Biomedical subjects

K Mahomed

Publications and source records attributed to K Mahomed.

At least 19 recordsLinked to original sources

PubMed1996

Prevalence of hypertension among women in rural Zimbabwe: a comparison of pregnant and non-pregnant women.

OBJECTIVES: To determine the prevalence of pregnancy induced hypertension (PIH) in rural Zimbabwe. DESIGNS: A blood pressure survey conducted in three socio-economic strata of rural Zimbabwe, communal lands, commercial farms and mining areas. SETTING: Rural Zimbabwe, Mashonaland West Province. SUBJECTS: 627 pregnant (> 20 weeks gestation) and 483 non pregnant (ages 16 to 45) women. MAIN OUTCOME MEASURE: Prevalence of PIH. RESULTS: PIH was defined in two ways: 1. A combination of > or = 2+ proteinuria and systolic and/or diastolic pressure > or = SD above the mean for all pregnant women (> or = 123/75 mmHg). 2. > or = 1+ proteinuria and blood pressure of 140 and/or 90 mmHg. Eight women met definition 1 and seven met definition 2, giving a prevalence of 0.8pc; 1.3pc and 3.2pc in communal lands, commercial farms and mines respectively. In non-pregnant women the prevalence of hypertension (> or = 160 and/or 95 mmHg) was 3.5pc; 5.4pc and 15.1pc in communal lands, commercial farms and mines respectively. CONCLUSION: PIH is rare in rural Zimbabwe. Hypertension among non-pregnant women of child bearing age is most common in mining communities which have many similarities to urban environments.

Adolescent↗

PubMed1995

Labor experience, maternal mood and cortisol and catecholamine levels in low-risk primiparous women.

This exploratory, prospective study was set up to determine the relationship between cortisol and catecholamine levels and labor experience and postpartum maternal mood. It was performed at the Coronation Hospital, which serves a low-income urban population in Johannesburg. Blood samples were taken from 189 low-risk primiparous women in active first stage of labor and analyzed for cortisol, norepinephrine, epinephrine and dopamine. The stress hormone levels were then correlated with maternal anxiety, depression and self-esteem scores, and changes associated with mothers' labor experience and pain. Patients who were distressed and required analgesia had higher cortisol levels. Those who described a more positive labor experience at 24 hours also had higher cortisol levels. There were no significant correlations between psychological test scores and stress hormone levels. Both labor pain at the time and a more positive recollected labor experience were associated with high cortisol levels. Cortisol and catecholamine levels in labor did not correlate with postpartum psychological test scores.

Adolescent↗

PubMed1994

Randomised controlled trial of intrapartum fetal heart rate monitoring.

OBJECTIVE: To compare effectiveness of different methods of monitoring intrapartum fetal heart rate. DESIGN: Prospective randomised controlled trial. SETTING: Referral maternity hospital, Harare, Zimbabwe. SUBJECTS: 1255 women who were 37 weeks or more pregnant with singleton cephalic presentation and normal fetal heart rate before entry into study. INTERVENTIONS: Intermittent monitoring of fetal heart rate by electronic monitoring, Doppler ultrasound, use of Pinard stethoscope by a research midwife, or routine use of Pinard stethoscope by attending midwife. MAIN OUTCOME MEASURES: Abnormal fetal heart rate patterns, need for operative delivery for fetal distress, neonatal mortality, Apgar scores, admission to neonatal unit, neonatal seizures, and hypoxic ischaemic encephalopathy. RESULTS: Abnormalities in fetal heart rate were detected in 54% (172/318) of the electronic monitoring group, 32% (100/312) of the ultrasonography group, 15% (47/310) of the Pinard stethoscope group, and 9% (28/315) of the routine monitoring group. Caesarean sections were performed for 28% (89%), 24% (76), 10% (32), and 15% (46) of the four groups respectively. Neonatal outcome was best in the ultrasonography group: hypoxic ischaemic encephalopathy occurred in two, one, seven, and 10 cases in the four groups respectively; neonatal seizures occurred only in the last two groups (six and nine cases respectively); and deaths occurred in eight, two, five, and nine cases respectively. CONCLUSIONS: Abnormalities in fetal heart rate were more reliably detected by Doppler ultrasonography than with Pinard stethoscope, and its use resulted in good perinatal outcome. The use of relatively cheap ultrasound monitors should be further evaluated and promoted in obstetric units caring for high risk pregnancies in developing countries with scarce resources.

Female↗

PubMed1994

A comparison of manual vacuum aspiration (MVA) and sharp curettage in the management of incomplete abortion.

