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Biomedical subjects

H A van Coeverden de Groot

Publications and source records attributed to H A van Coeverden de Groot.

At least 19 recordsLinked to original sources
PubMed2005

A 50-year audit of maternal mortality in the Peninsula Maternal and Neonatal Service, Cape Town (1953-2002).

OBJECTIVE: To audit trends in maternal mortality in the Peninsula Maternal and Neonatal Service (PMNS) over a 50-year period, with respect to rates and patterns of causation. DESIGN: Retrospective and prospective audit. SETTING: The PMNS, an integrated perinatal service composed of primary, secondary and tertiary facilities in Cape Town. Population All women giving birth in the area of the Cape Peninsula served by the PMNS over the 50-year period. METHODS: Data on maternal deaths were collected for 1953-2002 inclusive, from annual obstetric and gynaecological reports. Three triennia (1954-1956, 1981-1983 and 1999-2001) were selected for a detailed comparison of trends in rates and causes of death. MAIN OUTCOME MEASURES: Maternal mortality rates (MMRs). Causes of maternal deaths. RESULTS: Total deliveries increased from 7315 in 1953 to 27,575 in 2002. The MMR declined from 301 deaths per 100,000 deliveries in 1953 to 31.2 in the triennium, 1987-1989. From 1999, the MMR increased, reaching 112 in 2002. Comparing 1954-1956 (MMR of 253.9) with 1981-1983 (MMR of 43.8), there was a marked decline in the MMR related to hypertension (80.4 to 11.3), haemorrhage (50.8 to 4.2), abortion (55 to 4.2), suspected pulmonary embolism (25.4 to 2.8), pregnancy-related sepsis (8.5 to 4.2) and cardiac disease (21.2 to 2.8). Comparing 1981-1983 (MMR of 43.8) with 1999-2001 (MMR of 59.4), there was a decline in the MMR associated with abortion (4.2 to 0). The MMR for haemorrhage, suspected pulmonary embolism and cardiac disease remained the same. There was a slight increase in the MMR attributed to hypertension (11.3 to 14.5) and pregnancy-related sepsis (4.2 to 7.3). There was a marked increase in the MMR associated with non-pregnancy-related infections/AIDS (4.2 to 18.2). CONCLUSIONS: The MMR for all causes of maternal death declined significantly from 1953 to 1981 as a result of several interventions. From 1999, there has been a non-significant increase in MMR, predominantly due to the burden of HIV/AIDS-related mortality.

Cause of Death↗
PubMed1997

The prevalence of domiciliary deliveries in Khayelitsha, Cape Town.

OBJECTIVE: To determine whether the 17% decrease in the number of patients cared for at the Khayelitsha Midwife Obstetric Unit (MOU) between 1991 and 1994 could be ascribed to an increase in home deliveries. METHOD: Survey of Khayelitsha labour ward records, vaccination cards and family planning statistics at various clinics in Khayelitsha, Cape Town. RESULTS: The prevalence of home deliveries in Khayelitsha during the study period was estimated at 8%. Between 1992 and 1994, the number of acceptors at family planning clinics in Khayelitsha increased by 89%. CONCLUSION: As the number of home deliveries had apparently remained static, it was unlikely that an increase in the former had been responsible for the observed decrease in Khayelitsha MOU patients. Other possible reasons for the decline, viz. (i) an increase in hospital deliveries; (ii) an increase in the number of patients returning to the so-called homelands to be delivered there; (iii) an increase in confinements by private doctors and midwives; and (iv) that patients had shunned the MOU, were equally unlikely. The decline in the number of patients cared for at Khayelitsha MOU between 1991 and 1994 was most likely due to the evident success of the local family planning programme.

Female↗
PubMed1994

Referrals for inadequate progress of labour from the midwife obstetric units to the referral hospitals in Cape Town.

