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Biomedical subjects

G B Theron

Publications and source records attributed to G B Theron.

At least 19 recordsLinked to original sources
PubMed2000

The potential of midwives providing primary obstetric care to reduce perinatal deaths in a rural region.

OBJECTIVE: To determine the proportion of perinatal deaths that could be reduced by midwives providing primary obstetric services. METHOD: The study was conducted in a rural region of the Eastern Cape, South Africa. The primary obstetric and final causes of perinatal deaths and avoidable factors related to these deaths were determined in a large town and two small towns. RESULTS: In the three towns 52 (48.6%) of the 107 avoidable factors were related to medical care while 20 (38.5%) of these had the potential to be prevented at the level of care rendered by midwives. In the large town 21 (20.6%) of 102 and in the smaller towns 15 (24.6%) of 61 perinatal deaths had potential for intervention by midwives. CONCLUSION: The 22.1% of perinatal deaths potentially preventable by midwives presupposes complete patient cooperation within an optimally functioning health system.

Adolescent↗
PubMed1999

Improved cognitive knowledge of midwives practising in the eastern Cape Province of the Republic of South Africa through the study of a self-education manual.

OBJECTIVES: To determine whether the Maternal Care manual of the Perinatal Education Programme (PEP) is effective in improving the cognitive knowledge of midwives. DESIGN: A prospective controlled trial in a region where PEP was not previously used. The midwifery knowledge of all midwives caring for pregnant women in the three towns was tested before the commencement of the study. The Maternal Care manual was then introduced to the midwives in he study town and they worked through the programme. Following the completion of the manual, all midwives were tested again with the same test. The time interval between the pre and post testing was 12 months. SETTING: Three towns on the Eastern Cape Province of South Africa. PARTICIPANTS: All Midwives caring for pregnant women in three towns. INTERVENTIONS: The Maternal Care manual of PEP was studied by the midwives in the study town. MEASUREMENTS AND FINDINGS: Changes in cognitive knowledge were tested with multiple choice questions. A significant improvement (p < 0.0001) was achieved in the study town. The mean score (maximum 70) improved by 22.4 (32%) marks, from 35.9 (51%) to 58.3 (83%). KEY CONCLUSIONS: The cognitive knowledge of midwives who completed the Maternal Care manual improved significantly. IMPLICATIONS FOR PRACTICE: These findings are to particular importance as the method by which the Maternal Care manual of PEP was applied conforms to the method suggested for the its national use.

Adult↗
PubMed1999

Hypermobility and peripartum pelvic pain syndrome in pregnant South African women.

OBJECTIVE: To determine the incidence and correlation of joint hypermobility (HM) and peripartum pelvic pain (PPPP) in an homogeneous pregnant South African population. STUDY DESIGN: A cross-sectional study among Cape Coloured pregnant women. Joint mobility was measured by Beighton score; PPPP with a specially developed PPPP score. RESULTS: Using the Beighton scores with a cut-off point of HM > or = 5/9, only 4.9% of the 509 pregnant women were hypermobile. Hyperextension of the elbow was the largest contributor to HM (35.4%). No correlation of HM with the incidence of PPPP was established. Only 20 very mild cases of PPPP were recorded. Back pain increased significantly during pregnancy to a mean of 38%. Right handedness occurred in 95.9%. No significant relation was found between HM and the non-dominant side. CONCLUSION: Hypermobility in pregnant Cape Coloured women was surprisingly low (4.9%) with a decrease with age, but no increase during pregnancy. Peripartum pelvic pain is virtually absent and has no correlation with joint laxity. Back pain increased during pregnancy to a mean of 38%. Right handedness was high (96%) in comparison with the world-wide figure of 85%. No correlation was found between the dominant body side and hypermobility.

Adolescent↗
PubMed1999

Effect of the maternal care manual of the perinatal education programme on the ability of midwives to interpret antenatal cards and partograms.

