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Biomedical subjects

D W Steyn

Publications and source records attributed to D W Steyn.

14 recordsLinked to original sources
PubMed1998

Trends in caesarean sections at Tygerberg Hospital, South Africa: a 20 year experience.

OBJECTIVE: To investigate the caesarean section (CS) rate and the individual components thereof at Tygerberg Hospital; the trend and its relationship to the perinatal mortality rate. DESIGN: A retrospective study, using data from 1975 to 1994. SETTINGS: Tygerberg Academic Hospital (TBH) is the referral hospital for regional Midwife Obstetric Units (MOU) as well as the tertiary referral hospital for secondary hospitals in the former Cape Province, excluding the Eastern Cape. In the last year of the study there were 7,035 deliveries in TBH, 4,040 deliveries in the MOU and 28,596 in the secondary hospitals. SUBJECTS: 174,713 deliveries and 22,773 CS from 1975 to 1994. MAIN OUTCOME MEASURE: The individual components of the CS rate. RESULTS: The CS rate stayed constant at about 13%. The perinatal mortality rate declined from 34.7/1000 to 18.4/1000. CONCLUSION: A low, constant CS rate can be maintained without compromising the perinatal mortality rate.

Academic Medical Centers↗
PubMed1997

Randomised controlled trial of ketanserin and aspirin in prevention of pre-eclampsia.

BACKGROUND: Pre-eclampsia is associated with extensive endothelial-cell damage and platelet activation, resulting in lower production of vasodilator prostaglandins and increased release of the vasoconstrictors thromboxane A2 and serotonin. Damage to endothelial-cell serotonin-1 receptors leaves vasoconstriction and platelet aggregation mediated by serotonin-2 receptors unopposed. We investigated the role of ketanserin, a selective serotonin-2-receptor antagonist, in lowering the rate of pre-eclampsia among pregnant women with mild to moderate hypertension. METHODS: We recruited 138 pregnant women into a double-blind, randomised, placebo-controlled trial. They had diastolic blood pressure persistently more than 80 mm Hg before 20 weeks' gestation. 69 women received ketanserin and 69 received placebo. Both groups also received aspirin. Patients were initially given two tablets daily, increased to four tablets daily in diastolic blood pressure was more than 90 mm Hg. Primary outcomes were the development of pre-eclampsia and severe hypertension, and perinatal mortality. FINDINGS: There were significantly fewer cases of pre-eclampsia (two vs 13; relative risk 0.15 [95% CI 0.04-0.66], p = 0.006) and severe hypertension (six vs 17; p = 0.02) in the ketanserin than in the placebo group. There was also a trend towards less perinatal mortality (one vs six deaths) but this was not significant (p = 0.28). Rates of abruptio placentae and pre-eclampsia before 34 weeks' gestation were lower in the ketanserin group, and mean birthweight was significantly higher. INTERPRETATION: We found an association between the addition of ketanserin to aspirin and a decrease in the number of cases of pre-eclampsia and severe hypertension, as well as improved pregnancy outcome among patients with mild to moderate midtrimester hypertension.

Adult↗
PubMed1997

Dihydralazine or ketanserin for severe hypertension in pregnancy? Preliminary results.

OBJECTIVE: To compare the efficacy and safety of intravenous dihydralazine with ketanserin in the management of severe hypertension in the third trimester. STUDY DESIGN: A double blind randomised controlled trial, comparing 5 mg dihydralazine with 10 mg ketanserin after an intravenous infusion of 500 ml of a crystalloid solution. Medication was repeated every 20 min till the therapeutic goal of 90 mm Hg was reached, to a maximum of 4 dosages. Main outcome measures were treatment failures and emergency deliveries for fetal distress. RESULTS: The therapeutic goal was met more often in patients receiving dihydralazine (36/38 compared to 27/42; P < 0.01). The need for delivery for fetal distress did not differ (3 after dihydralazine, 1 after ketanserin, P = 0.29) No therapy related perinatal loss occurred, but one mother with an undiagnosed phaechromocytoma died 24 h after receiving dihydralazine. CONCLUSION: Ketanserin in this dosage is less effective to lower diastolic blood pressure. The place of a fluid load prior to dihydralazine needs to be further investigated, as fetal heart rate decelerations were less common than previously reported.

Adult↗
PubMed1996

Pregnancy in partially remitted hepatitis B-associated membranous glomerulonephritis.

