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R C Pattinson

Publications and source records attributed to R C Pattinson.

At least 37 records · Page 2Linked to original sources
PubMed2003

Severe acute maternal morbidity and maternal death audit--a rapid diagnostic tool for evaluating maternal care.

OBJECTIVE: To analyse severe acute maternal morbidity (SAMM) and maternal mortality in the Pretoria region over a 2-year period (2000-2001). SETTING: Public hospitals in the Pretoria region, South Africa, serving a mainly indigent urban population. METHODS: A descriptive study was performed whereby women with SAMM and maternal deaths were identified at daily audit meetings and an audit form was completed for all cases fulfilling the definition of SAMM ('near miss') and for all maternal deaths. RESULTS: The number of maternal deaths declined slightly but not significantly from 18 deaths in 2000 to 16 in 2001. This represents a change in the maternal mortality ratio (MMR) from 130/100,000 live births in 2000 to a MMR of 100/100,000 live births in 2001. However, when data for women with SAMM and maternal deaths were combined, there was a significant increase in major maternal morbidity from 90 cases (SAMM and maternal death rate 649/100,000 live births) in 2000 to 142 cases (SAMM and maternal death rate 889/100,000 live births) in 2001 (p = 0.006). This increase was due to a significant increase in severe maternal morbidity related to abortions and obstetric haemorrhages. CONCLUSION: Analysis of maternal deaths only in the Pretoria region failed to identify abortions and haemorrhages as major maternal care problems. When data for women with SAMM were combined with data for maternal deaths, however, these problems were clearly identified, and remedial action could be taken. Including SAMM in maternal death audits increases the rapidity with which health system problems can be identified.

Abortion, Induced↗
PubMed2002

Uricult trio as a screening test for bacteriuria in pregnancy.

OBJECTIVE: To establish the effectiveness in an indigent urban population of Uricult Trio as a screening test for asymptomatic bacteriuria in pregnancy and in diagnosing urinary tract infections (UTI) in symptomatic pregnant women. Likelihood ratios were established for positive and negative Uricult Trio test results. SUBJECTS: Two populations of patients from the Pretoria region were involved: (i) asymptomatic pregnant women attending the antenatal clinic for the first time or presenting in labour; and (ii) pregnant women with symptoms suggestive of UTI. METHOD: A midstream urine specimen was collected from the two populations of patients, plated onto the Uricult Trio and sent to the laboratory for culture. RESULTS: The prevalence of asymptomatic bacteriuria in this population was 23%, and for women with symptoms suggestive of UTI, 29%. The likelihood ratios for a positive test were 1.8 and 1.5 for asymptomatic and symptomatic patients respectively. The likelihood ratios for a negative test were 0.35 and 0.44 for asymptomatic and symptomatic patients respectively. Escherichia coli was the causative agent in 36% of cases. CONCLUSION: Uricult Trio is not effective as a screening test for asymptomatic bacteriuria in pregnancy or for diagnosing UTIs in women with symptoms suggestive of infection.

Bacteriuria↗
PubMed2002

The tap test--an accurate first-line test for fetal lung maturity testing.

OBJECTIVE: To determine the accuracy of near-patient and laboratory-based fetal lung maturity tests in predicting the need for neonatal ventilation. DESIGN: A prospective descriptive study. SUBJECTS: One hundred high-risk obstetric patients where confirmation of fetal lung maturity would initiate delivery. METHODS: Fetal weight estimation, placental maturity grading, and amniocentesis were performed. The investigators examined the amniotic fluid visually, and performed the tap test and shake test. Laboratory technicians estimated the lecithin-sphingomyelin (L/S) ratio, determined the presence of a phosphatidyl glycerol (PG) band on gel electrophoresis, and the optical density at 650 nm. Neonates delivered within 1 week of amniocentesis were included in the analysis. The primary end-point was the ability of the lung maturity tests to predict the need for neonatal ventilation. RESULTS: Twelve of 100 neonates required ventilation. The tap test and optical density (OD) shift at 650 nm predicted the need for neonatal ventilation with the greatest accuracy. CONCLUSION: The tap test is a rapid, easy and accurate predictor of the need for neonatal ventilation. The OD shift at 650 nm is the laboratory-based test with the greatest accuracy in our setting.

Amniotic Fluid↗
PubMed2002

Intrapartum-related birth asphyxia in South Africa--lessons from the first national perinatal care survey.

