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Biomedical subjects

K Mahomed

Publications and source records attributed to K Mahomed.

At least 19 recordsLinked to original sources
PubMed1994

A comparison of manual vacuum aspiration (MVA) and sharp curettage in the management of incomplete abortion.

OBJECTIVES: A prospective longitudinal study was carried out in two Harare hospitals to determine whether manual vacuum aspiration (MVA) was as safe and as effective as sharp curettage for treatment of incomplete abortion. METHODS: Demographic and clinical data were collected over a 3-month period on 589 women treated with sharp curettage for incomplete abortion < or = 12 weeks gestation. One year later, after faculty and staff at the two hospitals were trained to use MVA, data were similarly collected on 834 women treated with MVA for incomplete abortion. RESULTS: Based on procedure-related complications at the time of treatment, MVA was found to be as safe as sharp curettage in treating incomplete abortion < or = 12 week gestation. MVA was more effective than sharp curettage in achieving complete uterine evacuation (0% incomplete evacuations vs. 0.7%, P < 0.05). CONCLUSIONS: Given the safety and effectiveness of the MVA procedure and the potential for reducing health care costs and improving patient management, this technology should be considered by health care systems in developing countries for improving treatment of abortion complications.

Abortion, Incomplete↗
PubMed1994

Meconium staining of the liquor in a low-risk population.

Although the significance of meconium-stained amniotic fluid as a sign of fetal distress remains controversial, its presence remains a concern to both obstetricians and neonatologists since signs of asphyxia and meconium staining are associated with an increase in perinatal morbidity and mortality. The aim of this study was to evaluate the role of meconium staining of the liquor in the low-risk obstetric population in terms of fetal distress and perinatal morbidity and mortality. In a prospective cohort study at a referral hospital and at one of two municipal clinics, women with a singleton pregnancy of 37 to 42 weeks gestation and with no pre-defined risk factor were recruited into the study. Study patients comprised those with meconium staining of the liquor and controls comprised similar women but with clear liquor. Meconium staining of the liquor was associated with poor outcome in all the outcome measures assessed. Fetal heart rate (FHR) abnormality was more closely associated with adverse outcome than meconium staining, and thin meconium alone was not associated with any adverse outcome except respiratory distress. Women with thin meconium in the presence of normal FHR can therefore be safely managed at the clinic level. Thick meconium itself was a risk factor for poor outcome, more so if associated with FHR abnormality, and should be an indicator for early referral.

Amniotic Fluid↗
PubMed1992

A simplified form of cardiotocography for antenatal fetal assessment.

Antenatal cardiotocography has become the primary method of evaluation of fetal wellbeing, and the relationship between the presence of fetal heart rate accelerations in response to fetal movement and subsequent good fetal outcome has been demonstrated. However, in areas where electronic monitors are few or not available it would be useful if such accelerations could be demonstrated using the Pinard stethoscope. A prospective study involving 200 women with a singleton pregnancy of more than 34 weeks gestation was performed at Harare Maternity Hospital, Harare, Zimbabwe, when a 6 min electronic trace using an external transducer was compared with simultaneously performed 6 min manual record using the Pinard stethoscope. The findings showed that the manual record has a sensitivity of 75% and although traces with excessive base line variability would show an acceleration on the manual record, in no case with a flat trace was an acceleration noted on the manual record. This acceptable degree of sensitivity would allow for a significant decrease in the number of women being referred for electronic tracing and would be a more appropriate use of limited resources in terms of manpower and equipment.

Auscultation↗
PubMed1992

Intrapartum foetal heart rate monitoring--continuous electronic versus intermittent Doppler--a randomised controlled trial.

OBJECTIVE: To compare different methods of intrapartum foetal heart rate monitoring in high risk pregnancies in detecting foetal heart rate abnormalities, need for operative delivery for foetal distress, and neonatal mortality and short term neonatal morbidity. DESIGN: A prospective randomised controlled trial. SETTING: Women in labour at a referral maternity hospital. PATIENTS: Women who were 37 weeks or more pregnant with singleton cephalic presentation and normal foetal heart rate prior to entry into the study. INTERVENTION: Women were randomly allocated using sealed opaque envelopes to either continuous electronic foetal heart rate monitoring or intermittent monitoring using hand held doppler foetal heart rate detector. OUTCOME MEASURES: These include abnormal foetal heart rate patterns, need for operative delivery for foetal distress, neonatal mortality, Apgar scores, admission to NNU, neonatal seizures, and hypoxic encephalopathy. RESULTS: Randomisation achieved good comparability between the two groups. Abnormal FHR patterns were more frequent in the electronic group (54 pc versus 32 pc). Caesarean section rate was not significantly different in the two groups (28 pc versus 24 pc) although slightly higher compared to overall for the unit (18pc). Foetal outcome was also comparable between the two groups. CONCLUSIONS: Asphyxia can be detected with a hand held doppler just as reliably as by the use of electronic monitors and their use should be further evaluated and promoted in obstetric units caring for high risk pregnancies in developing countries with scarce resources.

