Exosomal microRNA profiling in early and late onset preeclamptic pregnant women reflects pathophysiology.

Preeclampsia is the leading cause of maternal and fetal mortality due to the inability to diagnose and treat the disorder early in pregnancy. This is attributed to the complex pathophysiology and unknown etiology of the disorder, which is modulated by several known and unknown factors. Exosomes have recently been implicated as possible mediators of the pathogenesis of preeclampsia, with, however, no evidence linking these nanovesicles to the pathophysiology of preeclampsia and its subtypes.

The costs and cost effectiveness of providing first-trimester, medical and surgical safe abortion services in KwaZulu-Natal Province, South Africa.

Background: Despite a liberal abortion law, access to safe abortion services in South Africa is challenging for many women. Medication abortion was introduced in 2013, but its reach remains limited. We aimed to estimate the costs and cost effectiveness of providing first-trimester medication abortion and manual vacuum aspiration (MVA) services to inform planning for first-trimester service provision in South Africa and similar settings.

Clinical awareness for health care professionals: Fatal encephalopathy complicating persistent vomiting in pregnancy.

Women with persistent vomiting during pregnancy need early referral to appropriate health facilities. Delayed referral and inappropriate management may lead to metabolic encephalopathy from a variety of causes, including electrolyte derangements or thiamine deficiency (Wernicke's encephalopathy) (WE). We present a case of persistent vomiting in pregnancy in which there was delayed referral, inappropriate treatment and failure to associate neurological signs such as terminal neck stiffness with WE, resulting in poor fetomaternal outcomes.

Severe hypertension in pregnancy: Using dynamic checklists to save lives.

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

Introducing medication abortion into public sector facilities in KwaZulu-Natal, South Africa: an operations research study.

Objectives: Examine the feasibility of introducing mifepristone-misoprostol medication abortion into existing public sector surgical abortion services in KwaZulu-Natal, South Africa.

Study Design: Cohort study of women offered medication or surgical abortion in a larger medication abortion introduction study. The sample included 1167 women seeking first-trimester abortion at four public sector facilities; 923 women at ≤9 weeks' gestation were eligible for medication abortion.

Evaluation of standard and modified severity of illness scores in the obstetric patient.

Purpose: To test discrimination and calibration of APACHE-II and SAPS-II risk prediction scores in a cohort of obstetric patients, and to evaluate the effect of modifying these scores for the physiological changes in pregnancy.

Materials And Methods: A retrospective review of obstetric patients, 12 weeks gestation to 48 hours postpartum, admitted to the ICU for more than 24 hours. APACHE-II and SAPS-II, and versions modified for the physiological changes of pregnancy, were evaluated by receiver operating characteristic (ROC) curves and standardized mortality ratios (SMR).

Women living with HIV and AIDS: right to prevention, treatment, and health care.

Women living with HIV/AIDS not only bear the burden of this pandemic in under-resourced countries, but are faced with the human rights issues concerning the management of their condition, not only for their own health, but also for prevention of mother-to-child transmission of the virus and infertility investigation. This article tackles the issues of reproductive health rights pertaining to prevention of HIV, and rights regarding HIV testing including the ethical dilemmas associated with "opt in," "opt out," and mandatory testing. Accountability, rights to treatment and travel, and employment issues are also discussed.

Every death counts: use of mortality audit data for decision making to save the lives of mothers, babies, and children in South Africa.

South Africa is one of the few developing countries with a national confidential inquiry into maternal deaths. 164 health facilities obtain audit data for stillbirths and neonatal deaths, and a new audit network does so for child deaths. Three separate reports have been published, providing valuable information about avoidable causes of death for mothers, babies, and children.

HIV in pregnancy.

Purpose Of Review: This review discusses recent articles on various aspects of the prevention of mother-to-child transmission during pregnancy and delivery.

Recent Findings: Rapid human immunodeficiency virus (HIV) testing of women in labour whose status is not known allows the prompt treatment of mother and baby to reduce transmission risk. The feared clinical resistance in the mother after treatment with a single dose of nevirapine has been confirmed.

Combined oral contraceptives and cervical cancer.

Purpose Of Review: The issue of whether there might be an increased risk of cervical cancer associated with the use of oral contraceptives has been debated for decades. Early studies found a modest association with long-term use. A literature review was performed over the past 3 years, to establish whether there is any new evidence linking cervical cancer with the use of oral contraceptives.

