SUNScholar - Browsing by Author "Odendaal, H. J."

Browsing by Author "Odendaal, H. J."

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Abrupt fall in the fetal heart rate during labour
(Health and Medical Publishing Group (HMPG), 1976-11) Odendaal, H. J.; Van der Merwe, J. V.
Cardiotocograms of 6044 patients in labour were examined for evidence of an abrupt fall in the fetal heart rate. The latter was defined as a deceleration of at least 50 beats within 3 minutes, without a demonstration of signs of recovery in the following 2 minutes. Only 9 instances could be found, an incidence of 0,15%. Umbilical cord entanglement possibly played a role in 6 of these instances, and 2 of the infants concerned were stillborn. Intra uterine growth retardation was associated with deceleration in 3 infants, 1 of whom was stillborn.
Acceleration patterns of the fetal heart rate before and during labour
(Health and Medical Publishing Group (HMPG), 1977-12) Odendaal, H. J.; Sandenbergh, H. A.
In infants in whom accelerations of the fetal heart rate were present during the first stage of labour, the incidence of low Apgar scores was significantly less than in those in whom accelerations were not present. Absence of acceleration patterns during the contraction stress test (CST) was associated with a lower birth weight. In patients in whom acceleration patterns were observed during a positive CST, fetal distress occurred in the minority of subsequent labours. When accelerations as well as late decelerations are observed during a CST, the possibility of a false positive test should be excluded.
Analysis of two mutations in the MTHFR gene associated with mild hyperhomocysteinaemia - heterogeneous distribution in the South African population
(Health & Medical Publishing Group, 2002-6) Scholtz, C. L.; Odendaal, H. J.; Thiart, R.; Loubser, L.; Hillermann, R.; Delport, R.; Hayward Vermaak, W. J.; Kotze, M. J.
Objective. The frequencies of mutations 677C→T and 1298A→C in the methylenetetrahydrofolate reductase (MTHFR) gene, previously shown to be associated with decreased enzyme activity that may lead to hyperhomocysteinaemia and consequently increased risk of cardiovascular disease (CVD), were determined in the South African population. Methods. HinfI (677C→T) and MboII (1298A→C) restriction enzyme analyses were performed on amplified DNA samples of 76 white, 73 coloured and 60 black subjects. Results. The mutant alleles of mutations 677C→T and 1298A→C were more common in the white (allele frequencies 0.36 and 0.37, respectively) than in the black population (0.04 and 0.09), while intermediate frequencies were detected in the coloured population (0.18 and 0.30). Homozygosity for mutation 677C→T was not detected in the black cohort, while this genotype was detected in 1 coloured (1.4%) and 8 white (10.5%) subjects. In the black population, 5% of the 60 subjects analysed were homozygous for mutation 1298A→C, compared with approximately 12% in both the white and coloured populations. Conclusions. Since hyperhomocysteinaemia is a risk factor for premature CVD, the heterogeneous distribution of the 677C→T and 1298A→C mutations across ethnic groups may partly explain ethnic differences in heart disease risk through decreased enzyme activity and hence increased homocysteine levels.
The association between preterm labour, perinatal mortality and infant death (during the first year) in Bishop Lavis, Cape Town, South Africa
(Health & Medical Publishing Group, 2019) Brink, L. T.; Gebhardt, G. S.; Mason, D.; Groenewald, C. A.; Odendaal, H. J.