BACKGROUND: The recent amalgamation of data by users of the Perinatal Problem Identification Programme (PPIP) throughout South Africa has culminated in the publication of the Saving Babies report. OBJECTIVES: To determine the absolute rate of death from intrapartum-related birth asphyxia, and the contribution of intrapartum-related asphyxia to total perinatal mortality in South African hospitals, and to identify the primary obstetric causes and avoidable factors for these deaths. METHODS: The amalgamated PPIP data for the year 2000 were obtained from 27 state hospitals (6 metropolitan, 12 town and 9 rural) in South Africa. In PPIP-based audit, all perinatal deaths are assigned primary obstetric causes and avoidable factors, and these elements were obtained for all deaths resulting from intrapartum-related birth asphyxia. RESULTS: There were 123,508 births in the hospitals surveyed, with 4,142 perinatal deaths among infants > or = 1,000 g, giving a perinatal mortality rate of 33.5/1,000 births. The perinatal mortality rate from intrapartum-related birth asphyxia was 4.8/1,000 births. The most frequent avoidable factors were delay by mothers in seeking attention during labour (36.6%), signs of fetal distress interpreted incorrectly (24.9%), inadequate fetal monitoring (18.0%) and no response to poor progress in labour (7.0%). The perinatal mortality rates for metropolitan, town, and rural areas were 30.0, 39.4 and 30.9/1,000 births respectively. The contribution of intrapartum-related birth asphyxia to perinatal mortality in these areas was 10.8%, 16.7% and 26.4% respectively. CONCLUSION: The high rates of perinatal death from intrapartum-related birth asphyxia in South Africa are typical of those in underdeveloped countries, with the most serious deficiencies in rural areas. Most of these deaths are avoidable and the reduction of these rates presents an important challenge to providers of perinatal care in this country. Areas worthy of research and action include provision of mothers' waiting facilities in rural regions, improvements in fetal monitoring, partogram-based labour management, and the establishment of midwifery staffing norms for South African labour units.

Asphyxia Neonatorum↗
PubMed2001

Symphysis-fundal measurement as a predictor of low birthweight.

OBJECTIVE: To prospectively test the value of a symphysis-fundal measurement in labor of less than or equal to 29 cm as a predictor of birth mass below 2000 g. METHOD: Women admitted to Kalafong Hospital in labor with a singleton pregnancy were included in the study. Symphysis-fundal measurement according to the method of Westin was performed on two separate occasions and recorded together with other pertinent details. A receiver-operator curve was constructed to test various cut-off measurements. RESULTS: A total of 1216 women were included in the study. One hundred twenty-one fetuses had a birth mass less than 2000 g (10%). A measurement of less than or equal to 29 cm had a sensitivity of 69% and a specificity of 98% with a positive predictive value of 81% and a negative predictive value of 97%. On the receiver-operator curve a cutoff of 30 cm showed a better sensitivity with little loss of specificity. CONCLUSION: A symphysis-fundal measurement of less than or equal to 29 cm is a good predictor of birth mass less than 2000 g and can be used as an indication for referral to centres with neonatal facilities.

Adult↗
PubMed2000

Pelvimetry for fetal cephalic presentations at term.

BACKGROUND: Pelvimetry assesses the size of a woman's pelvis by clinical examination, or by conventional X-rays, computerised tomography scanning, or magnetic resonance imaging. OBJECTIVES: The objective of this review was to assess the effects of pelvimetry (performed antenatally, intrapartum or postpartum) on the method of delivery, and on perinatal mortality and morbidity, and on maternal morbidity. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register was searched. SELECTION CRITERIA: Acceptably randomised comparisons of the use of pelvimetry in cephalic presentations. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted by one author. MAIN RESULTS: Four trials of over 1000 women were included. The trials were generally not of good quality. Women undergoing pelvimetry were more likely to be delivered by caesarean section (odds ratio 2.17, 95% confidence interval 1.63 to 2.88). No significant impact was detected on perinatal outcome. REVIEWER'S CONCLUSIONS: There is not enough evidence to support the use of X-ray pelvimetry in women whose fetuses have a cephalic presentation.

Cesarean Section↗
PubMed2000

The impact of a pregnancy confirmation clinic on the commencement of antenatal care.

OBJECTIVE: To introduce a pregnancy confirmation clinic as part of antenatal care and to determine whether this would alter the gestational age at which patients commence antenatal care. SETTING: Three municipal antenatal clinics in Atteridgeville and Central Pretoria. METHOD: A pregnancy confirmation clinic was set up at three sites. At the clinic any woman wishing to confirm whether she was pregnant was offered a urine beta-HCG test. If this test was positive, on-site testing for syphilis, anaemia and rhesus status, dipstick testing of the urine, clinical examination and ultrasound examination were performed. Women with abnormal test results were commenced on appropriate treatment immediately and women requiring further medical care or investigation were referred appropriately. RESULTS: The study recruited 382 women, 145 of whom were defaulters from contraception. Half of the women (191) had a positive pregnancy test. The mean presenting gestational age was 12 weeks 4 days (standard deviation 5 weeks, range 5 weeks-25 weeks 2 days). Treatable conditions with the potential to influence pregnancy outcome were identified in 37 of the pregnant women (19.4%) Forty-three of the pregnant women intended to terminate the pregnancy. CONCLUSION: It is possible to shift the commencement of antenatal care to an earlier gestational age.