Hypertension-related gene polymorphisms in pre-eclampsia, eclampsia and gestational hypertension in Black South African women.

Objective: To examine whether polymorphisms in the renin-angiotensin system (RAS) are associated with pregnancy-related hypertensive disorders in a black South African population.

Design: The angiotensin-converting enzyme (ACE) insertion/deletion, angiotensinogen M235T and angiotensin II receptor type 1 1166A<--C polymorphisms were assessed in study groups comprising 204 women with pre-eclampsia, 120 with eclampsia, 67 with early onset pre-eclampsia and 78 with gestational hypertension.

Methods: Using chi analysis, results were compared with those obtained from 338 ethnically matched normotensive pregnant women following normal full term pregnancies.

Methylenetetrahydrofolate reductase gene polymorphisms in black South Africans and the association with preeclampsia.

Background: A methylenetetrahydrofolate reductase (MTHFR) polymorphism (1317T --> C) that occurs commonly in black African individuals prompted this study to establish whether this polymorphism, alone or in association with other MTHFR variants, is associated with preeclampsia in black South African women.

Methods: A group of 204 black women with preeclampsia was examined for the 677C --> T, 1298A --> C and 1317T --> C MTHFR polymorphic alleles using standard techniques. Also examined were women with early-onset preeclampsia (n = 67) and gestational hypertension (n = 78).

Plasminogen activator inhibitor type 1 (PAI1) and platelet glycoprotein IIIa (PGIIIa) polymorphisms in Black South Africans with pre-eclampsia.

Background: Association of fibrin abnormalities with pre-eclampsia prompted this study to examine whether polymorphisms in the plasminogen activator inhibitor Type 1 and platelet glycoprotein IIIa genes constitute risk factors for this condition.

Methods: A group of 151 Black Zulu-speaking pre-eclamptics was examined for 4G/5G plasminogen activator inhibitor Type 1 and PlA1/A2 platelet glycoprotein IIIa polymorphic alleles using standard techniques. Results were compared with those found in 217 ethnically matched healthy normotensive pregnant women who had normal full-term gestations.

Nitric oxide: does it have an etiological role in pre-eclampsia?

Aim: To determine evidence of nitric oxide (NO) in decidual biopsies and fetal membranes of preeclamptic women.

Background: Nitric oxide, a potent vasodilator, has been postulated to have a role in the etiology of preeclampsia. Investigations in peripheral blood have led to conflicting results.

Comparison of the efficacy of continuous furosemide and low-dose dopamine infusion in preeclampsia/eclampsia-related oliguria in the immediate postpartum period.

Aim: To compare the efficacy of furosemide infusion with that of low-dose dopamine infusion in improving urine output and subsequent renal function in preeclamptic/eclamptic patients with oliguria in the immediate postpartum period.

Design: Prospective randomised single blind clinical trial.

Setting: Obstetric High Care Unit of King Edward VIII Hospital, a large referral tertiary hospital.

Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial.

Background: Anticonvulsants are used for pre-eclampsia in the belief they prevent eclamptic convulsions, and so improve outcome. Evidence supported magnesium sulphate as the drug to evaluate.

Methods: Eligible women (n=10141) had not given birth or were 24 h or less postpartum; blood pressure of 140/90 mm Hg or more, and proteinuria of 1+ (30 mg/dL) or more; and there was clinical uncertainty about magnesium sulphate.

Trichomonas vaginalis is associated with pelvic inflammatory disease in women infected with human immunodeficiency virus.

We assessed the association between the causative agents of vaginal discharge and pelvic inflammatory disease (PID) among women attending a rural sexually transmitted disease clinic in South Africa; the role played by coinfection with human immunodeficiency virus type 1 (HIV-1) was studied. Vaginal and cervical specimens were obtained to detect Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, and bacterial vaginosis. HIV-1 infection was established by use of serum antibody tests.

Can a developed country's maternal mortality review be used as the 'gold standard' for a developing country?

Background: Relative to other public health problems, maternal mortality ratio (MMR) differences between developed and developing countries are greater than expected. South Africa (SA) produced its first national report on maternal deaths in 1998. UK's last report covered the period 1994-1996.