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Transverse vaginal septum is a rare congenital anomaly. It is one of the variants of müllerian duct anomalies whichresults from defective fusion or recanalization of the vaginal and müllerian organs. It can present with primaryamenorrhea with cyclical abdominal pain at early age or with infertility and dyspareunia later in life.

Background: Acute kidney injury (AKI) in pregnancy presents with complexities relating to the pathophysiologyof the disease. It is associated with an increased risk of maternal and perinatal morbidity and mortality. Casesmay be mild or severe, requiring renal replacement therapy. The physiological changes of pregnancy makediagnosis difficult due to an increase in glomerular fi ltration rate and reduction in serum creatinine. Due to thesephysiological changes, there is inadequate information to aid the precise defi nition of the disease in pregnancy. Inaddition, data on AKI in pregnancy is limited in the South African population.Aim of the study: The aim of the study was to describe the characteristics of obstetric patients who developedAKI from 22 weeks of gestation to 6 weeks postpartum.Methods: Pregnant women admitted to Kalafong Provincial Tertiary Hospital (KPTH) from July 2019 to July 2020were screened based on admission status and special investigations. The inclusion criteria were all consentingpregnant women above 18 years, gestational age of 22 weeks or more.Results: A total of 38 patients were recruited. Twenty-fi ve (66%) of these patients had a hypertensive disorderin pregnancy. AKI was graded as stage 1, 2 or 3 using the KDIGO classifi cation. Seventeen patients (45%)had stage 1 AKI, 11 patients (29%) were in stage 2, and 10 (26%) were diagnosed as stage 3. Fifteen patients(39%) were admitted to the intensive care unit. Thirty-three patients (87%) recovered fully. However, two patientsdemised, of which one had an amniotic fl uid embolus complicated by postpartum haemorrhage and another wasdiagnosed sepsis unrelated to the pregnancy.Conclusion: AKI in pregnancy was associated with varying conditions, with hypertensive disorders making upmost of the conditions. However, the recovery rate was good despite the degree of AKI, with only one of thepatients in the study requiring dialysis.

To evaluate whether the introduction of a strict protocol approach based on the systemic evaluation of critically ill pregnant women with complications of abortion affected outcome.Indigent South Africans managed in the regional and tertiary hospitals of the Pretoria Academic Complex.Since 1997 a standard definition of severe acute maternal morbidity (SAMM) has been used in the Pretoria Academic Complex. All cases of SAMM and maternal deaths were entered on the Maternal Morbidity and Mortality Audit System programme. A comparison of outcome of severely ill women who had complications of abortion was made between 1997-1998 (original protocol) and 2002-2004 (strict protocol).The mortality index and prevalence of organ system failure or dysfunction.In 1997-1998 there were 43 women with SAMM who survived and a further 10 maternal deaths due to complications of abortion, compared with 107 women with SAMM and 7 maternal deaths during 2002-2004. The mortality index declined from 18.9% in 1997-1998 to 6.1% in 2002-2004 (p = 0.02, odds ratio 0.28, 95% confidence limits 0.10 - 0.79). Significantly more women had hypovolaemic shock in 2002-2004 compared with 1997-1998 (54.4% v. 35.8%, p = 0.04), but fewer women had immune system failure including septic shock (18.4% v. 47.2%, p = 0.0002) and metabolic dysfunction (0 v. 5.7%, p = 0.03) and there was a trend to less renal failure (10.5% v. 22.6%, p = 0.06) and cardiac failure (4.4% v. 13.2%, p = 0.08).The strict protocol approach based on systemic evaluation in managing critically ill pregnant women with complications of abortion, coupled with an intensive, regular feedback mechanism, has been associated with a reduction in the mortality index.