Head of Department: Professor Lynette Denny
Our Mission Statement
· To provide high quality care to all women seeking our services
· To foster a climate of intellectual enquiry
· To pursue excellence in research at every level of care
· To help create a world-class African University
The Department of Obstetrics and Gynaecology provides a wide-range of clinical services to the women of Cape Town as well as receiving referrals from the Eden Region. The Department takes care of over 40 000 women who give birth in our services per year. In addition, we provide comprehensive general and subspecialist gynaecological care to women, including services for termination of pregnancy and the management of women who have been raped or violated in any way. In addition, the Department is responsible for providing teaching at undergraduate level to 3rd, 4th, 5th and 6th year medical students and at post graduate level to interns, community officers, registrars in specialist and sub-specialist training and to specialists. The Department provides clinical services at primary, secondary and tertiary levels of care.
Research is largely clinical and in recent years has increased in output due to the requirement that registrars complete a MMED dissertation, which should be publishable, prior to graduation as a specialist.
In obstetrics we have the following:
· Mowbray Maternity Hospital (MMH) (secondary level obstetrics). This unit is run by A/Prof Sue Fawcus with assistance from Dr Anne Horak and Dr Saadiqa Allie. Prof Fawcus is internationally respected for her work on Maternal Mortality and in 2010 she was invited to write 3 Chapters in books and edited a monograph commissioned by the National Department of Health on the management of Post Partum Haemorrhage. Through her supervision of registrars, the impact of maternal HIV infection and perinatal outcome at MMH has been evaluated. In addition, her group are investigating obstetric risk factors for neonatal encephalopathty, induction of labour for prolonged pregnancy and prevalence of various vaginal flora in women with previous preterm labour. Further, the influence of HIV status on the incidence and severity of post partum haemorrhage is the subject of the thesis of one of her MPhil students.
· Somerset Hospital (secondary level obstetrics). This unit is run by Dr Greg Petro, assisted by Dr Tham Mathinde, Dr Valentin Stefan and Dr Lynelle Kenneth. Currently the group is recruiting women to a study on Microchimerism in the obstetric transfused population. They are also co-investigators in a study on second trimester termination of pregnancy, which will be a randomized controlled trial comparing laminaria tents to misoprostil for the termination of second trimester pregnancies.
· Groote Schuur Hospital (tertiary level obstetrics). Headed by A/Prof John Anthony with assistance from Dr Chantal Stewart (Head of Ultrasound and Fetal Medicine), Dr Leann Schoeman, Dr Hetta van Zyl and Dr Linda Walmsley. This unit looks after a wide range of often severely ill pregnant women as well as women with fetal anomalies. The Unit has established two important databases:1] of women with cardiac disease in pregnancy and 2] one for pregnant HIV infected women. They are auditing their experience of genetic amniocentesis in HIV positive women and the HIV transmission rate to the babies. Protocols are being developed to evaluate the role of brain natiuretic peptide in preeclampsia as well as a qualitative study on attitudes of women diagnosed with fetal abnormalities. An audit has recently been completed on pregnancy outcomes in women with cardiac valve replacements who use warfarin during pregnancy. Protocols to evaluate the use of calcium supplementation in prevention of pre-eclampsia are to be implemented in 2011.
Gynaecology is divided into three firms or units:
· Reproductive Medicine, which is headed overall by A/Prof Silke Dyer and Dr Femi Olarogun (Head of Firm), assisted by Dr Linda Walmsely and Dr Malikah Patel (both of the latter are in sub-specialist training). Professor Van Der Spuy is an integral member of this unit. This unit, which is the only unit in the country that provides Infertility services to women using the public sector and is involved in a range of research studies which include:
o Quality of life among infertile women and their partners attending the infertility clinic which is part of a larger study looking at Disability and Infertility and how this impacts on quality of life. This will form the basis of a PhD thesis
o Work on the out-of-pocket payments required by women requesting Assisted Reproduction showed that these expenses often had a catastrophic impact on the households of infertile couples leading to a great deal of social distress. This work is being prepared for publication
o A study of dyslipidaemia in women with Polycystic ovaries (PCOS), as well as genotyping of women with PCOS and uterine fibroids.
o In addition, registrar projects supervised by Professor Van Der Spuy include:
§ Knowledge and access to contraception in women requiring repeat termination of pregnancy,
§ Knowledge and access to contraception among teenagers
§ The prevalence and complications of hysterectomy in a developing country
§ Knowledge and counseling of women with major medical disorders and their contraceptive knowledge and access to services.
§ The impact of selenium deficiency on reproductive failure this MMED has been awarded and the candidate graduated
· Urogynaecology, headed by Dr Stephen Jeffery
o This group performed a meta-analysis on Mini-Sling procedures (for urinary incontinence) and they are now busy with a Cochrane Review on the same subject. They have also developed a collaboration with a colleague in Australia and they are working on a study to prevent injury to the pelvic floor during childbirth. The unit is currently evaluating the role of Urodynamic studies prior to surgery and has acquired state of the art equipment to undertake this study. In addition, they have an ongoing study looking at the use of acupuncture in the treatment of intractable detrussor instability.
· Gynaecology Oncology, headed by Dr Robbert Soeters
o The main thrust of research in this unit is cervical cancer prevention in low resource settings and in 2010 the group continued with a study evaluating the safety and immunogenicity in a randomized double-blind trial of the bivalent HPV vaccine in HIV positive 18 25 year old women. The cohort have been vaccinated and are now in the follow up phase. A large demonstration project of the implementation of HPV vaccination has been developed for implementation in rural Kwazulu Natal in collaboration with Department of Health of KZN. Currently a randomized trial of screening and treating HIV positive women for cervical cancer prevention is in preparation and due to begin March 7th, 2011. A study on the natural history of cervical disease in HIV positive women is ongoing and entering its 7th year.
o In addition, a multicentred study on genotyping African women with cervical cancer was completed in 2010, as well as a study on genotyping women with genital warts in HIV positive and HIV negative women.
o Audits were performed on women with Gestational trophoblastic disease treated over a 10 year period in the unit, as well as women with carcinosarcoma of the uterus during that time period. Both are completed and being prepared for publication. An audit on the value of frozen section for endometrial cancer is also completed.
Undergraduate Education (Headed by A/Professor Athol Kent, and assisted by Dr Vanessa Perrott and Mr Jason Marcus)
This unit is actively developing and plans to become as important to the Department as other specialities such as maternal-fetal medicine and others. Ares of particular interest include appropriate, accurate and predictable assessment of students as well as using IT as a teaching tool. The Faculty is busy re-evaluating the new curriculum developed 10 years ago and our Department is at the forefront of developing innovative and challenging methods of medical education.