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- Volume 14, Issue 1, 2008
South African Journal of Obstetrics and Gynaecology - Volume 14, Issue 1, 2008
Volume 14, Issue 1, 2008
Author Edward CoetzeeSource: South African Journal of Obstetrics and Gynaecology 14 (2008)More Less
The South African Society of Ultrasound in Obstetrics and Gynaecology congress in Durban has been crafted by dedicated members who feel strongly about education, and they have gathered together the very best teachers from four continents to share their knowledge with us.
Abstracts released on the occasion of the 10th SASUOG Congress : Durban, 18 - 20 April 2008 : abstractsSource: South African Journal of Obstetrics and Gynaecology 14, pp 8 –32 (2008)More Less
Intrauterine deaths in high-risk pregnancies with normal and borderline umbilical artery Doppler flow velocity waveforms : research articleSource: South African Journal of Obstetrics and Gynaecology 14, pp 33 –37 (2008)More Less
Objective. To investigate the use of a personal computer (PC)-based, continuous-wave Doppler device by a trained midwife at the fetal evaluation clinic at a tertiary hospital to assess flow velocity waveforms (FVWs) of the umbilical artery flow in referred women.
Methods. Pregnant women referred for suspected poor fetal growth were evaluated from June 2002 through December 2004. The Umbiflow device (still prototype, developed by CSIR / MRC / Stellenbosch University), consisting of a Pentium 3 PC with an ultrasound transducer plugged into the USB port, was used to analyse the FVW of the umbilical artery. Pregnancies in which the resistance index (RI) was < 75th percentile (< P75) were not further evaluated for fetal well-being unless the clinical condition of the mother had changed. Pregnancies with an RI > P75 were followed up according to a specific protocol. Primary endpoints were intrauterine death and intrauterine growth restriction.
Results. Doppler FVWs were assessed in 955 pregnancies. The RI was < P75 in 529 participants (55.4%), between the P75 and P95 percentile in 350 (36.6%) and > P95 in 53 (5.5%). In 23 cases (2.4%) end-diastolic flow was absent or reversed (AREDF). Intrauterine death within 1 week of the test occurred in 1, 4, 0 and 2 women respectively in these four groups, and 16.7%, 34.5%, 54.9% and 65.5% respectively gave birth to infants that were small for gestational age.
Conclusions. Intrauterine death, within 1 week of the test, was extremely rare when the RI was < P75 (0.2%). Relatively more deaths within a week of the Doppler examination occurred in the P75 - P95 group. This group should be regarded as being at high risk and needs careful antenatal surveillance.
Source: South African Journal of Obstetrics and Gynaecology 14, pp 38 –42 (2008)More Less
Objective. To determine the effectiveness of nuchal translucency (NT) screening in predicting aneuploidy and structural abnormalities in a South African population.
Study design. Descriptive study.
Setting. Chris Hani Baragwanath Hospital fetal medicine unit.
Outcome measures. An adjusted risk was derived from the combination of maternal age-related risk and the risk derived from NT screening. A positive screen was denoted by an adjusted risk of more than 1/300 and a negative screen by an adjusted risk of less than 1/300. In order to determine the number of undiagnosed abnormalities in the group, all babies were examined by a paediatrician at birth to detect and describe dysmorphic features.
Results. A total of 428 patients underwent first-trimester screening between July 2003 and July 2005. Three per cent were lost to follow-up. Of the 415 patients analysed, 59 screened positive and 356 screened negative. The mean age for both groups of patients was 30.1 years. Of the 57 patients who screened positive, 24 elected to have chorionic villus sampling (CVS). This resulted in the detection of 6 chromosomal abnormalities and 2 structural abnormalities. Among the remaining 356 patients, who had screened negative, 2 had an increase in the adjusted risk when the risk was compared with the background risk, and 1 chromosomal abnormality was detected in this group; 8 elected to have CVS because of a previous history of a chromosomal abnormality, and there were no abnormalities among them.
Conclusions. The use of these screening methods has enabled prenatal karyotyping to become cost effective, and allows concentration on pregnancies at highest risk for chromosomal abnormalities, regardless of age.
Source: South African Journal of Obstetrics and Gynaecology 14, pp 43 –48 (2008)More Less
A Western Cape Provincial Reference Group compiled this guideline for use in the Western Cape Province of South Africa with contributions from staff of the health facilities and academic institutions in the province. It was accredited by the Western Cape Clinical Guidelines Advisory Committee, established by the Provincial Government to advise on matters related to the development of clinical guidelines that deal with interventions provided at all levels of care, and to accredit those guidelines that meet pre-specified standards or criteria. Professor J Volmink, the director of the South African Cochrane Centre, chairs the advisory group.
For the purpose of this guideline, induction of labour is defined as an intervention designed to artificially initiate uterine contractions leading to progressive dilatation of the cervix and delivery of the baby, from 28 weeks of gestation onwards (the legal gestational age of fetal viability). This will include induction of labour in women with intact membranes and women with spontaneous rupture of membranes but who are not in labour. Induction of labour is only indicated when it is agreed that the mother or fetus will benefit from a higher probability of a healthy outcome than if the birth is delayed.
Author James DrifeSource: South African Journal of Obstetrics and Gynaecology 14 (2008)More Less
The Beijing Olympics are only a few months away and it looks as if I won't be going. August is always a difficult month for the on-call rota. As most of my fellow consultants have young families, the school holidays are one of the few times when we of the granddad generation feel really useful. Besides, China is a long way away and I dislike visiting cities whose names I can't spell. (What was wrong with 'Peking', for goodness sake? If it's good enough for my old school atlas and our local Chinese restaurant, why change it?)