Biomedical subjects
Publications and source records attributed to D B Cowan.
Recent advances in computer technology provide improved means for the collection of information for the perinatal database. They depend principally upon online entry via a computer terminal which allows immediate checking of the data input. The availability of such effective procedures for information gathering demands a careful review of the purposes, content, and structure of a computerized perinatal questionnaire.
Uterine activity was measured in 29 nulliparous African women, who were in the active phase of spontaneous labour, and who were delivered vaginally without supplementary oxytocin. A fluid-filled intrauterine catheter, an external strain gauge and a pressure-curve integrator were used to quantitate uterine activity. The rate of dilatation of the cervix from entry to the study to full dilatation of the cervix was greater than 1 cm/h; this constituted normal labour progress. In nulliparous African women the minimum level of uterine activity likely to be associated with a cervical dilatation rate of 1 cm/h was 1200 kPas/15 min and the median uterine activity level in the active phase of normal labour was 1824 kPas/15 min.
Uterine activity was measured in 43 African nulliparae who were in the active phase of spontaneous labour and in whom delay in cervical dilatation had occurred. Details of labour were recorded on a partogramme, on which an alert and an action line had been drawn, and which were 2 h apart. Delay was defined as a cervical dilatation rate of less than 1 cm/h. Uterine activity was measured with a fluid-filled intrauterine catheter, an external strain gauge and a pressure-curve integrator. The uterine activity levels which were observed in association with delay are considerably less than those associated with normal labour progress. The uterine activity levels that were associated with pitocin augmentation after the action line and which resulted in vaginal delivery have been analysed. They were similar to the levels observed in normal labour. The uterine activity levels which were associated with 'failure to progress in labour' beyond the action line have also been analysed. It is argued that a minimum uterine activity level of 1800 kPas/15 min is required to fully test the cephalopelvic relation.
Fetal distress is defined. The pathophysiology of fetal distress is discussed and tretment is recommended. The principles of intrapartum fetal resuscitation are proposed, with particular reference to the inhibition of uterine activity.
The influence of prophylactic tinidazole therapy on vaginal carriage rates of anaerobes and the development of post-operative anaerobic infection was studied in 100 women undergoing abdominal hysterectomy. Tinidazole prophylaxis (50 patients) led to a decrease of anaerobe vaginal carriage rate from 56% pre-operatively to 10 and 30% on the third and seventh post-operative days, respectively. In the control group (50 patients), no significant decrease in anaerobe yield was noted, corresponding percentages being 72, 64 and 74. Post-operative infection occurred in 34 cases (28 controls, 6 tinidazole prophylaxis). Wound swabs from patients in the latter group did not yield anaerobes on culture, and infections either resolved spontaneously (2 cases) or responded to tinidazole therapy, with or without addition of ampicillin and kanamycin (4 cases). In the control group, 21 cases of post-operative wound infection and 4 of vault infection were seen. Wound swabs from 6 of the former group yielded aerobes only and 10 mixed growth of aerobes/anaerobes. Post-operative wound/vault infections in control patients cleared spontaneously (18 cases) or responded to imidazole therapy, with or without ampicillin and kanamycin (7 cases). These data suggest that tinidazole may be a useful adjunct in imidazole prophylaxis and treatment of anaerobic infection.
Pelvic contraction is very prevalent in Africa while radiological facilities to assess pelvic size and shape are seldom available. A trial of labour using simple guidelines on a cervicograph can enable the midwife to detect dysfunctional labour and can help medical staff to manage these problems. Radiological checks in 116 Black primigravid patients with dysfunctional labour demonstrated that an active trial of labour is accurate in determining which of these patients have marked disproportion requiring caesarean section, minimal disproportion requiring assisted delivery, or primary uterine inertia responding to oxytocic stimulation. The role of radiological pelvimetry in African obstetrics is discussed, and the radiological features of the Shona and Zulu pelves in this series are described.
The influence of prophylactic metronidazole on vaginal carriage rates of anaerobes and the development of postoperative anaerobic infection was studied in 104 women who underwent abdominal hysterectomy. Metronidazole prophylaxis in 54 patients led to a decrease in the anaerobe vaginal carriage rate from 65% pre-operatively to 17% and 28% on the 3rd and 7th postoperative days respectively. In the control group (50 patients) no significant decrease in anaerobe yield was noted, corresponding percentages being 72%, 64%, and 74%. Postoperative infection occurred in 36 patients (28 controls; 8 on prophylactic metronidazole). Wound swabs from all 8 patients in the latter group yielded aerobes, and in 1 patient mixed infection (aerobes/anaerobes) occurred. In 7 of these patients (including the patient with mixed infection), the infection resolved spontaneously, while the 8th patient responded to therapy with metronidazole, kanamycin and ampicillin. In the control patients, 21 cases of postoperative wound infection and 4 of vault infection were seen; wound swabs from patients in the former group yielded aerobes in only 6 cases, and mixed growth of aerobes/anaerobes in 10 cases. Postoperative wound/vault infections in control patients cleared spontaneously in 18 cases and responded to imidazole therapy, with or without ampicillin and kanamycin, in 7 cases.
The association between hepatic amoebiasis and pregnancy is rare. Between 1966 and 1976 only 5 cases have been described in the world literature. A sixth case is described, and the literature to date is reviewed. Guidelines for management are presented.
The lecithin/sphingomyelin (L/S) ratio has been estimated in the amniotic fluid from 20 patients with a twin pregnancy. The values in each pair of amniotic fluids were closely related. If amniotic fluid from one sac only is available, it is suggested that a ratio of 2-5:1 is taken as the lower limit to predict the functional lung maturity of both twins.
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