Browsing by Author "Odendaal, H. J."
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- ItemAcceleration patterns of the fetal heart rate before and during labour(Health and Medical Publishing Group (HMPG), 1977-12) Odendaal, H. J.; Sandenbergh, H. A.In infants in whom accelerations of the fetal heart rate were present during the first stage of labour, the incidence of low Apgar scores was significantly less than in those in whom accelerations were not present. Absence of acceleration patterns during the contraction stress test (CST) was associated with a lower birth weight. In patients in whom acceleration patterns were observed during a positive CST, fetal distress occurred in the minority of subsequent labours. When accelerations as well as late decelerations are observed during a CST, the possibility of a false positive test should be excluded.
- ItemThe association between preterm labour, perinatal mortality and infant death (during the first year) in Bishop Lavis, Cape Town, South Africa(Health & Medical Publishing Group, 2019) Brink, L. T.; Gebhardt, G. S.; Mason, D.; Groenewald, C. A.; Odendaal, H. J.Background. We present further analyses from the Safe Passage Study, where the effect of alcohol exposure during pregnancy on sudden infant death syndrome and stillbirth was investigated. Objectives. To describe pregnancy and neonatal outcome in a large prospective study where information on the outcome of pregnancy was known in >98.3% of participants and ultrasound was used to determine gestational age (GA). Methods. As part of the Safe Passage Study of the PASS Network in Cape Town, South Africa, the outcomes of 6 866 singleton pregnancies were prospectively followed from recruitment in early pregnancy until the infant was 12 months old to assess pregnancy outcome. Fetal growth was assessed by z-scores of the birth weight, and GA at birth was derived from early ultrasound assessments. The effects of fetal growth restriction and preterm delivery on pregnancy outcome were determined. Results. There were 66 miscarriages, 107 stillbirths at ≥22 weeks’ gestation, 66 stillbirths at ≥28 weeks’ gestation, 29 and 18 neonatal deaths at ≥22 and ≥28 weeks’ gestation, respectively, and 54 post-neonatal deaths (28 days - 12 months). The miscarriage rate was 9.6/1 000 and the infant mortality rate 12.4/1 000. Of the births, 13.8% were preterm. For deliveries at ≥22 and ≥28 weeks, the stillbirth rates were 15.7 and 9.8/1 000 deliveries, respectively. For deliveries at ≥22 and ≥28 weeks, the neonatal death rates were 4.3 and 2.7/1 000 live births, respectively. For these pregnancies the perinatal mortality rates were 20.0/1 000 (≥22 weeks) and 12.5/1 000 (≥28 weeks), respectively. Only 15.9% of stillbirths occurred during labour (in 15.9% of cases it was uncertain whether death had occurred during labour). In the majority of cases (68.2%) fetal death occurred before labour, and 82.2% of stillbirths and 62.1% of neonatal deaths occurred in deliveries before 37 weeks. Including the miscarriages, stillbirths and infant deaths, there were 256 pregnancy losses; 77.3% were associated with deliveries before 37 weeks. Only 1.8% of all the women were HIV-positive, whereas the HIV-positive rate was 3.7% among those who had stillbirths. Birth weight was below the 10th centile in 25.6% of neonatal and post-neonatal deaths compared with 17.7% of survivors. Conclusions. Preterm birth and fetal growth restriction play significant roles in fetal, neonatal and infant losses.
- ItemBereaved mothers' attitudes regarding autopsy of their stillborn baby(Health and Medical Publishing Group, 2017-12) Human, M.; Goldstein, R. D.; Groenewald, C. A.; Kinney, H. C.; Odendaal, H. J.Background. Here we present additional information from the Safe Passage Study, where the effect of alcohol exposure during pregnancy on sudden infant death syndrome and stillbirth was investigated. Objective. To explore bereaved mothers’ attitudes toward obtaining an autopsy on their stillborn baby, and the future implications of consenting or non-consenting to autopsy in retrospect. Methods. Demographic data was obtained by a questionnaire. A largely qualitative mixed-methods approach was used to meet the aims of the study, using an exploratory and descriptive research design to provide a detailed description of maternal attitudes. A semistructured questionnaire based on information from literature and reflections on practice was administered during individual interviews. Results. We interviewed 25 women who had had a recent stillbirth. The time interval between the time of consenting to autopsy and completing this study ranged from 6 to 18 months. Most participants reported that autopsy results provided peace of mind and helped alleviate their feelings of blame. Participants who were unable to comprehend the results reported negative reactions to receiving autopsy results. The majority of participants were of the opinion that they benefited from consenting to autopsy. Conclusion. Autopsy and the disclosure of its results generally contribute positively to coping following stillbirth.