Hepatitis B-associated glomerulonephritis is a relatively common cause of nephrotic syndrome in endemic areas affecting especially male children. When this disease affects girls or women, both the glomerular disease and the hepatitis B carrier state could affect subsequent pregnancies. This may be the first reported case of such a pregnancy. In this patient the partially remitted renal disease and the reduced infectivity of the hepatitis B carrier state decreased the influence of the disease on the pregnancy.

Carrier State↗
PubMed1996

Computerised cardiotocography in a high-risk unit in a developing country--its influence on inter-observer variation and duration of recording.

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.

Cardiotocography↗
PubMed1996

Management of premature rupture of the membranes after 34 weeks' gestation -- early versus delayed induction of labour.

OBJECTIVE: To determine the optimal way to manage patients with premature rupture membranes after 34 weeks' gestation. DESIGN: A prospective, randomised controlled trial comparing immediate induction and delayed induction after 24 - 48 hours. SETTING: Tygerberg Hospital, Cape Town. PARTICIPANTS: Seventy consecutive patients with premature rupture of the membranes who presented at Tygerberg Hospital between July and October 1991. MAIN OUTCOME MEASURES: The two groups were compared with regard to infectious morbidity and antibiotic requirement in the mothers and babies, days spent in hospital, caesarean section rates, duration of labour and analgesic requirements. RESULTS: There was no difference between the two groups in terms of infectious morbidity in either the mothers or the babies, the duration of labour or the caesarean section rates. Nine patients (26%) in the delayed induction group required analgesic treatment during labour versus 18 patients (52%) in the group that was induced immediately (P = 0.049; odds ratio = 0.327; 95% confidence limits = 0.014 - 0.0998). In the delayed induction group, 74% of the patients went into spontaneous labour during the conservative management period. Patients in the active group (immediate induction) had a statistically significant better chance of being discharged within 48 hours of admission (P = 0.028; odds ratio = 3.34; 95% confidence limits = 1.12 -10.73). CONCLUSIONS: The management of patients with premature rupture of the membranes afer 34 weeks should be decided upon according to the level of antepartum and neonatal care which is available at the particular unit. Where there is adequate neonatal support and pressure on bed occupancy, immediate induction of labour should be considered, while peripheral units should consider conservative management before referral of patients.

Adolescent↗
PubMed1995

Improved perinatal mortality rates in 1001 patients with severe pre-eclampsia.

OBJECTIVE: To ascertain the change in perinatal mortality (PNM) rate over a period of 10 years in 1001 patients with severe pre-eclampsia. METHODS: Patients with severe pre-eclampsia before a gestational age of 34 weeks were managed expectantly. Initial treatment consisted of the administration of magnesium sulphate to prevent convulsions and dihydralazine to reduce blood pressure. Methyldopa alone or in combination with other oral antihypertensive drugs was started soon after admission. In order to prevent fetal death from abruptio placentae, the fetal heart rate was monitored at least four times per day. Patients were delivered either at 34 weeks' gestation or when fetal or maternal indications for immediate delivery were present. The 10-year study was divided into four successive time periods and the PNM rate was calculated separately for each of these time periods. RESULTS: Perinatal survival was low if patients were delivered before or at 26 weeks' gestation but improved rapidly if delivered thereafter. There were only 33 intrauterine deaths of babies who weighed 1000 g or more. The majority of these deaths were due to abruptio placentae which had occurred prior to admission to hospital. The PNM rate for babies of 1000 g or more decreased from 61 in the first time phase and 83 in the second to 19 in the last. The overall PNM rate during the 10-year study was 62. CONCLUSION: Improved knowledge about the management of patients with severe pre-eclampsia in early pregnancy resulted in a decline in the PNM rate. Although the exact cause of this reduction towards the end of the study is not known, several factors probably played a role. They are expectant management with a little gain in the gestational age, better fetal monitoring before and during labour, earlier detection of fetal distress, earlier referral to the tertiary hospital and improved neonatal care.

Blood Pressure↗
PubMed1995

The outcome of babies of mothers with severe rhesus incompatibility treated at Tygerberg Hospital, 1980-1993.

