Cervical Cancer Screening and Treatment Algorithms Using Human Papillomavirus Testing-Lessons Learnt from a South African Pilot Randomized Controlled Trial.

Background: To report quantitative and qualitative results on cervical cancer human papillomavirus (HPV)-based screening and treatment algorithms, with/out triage with visual inspection after acetic acid (VIA), followed by ablative treatment (AT).

Methods: Women 30 to 54 years old from Durban, South Africa were recruited, regardless of human immunodeficiency virus (HIV) status, randomized into one of two study arms and screened for HPV. VIA triage arm: HPV-positive women were triaged using VIA, biopsied and received AT if VIA positive and eligible; no triage arm: eligible HPV-positive women received AT.

Patients' experiences of termination of pregnancy at a regional hospital in Durban, South Africa.

Background: Safe and effective termination of pregnancy (ToP) services have helped to resolve the uncertainty that surrounds unwantedpregnancies globally and in South Africa (SA). It is important to determine the demographic profile of women requesting ToP and to assessthe reasons for ToP and the beliefs and experiences of women seeking these services in order to improve service delivery.

Objectives: To determine the sociodemographic profile and emotional and psychological experiences of women undergoing ToP at aregional hospital in Durban, SA.

Influence of HIV and its treatment on hypertensive disorders of pregnancy in women from a low- to middle-income country.

Objective: To establish a potential relationship between hypertensive disorders of pregnancy (HDP) and HIV infection.

Methods: This cross-sectional observational study involving 300 women with HDP was undertaken from September 2018 to February 2019 in a regional hospital in Durban, South Africa, a setting with a background HIV prevalence of 45% among pregnant women. All women with new-onset elevation of blood pressure after the 20th week of pregnancy were enrolled and, following informed consent, the relevant information was extracted from their files.

A clinical conundrum: review of anticoagulation in pregnant women with mechanical prosthetic heart valves.

In South Africa, maternal mortality from cardiovascular disease remains high. The recent Saving Mothers report 2017-2019 from the Confidential Enquiries into Maternal Deaths revealed that indirect maternal death from medical and surgical disorders is the fourth commonest cause of maternal death, accounting for 16.9% of deaths, with cardiac disease accounting for one-third of this.

The impact of the duration of HAART on cytokine profiles in pregnancy.

Objective: To determine the cytokine profile of HIV infected women treated with highly active anti-retroviral therapy (HAART) of variable duration in pregnancy.

Methods: HIV infected women were enrolled at a large tertiary hospital in Durban, South Africa in their antenatal period and stratified into those that initiated HAART before pregnancy (pre-pregnancy HAART or PPH group) and those who initiated HAART during pregnancy (in-pregnancy HAART or IPH group). These were compared with HIV negative women (HN group), matched for gestational age at the time of enrolment.

Maternal and obstetric complications among HIV-infected women treated with highly active antiretroviral treatment at a Regional Hospital in Durban, South Africa.

Introduction: HIV is the leading cause of maternal deaths in resource-poor countries. The use of highly active antiretroviral treatment (HAART) has been shown to almost eliminate vertical transmission and improve maternal health outcomes. Its effect on direct obstetric conditions has not been well documented.

An increase in rates of obstetric haemorrhage in a setting of high HIV seroprevalence.

Background: Obstetric haemorrhage (OH) is the leading cause of maternal mortality worldwide, although, indirectly, HIV is also a leading cause of maternal mortality in some settings with a high HIV seroprevalence.

Objective: To determine the possible association between increasing rates of OH and HIV or its treatment.

Methods: We conducted a retrospective chart review of women with OH at King Edward VIII Hospital, Durban, South Africa, over a 3-year period (2009 - 2011), during which the drug regimen for the prevention of mother-to-child transmission was evolving from single-dose nevirapine to antenatal zidovudine combined with intrapartum nevirapine (also referred to as dual therapy), and finally to a combination or highly active antiretroviral therapy (cART or HAART).