OBJECTIVE: To assess the ability of midwives to interpret antenatal cards and partograms correctly following completion of the Maternal Care Manual of the Perinatal Education Programme. STUDY DESIGN: We conducted a prospective, controlled trial in a study town and two control towns in the Eastern Cape Province of South Africa. All 93 midwives caring for pregnant women in the three towns were included in the study. Samples were compared using the two-tailed Student's t-test. RESULTS: The marks achieved by the study group for questions from the antenatal card and the partogram improved by 33.0% (p < 0.001) and 17.5% (p = 0.001), respectively. No changes were observed in the control group. CONCLUSION: Midwives that studied the Maternal Care Manual significantly improved their ability to interpret clinical information and apply knowledge. If this ability is applied in clinical practice, a reduction in maternal and perinatal deaths is possible.

Achievement↗
PubMed1999

The effect of the Maternal Care Manual of the Perinatal Education Programme on the attitude of midwives towards their work.

OBJECTIVE: In this study the changes in attitude of midwives towards their work following completion of the Maternal Care Manual of the Perinatal Education Programme (PEP), were determined. METHOD: A prospective, controlled trial was performed in a study, and two control towns in a region where PEP had not previously been used. All midwives caring for pregnant women in the three towns were included in the study. First the attitude of these midwives was determined by means of a questionnaire. Subsequent to this, the Maternal Care Manual was introduced and studied by the midwives in the study town. Following the completion of the Manual after 12 months, the attitude of all midwives was again evaluated using the same questionnaire. RESULTS: A total of 40 midwives in the study town and 53 in the two control towns were included in the study. There were no differences on comparing the ages of the midwives in the study town to those in the control towns. The attitude of the midwives in the study town improved significantly (p < 0.001). The mean result in the study town improved by 6.1 (24.4%) marks from 14.5 (58.0%) to 20.6 (82.4%). A significant shift also occurred in the range of the marks from 0-25 to 13-25. No changes were observed in the control towns. CONCLUSION: Most studies that have evaluated educational programmes measured improvement in health services, and did not evaluate changes in attitude. This study found that the attitude of midwives improved significantly in the study town. This positive attitude of midwives towards their work and their ability to perform their daily tasks must be an important component of any programme to improve the quality of care rendered to women during pregnancy, labour and the puerperium.

Adult↗
PubMed1998

The usefulness of a weight gain spurt to identify women who will develop preeclampsia.

OBJECTIVE: The usefulness of adaptive centiles for weight gain as well as sudden weight gain spurts in identifying women who will develop preeclampsia was assessed. METHODS: A study sample of 99 women who developed preeclampsia and a control sample of 675 women with normal pregnancies, were randomly selected. Weight gain spurts were identified by the upper bound of adaptive maternal weight centiles. Average changes in weight between successive clinic visits were also assessed. RESULTS: Weight gain exceeding the 90th percentile of the adaptive centiles resulted in estimated sensitivity and specificity of 52% and 66% and weight gain >0.9 kg per week between visits in 76% and 29% respectively. Of women who would develop preeclampsia identified by the adaptive chart, 62.0% exhibited abnormal weight gain prior to the onset of abnormal clinical findings. CONCLUSIONS: A sudden weight gain spurt is a far from reliable sign of impending preeclampsia. This reason for weighing women at antenatal visits appears to be unfounded.

Adult↗
PubMed1997

Predictive value of conditional centile charts for weight and fundal height in pregnancy in detecting light for gestational age births.

OBJECTIVE: To estimate the predictive value of weight and symphysis fundal height (SFH) in pregnancy to detect light for gestational age (LiGA) births. STUDY DESIGN: New conditional centile charts for longitudinal monitoring of maternal weight and fundal height in pregnancy were developed based on the records of 676 women with singleton pregnancies and no complications. The records of these women and of a further sample of 102 women who had LiGA deliveries were used to assess the sensitivity and specificity of the charts in detecting LiGA during pregnancy. RESULTS: Maternal weight is a poor predictor of LiGA births. Fundal height shows moderate predictive ability. The simple cross-sectional chart for fundal height at the 20th percentile cutoff has sensitivity and specificity of 66% in detecting LiGA births. CONCLUSIONS: Monitoring via a cross-sectional chart of fundal height offers a potentially useful screening method. The results of this study add support to arguments that routine weighing in pregnancy should be abandoned.