OBJECTIVE: To determine the outcome of babies of mothers with severe rhesus (Rh) incompatibility treated by elective delivery when the amniotic optical density at 450 nm crossed Whitfield's action line (group 1), by plasmapheresis and immunotherapy (group 2) or by means of intra-uterine intravascular transfusions (group 3). STUDY DESIGN: A retrospective study of 55 mothers and their 57 fetuses with severe Rh incompatibility at < 34 weeks' pregnancy duration. MAIN OUTCOME PARAMETERS: Number of mothers in each treatment group, prevalence of intra-uterine death, hydrops, intra-uterine intravascular transfusions, cord haematocrit, cord bilirubin, number of liveborn babies, birth weight, neonatal death, hyaline membrane disease (HMD) and exchange transfusions. STUDY POPULATION AND SETTING: All mothers and babies with severe Rh incompatibility (defined as an amniotic optical density of 450 nm in the upper and upper-mid zone on the Liley chart at < 34 weeks' pregnancy duration, previous fetal hydrops or Rh-related intra-uterine death (IUD), fetal hydrops on ultrasound or a fetal haematocrit < 30% at cordocentesis) treated at Tygerberg Hospital between January 1980 and January 1993. There were 20 fetuses each in groups 1 and 3, and 17 in group 2. RESULTS: A total of 48 babies (84%) were liveborn and of these 74% survived the neonatal period. (ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Mid-trimester termination of pregnancy--a randomised controlled trial of two prostaglandin regimens.

OBJECTIVE: To determine the more applicable of two ways of prostaglandin induction currently in use in second trimester induced abortions for congenital or chromosomal abnormalities. DESIGN: A prospective randomised controlled trial. SETTING: Department of Obstetrics and Gynaecology, Tygerberg Hospital, CP. STUDY POPULATION: Twenty consecutive patients admitted for termination of pregnancy for congenital or chromosomal abnormalities between 14 and 26 weeks' pregnancy duration. MANAGEMENT: Patients were randomly selected to receive either 1.5 mg prostaglandin E2 (PGE2) gel extra-amniotically or 25 mg prostaglandin F2 alpha (PGF2 alpha) intra-amniotically. Patients in both groups received oxytocin to a maximum dosage of 120 mU per minute if they had not aborted 18 hours after the original administration of either prostaglandin regimen. If abortion had not taken place 36 hours after commencement of treatment, management was considered unsuccessful. MAIN OUTCOME MEASUREMENTS: Proportion of successful inductions and complications. RESULTS: Complications of management were rare and did not differ between the two management groups. However, there were significantly more failures in the group who received intra-amniotic PGF2 alpha (7 v. 2 patients) as well as a significantly higher need for oxytocin in this group (10 v. 4 patients). CONCLUSIONS: With promising drugs such as prostaglandin analogues and anti-progesterones not universally available, methods of induction suitable to the local situation should be sought. Extra-amniotic PGE2 seems more suitable than intra-amniotic PGF2 alpha because of a shorter induction-to-delivery time without increased morbidity.

Abortion, Induced↗
PubMed1992

Amniocentesis--still important in the management of severe rhesus incompatibility.

OBJECTIVE: To determine the role of amniocentesis in the management of severe rhesus (Rh), incompatibility. DESIGN: A 10-year retrospective descriptive study. SETTING: Department of Obstetrics and Gynaecology, Tygerberg Hospital, CP. STUDY POPULATION: 111 pregnancies complicated by severe Rh incompatibility where management had been based on results obtained from amniocentesis. MAIN OUTCOME MEASUREMENTS: Neonatal haemoglobin values, neonatal survival and short-term morbidity as compared with the position on the Liley chart after amniocentesis immediately before delivery. RESULTS: Average neonatal haemoglobin value decreased for the group in the lower zone through the midzone to the upper zone, but wide scattering of individual values between the various zones occurred. Perinatal mortality rate was 93/1,000 deliveries with Rh-related deaths occurring only in the upper midzone and upper zones. One death and 7 cases of morbidity occurred after acting on misleading information from the Liley curve. CONCLUSION: Amniotic fluid bilirubin values are at best an indirect evaluation of the state of disease. No serious complications are likely to occur when these values fall in the lower or lower mid-zones of the Liley chart. When bilirubin values fall in the upper midzone or upper zone, cordocentesis should be performed to prevent overreaction or to perform an intra-uterine transfusion.

Amniocentesis↗
PubMed1989

Fetal resuscitation in a patient with varicella pneumonia and preterm labor.

A primigravida presented at 33 weeks gestation with varicella pneumonia. Cardiotocography demonstrated repeated late decelerations of fetal heart rate. Cesarean section was indicated for contracted maternal pelvis and breech presentation, but was decided against because of the risks of anesthesia. Maternal and fetal improvement followed intrauterine resuscitation and suppression of preterm labor. Cesarean section was performed 9 days later after spontaneous rupture of membranes with excellent outcome. The same approach is suggested for similar cases.

Adult↗