Dr LJ Kriel - Gynecologist and Obstetrician (Olivedale Clinic, Johannesburg)

FDA Safety Communication: UPDATE on Serious Complications Associated with Transvaginal Placement of Surgical Mesh for Pelvic Organ Prolapse

2011-11-30T08:55:00.001+02:00

http://pause.acog.org/topics/surgery-urinary-incontinence

Colposcopy

2011-11-30T00:04:00.001+02:00

Colposcopy is a way of looking at the cervix through a special magnifying device called a colposcope. It shines a light onto the vagina and cervix. A colposcope can enlarge the normal view by 2-60 times. This exam allows the doctor to find problems that cannot be seen by the eye alone.

Colposcopy is done when a Pap test result shows abnormal changes in the cells of the cervix.

Reasons for Colposcopy

Colposcopy is done when a Pap test result shows abnormal changes in the cells of the cervix. Colposcopy provides more information about the abnormal cells.

Colposcopy also may be used to further assess other problems:

Genital warts on the cervix
Cervicitis (an inflamed cervix)
Benign (not cancer) growths, such as polyps
Pain
Bleeding

Sometimes colposcopy may need to be done more than once. It also can be used to check the result of a treatment.

The Procedure

Colposcopy is done like a Pap test in a doctor's office. You may be referred to another doctor or to a special clinic to have it done.

Colposcopy

The procedure is best done when a woman is not having her period. This gives the doctor a better view of the cervix. For at least 24 hours before the test, you should not

douche
use tampons
use vaginal medications
have sex

As with a pelvic exam, you will lie on your back with your feet raised and placed on foot rests for support. A speculum will be used to hold apart the vaginal walls so that the inside of the vagina and the cervix can be seen. The colposcope is placed just outside the opening of your vagina.

A mild solution will be applied to your cervix and vagina with a cotton swab or cotton ball. This liquid makes abnormal areas on the cervix easier to see. You may feel a slight burning.

Reducing Your Risk of Breast Cancer

2011-11-30T00:01:00.001+02:00

Every three minutes, a woman is diagnosed with breast cancer in the US. While it may seem as if you have no control over cancer, research has shown that there are certain lifestyle choices that can reduce your chances of developing the disease.

The American Institute for Cancer Research estimates that almost 40% of breast cancer cases in the US—roughly 70,000 cases per year—could be prevented if women stayed within a healthy weight range, exercised more, and cut down the amount of alcohol they consumed. The good news is that every woman has control over these factors.

Maintain a healthy weight. Women who gain excess weight, especially after menopause, are more prone to breast cancer. Extra body fat produces estrogen, which can fuel certain cancers, such as some breast and endometrial cancers. Find out your ideal body mass index (BMI)—a measure of body fat in comparison to your height and weight—at nhlbisupport.com/bmi.

Get active. Women who exercise regularly have a 20–30% reduction in breast cancer risk. Physical activity helps keeps weight in check and may have a positive effect on harmful factors that can raise the risk of cancer, such as inflammation and excess hormones.

Just 30 minutes of moderate exercise, such as brisk walking, every day is a good start and may be enough to provide some protection. As your strength and stamina increase, add more time, intensity, and variety to your workout schedule to gain added benefit.

Drink less. Despite the often-touted cardiovascular benefits of moderate alcohol consumption, drinking has been linked to a higher risk of breast cancer. If you choose to drink, limit it to one drink per day. That translates into 5 ounces of wine, 1.5 ounces of hard liquor, or one 12-ounce beer.

Eat Healthier. Aim to eat a balanced diet rich in a wide variety of colorful fruits and vegetables, whole grains, lowfat dairy, and lean protein. By filling your plate with healthy whole foods, you have less room for foods that are high in fat, sodium, and processed sugar.

National Breast Cancer Awareness Month is the perfect time to learn about the factors that may raise your risk, and then try your best to reduce them. To learn more, go to nbcam.org

Diagnosing and Treating Preeclampsia

2011-11-29T23:58:00.001+02:00

Up to seven percent of pregnant women will develop preeclampsia, a serious pregnancy-related condition that can affect the placenta, liver, kidneys, blood, brain, and other organs. It is a leading cause of maternal and infant sickness and death in the US.

While the cause of preeclampsia is unknown, high blood pressure is a main contributing factor. Normally, blood pressure changes throughout the course of the day—for example, it increases when you exercise and slows when you’re at rest. But when it stays elevated, it can strain the heart and blood vessels, increasing the risk of heart attack and stroke and damage to the kidneys, brain, and eyes. During pregnancy, high blood pressure can also restrict the flow of blood, oxygen, and nutrients to the fetus.

Some women have ongoing (chronic) high blood pressure before they get pregnant. Others may develop high blood pressure during pregnancy, usually after the 20th week of gestation. Women who have chronic or gestational high blood pressure, are pregnant for the first time, have had preeclampsia in a previous pregnancy, are 35 years or older, are carrying more than one fetus, have certain medical conditions such as diabetes or kidney disease, are obese, are African American, or have certain immune disorders such as lupus or blood diseases are at increased risk of developing preeclampsia.

Other symptoms of preeclampsia include increased amounts of protein in the urine, headaches, visual problems, and swelling of the hands and face. Severe preeclampsia may be accompanied by lung, liver, kidney, or clotting complications and seizures (eclampsia).

If you have chronic high blood pressure, it’s important to make efforts to lower blood pressure before pregnancy by losing weight and taking medication as prescribed. Regular prenatal care during pregnancy can help detect preeclampsia early in all pregnant women. At each prenatal visit, a woman’s weight and blood pressure are taken along with a urine sample to monitor any changes. You may be checked more often if your blood pressure is high.

The gestational age of the fetus, the severity of the mother’s preeclampsia, and risks to mother and fetus will be assessed to guide the decision on when to deliver. Some women will be monitored to see if the situation improves, or—if the risk to the fetus is greater in the womb than in a special nursery—delivery may be necessary. Women with slightly increased blood pressure who are not near the end of pregnancy may be prescribed bed rest at home or in the hospital.

For more information, the ACOG Patient Education Pamphlet “High Blood Pressure During Pregnancy” is available athttp://www.acog.org/publications/faq/.

When can I stop having mammograms?

2011-11-29T23:52:00.001+02:00

According to The American College of Obstetricians and Gynecologists, there is no consensus at this time on the upper age limit for mammograms, although the benefits of screening declines with increasing age compared with the risks of overtreatment. So, if you are 75 or older you should discuss with your doctor whether to continue getting mammograms.

Morning snacking can sink diet goals, a study suggests

2011-11-29T23:33:00.001+02:00

Snacking between breakfast and lunch is probably not a good strategy for women trying to lose weight, according to a new study.

Some diet plans advocate eating snacks in order to avoid overeating at regular meal times. But research from the Fred Hutchinson Cancer Research Center in Seattle suggests that the value of snacking really depends on a person's hunger.

