Biomedical subjects
Publications and source records attributed to J Dommisse.
Anaemia in pregnancy is often a reflection of underlying malnutrition and may, therefore, be associated with other obstetric complications. The diagnosis and management of common pregnancy anaemias are outlined and the importance of both prevention and adequate treatment is stressed.
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Hypertension in pregnancy probably has many causes. Increasing blood pressure carries an increasing risk to mother and fetus, particularly when associated with proteinuria and hyperuricaemia. Insufficient attention has been paid to a normal fall in diastolic blood pressure during early and mid-pregnancy; hence standards of normality need to be set. Antihypertensive treatment may reduce perinatal mortality and improve fetal and placental growth. Alpha- and beta-adrenergic blockers may be better than alpha-methyldopa. Pregnancy should be terminated as soon as risk from hypertension is greater than risk of fetal prematurity. Successful management depends upon a careful clinical, biochemical, and biophysical assessment of maternal and fetal condition and fetal maturity. Examination of amniotic fluid for surfactant, the use of dexamethasone to accelerate pulmonary maturity, and intravaginal PGE2 for cervical ripening and induction of labour are significant advances. With critical observation, timely intervention and sympathetic care a successful and happy outcome can be achieved in most pregnancies.
Prostaglandin E2 (PGE2) 4,5 mg in the form of either 0,5 mg oral tablets or tylose gel, was inserted intravaginally to induce labour in 11 pairs of patients with an unripe cervix. Labour commenced spontaneously in 68% of the patients and there was no difference in efficacy or complications between the tablets and the gel. PGE2 in tylose gel was originally introduced as the optimal preparation, but is not readily available. PGE2 oral tablets, inserted vaginally, although not ideal, are available and are as effective. The use of intravaginal PGE2 for induction of labour is a significant advance in obstetric practice.
Prostaglandin E2 tablets administered vaginally succesfully induced labour in 64% of patients. There were no maternal or fetal complications. Comparison of the Bishop score failed to identify any factors which significantly influenced the success rate.
A historical review reveals that Naegele's rule was based on anecdotal evidence. This rule should be reviewed and calculations of true gestational age should be based on the probable date of ovulation and conception.
A questionnaire completed by 70% of the members of the South African Society of Obstetricians and Gynaecologists revealed that whereas only 30% favoured 'abortion on demand', 80% were in favour of a modification of the present law or its application.
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Serum ferritin estimation was used to determine the iron stores in 55 patients with severe iron deficiency anaemia in pregnancy. The response to oral or intravenous iron therapy was monitored in 18 of these patients. The results in all cases indicated deficient iron stores. Replenishment of iron stores was significantly greater in those patients treated with parenteral iron. This may be the treatment of choice for severe iron deficiency anaemia during pregnancy.
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Previously published studies have documented a reduction in the rate at which iron stores laid down by iron dextran therapy can be utilized for haemoglobin synthesis after the acute demands of haemorrhage and phlebotomy. In order to determine if a defect in the mobilization of these stores exists in the face of a chronic stimulus to red cell production, 93 patients who had previously received a total dose infusion of iron dextran were examined for a recurrence of iron deficiency anaemia, and in those in whom anaemia had recurred, iron stores were assessed by marrow aspiration. Twenty of the 93 patients were found to have recurrent iron deficiency anaemia, and marrow aspiration in all failed to demonstrate stainable iron stores. Although the rate at which iron dextran can be mobilized from storage sites is reduced, the present study demonstrates that ultimately these stores are fully utilizable.
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