OBJECTIVES: A prospective longitudinal study was carried out in two Harare hospitals to determine whether manual vacuum aspiration (MVA) was as safe and as effective as sharp curettage for treatment of incomplete abortion. METHODS: Demographic and clinical data were collected over a 3-month period on 589 women treated with sharp curettage for incomplete abortion < or = 12 weeks gestation. One year later, after faculty and staff at the two hospitals were trained to use MVA, data were similarly collected on 834 women treated with MVA for incomplete abortion. RESULTS: Based on procedure-related complications at the time of treatment, MVA was found to be as safe as sharp curettage in treating incomplete abortion < or = 12 week gestation. MVA was more effective than sharp curettage in achieving complete uterine evacuation (0% incomplete evacuations vs. 0.7%, P < 0.05). CONCLUSIONS: Given the safety and effectiveness of the MVA procedure and the potential for reducing health care costs and improving patient management, this technology should be considered by health care systems in developing countries for improving treatment of abortion complications.

Abortion, Incomplete↗

PubMed1994

Meconium staining of the liquor in a low-risk population.

Although the significance of meconium-stained amniotic fluid as a sign of fetal distress remains controversial, its presence remains a concern to both obstetricians and neonatologists since signs of asphyxia and meconium staining are associated with an increase in perinatal morbidity and mortality. The aim of this study was to evaluate the role of meconium staining of the liquor in the low-risk obstetric population in terms of fetal distress and perinatal morbidity and mortality. In a prospective cohort study at a referral hospital and at one of two municipal clinics, women with a singleton pregnancy of 37 to 42 weeks gestation and with no pre-defined risk factor were recruited into the study. Study patients comprised those with meconium staining of the liquor and controls comprised similar women but with clear liquor. Meconium staining of the liquor was associated with poor outcome in all the outcome measures assessed. Fetal heart rate (FHR) abnormality was more closely associated with adverse outcome than meconium staining, and thin meconium alone was not associated with any adverse outcome except respiratory distress. Women with thin meconium in the presence of normal FHR can therefore be safely managed at the clinic level. Thick meconium itself was a risk factor for poor outcome, more so if associated with FHR abnormality, and should be an indicator for early referral.

Amniotic Fluid↗

PubMed1994

An incident case-referent study of stillbirths at Harare Maternity Hospital: socio-economic and obstetric risk factors.

This incident case-referent study was conducted at Harare Maternity Hospital in 1989-1990 on 104 consecutive cases of stillbirth with unknown aetiology and 96 age- and parity-matched referents. Information was collected by interviewing the women following a standardized form and by review of antenatal cards. None of the women refused to participate. The most significant obstetric risk factors were prevalence of earlier stillbirths (odds ratio, OR = 6.1) and miscarriages (OR = 4.8). Low height and body mass index also increased the risk of having a stillborn baby significantly as well as a history of flue-like illness during pregnancy (OR = 4.6). The latter may have stimulated the women to book early causing the unexpectedly high OR for early booking among these cases. The pattern for the socio-economic risk factors was not easy to interpret. The most striking finding was the U-shaped relationship between socio-economic status and stillbirths with a higher risk among those with low and high status.

Adolescent↗

PubMed1993

Amniotic fluid zinc and pregnancy outcome.

OBJECTIVE: To examine for an association between amniotic fluid zinc and pregnancy outcome. DESIGN: A prospective study. SETTING: Southmead Hospital, Bristol, UK. SUBJECTS: 191 amniotic fluid samples from 11 centers in the Southwest of England, obtained at 16-20 weeks gestation. METHOD: Samples of amniotic fluid (AF) sent for prenatal diagnosis were collected from the laboratory and analysed for zinc level. Data were then collected at a later date concerning pregnancy outcome. OUTCOME MEASURE: Antenatal complications as well as events in labour, and in particular birth weight and congenital malformations. RESULTS: 182 cases with complete data showed a mean AF zinc level (+/- S.E.) of 1.39 (+/- 0.11). There was no relation between AF zinc and antepartum haemorrhage, pregnancy-induced hypertension, post-partum haemorrhage or time and mode of delivery. Neither was there an association with birth weight. As there were no cases with major malformations, particularly of the central nervous system, possible association could not be ascertained. CONCLUSION: The study failed to demonstrate any association between AF zinc and abnormal pregnancy outcome. A modified prospective study is suggested to explore this further.

Adult↗

PubMed1993

Failure to taste zinc sulphate solution does not predict zinc deficiency in pregnancy.

As part of a double-blind randomised controlled trial to test the efficacy of 20 mg of zinc supplementation during pregnancy, 494 mothers were enrolled at booking. After giving informed consent they were asked to taste a dilute solution of zinc sulphate. Of the 489 mothers who were given the solution, 44 (9%) were unable to taste it. Mothers who failed this test did not differ significantly from the rest of the population in background factors such as social class, ethnic group, maternal age or parity. Significantly more non-tasting mothers had had a previous growth-retarded infant. Their diets did not differ in any way from those of the tasters. Zinc supplementation did not affect their taste as assessed at the end of pregnancy. Of the possible outcome measures considered, the zinc taste test did predict whether the mother was to develop diastolic hypertension (23% of non-tasters, 8% of tasters), but the mean birthweight, preterm delivery rate and other outcomes were identical.