The study included 123 adult women, ages 50 to 75, who were overweight or obese. They were randomly assigned to a diet that restricted calories or diet plus exercise. They were not given any special instructions regarding snacking.

When researchers analyzed the data on snacking habits they found midmorning snackers lost an average of 7% of their body weight while those who ate a healthy breakfast but did not eat food or drink a beverage between breakfast and lunch lost 11% of their body weight.

It could be that midmorning snacking reflects "mindless" eating habits rather than the eating driven by hunger, the lead author of the study, Dr. Anne McTiernan, said in a news release.

"We think this finding may not relate necessarily to the time of day one snacks, but rather to the short interval between breakfast and lunch," she said.

Snacking can support diet goals if you are eating because you're really hungry, she added.

The study also found that women who snacked in the afternoon were more likely to eat more fruits and vegetables compared to women who didn't snack in the afternoon.

If people choose to snack, it should be to satisfy hunger and the snack should be healthy, McTiernan said, such as low-fat yogurt, sting cheese, a few nuts, vegetables, fresh fruit, whole-grain crackers and non-caloric beverages such as coffee or tea.

The study is published in the December issue of the Journal of the American Dietetic Assn.

Childbirth: Benefits Seen in Clamping the Cord Later

2011-11-29T23:30:00.000+02:00

Waiting three minutes or longer before clamping a newborn’s umbilical cord reduces the prevalence of iron deficiency at four months, a large trial has found.

More Vital Signs Columns

Swedish researchers studied 334 infants, randomly assigning half to have their cords clamped within 10 seconds of birth and the rest to clamping after three minutes or longer. The two groups were statistically identical in gestational age, head circumference, health and age of the mother, and other characteristics.

In blood tests at two days after birth, there were no significant differences in iron status. But when researchers analyzed blood taken at four months, they found iron concentrations were 45 percent higher in the delayed clamping group, and iron deficiency was significantly more prevalent in those who were clamped early.

Dr. Ola Andersson, the lead author and a pediatrician at the Hospital of Halland in Halmstad, Sweden, pointed out that there were no adverse effects to delayed clamping.

“Many obstetricians worry about jaundice, and most believe that delayed clamping causes it,” he said. But he and his colleagues found no difference in rates of jaundice.

The study, published this month in the journal BMJ, is one of the largest randomized trials of delayed cord clamping and the first to assess iron status beyond the neonatal period in a high-income country.

Vulvar pain syndromes: Causes and treatment of vestibulodynia — OBG Management

2011-11-29T23:24:00.000+02:00

Vulvar pain syndromes: Causes and treatment of vestibulodynia — OBG Management

The 11- 13 weeks scan : Competance sertificate : The Fetal Medcine Foundation

2011-11-21T16:10:00.001+02:00

One of only 40 Gynecologists in South Africa......

Laparoscopy: Advance techniques`

2011-11-21T16:04:00.001+02:00

26-27 August 2011: Laparoscopic assisted hysterectomies , etc.

Masterclass in Laparoscopic surgery.

2011-11-21T15:58:00.001+02:00

05-07 August 2011:

a Practical hands-on 3 day training course, at the Wits laboratory.

ESSURE

2011-09-20T11:58:00.000+02:00

The Essure procedure is the ideal contraceptive solution for women whose families are complete. It is a cutting-edge technology that liberates you from your temporary contraceptive regimen and enables you to fully enjoy your relationship with your partner and your children.

http://essure.co.za/

HYSTERECTOMY AND ITS ALTERNATIVES

2011-09-20T11:52:00.000+02:00

Hysterectomy, or the removal of the uterus orwomb, is the second most frequent operation for women, topped only by cesareansection. Seventy-four percent of hysterectomies are done when women are betweenthe ages of 30 and 54; by age 65, more than 37 percent of all women in the United Stateswill have had one. Critics of this operation say these numbers are too high.They claim that hysterectomy is routinely recommended for women with variousgynecological problems because doctors gain financially, think the uterusserves no purpose for middle-aged women, or find it too inconvenient to exploreother options.

As shocking as it may seem, geographical dataindicates there where a woman lives may also increase her chances of having ahysterectomy. Compared with women living in the Northeast, women are 78 percentmore likely to have the operation if they live in the South; 41 percent morelikely if they live in the Midwest; and 20percent more likely if they live in the West. A task force of the AmericanCollege of Obstetricians and Gynecologists (ACOG) attributed thegeographical disparities partly to regional differences in gynecologists'training.

Number of Hysterectomies in the United States (1975-1997)
Year	Number	Rate per 1,000 Women (age 15+)
1997	603,000	4.4
1996	591,000	5.5
1995	583,000	5.5
1990	591,000	5.8
1985	670,000	6.9
1980	649,000	7.1
1975	724,000	8.6
*Source:* National Center for Health Statistics

The number of hysterectomies performed annuallyhas dropped by about 160,000 in the past decade perhaps due to the outcryagainst it. But to cut the high rate of hysterectomy further, both women anddoctors must be knowledgeable about more conservative treatments. They mustalso recognize when a hysterectomy is the best solution.

What is a Hysterectomy?

In order to remove theuterus, a surgeon usually makes a vertical or horizontal incision in theabdomen. Or the doctor can perform a laparoscopically assisted vaginalhysterectomy (LAVH), a type of surgery that requires less extensiveincisions, making it less traumatic. In LAVH, tiny incisions in the abdomenserve as entry ports for a camera and operating tools. Once the uterus issevered, it is removed via the vagina. But this technique is still experimentaland questions have been raised about its safety. For example, it appears topose a higher risk of bladder damage than traditional surgery.

About 50 percent of women who undergo ahysterectomy also have their ovaries removed (oophorectomy). Thispractice is extremely controversial because sometimes perfectly healthy ovariesare removed. Why? Some doctors say that removal of the ovaries may preventovarian cancer. Yet studies dating back as far back as the 1950's show thatremoving the uterus alone may be enough to lower the risk of ovarian cancer.

The Organs Affected
This figure illustrates the woman's reproductive organs that are affected by hysterectomy. The uterus, or womb, is a hollow, muscular organ that nourishes the developing fetus during the nine months of pregnancy. The endometrium is the tissue that lines the uterus. The ovaries produce the female sex hormones estrogen and progesterone, and store the ovum (eggs), releasing one a month. The fallopian tubes then carry the egg from the ovary to the uterus. If fertilized, the egg implants itself in the uterus. Otherwise, it is expelled through menstruation.

What Are the Side Effects of aHysterectomy?

ACOG estimates that 25to 50 percent of hysterectomy patients will have one or more complicationsalthough they consider most to be minor or reversible. First, a hysterectomyends a woman's ability to become pregnant. Other postoperative complicationsmay include severe vaginal bleeding, injury to the bowel or bladder, infection,persistent pain and diminished sexual response. Studies also indicate thatwomen who have had hysterectomy have a 60 percent greater risk of beingincontinent by 60 years of age. It's not known why incontinence might crop upby 10 or 20 years after the time most women have the surgery.