Referrals for inadequate progress of labour from the Midwife Obstetric Units (MOUs) to the referral hospitals are responsible for a significant part (approximately 5%) of the workload of these institutions in the Peninsula Maternal and Neonatal Service Region in Cape Town. It is essential for the maintenance of community credibility in the MOUs that patients who develop complications are timely and speedily transferred to the appropriate referral hospital. A sample of 251 patients, who were transferred from the MOUs to the referral hospitals for inadequate progress of labour in the first half of 1992, was analysed. The study showed that midwives in the MOUs had largely adhered to the Departmental referral criteria for that potentially serious complication of labour and had kept excellent records. The referrals, in terms of eventual outcome for the patients and their infants, had been largely appropriate. Several areas of concern were identified. These included incomplete assessment of the stage of labour on admission and inadequate monitoring of the fetal heart in a number of patients. Provision of analgesia in labour was generally inadequate. Ambulance delay was disturbingly common. Recommendations for measures to redress these management deficiencies are presented.

Female↗
PubMed1990

The relative risks of caesarean section (intrapartum and elective) and vaginal delivery: a detailed analysis to exclude the effects of medical disorders and other acute pre-existing physiological disturbances.

OBJECTIVE: To compare maternal mortalities attributable to vaginal delivery, elective caesarean section (CS) and intrapartum CS. DESIGN: The number of deaths associated with each method of delivery was ascertained among unselected and among low-risk women by detailed retrospective review of the case-notes of women who died after delivery. The frequency of each method of delivery throughout the study period was ascertained from the computer database and enhanced by analysis of the case-notes of unselected groups of women. SETTING: The Peninsula Maternity Services (Cape Town) during the years 1975-1986 inclusive. SUBJECTS: A total of 108 maternal deaths arising from 263,075 maternities provided accurate information. The relative frequency of vaginal and abdominal delivery was determined from the computer database. The ratio of elective CS to emergency prepartum CS to intrapartum CS was obtained by review of the first 200 operations in the years 1975, 1977, 1979, 1982 and 1984. MAIN OUTCOME MEASURES: (i) Mortality rates associated with the different methods of delivery in unselected women and in women who were healthy before surgery; (ii) mortality rates apparently attributable to the method of delivery. RESULTS: The overall relative risk of mortality associated with caesarean section compared with vaginal delivery was 7 decreasing to 5 after the exclusion of women with medical or life-threatening antenatal complications (eg, haemorrhage, hypertension). The relative risk associated with intrapartum compared with elective sections was 2.3 decreasing to 1.4 after the exclusion of women with medical disorders or life-threatening complications. The relative risk of maternal mortality which was apparently attributable to intrapartum compared with elective sections was 1.7. However, the 95% confidence intervals of these values, even from this large data-set, are wide. Nevertheless, these rates are in broad agreement with an approximation derived from the British confidential enquiries into maternal deaths. CONCLUSION: The attributable relative mortalities of caesarean section compared with vaginal delivery and intrapartum compared with elective caesarean section are lower than the overall relative mortalities of these modes of delivery and are approximately 5:1 and 1.5:1 respectively. These data are crucially important in the decision to recommend elective caesarean section compared with trial of labour.

Cause of Death↗
PubMed1987

The Cape Town Teenage Clinic.

Over a 6-month period 265 white females aged under 24 years attending the Teenage Clinic of the Western Cape Region of the Family Planning Association were interviewed at their first visit; 81% were sexually active. The age of menarche and the parents' marital status were important parameters of socio-sexual behaviour. The earlier the menarche, the higher the prevalence of coitus at a younger age, and the shorter the interval between menarche and the first coitus. Young age at first coitus, in turn, was associated with a higher prevalence of multiple sexual partners and smoking, and a longer period of unprotected intercourse before attending the clinic than among those who first attempted intercourse at a later age. Of those who had first experienced coitus at under 17 years, 37% came from single-parent families, compared with 12% of those in whom coitus was delayed until over 19 years of age. The important health and educational implications are discussed.

Adolescent↗
PubMed1986

The obstetric scene in Cape Town, 1974-1983. A ray of demographic hope.