- ItemClinical experience with the contraction stress test(Health & Medical Publishing Group, 1977) Sandenbergh, H. A.; Odendaal, H. J.During a period of 16 months, 1 170 contraction stress tests (CST) were performed on 767 women who were at high risk of losing their babies. The tests were positive in 42 patients, of whom 29 were subsequently delivered by caesarean section. Fetal distress, which necessitated caesarean section, occurred in 5 of 6 cases of intra-uterine growth retardation in which labour was induced. Abruptio placentae caused the intra-uterine death of 4 fetuses, 3 of which died within 7 days of a negative CST. The low perinatal mortality rate of 13 demonstrates the reliability of the CST in the evaluation of placental function in obstetric patients who are at high risk.
- ItemComparison between a newly developed PC-based Doppler umbilical artery waveform analyser and a commercial unit(Health and Medical Publishing Group (HMPG), 2005-01) Theron, G. B.; Theron, A. M.; Odendaal, H. J.; Bunn, A. E.Objectives. To determine the accuracy of the resistance index (RI) of flow velocity waveforms of the umbilical artery measured using a newly developed PC-based continuous wave Doppler device (Umbiflow) with regard to systematic and random variations when compared with a commercial standard (Vasoflow). Design. A cohort study. Setting. The fetal evaluation clinic (FEC) at Tygerberg Hospital. Subjects. Patients referred to the FEC at Tygerberg Hospital with suspected chronic placental insufficiency. Outcome measures. The correlation coefficients indicating the strength of the relationship between the two devices and their agreement using the method of Bland and Altman. Results. A total of 248 patients were studied. The mean RIs of the first Doppler assessment were 0.69 (standard deviation (SD) 0.11) and 0.67 (SD 0.11) using the Vasoflow and Umbiflow respectively. The Pearson's correlation coefficient comparing the RI of the first test was 0.85. The degree of agreement between the two methods was excellent, the mean differences being very small (< 0.024) with tight confidence intervals. One hundred and ninety-four patients (78.2%) of patients remained in the same percentile category with both the Vasoflow and Umbiflow. Conclusions. The accuracy of the Umbiflow has been proved. A non-significant trend towards slightly lower values needs to be considered. This could be addressed by changing the percentile cut-off to slightly lower values.
- ItemComparison between umbilical artery and vein endogenous digoxin-like immuno-active factor levels in normal and pre-eclamptic patients(Health & Medical Publishing Group, 1991) Schabort, I.; Odendaal, H. J.; Lombard, C. J.; Bredell, L.Recent studies have pointed to the existence of an endogenous digoxin-like immuno-active factor (DLIF), which may be associated with hypertension and pre-eclampsia. The DLIF levels in the umbilical venous and umbilical arterial blood of neonates, as well as the maternal serum of primigravidas and multigravidas with and without pre-eclampsia, were determined by means of a commercially available radioimmunoassay kit, which is cross-reactive with DLIF, in 44 mothers and their babies in search for a possible placental, fetal or maternal origin of the DLIF. The mean placental and neonatal masses were significantly lower in the pre-eclampsia group than in the control group (P < 0,01). However, the DLIF levels in the maternal serum, umbilical cord venous and umbilical cord arterial serum were statistically significantly higher in the pre-eclampsia group than in the control pregnant group (P < 0,05). A very strong correlation was found between umbulical cord venous and arterial DLIF levels (r = 0,90; P = 0,001, Spearman rank-correlation coefficient). Although the mean DLIF level in cord arterial serum was lower than that of cord venous serum, statistical significance was not reached if the Bonferroni adjustment was applied to the P value.