Anthropometry↗
PubMed1996

Routine obstetric ultrasound examinations in South Africa: cost and effect on perinatal outcome--a prospective randomised controlled trial.

OBJECTIVE: To compare routine midtrimester with selective obstetric ultrasonography concerning the Health Service cost and the effect on perinatal outcome. DESIGN: A randomised controlled trial. SETTING: Urban area served by Tygerberg Hospital, a tertiary referral centre in South Africa. PARTICIPANTS: Pregnant patients without risk factors for congenital anomalies referred for ultrasonography between 18 and 24 weeks of gestation. INTERVENTION: Between 18 and 24 weeks, a level one ultrasound examination was performed on study patients only. Except for the routine scan, both groups received the same antenatal care and could be referred later for additional scans as judged by their clinicians. MAIN OUTCOME MEASURES: Overall adverse perinatal outcome and use of antenatal and neonatal services. RESULTS: The groups did not differ significantly in their use of antenatal and neonatal services except for a greater number of ultrasound scans in the study group. More suspected postdate pregnancies occurred in control patients, as well as more amniocenteses for confirmation of lung maturity. More babies of low birthweight were born in the study group. The incidence of overall or major adverse perinatal outcome was comparable. Routine ultrasonography was accompanied by a considerable increase in costs. CONCLUSION: Selective use of obstetric ultrasonography did not increase the use of antenatal and neonatal services. Not routinely performing ultrasonography has led to considerable Health Service savings without increasing the risk for adverse perinatal outcome. It saved 75% of selected patients a referral to an ultrasound unit. Specific problems related to inaccurate gestational age determination need to be addressed.

Adult↗
PubMed1995

The impact of the Perinatal Education Programme on cognitive knowledge in midwives.

OBJECTIVE: To determine whether the Maternal Care and Newborn Care manuals from the Perinatal Education Programme significantly improves the cognitive knowledge of midwives. DESIGN: Assessment of cognitive knowledge by means of multiple-choice testing. These tests were conducted before and after each of the 30 units of the Programme. In addition, a multiple-choice examination was arranged on completion of each of the two manuals. SETTING: Level I, II and III hospitals and level I clinics in urban and rural areas of South Africa. PARTICIPANTS: One hundred and fourteen midwives from hospitals and clinics. INTERVENTION: Maternal and Newborn Care manuals of the Perinatal Education Programme, studied at home and later discussed by the participants in groups every few weeks. MAIN OUTCOMES MEASURED: Number of participants who completed a manual, mean results of the pretests and post-tests, mean results of the final examination, and percentage of participants achieving 80% or more in the pretests, post-tests and final examination. RESULTS: Mean pretest and post-test results for the Maternal Care manual were 65% and 85% respectively. Mean pretest and post-test results for the Newborn Care manual were 72% and 93% respectively. The mean result for the final examination for the Maternal Care manual was 90%, while the mean result for the Newborn Care manual was 95%. There was a significant improvement in cognitive knowledge when either manual was used. CONCLUSION: The cognitive knowledge of both maternal and newborn care can be significantly improved when midwives use the Perinatal Education Programme in an outreach, co-operative learning course.

Female↗
PubMed1995

A centile chart for birth weight for an urban population of the Western Cape.

Evidence from large epidemiological studies has supported concern that being born light for gestational age (LiGA) may be detrimental. The incidence of LiGA babies is an important indicator of the health of women of reproductive age in deprived communities. In the assessment of LiGA in the Western Cape, centile charts constructed for populations in other parts of the world are generally used. These charts, however, may not be appropriate. Patients residing in the area served by the Tygerberg Hospital obstetric service, who booked early with singleton pregnancies, had their gestational age confirmed by early ultrasound and delivered between 1 March 1989 and 28 February 1990 were included in the study. The sample consisted of 3,643 patients. The mean birth weight was 2,995 g (SD 573 g) and the range 760-5,080 g. The distribution of birth weight at each week of gestation from 28 to 42 weeks was not normal. The 4-parameter Johnson family of densities was used to model the distribution of birth weight at each gestational age. A comparison of the distribution of birth weight in the study relative to the perinatal growth chart for international reference constructed by Dunn was also made. In addition to considering an overall chart, the sample was subdivided according to a number of characteristics (e.g. gender, firstborn and latter-born babies, smoking habit, hypertensive disorders and induction of labour) in order to explore their impact on the distribution of birth weight. Having explored the potential impact of all these factors, it was concluded that a single chart including all patients could be constructed.

