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Biomedical subjects

G J Hofmeyr

Publications and source records attributed to G J Hofmeyr.

At least 19 recordsLinked to original sources
PubMed1998

The Collaborative Randomised Amnioinfusion for Meconium Project (CRAMP): 1. South Africa.

OBJECTIVE: To evaluate transcervical amnioinfusion for meconium stained amniotic fluid during labout. DESIGN: Multicentre randomised controlled trial. SETTING: Four urban academic hospitals in South Africa. Obstetric surveillance included the use of electronic fetal heart rate monitoring in most cases. PARTICIPANTS: Women in labour at term with moderate or thick meconium staining of the amniotic fluid. INTERVENTIONS: Transcervical amnioinfusion of 800 mL saline at 15 mL per minute, followed by a maintenance infusion at 3 mL per minute. The control group received routine care. Blinding of the intervention was not possible. MAIN OUTCOME MEASURES: Caesarean section, meconium aspiration syndrome and perinatal mortality. RESULTS: Caesarean section rates were similar (amnioinfusion group 70/167 vs control group 68/159; RR 0.98, 95% CI 0.76-1.26). The incidence of meconium aspiration syndrome was lower than expected on the basis of previous studies (4/162 vs 6/163; RR 0.67, 95% CI 0.19-2.33). There were no perinatal deaths. There were no significant differences between any of the subsidiary outcomes. CONCLUSIONS: This study concurred with three previous trials which found no effect of amnioinfusion for meconium-stained amniotic fluid on caesarean section rate, though the pooled data from all identified trials to date show a significant reduction. The findings with respect to meconium aspiration syndrome were inconclusive in this study alone because of the small number of babies affected, but the point estimate of the relative risk was consistent with the finding of a significant reduction in previous studies and with the Zimbabwe arm (CRAMP 2) of this study. Pooled data clearly support the use of amnioinfusion for meconium stained amniotic fluid to reduce the incidence of meconium aspiration syndrome.

Amnion↗
PubMed1998

The Collaborative Randomised Amnioinfusion for Meconium Project (CRAMP): 2. Zimbabwe.

OBJECTIVE: To evaluate transcervical amnioinfusion for meconium stained amniotic fluid during labour. DESIGN: Multicentre randomised controlled trial. SETTING: A large urban academic hospital. Electronic fetal heart rate monitoring was not used. PARTICIPANTS: Women in labour at term with moderate or thick meconium staining of the amniotic fluid. INTERVENTIONS: Transcervical amnioinfusion of 500 mL saline over 30 minutes, then 500 mL at 30 drops per minute. The control group received routine care. Blinding of the intervention was not possible. MAIN OUTCOME MEASURES: Caesarean section, meconium aspiration syndrome and perinatal mortality. RESULTS: There was no difference in risk for caesarean section in the two groups (amnioinfusion 9.5% vs control 12.3%; RR 0.84, 95% CI 0.53-1.32). Meconium aspiration syndrome was significantly less frequent in the amnioinfusion group (3.1% vs 12.8%; RR 0.24, 95% CI 0.12-0.48), and there was a trend towards fewer perinatal deaths (1.2% vs 3.6%; RR 0.34, 95% CI 0.11-1.06). CONCLUSIONS: Amnioinfusion is technically feasible in a developing country situation with limited intrapartum facilities. In this study amnioinfusion for meconium stained amniotic fluid was associated with striking improvements in perinatal outcome.

Abnormalities, Multiple↗
PubMed1998

A randomised placebo controlled trial of oral misoprostol in the third stage of labour.

OBJECTIVE: To compare oral misoprostol 400 microg with placebo in the routine management of the third stage of labour. DESIGN: A double-blind placebo controlled trial. Setting The labour ward of an academic hospital in Johannesburg, South Africa with 7000 deliveries per annum. PARTICIPANTS: Low-risk women expected to deliver vaginally. METHODS: Women in labour were randomly allocated to receive either misoprostol 400 microg orally or placebo after the birth. Conventional oxytocics were given immediately if blood loss was thought to be more than usual. Postpartum blood loss in the first hour was measured by collection in a special flat plastic bedpan. Side effects were recorded. MAIN OUTCOME MEASURES: Measured blood loss > or = 1000 ml within the first hour after birth. Use of additional oxytocics. RESULTS: The groups were well matched. Measured blood loss > or = 1000 ml occurred in 15/250 (6%) after misoprostol and 23/250 (9%) after placebo (relative risk 0.65; 95% confidence interval 0.35-1.22). The difference may have been reduced by the greater use of conventional oxytocics in the placebo group, which was statistically significant for intravenous oxytocin infusion (2.8% vs 8.4%, relative risk 0.33, 95% confidence interval 0.14-0.77). Shivering was more common in the misoprostol group (19% vs 5%, relative risk 3.69; 95% confidence interval 2.05-6.64). CONCLUSIONS: Shivering has been shown in this study to be a specific side effect of misoprostol administered orally in the puerperium. No serious side effects were noted. Misoprostol shows promise as a method of preventing postpartum haemorrhage. Because of the potential benefits for childbearing women, particularly those in developing countries, further research to determine its effects with greater certainty should be expedited.