- ItemContinuous monitoring of uterine contractions to control intra-amniotic administration of prostaglandin F2α for therapeutic and missed abortion(Health & Medical Publishing Group, 1981) Roux, C. J.; Odendaal, H. J.Intra-amniotic prostaglandin F2α (PFG2α) was administered to 10 patients for midtrimester therapeutic abortion and to 20 patients for missed abortion. An epidural catheter was placed into the amniotic cavity and the other end was connected to a physiological pressure transducer to measure the uterine contractions continuously. The dosage was adjusted according to the uterine contractions, and was therefore individualized for each patient. Half the patients with therapeutic abortion required PGF2α 30 mg or less, and only 20% of patients with missed abortion needed more than 30 mg. Complications such as uterine cervical lacerations could be prevented by administration of the correct dosage of prostaglandin in each case.
- ItemDoctors' attitudes and practices regarding smoking cessation during pregnancy(Health and Medical Publishing Group (HMPG), 2005-05) Everett, K.; Odendaal, H. J.; Steyn, K.Objective. To investigate the current smoking cessation practices and attitudes of doctors working in the public antenatal services, as well as their perceived barriers to addressing the issue in the context of routine care. Study design. The study was qualitative, consisting of 14 semi-structured, one-to-one interviews with doctors purposefully sampled from 5 public sector hospitals in Cape Town, South Africa. Results. The doctors in this study regarded HIV, poor nutrition, alcohol abuse and psychosocial stress as equal or higher risks to pregnant women than smoking. They tended to underestimate the magnitude of the risk of smoking during pregnancy. Doctors were unaware of the guidelines offering clinicians brief, structured approaches to smoking cessation counselling and were generally pessimistic that they could influence the smoking behaviour of pregnant women, especially poor, disadvantaged women who face multiple barriers to achieving health-enhancing behaviour. However, most doctors were concerned about improving their communication with pregnant women about smoking and open to adopting new approaches or tools that could assist them. Perceived barriers to providing smoking cessation interventions included a lack of counselling skills and educational resources, other pressing priorities, too little time, and the levels of stress currently experienced by doctors and midwives working in public sector hospitals as a result of dramatic staff and budget cuts. Conclusion. The study suggests that doctors working in the public sector antenatal services are not routinely addressing the issue of smoking during pregnancy or using effective methods to assist women to give up smoking. Doctors need convincing that smoking cessation interventions can be effective. The promotion and provision of evidence-based guidelines such as the Clinical Practice Guideline for Treating Tobacco Use and Dependence (Fiore, 2000), with minimal training, is a possible strategy for integrating smoking cessation interventions into routine antenatal care in South Africa.
- ItemDoes coupling of uterine contractions reflect uterine dysfunction?(Health & Medical Publishing Group, 1994) Ferreira, C. J.; Odendaal, H. J.In a cohort analytical study 47 primigravidas in spontaneous normal labour at term were divided into two groups depending on the presence or absence of coupled uterine contractions during active labour. During monitoring with a pressure tip intra-uterine catheter, 24 patients developed coupled contractions and 23 had a normal contraction pattern. There were no statisfically significant differences between the two groups with regard to maternal age, gestational age, maternal height, fetal weight, head circumference and pelvic size. Patients who developed coupled contractions had a longer duration of labour, a higher uterine activity integral and an increased incidence of caesarean section for failure to progress. Because coupling of uterine contractions may be indicative of dysfunctional uterine activity, and hence a prolonged first stage of labour, failure to progress during labour in these patients should be interpreted with caution in order to avoid the incorrect diagnosis of cephalopelvic disproportion.
