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Biomedical subjects

R C Pattinson

Publications and source records attributed to R C Pattinson.

At least 19 recordsLinked to original sources
PubMed1995

Relationship between the fetal heart rate pattern and perinatal mortality in fetuses with absent end-diastolic velocities of the umbilical artery: a case-controlled study.

Fetal decompensation is usually diagnosed by the onset of late decelerations and decreased fetal heart rate (FHR) variability and is associated with fetal hypoxemia and acidemia and has a high perinatal mortality. Objective analysis of the FHR pattern can be performed using the Fischer score and a score of less than 6 correlates with fetal decompensation. Fetuses with absent end-diastolic velocities (AEDV) of the umbilical artery have severe placental disease and coupled with this a high perinatal mortality and morbidity. Importantly, AEDV is usually observed before the occurrence of fetal decompensation. In fetuses with AEDV, delivery before decompensation may improve the perinatal mortality and morbidity. To test this hypothesis, the perinatal outcome of fetuses with AEDV delivered before decompensation (Fischer score of 6 or more), were compared with similar fetuses delivered after decompensation (Fischer score of less than 6). All FHR pattern records of fetuses who had AEDV with a birthweight greater than 750 g and a gestational age of 28 weeks or more were evaluated using Fischer's score by a single observer unaware of the perinatal outcome. Fifty-seven fetuses qualified for the study and 17 of these babies subsequently died. The babies who died had significantly lower mean Fischer scores during the preceding 6 hours before delivery (5.9 +/- 1.8 SD) than the survivors (7.7 1.9; p < 0.05), but also had lower birthweights and gestational ages.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

The value of incorporating avoidable factors into perinatal audits.

OBJECTIVE: To assess whether incorporating a system of identifying, classifying and grading avoidable factors into a perinatal audit can be useful in identifying problem areas. DESIGN: Descriptive study. SETTING: Black urban population, Pretoria, South Africa. SUBJECTS: All perinatal deaths of infants weighing more than 1,000 g from urban areas served by Kalafong Hospital between August 1991 and July 1992. METHODS: All perinatal deaths were classified according to the primary obstetric cause of death and neonatal cause of death, and whether any avoidable factors were present which could have contributed to the death. RESULTS: The perinatal mortality rate was 26/1,000 deliveries. Avoidable factors occurred in 58% of perinatal deaths. Our problem areas which were immediately remedial were identified as labour management-related problems, administrative problems in obtaining syphilis results, and estimation of fetal weight. Other problem areas which need to be solved are patient education, early attendance at clinics, improved documentation and continuing education of medical personnel. CONCLUSION: The use of this classification of avoidable factors has enabled the detection of problem areas that can be improved immediately at very little cost.

Cause of Death↗
PubMed1995

Audit incorporating avoidability and appropriate intervention can significantly decrease perinatal mortality.

OBJECTIVE: To evaluate the role of the ICA (Identification, Cause, Avoidable factor) Solution method of perinatal audit in reducing perinatal mortality. DESIGN: Retrospective audit of 1,060 perinatal deaths between 1 January 1991 and 31 December 1992. SETTING: Livingstone Hospital Maternity Service. SUBJECTS: One thousand and sixty perinatal deaths, where the gestational age exceeded 28 weeks or, when gestational age was unknown, the birth weight was equal to or exceeded 1,000 g. MAIN OUTCOME MEASURES: All perinatal deaths were identified and classified by primary obstetric cause for perinatal loss. In the second year of the study avoidable factors were sought and, if found, graded and categorised. RESULTS: The major primary obstetric causes of perinatal loss identified and amenable to intervention were intrapartum trauma, intrapartum asphyxia and infection. In the second year of study potentially avoidable factors were sought and identified in almost 50% of perinatal deaths. Appropriate intervention lowered the perinatal mortality rate by 23% (P < 0.05; odds ratio 0.76; 95% confidence interval 0.67-0.86). CONCLUSION: The ICA Solution method of perinatal audit identified problems in overall obstetric care, facilitating a significant fall in perinatal mortality.

Cause of Death↗
PubMed1994

Ampicillin and metronidazole treatment in preterm labour: a multicentre, randomised controlled trial.

