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Biomedical subjects

C Nikodem

Publications and source records attributed to C Nikodem.

7 recordsLinked to original sources
PubMed2001

Titrated oral misoprostol solution--a new method of labour induction.

BACKGROUND: Misoprostol, a cheap, stable, orally active prostaglandin analogue, is effective for labour induction when administered either vaginally or orally, but uterine hyperstimulation and rupture have been reported. Previous studies of oral misoprostol for labour induction have used fixed dosages 3-6-hourly. OBJECTIVES: To develop a new method of misoprostol use for labour induction using very small, frequent, titrated oral dosages, and to pilot effectiveness. STUDY DESIGN: Open clinical pilot study. SETTING: Coronation Hospital, an academic hospital in Johannesburg, South Africa. METHODS: We developed a method using 2-hourly titrated misoprostol doses commencing with 20 micrograms, increased after three doses to 40 micrograms. To administer such small doses we dissolved one misoprostol tablet in 200 ml water. A pilot study of this method was undertaken in 25 women with various indications for induction of labour. RESULTS: Eighteen women (72%) delivered vaginally within 32 hours of induction and two women developed uterine hyperstimulation. The caesarean section rate was 20%. CONCLUSIONS: Women may respond to much smaller dosages of misoprostol than are currently in use. A multicentre randomised trial of this method is underway. We emphasise the dangers inherent in the current unregistered use of misoprostol in clinical practice.

Administration, Oral↗
PubMed2000

Maternal posture in labour.

The position adopted naturally by women during birth has been described as early as 1882 by Engelmann. He observed that primitive woman, not influenced by Western conventions would try to avoid the dorsal position and was allowed to change position as and when she wished. Different upright positions could be achieved using posts, slung hammock, furniture, holding on to a rope, knotted piece of cloth, or the woman could kneel, crouch, or squat using bricks, stones, a pile of sand, or a birth stool. Today the majority of women in Western societies deliver in a dorsal, semi-recumbent or lithotomy position. It is claimed that the dorsal position enables the midwife/obstetrician to monitor the fetus better and thus to ensure a safe birth. This paper examines the historical background of the different positions used and its evolution throughout the decades. We have reviewed the available evidence about the effectiveness, benefits and possible disadvantages for the use of different positions during the first and second stage of labour.

Female↗
PubMed1996

Breast-feeding: current knowledge, attitudes and practices of paediatricians and obstetricians.

OBJECTIVE: To assess the current knowledge, attitudes and practices of Paediatricians and Obstetricians in the greater Johannesburg area, using WHO/UNICEF 10 Steps to Successful Breastfeeding as a guideline. DESIGN: Survey. SUBJECTS: All Paediatricians and Obstetricians registered with the SAMDC and practising in the greater Johannesburg area. RESULTS: Most Paediatricians and Obstetricians advocate breastfeeding, but very few conform adequately to recommended guidelines. CONCLUSION: Doctors, as part of the healthcare team, can have a significant impact on the successful initiation and maintenance of breastfeeding. There is a need for ongoing education and intervention programmes to update current knowledge on breastfeeding management.

Adult↗
PubMed1995

Breastfeeding in crisis: survey results of the Baby-Friendly Hospital Initiative.

OBJECTIVE: To assess current breastfeeding practices in hospital in South Africa. DESIGN: Survey conducted by means of a postal questionnaire for hospitals and a questionnaire based on the baby-friendly initiative action folder for mothers. SETTING: All private and provincial hospitals according to the 1992 address list supplied by the Department of National Health: Readers of "Living and Loving" and breastfeeding liaison groups. MAIN OUTCOME MEASURE: The level of implementation of the "Ten Steps to Successful Breastfeeding" RESULTS: Less than half of the responding hospitals reported having a written breastfeeding policy. Most hospitals have a shortage of specialized training in the support of breastfeeding. This is consistent with the outcome of the maternal questionnaire indicating that the average hospital is not baby friendly. CONCLUSIONS: A concerted effort should be made by hospitals to implement the "Ten Steps to Successful Breastfeeding" and attention should be given to building breastfeeding skills into the curriculum for medical students, nurses and allied disciplines as well as in-service training for current health care workers.

Breast Feeding↗
PubMed1993

Periventricular/intraventricular hemorrhage following early and delayed umbilical cord clamping. A randomized controlled trial.

OBJECTIVE: To test the hypothesis that early compared with delayed clamping of the umbilical cords of low-birthweight babies may increase the incidence of periventricular/intraventricular hemorrhage (PVH/IVH). DESIGN: Randomized controlled trial. SETTING: The labor wards of 3 teaching hospitals of the University of the Witwatersrand, Johannesburg. PATIENTS: Women expected to give birth to babies weighing less than 2000 g. INTERVENTIONS: Allocation by randomly ordered, sealed cards to a policy either of clamping the umbilical cord immediately after delivery, or, if possible, delaying cord clamping for 1 to 2 min. MAIN OUTCOME MEASURES: Ultrasound diagnosis of PVH/IVH about 24 h after birth by an observer blind to the allocation of each patient. RESULTS: PVH/IVH was diagnosed in 8/40 (20%) of neonates following delayed umbilical cord clamping and 11/46 (24%) following early cord clamping (odds ratio 0.80; 95% confidence interval, 0.29 to 2.20). CONCLUSIONS: This study does not confirm that early clamping of the umbilical cord may contribute to the initiation of PVH/IVH in low-birthweight neonates, but further studies are required before the hypothesis can be rejected with confidence.

Cerebral Hemorrhage↗