Development and launch of the first obstetrics and gynaecology master of medicine residency training programme in Botswana.

BACKGROUND: Sub-Saharan Africa (SSA) faces a severe shortage of Obstetrician Gynaecologists (OBGYNs). While the Lancet Commission for Global Surgery recommends 20 OBGYNs per 100,000 population, Botswana has only 40 OBGYNs for a population of 2.3 million. We describe the development of the first OBGYN Master of Medicine (MMed) training programme in Botswana to address this human resource shortage. METHODS: We developed a 4-year OBGYN MMed programme at the University of Botswana (UB) using the Kern's approach. In-line with UB MMed standards, the programme includes clinical apprenticeship training complemented by didactic and research requirements. We benchmarked curriculum content, learning outcomes, competencies, assessment strategies and research requirements with regional and international programmes. We engaged relevant local stakeholders and developed international collaborations to support in-country subspecialty training. RESULTS: The OBGYN MMed curriculum was completed and approved by all relevant UB bodies within ten months during which time additional staff were recruited and programme financing was assured. The programme was advertised immediately; 26 candidates applied for four positions, and all selected candidates accepted. The programme was launched in January 2020 with government salary support of all residents. The clinical rotations and curricular development have been rolled out successfully. The first round of continuous assessment of residents was performed and internal programme evaluation was conducted. The national accreditation process was initiated. CONCLUSION: Training OBGYNs in-country has many benefits to health systems in SSA. Curricula can be adjusted to local resource context yet achieve international standards through thoughtful design and purposeful collaborations.

Obstetric outcome after failed termination of pregnancy--a report of two cases.

Unsuccessful therapeutic abortion resulting in continued viability of the fetus is rare. No case of a live birth after unsuccessful vacuum curettage has been published. We report two cases with persistent pregnancies after failed termination, with outcomes complicated by premature rupture of membranes and preterm delivery.

Ultrasound evaluation of cervical shortening after loop excision of the transformation zone (LETZ).

OBJECTIVES: To assess cervical shortening after loop excision of the transformation zone (LETZ), and confirm the validity of ultrasound measurement of cervical length. METHODS: Subjects (n = 29) were patients at the colposcopy clinic of Beth Israel Hospital who underwent vaginal ultrasound measurement of cervical length before and after LETZ. The pathologic specimen was measured by ruler. Mean cervical length (+/- S.D.), mean percentage (+/- S.D.) of cervical length removed, and correlation (r) between ultrasound and pathology specimen measurement were determined. RESULTS: Mean (+/- S.D.) cervical length measurements prior to LETZ were 3.2 +/- 0.9 cm and after LETZ were 2.6 +/- 0.9 cm, with a difference of 0.7 +/- 0.4 cm. The pathologic specimen (mean +/- S.D.) was 0.6 +/- 0.3 cm. The correlation between ultrasound and pathology measurement was r = 0.9 (p = 0.0001). Mean (+/- S.D.) cervical length was shortened by 22 +/- 12%. CONCLUSIONS: There is excellent correlation between ultrasound and ruler measurement of the cervix. There is significant cervical length shortening after LETZ, but further study is needed to see whether this persists or leads to pregnancy complications.

Deep venous thrombosis treated with an inferior vena cava filter in a pregnant woman after recent neurosurgery. A case report.

A pregnant woman developed iliofemoral thrombosis several weeks after neurosurgery; anticoagulation was contraindicated. The thrombosis was treated successfully with an inferior vena cava filter.

The role of obstetrical medical technology in preventing low birth weight.

Technology plays an important role in the practice of medicine, and it is essential that controlled clinical trials be conducted before new technologies are widely disseminated. In this article, information from the medical literature is summarized and critiqued for several common obstetric technologies which are aimed at reducing the incidence or sequelae of low birth weight and preterm birth. These technologies include home uterine activity monitoring, tocolytic drugs to suppress uterine contractions, corticosteriods to accelerate fetal lung maturity, bed rest to prevent preterm delivery, delivery methods, multifetal pregnancy reduction, and cervical cerclage. A major challenge to the practice of medicine is to find effective ways to modify physician behavior to encourage the use of proven, effective technologies, and discourage the use of unproven, ineffective technologies. Despite widespread use, most obstetrical technologies appear to have had little impact on reducing the incidence of low birth weight or preterm births, as rates of low birth weight and preterm birth have not decreased appreciably in the past 25 years. Uncovering the basic mechanisms responsible for the onset of preterm labor will undoubtedly facilitate the discovery of new technologies to prevent low birth weight and preterm births.