The use of traditional herbal medication during pregnancy.
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Adolescent↗
Biomedical subjects
J Moodley
Publications and source records attributed to J Moodley.
Obstetric and gynaecological patients in an intensive care unit: a 1 year review.
Management of the critically ill patient forms a significant proportion of obstetric and gynaecological (O & G) practice. There have however, been very few reports on the management of such patients in intensive care units (ICU). We review all O & G patients admitted to the surgical ICU at King Edward VIII Hospital, Durban, South Africa, and make recommendations regarding management of such patients. The medical records of all O & G patients admitted to the surgical ICU between the period January-December 1992 were analysed. Of all admissions to the ICU 13.6% (n = 122) were O & G patients. Eclampsia was the most common diagnosis accounting for 66% of all obstetric admissions. Of all eclamptics in the study period 24% were admitted to the ICU. The overall maternal mortality was 21%. O & G patients form a major workload of surgical ICUs and the majority of these patients are women with eclampsia. Management of such patients requires an understanding of the physiological changes of normal and abnormal pregnancies. Therefore, all large obstetrical units in developing countries should establish their own ICU in order that patient care, health personnel training and continuing health care education may be improved.
Adolescent↗
Laparoscopic diagnosis of gallbladder agenesis.
We describe the case of a 32-year-old patient with gallbladder agenesis encountered at laparoscopy. Diagnostic confirmation was made by endoscopic retrograde cholangiopancreatography and computerized scanning. Formal laparotomy was avoided. A review of the literature is presented.
Adult↗
Ileal amoebiasis.
Whilst colonic amoebiasis and its complications are well-documented, ileal amoebiasis has not been described in the literature. We report the cases of two patients with ileal amoebiasis and outline their management and outcome. It is important that surgeons working in areas endemic for amoebiasis be mindful of this entity.
Adult↗
The effect of traditional herbal medicines on pregnancy outcome. The King Edward VIII Hospital experience.
OBJECTIVE: To determine the effect of herbal medication in pregnancy. METHOD: Patients (N = 229) presenting in early labour were randomly selected and interviewed. All interviews were conducted by one of the authors (MHM) familiar with the nuances of the Nguni languages. RESULTS: One hundred and twenty-six patients (55%) gave a positive history of herbal ingestion (study group) and 103 (45%) had a negative history (control group). Fifteen per cent of the control group and 55.6% of the study group had grade II-III meconium staining of liquor, while 22% of the control group and 38.5% of the study group were delivered by caesarean section. CONCLUSION: Herbal medication is commonly used in pregnancy by women attending King Edward VIII Hospital. Its use may lead to fetal distress, as indicated by the high frequency of meconium-stained liquor and high caesarean section rates in this group of women presenting in labour.
Adolescent↗
Granuloma inguinale in association with pregnancy and HIV infection.
OBJECTIVES: A retrospective study to confirm the clinical impression of an increasing prevalence of granuloma inguinale (GI) in women, and to evaluate its association with pregnancy and HIV infection. METHODS: Clinical records of all patients with a definitive diagnosis of GI attending the gynecology and antenatal clinics at King Edward VIII Hospital, Durban, South Africa, over a period of 36 months (January 1991-December 1993). RESULTS: A total of 123 women were diagnosed with GI. The diagnosis was made by tissue smear alone in 21% (n = 26), histology 43% (n = 53) and by a combination of smear and histology in the rest. Forty-two percent (n = 52) were pregnant. The only difference between pregnant and non-pregnant women were the presence of rectal and pelvic lesions in the latter. Sixty-nine percent (n = 36) delivered vaginally while the remaining (n = 16) were delivered by cesarean section. The indications for cesarean section were obstetric except for a patient in labor with extensive untreated vulval granuloma. In the majority (85%) GI had no influence on pregnancy outcome. There was no evidence of congenital GI in the neonates. Twenty-seven percent (30/113) had positive syphilis serology and 16% (18/110) had antibody to HIV. There were no differences in the clinical features and outcome of HIV positive and negative women. CONCLUSION: This study shows that GI is increasing in pregnancy in Durban, South Africa. Despite the concern that pregnancy promotes dissemination of GI, such an effect could not be established as the clinical response to treatment and outcome were similar in both pregnant and non-pregnant women. Infection with HIV also did not alter the clinical presentation and outcome of the disease in the patients studied.