Birth Weight↗
PubMed1995

Improved perinatal mortality rates in 1001 patients with severe pre-eclampsia.

OBJECTIVE: To ascertain the change in perinatal mortality (PNM) rate over a period of 10 years in 1001 patients with severe pre-eclampsia. METHODS: Patients with severe pre-eclampsia before a gestational age of 34 weeks were managed expectantly. Initial treatment consisted of the administration of magnesium sulphate to prevent convulsions and dihydralazine to reduce blood pressure. Methyldopa alone or in combination with other oral antihypertensive drugs was started soon after admission. In order to prevent fetal death from abruptio placentae, the fetal heart rate was monitored at least four times per day. Patients were delivered either at 34 weeks' gestation or when fetal or maternal indications for immediate delivery were present. The 10-year study was divided into four successive time periods and the PNM rate was calculated separately for each of these time periods. RESULTS: Perinatal survival was low if patients were delivered before or at 26 weeks' gestation but improved rapidly if delivered thereafter. There were only 33 intrauterine deaths of babies who weighed 1000 g or more. The majority of these deaths were due to abruptio placentae which had occurred prior to admission to hospital. The PNM rate for babies of 1000 g or more decreased from 61 in the first time phase and 83 in the second to 19 in the last. The overall PNM rate during the 10-year study was 62. CONCLUSION: Improved knowledge about the management of patients with severe pre-eclampsia in early pregnancy resulted in a decline in the PNM rate. Although the exact cause of this reduction towards the end of the study is not known, several factors probably played a role. They are expectant management with a little gain in the gestational age, better fetal monitoring before and during labour, earlier detection of fetal distress, earlier referral to the tertiary hospital and improved neonatal care.

Blood Pressure↗
PubMed1994

Does a nonreactive fetal heart rate pattern really mean fetal distress?

The aim of the study was to compare three different fetal heart rate (FHR) patterns, namely, a nonreactive pattern with good long-term variability (fluctuation of 5 or more beats/min), a reactive pattern, and a nonreactive pattern with poor long-term variability (less than 5 beats/min). For this purpose, nonstress tests done less than 24 hours before delivery and FHR patterns recorded during labor were separately assessed. Endpoints for comparison were 5-minute Apgar scores, intrauterine growth retardation, and umbilical blood gas values at birth. Regarding the nonstress test, the prevalence of low 5-minute Apgar scores in reactive, good variability, and in poor variability patterns were 7.2%, 5.3%, and 24%, respectively. The prevalences of small for gestational age newborns were 8%, 17.6%, and 60.6%, respectively. Blood gas values did not differ significantly. Regarding the FHR patterns during labor, using the same sequence, the prevalences of low 5-minute Apgar scores were 3.5%, 6%, and 23%, respectively. Small for gestational age babies occurred in 8.8%, 15.6%, and 80% of the different FHR patterns, respectively. Regarding umbilical artery blood gas values, the only significant difference was a lower pH in the poor variability group. No difference was found between the blood gas values of babies with a reactive pattern and a nonreactive pattern with good variability.

Apgar Score↗
PubMed1993

The usefulness of weight gain in predicting pregnancy complications.

The usefulness of recently constructed centile charts for weight gain during pregnancy was studied. The association of weight gain in pregnancy with pregnancy complications was investigated. The incidence of pre-eclampsia and small for gestational age babies both had a significant relationship with weight gain. Use of the charts to screen for pregnancy complications on a selected population had both a sensitivity and specificity of about 50 per cent. The positive and negative predictive values of the charts ranged from 49 to 53 per cent. The question arises as to whether the routine recording of maternal weight at each antenatal visit is necessary.

Birth Weight↗