Additionally, since the uterus produces prostacyclin,a hormone that inhibits blood clots, removal of the organ may make blood morelikely to clot and could be a factor in the increased risk of heart attackamong women who have had a hysterectomy. Many women also report fatigue, weightgain, aching joints, urinary tract disorders and depression after having ahysterectomy. One in 1,000 women die as a result of having ahysterectomy--that's a relatively small risk factor.

If the ovaries are taken out along with theuterus, a woman loses most of her supply of the female sex hormone, estrogen.Women who cannot take estrogen replacement therapy, will experience instantmenopause and may have a greater chance of developing heart disease andosteoporosis.

Whether or not they have had their ovariesremoved, many women also report fatigue, aching joints, urinary tract disordersand depression after having a hysterectomy.

Major Diagnostic Indications for Hysterectomies* (1988-1993)
Reason	Percent Diagnosis
Fibroids	33.3
Endometriosis	18.8
Prolapse	16.4
Other	15.9
Cancer	10.1
Endometrial Hyperplasia	5.3
Reasons for hysterectomy differ by age. For women ages 35-54, uterine fibroids is the most frequently associated diagnosis vs. uterine prolapse and cancer for women ages 55 and over. Source: American College of Obstetricians and Gynecologists,* 2000

When Is Hysterectomy Necessary?

Many women experienceextreme discomfort because of various gynecological conditions and find theirlives greatly improved by hysterectomy. The surgery can also be a lifesaver ifa woman has the following problems:

Cancer of the uterus and possibly of the ovaries
Uncontrollable hemorrhaging after delivery
Severe pelvic infection

What are the Alternatives?

Doctors often recommendhysterectomy to relieve conditions like chronic pain or heavy bleeding eventhough there are a variety of other therapies that can be tried. Sometimesdoing nothing is a viable alternative depending on how much the symptoms affecta woman's daily life. Alternatives aren't always perfect, but a woman should begiven the opportunity to consider them before having her uterus removed. Infact, ACOG advises that hysterectomy be a treatment of last resort that shouldbe performed only after proper diagnostic tests have confirmed the underlyingcondition; conservative treatments have failed to improve the condition andfertility is not an issue for the woman; and properly counseling has informedthe woman of the risks and benefits of the procedure. Here, a list of the mostcommon reasons (in order of prevalence) hysterectomies are done along withtreatment options.

Fibroid Tumors

Medically known as leiomyomas,these non-cancerous uterine tumors are sometimes symptomless and often requireno treatment. But at times they cause excessive bleeding, anemia, and pelvicpain and incontinence. Fibroids can also interfere with pregnancy, and, if theygrow too large, can crowd other organs and prevent them from functioningproperly. Since fibroids grow in response to estrogen, they often shrink once awoman reaches menopause and estrogen levels drop. Fibroids tend to run infamilies, and there is some evidence that a diet high in red meats and low ingreen vegetables spurs their growth.

Treatment options

Drug therapy. If nonsteroidal antiinflammatory drugs (such as Motrin) or birth-control pills don't control symptoms, a doctor may suggest trying a gonadotropin-releasing hormone agonist (such as Lupron). This synthetic hormone shrinks fibroids by shutting off the ovaries and depriving the growths of the estrogen they need to grow. Hormone therapy is not recommended for long-term use since it triggers temporary menopause, complete with hot flashes and vaginal dryness; it can also raise the risk of osteoporosis. Though fibroids grow back after treatment stops, many women continue to have relief from pain and other symptoms. These hormones can also be used to shrink bulky fibroids prior to a myomectomy or myolysis.
Myomectomy. In this surgery, just the tumors are removed either through an incision in the abdomen or by using a vaginal procedure. Although there is a 30 percent chance fibroids may recur, a myomectomy can save a woman's ability to have children. On the down side, the procedure can cause internal scar tissue that results in infertility.
Uterine artery embolization Gaining in popularity, this procedure, done with local anesthesia, involves insertion of a catheter through a tiny incision in the groin. Synthetic particles injected through the catheter into the arteries cut off blood supply to the fibroid, causing it to shrink. More studies are needed to confirm the pros and cons of this technique and find out how long its effects last. Though some women have had normal pregnancies after embolization, doctors are concerned about the fact that it works by impairing blood flow to the uterus.
Myolysis. In this technique, which requires general anesthesia, a surgeon makes two small incisions in the abdomen to insert instruments that destroy fibroids with an electric current or a laser beam. Complications might include scarring which can interfere with pregnancy, so some doctors don't recommend myolysis for women who want children. Other doctors, however, advise women to become pregnant as soon as possible after myolysis.
Hysterectomy may be appropriate if these alternatives fail to contol symptoms such as heavy bleeding or pain. Also if fibroid tumors continue to grow in post-menopausal women, removing the uterus might be necessary to determine whether the growths are cancerous.

Abnormal Bleeding

Persistent, heavyvaginal bleeding not related to menstruation or any known illness can have anenormous impact on a woman's life.

Treatment options

Drug therapy. The following drugs may control bleeding: Nonsteroidal anti-inflammatory drugs such as ibuprofen; a group of hormones known as progestins; and oral contraceptives. Drugs that block estrogen production (leuprolide or danazol) may work too, but they induce menopausal symptoms while they're taken.
Endometrial ablation. Gynecologists view the inside of the uterus with a special scope and then burn away the lining of the uterus with a laser. This procedure causes sterility, but it does not trigger menopause and menstrual flow is largely reduced or eliminated.
Thermachoice. Recently approved by the FDA, this device is a heated balloon that destroys a significant part of the endometrial lining of the uterus--the source of abnormal bleeding. This procedure may replace 20 percent to 30 percent of hysterectomies, but women should not try to get pregnant after Thermachoice treatment.
Hysterectomy is recommended when other treatments fail to control bleeding that interferes with a woman's daily life and retaining the ability to bear children is not an issue for the patient.

Endometriosis

In this disorder,tissue from the lining of the uterus, or endometrium (see illustration),attaches itself to other pelvic structures. Endometriosis can result in pelvicpain, extremely painful menstrual periods, pain during urination, irregularbleeding, infertility and painful intercourse.

Treatment options

Drug therapy. The anti-hormones leoprolide or danazol can sometimes reduce or eliminate endometriosis.
Laser surgery. The troublesome endometrial tissue can sometimes be removed with miniature instruments inserted through small incisions made in the abdomen.
Hysterectomy may be necessary when symptoms cannot be controlled with other treatments or when endometrial tissue is found within the wall of the uterus. The ovaries and fallopian tubes may also have to be removed if wayward tissue has spread to those organs. If the tissue has already seeded itself throughout the pelvis, removing the ovaries may cause the excess tissue to atrophy.