Adolescent↗
PubMed1999

The use of dexamethasone in women with preterm premature rupture of membranes--a multicentre, double-blind, placebo-controlled, randomised trial. Dexiprom Study Group.

OBJECTIVE: To assess whether administration of dexamethasone in women with preterm premature rupture of membranes (PPROM) has an effect on the prevalence of maternal sepsis, neonatal respiratory distress syndrome (RDS), perinatal mortality and neonatal sepsis in a developing country. SETTING: Six public hospitals in South Africa that deal mainly with indigent women. METHOD: A multicentre, double-blind, placebo-controlled, randomised trial was performed on women with PPROM and fetuses of 28-34 weeks' gestation or clinically estimated fetal weight between 1,000 and 2,000 g if the gestational age was unknown. Women were randomised to receive either dexamethasone 24 mg intramuscularly or placebo in two divided doses 24 hours apart. All women received amoxycillin and metronidazole and were managed expectantly. Hexoprenaline was administered if contractions occurred within the first 24 hours after admission to the trial. OUTCOME MEASURES: The maternal outcome measures were clinical chorio-amnionitis and postpartum sepsis. The outcome measures for infants were perinatal death, RDS, mechanical ventilation, necrotising enterocolitis, and neonatal infection within 72 hours. RESULTS: One hundred and two women who delivered 105 babies were randomised to the dexamethasone group and 102 women who delivered 103 babies, to the placebo group. The groups were well balanced with regard to clinical features. There was a trend towards fewer perinatal deaths in the dexamethasone group: 4 compared with 10 (P = 0.16, odds ratio 0.37, 95% confidence intervals 0.09-1.34). A subanalysis of mothers who delivered more than 24 hours after admission to the study and their infants revealed a significant reduction in perinatal deaths; 1 death in the dexamethasone group and 7 in the placebo group, P = 0.047 (Fisher's exact test). No woman in either group developed severe sepsis, and the incidence of sepsis in the women did not differ significantly. Eleven infants in each group developed sepsis. CONCLUSION: This is the first randomised trial in women with PPROM to compare the effects of the use of corticosteroids with placebo, where all women received prophylactic antibiotics concomitantly with the corticosteroids. A trend towards an improved perinatal outcome was demonstrated in the women who received dexamethasone. There was no increased risk of infection in the women or their infants where dexamethasone was administered. Administration of corticosteroids to women with PPROM has more advantages than disadvantages in developing countries.

Anti-Inflammatory Agents↗
PubMed1999

A meta-analysis of the use of corticosteroids in pregnancies complicated by preterm premature rupture of membranes.

A systematic review of the literature has been undertaken with regard to the use of corticosteroids in women with preterm premature rupture of membranes (PPROM). the benefit of corticosteroids clearly outweighs their potential harmful effects. Antibiotics should probably be included in any management protocol for women with PPROM. There is no reason to suggest that use of corticosteroids in women with PPROM needs to be restricted in developing countries.

Adrenal Cortex Hormones↗
PubMed1998

Severe acute maternal morbidity: a pilot study of a definition for a near-miss.

OBJECTIVE: To test the application of a clinical definition of severe acute maternal morbidity. DESIGN: A one-year prospective descriptive multi-centre study. SETTING: Kalafong and Pretoria Academic hospitals, catering for the delivery of indigent women in the Pretoria Health Region. METHODS: A 'near-miss' describes a patient with an acute organ system dysfunction, which if not treated appropriately, could result in death. The case notes of women fitting this definition and all maternal deaths were analysed and compared. OUTCOME MEASURE: Determine the primary obstetric factors and the organ systems that failed. Identification of episodes of sub-standard care and missed opportunities. Results One hundred and forty-seven near misses and 30 maternal deaths were identified. The commonest reasons for a near-miss were: emergency hysterectomy in 42 women (29%); severe hypotension in 40 (27%); and pulmonary oedema in 24 (16%). The most common initiating obstetric conditions were hypertension in 38 women (26%); haemorrhage in 38 (26%); and abortion or puerperal sepsis in 29 (20%). The primary obstetric factors amongst the maternal deaths were: hypertension (33%); sepsis (27%); and maternal medical diseases (17%) in 10, 8 and 5 women respectively. Sub-standard care was identified in 82 cases. Breakdown in the health care administration was identified in 33, and patient-orientated missed opportunities on 34 occasions. CONCLUSION: The definition of severe acute maternal morbidity identified nearly five times as many cases as maternal death. This definition allows for an effective audit system of maternal care because it is clinically based, the definition is robust and the cases identified reflect the pattern of maternal death.