Background. We present further analyses from the Safe Passage Study, where the effect of alcohol exposure during pregnancy on sudden infant death syndrome and stillbirth was investigated. Objectives. To describe pregnancy and neonatal outcome in a large prospective study where information on the outcome of pregnancy was known in >98.3% of participants and ultrasound was used to determine gestational age (GA). Methods. As part of the Safe Passage Study of the PASS Network in Cape Town, South Africa, the outcomes of 6 866 singleton pregnancies were prospectively followed from recruitment in early pregnancy until the infant was 12 months old to assess pregnancy outcome. Fetal growth was assessed by z-scores of the birth weight, and GA at birth was derived from early ultrasound assessments. The effects of fetal growth restriction and preterm delivery on pregnancy outcome were determined. Results. There were 66 miscarriages, 107 stillbirths at ≥22 weeks’ gestation, 66 stillbirths at ≥28 weeks’ gestation, 29 and 18 neonatal deaths at ≥22 and ≥28 weeks’ gestation, respectively, and 54 post-neonatal deaths (28 days - 12 months). The miscarriage rate was 9.6/1 000 and the infant mortality rate 12.4/1 000. Of the births, 13.8% were preterm. For deliveries at ≥22 and ≥28 weeks, the stillbirth rates were 15.7 and 9.8/1 000 deliveries, respectively. For deliveries at ≥22 and ≥28 weeks, the neonatal death rates were 4.3 and 2.7/1 000 live births, respectively. For these pregnancies the perinatal mortality rates were 20.0/1 000 (≥22 weeks) and 12.5/1 000 (≥28 weeks), respectively. Only 15.9% of stillbirths occurred during labour (in 15.9% of cases it was uncertain whether death had occurred during labour). In the majority of cases (68.2%) fetal death occurred before labour, and 82.2% of stillbirths and 62.1% of neonatal deaths occurred in deliveries before 37 weeks. Including the miscarriages, stillbirths and infant deaths, there were 256 pregnancy losses; 77.3% were associated with deliveries before 37 weeks. Only 1.8% of all the women were HIV-positive, whereas the HIV-positive rate was 3.7% among those who had stillbirths. Birth weight was below the 10th centile in 25.6% of neonatal and post-neonatal deaths compared with 17.7% of survivors. Conclusions. Preterm birth and fetal growth restriction play significant roles in fetal, neonatal and infant losses.
Bereaved mothers' attitudes regarding autopsy of their stillborn baby
(Health and Medical Publishing Group, 2017-12) Human, M.; Goldstein, R. D.; Groenewald, C. A.; Kinney, H. C.; Odendaal, H. J.
Background. Here we present additional information from the Safe Passage Study, where the effect of alcohol exposure during pregnancy on sudden infant death syndrome and stillbirth was investigated. Objective. To explore bereaved mothers’ attitudes toward obtaining an autopsy on their stillborn baby, and the future implications of consenting or non-consenting to autopsy in retrospect. Methods. Demographic data was obtained by a questionnaire. A largely qualitative mixed-methods approach was used to meet the aims of the study, using an exploratory and descriptive research design to provide a detailed description of maternal attitudes. A semistructured questionnaire based on information from literature and reflections on practice was administered during individual interviews. Results. We interviewed 25 women who had had a recent stillbirth. The time interval between the time of consenting to autopsy and completing this study ranged from 6 to 18 months. Most participants reported that autopsy results provided peace of mind and helped alleviate their feelings of blame. Participants who were unable to comprehend the results reported negative reactions to receiving autopsy results. The majority of participants were of the opinion that they benefited from consenting to autopsy. Conclusion. Autopsy and the disclosure of its results generally contribute positively to coping following stillbirth.
Clinical experience with the contraction stress test
(Health & Medical Publishing Group, 1977) Sandenbergh, H. A.; Odendaal, H. J.
During a period of 16 months, 1 170 contraction stress tests (CST) were performed on 767 women who were at high risk of losing their babies. The tests were positive in 42 patients, of whom 29 were subsequently delivered by caesarean section. Fetal distress, which necessitated caesarean section, occurred in 5 of 6 cases of intra-uterine growth retardation in which labour was induced. Abruptio placentae caused the intra-uterine death of 4 fetuses, 3 of which died within 7 days of a negative CST. The low perinatal mortality rate of 13 demonstrates the reliability of the CST in the evaluation of placental function in obstetric patients who are at high risk.
Comparison between a newly developed PC-based Doppler umbilical artery waveform analyser and a commercial unit
(Health and Medical Publishing Group (HMPG), 2005-01) Theron, G. B.; Theron, A. M.; Odendaal, H. J.; Bunn, A. E.
