Browsing by Author "Muller, C. J. B."

Now showing 1 - 7 of 7
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    Delivery outcomes of patients with pre-eclampsia at 27 - 34 weeks’ gestation at Tygerberg Hospital, Cape Town, South Africa : a retrospective observational study
    (Health & Medical Publishing Group, 2021-04-03) Olivier, S. E.; De Waard, L.; Muller, C. J. B.; Gebhardt, G. S.
    Background. Obstetricians are cognisant of the serious nature of hypertensive disorders in pregnancy. Despite a 17% overall reduction in maternal deaths in South Africa between 2011 and 2016, there was a 14% increase in deaths due to hypertension. Delivery is the only known cure for pre-eclampsia, but the question regarding the safest route of delivery remains difficult to answer. Objectives. To determine the success rate of induction of labour (IoL) in patients with early-onset pre-eclampsia with severe features (EOPES) before 34 weeks’ gestation. Furthermore, the data from the induction group were compared with those of the caesarean delivery (CD) groups where patients were not eligible for IoL. Additional objectives were to identify variables that could influence the success rate, to determine whether any delivery method was associated with increased morbidity, to assess the short-term maternal and neonatal outcomes, and to make recommendations for future decision-making regarding delivery for women with EOPES. Methods. In this single-institution retrospective observational study, all cases in which a decision for delivery was made before 34 weeks 0 days of gestation (or the infant’s birthweight was ≤2 000 g with uncertain gestation) at Tygerberg Hospital, Cape Town, between 1 January and 30 June 2017 were identified from the electronic birth register. The cohort fitting the inclusion criteria was subdivided into IoL and CD groups. Results. From a total of 3 938 deliveries, 168 patients met the inclusion criteria. IoL was indicated in 55 cases, resulting in 20 vaginal deliveries (VDs) (36%) and 35 CDs (64%). The remaining 113 patients were not candidates for IoL; of these, 89 required emergency CDs and 24 had semi-elective CDs. In the IoL group with abnormal umbilical artery Dopplers (UADs) there was 1 VD, and 4 CDs were performed for fetal compromise. Of cases with an estimated fetal weight (EFW) ≤3rd centile, emergency CD was required in 24 (65%), and 8 (22%) were considered for IoL, in 6 of which CD was required. Conclusions. Of the EOPES population, 36% had successful IoL that culminated in VD. VD was more likely to occur with fetal growth appropriate for gestational age. The likelihood of CD increased if the UAD was abnormal, if the EFW was ≤3rd centile or if eclampsia was present. The decision to induce should be considered carefully in these circumstances.
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    Kleur-termografie
    (Health and Medical Publishing Group (HMPG), 1974-04) Muller, C. J. B.
    Thermography is discussed, and attention is drawn to its ancillary value in making a diagnosis. Some examples of thermograms are demonstrated.
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    Radiologiese diens by Tygerberg-Hospitaal
    (Health and Medical Publishing Group (HMPG), 1975) Muller, C. J. B.
    The Tygerberg Hospital, of the Medical Faculty of the University of Stellenbosch, has a decentralised radiological service where -50% of the radiology forms part of specialised departments. This obviates patient traffic and ensures an effi:ient technical service and close collaboration between the radiologist and the specialist concerned. The main department, when finally completed in a few years' time, will have 24 diagnostic rooms for gen~ral and special purposes and about 20 decentralised rooms.
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    Radiology and the law in South Africa
    (HMPG, 1978-02) Muller, C. J. B.
    In terms of regulations gazetted in 1973, the Department of Health has control of the practice of medical radiology in South Africa. The regulations and the rules of the South African Medical and Dental Council that apply to radiology are discussed, and the legal position of workers is noted.
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    Radiology in trauma cases : an obligatory investigation (Afrikaans)
    (Health & Medical Publishing Group, 1976) Muller, C. J. B.
    The radiology of trauma is of increasing importance in South Africa, where the treatment of victims of motor accidents forms a major part of emergency medical practice. All practitioners should be aware of the medical and legal obligations that they have to fulfil in this investigation, which nowadays is regarded as part of clinical medicine. The most important principles in the radiology of trauma are briefly discussed.
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    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.
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    Rural anaesthetic practices in the Western Cape
    (Health & Medical Publishing Group, 1991) Payne, K. A.; Muller, C. J. B.; Coetzee, A. R.
    The findings of specialist anaesthetists on visits to rural towns in the western Cape over 6 years are reported. The importance of academic units communicating with general practitioners, nursing staff and hospital authorities in their own working environment is emphasised. Hospital anaesthetic facilities and general practice anaesthetic methods are discussed and recommendations made and, in addition, common problems that could improve anaesthesia in general practice are summarised.