Uterine Prolapse

A weakening of thesupporting muscles and ligaments of the uterus can cause it to sag into thevagina and eventually protrude from the body. Symptoms can include a sensationof heaviness in the pelvic area and urinary incontinence.

Treatment options

Pelvic floor exercises. If done at the first sign of prolapse, Kegel exercises, which strengthen vaginal muscles, may prevent this condition from worsening.
Drug therapy. Estrogen replacement therapy for post-menopausal women may lessen symptoms.
Conservative surgery. A minor prolapse may be treated with surgery to repair supporting ligaments.
Pessary. This diaphragm-like device can be inserted around the cervix to help prop up the uterus. The drawbacks: it may dislodge or cause irritation, may interfere with intercourse, and it must be removed regularly to be cleaned.
Hysterectomy may be in order if other treatments fail to effectively support the uterus and alleviate discomfort.

Chronic Pelvic Pain

If a woman experienceschronic pelvic pain of unknown origin, a thorough evaluation is necessary tomake sure there are no gastrointestinal, urinary or muscular causes.Psychological evaluations are also encouraged.

Treatment options

Multidisciplinary approaches. Non-steroidal anti-inflammatory drugs (such as ibuprofen) and oral contraceptives along with physical therapy, and nutritional and psychological counseling may be effective.
Hysterectomy may be necessary to relieve lower abdominal pressure for the few women whose pelvic veins are persistently swollen or when all other measures have been exhausted. However, it is not always effective in relieving the pain.

Endometrial Hyperplasia

This potentiallyserious condition causes an overgrowth of the tissue lining of the uterus thatcan develop into cancer over time.

Treatment options

Drug therapy. Treatment with a synthetic hormone called progestin usually stops tissue growth. However, frequent biopsies may be necessary to monitor any signs of cancer.
Hysterectomy is recommended only when endometrial cancer is diagnosed.

Making a Treatment Choice

If you are trying todecide whether or not to have a hysterectomy, weigh its risks and benefitscarefully. Find out as much as you can about the alternatives available. Somewomen who have had hysterectomies welcome the freedom from pain, discomfort andbleeding. Others wish they had exhausted all of their options before agreeingto surgery. Talking to more than one doctor and to other women who have been inyour position and made different choices may also help you decide what is bestfor you .

Talking to Your Doctor

You should always seeka second opinion when a hysterectomy is recommended. Indeed, many insurancecompanies will not cover the procedure if you don't. A study from theUniversity of of NOrth Carolina suggests women can cut their chances of havinga hysterectomy by making their feelings clear to their doctors and by choosingyounger gynecologists who are less likely to think surgery is the besttreatment. To help you make a decision, discuss the following issues with yourphysicians:

Are more conservative options appropriate? If not, why?
How much relief can I expect from my symptoms after surgery?
Will my ovaries be removed as well? If so, why?
If my ovaries are removed, should I have hormone-replacement therapy?
Will hysterectomy affect my sexual responsiveness?
Will my cervix be removed?
What are the possible complications?
What are the hospital's and the surgeon's complication rates?
Is a vaginal or laparoscopic hysterectomy possible? If so, is the surgeon experienced in the technique?

Is Sugar Toxic?

2011-04-14T11:31:00.001+02:00

On May 26, 2009, Robert Lustig gave a lecture called “Sugar: The Bitter Truth,” which was posted on YouTube the following July. Since then, it has been viewed well over 800,000 times, gaining new viewers at a rate of about 50,000 per month, fairly remarkable numbers for a 90-minute discussion of the nuances of fructose biochemistry and human physiology.

Lustig is a specialist on pediatric hormone disorders and the leading expert in childhood obesity at the University of California, San Francisco, School of Medicine, which is one of the best medical schools in the country. He published his first paper on childhood obesity a dozen years ago, and he has been treating patients and doing research on the disorder ever since.

.....read here... http://www.nytimes.com/2011/04/17/magazine/mag-17Sugar-t.html?pagewanted=1&ref=homepage&src=me

Treatment strategies - PREMATURE LABOUR

2011-01-31T14:15:00.000+02:00

No benefit in reducing the risk of recurrence has been shown for the following strategies:

· Bed rest in hospital or at home is widely recommended for the prevention of preterm birth but there is no scientific evidence to support this practice. Indeed, randomized studies in twin pregnancies showed that bed rest increases the risk of preterm delivery. Bed rest may also have some adverse effects for women, including increased likelihood of venous thrombosis, muscle atrophy and stress.

· Betamimetics given prophylactically.

· Life style interventions, such as decrease in manual labor, increase in visits to antenatal clinics, psychological support, or diet supplementation with iron, folate, calcium, zinc magnesium, vitamins, or fish oil.

Benefit in reducing the risk of recurrence has been proven for the following two strategies:

· Cervical cerclage reduces the risk of delivery before 34 weeks by about 25%. There are two options in the management of patients with previous preterm births. Firstly, elective cerclage in all women soon after the 11-13 weeks scan demonstrates no major fetal abnormality. Secondly, measurement of cervical length every two weeks and placement of a suture only if cervical length becomes of less than 25 mm. The overall rate of preterm delivery is similar with the two approaches but the second approach is preferable because it reduces the need for cerclage by about 50%.

· Progesterone given from 20 to 34 weeks reduces the risk of delivery before 34 weeks by about 25%. Progesterone can be given as a vaginal pessary of the natural product (200 mg) every night or as an intramuscular injection of the synthetic 17 alpha-hydroxyprogesterone carporate (250 mg). Natural progesterone is preferable because of lack of undesirable side effects, such as sleepiness, fatigue and headaches. Additionally, there is some concern that injections of 17-OHP-C may increase the risk of fetal death.

Cervical assessment Theoretical Course

2011-01-31T13:34:00.000+02:00

Health care professionals who have attended the internet based course on Cervical assessment

Country:

Alison Boutall

Sarel Brand

Olivia Byrnes

Isabel Coetzee

Sonia Constantatos

Jean-Pierre Du Buisson

Douglas Dumbrill

Lut Geerts

Carlos Hartmann

Tracey Horak

Victor Hulme

Lourens Kriel

Heidi Moors

Shannon Morris

Ermos Nicolaou

Kerry Rademan

Heinrich Sauer

Christine Schabort

Arina Van Litsenborgh

Fertility Tips: Getting Pregnant

2011-01-31T10:44:00.000+02:00

Start taking folic acid now. You reduce your chances of giving birth to a baby with a neural tube defect (for example, anencephaly or spina bifida) by 50% to 70% if you start taking at least 0.4 mg of folic acid each day two to three months before you start trying to conceive.

Try to keep sex fun when you're trying to conceive. Use rooms other than the bedroom or schedule your babymaking rendezvous for an odd time of day. The rationale? You won't be able to keep up the babymaking pace for very long if sex starts feeling like a chore.