Objectives. To determine the accuracy of the resistance index (RI) of flow velocity waveforms of the umbilical artery measured using a newly developed PC-based continuous wave Doppler device (Umbiflow) with regard to systematic and random variations when compared with a commercial standard (Vasoflow). Design. A cohort study. Setting. The fetal evaluation clinic (FEC) at Tygerberg Hospital. Subjects. Patients referred to the FEC at Tygerberg Hospital with suspected chronic placental insufficiency. Outcome measures. The correlation coefficients indicating the strength of the relationship between the two devices and their agreement using the method of Bland and Altman. Results. A total of 248 patients were studied. The mean RIs of the first Doppler assessment were 0.69 (standard deviation (SD) 0.11) and 0.67 (SD 0.11) using the Vasoflow and Umbiflow respectively. The Pearson's correlation coefficient comparing the RI of the first test was 0.85. The degree of agreement between the two methods was excellent, the mean differences being very small (< 0.024) with tight confidence intervals. One hundred and ninety-four patients (78.2%) of patients remained in the same percentile category with both the Vasoflow and Umbiflow. Conclusions. The accuracy of the Umbiflow has been proved. A non-significant trend towards slightly lower values needs to be considered. This could be addressed by changing the percentile cut-off to slightly lower values.
Comparison between umbilical artery and vein endogenous digoxin-like immuno-active factor levels in normal and pre-eclamptic patients
(Health & Medical Publishing Group, 1991) Schabort, I.; Odendaal, H. J.; Lombard, C. J.; Bredell, L.
Recent studies have pointed to the existence of an endogenous digoxin-like immuno-active factor (DLIF), which may be associated with hypertension and pre-eclampsia. The DLIF levels in the umbilical venous and umbilical arterial blood of neonates, as well as the maternal serum of primigravidas and multigravidas with and without pre-eclampsia, were determined by means of a commercially available radioimmunoassay kit, which is cross-reactive with DLIF, in 44 mothers and their babies in search for a possible placental, fetal or maternal origin of the DLIF. The mean placental and neonatal masses were significantly lower in the pre-eclampsia group than in the control group (P < 0,01). However, the DLIF levels in the maternal serum, umbilical cord venous and umbilical cord arterial serum were statistically significantly higher in the pre-eclampsia group than in the control pregnant group (P < 0,05). A very strong correlation was found between umbulical cord venous and arterial DLIF levels (r = 0,90; P = 0,001, Spearman rank-correlation coefficient). Although the mean DLIF level in cord arterial serum was lower than that of cord venous serum, statistical significance was not reached if the Bonferroni adjustment was applied to the P value.
Computerised 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.
Conservative management of severe proteinuric hypertension before 28 weeks gestation
(Health & Medical Publishing Group, 1988-05) Pattinson, R. C.; Odendaal, H. J.; Du Toit, R.
Forty-five patients with severe proteinuric hypertension who presented before 28 weeks' gestation were managed conservatively by bed rest, antihypertensive treatment, betamethasone administration after 26 weeks' gestation, and intensive fetal and maternal monitoring. Eleven patients presented before 24 weeks and their babies all died; 34 patients presented at or after 24 weeks and 13 of their babies survived (38%). The indications for delivery were intra-uterine death (13), fetal distress (9), deterioration in the mother's condition (17), and maternal complications - pulmonary oedema in 3 cases and pleural effusion in 1. One patient went into spontaneous labour and one was induced at 34 weeks. At postpartum follow-up examination all the mothers in the group that had presented before 24 weeks were found to have underlying diseases, compared with 42% of those who had presented between 24 and 27 weeks. The low incidence of maternal complications and the relatively good survival rate of 38% indicate that there is a place for conservative management in patients with severe proteinuric hypertension presenting at 24 weeks or later. Termination of the pregnancy should, however, be seriously considered in those patients presenting before 24 weeks' gestation.
