Browsing by Author "Pattinson, R. C."
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- 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.
- ItemComplications in 8,509 laparoscopic Falope ring sterilizations performed under local anaesthesia(Health & Medical Publishing Group, 1983) Pattinson, R. C.; Louw, N. S.; Engelbrecht, B.; Nieuwoudt, A. J.During the 3-year period 1 January 1980 - 31 December 1982, 8,509 laparoscopic Falope ring sterilizations were performed under local anaesthesia in rural areas of the Cape Province by the Sterilization Service of Tygerberg Hospital. Despite the fact that 476 of the patients had undergone previous lower abdominnal surgery, major complications (anaphylactic shock after injections of lignocaine and inadvertent perforation of the bladder by the trocar) occurred in only 2 cases. It was not possible to complete the sterilization under local anaesthesia in 98 cases, resulting in a technical failure rate of 1.15%. A prospective study of the minor complications encountered among the 193 patients sterilized during November 1982 showed that torn tubes occrred in 3.1% and uterine perforation in 2.1%. This can be partially explained by the fact that evidence of previous pelvic infection was seen during laparoscopy in 9.3% of cases. The pregnancy rates after sterilization was 0.28% for the group as a whole.
- ItemConservative management of severe proteinuric hypertension before 28 weeks gestation(Health & Medical Publishing Group, 1988-05) Pattinson, R. C.; Odendaal, H. J.; Du Toit, R.Forty-five patients with severe proteinuric hypertension who presented before 28 weeks' gestation were managed conservatively by bed rest, antihypertensive treatment, betamethasone administration after 26 weeks' gestation, and intensive fetal and maternal monitoring. Eleven patients presented before 24 weeks and their babies all died; 34 patients presented at or after 24 weeks and 13 of their babies survived (38%). The indications for delivery were intra-uterine death (13), fetal distress (9), deterioration in the mother's condition (17), and maternal complications - pulmonary oedema in 3 cases and pleural effusion in 1. One patient went into spontaneous labour and one was induced at 34 weeks. At postpartum follow-up examination all the mothers in the group that had presented before 24 weeks were found to have underlying diseases, compared with 42% of those who had presented between 24 and 27 weeks. The low incidence of maternal complications and the relatively good survival rate of 38% indicate that there is a place for conservative management in patients with severe proteinuric hypertension presenting at 24 weeks or later. Termination of the pregnancy should, however, be seriously considered in those patients presenting before 24 weeks' gestation.
- ItemDoppler ultrasonography of the fetoplacental circulation : normal reference values(Health & Medical Publishing Group, 1989) Pattinson, R. C.; Theron, G. B.; Thompson, M. L.; Lai Tung, M.Normal reference values for the resistance index, A/B ratio and pulsatility index of the umbilical artery obtained by Doppler ultrasonography are presented. The resistance index and A/B ratio values are very similar to those previously published, indicating no need for formulate normal values for different populations. The pulsatility index differed from other published values, probably reflecting different calculation methods built into the spectrum analysers rather than differences in waveforms. The resistance index had the lowest coefficient of variation and showed least inter-observer variation. For routine use the resistance index is preferable to other indices.
- 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.
- ItemFailure 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.
- ItemFetal and neonatal outcome in patients with severe pre-eclampsia before 34 weeks(Health & Medical Publishing Group, 1987-05) Odendaal, H. J.; Pattinson, R. C.; Du Toit, R.ENGLISH ABSTRACT: Delivery was delayed until 34 weeks in 129 patients with severe pre-eclampsia, unless the maternal or fetal conditions necessitated earlier delivery. No patient developed eclampsia although all sedation was terminated from 24 hours after admission until labour started, unless there was a sudden change in the patient's clinical condition. Of the 14 fetuses that died in utero, only 4 weighed more than 1000 g at delivery. Three of these 4 already died by the time of the mothers' admission. Abruptio placentae was the cause of 36% of intra-uterine deaths. The perinatal mortality rate was 223/1000. Survival rates for liveborn babies was 47%, 78% and 82% for birth weights of 750-999 g, 1000-1249 g and 1250-1499 g respectively. No neonate died when the birth weight was 1500 g or more.
- 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.
- ItemIncreased placental resistance and late decelerations associated with severe proteinuric hypertension predicts poor fetal outcome(Health & Medical Publishing Group, 1989) Pattinson, R. C.; Kriegler, E.; Odendaal, H. J.; Muller, L. M. M.; Kirsten, G.The flow velocity wave forms generated by Doppler ultrasound examination of the umbilical artery were correlated with feto-placental blood flow and numerically expressed as a ratio between the systolic (A) and the end-diastolic point (B). The technique is non-invasive and simple to perform. A cohort analytical study was done to see whether useful information could be obtained from the A/B ratio that could help in the management of patients with severe proteinuric hypertension. Fifty patients with severe proteinuric hypertension at less than 34 weeks' gestation were studied and serial Doppler ultrasound examinations of the umbilical artery were performed. No ultrasound results were made available to the clinician. An A/B ratio of 6 or greater was regarded as increased. Twenty-eight of the patients had an increased A/B ratio; in this group these 14 infants were small for gestational age, 14 developed late decelerations and there were 12 perinatal deaths. The remaining 22 patients had an A/B ratio of less than 6 and only 3 produced infants which were small for gestational age; 2 fetuses developed late decelerations and there was 1 perinatal death. A significant difference was found between the two groups in respect of these results. The group with an abnormal A/B ratio also experienced more neonatal morbidity. The A/B ratio of the umbilical artery wave form may assist in planning delivery of patients with severe proteinuric hypertension more accurately.