Adult↗
PubMed1992

Socio-democratic characteristics of women presenting with abortion--a hospital based study.

OBJECTIVE: To determine socio-demographic characteristics and clinical features of women presenting with abortion, and to define factors associated with complications of abortion. DESIGN: A prospective descriptive study. SETTING: Women in Gynaecology casualty department at Harare Central Hospital, Harare, Zimbabwe. PATIENTS: 307 women with features of complete or incomplete abortion were interviewed during February to June 1991. They were randomly selected and represented 53pc of all women with the problem. RESULTS: Three quarters of the women were married and lived with their spouses. In 23.1pc this was a first pregnancy. Over a quarter of the women who were on the pill claimed to have fallen pregnant whilst on the pill, mainly because of poor compliance. One hundred and twenty-two were not on the pill but in only 16pc it was intended to fall pregnant. In nearly 30pc the pregnancy was not wanted but only 2.3pc admitted to having induced the abortion. Sepsis was present in 25.6pc and they tended to be younger, not presently married and have an unplanned pregnancy. Although there was some evidence of trauma in 6.2pc, it was not possible from the study to assess the percentage of abortion likely to have been induced. CONCLUSION: Contraceptive usage is generally low and cultural and traditional factors may play a role, but expanded sex education programmes and continued contraceptive counselling need reinforcing before attempts are made to review the legal issues regarding termination.

Abortion, Illegal↗
PubMed1992

Reference values for glucose tolerance test in the urban Zimbabwean pregnant woman.

A 50 g oral glucose tolerance test (OGTT) was performed on normal pregnant urban Zimbabwean women at 26-28 weeks (n = 65) and 36-40 weeks (n = 72) gestation. Women with factors predisposing to impaired glucose tolerance were excluded. The fasting, one hour and two hours values were compared to the North American standards as proposed by O'Sullivan and Mahan which are currently in use. The mean fasting levels were significantly higher and those at one and two hours significantly lower than the standards. The study also failed to demonstrate impairment of glucose tolerance with advancing gestation. These may have implications in the screening for impaired glucose tolerance in our African population.

Adult↗
PubMed1991

External cephalic version at term. A randomized controlled trial using tocolysis.

OBJECTIVE: To assess the role of external cephalic version (ECV) at term, using tocolysis. DESIGN: A randomized controlled trial over a 12 month period. SETTING: Harare Maternity Hospital, Harare, Zimbabwe. SUBJECTS: 208 women with breech presentation at term were recruited after satisfying eligibility criteria. There were 103 women in the study group and 105 in the control group. At the end of the study a further 104 women were recruited for ECV. INTERVENTION: ECV attempted after intravenous injection of 10 micrograms of hexaprenaline, using either forward or backward somersault over a maximum period of 5 min. MAIN OUTCOME MEASURES: Success rate in terms of presentation during labour, need for caesarean section, and various variables related to fetal outcome. RESULTS: ECV reduced the frequency of breech presentation during labour from 83% to 17% and that of caesarean section from 33% to 13%. There were no troublesome complications from the procedure. CONCLUSION: In carefully selected women with breech presentation, ECV at term using tocolysis, safely reduced the rate of breech presentation in labour and also the caesarean section rate. Further research is needed to determine the role of ECV in early labour.

Adolescent↗
PubMed1991

Time of delivery--effect on obstetric outcome: a retrospective study.

This retrospective study involving 3,896 births is performed to see if there is any association between time of delivery and feto-maternal outcome. 34 pc of all deliveries occurred in the four-hour period 2000 hours to 2400 hours. Generally, there were more unbooked women arriving during the night. The higher caesarean section rate during the day time is probably related to the number of elective procedures performed during this time. This study, however, failed to confirm others which demonstrate a poorer outcome during the night infant outcome, in fact tended to be worse during the period 0800 hours to 2000 hours, and this was particularly so for the women delivering between 1600 and 2000 hours. Implications for reorganisation of the mid-wifery staff are discussed.

Adult↗
PubMed1991

Adolescent pregnancy--a prospective survey of contraceptive knowledge and reproductive behaviour.

Adolescent sexual activity is occurring at younger ages resulting in unplanned and often unwanted pregnancies. The prospective case controlled study of 200 teenagers aged 16 and under and 200 controls aged over 20 was conducted in Harare, Zimbabwe. The study group tended to belong to the low socio-economic group and a large number became pregnant whilst still at school. Although sexually active, the group contained a very small percentage of contraceptive users. A significant number not only claimed having little knowledge of the service but appeared uniformed or misinformed of the risks associated with the use of contraceptive methods. Regarding support during pregnancy, the Zimbabwe teenager is certainly aided by the extended family unit and formal health centres appear to play a minor role. Prevention of teenager pregnancies needs us to focus on adolescent peer pressure as well as towards parents and community leaders.

Adolescent↗
PubMed1991

Seroprevalence of HIV infection amongst antenatal women in greater Harare, Zimbabwe.