Continuous monitoring of uterine contractions to control intra-amniotic administration of prostaglandin F2α for therapeutic and missed abortion
(Health & Medical Publishing Group, 1981) Roux, C. J.; Odendaal, H. J.
Intra-amniotic prostaglandin F2α (PFG2α) was administered to 10 patients for midtrimester therapeutic abortion and to 20 patients for missed abortion. An epidural catheter was placed into the amniotic cavity and the other end was connected to a physiological pressure transducer to measure the uterine contractions continuously. The dosage was adjusted according to the uterine contractions, and was therefore individualized for each patient. Half the patients with therapeutic abortion required PGF2α 30 mg or less, and only 20% of patients with missed abortion needed more than 30 mg. Complications such as uterine cervical lacerations could be prevented by administration of the correct dosage of prostaglandin in each case.
Doctors' attitudes and practices regarding smoking cessation during pregnancy
(Health and Medical Publishing Group (HMPG), 2005-05) Everett, K.; Odendaal, H. J.; Steyn, K.
Objective. To investigate the current smoking cessation practices and attitudes of doctors working in the public antenatal services, as well as their perceived barriers to addressing the issue in the context of routine care. Study design. The study was qualitative, consisting of 14 semi-structured, one-to-one interviews with doctors purposefully sampled from 5 public sector hospitals in Cape Town, South Africa. Results. The doctors in this study regarded HIV, poor nutrition, alcohol abuse and psychosocial stress as equal or higher risks to pregnant women than smoking. They tended to underestimate the magnitude of the risk of smoking during pregnancy. Doctors were unaware of the guidelines offering clinicians brief, structured approaches to smoking cessation counselling and were generally pessimistic that they could influence the smoking behaviour of pregnant women, especially poor, disadvantaged women who face multiple barriers to achieving health-enhancing behaviour. However, most doctors were concerned about improving their communication with pregnant women about smoking and open to adopting new approaches or tools that could assist them. Perceived barriers to providing smoking cessation interventions included a lack of counselling skills and educational resources, other pressing priorities, too little time, and the levels of stress currently experienced by doctors and midwives working in public sector hospitals as a result of dramatic staff and budget cuts. Conclusion. The study suggests that doctors working in the public sector antenatal services are not routinely addressing the issue of smoking during pregnancy or using effective methods to assist women to give up smoking. Doctors need convincing that smoking cessation interventions can be effective. The promotion and provision of evidence-based guidelines such as the Clinical Practice Guideline for Treating Tobacco Use and Dependence (Fiore, 2000), with minimal training, is a possible strategy for integrating smoking cessation interventions into routine antenatal care in South Africa.
Does coupling of uterine contractions reflect uterine dysfunction?
(Health & Medical Publishing Group, 1994) Ferreira, C. J.; Odendaal, H. J.
In a cohort analytical study 47 primigravidas in spontaneous normal labour at term were divided into two groups depending on the presence or absence of coupled uterine contractions during active labour. During monitoring with a pressure tip intra-uterine catheter, 24 patients developed coupled contractions and 23 had a normal contraction pattern. There were no statisfically significant differences between the two groups with regard to maternal age, gestational age, maternal height, fetal weight, head circumference and pelvic size. Patients who developed coupled contractions had a longer duration of labour, a higher uterine activity integral and an increased incidence of caesarean section for failure to progress. Because coupling of uterine contractions may be indicative of dysfunctional uterine activity, and hence a prolonged first stage of labour, failure to progress during labour in these patients should be interpreted with caution in order to avoid the incorrect diagnosis of cephalopelvic disproportion.
Early detection of poor fetal prognosis by serial Doppler velocimetry in high-risk pregnancies
(Health & Medical Publishing Group, 1991) Pattinson, R. C.; Brink, A. L.; De Wet, P. E.; Odendaal, H. J.
