Browsing by Author "Cluver, C. A."

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Delivery of the extremely low-birth-weight vertex-presenting baby : caesarean section or the vaginal route?
    (Health and Medical Publishing Group, 2010-02) Cluver, C. A.; Hall, D. R.
    ENGLISH ABSTRACT: Improvements in neonatal care have resulted in a downward shift of the viability threshold for preterm babies. In general, the lower the gestational age and birth weight at delivery, the higher the chance of mortality and morbidity. Some may argue that the softer cranium and vulnerable brain of the extremely low-birth-weight baby should not be exposed to the 'stresses' of vaginal birth. In this article we briefly discuss the difficulties in decision making surrounding the lowest thresholds of viability and examine what the literature has to say regarding route of delivery. It is important that parents only make these difficult decisions after being fully informed of the likely short- and long-term outcomes. With regard to route of delivery we conclude that in the absence of an obstetric indication there is no clear evidence to support performing a caesarean delivery.
  • Thumbnail Image
    Item
    Retrospective review of the medical management of ectopic pregnancies with methotrexate at a South African tertiary hospital
    (Health and Medical Publishing Group, 2014) De Waard, L.; Butt, J. L.; Muller, C. J. B.; Cluver, C. A.
    Background. An ectopic pregnancy can be a life-threatening condition. Early diagnosis with ultrasonography and quantitative betahuman chorionic gonadotrophin (β-hCG) measurement has improved early and accurate diagnosis and treatment. Medical management with methotrexate internationally has a success rate of up to 93%, but there is a paucity of data on this treatment option in developing countries. Objective. To determine the success of methotrexate treatment for ectopic pregnancies at a referral hospital in a developing country. This non-surgical, outpatient treatment seems a good option in hospitals with an ever-rising pressure on bed occupation and long waiting lists for emergency surgery. Methods. A 5-year retrospective audit was performed on 124 patients treated for ectopic pregnancies with methotrexate at Tygerberg Hospital, Cape Town, South Africa. Results. With success defined as a β-hCG level of <15 IU/L without requiring surgical intervention, the success rate was 44%. Fifteen per cent of medically managed patients required surgery. The remaining 41% were lost to follow-up. One patient had a major adverse outcome with a ruptured ectopic and required 2 units of blood, resuscitation and emergency laparotomy. Conclusion. Medical management of ectopic pregnancies is a safe and effective management option, as proven by international data, but at Tygerberg Hospital the safety of this treatment modality cannot be guaranteed because of poor follow-up. Improvement in patient selection with consideration of predictors of success and thorough counselling, as well as full informed consent, is recommended before using this treatment modality. A new follow-up system should be developed at Tygerberg Hospital to guarantee patient safety.