Browsing by Author "Nel, J. T."

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    Clinical effects of epidural block during labour : a prospective study
    (Health and Medical Publishing Group (HMPG), 1985-09) Nel, J. T.
    The aim of this study was to evaluate the clinical effects of epidural block for pain relief during labour in an obstetric unit which manages mainly high-risk pregnancies. In the majority of the 62 patients studied only 5 ml of a 0,5% solution of bupivacaine was sufficient for effective pain relief. In 75% of patients total pain relief was obtained. complications of the procedure were hypotension in 32% of patients and bladder atony needing catheterization in 19%. The mean fall in blood pressure was greater in patiens with pre-existing hypertension. The incidence of instrumental delivery was 40%, inadequate bearing- down effort being the indication in 54% of these cases. An abnormal fetal heart rate pattern on cardiotocography developed in 13 of 58 fetuses who were monitored internally, while in 3 cases an abnormal pattern became even more abnormal (in one-third of these cases this followed hypotension in the mother). The only statistically significant change in fetal heart rate patterns on cardiotocography was a decrease in the beat-to-beat variability. Epidural block is a very effective form of pain relief during labour but has potentially serious effects, especially in high-risk pregnancies. Precautions to minimize the risk of complications include the administration of intravenous fluid before the procedure and careful monitoring of the patient and her unborn baby. A cardiotocographic monitor is essential for the latter purpose.
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    Morular metaplasia of the endometrium misdiagnosed as adeno-acanthoma in a patient with tubal pregnancy : a case report
    (Health & Medical Publishing Group, 1986) Von der Heyden, U.; Deale, C. J. C.; Nel, J. T.
    A 41-year-old woman underwent a fractional dilatation and curettage for menorrhagia and a diagnosis of adeno-acanthoma was made from the curettings. However, the subsequently hysterectomy and bilateral salpingo-oophorectomy specimen revealed the presence of a clinically undiagnosed tubal pregnancy and extensive immature squamous metaplasia (morules) of the endometrium. No malignancy was present. A review of the original curettings lead to the recognition of the benign lesion already present at that stage. Difficulties in the differential diagnosis are discussed. The presence of endometrial polyps is considered as a possible factor responsible for the morular metaplasia rather than the tubal pregnancy, which seems to be a previously undescribed and interesting coincidence.
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    Thiamine deficiency-induced gestational polyneuropathy and encephalopathy : a case report
    (Health & Medical Publishing Group, 1985) Nel, J. T.; Van Heyningen, C. F.; Van Eeden, S. F.; Labadarios, D.; Louw, N. S.
    A 22-year-old multigravida presented with polyneuropathy and encephalopathy at 18 weeks' pregnancy. After excluding other applicable conditions, the diagnosis of a hyperemesis-induced thiamine deficiency was made. With the necessary vitamin supplementation the patient gradually recovered over a period of 4 months and was delivered of a normal infant at term. Gestational polyneuropathy and encephalopathy due to thiamine deficiency has very rarely been reported. The literature is reviewed with discussion of the differential diagnosis, the treatment and the prognosis.
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    An unusual case of uterine rupture : a case report
    (Health & Medical Publishing Group, 1984) Nel, J. T.
    An unusual case of uterine rupture in a primigravida, in which the left leg of the infant ruptured through the posterior fundal part of the uterus, is presented. No definitive predisposing cause could be found. Some of the clinical signs and symptoms resembled those of abruptio placentae. Recording of internal uterine pressure revealed increased basal tone and frequent small contractions, are as often seen with abruptio placentae. This could possibly have been due to prostaglandin release from the injured decidua.