Department of Obstetrics and Gynaecology

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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.
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    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.
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    The accuracy of non-invasive blood pressure monitoring when compared to intra-arterial blood pressure monitoring in patients with severe pre-eclampsia during an acute hypertensive crisis
    (Stellenbosch : University of Stellenbosch, 2010-12) Dalla, Sangita; Langenegger, Eduard; Petro, Gregory; University of Stellenbosch. Faculty of Health Sciences. Dept. of Obstetrics and Gynaecology.
    ENGLISH ABSTRACT: OBJECTIVE: The aim of this study was to compare the accuracy of non-invasive blood pressure measurements, using automated and manual devices, against invasive intra-arterial blood pressure measurements in patients with pre-eclampsia, during a hypertensive blood pressure peak. STUDY DESIGN: In this prospective study, women admitted to the Obstetrics Critical Care Unit, with confirmed pre-eclampsia and acute severe hypertension, who had an intra-arterial line in situ, were asked to participate. During an intra-arterial blood pressure peak, both an automated oscillometric and a blinded manual aneroid sphygmomanometric blood pressure was recorded. These two methods of blood pressure measurements were compared to intra-arterial blood pressure measurements. The accuracy of a mean arterial pressure (MAP) ≥ 125mmHg in detecting a systolic blood pressure (SBP) ≥ 160mmHg, using all three methods, was also determined. RESULTS: There was poor correlation between intra-arterial SBP and automated and manual SBP (r = 0.34, p < 0.01; r = 0.41, p < 0.01 respectively). The mean differences between automated and manual SBP compared to the intra-arterial SBP was 24 ± 17mmHg (p < 0.01) and 20 ± 15 mmHg (p < 0.01) respectively. There was better correlation between intra-arterial diastolic blood pressure (DBP) and automated and manual DBP (r = 0.61, p < 0.01; r = 0.59, p < 0.01 respectively). The mean differences of the automated and manual DBP was not statistically significant when compared to the intra-arterial DBP. There was poor correlation between the intra-arterial MAP and the automated MAP (r = 0.44, p < 0.01) and good correlation with the manual MAP (r = 0.56, p < 0.01). The mean differences of the automated and manual MAP were statistically significant (5 ± 13mmHg, p < 0.01; 8 ± 11mmHg, p < 0.01 respectively). The sensitivity of automated and manual methods in detecting a SBP ≥ 160mmHg was 23.4% and 37.5% respectively. A MAP ≥ 125mmHg in detecting a SBP ≥ 160mmHg, when using intra-arterial, automated and manual methods of blood pressure measurements showed low sensitivity (35.9%, 21.9% and 17.2% respectively). CONCLUSION: This study demonstrated that both the automated and manual methods of blood pressure measurements were not an accurate measure of the true systolic intra-arterial blood pressure, when managing pre-eclamptic patients with acute severe hypertension. In such situations, intra-arterial blood pressure monitoring should be used when possible. When this is not possible, manual aneroid sphygmomanometry is recommended. Underestimating blood pressure, particularly SBP, may lead to severe maternal morbidity and mortality.
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    Acetylated fetal haemoglobin in neonates born to mothers with established and gestational diabetes
    (Health and Medical Publishing Group (HMPG), 1985-10) MacFarlane, C. M.; Tsakalakos, N.; Taljaard, J. J. F.
    Birth weight ratios (BWRs) and cord blood C-peptide values were significantly higher in neonates born to mothers with well-controlled gestational diabetes (GD) than in those born to mothers with well-controlled established diabetes (ED) or mothers with normal results on glucose tolerance testing. The neonates born to the ED mothers had the highest cord blood acetylated fetal haemoglobin (Hb F1) values, and these values correlated with cord C-peptide values. The cord C-peptide values in the GD group correlated with BWRs, but not with Hb F1 values. These results suggest differential tissue utilization of glucose in neonates born to mothers with different types of diabetes.
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    Acute appendicitis in pregnancy
    (Health and Medical Publishing Group (HMPG), 1975) Rosemann, G. W. E.
