Department of Obstetrics and Gynaecology
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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.
- ItemAcute appendicitis in pregnancy(Health and Medical Publishing Group (HMPG), 1975) Rosemann, G. W. E.Acute appendicitis in pregnancy and its treatment are reviewed. Six cases are described. Early surgery is recommended and a conservative watchfulness for more than 4 to 6 hours is condemned.
- ItemAdditional value of advanced neurosonography and magnetic resonance imaging in fetuses at risk for brain damage(John Wiley & Sons, 2020) Van der Knoop, B. J.; Zonnenberg, I. A.; Verbeke, J. I. M. L.; De Vries, S.; Pistorius, L. R.; Van Weissenbruch, M. M.; Vermeulen, R. J.; De Vries, J. I. P.Objective: To assess the additional value of fetal multiplanar (axial, coronal and sagittal) neurosonography and magnetic resonance imaging (MRI) to that of the standard axial ultrasound planes in diagnosing brain damage in fetuses at high risk. Methods: This was a prospective, multicenter, observational study. Women were eligible for participation if their fetus was at risk for acquired brain anomalies. Risk factors were congenital infection, alloimmune thrombocytopenia, fetal growth restriction, trauma during pregnancy, fetal hydrops, monochorionic twins and prior ultrasound finding suggestive of an acquired brain anomaly. Examinations of the fetal brain before birth comprised axial ultrasound and advanced neurosonography biweekly and MRI once. After birth, neonatal cranial ultrasound was performed at < 24 h and at term-equivalent age. Neonatal brain MRI was performed once at term-equivalent age. An expert panel blinded to medical information, including imaging findings by the other methods, evaluated the presence of periventricular echogenicity (PVE) changes, peri- and intraventricular hemorrhage (IVH) and changes in basal ganglia and/or thalami echogenicity (BGTE) on ultrasound, and the equivalent signal intensity (SI) changes on MRI. Conclusions on imaging findings were generated by consensus. The children were followed up with examinations for psychomotor development at 1 year of age, using the Touwen examination and Alberta Infant Motor Scale, and at 2 years of age using Bayley Scale of Infant Development-III (BSID-III) and behavioral, sensory profile and linguistic questionnaires; scores > 1 SD below the mean were considered suspicious for neurodevelopmental sequelae. Results: Fifty-six fetuses were examined, and in 39/56 fetuses, all fetal-imaging modalities were available. PVE/SI changes were observed in 6/39, 21/39 and 2/39 fetuses on axial ultrasound planes, multiplanar neurosonography and MRI, respectively. IVH was found in 3/39, 11/39 and 1/39 fetuses, and BGTE/SI changes in 0/39, 12/39 and 0/39 fetuses, respectively. Outcome was suspicious for neurodevelopmental sequelae in 13/46 infants at 1 year, and at 2 years, 41/41 children had scores within 1 SD of the mean on BSID-III and 20 had scores > 1 SD below the mean on the behavioral (5/38), sensory profile (17/37) and/or linguistic (6/39) questionnaires. Conclusions: In this cohort of fetuses at risk for brain damage, the severity of acquired brain anomalies was limited. Nevertheless, multiplanar neurosonography detected more fetal PVE changes, IVH and/or BGTE changes compared to the standard axial ultrasound planes and MRI. Fetal MRI did not demonstrate any anomalies that were not seen on neurosonography. Neurodevelopmental outcome at 2 years of age showed no or mild impairment in most cases. © 2019 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
- ItemAdenocarcinoma of the stomach in pregnancy - Ultrasonographic diagnosis: A case report(Health & Medical Publishing Group, 1987-04) Muller, L. M. M.ENGLISH ABSTRACT: The ultrasonographic findings in a rare case of adenocarcinoma of the stomach in pregnancy are described. The patient presented with hyperemesis gravidarum in the second trimester.
- ItemAdult circumcision in the prevention of HIV/AIDS(Health & Medical Publishing Group, 2014-01) Goldstuck, Norman D.No abstract.