Fifty-three high-risk pregnancies were followed up serially with Doppler velocimetry of the umbilical artery and uterine vessels from early on to investigate whether abnormalities in Doppler waveforms can predict the outcome of pregnancy accurately before other clinical signs develop. Results of Doppler velocimetry were withheld from the clinicians managing the patients. When the absence of end-diastolic velocities was first detected (in 13 fetuses) (AEDV group) there was no clinical difference between these pregnancies and those in which enddiastolic velocities were present (EDV group). Nine of the 13 fetuses with AEDVs died, compared with 3 of 40 with EDVs (P < 0,0001). In deaths associated with AEDVs, the latter were detected a median of 5,5 (range 3-11) weeks before death and are present from the first Doppler examination. In the 4 fetuses with AEDVs that survived, the AEDVs were not persistent. The only significant association of Doppler velocimetry of the uterine vessels was with proteinuric hypertension (P < 0,05), but the prediction was not strong enough to be of clinical value. Persistent AEDVs of the umbilical artery are an accurate predictor of poor fetal outcome and occur before other clinical signs of impending problems.
Fetal and neonatal outcome in patients with severe pre-eclampsia before 34 weeks
(Health & Medical Publishing Group, 1987-05) Odendaal, H. J.; Pattinson, R. C.; Du Toit, R.
ENGLISH ABSTRACT: Delivery was delayed until 34 weeks in 129 patients with severe pre-eclampsia, unless the maternal or fetal conditions necessitated earlier delivery. No patient developed eclampsia although all sedation was terminated from 24 hours after admission until labour started, unless there was a sudden change in the patient's clinical condition. Of the 14 fetuses that died in utero, only 4 weighed more than 1000 g at delivery. Three of these 4 already died by the time of the mothers' admission. Abruptio placentae was the cause of 36% of intra-uterine deaths. The perinatal mortality rate was 223/1000. Survival rates for liveborn babies was 47%, 78% and 82% for birth weights of 750-999 g, 1000-1249 g and 1250-1499 g respectively. No neonate died when the birth weight was 1500 g or more.
Frequent fetal heart-rate monitoring for early detection of abruptio placentae in severe proteinuric hypertension
(Health & Medical Publishing Group, 1988) Odendaal, H. J.; Pattinson, R. C.; Du Toit, R.; Grove, D.
Abruptio placentae occurred in 16 of 132 patients with severe pre-eclampsia who were admitted to an obstetric high-risk ward before 34 weeks' gestation. These 16 patients were compared with those who did not develop abruptio placentae. Systolic and diastolic blood pressure levels, proteinuria and birth weights did not differ significantly between the two groups. Apgar scores were significantly lower in the abruptio placentae group. There were 6 intra-uterine and 2 neonatal deaths in the abruptio placentae group (50% perinatal mortality (PNM)) and 3 intra-uterine and 16 neonatal deaths in the other group (18% PNM). Four patients with abruptio placentae presented with abnormal fetal heart-rate patterns and 8 with abdominal pain. No warning signs were present in 3 patients and the fetal heart-rate pattern before delivery was not available in 1 patient. Abnormal fetal heart-rate patterns were present in 5 of the 8 patients who presented with pain. Abruptio placentae occurring in patients with severe proteinuric hypertension carries a high PNM. Frequent monitoring of the fetal heart rate sometimes helps to diagnose fetal distress before the clinical signs of abruption become apparent.
Genital tuberculosis at Tygerberg Hospital : prevalence, clinical presentation and diagnosis
(Health & Medical Publishing Group, 1992) Margolis, K.; Wranz, P. A. B.; Kruger, T. F.; Joubert, J. J.; Odendaal, H. J.