    Acute appendicitis in pregnancy and its treatment are reviewed. Six cases are described. Early surgery is recommended and a conservative watchfulness for more than 4 to 6 hours is condemned.
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    Additional value of advanced neurosonography and magnetic resonance imaging in fetuses at risk for brain damage
    (John Wiley & Sons, 2020) Van der Knoop, B. J.; Zonnenberg, I. A.; Verbeke, J. I. M. L.; De Vries, S.; Pistorius, L. R.; Van Weissenbruch, M. M.; Vermeulen, R. J.; De Vries, J. I. P.
    Objective: To assess the additional value of fetal multiplanar (axial, coronal and sagittal) neurosonography and magnetic resonance imaging (MRI) to that of the standard axial ultrasound planes in diagnosing brain damage in fetuses at high risk. Methods: This was a prospective, multicenter, observational study. Women were eligible for participation if their fetus was at risk for acquired brain anomalies. Risk factors were congenital infection, alloimmune thrombocytopenia, fetal growth restriction, trauma during pregnancy, fetal hydrops, monochorionic twins and prior ultrasound finding suggestive of an acquired brain anomaly. Examinations of the fetal brain before birth comprised axial ultrasound and advanced neurosonography biweekly and MRI once. After birth, neonatal cranial ultrasound was performed at < 24 h and at term-equivalent age. Neonatal brain MRI was performed once at term-equivalent age. An expert panel blinded to medical information, including imaging findings by the other methods, evaluated the presence of periventricular echogenicity (PVE) changes, peri- and intraventricular hemorrhage (IVH) and changes in basal ganglia and/or thalami echogenicity (BGTE) on ultrasound, and the equivalent signal intensity (SI) changes on MRI. Conclusions on imaging findings were generated by consensus. The children were followed up with examinations for psychomotor development at 1 year of age, using the Touwen examination and Alberta Infant Motor Scale, and at 2 years of age using Bayley Scale of Infant Development-III (BSID-III) and behavioral, sensory profile and linguistic questionnaires; scores > 1 SD below the mean were considered suspicious for neurodevelopmental sequelae. Results: Fifty-six fetuses were examined, and in 39/56 fetuses, all fetal-imaging modalities were available. PVE/SI changes were observed in 6/39, 21/39 and 2/39 fetuses on axial ultrasound planes, multiplanar neurosonography and MRI, respectively. IVH was found in 3/39, 11/39 and 1/39 fetuses, and BGTE/SI changes in 0/39, 12/39 and 0/39 fetuses, respectively. Outcome was suspicious for neurodevelopmental sequelae in 13/46 infants at 1 year, and at 2 years, 41/41 children had scores within 1 SD of the mean on BSID-III and 20 had scores > 1 SD below the mean on the behavioral (5/38), sensory profile (17/37) and/or linguistic (6/39) questionnaires. Conclusions: In this cohort of fetuses at risk for brain damage, the severity of acquired brain anomalies was limited. Nevertheless, multiplanar neurosonography detected more fetal PVE changes, IVH and/or BGTE changes compared to the standard axial ultrasound planes and MRI. Fetal MRI did not demonstrate any anomalies that were not seen on neurosonography. Neurodevelopmental outcome at 2 years of age showed no or mild impairment in most cases. © 2019 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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    Adenocarcinoma of the stomach in pregnancy - Ultrasonographic diagnosis: A case report
    (Health & Medical Publishing Group, 1987-04) Muller, L. M. M.
    ENGLISH ABSTRACT: The ultrasonographic findings in a rare case of adenocarcinoma of the stomach in pregnancy are described. The patient presented with hyperemesis gravidarum in the second trimester.
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    Adult circumcision in the prevention of HIV/AIDS
    (Health & Medical Publishing Group, 2014-01) Goldstuck, Norman D.
    No abstract.
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    'n Analise van sitogenetiese studies op 2 334 pasiente
    (HMPG, 1979-06) Retief, A. E.; Kotze, G. M.; Fox, M. F.; Venter, P. A.; Van Zyl, J. A.; Van Niekerk, W. A.