- ItemEarly detection of poor fetal prognosis by serial Doppler velocimetry in high-risk pregnancies(Health & Medical Publishing Group, 1991) Pattinson, R. C.; Brink, A. L.; De Wet, P. E.; Odendaal, H. J.Fifty-three high-risk pregnancies were followed up serially with Doppler velocimetry of the umbilical artery and uterine vessels from early on to investigate whether abnormalities in Doppler waveforms can predict the outcome of pregnancy accurately before other clinical signs develop. Results of Doppler velocimetry were withheld from the clinicians managing the patients. When the absence of end-diastolic velocities was first detected (in 13 fetuses) (AEDV group) there was no clinical difference between these pregnancies and those in which enddiastolic velocities were present (EDV group). Nine of the 13 fetuses with AEDVs died, compared with 3 of 40 with EDVs (P < 0,0001). In deaths associated with AEDVs, the latter were detected a median of 5,5 (range 3-11) weeks before death and are present from the first Doppler examination. In the 4 fetuses with AEDVs that survived, the AEDVs were not persistent. The only significant association of Doppler velocimetry of the uterine vessels was with proteinuric hypertension (P < 0,05), but the prediction was not strong enough to be of clinical value. Persistent AEDVs of the umbilical artery are an accurate predictor of poor fetal outcome and occur before other clinical signs of impending problems.
- ItemFrequent fetal heart-rate monitoring for early detection of abruptio placentae in severe proteinuric hypertension(Health & Medical Publishing Group, 1988) Odendaal, H. J.; Pattinson, R. C.; Du Toit, R.; Grove, D.Abruptio placentae occurred in 16 of 132 patients with severe pre-eclampsia who were admitted to an obstetric high-risk ward before 34 weeks' gestation. These 16 patients were compared with those who did not develop abruptio placentae. Systolic and diastolic blood pressure levels, proteinuria and birth weights did not differ significantly between the two groups. Apgar scores were significantly lower in the abruptio placentae group. There were 6 intra-uterine and 2 neonatal deaths in the abruptio placentae group (50% perinatal mortality (PNM)) and 3 intra-uterine and 16 neonatal deaths in the other group (18% PNM). Four patients with abruptio placentae presented with abnormal fetal heart-rate patterns and 8 with abdominal pain. No warning signs were present in 3 patients and the fetal heart-rate pattern before delivery was not available in 1 patient. Abnormal fetal heart-rate patterns were present in 5 of the 8 patients who presented with pain. Abruptio placentae occurring in patients with severe proteinuric hypertension carries a high PNM. Frequent monitoring of the fetal heart rate sometimes helps to diagnose fetal distress before the clinical signs of abruption become apparent.
- ItemHormonal placental functions and intrauterine growth retardation in patients with positive contraction stress tests(Health & Medical Publishing Group, 1981) Odendaal, H. J.; Malan, C.; Oosthuizen, J.Human placental lactogen (HPL) and urinary and serum oestriol levels were studied in patients in whom the contraction stress test was positive. After birth the infants were assessed for growth retardation. Low PHL, serum oestriol and urinary oestrogen levels were found in 66%, 30% and 15% of patients respectively. Gestational ages were known in 148 patients, of whom 72 (49%) had infants whose weights were below the 10th percentile for gestational age. HPL values were low in 81% of mothers who gave birth to growth-retarded infants, but serum and urinary oestriol levels were low in only 43% and 21% respectively. When both a positive stress test and a low HPL value were present 69% of infants were growth retarded. The incidence of growth retardation rose to 85% when both HPL and serum oestriol levels were abnormal in patients with positive contraction stress tests. In this study estimation of HPL levels was found to be superior to that of oestrogen levels in detecting growth-retarded infants.
- ItemImmunoreactive digitalis-like substance in pre-eclampsia(Health & Medical Publishing Group, 1986) Odendaal, H. J.; Beyers, A. D.; Van Heyningen, C. F.; Spruyt, L. L.; Kotze, T. J. van W.; Van Jaarsveld, P. P.An endogenous digitalis-like substance (DLS) may be involved in the pathogenesis of essential hypertension and pre-eclampsia. The digoxin levels in maternal and cord blood of 504 randomly selected patients were determined. Since none of the patients received digoxin, these levels indicated a cross-reacting substance (immunoreactive DLS). DLS levels were significantly higher in the cord blood of pre-eclamptic patients than in the cord blood of controls. DLS levels in cord blood increased with the severity of pre-eclampsia, and levels were higher in primigravidas than in multigravidas. The structure and biological activity of DLS must be determined before definite conclusions about its role in the pathogenesis of pre-eclampsia can be made.