Don't hop up and run to the bathroom right after you make love. Lying down for at least a few minutes (some fertility experts say five minutes) after intercourse increases the odds that the sperm will be able to keep their date with the awaiting egg and that you'll win at baby roulette.

Make love often during your fertile period (the five days leading up to ovulation). If you've got the stamina to make love at least every 48 hours, you will ensure that there's a fresh shipment of sperm waiting in the fallopian tube at any given time. Of course, you can get too much of a good thing if your partner has a low sperm count, so if you're aware of a pre-existing fertility problem, you'll want to talk this issue over with your fertility specialist.

Keep in mind that babymaking is a numbers game. Even if you do everything "right," you still have only a 25% to 30% chance of conceiving in any given cycle.

Here's a bit of sex-related trivia, just in case you and your partner are looking for a little inspiration. There are over 114 million sex acts performed around the world.

Are you a coffee drinker? Time to give it up or switch to decaf! Caffeine is thought to restrict the growth of a developing baby by constricting blood vessels and reducing blood flow to the uterus. What's more, a few studies have indicated that excessive consumption of caffeine (that is, more than three cups of drip coffee per day) may contribute to fertility problems. The jury is still out on this last point, however.

Are you or your partner regularly exposed to hazardous substances in the workplace? You may need to consider a job change or job modification before you start your family. Certain substances can affect both the quality of sperm and the development of the embryo.

Have you had your preconception checkup yet? Set up an appointment with your doctor to review your medical history and to talk about your plans to start trying to conceive

Are you currently taking any prescription or over-the-counter drugs? Be sure to ask your doctor if it's safe for you to continue taking them once you start trying to conceive.

If you aren't already doing so, start keeping a menstrual calendar. Note the date when your period starts, the number of days it lasts, and anything else your doctor might want to know about. This information could prove helpful if you experience problems in conceiving. It can also prove invaluable in pinpointing the date of conception -- and consequently your due date.
Try to book the last appointment of the day for your preconception checkup. That's when your doctor or midwife is most likely to be able to take the time to answer your questions and address your concerns without feeling rushed to go on to the next patient.
Make your vaginal environment as sperm-friendly as possible. Avoid vaginal sprays and scented tampons (which can cause a pH imbalance in your vagina); artificial lubricants, vegetable oils, and glycerin (because they can kill off sperm); saliva (because saliva can also kill sperm); and douching (because it alters the normal acidity of the vagina; can cause vaginal infections and/or pelvic inflammatory disease; and may wash away the cervical mucus that is needed to transport the sperm).
If you're monitoring your cervical mucus in an attempt to predict your most fertile days, do your checks before you shower, bathe, or swim. These activities can all affect the quantity and quality of your cervical mucus.

Anders Ynnerman: Visualizing the medical data explosion

2011-01-24T11:51:00.002+02:00

A tool that finds 3x more breast tumors, and why it's not available to you

2011-01-19T16:46:00.000+02:00

South African attendees: 11- 13 weeks Scan

2010-12-02T13:50:00.002+02:00

Health care professionals who have attended the internet based course on The 11-13 weeks scan

Country:

Timothy Berios

Ismail Bhorat

Alison Boutall
Sarel Brand
Olivia Byrnes
Johannes Benjamin Frans Cilliers
Johan Coetzee
Sonia Constantatos
Gertraud Danler
Janneman De Bruijn
Elizabeth De Coning

Rene Doubell

Jean-Pierre Du Buisson
Narina Du Plessis
Louis Du Toit
Douglas Dumbrill
Bertina Faber
El-Marie Farrell
Lut Geerts
Logie Govender
Anton Greeff
Clayton Grieve
Carlos Hartmann
Debra Lynn Hattingh
Cherylene Hendricks
Tracey Horak
Victor Hulme
Abdul Karim Ismail
Maryke Kilian
Adel Kirsten
Peter Koll
Lourens Kriel
Louis Leipoldt
Hennie Lombaard
Louise Matthews
Heidi Moors

Shannon Morris
Anel Mostert
Sonja Mulder
Linnie Muller
Ermos Nicolaou
Melanie Nieuwoudt
Karin Norman
Natalia Novikova
John R Parkes
Alma Piek
Neelanrajah Pillay
Elizabeth Poggenpoel
Martin Puzey
Kerry Rademan
Tanya Reynolds
Desmond Sankar
Heinrich Sauer
Christine Schabort
Wilna Scheepers
Marilise Semmelink
Engela Steyn
Gerhard Strydom
Jaco Strydom
Satish Vallabh
Madale Van Wyk
Jacobus Venter
Christine Ventress
Almero Viljoen
Abrie Warnich
Lizette White

International ultrasound training and accreditation

2010-11-24T13:51:00.000+02:00

SASUOG ( http://www.sasuog.org.za/index.html ) has introduced a way of verifying skill levels and obtaining international accreditation. The Fetal medicine foundation in London http://www.fetalmedicine.com/fmf/ do our accreditation.

I have started on the long road to get international recognized accreditation in ultrasonography.

I have completed my first course: The 11-13week scan. (https://courses.fetalmedicine.com/lists/web)

Women's Brains on Steroids Birth control pills appear to remodel brain structure

2010-10-06T07:30:00.001+02:00

http://www.scientificamerican.com/article.cfm?id=womens-brains-on-steroids

It seems that weekly we hear about some professional athlete who sullies himself and his sport through abuse of steroids. The melodrama unfolds, careers and statistics are brought low and asterisked, and everyone bemoans another fallen competitor. Yet there are millions of cases of steroid use that occur daily with barely a second thought: Millions of women takebirth control pills, blithely unaware that their effects may be subtly seeping into and modulating brain structure and activity.

It is a huge experiment whose resolution will not be known for a while, but a new study in the journal Brain Research demonstrates that the effects are likely to be dramatic. It found that birth control pills have structural effects on regions of the brain that govern higher-order cognitive activities, suggesting that a woman on birth control pills may literally not be herself -- or is herself, on steroids.

The human brain is a remarkable structure, not least because of its seemingly infinite capacity for change, adapting millisecond by millisecond. Indeed, a structure with tens of billions of neurons, each of which has the ability to elaborate and branch and become more complex, while changing its activity in the process, is the very definition of change. This so-called neuroplasticity is a hallmark of the nervous system. It can, however, be augmented, boosted, by artificial means, and if we are not careful, the brain may go all catawampus.

Steroid hormones, which are excreted by endocrine organs such as testes and ovaries, flow in abundance throughout the bloodstream, reach target organs and structures, and exert powerful effects on them. To wit, the cock’s comb, the buck’s antlers, the lion’s mane, the blood-engorged uterus.