Adolescent↗
Bacterial vaginosis and associated infections in pregnancy.
OBJECTIVE: To assess the role of bacterial vaginosis (BV) on pregnancy complications in a developing community where mixed cervico-vaginal infections are common. SETTING: The antenatal clinic at King Edward VIII Hospital (KEH), Durban, South Africa, which is a large urban tertiary hospital serving mainly a Black underprivileged population of KwaZulu/Natal. METHODS: Asymptomatic pregnant women < or = 30 weeks gestation were recruited at their first antenatal visit. Clinical data including the sexual history were recorded. Swab specimens were collected from the vagina and endocervix for diagnosing BV, trichomoniasis, candidiasis, gonorrhea and chlamydial infection. Venous blood specimens were tested for antibody to syphilis and human immunodeficiency virus (HIV). All women continued standard antenatal care and hospital records were reviewed following delivery to evaluate pregnancy outcome. RESULTS: BV was found in 52% of the women studied and was the commonest infection diagnosed. Mixed vaginal infections of BV and trichomoniasis were diagnosed in 14%. Only 29% of asymptomatic women did not have any microbiological evidence of a lower genital tract infection. A total of 46% of women studied had poor pregnancy outcome as measured by obstetrical complications, pregnancy loss and/or neonatal morbidity. There was a significant difference in outcome in women with BV (55 of 88) compared to those having infections other than BV (13 of 31), or no infection (5 of 9)-P = 0.005. This difference was for obstetrical complications of preterm delivery, premature rupture of membranes and intrauterine infection, but not for pregnancy losses and neonatal morbidity. CONCLUSIONS: The high prevalence of BV and concomitant lower genital tract infections among asymptomatic pregnant women and the resultant adverse pregnancy outcome associated with BV, confirms reports from developed countries of the need for screening for BV at the initial antenatal clinic visit. Whether pregnancy outcome was worse in the presence of BV and other infections than BV alone could not be determined. Future studies with appropriate interventions are needed to evaluate the unique problems of developing countries.
Adolescent↗
Thrombelastography changes in pre-eclampsia and eclampsia.
We have measured platelet count, bleeding time and thrombelastography (TEG) variables and the correlation between these variables in 49 pregnant patients presenting with pre-eclampsia or eclampsia. Eighteen patients (37%) had a platelet count < or = 150 x 10(9) litre-1 and seven (14%) had a platelet count < or = 100 x 10(9) litre-1. Bleeding time was prolonged > 9.5 min in 13 (27%) patients and the TEG was abnormal in four (8%). The TEG variables, k time and maximum amplitude (MA) had a strong correlation with platelet count (k time-platelet count < or = 150 x 10(9) litre-1, r = -0.68, P = 0.003, platelet count < or = 100 x 10(9) litre-1, r = -0.84, P = 0.02; MA--platelet count < or = 150 x 10(9) litre-1, r = 0.72, P = 0.001, platelet count < or = 100 x 10(9) litre-1, r = 0.78, P = 0.04). There was no correlation between bleeding time and thrombocytopenia (platelet count < or = 150 x 10(9) litre-1, r = -0.18, ns; platelet count < or = 100 x 10(9) litre-1, r = 0.09, ns). There was no correlation between bleeding time and any measured TEG variable. Of the 10 (20%) patients with an adequate platelet count (> 100 x 10(9) litre-1) but prolonged bleeding time, the TEG was normal, suggesting adequate haemostasis. An MA of 53 mm, which is the lower limit for normal pregnancy, correlated with a platelet count of 54 x 10(9) litre-1 (95% confidence limits 40-75 x 10(9) litre-1). Although the number of patients with severe thrombocytopenia was small, a platelet count of 75 x 10(9) litre-1 should be associated with adequate haemostasis.