- ItemThe in vitro fertilisation programme at Tygerberg Hospital and the University of Stellenbosch. Five years' experience, April 1983 - January 1988(Health & Medical Publishing Group, 1990) Kruger, T. F.; Van der Merwe, J. P.; Odendaal, H. J.; Stander, F. S. H.; Grobler, G. M.; Hulme, V. A.; Erasmus, E. L.; Coetzee, K.; Windt, M.-L.; Swart, Y.; Smith, K.; Menkveld, R.The results of the in vitro fertilisation programme at Tygerberg Hospital for the period April 1983 to January 1988 are presented. Of the 1117 laparoscopies performed, 825 patients reached the transfer stage. A live-birth rate of 9.3% was achieved. The pregnancy rate after transfer of 4 embryos was 25,9% compared with 15,4% after 2 embryos and 10,8% after 3 embryos (P = 0.0001). The multiple pregnancy rate was 2.8% in the group receiving 2 embryos and 11.7% and 10,4% in those receiving 3 and 4 embryos, respectively. Of the 77 successful pregnancies (90 babies), 1 baby died at 34 weeks' gestation as the result of abruptio placentae due to preeclampsia and 1 cot death occurred. The only congenital abnormality encountered was a cleft palate.
- ItemIntraiiteriene dood tydens monitor van die fetale harttempo(Health & Medical Publishing Group, 1980) Odendaal, H. J.Stressed and non-stressed antenatal fetal monitoring was carried out 9,520 times in 5,932 high risk-patients. Intrauterine death occurred in 48 patients. In 19 patients the fetus died within 1 week of monitoring but before the onset of labour; the results of monitoring had been normal in 14 of these. Abruptio placentae was the cause of 6 of these deaths. Many of the other causes of intrauterine death were also acute complications such as haemorrhage due to placenta praevia, amniotic fluid infection, and cord prolapse. True false-negative test results were rare, and were seen most often in patients with preeclampsia, diabetes and haemolytic disease. Twin pregnancies also caused a problem, as double recording of the heart rate of the normal fetus could create a false sense of security.
- ItemIntraiiteriene dood tydens monitor van die fetale harttempo(HMPG, 1980-05) Odendaal, H. J.Although the fetal heart rate was being monitored in 16 378 patients during labour, intra-uterine death occurred in 13 cases (0,08%). These fetuses had birth weights of more than 1 000 g. In one patient monitoring was discontinued long before delivery, and fetal death occurred when a partially dilated cervis prevented quick delivery of the fetus which presented by the breech. In all the remaining patients an abnormal fetal heart rate pattern preceded intra-uterine death. Fetal death was probably unavoidable in 4 patients, even with monitoring. Abnormal fetal heart rate patterns were recorded in 2 of these, but the fetuses were estimated as being too small to be delivered by caesarean section. However, they weighed 1 160 g and 1 120 g. The 3rd patient had severe fetal bradycardia on admission and intra-uterine death occurred soon afterwards. The 4th patient refused caesarean section for a prolapse of the umbilical cord, and a vacuum extraction was attempted when the cervix was not yet fully dilated. Severe variable decelerations occurred in 5 of the 8 patients in whom intra-uterine death could have been avoided. Severe bradycardia was present in 3 patients immediately before fetal death, but it may have been present in more patients because the fetal heart rate was not recorded in all cases until death had occurred.
- ItemKetanserin and hydralazine in hypertension in pregnancy : a randomised double-blind trial(Health & Medical Publishing Group, 1995) Rossouw, H. J.; Howarth, G.; Odendaal, H. J.Objectives. To compare ketanserin with hydralazine in the treatment of hypertension in late pregnancy. Study design. Randomised control trial. Ten milligrams ketanserin were compared with 5 mg hydralazine, both given intravenously to 10 patients in each group. Blood pressure, maternal and fetal heart rate and umbilical and arcuate artery Doppler flow velocimetry waveforms were recorded before and every 10 minutes after administration of the drug. Results. No significant differences were found between the two drugs in respect of initial blood pressures and readings taken 10 minutes after each 30-minute administration. One patient in the hydralazine group developed severe hypotension and fetal distress for which a caesarean section was performed. No change in the flow velocity waveforms of umbilical and arcuate arteries was noticed. Conclusion. No unforeseen complications followed the administration of ketanserin. No major differences in the effects of the two drugs could be detected. Ketanserin appears to be safer as no hypotension occurred, and it reduced blood pressure more gradually. As ketanserin could become an alternative to hydralazine, more studies with larger numbers of patients are needed to compare it with hydralazine.