Administration, Oral↗
PubMed1998

Randomized comparison of rectal misoprostol with Syntometrine for management of third stage of labor.

BACKGROUND: The search for an effective, easily stored, affordable uterotonic agent in preventing postpartum hemorrhage is of importance, especially in the developing world. The objective of this study was to randomly compare the effectiveness of rectal misoprostol with Syntometrine in the management of the third stage of labor. METHODS: Four hundred and ninety-one low risk women in labor were randomly allocated to receive either misoprostol 400 microgram rectally or Syntometrine 1 ampuole intramuscularly, and postpartum blood loss was estimated as the principal end point. Comparisons were by the chi-square test or Fisher's test and relative risks with 95% confidence intervals for categorical data, and the Mann-Whitney test for ranked continuous variables. RESULTS: The baseline characteristics in terms of hemoglobin estimation in antenatal clinic, mean age, parity, and duration of labor in the 250 patients who received Syntometrine and 241 patients who received misoprostol were similar. However, there was a significant difference in the pre-delivery blood pressure of the two groups because of the non-protocol exclusion of women with elevated blood pressure allocated to receive Syntometrine. Duration of third stage of labor, blood loss postpartum and hemoglobin estimation post partum were all similar. Postpartum diastolic hypertension was more common in the Syntometrine group (p= 0.002). No other apparent side effect was noted in either group. CONCLUSION: Misoprostol rectally for management of the third stage of labor merits further investigation.

Administration, Rectal↗
PubMed1998

Fetal vibro-acoustic stimulation with a can--a clinical study.

OBJECTIVE: To assess the usefulness of the can as a fetal vibro-acoustic stimulator in the clinical environment. PATIENTS AND SETTING: 112 high-risk obstetric patients at Coronation Hospital, Johannesburg. METHOD: 161 vibro-acoustic stimulation tests with a can and 159 non-stress tests (NSTs) were performed. The results of the can test were compared with those of the NSTs and with fetal outcome at delivery. RESULTS: The can test showed poor sensitivity (5/9). Three of the 4 false-negative results were due to placental abruption that occurred subsequent to the can test. The ability of the can test to predict a reactive NST and good fetal outcome was 94% (negative predictive value). CONCLUSIONS: In view of the reasonable negative predictive value, the test should be evaluated further as a screening test at primary care level, where there are few or no cardiotocographic facilities.

Acoustic Stimulation↗
PubMed1997

Antioxidants in the treatment of severe pre-eclampsia: an explanatory randomised controlled trial.

OBJECTIVE: To determine whether antioxidant therapy alters the disease process in severe early onset pre-eclampsia, in support of the hypothesis that increased lipid peroxides and reactive oxygen species production-play an important role in the pathogenesis of the disease. DESIGN: Randomised, double-blind, placebo controlled trial. SETTING: Two tertiary care, referral hospitals in Johannesburg, South Africa. PARTICIPANTS: Women with severe pre-eclampsia diagnosed between 24 and 32 weeks of gestation. INTERVENTION: Combined antioxidant treatment with vitamin E (800 IU/day), vitamin C (1000 mg/day), and allopurinol (200 mg/day). MAIN OUTCOME MEASURES PRIMARY OUTCOMES: 1. prolongation of pregnancy and 2, biochemical assessment of lipid peroxides and antioxidants. SECONDARY OUTCOMES: data on maternal complications, side effects of treatment, infant outcomes and regular assessment of haematologic and renal parameters. RESULTS: The proportion of women delivered within 14 days in the antioxidant group was 52% (14/27) compared with 76% (22/29) in the placebo group (relative risk 0.68, 95% confidence interval 0.45-1.04). One woman in each group had eclampsia. Eleven women (42%) in the antioxidant and 16 (59%) in the placebo group required two antihypertensives for blood pressure control. Trial medications were well tolerated with few side effects. Lipid peroxide levels were not significantly altered in the antioxidant and placebo groups. Serum uric acid levels decreased and vitamin E levels increased significantly. CONCLUSION: The results of this explanatory randomised trial do not encourage the routine use of antioxidants against pre-eclampsia. However, further research with modified strategies such as earlier initiation of therapy or different combinations seem worthwhile.

Adolescent↗
PubMed1997

Sonographic hydrotubation using agitated saline: a new technique for improving fallopian tube visualization.