Chi-Square Distribution↗

PubMed1992

A simplified form of cardiotocography for antenatal fetal assessment.

Antenatal cardiotocography has become the primary method of evaluation of fetal wellbeing, and the relationship between the presence of fetal heart rate accelerations in response to fetal movement and subsequent good fetal outcome has been demonstrated. However, in areas where electronic monitors are few or not available it would be useful if such accelerations could be demonstrated using the Pinard stethoscope. A prospective study involving 200 women with a singleton pregnancy of more than 34 weeks gestation was performed at Harare Maternity Hospital, Harare, Zimbabwe, when a 6 min electronic trace using an external transducer was compared with simultaneously performed 6 min manual record using the Pinard stethoscope. The findings showed that the manual record has a sensitivity of 75% and although traces with excessive base line variability would show an acceleration on the manual record, in no case with a flat trace was an acceleration noted on the manual record. This acceptable degree of sensitivity would allow for a significant decrease in the number of women being referred for electronic tracing and would be a more appropriate use of limited resources in terms of manpower and equipment.

Auscultation↗

PubMed1992

Intrapartum foetal heart rate monitoring--continuous electronic versus intermittent Doppler--a randomised controlled trial.

OBJECTIVE: To compare different methods of intrapartum foetal heart rate monitoring in high risk pregnancies in detecting foetal heart rate abnormalities, need for operative delivery for foetal distress, and neonatal mortality and short term neonatal morbidity. DESIGN: A prospective randomised controlled trial. SETTING: Women in labour at a referral maternity hospital. PATIENTS: Women who were 37 weeks or more pregnant with singleton cephalic presentation and normal foetal heart rate prior to entry into the study. INTERVENTION: Women were randomly allocated using sealed opaque envelopes to either continuous electronic foetal heart rate monitoring or intermittent monitoring using hand held doppler foetal heart rate detector. OUTCOME MEASURES: These include abnormal foetal heart rate patterns, need for operative delivery for foetal distress, neonatal mortality, Apgar scores, admission to NNU, neonatal seizures, and hypoxic encephalopathy. RESULTS: Randomisation achieved good comparability between the two groups. Abnormal FHR patterns were more frequent in the electronic group (54 pc versus 32 pc). Caesarean section rate was not significantly different in the two groups (28 pc versus 24 pc) although slightly higher compared to overall for the unit (18pc). Foetal outcome was also comparable between the two groups. CONCLUSIONS: Asphyxia can be detected with a hand held doppler just as reliably as by the use of electronic monitors and their use should be further evaluated and promoted in obstetric units caring for high risk pregnancies in developing countries with scarce resources.

Adult↗

PubMed1992

Socio-democratic characteristics of women presenting with abortion--a hospital based study.

OBJECTIVE: To determine socio-demographic characteristics and clinical features of women presenting with abortion, and to define factors associated with complications of abortion. DESIGN: A prospective descriptive study. SETTING: Women in Gynaecology casualty department at Harare Central Hospital, Harare, Zimbabwe. PATIENTS: 307 women with features of complete or incomplete abortion were interviewed during February to June 1991. They were randomly selected and represented 53pc of all women with the problem. RESULTS: Three quarters of the women were married and lived with their spouses. In 23.1pc this was a first pregnancy. Over a quarter of the women who were on the pill claimed to have fallen pregnant whilst on the pill, mainly because of poor compliance. One hundred and twenty-two were not on the pill but in only 16pc it was intended to fall pregnant. In nearly 30pc the pregnancy was not wanted but only 2.3pc admitted to having induced the abortion. Sepsis was present in 25.6pc and they tended to be younger, not presently married and have an unplanned pregnancy. Although there was some evidence of trauma in 6.2pc, it was not possible from the study to assess the percentage of abortion likely to have been induced. CONCLUSION: Contraceptive usage is generally low and cultural and traditional factors may play a role, but expanded sex education programmes and continued contraceptive counselling need reinforcing before attempts are made to review the legal issues regarding termination.

Abortion, Illegal↗

PubMed1992

Reference values for glucose tolerance test in the urban Zimbabwean pregnant woman.

A 50 g oral glucose tolerance test (OGTT) was performed on normal pregnant urban Zimbabwean women at 26-28 weeks (n = 65) and 36-40 weeks (n = 72) gestation. Women with factors predisposing to impaired glucose tolerance were excluded. The fasting, one hour and two hours values were compared to the North American standards as proposed by O'Sullivan and Mahan which are currently in use. The mean fasting levels were significantly higher and those at one and two hours significantly lower than the standards. The study also failed to demonstrate impairment of glucose tolerance with advancing gestation. These may have implications in the screening for impaired glucose tolerance in our African population.