Prevalence of HIV infection appears to be rising in many African countries. HIV infection in the pregnant woman poses a dilemma for the mother as well as for her unborn child. There are no data on HIV prevalence in Zimbabwe. This prospective study designed to determine HIV prevalence, enrolled pregnant women booking for antenatal care at Harare hospital and two of its peripheral municipal clinic. Two Elisa and a confirmatory Western Blot test on 1008 blood samples provided an HIV sero-prevalence rate in the studied population of 18 pc. High groups included unskilled labourers who were unbooked, single, divorced or cohabiting and below 30 years of age. Regarding education and income, women with over 11 years of education or earning over $600 per month constituted a lower risk category. Implications of this high prevalence rate are discussed and the urgency to examine feto maternal transmission and the effect of pregnancy on HIV status is expressed. Further more, intensification of preventive information and education programmes is recommended.

Adult↗
PubMed1990

Breech delivery of infants weighing more than 2000 grams: a case controlled retrospective analysis of 751 patients.

This is a case controlled study of 385 women with breech presentation and 357 with cephalic presentation. Unlike many recent studies, vaginal breech delivery was associated with a significantly worse outcome for the infant. The reasons for these are discussed particularly in relation to developing countries and a protocol for management of these women is suggested to attempt to reduce the unacceptably poor outcome. Selective external cephalic version is advocated.

Adolescent↗
PubMed1990

The roll over test is not of value in predicting pregnancy induced hypertension.

As a predictor of pregnancy induced hypertension (PIH) the roll over test (ROT) has conflicting predictive values in the literature, possibly as a result of sample size, composition or methodology. In this study the roll over test was performed on 600 African women in their first pregnancy and at 26-32 weeks. The test was positive in 15% of women and had a positive predictive value of only 20%. It is concluded that the roll over test is of no value in the prediction of PIH.

Female↗
PubMed1989

Zinc supplementation during pregnancy: a double blind randomised controlled trial.

OBJECTIVE: To see whether zinc supplementation during pregnancy improves maternal and fetal outcome. DESIGN: Prospective study started at booking and continued till discharge of mother and baby from the maternity hospital. Mothers were randomly assigned to receive zinc supplementation or placebo in a double blind trial. SETTING: Mothers booking at one hospital. PATIENTS: Women booking before 20 weeks of gestation who agreed to take part in the study. 494 Mothers were followed up till the end of pregnancy. There was no difference between the groups given zinc and placebo in their social or medical backgrounds. INTERVENTIONS: Mothers in the active treatment group received one capsule of 20 mg elemental zinc daily and those in the placebo treated group a capsule identical in appearance and taste with the active capsule but which contained inert substances. MAIN OUTCOME MEASURE: Various adverse outcomes were tested, including maternal bleeding, hypertension, complications of labour and delivery, gestational age, Apgar scores, and neonatal abnormalities. The main outcome measure was birth weight. RESULTS: There were no differences whatsoever between mothers given a zinc supplement and those given a placebo. CONCLUSION: Zinc supplementation in pregnancy in the United Kingdom does not seem to offer any benefits to the mother or her fetus.

Adult↗
PubMed1989

The Southmead perineal suture study. A randomized comparison of suture materials and suturing techniques for repair of perineal trauma.

Commonly used suture materials and techniques for perineal repair following vaginal delivery were compared in a randomized controlled trial involving 1574 women. Three comparisons were made using a modified factorial design. In the comparison of teflon-coated polyglycolic acid (Dexon plus) with chromic catgut for repair of the vagina and deep perineal tissues there was no clear difference other than less short-term analgesia being required in association with polyglycolic acid. Outcome was also similar after skin repair with either polyglycolic acid or chromic catgut or silk, although silk repair required more packets of material and was associated with delay in resuming sexual intercourse; polyglycolic acid was more likely to need removal than chromic catgut but it appeared to reduce the need for resuturing. There was no clear difference between continuous subcuticular and interrupted transcutaneous sutures for repair of perineal skin.

Adult↗
PubMed1989

Outcome of term breech presentation.

Three hundred and ninety five cases of breech presentation at Harare Maternity Hospital, Harare revealed that caesarean section either electively or in labour resulted in good fetal outcome. Vaginal breech delivery was associated with a perinatal mortality of 74 per 1,000. Fifty four (25%) out of 216 infants delivered vaginally required admission to the Neonatal Unit and thirteen of these had a five minute Apgar Score of 5 or less. Various reasons for this unacceptably high morbidity and mortality are discussed in order to develop a protocol for management of breech presentation in a developing country. The protocol includes the advocation of external cephalic version.

Breech Presentation↗
PubMed1989

The young pregnant teenager--why the poor outcome?

Studies have repeatedly emphasised the poor obstetric outcome in teenage pregnancies. This study examined 444 teenagers of 16 years and under and demonstrated little difference in the outcome between 14 years and under group and 15 to 16 year old. The poor pregnancy outcome, however, was predominantly related to the adequacy of antenatal care. The discussion emphasises the point that teenage pregnancy is not primarily a medical problem and much effort is required to create an awareness so that prenatal care is both accessible and acceptable to the pregnant teenager.

Adolescent↗