Vaginal sonographic hydrotubation (SHT) was assessed in the evaluation of uterine configuration and tubal patency in 71 women undergoing investigation for infertility. In addition, a new technique using "agitated" saline during transvaginal sonography was evaluated in 50 of the patients. Ultrasound was more sensitive in detecting uterine abnormalities (89% compared with 6% for hysterosalpingography (HSG). Of 142 individual fallopian tubes studied, the diagnosis on SHT and HSG were the same in 120 (85%). Laparoscopic results were available on 15 patients. The findings on all 19 tubes in which the SHT and HSG diagnosis had concurred were confirmed. Of 11 tubes in which the diagnoses had differed, the laparoscopic finding agreed with the diagnosis made with SHT in seven, HSG in three, and neither in one. As shown in previous studies, sonographic hydrotubation is a simple technique with a high degree of accuracy. The use of "agitated" saline improved the ease with which the fallopian tubes were visualized.

Fallopian Tube Patency Tests↗
PubMed1997

Betamimetics in fetal distress: randomised controlled trial.

The objective of the study was to investigate if a single dose of Hexoprenaline administered to patients diagnosed as having fetal distress improves neonatal outcome and whether there are any side effects and complications related to hexoprenaline injection. Patients with fetal distress diagnosed by electronic fetal heart rate monitoring with a gestational age of 35 weeks or more in active labor were eligible. Once the decision to deliver the patient by Cesarean section was made, patients were approached and randomised by sealed opaque envelopes to hexoprenaline or control groups. Ten micrograms of hexoprenaline were administered intravenously to study patients. Main outcomes were cord blood gas values, Apgar scores, the need for resuscitation and admission to intensive care. There were no statistically significant differences in the main outcome measures between the two groups. Fewer babies in the hexoprenaline group had a pH of < 7.2 and a base excess of < -10, but this was not statistically significant. The fetal heart rate pattern was improved in significantly more patients after hexoprenaline administration than controls. In conclusion, despite the statistically significant improvement in fetal heart rate tracings, Apgar scores and blood gas values showed only a trend towards improvement in the hexoprenaline group.

Adrenergic beta-Agonists↗
PubMed1997

Primary care fetal assessment--low-cost fetal arousal testing.

Conventional vibro-acoustic stimulation tests require expensive vibro-acoustic stimulators and electronic monitoring equipment. Attempts to simplify the test have been made using an electric toothbrush and razor but even these simpler devices are not available in most primary care settings. We compared the sound pressure generated by a Corometrics 146 vibro-acoustic stimulator to that of an empty soft-drink can in an in vitro study. The can compared favourably to the conventional vibro-acoustic stimulator.

Acoustic Stimulation↗
PubMed1996

Prenatal sonographic diagnosis of congenital varicella infection--a case report.

We report a case of fetal varicella infection following the diagnosis of maternal varicella infection at 13 weeks of pregnancy. Anomalies noted sonographically at 26 weeks' gestation included oligohydramnios, symmetrically impaired fetal growth, limb anomalies, a thin placenta, and widespread dystrophic calcification of the abdominal cavity and chest, including the lungs and myocardium. Some of these sonographic anomalies have been reported previously. However, to our knowledge, prenatal diagnosis of calcification of the lungs and myocardium has not been described.

Adult↗
PubMed1996

Amnioinfusion.

Abnormal amniotic fluid volume may be both the result and the cause of complications at various stages of pregnancy. This review focuses on evidence from randomised trials of the effectiveness of amnioinfusion. Attempts to prevent the development of pulmonary hypoplasia by means of transabdominal amnioinfusion to correct severe oligohydramnios in the middle trimester of pregnancy have not been evaluated by randomised trials. Long-term transcervical amnioinfusion for prelabour rupture of the membranes has shown promising results in prospective studies, but has also not been subjected to randomised evaluation. Transcervical amnioinfusion during labour is a relatively simple procedure. Normal saline is infused through an intrauterine catheter, preferably one with a catheter-tip pressure transducer. Once an adequate volume of amniotic fluid has been achieved, it is maintained by means of a slow continuous infusion or repeated bolus infusions. Amnioinfusion has been used to prevent or treat fetal heart rate (FHR) decelerations thought to be due to oligohydramnios. In several rather small randomised trials, amnioinfusion has been associated with a reduction in FHR decelerations, caesarean sections, low Apgar scores, low umbilical arterial pH values and postpartum endometritis. Amnioinfusion has also been used to dilute thick meconium-staining of the amniotic fluid. In trials for this indication, amnioinfusion has been associated with similar benefits, and in addition a reduction in meconium presence below the vocal cords, meconium aspiration syndrome and the need for neonatal ventilation. Larger trials are needed to determine whether amnioinfusion is associated with an effect on perinatal mortality, and whether complications such as umbilical cord prolapse are increased.

Amnion↗