- ItemAntenatal detection of small-for-gestational-age babies : choice of a symphysis-fundus growth curve(Health & Medical Publishing Group, 1988) Pattinson, R. C.By using symphysis-fundus measurements serially and plotting them on a curve, small-for-gestational-age babies can be detected. To determine which symphysis-fundus curve to choose for our population, the predictive values of three of the commonly used of these growth curves were compared using serial measurements obtained from 97 low-risk obstetric patients with accurate gestational ages. The curves of Calvert and Quaranta had the best sensitivities of 92,9% each compared with Belizan's (85,7%). However, the specificity of Calvert's and Quaranta's curves were poorer being 74,7% and 50,6% compared with 89,2% for Belizan. The positive predictive value for the curves were Belizan 57,1%, Calvert 38,2% and Quaranta 24,1%. The results indicate that for a Third-World urban population Belizan's curve is most suitable.
- ItemAre women with history of pre-eclampsia starting a new pregnancy in good nutritional status in South Africa and Zimbabwe?(BioMed Central, 2018-06-15) Cormick, Gabriela; Betran, Ana Pilar; Harbron, Janetta; Dannemann Purnat, Tina; Parker, Catherine; Hall, David R.; Seuc, Armando H.; Roberts, James M.; Belizan, Jose M.; Hofmeyr, G. JustusBackground: Maternal nutritional status before and during pregnancy is an important contributor to pregnancy outcomes and early child health. The aim of this study was to describe the preconceptional nutritional status and dietary intake during pregnancy in high-risk women from South Africa and Zimbabwe. Methods: This is a prospective observational study, nested to the CAP trial. Anthropometric measurements before and during pregnancy and dietary intake using 24-h recall during pregnancy were assessed. The Intake Distribution Estimation software (PC-SIDE) was used to evaluate nutrient intake adequacy taking the Estimated Average Requirement (EAR) as a cut-off point. Results: Three hundred twelve women who had pre-eclampsia in their last pregnancy and delivered in hospitals from South Africa and Zimbabwe were assessed. 73.7 and 60.2% women in South Africa and Zimbabwe, respectively started their pregnancy with BMI above normal (BMI ≥ 25) whereas the prevalence of underweight was virtually non-existent. The majority of women had inadequate intakes of micronutrients. Considering food and beverage intake only, none of the micronutrients measured achieved the estimated average requirement. Around 60% of pregnant women reported taking folic acid or iron supplements in South Africa, but almost none did so in Zimbabwe. Conclusion: We found a high prevalence of overweight and obesity and high micronutrient intake inadequacy in pregnant women who had the previous pregnancy complicated with pre-eclampsia. The obesity figures and micronutrient inadequacy are issues of concern that need to be addressed. Pregnant women have regular contacts with the health system; these opportunities could be used to improve diet and nutrition.
- ItemAssisted reproduction in the HIV-serodiscordant couple(Health & Medical Publishing Group, 2007-01) Nosarka, S.; Hoogendijk, C. F.; Siebert, T. I.; Kruger, T. F.ENGLISH ABSTRACT: No abstract available
- ItemAssisted reproductive technology in South Africa : first results generated from the South African Register of Assisted Reproductive Techniques(Health and Medical Publishing Group (HMPG), 2012-03) Dyer, S. J.; Kruger, T. F.Objective. We present the first report from the South African Register of Assisted Reproductive Techniques. Methods. All assisted reproductive technology (ART) centres in South Africa were invited to join the register. Participant centres voluntarily submitted information from 2009 on the number of ART cycles, embryo transfers, clinical pregnancies, age of female partners or egg donors, and use of fertilisation techniques. Data were anonymised, pooled and analysed. Results. The 12 participating units conducted a total of 4 512 oocyte aspirations and 3 872 embryo transfers in 2009, resulting in 1 303 clinical pregnancies. The clinical pregnancy rate (CPR) per aspiration and per embryo transfer was 28.9% and 33.6%, respectively. Fertilisation was achieved by intracytoplasmic sperm injection in two-thirds of cycles. In most cycles, 1 - 2 embryos or blastocysts were transferred. Female age was inversely related to pregnancy rate. Conclusion. The register achieved a high rate of participation. The reported number of ART cycles covers approximately 6% of the estimated ART demand in South Africa. The achieved CPRs compare favourably with those reported for other countries.
