embolism., Conclusion: This is an area of concern, and a concentrated effort should be done to make CS in SA safer. Several recommendations are

Objective: This study was undertaken to investigate the involvement of MTHFR gene mutations C677T and A1298C implicated in vascular disease, in patients with abruptio placentae and intrauterine growth restriction (IUGR)., Study Design: DNA was extracted from blood samples of 54 patients with placental vasculopathy (18 patients with abruptio placentae and 36 with IUGR) and 114 control patients and amplified by the polymerase chain reaction (PCR). The resulting fragments were subjected to restriction enzyme analysis and resolved by gel electrophoresis., Results: A significant association could be demonstrated between mutation A1298C and both abruptio placentae and IUGR. Combined heterozygosity for mutations C677T and A1298C was detected in 22.2% of abruptio placentae cases., Conclusions: Combined heterozygosity for MTHFR mutations C677T and A1298C may represent a genetic marker for abruptio placentae.

A case report is presented of a 30-year-old woman, gravida 3 para 2, presented with an advanced extra-uterine pregnancy with complete development of the placenta in the fallopian tube.