Biomedical subjects
Publications and source records attributed to K D Gunston.
All pregnant patients should be screened for atypical antibodies. Anti-D immunoglobulin should be administered to Rh-negative patients after an abortion, ectopic pregnancy, and delivery of an Rh-negative infant to prevent the occurrence of immunization. The management of immunized patients is discussed.
A prospective series of 307 patients who underwent laparoscopic sterilization on a day-case basis is presented. Of these, 196 patients attended for the 6-month and 117 for the 1-year follow-up visit. There were 5 Blacks, 197 Coloureds and 105 Whites. Sterilization was done by means of tubal cauterization (137), Hulka-Clemens clips (34) and Falope rings (136). Although 18% of patients were under 30 years old, 16% were 40 years of age or older. A marked tendency to low parity was evident, 43% of Coloureds and 90% of Whites being para 3 or less. The main operative problem was uterine perforation. Of the patients 17% were not discharged on the day of operation. By the 5th postoperative day 86% had returned to normal working activities. Significantly more postoperative abdominal pain was reported in the clip and ring groups. Seven pregnancies occurred in the series, 6 after tubal cauterization and 1 after the application of Falope rings. On patient was probably pregnant at the time of the operation. Most patients reported no change in libido at the 1-year follow-up visit, and in 20% libido was increased Mild pelvic infection was the only significant finding at the 6-month and 1-year follow-up visits. Apart from the disturbingly high pregnancy rate and the relatively large number of patients who were not discharged on the day of operaton, the sterilization programme has been most acceptable.
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The antibacterial activity of amniotic fluid against Escherichia coli in the last month of pregnancy was reduced in an unselected sample of mothers delivering in Cape Town. Amniotic fluid zinc, required for normal antibacterial activity, was also reduced. These findings offer an explanation for the high incidence of amniotic fluid infection previously reported.
The effect of prenatally administered phenobarbitone, fenoterol (a beta-sympathomimetic drug) and dexamethasone on fetal pulmonary maturity, as measured by the total phospholipid (TPL) content of amniotic fluid, was assessed. Compared with control values, there was a significantly greater rise after fenoterol (P less than 0,01) and dexamethasone (P less than 0,01), but not after phenobarbitone administration. The ability of dexamethasone to convert the TPL value to mature levels (greater than or equal 2,0 microgram/ml) was significantly greater than that of fenoterol (P less than 0,05).
Two hundred and sixteen patients were selected for laparoscopic sterilization on a day-case basis. Patients were sterilized by electrocautery, by applying Silastic bands (Falope rings), and by means of Hulka-Clemens clips. Three patients required laparotomy and 35 patients were discharged the day after the operation. By the 3rd day 146 (69%) and by the 5th day 184 (86%) patients had returned to their routine work. From the technical and immediate postoperative point of view, there appears to be relatively little difference between the three techniques. There may be slightly more risk of thermal complications with bipolar cauterization, a slightly highly incidence of postoperative abdominal pain with the Silastic band applicator, and slightly more difficulty in applying the Hulka-Clemens clip. These problems are all reduced by experience and proper training of the operator, which is essential. Our experience confirms that laparoscopic sterilization is safe, efficient, and feasible as a day-case procedure, and that it has major advantages in terms of patient convenience and acceptability as well as reduction in hospitalization costs.
Obstetric patients requiring premature termination of pregnancy with low levels of surfactant in the amniotic fluid were given dexamethasone for 2 or 7 days to assess the effect of the duration of treatment on the total phospholipid content of the amniotic fluid. A significant rise in lung surfactant occurred in both groups, but dexamethasone administered for 7 days was not more effective than 2 days' administration. It is suggested that it is not the duration of treatment, but the stage of pregnancy or the functional maturity of the fetus at the time of administration of dexamethasone that affects the outcome.
Many patients are admitted with premature rupture of the membranes draining amniotic fluid contaminated with vaginal secretions, and the fluid is used for tests of fetal pulmonary maturity. Among 15 patients contamination of amniotic fluid by vaginal and cervical secretions was found to result in a rise in the bubble score in 6 and a rise in total phospholipids (TPL) in 12.
The amniotic fluid of 250 patients in the third trimester of pregnancy was examined for surfactant content by means of the bubble test and total phospholipid estimation. No evidence was found that intra-uterine growth retardation accelerates pulmonary maturity in the fetus, and the finding of early pulmonary maturity does not indicate intrauterine growth retardation.
The bubble test was compared with the lecithin-sphingomyelin (L/S) ratio and total phospholipids (TPL) test as a measure of fetal lung surfactant in the amniotic fluid. Of 161 patients, all but 1 with a bubble score of 2 + or more also had mature L/S ratios and TPL values, whereas those with a bubble score of 0 - 1 + had L/S ratios and TPL values ranging from immature to mature. A total of 161 patients who delivered within 72 hours of TPL test and bubble test were assessed for the presence of hyaline membrane disease (HMD). No cases of HMD were associated with a bubble score of 2+ or more. However, the fetuses of 10 of 66 patients with a bubble score of 0 or 1 + developed HMD.
The fat cell count in amniotic fluid samples from 100 patients was compared with the lecithin-sphingomyelin (L/S) ratio and total phospholipid content. When the fat cell count was over 10%, the L/S ratio indicated maturity in all cases and the total phospholipids indicated maturity in all but 1 case. When the presence of blood or meconium in the amniotic fluid renders lung surfactant tests unreliable, an indication for the fat cell count exists.
A method of low suprapubic amniocentesis after elevation of the fetal head during vaginal examination has been found to be a safe and valuable obstetric procedure. The incidence of the only complication in 1 362 consecutive amniocenteses, viz. rupture of the membranes, was similar to the spontaneous rate and could well be unrelated to the procedure. Failure to obtain amniotic fluid occurred in 13 patients and in a further 18 patients the amniotic fluid was blood-stained. High, peri-umbilical amniocentesis without ultrasonic control is not justified in obstetric practice because of the possible complications.
A close correlation was found between amniotic fluid volume measured by using para-aminohippuric acid and the clinical assessment of volume. No correlation was found between measured amniotic fluid volume and fetal weight, length, or weight for gestational age.
The number and nature of the calls received by the Cape Town Flying Squad Service during 1972 are compared with those received from 1954 to 1960. A threefold increase in the total number of calls received per year is related to a fall from 74% to 30% in calls connected with postpartum complications. Reasons for these changes are suggested.