What of the mammal’s nervous system? It turns out that the brain is a veritable sponge for steroid hormones. In the male, the androgen testosterone (or a metabolite) binds to brain receptors and sculpts that structure into the aggression-promoting, sex-craving, risk-taking regulator with which we are all familiar. By the same token, the comparative lack of androgen hormones in the female produces the kinder, gentler, softer neural substrate that distinguishes itself from the male by dint of its vastly different behavioral repertoire.

Whereas the subtle structural effects of naturally-occurring steroid hormones and sex differences in the brain have been extensively studied, few studies have examined the role of synthetic hormones on changes in the human brain. What happens, then, when the female brain gets a significant and artificial dose of steroid hormone, either progesterone, estrogen or both? We know what happens below the waist, the pregnancies prevented. What happens above the neck, as this steroidal tsunami washes over the neural coastline?

It appears that the brain, that sensitive organ replete with steroid receptors, reacts to its hormonal milieu with startling structural modifications. Researcher Belinda Pletzer, of Paris-Lodron-University Salzburg, and her colleagues used MRI and voxel-based morphology to examine the brains of men; women on the pill; and “naturally cycling” women not on the pill.

The researchers found that males have considerably larger areas of gray matter in brain regions associated with learning and memory, known as the parahippocampal gyrus and hippocampus, as well as an area associated with emotional regulation, the amygdala. These data are consistent with many studies that provide evidence for gender differences in brain and behavior.

Further, naturally cycling women showed an increase in gray matter volume in the right fusiform/parahippocampal gyrus when circulating levels of estrogen and progesterone were low versus the phase when levels of these hormones were both high.

Does that increased gray matter translate into enhanced performance? It is not clear. Research into the hormonal regulation of cognition is extremely complicated. As Pletzer mentions, human fMRI studies have revealed that these areas are associated with spatial navigation abilities. Other work suggests that hippocampal–dependent spatial memory is enhanced by higher levels of estrogen. Under some conditions, however, estrogens have no effect or can even impair performance in rats.

Additionally, in Pletzer’s study, women using hormonal contraceptives showed larger gray matter volumes in the prefrontal cortex, pre- and postcentral gyri, the parahippocampal and fusiform gyri and temporal regions, when compared to naturally cycling women. The brain works like a neural beehive; the proper coordinated functioning of groups of tasked neurons are important to successfully accomplish a variety of mental tasks -- even the sensory processing and motor coordination needed for something as simple as picking up a hot cup of coffee without scalding oneself. Again, we do not know whether this increased gray matter translates into better or worse performance, but there likely is little good about treating a woman's brain like a spongy accordion.

Further, although the Pletzer data are suggestive, there are other methodological and interpretational issues worth considering. For example, the authors did not examine levels of circulating hormones in the male and female subjects (e.g., testosterone or estrogen, respectively). Such data would have been helpful in determining the timing of the neural structural effects.

Furthermore, the types of hormonal contraceptive were not examined, lumping them all into a vague “hormonal contraceptives” group. There is a high level of variability and differential ratios in levels of estrogen and progesterones in birth control pills.

Pletzer’s team, despite showing significant neuroanatomical alterations, did not perform behavioral or cognitive tests of their subjects that could have helped explain the meaning or functional consequences of the changes. Comparing other published work with the Pletzer study allows us to make inferences, but they are, at best, speculative given the unique details of the current research. There are pretty large differences in the structure of the brain that are attributable to cyclic fluctuations in natural hormones, and that appear to be due to unnatural concentrations of synthetic hormones. But since the authors did no cognitive testing of their subjects, we can only speculate about the behavioral effects.

Last, birth control pills also keep hormones low. So, there are two simultaneous events tugging at the data, a confound: the hormonal effects of the pills themselves, and the lowering of the normal hormones, both of which could bring about the structural effects. So even the actual hormonal basis underlying the reported structural differences remains unclear.

Still, overall, the Pletzer data do reveal some startling effects of oral contraceptive hormones. There are natural hormonal fluctuations that are a consequence of menstrual cycle oscillations, and which have organic effects of their own, but these have been a part of female mammals’ lives since time immemorial. Now, we are superimposing onto this sensitive substrate a steroid hormone cocktail with the potential of marking the brain in dramatic fashion.

The possibility that an accepted form of chemical contraception has the ability to alter the gross structure of the human brain is a cause for concern, even if the changes seem benign -- for the moment. In any event, women need to have all of the medical and now, neurobiological, information they can use in informing their personal contraceptive decisions. Like the rest of life, and like the steroid choices made by those ballplayers, there are costs and benefits. The benefits are well established; the costs, however, are still coming to light.

New Guidelines OK Vaginal Birth After Cesarean (VBAC)

2010-09-15T14:08:00.003+02:00

Published here...... http://journals.lww.com/greenjournal/Citation/2010/08000/Practice_Bulletin_No__115__Vaginal_Birth_After.40.aspx

Morning Sickness, Still No Relief

2010-09-15T14:01:00.000+02:00

There are currently no reliably safe and effective treatments for morning sickness, according to Cochrane researchers who conducted a systematic review of the available evidence. There was very limited evidence for all pharmaceutical and alternative medicines tested.

Morning sickness is the term used to describe vomiting and feelings of nausea in pregnant women. Symptoms can in fact occur at any time of the day and affect more than half of all women in the early stages of pregnancy. Due to concerns that pharmaceutical medicines may damage their unborn children, women are increasingly turning to non-drug treatments, including complementary and alternative therapies, to treat these symptoms. However, there is less evidence that alternative therapies work and they tend to be less well-regulated.

The review included 27 randomised controlled trials, which together involved 4,041 women who were up to 20 weeks pregnant. Benefit was measured by various scales commonly used to gauge the severity of nausea at a time as close as possible to three days after treatment. In six studies of acupressure and two of acupuncture there were no significant differences in benefit compared to control groups. One study of acustimulation did, however, report some improvement over three weeks. There was limited evidence of an effect of ginger in relieving nausea, as there was for vitamin B6, antihistamines and antiemetic (anti-vomiting) drugs including the antenatal drug Debendox.

In addition, some of the treatments caused adverse effects including drowsiness in those taking antiemetics. Ginger caused heartburn in some people.

"A number of the studies we looked at appeared to show benefits, but in general the results were inconsistent and it was difficult to draw firm conclusions about any one treatment in particular," said lead researcher Dr Anne Matthews, of the School of Nursing at Dublin City University in Dublin Ireland. "We were also unable to obtain much information about whether these treatments are actually making a difference to women's quality of life."

"Despite the wealth of different treatments available, it is not possible currently to identify with confidence any safe and effective interventions for nausea and vomiting in early pregnancy," said Matthews. "The difficulties in interpreting the results of the studies highlight the need for further, more rigorous trials in this area."

Sources: Wiley - Blackwell, AlphaGalileo Foundation.

