Browsing by Author "Gebhardt, G. S."

Now showing 1 - 8 of 8
  • Thumbnail Image
    Item
    The 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.
  • Thumbnail Image
    Item
    Delivery outcomes of patients with pre-eclampsia at 27 - 34 weeks’ gestation at Tygerberg Hospital, Cape Town, South Africa : a retrospective observational study
    (Health & Medical Publishing Group, 2021-04-03) Olivier, S. E.; De Waard, L.; Muller, C. J. B.; Gebhardt, G. S.
    Background. Obstetricians are cognisant of the serious nature of hypertensive disorders in pregnancy. Despite a 17% overall reduction in maternal deaths in South Africa between 2011 and 2016, there was a 14% increase in deaths due to hypertension. Delivery is the only known cure for pre-eclampsia, but the question regarding the safest route of delivery remains difficult to answer. Objectives. To determine the success rate of induction of labour (IoL) in patients with early-onset pre-eclampsia with severe features (EOPES) before 34 weeks’ gestation. Furthermore, the data from the induction group were compared with those of the caesarean delivery (CD) groups where patients were not eligible for IoL. Additional objectives were to identify variables that could influence the success rate, to determine whether any delivery method was associated with increased morbidity, to assess the short-term maternal and neonatal outcomes, and to make recommendations for future decision-making regarding delivery for women with EOPES. Methods. In this single-institution retrospective observational study, all cases in which a decision for delivery was made before 34 weeks 0 days of gestation (or the infant’s birthweight was ≤2 000 g with uncertain gestation) at Tygerberg Hospital, Cape Town, between 1 January and 30 June 2017 were identified from the electronic birth register. The cohort fitting the inclusion criteria was subdivided into IoL and CD groups. Results. From a total of 3 938 deliveries, 168 patients met the inclusion criteria. IoL was indicated in 55 cases, resulting in 20 vaginal deliveries (VDs) (36%) and 35 CDs (64%). The remaining 113 patients were not candidates for IoL; of these, 89 required emergency CDs and 24 had semi-elective CDs. In the IoL group with abnormal umbilical artery Dopplers (UADs) there was 1 VD, and 4 CDs were performed for fetal compromise. Of cases with an estimated fetal weight (EFW) ≤3rd centile, emergency CD was required in 24 (65%), and 8 (22%) were considered for IoL, in 6 of which CD was required. Conclusions. Of the EOPES population, 36% had successful IoL that culminated in VD. VD was more likely to occur with fetal growth appropriate for gestational age. The likelihood of CD increased if the UAD was abnormal, if the EFW was ≤3rd centile or if eclampsia was present. The decision to induce should be considered carefully in these circumstances.
  • Thumbnail Image
    Item
    Failure to perform assisted deliveries is resulting in an increased neonatal and maternal morbidity and mortality : an expert opinion
    (Health & Medical Publishing Group, 2018) Pattinson, R. C.; Vannevel, V.; Barnard, D.; Baloyi, S.; Gebhardt, G. S.; Le Roux, K.; Moran, N.; Moodley, J.
    The need to perform assisted vaginal delivery (AVD) has been regarded as self-evident. In high-income countries, rates of AVD range between 5% and 20% of all births. In South Africa, the rate of AVD is only 1%. This has resulted in increased neonatal morbidity and mortality due to intrapartum asphyxia, and increased maternal morbidity and mortality due to a rise in second-stage caesarean deliveries. In this article, we address the possible causes leading to a decrease in AVD and propose measures to be taken to increase the rates of AVD and subsequently reduce morbidity and mortality.
  • Thumbnail Image
    Item
    Genetic aspects of pre-eclampsia : mutation screening of the low-density lipoprotein receptor, methylenetetrahydrofolate reductase, prothrombin and factor V candidate genes
    (Stellenbosch : Stellenbosch University, 2001-03) Gebhardt, G. S.; Odendaal, H. J.; Hillermann, R.; Kotze, Maritha J.; Stellenbosch University. Faculty of Medicine & Health Sciences. Dept. of Pathology. Anatomical Pathology.