- ItemMore perinatal deaths associated with poor long-term variability during antenatal fetal heart-rate monitoring(Health & Medical Publishing Group, 1990) Odendaal, H. J.Positive stress and non-stress tests of 243 infants were examined for accelerations and the duration of poor long-term variability during fetal heart rate monitoring. Accelerations were present in 47% when the variability was good. No accelerations were seen when poor variability lasted for more than 75% of the monitoring time; this was also associated with lower birth-weights, shorter gestational duration and lower 5-minute Apgar scores. These measurements improved as the period of poor variability decreased. Intra-uterine death occurred in 1,9% of infants when the variability was good, in 3,6% when the variability lasted for less than 75% of the recording time and in 19,6% when the poor variability lasted longer than 75% of the recording time. Neonatal deaths occurred in 7,5% and 21,7% of these three groups, respectively. Poor long-term variability was also associated with growth-retardation.
- ItemMortality rates in low-birth-weight infants born after a positive contraction stress test(Health & Medical Publishing Group, 1980) Odendaal, H. J.Perinatal mortality rates and the indications for contraction stress tests (CSTs) were studied in 46 patients with positive test results and who gave birth to infants weighing between 500 and 1500 g. Severe pre-eclampsia and intra-uterine growth retardation were the indications for the CST in the large majority of patients. The perinatal mortality rate for infants weighing between 500 and 1.000 g was 76.9%, for infants between 1.001 and 1.250 g 38.5%, and only 25% when the infants weighed 1.251-1.500 g. After conservative treatment because of fetal immaturity only 1 of 7 infants was born alive, but after immediate delivery by caesarean section there was a high rate of fatal hyaline membrane disease in infants weighing less than 1.000 g. The real danger of intra-uterine death in the presence of a positive CST result indicates prompt delivery when the fetus has a reasonable chance of survival in the neonatal period.
- ItemObstetric causes for delivery of very-low-birth-weight babies at Tygerberg Hospital(Health and Medical Publishing Group (HMPG), 2003-01) Odendaal, E. S.; Steyn, D. W.; Odendaal, H. J.Objective. To determine the primary reasons for the delivery of very-low-birth-weight (VLBW) babies. Design. Cross-sectional descriptive study. Study period. 1 March 1997 - 31 August 1997. Methods. Data were collected from all mothers who delivered babies weighing 500 - 1499 g. The following primary causes were selected and clearly defined: spontaneous preterm labour, preterm prelabour rupture of membranes, hypertensive disease, antepartum haemorrhage, intrauterine death and congenital abnormalities. A total of 227 patients were admitted to the study. One patient was excluded from the study as the data in her file were inadequate. Of the remaining 226 patients, 210 had singleton pregnancies and 16 had twin pregnancies. In total 242 babies were delivered; however, 6 babies from the twin pregnancies were excluded from the analysis as they had a birth weight exceeding 1 499 g. Results. Primary causes of delivery were hypertensive disease in 101 patients (44.7%), spontaneous preterm labour 65 (28.8%), preterm prelabour rupture of membranes 21 (9.3%), intrauterine death 17(7.5%), antepartum haemorrhage 10 (4.4%), congenital abnormalities 3 (1.3%), and other 9 (4%). Of the hypertensive cases, 43 were delivered for fetal distress, 16 for fetal distress due to abruptio placentae, 20 for material reasons, 19 for intrauterine death and 3 for both fetal and maternal reasons. Conclusion. Hypertention, preterm labour and prelabour rupture of membranes were the main causes of delivery of VLBW babies. Further research should address methods to reduce the number of these deliveries.