- ItemAn audit of stillborn babies in mothers with diabetes mellitus at a tertiary South African Hospital(Taylor & Francis, 2019-12) Hall, David R.; Masona, Deidre; Gebhardta, Gabriel; Rossouw, Jana Nicolene; Obstetrics & GynaecologyObjectives and design: This study is a retrospective audit spanning six years following the implementation of a new guideline on the management of diabetes in pregnancy. It aims to describe the patient profile of pregnancies complicated by diabetes and stillbirth. Setting: The study was performed in Tygerberg Hospital, Cape Town, a secondary and tertiary referral centre. Subjects: Fifty-eight pregnancies were complicated by stillbirth (> 500 g). Outcome measures: the patient profile, gestational age, co-morbidities, foetal/placental monitoring and avoidable factors were described. Results: Many patients (32%) booked after 24 weeks’ gestation and missed appointments were common (26.2%). Stillbirths ascribed to diabetes constituted 2.3% of all stillbirths at the hospital during the study period. Of the stillbirths 28.1% had Type I diabetes mellitus (DM), 64.9% had Type II and 7.0% were in patients with gestational diabetes. The median HbA1c at delivery was 8.4% (range 6.0–14.1%). In the Type II group, 31 (77.5%) of the stillbirths occurred after 36 weeks, while those among the Type I cases ranged from 26 to 38 weeks. Conclusion: Stillbirths amongst pregnant women with diabetes constituted a small percentage of the total stillbirth burden. Emphasising the importance of appropriate antenatal care to women with diabetes and increased surveillance from 36 weeks’ gestation may lower the number of stillbirths.
- ItemAudit of term elective caesarean section outcomes at Tygerberg Academic Hospital(Stellenbosch : Stellenbosch University, 2021-12) De Jager, Kobie; Geerts, Lutgart Therese Gaston Maria; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.ENGLISH ABSTRACT: Aim The aim of this study was to determine the proportion of patients intended for elective caesarean section (ELCS) at 39+0 weeks who are converted to emergency caesarean sections (EMCS) or normal vaginal delivery (NVD) and risk factors associated with these. Materials and Methods This retrospective observational study was conducted at Tygerberg Academic Hospital (TAH) which is a secondary and tertiary level hospital. Data was collected for all patients eligible for ELCS at 39+0 weeks with certain gestational age (GA). Data was collected on antenatal, peri- partum and post-partum information on maternal and neonatal outcome. Results Of the 307 patients who were eligible for ELCS at ≥ 39 weeks, 76 (24.8%) went into labour before their planned surgery date, 110 (35.8%) had their surgery postponed, 99 (32.2%) ended their pregnancy with an EMCS and 2 (0.7%) with NVD. There was no significant difference in the mean GA at delivery for patients in labour (39+1, SD 4 days) and patients who did not go into labour (39+1, SD 4 days) (p = 0.4). There was no significant difference in maternal or neonatal outcomes between groups who delivered < 39+0 weeks and 39+0 weeks. Conclusion ELCS theatre list over-run is a common problem in obstetric units and our setting is no exception. Considering there was no significant difference in maternal or neonatal outcome between groups that delivered at < 39+0 weeks and 39+0 weeks we could consider booking ELCS at a marginally earlier gestational age to reduce the rate of conversion to EMCS.
- ItemAvoiding paternalism but not moral perplexity(Health & Medical Publishing Group, 2018) Hall, D. R.Maternal autonomy has replaced medical paternalism, but conflicts between beneficence and autonomy persist.
- 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.
