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- South African Journal of Obstetrics and Gynaecology
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- Volume 9, Issue 1, 2003
South African Journal of Obstetrics and Gynaecology - Volume 9, Issue 1, 2003
Volume 9, Issue 1, 2003
Source: South African Journal of Obstetrics and Gynaecology 9, pp 4 –7 (2003)More Less
<i>Objective</i>. To determine the accuracy of near-patient and laboratory-based fetal lung maturity tests in predicting the need for neonatal ventilation. <br><i>Design</i>. A prospective descriptive study. <br><i>Subjects</i>. One hundred high-risk obstetric patients where confirmation of fetal lung maturity would initiate delivery. <br><i>Methods</i>. Fetal weight estimation, placental maturity grading, and amniocentesis were performed. The investigators examined the amniotic fluid visually, and performed the tap test and shake test. Laboratory technicians estimated the lecithin-sphingomyelin (L / S) ratio, determined the presence of a phosphatidyl glycerol (PG) band on gel electrophoresis, and the optical density at 650 nm. Neonates delivered within 1 week of amniocentesis were included in the analysis. The primary end-point was the ability of the lung maturity tests to predict the need for neonatal ventilation. <br><i>Results</i>. Twelve of 100 neonates required ventilation. The tap test and optical density (OD) shift at 650 nm predicted the need for neonatal ventilation with the greatest accuracy. <br><i>Conclusion</i>. The tap test is a rapid, easy and accurate predictor of the need for neonatal ventilation. The OD shift at 650 nm is the laboratory-based test with the greatest accuracy in our setting.
Source: South African Journal of Obstetrics and Gynaecology 9, pp 8 –11 (2003)More Less
<i>Objectives</i>. This report analyses the outcome and complications of 262 consecutive sacrocolpopexy procedures for the repair of vaginal vault prolapse and enterocele. <br><i>Methods</i>. From March 1994 to February 2001, 262 patients underwent surgical repair using a standardised retroperitoneal technique. Initially dura mater strips were used and from the 19th patient onwards, Gore-tex soft tissue patch was used to suspend the vaginal apex to the anterior sacral ligament. Halban-type occluding sutures were placed in the pouch of Douglas. All patients were followed up and the minimum duration of follow-up was 16 months. <br><i>Results</i>. Vaginal vault prolapse was successfully managed in 259 of 262 patients giving a success rate of 98.8%. In addition, 4 patients had a repeat enterocele that required surgical repair. The overall surgical complication rate was low. Erosion of the patch through the vaginal vault occurred in 10 patients, necessitating removal of the patch. Prolapse did not recur in any of these patients. <br><i>Conclusion</i>. Abdominal sacrocolpopexy is a very successful and safe surgical management of vaginal vault prolapse.
Intrapartum-related birth asphyxia in South Africa - lessons from the first national perinatal care surveySource: South African Journal of Obstetrics and Gynaecology 9, pp 12 –15 (2003)More Less
<i>Background</i>. The recent amalgamation of data by users of the Perinatal Problem Identification Programme (PPIP) throughout South Africa has culminated in the publication of the Saving Babies report. <br><i>Objectives</i>. To determine the absolute rate of death from intrapartum-related birth asphyxia, and the contribution of intrapartum-related asphyxia to total perinatal mortality in South African hospitals, and to identify the primary obstetric causes and avoidable factors for these deaths. <br><i>Methods</i>. The amalgamated PPIP data for the year 2000 were obtained from 27 state hospitals (6 metropolitan, 12 town and 9 rural) in South Africa. In PPIP-based audit, all perinatal deaths are assigned primary obstetric causes and avoidable factors, and these elements were obtained for all deaths resulting from intrapartum-related birth asphyxia. <br><i>Results</i>. There were 123 508 births in the hospitals surveyed, with 4 142 perinatal deaths among infants ≥ 1 000 g, giving a perinatal mortality rate of 33.5 / 1 000 births. The perinatal mortality rate from intrapartum-related birth asphyxia was 4.8 / 1 000 births. The most frequent avoidable factors were delay by mothers in seeking attention during labour (36.6%), signs of fetal distress interpreted incorrectly (24.9%), inadequate fetal monitoring (18.0%) and no response to poor progress in labour (7.0%). The perinatal mortality rates for metropolitan, town and rural areas were 30.0, 39.4 and 30.9 / 1 000 births respectively. The contribution of intrapartum-related birth asphyxia to perinatal mortality in these areas was 10.8%, 16.7% and 26.4% respectively. <br><i>Conclusion</i>. The high rates of perinatal death from intrapartum-related birth asphyxia in South Africa are typical of those in underdeveloped countries, with the most serious deficiencies in rural areas. Most of these deaths are avoidable and the reduction of these rates presents an important challenge to providers of perinatal care in this country. Areas worthy of research and action include provision of mothers' waiting facilities in rural regions, improvements in fetal monitoring, partogram-based labour management, and the establishment of midwifery staffing norms for South African labour units.
Source: South African Journal of Obstetrics and Gynaecology 9, pp 16 –20 (2003)More Less
<i>Objective</i>. To determine the primary reasons for the delivery of very-low-birth-weight (VLBW) babies. <br><i>Design</i>. Cross-sectional descriptive study. <br><i>Study period</i>. 1 March 1997 - 31 August 1997. <br><i>Methods</i>. Data were collected from all mothers who delivered babies weighing 500 - 1 499 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. <br><i>Results</i>. 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 maternal reasons, 19 for intrauterine death and 3 for both fetal and maternal reasons. <br><i>Conclusion</i>. Hypertension, 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.
Incidence and outcome of caesarean section in the private sector - 3-year experience at Pretoria Gynaecological Hospital : research in private practiceSource: South African Journal of Obstetrics and Gynaecology 9, pp 21 –24 (2003)More Less