Over a period of 30 months (1 July 1986-31 December 1988) 57 cases of genital tuberculosis were diagnosed at Tygerberg Hospital. Forty of these cases were diagnosed as a result of routine screening in 650 patients who presented with infertility and the other 17 were diagnosed in patients admitted to the gynaecological wards. The prevalence in patients presenting with infertility was 6,15%. The commonest gynaecological presenting symptom was infertility (73,7%). Dysmenorrhoea in 29,8% and deep dyspareunia in 12,3% were the only other frequently occurring gynaecological symptoms. Menstruation was normal in 50 patients (87,7%). Seven per cent of patients were postmenopausal. Abdominal symptoms were only present in 15,8%. These findings re-emphasise that genital tuberculosis is often a disease absent of or with few symptoms. General, abdominal and pelvic examinations were normal in 56,1% of patients and even when clinical signs were present they were nonspecific. Menstrual fluid collection and culture proved to be the most reliable diagnostic procedure, since it was positive in 11 patients in whom premenstrual endometrial sample cultures were negative and also in 17 patients in whom histological examination of premenstrual endometrial samples for tuberculosis were negative. The possible reasons for this and its clinical importance are discussed. Other than histological examination of operation and/or biopsy specimens, special investigations proved to be of little help in the diagnosis of genital tuberculosis.
Hormonal placental functions and intrauterine growth retardation in patients with positive contraction stress tests
(Health & Medical Publishing Group, 1981) Odendaal, H. J.; Malan, C.; Oosthuizen, J.
Human placental lactogen (HPL) and urinary and serum oestriol levels were studied in patients in whom the contraction stress test was positive. After birth the infants were assessed for growth retardation. Low PHL, serum oestriol and urinary oestrogen levels were found in 66%, 30% and 15% of patients respectively. Gestational ages were known in 148 patients, of whom 72 (49%) had infants whose weights were below the 10th percentile for gestational age. HPL values were low in 81% of mothers who gave birth to growth-retarded infants, but serum and urinary oestriol levels were low in only 43% and 21% respectively. When both a positive stress test and a low HPL value were present 69% of infants were growth retarded. The incidence of growth retardation rose to 85% when both HPL and serum oestriol levels were abnormal in patients with positive contraction stress tests. In this study estimation of HPL levels was found to be superior to that of oestrogen levels in detecting growth-retarded infants.
Immunoreactive digitalis-like substance in pre-eclampsia
(Health & Medical Publishing Group, 1986) Odendaal, H. J.; Beyers, A. D.; Van Heyningen, C. F.; Spruyt, L. L.; Kotze, T. J. van W.; Van Jaarsveld, P. P.
An endogenous digitalis-like substance (DLS) may be involved in the pathogenesis of essential hypertension and pre-eclampsia. The digoxin levels in maternal and cord blood of 504 randomly selected patients were determined. Since none of the patients received digoxin, these levels indicated a cross-reacting substance (immunoreactive DLS). DLS levels were significantly higher in the cord blood of pre-eclamptic patients than in the cord blood of controls. DLS levels in cord blood increased with the severity of pre-eclampsia, and levels were higher in primigravidas than in multigravidas. The structure and biological activity of DLS must be determined before definite conclusions about its role in the pathogenesis of pre-eclampsia can be made.
The in vitro fertilisation programme at Tygerberg Hospital and the University of Stellenbosch. Five years' experience, April 1983 - January 1988
(Health & Medical Publishing Group, 1990) Kruger, T. F.; Van der Merwe, J. P.; Odendaal, H. J.; Stander, F. S. H.; Grobler, G. M.; Hulme, V. A.; Erasmus, E. L.; Coetzee, K.; Windt, M.-L.; Swart, Y.; Smith, K.; Menkveld, R.
The results of the in vitro fertilisation programme at Tygerberg Hospital for the period April 1983 to January 1988 are presented. Of the 1117 laparoscopies performed, 825 patients reached the transfer stage. A live-birth rate of 9.3% was achieved. The pregnancy rate after transfer of 4 embryos was 25,9% compared with 15,4% after 2 embryos and 10,8% after 3 embryos (P = 0.0001). The multiple pregnancy rate was 2.8% in the group receiving 2 embryos and 11.7% and 10,4% in those receiving 3 and 4 embryos, respectively. Of the 77 successful pregnancies (90 babies), 1 baby died at 34 weeks' gestation as the result of abruptio placentae due to preeclampsia and 1 cot death occurred. The only congenital abnormality encountered was a cleft palate.

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