OBJECTIVE: To ascertain whether adjuvant ampicillin and metronidazole given to women in preterm labour with intact membranes would prolong pregnancy and decrease the perinatal mortality and morbidity. DESIGN: A multicentre, prospective, randomised controlled trial. SETTING: Three perinatal centres serving an indigent population. SUBJECTS: Eighty-one women in active preterm labour with otherwise uncomplicated singleton pregnancies between 26 and 34 weeks gestation or an ultrasound fetal weight estimate of 800 g to 1500 g. INTERVENTIONS: The study group received ampicillin and metronidazole for five days. The control group received no antibiotics. In all women contractions were suppressed with hexoprenaline and indomethacin for 24 h, and betamethasone was given for fetal lung maturity. MAIN OUTCOME MEASURES: Days gained and perinatal mortality and morbidity. RESULTS: The study (n = 43) and control groups (n = 38) were comparable at entry. In those receiving ampicillin and metronidazole the pregnancy was significantly prolonged (median 15 days versus 2.5 days, P = 0.04) with significantly more women still pregnant after seven days (63% versus 37%, P = 0.03, OR 0.34 95% CI 0.13-0.94). Significantly more infants in the control group developed necrotising enterocolitis than in the study group (5 versus 0, P = 0.02). CONCLUSION: Adjuvant ampicillin and metronidazole in the management of women in preterm labour with intact membranes significantly prolonged the pregnancy and decreased neonatal morbidity.

Adult↗
PubMed1994

Is ward evacuation for uncomplicated incomplete abortion under systemic analgesia safe and effective? A randomised clinical trial.

OBJECTIVE: To compare evacuation under systemic analgesia (fentanyl and midazolam) in a treatment room (ward group) with evacuation under general anaesthesia in theatre. DESIGN: A prospective randomised clinical trial. SETTING: A tertiary medical centre serving a black urban population. SUBJECTS: One hundred and forty-two patients with uncomplicated incomplete abortions. INTERVENTION: Randomisation into two groups, those for evacuation under systemic analgesia and those for evacuation under general anaesthesia. MAIN OUTCOME MEASURES: Both groups were compared in terms of safety, efficacy, acceptability, blood consumption and time delay between admission and evacuation. RESULTS: Significantly less blood was used in the ward group (37 units for 13 patients) than in the theatre group (65 units for 24 patients) (P < 0.03). Significantly less time was taken between admission and evacuation in the ward group (median 7 hours 15 minutes) than in the theatre group (median 12 hours 38 minutes) (P < 0.0003). Evacuation under fentanyl and midazolam was safe, effective and acceptable for the majority of patients compared with evacuation under general anaesthesia. CONCLUSION: Patients with uncomplicated incomplete abortions (uterine size equivalent to a pregnancy of 14 weeks' duration or less) can undergo evacuation safely and effectively under fentanyl and midazolam and have a significantly smaller chance of requiring a blood transfusion.

Abortion, Incomplete↗
PubMed1993

The use of Doppler velocimetry of the umbilical artery before 24 weeks' gestation to screen for high-risk pregnancies.

OBJECTIVE: To describe the prevalence and natural history of absent end-diastolic velocities (AEDV) in the umbilical artery of the fetus between 16 and 24 weeks' gestation, and to evaluate its role as a screening test. DESIGN: Population-based descriptive study. SETTING: Tygerberg Hospital, Tygerberg, South Africa. The hospital serves a population from the lower socio-economic bracket. SUBJECTS: Doppler velocimetry was performed at routine ultrasound examinations for confirmation of gestational age in 496 women. MAIN OUTCOME MEASURES: The occurrence of perinatal death, small-for-gestational-age (SGA) babies and proteinuric hypertension. RESULTS: Forty-four (8.9%) patients had AEDVs at the first examination, but AEDV persisted in only 1. In this case, severe proteinuric hypertension developed unexpectedly at 29 weeks' gestation and the fetus needed delivery because of persistent late decelerations of the fetal heart rate pattern. There was a significant association between the group with AEDV at first examination and the development of proteinuric hypertension (P < 0.05), but no association with SGA babies. The association with proteinuric hypertension was too weak to be of clinical use. CONCLUSION: Doppler velocimetry of the umbilical artery, performed along with routine ultrasound examination to confirm gestational age, is not of use as a screening test for identifying high-risk pregnancies.

Blood Flow Velocity↗
PubMed1992

The role of obstetric factors in determining fetal viability.

OBJECTIVE: To study the influence of primary obstetric complications on the survival and short-term morbidity rates of very-low-birth-weight (VLBW) babies. DESIGN: A 1-year retrospective, descriptive study. SETTING: Department of Obstetrics and Gynaecology, Tygerberg Hospital, CP. STUDY POPULATION: 257 women admitted with live singleton fetuses and who eventually delivered babies with birth weights ranging from 750 to 1,499 g. MANAGEMENT: Primary obstetric complications responsible for the delivery of the VLBW babies were clinically diagnosed. Active management was undertaken if the fetus was viable and obstetric and neonatal resuscitation were applied. Management was conservative when the fetus was considered non-viable. This decision on the initial treatment option was taken by the obstetrician who managed the case. MAIN OUTCOME MEASUREMENTS: Survival and short-term morbidity rates of the babies. RESULTS: Spontaneous preterm labour (45%) and hypertensive disorders (39%) were equally responsible for delivery of VLBW babies at Tygerberg Hospital. The only obstetric factor influencing the babies' outcome, however, was the initial management decision by the obstetrician. There was a survival rate of 160/213 (75.1%) in the actively managed group compared with only 1/44 (2.3%) in the conservatively managed group. Other factors that significantly influenced neonatal survival of VLBW babies were: birth weight, gestational age, Apgar score at 5 minutes and length of time between admission to hospital and the delivery. CONCLUSION: The obstetric complication responsible for delivery of the VLBW baby did not influence the survival rate. The major determinant of neonatal survival was the obstetrician's decision to manage the fetus either actively or conservatively. It seems that the outcome of VLBW babies is influenced primarily by the intrinsic characteristics of the neonates' gestational age, birth weight and condition at birth, and not the reason for delivery.

