Browsing by Author "Steyn, D. W."
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- ItemComputerised cardiotocography in a high-risk unit in a developing country : its influence on inter-observer variation and duration of recording(Health & Medical Publishing Group, 1996) Steyn, D. W.; Odendaal, H. J.Objective. To determine the role of computer-assisted cardiotocography in an obstetric special care unit and its influence on inter-observer variation in interpretation, proposed management and monitoring time. Design. A prospective comparative study. Setting. The obstetric special care unit, Tygerberg Hospital, W. Cape. Study population. A group of 10 registrars in obstetrics who have had experience in the interpretation of both standard and computer-assisted cardiotocographs. Main outcome measures. The influence of method of cardiotocograph recording on inter-observer variation in respect of suggested management of the patient, as well as the observer's opinion of the duration of the recording. Results. Variation in suggested management decreased significantly after assessment of the computer reports, compared with the standard cardiotocographs. While delivery was regarded to be indicated in 3.5% of patients and an immediate repeat of the cardiotocograph in a further 10%, no such action was proposed after evaluation of the computer reports of the same recordings. Thirty-four per cent of tracings were considered to have been too long and 12.5% too short. However, suggested management in 40% of the latter cases seemed inappropriate for tracings regarded as of too short a duration. Conclusion. While computer-assisted cardiotocographs significantly decrease inter-observer variation in the proposed management of patients, its cost-effectiveness in an obstetric special care unit in a developing country should be validated, as it might increase monitoring time.
- ItemGenital schistosomiasis presenting as suspected ectopic pregnancy in the Western Cape(Health & Medical Publishing Group, 2000) Schneider, D.; Steyn, D. W.[No abstract available]
- ItemIs the use of a GnRH antagonist effective in patients with polycystic ovarian syndrome? A South African perspective(Health & Medical Publishing Group, 2012-01-19) Siebert, T. I.; Kruger, T. F.; Grieve, C. L.; Steyn, D. W.Introduction. Polycystic ovarian disease (PCOS) can account for up to 35 - 40% of the female factor causes of infertility. These patients present as medically complex cases and are challenging to manage and treat successfully. They are resistant to treatment and are often offered controlled ovarian stimulation (COS) and in vitro fertilisation (IVF) technology. Aim. The aim of this study was to assess whether there was a difference in the pregnancy outcomes of women with PCOS when a standard gonadotrophin-releasing hormone (GnRH) antagonist (cetrorelix) protocol was used for ovarian stimulation, compared with non-PCOS patients undergoing IVF. Methods. A retrospective patient record audit was performed on 142 patients with PCOS and 501 non-PCOS patients undergoing a similar cetrorelix-based COS treatment protocol during a specified time period. Results. The main primary outcome was an ongoing pregnancy at 12 weeks, achieved in 34% of patients in the PCOS group and 27% in the non-PCOS group. This was not significantly different (p=0.07). No patient in the PCOS group experienced severe hyperstimulation syndrome. Conclusion. There was no significant difference in pregnancy rates in patients with PCOS undergoing GnRH-antagonist ovarian stimulation compared with non-PCOS patients. The fact that no hyperstimulation syndrome occurred makes this an attractive option for women with PCOS.
- 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]
- ItemManagement of premature rupture of the membranes after 34 weeks' gestation : early versus delayed induction of labour(Health & Medical Publishing Group, 1996) Van Heerden, J.; Steyn, D. W.Objective. To determine the optimal way to manage patients with premature rupture of the membranes after 34 weeks' gestation. Design. A prospective, randomised controlled trial comparing immediate induction and delayed induction after 24-48 hours. Setting. Tygerberg Hospital, Cape Town. Participants. Seventy consecutive patients with premature rupture of the membranes who presented at Tygerberg Hospital between July and October 1991. Main outcome measures. The two groups were compared with regard to infectious morbidity and antibiotic requirements in the mothers and babies, days spent in hospital, caesarean section rates, duration of labour and analgesic requirements. Results. There was no difference between the two groups in terms of infectious morbidity in either the mothers or the babies, the duration of labour or the caesarean section rates. Nine patients (26%) in the delayed induction group required analgesic treatment during labour versus 18 patients (52%) in the group that was induced immediately (P = 0.049; odds ratio = 0.327; 95% confidence limits = 0.014 - 0.0998). In the delayed induction group, 74% of the patients went into spontaneous labour during the conservative management period. Patients in the active group (immediate induction) had a statistically significant better chance of being discharged within 48 hours of admission (P = 0.028; odds ratio = 3.34; 95% confidence limits = 1.12 - 10.73). Conclusions. The management of patients with premature rupture of the membranes after 34 weeks should be decided upon according to the level of antepartum and neonatal care which is available at the particular unit. Where there is adequate neonatal support and pressure on bed occupancy, immediate induction of labour should be considered, while peripheral units should consider conservative management before referral of patients.
- ItemMid-trimester termination of pregnancy - a randomised controlled trial of two prostaglandin regimens(Health & Medical Publishing Group, 1993) Steyn, D. W.; Pienaar, M. P.Objective. To determine the more applicable of two ways of prostaglandin induction currently in use in second trimester induced abortions for congenital or chromosomal abnormalities. Design. A prospective randomised controlled trial. Setting. Department of Obstetrics and Gynaecology, Tygerberg Hospital, CP. Study population. Twenty consecutive patients admitted for termination of pregnancy for congenital or chromosomal abnormalities between 14 and 26 weeks' pregrancy duration. Management. Patients were randomly selected to receive either 1,5 mg prostaglandin E2 (PGE2) gel extra-amniotically or 25 mg prostaglandin F2α (PGF2α) intra-amniotically. Patients in both groups received oxytocin to a maximum dosage of 120 mU per minute if they had not aborted 18 hours after the original administration of either prostaglandin regimen. If abortion had not taken place 36 hours after commencement of treatment, management was considered unsuccessful. Main outcome measurements. Proportion of successful inductions and complications. Results. Complications of management were rare and did not differ between the two management groups. However, there were significantly more failures in the group who received intra-amniotic PGF2α (7 v. 2 patients) as well as a significantly higher need for oxytocin in this group (10 v. 4 patients). Conclusions. With promising drugs such as prostaglandin analogues and anti-progesterones not universally available, methods of induction suitable to the local situation should be sought. Extra-amniotic PGE2 seems more suitable than intra-amniotic PCF2α because of a shorter induction-to-delivery time without increased morbidity.
- ItemMutations 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.
- 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.