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Biomedical subjects

D W Steyn

Publications and source records attributed to D W Steyn.

25 records · Page 2Linked to original sources
PubMed1995

The outcome of babies of mothers with severe rhesus incompatibility treated at Tygerberg Hospital, 1980-1993.

OBJECTIVE: To determine the outcome of babies of mothers with severe rhesus (Rh) incompatibility treated by elective delivery when the amniotic optical density at 450 nm crossed Whitfield's action line (group 1), by plasmapheresis and immunotherapy (group 2) or by means of intra-uterine intravascular transfusions (group 3). STUDY DESIGN: A retrospective study of 55 mothers and their 57 fetuses with severe Rh incompatibility at < 34 weeks' pregnancy duration. MAIN OUTCOME PARAMETERS: Number of mothers in each treatment group, prevalence of intra-uterine death, hydrops, intra-uterine intravascular transfusions, cord haematocrit, cord bilirubin, number of liveborn babies, birth weight, neonatal death, hyaline membrane disease (HMD) and exchange transfusions. STUDY POPULATION AND SETTING: All mothers and babies with severe Rh incompatibility (defined as an amniotic optical density of 450 nm in the upper and upper-mid zone on the Liley chart at < 34 weeks' pregnancy duration, previous fetal hydrops or Rh-related intra-uterine death (IUD), fetal hydrops on ultrasound or a fetal haematocrit < 30% at cordocentesis) treated at Tygerberg Hospital between January 1980 and January 1993. There were 20 fetuses each in groups 1 and 3, and 17 in group 2. RESULTS: A total of 48 babies (84%) were liveborn and of these 74% survived the neonatal period. (ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Mid-trimester termination of pregnancy--a randomised controlled trial of two prostaglandin regimens.

OBJECTIVE: To determine the more applicable of two ways of prostaglandin induction currently in use in second trimester induced abortions for congenital or chromosomal abnormalities. DESIGN: A prospective randomised controlled trial. SETTING: Department of Obstetrics and Gynaecology, Tygerberg Hospital, CP. STUDY POPULATION: Twenty consecutive patients admitted for termination of pregnancy for congenital or chromosomal abnormalities between 14 and 26 weeks' pregnancy duration. MANAGEMENT: Patients were randomly selected to receive either 1.5 mg prostaglandin E2 (PGE2) gel extra-amniotically or 25 mg prostaglandin F2 alpha (PGF2 alpha) intra-amniotically. Patients in both groups received oxytocin to a maximum dosage of 120 mU per minute if they had not aborted 18 hours after the original administration of either prostaglandin regimen. If abortion had not taken place 36 hours after commencement of treatment, management was considered unsuccessful. MAIN OUTCOME MEASUREMENTS: Proportion of successful inductions and complications. RESULTS: Complications of management were rare and did not differ between the two management groups. However, there were significantly more failures in the group who received intra-amniotic PGF2 alpha (7 v. 2 patients) as well as a significantly higher need for oxytocin in this group (10 v. 4 patients). CONCLUSIONS: With promising drugs such as prostaglandin analogues and anti-progesterones not universally available, methods of induction suitable to the local situation should be sought. Extra-amniotic PGE2 seems more suitable than intra-amniotic PGF2 alpha because of a shorter induction-to-delivery time without increased morbidity.

Abortion, Induced↗
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↗
PubMed1989

Fetal resuscitation in a patient with varicella pneumonia and preterm labor.

A primigravida presented at 33 weeks gestation with varicella pneumonia. Cardiotocography demonstrated repeated late decelerations of fetal heart rate. Cesarean section was indicated for contracted maternal pelvis and breech presentation, but was decided against because of the risks of anesthesia. Maternal and fetal improvement followed intrauterine resuscitation and suppression of preterm labor. Cesarean section was performed 9 days later after spontaneous rupture of membranes with excellent outcome. The same approach is suggested for similar cases.

Adult↗
PubMedDate not supplied

Blood pressure patterns in pregnant patients on oral ketanserin.

BACKGROUND: Ketanserin, a selective serotonin-2 receptor antagonist, decreases systolic blood pressure (SBP) and diastolic blood pressure (DBP) in non-pregnant patients with hypertension, but not in normotensive subjects. Its effect on longitudinal blood pressure (BP) patterns in pregnant women has not been documented. OBJECTIVES: To assess how ketanserin, given orally, influences maternal BP during pregnancy. DESIGN: A double-blind randomised controlled trial where patients with DBP > or =80 mmHg between 12 and 20 weeks' gestation received either ketanserin or placebo. SETTING: Tygerberg Hospital, a tertiary referral unit in the Western Cape. SUBJECTS: One hundred and two patients who received their study drug for at least 140 days during pregnancy. Patients requiring additional antihypertensive medication were excluded from the analysis. OUTCOME MEASURES: Changes in SBP and DBP in relation to gestational age and days since entering the study. RESULTS: The mean DBP over the total period was significantly lower in the ketanserin group (77 +/- 8.7 mmHg v. 80.8 +/- 9.1 mmHg). The decline in DBP was 9.2 mmHg in the ketanserin group and 5.3 mmHg in the placebo group. These differences were detected from within 7 days of therapy and persisted for most of the pregnancy. The mean SBP did not differ at any stage, although the mean fall in SBP was significantly greater in the ketanserin group (8.6 +/- 16.7 v. 4.1 +/- 17.1 mmHg). CONCLUSIONS: Ketanserin decreased DBP during pregnancy significantly more than placebo.

Administration, Oral↗