Delivery, Obstetric↗
PubMed1992

Umbilical artery Doppler velocimetry in the prediction of intrapartum fetal compromise.

The value of early intrapartum umbilical artery Doppler velocimetry in the prediction of fetal compromise was studied. One hundred patients were recruited into the study and fetal compromise was diagnosed by abnormal first- or second-stage fetal heart rate traces, a 5-minute Apgar score less than 7, or the development of hypoxic ischaemic encephalopathy. Fetal compromise developed in 30 patients. An umbilical artery resistance index (RI) of 0.66 or less did not predict fetal compromise (sensitivity 13%, specificity 89%, positive predictive value 25%, negative predictive value 70%). Since the mean umbilical artery RI was identical in the compromised and the non-compromised groups, we conclude that early intrapartum Doppler velocimetry is of very little clinical value in predicting fetal compromise at term.

Female↗
PubMed1992

Management of patients with poor symphysis pubis-fundus growth by Doppler flow velocimetry of the umbilical artery--an effective method to detect the fetus at risk.

This study evaluated Doppler flow velocimetry of the umbilical artery in patients with suspected intrauterine growth retardation as detected by poor symphysis-fundus growth (SFG). The sensitivity of Doppler in detecting light for gestational age babies and intrauterine growth retardation was poor. Antenatal complications, neonatal morbidity and perinatal mortality occurred significantly more frequently in patients with abnormal flow. Doppler flow velocimetry is an excellent test to identify babies at high risk for perinatal morbidity and mortality, when poor SFG is present.

Adult↗
PubMed1992

Management and outcome in tibial dysplasia.

Tibial dysplasia is a rare congenital deformity which must be distinguished from the more common fibular dysplasia. We have reviewed 24 patients with 35 affected legs. The classification system of Kalamchi and Dawe (1985) was found to be preferable to that of Jones, Barnes and Lloyd-Roberts (1978) as a guide to prognosis and management. We discuss the outcome of surgical treatment, recommending selective amputation for most cases.

Adolescent↗
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↗
PubMed1991

Early detection of poor fetal prognosis by serial Doppler velocimetry in high-risk pregnancies.

Fifty-three high-risk pregnancies were followed up serially with Doppler velocimetry of the umbilical artery and uterine vessels from early on to investigate whether abnormalities in Doppler waveforms can predict the outcome of pregnancy accurately before other clinical signs develop. Results of Doppler velocimetry were withheld from the clinicians managing the patients. When the absence of end-diastolic velocities was first detected (in 13 fetuses) (AEDV group) there was no clinical difference between these pregnancies and those in which end-diastolic velocities were present (EDV group). Nine of the 13 fetuses with AEDVs died, compared with 3 of 40 with EDVs (P less than 0.0001). In deaths associated with AEDVs, the latter were detected a median of 5.5 (range 3-11) weeks before death and are present from the first Doppler examination. In the 4 fetuses with AEDVs that survived, the AEDVs were not persistent. The only significant association of Doppler velocimetry of the uterine vessels was with proteinuric hypertension (P less than 0.05), but the prediction was not strong enough to be of clinical value. Persistent AEDVs of the umbilical artery are an accurate predictor of poor fetal outcome and occur before other clinical signs of impending problems.

Cohort Studies↗
PubMed1991

Total perinatal-related wastage in twin pregnancies.

The primary obstetric cause of total perinatal-related wastage (TPRW) in twin pregnancy was studied in a clearly defined population over a 3-year period. There were 77 deaths from 204 pairs of twins; the perinatal mortality rate (PMR) was 51/1,000 and TPRW was 189/1,000. Of the 77 deaths 52% were late abortions, 14% stillbirths, 10% early neonatal deaths, 18% late neonatal deaths and 5% perinatal-related infant deaths. The major obstetric factors leading to TPRW were spontaneous preterm labour (32%), antepartum haemorrhage (30%), infection (16%), unexplained intra-uterine death (10%) and hypertension (8%). The major factors responsible for perinatal-related loss in twin pregnancies are similar to the major factors in singleton pregnancies, but occur earlier in pregnancy. Rather than considering the primary causes of loss in twin pregnancies as a separate entity, we should direct our attention to solving the same obstetric factors responsible for initiating loss in both twin and singleton pregnancies.

Birth Weight↗