    The chromosome results of a series of 2 334 patients referred for cytogenetic analysis during 1966-1977 were tabulated by computer. The patients were grouped according to indications for referral, the main indications being amenorrhoea, congenital abnormalities, infertility and sex abnormalities. Among the patients with amenorrhoea, the largest percentage of chromosome abnormalities (28%) occurred in the group of 86 cases of primary amenorrhoea, whereas the percentage of chromosome abnormalities in the group of 113 secondary amenorrhoea patients was only 3.5. Of 615 patients with congenital abnormalities, 345 were referred for Down syndrome, of whom 64.6% had an abnormal chromosome constitution with extra chromosome 21 material. In the remainder of patients with chromosome abnormalities, trisomy 13 and trisomy 18 featured, although not all were referred as clearcut cases of Patau's or Edward's syndrome, the respective corresponding phenotypes. The incidence of chromosome abnormalities among patients with congenital abnormalities not typical of the above mentioned three syndromes was low (8.4%), with diverse chromosome constitutions. Among the infertile patients, 70 had azoospermia and 185 had oligozoospermia. The incidence of chromosome abnormalities within the two groups was 11.4% and 8.1% respectively. Of the 233 patients referred with sex abormalities, the highest proportion of chromosome abnormalities was found among those with Turner's and Klinefelter's syndromes. In these two classes 10 patients had a 45,XO or abnormal X chromosome constitution and 6 had 47,XXY karyotypes respectively. Another group of cases was classed among miscellaneous indications for referral. Of 61 amniotic fluid samples for prenatal diagnosis, there were 2 cases of trisomy 21. Of 154 male and female patients with a history of repeated miscarriages, 2.6% had chromosome abnormalities. Of a group of 62 patients with myelo- and lymphoproliferative disorders whose blood and/or bone marrow samples were included, 7 had chromosome abnormalities. Among 61 mentally retarded patients referred, 3 had mosaic chromosome constitutions. In every case a normal cell line was present. No chromosome abnormalities were found in 23 patients with retarded growth. 88 spontaneous and 19 ectopic abortusses showed 10.5% and 10.2% chromosome abnormalities respectively. Relatives of the original index patients were found to have chromosome abnormalities in 7.3% of cases, in most instances a rearrangement corresponding to that of the index patient. The significance of the observed abnormalities in this group of 2 334 individuals, when pooled, is discussed. The distribution of the chromosome abnormalities was 81% autosomal (largely as a result of chromosome 21) and 19% sex chromosomal. Additionally, 80% of all abnormalities were numerical and 20% were structural chromosome abnormalities in both autosomes and sex chromosomes.
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    Antenatal detection of small-for-gestational-age babies : choice of a symphysis-fundus growth curve
    (Health & Medical Publishing Group, 1988) Pattinson, R. C.
    By using symphysis-fundus measurements serially and plotting them on a curve, small-for-gestational-age babies can be detected. To determine which symphysis-fundus curve to choose for our population, the predictive values of three of the commonly used of these growth curves were compared using serial measurements obtained from 97 low-risk obstetric patients with accurate gestational ages. The curves of Calvert and Quaranta had the best sensitivities of 92,9% each compared with Belizan's (85,7%). However, the specificity of Calvert's and Quaranta's curves were poorer being 74,7% and 50,6% compared with 89,2% for Belizan. The positive predictive value for the curves were Belizan 57,1%, Calvert 38,2% and Quaranta 24,1%. The results indicate that for a Third-World urban population Belizan's curve is most suitable.
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    The antenatal ultrasonographic detection of the Holt-Oram syndrome
    (Health and Medical Publishing Group -- HMPG, 1985-08) Muller, L. M.; De Jong, G.; Van Heerden, K. M. M.
    The Holt-Oram syndrome is an autosomal dominant disease with 100% penetrance. No correlation exists between the maternal clinical expression and that of the affected offspring. The syndrome includes a wide range of cardiac and skeletal malformations. Real-time ultrasound, with a detailed study of the fetal heart and skeletal system, can play a crucial role in the counselling of affected pregnant women. This study describes the ultrasonographic findings of 2 affected fetuses at risk (at 34 and 14 weeks' gestational age). Ultrasonography detected and correctly estimated the severity of the cardiac and skeletal expressions.