Media Statement- Netcare Olivedale Hospital

2010-09-07T15:50:00.000+02:00

Update from hospital on unknown illness

Johannesburg, Tuesday 7 September 2010 Netcare Olivedale Hospital today issued an update following the death of two brothers who died after being hospitalised. The hospital confirmed that no new cases of the illness have been reported to date. Also, close personal contacts remain in good health.

Netcare Olivedale hospital again confirms that casual contact with family, friends, hospital staff or previous casual contact with the deceased do not pose a risk. Precautionary measures will continue and close contacts and medical personnel will be monitored. It added that two healthcare professionals at the hospital had presented with high fevers overnight but after being thoroughly investigated their ailments were found to be unrelated to the case of the deceased. Their symptoms differed considerably and were not of a serious nature. Both have subsequently been discharged. Key features of the illness included fevers and liver failure.

Diagnostic investigations revealed nothing conclusive to date and will continue until a direct cause of death can be established. Results of additional tests are anticipated in the next week. The hospital committed itself to daily updates and said that it will continue working closely with the National Institute of Communicable Diseases (NICD), a division of the National Health Laboratory Service, and the Department of Health.

Hospital management asked that media continue to respect the privacy of the grieving family and loved ones of the deceased and have thanked the media for their understanding and consideration. It reassured the public that, as always, everything necessary is being done to ensure the safety and wellbeing of patients, healthcare professionals and hospital staff members. Meetings between the NICD, the Department of Health and hospital management are continuing on a daily basis.

Please note that this statement will be updated by 15h00 every day.

Ends

Issued by: MNA for Netcare Olivedale Hospital

Contact: Martina Nicholson, Graeme Swinney or Clementine Eccles

Telephone: (011) 469 3016

Email: martina@mnapr.co.za or Graeme@mnapr.co.za

My new "baby".....

2010-08-26T15:52:00.000+02:00

Treating heavy periods

2010-08-26T15:34:00.000+02:00

Treating heavy periods

As the amount of blood that is lost during a woman's period varies considerably from one person to another, menorrhagia is not always diagnosed. In such cases, no treatment will be required. However, if menorrhagia is diagnosed, I will discuss all the possible treatment options with you.

•the effectiveness of treatments,

•the likelihood of any adverse effects following treatments,

•whether contraception will be required, and

•the implications of treatment on fertility.

The aims of treating menorrhagia are:

•to reduce or stop excessive menstrual bleeding,

•to prevent or correct iron-deficiency anaemia due to heavy menstrual bleeding,

•to use surgical treatments for women who may benefit, and

•to improve the quality of life of women with heavy menstrual bleeding.

Medication

Pharmaceutical treatment (medication) is recommended as the first type of treatment for use in cases of menorrhagia for women who:

•have no symptoms or signs that suggest a serious underlying cause, or

•are waiting for the results of further investigations.

If a particular medication is not suitable for you, or if you try a medication and it does not work, another one may be recommended. Some medications make your periods lighter, others may stop bleeding completely, and some are also contraceptives. I will explain how each type of medicaton works and any possible side effects, so that between you, a decision can be made about which one is most suitable for you.

The different types of medications that are used to treat menorrhagia are outlined below in the order that the National Institute for Health and Clinical Excellence (NICE) recommends they are are tried (as long as they are suitable for you).

Levonorgestrel-releasing intrauterine system (LNG-IUS) - MIRENA

The levonorgestrel-releasing intrauterine system (LNG-IUS) is a small plastic device that is placed in your womb and slowly releases the hormone progestogen. It prevents the lining of your womb from growing quickly, and is also a form of contraceptive. This medication does not affect your chances of getting pregnant after you stop using it. Possible side effects of using the LNG-IUS include:

•irregular bleeding that may last for more than six months,

•breast tenderness,

•acne - inflamed skin on the face,

•headaches - although they tend to be minor and short lived, and

•no periods at all.

The LNG-IUS has been shown to reduce blood loss by 71-90% and is the preferred first choice of treatment for women with menorrhagia, provided that long-term contraception using an intrauterine device is acceptable (it is usually used for a minimum of 12 months).

Tranexamic acid - Cyclocapron

If LNG-IUS is unsuitable, for example if contraception is not desired, tranexamic acid tablets may be considered. The tablets have been shown to reduce blood loss by 29-58%, and work by helping the blood in your womb to clot.

Two or three 500mg (milligrams) tranexamic acid tablets are taken once heavy bleeding has started, three or four times a day, for a maximum of three to four days. Usually, the lower end of this dosing range will be recommended - that is, two tablets, three times a day for four days. Treatment should be stopped if your symptoms have not improved within three months.

Tranexamic acid tablets are not a form of contraception and will not affect your chances of becoming pregnant. If necessary, tranexamic acid can be combined with a non-steroidal anti-inflammatory drug (see below).

Possible side effects include

•indigestion,

•diarrhoea, and

•headaches, but they are not very common.

Non-steroidal anti-inflammatory drugs (NSAIDs) ( eg Painkillers)

Non-steroidal anti-inflammatory drugs (NSAIDs) are also used to treat menorrhagia as a second choice of treatment if LNG-IUS is not appropriate. NSAIDs have been shown to reduce blood loss by 20-49%, and are taken in tablet form from the start of your period (or just before) and for the duration of bleeding, until it has stopped. As with tranexamic acid, treatment should be stopped if your symptoms have not improved within three months.

The NSAIDs that are recommended as a treatment for menorrhagia are mefenamic acid (500mg three times daily), naproxen (500mg as the first dose, then 250mg every six to eight hours), and ibuprofen (400mg three or four times daily).

NSAIDs work by reducing your body's production of a hormone-like substance, called prostaglandin, which is linked to heavy periods. NSAIDs are also painkillers but they are not a form of contraceptive. However, if necessary, they can be used in conjunction with the combined oral contraceptive pill (see below).

Common side effects include indigestion and diarrhoea.

NSAIDs can be used for an indefinite number of menstrual cycles, as long as they are relieving symptoms of heavy blood loss and are not causing significant adverse side effects. However, if NSAIDs are found to be ineffective, treatment should be stopped after three months.

Combined oral contraceptive pill

Combined oral contraceptive pills can be used to treat menorrhagia. They contain the hormones oestrogen and progestogen. One pill is taken every day for 21 days, before stopping for seven days. This cycle is then repeated.

The benefit of using combined oral contraceptives as a treatment for menorrhagia is that it offers a more readily reversible form of contraception than the LNG-IUS. It also has the benefit of regulating your menstrual cycle and reducing menstrual pain (dysmenorrhoea).

As its name suggests, the combined oral contraceptive is a contraceptive, and it works by regulating your menstrual cycle. However, it does not prevent you from becoming pregnant after you stop taking it. Common side effects include:

•mood changes,

•headaches,

•nausea,

•fluid retention, and

•breast tenderness.