    ENGLISH ABSTRACT: Pre-eclampsia is a condition unique to pregnancy and primarily affects the maternal and placental vascular endothelium. It has significant morbidity and mortality consequences for both mother and infant. Despite global research into the aetiology of the condition, the cause for this condition remains unknown. Several factors, including a strong family history of hypertension in pregnancy point to a familial or genetic component in the pathophysiology of this complication. The purpose of this research project was to investigate candidate genes implicated in endothelial damage. Common methylene-tetra-hydrofolate reductase (MTHFR) gene mutations C677T and A1298C, factor V Leiden mutation R506Q and prothrombin mutation A20210G were investigated in 50 patients with an uncomplicated pregnancy outcome (controls) and 350 patients with various clinical manifestations of preeclampsia, including severe, early onset forms and abruptio placentae. Fasting homocystein levels were determined biochemically on all participants. In addition, 126 consecutive pregnant patients were recruited at booking, fasting lipograms were performed on them as well as mutation screening of 7 common mutations in the low-density lipoprotein receptor gene. This was correlated with eventual pregnancy outcome, and those with an uncomplicated outcome were selected as an additional control group. A significant association between hyperhomocysteinaemia and early onset severe pre-eclampsia could be demonstrated. Mutant allele T of the C677T mutation could be associated with hyperhomocysteinaemia but not with pre-eclampsia whilst mutant allele C of mutation A1298C demonstrated a significant correlation with diastolic blood pressure. In addition, combined heterozygosity for these mutations may serve as a marker for abruptio placentae.
  • Thumbnail Image
    Item
    Maternal deaths from bleeding associated with caesarean delivery : a national emergency
    (Health & Medical Publishing Group, 2016) Fawcus, S.; Pattinson, R. C.; Moodley, J.; Moran, N. F.; Schoon, M. G.; Mhlanga, R. E.; Baloyi, S.; Bekker, E.; Gebhardt, G. S.
    ENGLISH ABSTRACT: Maternal deaths associated with caesarean deliveries (CDs) have been increasing in South Africa over the past decade. The objective of this report is to bring national attention to this increasing epidemic of maternal deaths due to bleeding associated with CD in the majority of provinces of the country. Individual chart reviews of women who died from bleeding at or after CD show that 71% had avoidable factors. Among the steps we can take are to improve surgical skills and experience, especially in rural hospitals, to improve clinical observations in the immediate postoperative period and in the postnatal wards, and to ensure that appropriate oxytocic agents are given to prevent postpartum haemorrhage. CEOs and medical managers of health facilities, district clinical specialists, heads of obstetrics and gynaecology, and midwifery training institutions must show leadership and accountability in providing an appropriate environment to ensure that women who require CD receive the procedure for the correct indications and in a safe manner to minimise risks.
  • Thumbnail Image
    Item
    Mutations in prothrombin and factor V genes do not contribute significantly to placental vasculopathy in a high-risk patient cohort in South Africa
    (Health & Medical Publishing Group, 2002) Hillermann, R.; Gebhardt, G. S.; Isaacs, R.; Steyn, D. W.; Odendaal, H. J.
    During normal pregnancy there are dramatic changes in the coagulation and fibrinolytic systems. There is deposition of fibrin in the uteroplacental walls and fibrinolysis is suppressed. An increase in levels of clotting factors VII, VIII and X and a doubling in the levels of fibrinogen are observed. The end result is the well-described hypercoagulability of pregnancy, protecting the mother against blood loss at delivery, but also predisposing her to possible thrombotic complications. Naturally occurring anticoagulants including antithrombin III and the protein C-thrombomodulin-protein S complex protect against generalised thrombosis. Protein C (with its co-factors protein S and thrombomodulin) inactivates factors V and VIII. Abnormal forms of factor V, such as those arising from DNA mutation, resist such inactivation and thrombosis can result.
  • Thumbnail Image
    Item
    'Reds flags' in antenatal care : fetal movements and fetal growth
    (Health & Medical Publishing Group, 2018) Gebhardt, G. S.
    Poor fetal growth in late pregnancy is a very common cause of stillbirth or fetal distress during labour. It is associated with reduced fetal movements, which can be detected by the mother antenatally. A simple management protocol is suggested that can be implemented at any hospital that has access to basic ultrasound scanning and electronic fetal heart rate monitoring.
  • Thumbnail Image
    Item
    Reducing neonatal deaths in South Africa : progress and challenges
    (Health & Medical Publishing Group, 2018) Rhoda, N.; Velaphi, S.; Gebhardt, G. S.; Kauchali, S.; Barron, P.
    Although current levels of the neonatal mortality rate (NMR) are within reach of the Sustainable Development Goal (SDG) target of 12 per 1 000 live births, the absolute number of deaths is unacceptably high for a lower-middle-income country such as South Africa (SA). Neonatal mortality over the last decade has declined very slowly, and is not commensurate with the level of government investment in healthcare. The recent neonatal mortality rate of 21 per 1 000 live births reported by the SA Demographic Health Survey is of major concern. This paper reviews recent efforts to reduce the neonatal mortality rate, including support for the implementation of neonatal policies and plans, and strengthening programmes to deliver low-cost, high-impact interventions. We review recent estimates of the NMR and causes of neonatal deaths, and discuss how the mortality from preventable causes of death could be reduced. If SA is to meet the SDG target, special attention should be given to the availability of high-impact interventions, providing an adequate number of appropriately trained healthcare providers and a more active role played by ward-based community health workers and district clinical specialist teams.