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    Are women with history of pre-eclampsia starting a new pregnancy in good nutritional status in South Africa and Zimbabwe?
    (BioMed Central, 2018-06-15) Cormick, Gabriela; Betran, Ana Pilar; Harbron, Janetta; Dannemann Purnat, Tina; Parker, Catherine; Hall, David R.; Seuc, Armando H.; Roberts, James M.; Belizan, Jose M.; Hofmeyr, G. Justus
    Background: Maternal nutritional status before and during pregnancy is an important contributor to pregnancy outcomes and early child health. The aim of this study was to describe the preconceptional nutritional status and dietary intake during pregnancy in high-risk women from South Africa and Zimbabwe. Methods: This is a prospective observational study, nested to the CAP trial. Anthropometric measurements before and during pregnancy and dietary intake using 24-h recall during pregnancy were assessed. The Intake Distribution Estimation software (PC-SIDE) was used to evaluate nutrient intake adequacy taking the Estimated Average Requirement (EAR) as a cut-off point. Results: Three hundred twelve women who had pre-eclampsia in their last pregnancy and delivered in hospitals from South Africa and Zimbabwe were assessed. 73.7 and 60.2% women in South Africa and Zimbabwe, respectively started their pregnancy with BMI above normal (BMI ≥ 25) whereas the prevalence of underweight was virtually non-existent. The majority of women had inadequate intakes of micronutrients. Considering food and beverage intake only, none of the micronutrients measured achieved the estimated average requirement. Around 60% of pregnant women reported taking folic acid or iron supplements in South Africa, but almost none did so in Zimbabwe. Conclusion: We found a high prevalence of overweight and obesity and high micronutrient intake inadequacy in pregnant women who had the previous pregnancy complicated with pre-eclampsia. The obesity figures and micronutrient inadequacy are issues of concern that need to be addressed. Pregnant women have regular contacts with the health system; these opportunities could be used to improve diet and nutrition.
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    Assisted reproduction in the HIV-serodiscordant couple
    (Health & Medical Publishing Group, 2007-01) Nosarka, S.; Hoogendijk, C. F.; Siebert, T. I.; Kruger, T. F.
    ENGLISH ABSTRACT: No abstract available
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    Assisted reproductive technology in South Africa : first results generated from the South African Register of Assisted Reproductive Techniques
    (Health and Medical Publishing Group (HMPG), 2012-03) Dyer, S. J.; Kruger, T. F.
    Objective. We present the first report from the South African Register of Assisted Reproductive Techniques. Methods. All assisted reproductive technology (ART) centres in South Africa were invited to join the register. Participant centres voluntarily submitted information from 2009 on the number of ART cycles, embryo transfers, clinical pregnancies, age of female partners or egg donors, and use of fertilisation techniques. Data were anonymised, pooled and analysed. Results. The 12 participating units conducted a total of 4 512 oocyte aspirations and 3 872 embryo transfers in 2009, resulting in 1 303 clinical pregnancies. The clinical pregnancy rate (CPR) per aspiration and per embryo transfer was 28.9% and 33.6%, respectively. Fertilisation was achieved by intracytoplasmic sperm injection in two-thirds of cycles. In most cycles, 1 - 2 embryos or blastocysts were transferred. Female age was inversely related to pregnancy rate. Conclusion. The register achieved a high rate of participation. The reported number of ART cycles covers approximately 6% of the estimated ART demand in South Africa. The achieved CPRs compare favourably with those reported for other countries.