- ItemInfluence of perinatal care on stillbirths in patients of low socio-economic class(Health & Medical Publishing Group, 1988-07) De Jong, G.; Pattinson, R. C.; Odendaal, H. J.ENGLISH ABSTRACT: In a series of 12,587 deliveries in patients of low socio-economic class, there were 356 stillbirths; prospective analysis of these showed that 42.1% occurred in the 4.7% of cases in which the mother had received no antenatal care. When booked and unbooked patients were compared it was found that the rate of stillbirths due to infection and anoxia was significantly higher among unbooked patients, who also accounted for more intra-uterine deaths due to abruptio placentae and congenital abnormalities. We speculate that diet and nutrition might play a major part in the causation of these intra-uterine deaths.
- ItemInter-observer variation in symphysis-fundus measurements : a plea for individualised antenatal care(Health & Medical Publishing Group, 1989) Pattinson, R. C.; Theron, G. B.Two groups of midwives were compared with regard to ability to detect small-for-gestational-age (SGA) babies using symphysis-fundus (S-F) measurements. The patients were all low-risk obstetric patients. In group A 2 midwives provided antenatal care to 97 patients; 14 delivered SGA babies, of which 12 were identified by S-F measurements (sensitivity 85,7%). In group B 15 midwives provided antenatal care to 126 patients, 12 delivered SGA babies, and 5 of these were identified (sensitivity 41,2%). It is considered that this difference was due to inter-observer variability. A plea is made for individualised antenatal care.
- ItemINTERGROWTH-21st v. local South African growth standards (Theron-Thompson) for identification of small-for-gestational-age fetuses in stillbirths : a closer look at variation across pregnancy(Health & Medical Publishing Group, 2019) Lavin, T.; Nedkoff, L.; Preen, D.; Theron, G.; Pattinson, R. C.Background. Global growth standards for fetuses were recently developed (INTERGROWTH-21st). It has been advocated that professional bodies should adopt these global standards. Objectives. To compare the ability of INTERGROWTH-21st with local standards (Theron-Thompson) to identify small-for-gestational-age (SGA) fetuses in stillbirths in the South African (SA) setting. Methods. Stillbirths across SA were investigated (>500 g, 28 - 40 weeks) between October 2013 and December 2016 (N=14 776). The study applied the INTERGROWTH-21st standards to classify stillbirths as <10th centile (SGA) compared with Theron-Thompson growth charts, across pregnancy overall and at specific gestational ages. Results. The prevalence of SGA was estimated at 32.2% and 31.1% by INTERGROWTH-21st and Theron-Thompson, respectively. INTERGROWTH-21st captured 13.8% more stillbirths as SGA in the earlier gestations (28 - 30 weeks, p<0.001), but 4.0% (n=315) fewer between 33 and 38 weeks (p<0.001). Observed agreement and the Kappa coefficient were lower at earlier gestations and at 34 - 36 weeks. Conclusions. Our findings demonstrated differences in the proportion of stillbirths considered SGA at each gestational age between the INTERGROWTH-21st and the local SA standard, which have not been considered previously by other studies.
- ItemThe Magpie study - clinical implications for poor countries(Health & Medical Publishing Group, 2003) Steyn, D. W.; Hofmeyr, G. J.; Jackson, K. C.; Kambaran, A.; MacDonald, P.; Matsela, L.; Moodley, J.; Pattinson, R. C.; Pirani, N. E.; Schoon, M. G.[No abstract available]
- ItemMaternal 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.
- ItemPrimary causes of total perinatally related wastage at Tygerberg Hospital(Health & Medical Publishing Group, 1989-01) Pattinson, R. C.; De Jong, G.; Theron, G. B.The primary obstetric cause of total perinatally related wastage (TPRW) (i.e. all antepartum or postpartum deaths of infants ≥ 500 g and who died before hospital discharge) was studied in a clearly defined population in the western Cape over a 1-year period. There were 302 deaths from 7,923 singletons and 31 deaths from 65 pairs of twins delivered from patients cared for by Tygerberg Hospital maternity services. Thirty per cent of the deaths were late abortions, 42% stillbirths, 18% early neonatal deaths, 7% late neonatal deaths and 4% perinatally related infant deaths. The major primary obstetric events leading to TPRW in singletons were antepartum haemorrhage (27,8%), spontaneous preterm labour (24,8%), unexplained intra-uterine deaths (11,9%), infections (9,3%) and fetal abnormalities (7,9%). Multiple pregnancies accounted for 9,3% of the TPRW of all deliveries. The cause, risk factors associated and methods of prevention of abruptio placentae, spontaneous preterm labour and infections should receive priority in perinatal research in the western Cape.