Oral progestogen

Oral progestogen is a form of medication for treating menorrhagia. It is taken in tablet form two to three times a day from days 5-26 of your menstrual cycle, counting the first day of your period as day one.

Oral progestogen works by preventing the lining of your womb from growing quickly. It is not an effective form of contraception. Oral progestogen can have particularly unpleasant side effects including:

•weight gain,

•bloating,

•breast tenderness,

•headaches, and

•acne (which does not usually last for long).

High-dose oral progestogen can be particularly useful in stopping very heavy menstrual bleeding (flooding), and has been shown to reduce blood loss by 83%.

Injected progestogen

The hormone-like substance, progestogen, is available as an injection (depot medroxyprogesterone acetate) and is sometimes used to treat menorrhagia. It works by preventing the lining of your womb from growing quickly, and is a form of contraception. However, it does not prevent you becoming pregnant after you stop using it, although there may be a delay.

Common side effects of injected progestogen include:

•weight gain,

•irregular bleeding,

•absence of periods (amenorrhoea),

•a delay in being able to become pregnant of six to 12 months after stopping the injection, and

•premenstrual symptoms, such as bloating, fluid retention and breast tenderness.

Surgical procedures

If the above medications do not prove effective in treating menorrhagia, your specialist may suggest surgery. Despite their long-term effectiveness, surgical treatments are almost always used as a last resort option because they are irreversible.

There are a number of different surgical procedures that can be carried out to prevent heavy menstrual bleeding, and your specialist will be able to discuss them with you, including the benefits and any associated risks.

Common surgical procedures for treating menorrhagia include:

•endometrial ablation - involves destroying the womb lining, and

•hysterectomy - surgical removal of the uterus (womb), which may sometimes also involve the removal of the cervix, fallopian tubes and the ovaries (oophorectomy). Hysterectomy is only usually used to treat menorrhagia following a thorough discussion with your specialist to outline the benefits and disadvantages of the procedure.

News: Hairspray + Abnormal male babies

2010-08-26T15:22:00.000+02:00

Women exposed to hairspray during the 1st trimester have a more than double risk of having a son with hypospadias.

Also noted was that the taking of folic acid supplements reduces the risk for hypospadia by 36%.

Antibacterial soaps + infertility

2010-08-19T16:23:00.001+02:00

http://www.newsinferno.com/archives/23172

HPV (human papiloma virus) + Vaccine info

2010-08-19T16:15:00.000+02:00

http://www.gardasil.com/what-is-gardasil/information-on-gardasil/

Philosophers on abortion

2010-08-18T07:30:00.000+02:00

Q&A: http://www.askphilosophers.org/?q=&cat=Abortion&panelist=Questions

Eva Vertes looks to the future of medicine

2010-08-18T07:16:00.000+02:00

Swallowing in a fetus

2010-08-18T07:09:00.000+02:00

a Book to read: The Female Brain by Louann Brizendine

2010-08-11T15:53:00.000+02:00

Get it here: http://www.loot.co.za/shop/main.jsp?page=detail&id=2011184082928

Current attitudes of members of SASOG to the present law on abortion.

2010-08-11T13:44:00.000+02:00

S Afr Med J. 1990 Dec 1;78(11):702-3.

Dommisse J.

Abstract

1. It is the opinion of 85% of the 289 gynecologists who replied to the questionnaire that the present Abortion Act should be reviewed.

2. At least 75% of respondents supported termination under the following circumstances: In a girl under age 14--85% In a girl under age 16--76% After failed female sterilisation--78%

3. TOP 'on request' before 12 weeks was not supported by the majority (60%) and 93% were opposed to termination 'on request' after 12 weeks gestation.

4. The results of this survey were discussed by the Council of SASOG who agreed to the publication of the data but considered that only changes acceptable to at least 75% of the members could be supported by Council and that the minority viewpoint should also be respected.

High Court Ruling on the Reference Price List Legal Challenge by Specialists and other Societies

2010-08-11T07:36:00.003+02:00

...follow the link....

Cesarean Cection video

2010-08-10T12:53:00.001+02:00

Surgeon : Dr Kriel
Aneathetist: Dr Sittmann
Peaditrician: Dr Li

My favorite "doctor" Tv series : Dr House

2010-08-04T14:31:00.000+02:00

It is broadcasted on Multichoice Channel 108, Monday to Fridays 18h15.

Alternatives to conventional HRT

2010-08-04T14:23:00.000+02:00

1. Phyto-oestrogens.
They are not very good in preventing vaso- motor symptoms(hot flushes) but they a protective role in preventing certain cancers( prostate,bowel, breast) as well as promoting brain health and protecting against cardiovascular disease and osteoporosis.
a:Isoflavones. They are found in soy and red clover.
b.Lignans . they are found in nuts and oil-seed products ( flaxseed and evening primrose oil)

2. Chasteberry ( Vitex agnus castus)
It works on the brain`s dopamine receptors, thus inhibiting prolactin production. It may in assist to treat mild depression, night sweats , hot flushes and vaginal dryness.

3. Black cohosh (Cimicifuga racemosa).
It my help for hot flushes and may help to prevent osteoporosis.

4. Wild Yam (Diosceria mexicana)
It my help for hot flushes and may help to prevent osteoporosis.

5. Clonidine ( Dixirit , Menograine)
Migraine medication that may be effective to treat hot flushes.

6. Replens
Vaginal moisturiser for treating vaginal dryness.

Premature labour - Magnesium sulphate and the prevention of cerebral palsy ( News)

2010-08-04T13:56:00.000+02:00

Prematurity is a powerful risk factor for the development of cerebral palsy. Infants born between 23 and 27 weeks of gestation have a 80 times higher risk than term infants.

The ACTOMgSO4, BEAM and PREMAG trails shows that if Magnesium Sulphate 4 grams IMI is administered to patients in premature labour (24- 32 weeks) the incidence and/or severity of cerebral palsy can be reduced or prevented.

Breast cancer- The prevention of recurrance ( News)

2010-08-04T13:42:00.002+02:00

a Study ( ATAC trail) shows that Anastrozole ( Arimidex 1 mg/ day for 5years) significantly improve the prevention of recurrent breast cancer in patients diagnosed with estrogen sensitive breast cancer.

SAUGA congress - 16/07/2010

2010-07-15T09:24:00.000+02:00

4D IMAGES (Ultrasound)

2007-10-17T14:06:00.001+02:00

Dr LJ Kriel - Gynecologist and Obstetrician (Olivedale Clinic, Johannesburg)

FDA Safety Communication: UPDATE on Serious Complications Associated with Transvaginal Placement of Surgical Mesh for Pelvic Organ Prolapse

Colposcopy

Reducing Your Risk of Breast Cancer

Diagnosing and Treating Preeclampsia

When can I stop having mammograms?

Morning snacking can sink diet goals, a study suggests

Childbirth: Benefits Seen in Clamping the Cord Later

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