Showing papers by "Robert Clive Pattinson published in 2002"

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

Abstract: 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 _ 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. S Afr Med J 2002; 92: 897-901.

Uricult trio as a screening test for bacteriuria in pregnancy.

Abstract: 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: (J) 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.

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

Abstract: 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. S Afr Med J 2002; 92: 720-722.