Female↗
PubMed1998

Does successful completion of the Perinatal Education Programme result in improved obstetric practice?

OBJECTIVE: To determine whether successful completion of the Perinatal Education Programme (PEP) improves obstetric practice. METHOD: The three midwife obstetric units (MOUs) in a health district of Mpumalanga were included in the study. Two MOUs enrolled in the PEP and the third did not. A 'before-and-after' study design was used to assess any changes in practice, and to monitor whether any changes occurred in the district during the time of the study; data were also collected at the third MOU. Data were collected by scoring of the obstetric files after the patient had delivered. OUTCOME MEASURES: We ascertained whether the obstetric history, syphilis testing, blood group testing, haemoglobin measurement and uterine growth assessment were performed during antenatal care along with whether appropriate action was taken. For intrapartum care, estimation of fetal weight, the performance of pelvimetry, blood pressure monitoring, urine testing, evaluation of head above pelvis, fetal heart rate monitoring, monitoring of contractions and plotting of cervical dilatation, and whether the appropriate actions were taken, were assessed. RESULTS: Eight of the 13 midwives at the two MOUs completed the PEP and all demonstrated an improvement in knowledge. Case notes of 303 patients from the various clinics were studied. There was no change in the referral patterns of any of the clinics during the study period. The obstetric history was well documented, but in no group was there a satisfactory response to a detected problem; appropriate action was taken in between 0% and 12% of cases. Syphilis testing was performed in 56-82% of cases, with no difference between the groups. The haemoglobin level was measured in only 4-15% of patients, with no difference before or after completion of the PEP. Where a problem in uterine growth was detected, an appropriate response occurred in 0-8% of patients and no difference before or after completion of the PEP was ascertained. In all groups, estimation of fetal weight and pelvimetry were seldom performed, the urine and fetal heart rate documentation were moderately well done and the blood pressure monitoring, assessment of head above pelvis, monitoring of contractions and plotting of cervical dilatation were usually performed. No differences before or after the PEP were detected. Where problems were detected, appropriate actions taken during labour improved, but not significantly. CONCLUSION: Completion of the obstetric manual of the PEP improved the knowledge of the midwives but no alteration in practice was detected.

Africa↗
PubMed1996

Screening for anemia in pregnancy with copper sulfate densitometry.

OBJECTIVE: The copper sulfate method of screening for anemia was evaluated to determine its accuracy in antenatal patients. METHODS: In an antenatal clinic in a tertiary referral center, which also serves a local urban black community, 100 antenatal patients were prospectively tested for anemia by Coulter hemoglobin analysis in comparison with the copper sulfate test. The respective accuracy and costs of the tests were evaluated. RESULTS: Once initial technical difficulties had been overcome, the copper sulfate test proved accurate in detecting a hemoglobin level < 10 g% in pregnancy (sensitivity 94%, specificity 95%, positive predictive value 80%, negative predictive value 99%). The cost of the copper sulfate test is estimated to be less than 0.3% that of the Coulter test. CONCLUSION: The copper sulfate test is accurate and inexpensive, and can be recommended for screening for anemia in pregnancy.

Anemia↗
PubMed1996

The potential for preventing the delivery and perinatal mortality of low-birth-weight babies in a black urban population.

OBJECTIVE: To determine the potential for preventing the delivery and perinatal mortality of low-birth-weight (LBW) babies in a black urban population. DESIGN: Cross-sectional descriptive study. SETTING: All women delivering babies weighing less than 2,500 g at Kalafong Hospital in a 6-month period (December 1991-May 1992). MAIN OUTCOME MEASURES: The primary obstetric reason for delivery; whether the labour was of spontaneous onset or iatrogenic; whether labour was theoretically preventable using currently accepted practice; the number of patients in whom suppression of delivery was attempted in the theoretically preventable group; and the perinatal mortality rate of that group. RESULTS: There were 124 perinatal deaths (22.5%) in the 550 LBW babies delivered from 465 singleton pregnancies, 42 twin pregnancies and 1 triplet pregnancy. The primary obstetric reasons for delivery were spontaneous preterm labour (28%), hypertensive diseases (19%), premature rupture of membranes (18%), spontaneous labour in light-for-gestational-age babies (16%), unexplained intra-uterine deaths (8%), antepartum haemorrhage (8%) and other causes (3%). A medical decision to terminate the pregnancy before labour was made in 177 (34.8%) cases, the major reason being hypertensive diseases (84 mothers; 47.5%). In the remaining 331 mothers with spontaneous onset of labour, labour was theoretically preventable in 63 (19%) and prevention was only attempted in 12 (2.4% of the total mothers). The major reason for not attempting to suppress labour in the others was that the patients arrived too late at the hospital for intervention to take place. CONCLUSION: Hospital staff can do little to prevent the delivery of LBW babies in a black urban population.

Black People↗