- ItemBone involvement in patients with cervical carcinoma – a single institution cohort study(Stellenbosch : Stellenbosch University, 2019-04) Butt, Jennifer Leigh; Botha, Matthys Hendrik; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.Introduction Bony metastases in cervical carcinoma are rare, occurring on average in 4.6% of patients. Autopsy studies indicate that it is underdiagnosed. It is important to recognise bony infiltration as palliative radiotherapy can relieve pain and prevent pathological fractures. As survival after the diagnosis of bone involvement is short, an appropriate palliative care plan should be tailored according to the patients’ limited prognosis. Methods A retrospective cohort analysis of women with cervical cancer, diagnosed between January 2014 and December 2015, was undertaken. Demographic, treatment and follow up data were collected for all women with bone metastases confirmed by imaging. Descriptive statistics were generated. Results The cohort study identified 642 patients with cervical carcinoma, of which 25 (3.89%) were diagnosed with bone involvement. Ten patients had bone involvement at diagnosis of cervical cancer and 15 had bone metastases at recurrence, occurring a median of 286 days after primary treatment. Survival after the diagnosis of bone metastases was short, with 88% of patients dying within the first 6 months. Women with a low WHO performance status at diagnosis of bone metastases had a significantly shorter survival (p=0.024). When a previously described prognostic score was applied, those with a high score had a significantly shorter survival (median 61 days) than those with a low score (median 158 days) (p=0.0065). Conclusions Although bone metastases are rare in women with cervical cancer, they are important to recognise as radiotherapy is a useful modality for palliating bone pain and reducing pathological fractures. Health care workers should be vigilant, especially during the first 2 years of follow up, to increased analgesic use and chronic pain as these may indicate bone involvement. Use of a prognostic score is valuable in tailoring treatment and counselling patients and their families with regard to survival. Survival after the diagnosis of bone involvement is short and a patient’s quality of life may be greatly improved by an appropriate radiotherapy and palliative care plan.
- ItemBreech deliveries in Tygerberg Academic Hospital : maternal and neonatal outcomes of vaginal and abdominal deliveries - a case-controlled study(Stellenbosch : Stellenbosch University, 2011-12) Lindeque, L. X.; Theron, G. B.; Stellenbosch University. Faculty of Health Sciences. Dept. of Obstetrics and Gynaecology.ENGLISH ABSTRACT: The Objective: To review the difference in short term neonatal and maternal outcomes among singleton infants with breech presentation delivered by vaginal or elective caesarean section route at term, at Tygerberg Academic Hospital (TBH) in Cape Town. The study design was a retrospective case control study. Method: Part I A total of 120 patients were selected. 60 vaginal breech deliveries and 60 elective caesarean sections for breech presentation (comprising the control group). 60 cases of vaginal deliveries were collected and 60 control cases of planned elective caesarean sections, where the indication for CS was breech presentation, were collected in the same manner. Part II Nineteen registrars completed a questionnaire regarding their subjective experiences of vaginal breech deliveries at Tygerberg Academic Hospital. Results: Part I An analysis of the results found statistically significant differences in maternal ages between the two groups, with younger women delivering by CS; gravidity and parity was lower in the CS group; blood loss was observed to be higher in the CS group with more women requiring a blood transfusion when compared to vaginal delivery; there were more neonatal admissions in the vaginal delivery group as well as more birth trauma, neonatal seizures and death in this group; Apgar scores were higher in the CS group and finally, neonates born by CS were more commonly discharged at the same time as their mothers in the CS group. Part II When analyzing the registrar questionnaire it can be noted that although clinicians are performing an adequate number of breech vaginal deliveries, with an average of 10 deliveries per year, the skills training for clinicians is invaluable. Not all registrars learned skills from a senior clinician and skills training in skills labs are essential for initial and even continual training of these clinicians. It is suggested that these skills training programs be made compulsory for all registrars and that a biyearly attendance and completing of such a course be mandatory for those wishing to work in the labour ward. Conclusions: Although not statistically significant, there was more morbidity and mortality associated with vaginal breech delivery.
- ItemC-reactive protein levels in ectopic pregnancy, pelvic infection and carcinoma of the cervix(Health & Medical Publishing Group, 1986-05) Theron, G. B.; Shepherd, E. G. S.; Strachan, A. F.ENGLISH ABSTRACT: The value of C-reactive protein (CRP) levels in the differential diagnosis of pelvic infection and ectopic pregnancy, in the staging of carcinoma of the cervix, and after necrotizing irradiation for tumour was assessed. CRP was measured using a sensitive magnetizable solid-phase immunoradiometric assay. There was an obvious difference in CRP levels between patients with ectopic pregnancies and acute pelvic infections, but CRP levels failed to differentiate between stages IIB and IIIB carcinoma of the cervix, the majority of patients not having a significant acute-phase response. During radiotherapy there was wide variation and substantial individual differences in CRP levels which could have been caused by undiagnosed infective complications.