Anesthesia, Conduction↗
Randomised study assessing the effect of phenytoin and magnesium sulphate on maternal cerebral circulation in eclampsia using transcranial Doppler ultrasound.
OBJECTIVE: To assess maternal middle cerebral artery flow velocity patterns as measured by transcranial Doppler ultrasound (TCD) in eclampsia and to investigate the effect of the anticonvulsants magnesium sulphate (MgSO4) and phenytoin on cerebral circulation. DESIGN: Prospective randomised study. SETTING: High care obstetric unit, King Edward VIII Hospital, Durban, South Africa. PARTICIPANTS: Twenty-four eclamptic patients: 13 received MgSO4 and 11 phenytoin. INTERVENTION: Middle cerebral artery flow velocity waveforms were measured using 2 MHz pulsed Doppler ultrasound via the transtemporal approach in eclamptic patients, before and 15 minutes after the loading dose of anticonvulsant. RESULTS: Magnesium sulphate significantly reduced the pulsatility index (P = 0.002) and mean flow velocity (P = 0.02) in the middle cerebral artery, whereas phenytoin failed to produce any statistically significant effect. However, differences between groups were not statistically significant. Systolic and diastolic blood pressures were reduced in both the MgSO4 and phenytoin groups. CONCLUSION: These findings provide firm evidence that MgSO4 relieves cerebral vasospasm, compared with phenytoin, and may therefore be the better drug for the prevention of eclamptic convulsion.
Adolescent↗
Cardiac abnormalities in pulmonary oedema associated with hypertensive crises in pregnancy.
OBJECTIVE: To describe the cardiac abnormalities by two-dimensional and Doppler echocardiography (echo-Doppler) in hypertensive crises in pregnancy (HCP) complicated by pulmonary oedema and identify pathogenic factors. DESIGN: A prospective observational study. SETTING: King Edward VIII Hospital, Durban, South Africa. PARTICIPANTS: Sixteen patients with HCP complicated by pulmonary oedema over a six-month period. Two control groups, 55 patients with HCP alone and 16 with normotensive pregnancies, were also studied. RESULTS: Echocardiography diagnosed impaired left ventricular systolic function in 4 of 16 (25%) patients with HCP and pulmonary oedema. In the remaining 12 patients with preserved systolic function, left ventricular diastolic filling abnormalities were demonstrated in a significant proportion compared to control hypertensive and normotensive groups. Fifteen of 16 (94%) study patients presented with pulmonary oedema antepartum; in seven of these patients, the use of dexamethasone to enhance fetal lung maturity appeared to be a contributing factor in precipitating pulmonary oedema. CONCLUSION: This study demonstrates the value of echo-Doppler to diagnose structural and functional cardiac abnormalities in HCP complicated by pulmonary oedema. The potential role of left ventricular diastolic filling abnormalities in the pathogenesis of pulmonary oedema complicating HCP is discussed.
Adult↗
Maternal mortality in Kwazulu/Natal: need for an information database system and confidential enquiry into maternal deaths in developing countries.
In a 2-year retrospective analysis of 147 maternal deaths in South African urban and rural hospitals, the maternal mortality rate (MMR) was estimated to be 144 per 100,000 live births. MMR was significantly higher (P = 0.025) in urban hospitals (160 per 100,000) and the main causes of death were hypertensive disease in pregnancy (33%), of which eclampsia contributed to 70% of deaths and haemorrhage (18%). Only 49.7% of women who died, attended an antenatal clinic. The MMR in South Africa is lower than sub-Saharan countries but unacceptably high for a country with a mix of private and public medicine. Disparities have been noted in maternal mortality rates within the country due to different study rates within the country due to different study designs and poor documentation, Structural changes in the health care system would only be possible if a common information database system were established and confidential enquiries held into maternal deaths.
