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Background. Caesarean section (CS) rates are rising worldwide. There is growing concern regarding the possible negative impacts on maternal and fetal health. Objective. To assess birth outcomes of CS v. normal vaginal deliveries (NVD) using the Robson 10-group classification system at a tertiary hospital in Gauteng Province, South Africa. Primary postpartum haemorrhage (PPH), neonatal Apgar scores, neonatal intensive care unit admissions and perinatal deaths were recorded. Methods. A retrospective review of all deliveries for neonates ≥500 g during September and October 2016 was undertaken. A total of 1 443 deliveries were assessed. The data were analysed using Statistical Package for the Social Sciences version 23. Results. There were 730 (50.6%) CSs and 713 (49.4%) NVDs. The greatest contributor to the CS rate was group 5 (15.8%). PPH occurred in 8.3% of women delivered by CS, with an odds ratio (OR) of 1.86 (95% confidence interval (CI) 1.194 -2.900). Additionally, three hysterectomies were performed in the CS group. A significant difference in Apgar scores was found only at 1 minute, with higher scores in the NVD group (CS mean (standard deviation) 7.74 (2.25), and NVD 8.10 (2.11); p=0.002). Eighty-nine (11.6%) neonates delivered by CS required high care admission, with an OR 1.865 (95% CI 1.292 -2.692) for neonates delivered by CS. Conclusion. The CS rate was 50.6%. Performing a CS should be weighed against the risks of the procedure. Although an understanding of some influences on the rate can be obtained, further research into indications, and protocol generation to optimise this rate, are needed to limit maternal and neonatal birth complications.

RESEARCHBackground. Primary umbilical endometriosis (PUE) is a rare condition affecting 0.5 -1% of all cases of extragenital endometriosis. The method of using routine laparoscopic inspection of the pelvis to exclude pelvic endometriosis has been applied extensively over the years. It has been demonstrated that even patients who have had no previous pelvic surgery or caesarean section, and have no symptoms of pelvic endometriosis or history of infertility, have presented with this condition. Objective. To investigate whether patients with PUE should always undergo a laparoscopy to exclude pelvic endometriosis. Methods. The study included women presenting with a history of painful umbilical nodules or bleeding from the umbilical nodule during or after menstruation in the absence of previous surgery either for gynecological disorders or caesarean section. The study began in January 2010 and ended in December 2016. All patients underwent umbilical biopsy confirming the presence of umbilical endometriosis before the diagnostic laparoscopy took place. Results. Fourteen patients with cutaneous (scar) and umbilical endometriosis attended the clinic during the study period. Of these, only six cases (42.8%) met the inclusion criteria of PUE clinically, and underwent diagnostic laparoscopy. Their mean age was 31.1 years (range 23 -48), and the mean parity was 1.1 (range 0 -3), with no history of previous pelvic surgery or caesarean section. Biopsies of the lesions confirmed the presence of endometrial tissue (gland and stroma) and haemorrhage. Diagnostic laparoscopy that took place immediately after the excision of umbilical endometriosis revealed no pelvic endometriosis. Conclusion. A laparoscopy to exclude pelvic endometriosis should not be undertaken in patients who present with PUE, as there is a potential risk of introducing endometriosis into the pelvic cavity. Additionally, there is a risk of exposing the patient to unnecessary intervention and possible complications associated with the procedure. Endometriosis is defined by the presence of functional endometrial glands and stroma outside the endometrial cavity. It is a common gynaecological condition that affects up to 22% of all women (8 -15% of women of reproductive age, and 6% of premenopausal women). [1,2] The aetiology of endometriosis remains unclear; it is considered to be a 'disease of theories' , with its pathophysiology only partially understood. Endometriosis usually occurs within the pelvic cavity. Common locations are the uterine wall, the fallopian tubes, the ovaries and the pelvic peritoneum. [3][4][5] Pelvic endometriosis presents clinically with a triad of symptoms: pain (chronic pelvic pain and dysmenorrhea), menorrhagia and infertility. S Afr J Obstet GynaecolExtrapelvic endometriosis affects up to 15% of patients, and can be found in almost all the organs (such as bowel, bladder, pericardium, pleura and even the brain). Extrapelvic endometriosis has varied signs and symptoms depending on the location. [6][7][8] Cutaneous and umbilical endometri...