- ItemCaesarean section - etymology and early history(Health and Medical Publishing Group, 2009-09) Van Dongen, Pieter Willem J.ENGLISH ABSTRACT: The expression caesarean section (CS) is most probably creative etymology and not derived from the CS allegedly performed on the mother of Julius Caesar. Mythology and legends emphasise the importance of being 'superhuman' if delivered by CS, and therefore avoid mentioning normal vaginal delivery. Many religions describe procedures to be followed after death as a result of CS. The first reliable account of a CS was in 1610 in Germany. The first successful CSs, i.e. proven survival of mother and child, were described in The Netherlands (1792), South Africa (1826), UK (1834), USA (1835) and Germany (1841). Maternal mortality decreased rapidly in the last quarter of the 19th century owing to new techniques, such as closing the uterine wound, drainage, asepsis, anti-sepsis, and elective CS.
- ItemA case series of post-partum haemorrhage managed using Ellavi uterine balloon tamponade in a rural regional hospital(AOSIS, 2021-05) Theron, Gerhard B.; Mpumlwana, VulikayaUterine balloon tamponade (UBT) should be attempted once emergency measures have been applied and medical treatment for post-partum haemorrhage (PPH) resulting from an atonic uterus has failed. Sinapi Biomedical (Pty) Ltd developed the Ellavi UBT, a free-flow pressure-controlled UBT unit. The device is affordable for use in lesser-resourced countries. A case series of Ellavi UBT used by medical officers in a rural regional hospital without specialist supervision was conducted. This case series was conducted in St Elizabeth’s Hospital in Lusikisiki, South Africa. The hospital serves as the regional hospital for the Ingquza Hill Subdistrict in the Eastern Cape Province. The Nelson Mandela Academic Hospital (NMAH) in Mthatha is the tertiary referral hospital. Workshops were conducted on the use of Ellavi UBT, and devices were made freely available to the hospital. The case series included 10 patients. Six patients delivered by caesarean section, and four had normal vertex deliveries. All patients had additional oxytocin infusions, and eight patients received misoprostol. Following the insertion and inflation of the Ellavi UBT, the PPH stopped in seven patients, was much reduced in one patient and reduced in one patient. In one case, the Ellavi UBT had no effect on the bleeding. All 10 patients were referred to the NMAH. All patients in the case series had good outcomes. The insertion of the Ellavi UBT and subsequent referral proved to be feasible in a rural regional hospital. All patients included in the case series arrived at the referral hospital and had a good outcome.
- ItemA centile chart for birth weight for an urban population of the Western Cape(Health and Medical Publishing Group (HMPG), 1995-12) Theron, G. B.; Thompson, M. L.Evidence from large epidemiological studies has supported concern that being born light for gestational age (LiGA) may be detrimental. The incidence of LiGA babies is an important indicator of the health of women of reproductive age in deprived communities. In the assessment of LiGA in the Western Cape, centile charts constructed for populations in other parts of the world are generally used. These charts, however, may not be appropriate. Patients residing in the area served by the Tygerberg Hospital obstetric service, who booked early with singleton pregnancies, had their gestational age confirmed by early ultrasound and delivered between 1 March 1989 and 28 February 1990 were included in the study. The sample consisted of 3 643 patients. The mean birth weight was 2 995 g (SD 573 g) and the range 760-5 080 g. The distribution of birth weight at each week of gestation from 28 to 42 weeks was not normal. The 4-parameter Johnson family of densities was used to model the distribution of birth weight at each gestational age. A comparison of the distribution of birth weight in the study relative to the perinatal growth chart for international reference constructed by Dunn was also made. In addition to considering an overall chart, the sample was subdivided according to a number of characteristics (e.g. gender, firstborn and latter-born babies, smoking habit, hypertensive disorders and induction of labour) in order to explore their impact on the distribution of birth weight. Having explored the potential impact of all these factors, it was concluded that a single chart including all patients could be constructed.
- ItemA centile chart for fetal weight for gestational ages 24 - 27 weeks(Health and Medical Publishing Group (HMPG), 2008) Theron, G. B.; Geerts, L.; Thompson, M. L.; Theron, A. M.The centile chart currently in use for Western Cape birth weight for gestational age covers a gestational age range from 28 to 42 weeks. Advances in maternal, fetal and neonatal medicine allow interventions prior to 28 weeks; a growing need therefore exists to extend the chart down to at least 24 weeks.