Associations between HIV, highly active anti-retroviral therapy, and hypertensive disorders of pregnancy among maternal deaths in South Africa 2011-2013.

Objective: To explore potential relationships between HIV and highly active anti-retroviral therapy (HAART), and hypertensive disorders of pregnancy (HDP).

Methods: A retrospective secondary analysis of maternal-deaths data from the 2011-2013 Saving Mothers Report from South Africa. The incidence of HIV infection amongst individuals who died owing to HDP was determined and comparisons were made based on HIV status and the use of HAART.

The impact of highly active antiretroviral therapy on obstetric conditions: A review.

HIV is the leading cause of maternal and neonatal morbidity and mortality in resource constrained countries. Highly active antiretroviral treatment (HAART) initiated in pregnancy has now almost eliminated mother to child transmission of the virus, and is beginning to show the desired effect of reducing HIV related maternal mortality. By modulating host immunological responses HAART has the potential to alter infections during pregnancy, in addition to modifying clinical conditions such as preeclampsia.

Thrombocytopenia during pregnancy in women with HIV infection receiving no treatment.

Unlabelled:  Background. Thrombocytopenia (TCP) complicates 5 - 8% of pregnancies. Most cases of TCP are gestational, and the condition is usually mild and occurs in the latter part of pregnancy.

Eliminating preventable HIV-related maternal mortality in sub-Saharan Africa: what do we need to know?

Introduction: HIV makes a significant contribution to maternal mortality, and women living in sub-Saharan Africa are most affected. International commitments to eliminate preventable maternal mortality and reduce HIV-related deaths among pregnant and postpartum women by 50% will not be achieved without a better understanding of the links between HIV and poor maternal health outcomes and improved health services for the care of women living with HIV (WLWH) during pregnancy, childbirth, and postpartum.

Methods: This article summarizes priorities for research and evaluation identified through consultation with 30 international researchers and policymakers with experience in maternal health and HIV in sub-Saharan Africa and a review of the published literature.

Pathogenic lower genital tract organisms in HIV-infected and uninfected women, and their association with postpartum infectious morbidity.

Objectives: To determine the prevalence of vaginal pathogens during pregnancy and their impact on postpartum infectious morbidity among antiretroviral-naïve HIV-infected, and HIV-uninfected, women.

Methods: Vaginal swabs were obtained during early labour by speculum examination prior to digital vaginal examination, and sent for microscopy and culture. Women were assessed for infectious complications within 24 - 72 hours of delivery, and up to 2 weeks postpartum.

Determinants of postpartum infectious complications among HIV uninfected and antiretroviral naïve-HIV infected women following vaginal delivery: a prospective cohort study.

Objective: To determine the incidence rate of postpartum infectious morbidity among HIV uninfected women compared to antiretroviral naïve-HIV infected women who were eligible for vaginal delivery.

Study Design: A nested study was conducted within a large prospective trial in which HIV infected women eligible for vaginal delivery at term were compared with HIV uninfected women. Women were reviewed within 72 h post delivery, at 1, 2 and 6 weeks for clinical signs of puerperal infection.

Changing patterns of maternal mortality (HIV/AIDS related) in poor countries.

Maternal mortality is greatest in poor countries and it is in exactly these countries that the human immunodeficiency virus (HIV) poses an added challenge in attaining the Millennium Development Goals. The prevalence of HIV infection in many poor countries continues to rise. South Africa is an example of how some of the challenges can be addressed.

Prophylactic antibiotics for the prevention of postpartum infectious morbidity in women infected with human immunodeficiency virus: a randomized controlled trial.

Objective: The purpose of this study was to determine the effect of intrapartum prophylactic antibiotics in the prevention of postpartum sepsis in laboring women who were infected with HIV.

Study Design: In a double-blind, randomized trial that was conducted in Durban (South Africa), pregnant women who were infected with HIV in whom vaginal delivery was anticipated were randomized to receive either a single dose of cefoxitin (2 g) or placebo intrapartum. Signs of sepsis were evaluated within 72 hours and at 1 and 2 weeks postpartum.