Adult↗
Endoscopic transthoracoscopic sympathectomy--the Durban experience.
Advances in optics, illumination and video-technology together with refinements in operative technique have made endoscopic transthoracoscopic sympathectomy (ETS) the method of choice for upper thoracic sympathectomy. Palmar hyperhidrosis is by far the main indication for ETS. The procedure is technically easy and well tolerated by patients, and complications are few and minor.
Adolescent↗
Primary gastric tuberculosis. A report of 3 cases.
Gastric tuberculosis is an uncommon clinical entity. Great difficulty is encountered in making the pre-operative diagnosis. Other chronic granulomatous conditions (Crohn's disease, sarcoidosis and isolated granulomatous gastritis) should always be considered. Surgery, with postoperative antituberculosis treatment, remains the main modality for accurate diagnosis and treatment.
Adult↗
Assessment of alleged rape victims.
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Female↗
Laparoscopic removal of intra-abdominal foreign body. An unusual case.
Laparoscopic retrieval of an intra-abdominal foreign body is described. This novel use of the laparoscope has not been described before.
Abdomen↗
'Never say die'--survival of a woman with massive abruptio placentae and a haemoglobin concentration of 0.6 g/dl.
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Abruptio Placentae↗
Free alpha-subunits of human chorionic gonadotropin in preeclampsia.
OBJECTIVE: To investigate free alpha-human chorionic gonadotropin (hCG) as a marker of preeclampsia. METHODS: Four groups of patients were studied: normal pregnancies, preeclampsia, eclampsia and normal pregnant women <20 weeks' gestation. Patients were further divided according to parity and gestational age (< or =20, 21-30, 31-40 weeks). An immunoradiometric assay employing monoclonal antibodies specific for free alpha-hCG was used. RESULTS: A total of 313 patients were analyzed. Thirty-four patients < or =20 weeks' gestation were followed until delivery: five (14.7%) developed preeclampsia; none had abnormal alpha-hCG levels before onset of preeclampsia. Patients with preeclampsia (21-30 weeks' gestation) demonstrated a mean alpha-hCG level greater than that of normotensive controls but this was not statistically significant. Between 31 and 40 weeks' gestation, mean alpha-hCG levels in the hypertensive and control groups were 210.8 ng/ml and 115.8 ng/ml, respectively (P < 0.001). A stronger association was observed between alpha-hCG and preeclampsia with increasing gestational age (relative risk [RR] 2.07, 21-30 weeks; RR 3.02, 31-40 weeks) and severity (RR 4.51, mild; RR 12.15, severe; RR 16.88, eclampsia). CONCLUSION: There is a strong association between alpha-hCG and preeclampsia, nevertheless this test is unsuitable for predicting preeclampsia.
Biomarkers↗
Is the human chorionic gonadotropin secreted by ectopic trophoblast different from that in normal intrauterine pregnancies?
OBJECTIVE: To determine whether different isoforms of hCG are secreted by trophoblast tissue from ectopic pregnancy (EP). DESIGN: Retrospective study of surgically confirmed EPs compared with normal pregnancies. SETTING: Teaching hospital in South Africa. PATIENTS: One hundred patients with EPs and 120 patients with normal pregnancies. MAIN OUTCOME MEASURES: Isoforms of hCG were measured by specific immunoassays, lectin binding, and examination of disappearance rates of hCG after surgical clearance of EP. RESULTS: There were no obvious differences between the two types of pregnancy apart from a lower binding of beta-subunit immunoactivity to ricin 120. No clinically useful diagnostic measures to distinguish hCG from normal and EPs were found. CONCLUSIONS: No obvious differences were found in the isoforms of hCG between the two types of pregnancy using these methods.
Blood↗