- ItemStillbirth risk across pregnancy by size for gestational age in Western Cape Province, South Africa : application of the fetuses-at-risk approach using perinatal audit data(South African Medical Association, 2019-11-27) Lavin, T.; Pattinson, R. C.; Nedkoff, L.; Gebhardt, S.; Preen, D. B.Background: There is little published work on the risk of stillbirth across pregnancy for small-for-gestational-age (SGA) and large-for-gestational (LGA) pregnancies in low-resource settings. Objectives: To compare stillbirth risk across pregnancy between SGA and appropriate-for-gestational-age (AGA) pregnancies in Western Cape Province, South Africa (SA). Methods: A retrospective audit of perinatal mortality data using data from the SA Perinatal Problem Identification Program was conducted. All audited stillbirths with information on size for gestational age (N=677) in the Western Cape between October 2013 and August 2015 were included in the study. The Western Cape has antenatal care (ANC) appointments at booking and at 20, 26, 32, 34, 36, 38 and 41 (if required) weeks’ gestation. A fetuses-at-risk approach was adopted to examine stillbirth risk (28 - 42 weeks’ gestation, ≥1 000 g) across gestation by size for gestational age (SGA <10th centile Theron growth curves, LGA >90th centile). Stillbirth risk was compared between SGA/LGA and AGA pregnancies. Results: SGA pregnancies were at an increased risk of stillbirth compared with AGA pregnancies between 30 and 40 weeks’ gestation, with the relative risk (RR) ranging from 3.5 (95% confidence interval (CI) 1.6 - 7.6) at 30 weeks’ gestation to 15.3 (95% CI 8.8 - 26.4) at 33 weeks’ gestation (p<0.001). The risk for LGA babies increased by at least 3.5-fold in the later stages of pregnancy (from 37 weeks) (p<0.001). At 38 weeks, the greatest increased risk was seen for LGA pregnancies (RR 6.6, 95% CI 3.1 - 14.2; p<0.001). Conclusions: There is an increased risk of stillbirth for SGA pregnancies, specifically between 33 and 40 weeks’ gestation, despite fortnightly ANC visits during this time. LGA pregnancies are at an increased risk of stillbirth after 37 weeks’ gestation. This high-risk period highlights potential issues with the detection of fetuses at risk of stillbirth even when ANC is frequent.
- ItemUmbilical artery Doppler velocimetry in the prediction of intrapartum fetal compromise(Health & Medical Publishing Group, 1992) Howarth, G. R.; Pattinson, R. C.; Kirsten, G.; Truter, H.; Odendaal, H. J.The value of early intrapartum umbilical artery Doppler velocimetry in the prediction of fetal compromise was studied. One hundred patients were recruited into the study and fetal compromise was diagnosed by abnormal first- or second-stage fetal heart rate traces, a 5-minute Apgar score less than 7, or the development of hypoxic ischaemic encephalopathy. Fetal compromise developed in 30 patients. An umbilical artery resistance index (RI) of 0,66 or less did not predict fetal compromise (sensitivity 13%, specificity 89%, positive predictive value 25%, negative predictive value 70%). Since the mean umbilical artery RI was identical in the compromised and the noncompromised groups, we conclude that early intrapartum Doppler velocimetry is of very little clinical value in predicting fetal compromise at term.
- ItemThe use of Doppler velocimetry of the umbilical artery before 24 weeks' gestation to screen for high-risk pregnancies(Health & Medical Publishing Group, 1993) Pattinson, R. C.; Norman, K.; Odendaal, H. J.Objective. To describe the prevalence and natural history of absent end-diastolic velocities (AEDV) in the umbilical artery of the fetus between 16 and 24 weeks' gestation, and to evaluate its role as a screening test. Design. Population-based descriptive study. Setting. Tygerberg Hospital, Tygerberg, South Africa. The hospital serves a population from the lower socio-economic bracket. Subjects. Doppler velocimetry was performed at routine ultrasound examinations for confirmation of gestational age in 496 women. Main outcome measures. The occurrence of perinatal death, small-for-gestational-age (SGA) babies and proteinuric hypertension. Results. Forty-four (8,9%) patients had AEDVs at the first examination, but AEDV persisted in only 1. In this case, severe proteinuric hypertension developed unexpectedly at 29 weeks' gestation ahd the fetus needed delivery because of persistent late decelerations of the fetal heart rate pattern. There was a significant association between the group with AEDV at first examination and the development of proteinuric hypertension (P < 0,05), but no association with SGA babies. The association with proteinuric hypertension was too weak to be of clinical use. Conclusion. Doppler velocimetry of the umbilical artery, performed along with routine ultrasound examination to confirm gestational age, is not of use as a screening test for identifying high-risk pregnancies.