The age and parity distributions of all black and coloured maternity patients whose babies were delivered by the Peninsula Maternal and Neonatal Service in Cape Town in 1974 were compared with those for the trienniums 1978 - 1980 and 1981 - 1983. The numbers and percentages of teenage pregnancies, grand multiparas and pregnancies in women greater than 34 years were analysed. Over the decade there was no change in these three demographic parameters among blacks. In contrast there was a marked decline in the percentage and number of grand multiparas and a slight decrease in the percentage of women over 34 years among the coloured patients. The prevention of teenage pregnancies must remain the major demographic priority in Cape Town.

Adolescent↗
PubMed1986

Maternal mortality in Cape Town, 1978-1983.

During 1978-1983, 57 maternal deaths (23 in blacks, 32 in coloureds and 2 in whites) occurred among 131,288 deliveries (36,564 in blacks, 89,335 in coloureds and 5389 in whites) in the Peninsula Maternal and Neonatal Service, Cape Town. Data for whites were not analysed further. Maternal mortality rates (MMRs) were higher in blacks than in coloureds. Age- and parity-specific MMRs showed that black teenagers and primiparas and coloureds aged 20-34 years and of parity 2-4 had the lowest rates. Advanced age and grand multiparity had a much greater adverse effect in coloureds than in blacks. Eighteen per cent of deaths in blacks and 9% of those in coloureds were in unbooked patients. The main causes of death (obstetric and non-obstetric) in blacks were sepsis, abruptio placentae, eclampsia and pneumonia. In coloureds they were eclampsia, other manifestations of proteinuric hypertension, cardiac disease, sepsis, haemorrhage (grouped) and diabetes. Of those who died, 43% of blacks and 38% of coloureds had had a caesarean section. The perinatal mortality rate was 417 for blacks and 469 for coloureds. A number of avoidable factors were identified. Most, if not all, deaths occurred because simple perinatal rules were broken.

Adult↗
PubMed1983

The cervical stump.

A retrospective series of 18 patients with a cervical stump is presented. Of the 12 patients who were followed up, all but one had a clinical indication for cervicectomy. Elective cervicectomy 2-3 months after subtotal hysterectomy is recommended.

Adult↗
PubMed1983

Coital injuries of the vagina in non-virginal patients.

A series of 19 non-virginal patients who sustained vaginal injuries during normal coitus is presented. Twelve were between 16 and 25 years of age and 5 were older than 45 years. All presented with profuse or prolonged vaginal bleeding. The initial diagnosis was frequently wrong because a history of injury was not forthcoming and visualization of the lesion was obscured by the bleeding. The possibility of such trauma should be kept in mind; digital examination confirms the diagnosis. Prompt surgical suturing under general anaesthesia is required to control the haemorrhage.

Adolescent↗
PubMed1983

Morbidity after total abdominal hysterectomy.

Total abdominal hysterectomy (TAH), the commonest major gynaecological operation performed at the Groote Schuur and Somerset Hospitals, is associated with considerable financial and social problems for the family. A retrospective series of 300 consecutive patients who had undergone TAH is presented. This series was analyzed for factors influencing the prevalence of wound haematoma, sepsis and dehiscence, pain and decreased mobility, the main parameters of postoperative morbidity. The four factors found to be important in minimizing postoperative complications of TAH were: (i) the experience of the surgeon; (ii) the use of the Pfannenstiel rather than the subumbilical midline incision; (iii) closure of the skin with Dermalon rather than with black silk; and (iv) drainage of the wound.

Adult↗
PubMed1983

Pregnancy after tubal occlusion. A 5-year study.

During the 5-year period 1976--1980 9 430 patients underwent tubal occlusion at Groote Schuur Hospital, Cape Town. Of these patients 24, or 2.5/1 000, became pregnant after the procedure. An analysis of the pregnancy rate for each method of tubal occlusion is reported. Bilateral tubal occlusion by laparotomy or falope rings has flow failure rate; cauterization has not.

Female↗