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    An audit of stillborn babies in mothers with diabetes mellitus at a tertiary South African Hospital
    (Taylor & Francis, 2019-12) Hall, David R.; Masona, Deidre; Gebhardta, Gabriel; Rossouw, Jana Nicolene; Obstetrics & Gynaecology
    Objectives and design: This study is a retrospective audit spanning six years following the implementation of a new guideline on the management of diabetes in pregnancy. It aims to describe the patient profile of pregnancies complicated by diabetes and stillbirth. Setting: The study was performed in Tygerberg Hospital, Cape Town, a secondary and tertiary referral centre. Subjects: Fifty-eight pregnancies were complicated by stillbirth (> 500 g). Outcome measures: the patient profile, gestational age, co-morbidities, foetal/placental monitoring and avoidable factors were described. Results: Many patients (32%) booked after 24 weeks’ gestation and missed appointments were common (26.2%). Stillbirths ascribed to diabetes constituted 2.3% of all stillbirths at the hospital during the study period. Of the stillbirths 28.1% had Type I diabetes mellitus (DM), 64.9% had Type II and 7.0% were in patients with gestational diabetes. The median HbA1c at delivery was 8.4% (range 6.0–14.1%). In the Type II group, 31 (77.5%) of the stillbirths occurred after 36 weeks, while those among the Type I cases ranged from 26 to 38 weeks. Conclusion: Stillbirths amongst pregnant women with diabetes constituted a small percentage of the total stillbirth burden. Emphasising the importance of appropriate antenatal care to women with diabetes and increased surveillance from 36 weeks’ gestation may lower the number of stillbirths.
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    Audit of term elective caesarean section outcomes at Tygerberg Academic Hospital
    (Stellenbosch : Stellenbosch University, 2021-12) De Jager, Kobie; Geerts, Lutgart Therese Gaston Maria; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.
    ENGLISH ABSTRACT: Aim The aim of this study was to determine the proportion of patients intended for elective caesarean section (ELCS) at  39+0 weeks who are converted to emergency caesarean sections (EMCS) or normal vaginal delivery (NVD) and risk factors associated with these. Materials and Methods This retrospective observational study was conducted at Tygerberg Academic Hospital (TAH) which is a secondary and tertiary level hospital. Data was collected for all patients eligible for ELCS at  39+0 weeks with certain gestational age (GA). Data was collected on antenatal, peri- partum and post-partum information on maternal and neonatal outcome. Results Of the 307 patients who were eligible for ELCS at ≥ 39 weeks, 76 (24.8%) went into labour before their planned surgery date, 110 (35.8%) had their surgery postponed, 99 (32.2%) ended their pregnancy with an EMCS and 2 (0.7%) with NVD. There was no significant difference in the mean GA at delivery for patients in labour (39+1, SD 4 days) and patients who did not go into labour (39+1, SD 4 days) (p = 0.4). There was no significant difference in maternal or neonatal outcomes between groups who delivered < 39+0 weeks and  39+0 weeks. Conclusion ELCS theatre list over-run is a common problem in obstetric units and our setting is no exception. Considering there was no significant difference in maternal or neonatal outcome between groups that delivered at < 39+0 weeks and  39+0 weeks we could consider booking ELCS at a marginally earlier gestational age to reduce the rate of conversion to EMCS.
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    Avoiding paternalism but not moral perplexity
    (Health & Medical Publishing Group, 2018) Hall, D. R.
    Maternal autonomy has replaced medical paternalism, but conflicts between beneficence and autonomy persist.
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    Barton's forceps deliveries at Paarl Hospital
    (Health & Medical Publishing Group, 1988-02) De Villiers, V. P.
    ENGLISH ABSTRACT: Experience in using Barton's forceps for mid-pelvic arrest of the fetal head in 348 cases has proved that this instrument is both easy to apply and safe for the baby, provided rigid adherence to safety criteria are observed. As modern obstetric practice is favourably disposed towards mid-pelvic forceps vaginal delivery, the particular advantages of Barton's forceps should be more widely extolled. Their use is an invaluable addition to the obstetrician's armamentarium. Training in their use should, however, be thorough and extensive and under the guidance of a skilled senior obstetrician.
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    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.
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    Blaasnekinkompetensie by die vrou
    (Health & Medical Publishing Group, 1981-08) Louw, N. S.; De Klerk, J. N.
    Bladder neck incompetence is responsible for 15,5% of true anatomical defects that cause stress incontinence in the female. Confirmation of the diagnosis of this condition, as well as a new surgical technique for the repair of the defect, is described.