Adult↗

PubMed1991

External cephalic version at term. A randomized controlled trial using tocolysis.

OBJECTIVE: To assess the role of external cephalic version (ECV) at term, using tocolysis. DESIGN: A randomized controlled trial over a 12 month period. SETTING: Harare Maternity Hospital, Harare, Zimbabwe. SUBJECTS: 208 women with breech presentation at term were recruited after satisfying eligibility criteria. There were 103 women in the study group and 105 in the control group. At the end of the study a further 104 women were recruited for ECV. INTERVENTION: ECV attempted after intravenous injection of 10 micrograms of hexaprenaline, using either forward or backward somersault over a maximum period of 5 min. MAIN OUTCOME MEASURES: Success rate in terms of presentation during labour, need for caesarean section, and various variables related to fetal outcome. RESULTS: ECV reduced the frequency of breech presentation during labour from 83% to 17% and that of caesarean section from 33% to 13%. There were no troublesome complications from the procedure. CONCLUSION: In carefully selected women with breech presentation, ECV at term using tocolysis, safely reduced the rate of breech presentation in labour and also the caesarean section rate. Further research is needed to determine the role of ECV in early labour.

Adolescent↗

PubMed1991

Time of delivery--effect on obstetric outcome: a retrospective study.

This retrospective study involving 3,896 births is performed to see if there is any association between time of delivery and feto-maternal outcome. 34 pc of all deliveries occurred in the four-hour period 2000 hours to 2400 hours. Generally, there were more unbooked women arriving during the night. The higher caesarean section rate during the day time is probably related to the number of elective procedures performed during this time. This study, however, failed to confirm others which demonstrate a poorer outcome during the night infant outcome, in fact tended to be worse during the period 0800 hours to 2000 hours, and this was particularly so for the women delivering between 1600 and 2000 hours. Implications for reorganisation of the mid-wifery staff are discussed.

Adult↗

PubMed1991

Adolescent pregnancy--a prospective survey of contraceptive knowledge and reproductive behaviour.

Adolescent sexual activity is occurring at younger ages resulting in unplanned and often unwanted pregnancies. The prospective case controlled study of 200 teenagers aged 16 and under and 200 controls aged over 20 was conducted in Harare, Zimbabwe. The study group tended to belong to the low socio-economic group and a large number became pregnant whilst still at school. Although sexually active, the group contained a very small percentage of contraceptive users. A significant number not only claimed having little knowledge of the service but appeared uniformed or misinformed of the risks associated with the use of contraceptive methods. Regarding support during pregnancy, the Zimbabwe teenager is certainly aided by the extended family unit and formal health centres appear to play a minor role. Prevention of teenager pregnancies needs us to focus on adolescent peer pressure as well as towards parents and community leaders.

Adolescent↗

PubMed1991

Seroprevalence of HIV infection amongst antenatal women in greater Harare, Zimbabwe.

Prevalence of HIV infection appears to be rising in many African countries. HIV infection in the pregnant woman poses a dilemma for the mother as well as for her unborn child. There are no data on HIV prevalence in Zimbabwe. This prospective study designed to determine HIV prevalence, enrolled pregnant women booking for antenatal care at Harare hospital and two of its peripheral municipal clinic. Two Elisa and a confirmatory Western Blot test on 1008 blood samples provided an HIV sero-prevalence rate in the studied population of 18 pc. High groups included unskilled labourers who were unbooked, single, divorced or cohabiting and below 30 years of age. Regarding education and income, women with over 11 years of education or earning over $600 per month constituted a lower risk category. Implications of this high prevalence rate are discussed and the urgency to examine feto maternal transmission and the effect of pregnancy on HIV status is expressed. Further more, intensification of preventive information and education programmes is recommended.

Adult↗

PubMed1990

Breech delivery of infants weighing more than 2000 grams: a case controlled retrospective analysis of 751 patients.

This is a case controlled study of 385 women with breech presentation and 357 with cephalic presentation. Unlike many recent studies, vaginal breech delivery was associated with a significantly worse outcome for the infant. The reasons for these are discussed particularly in relation to developing countries and a protocol for management of these women is suggested to attempt to reduce the unacceptably poor outcome. Selective external cephalic version is advocated.

Adolescent↗

PubMed1990

The roll over test is not of value in predicting pregnancy induced hypertension.

As a predictor of pregnancy induced hypertension (PIH) the roll over test (ROT) has conflicting predictive values in the literature, possibly as a result of sample size, composition or methodology. In this study the roll over test was performed on 600 African women in their first pregnancy and at 26-32 weeks. The test was positive in 15% of women and had a positive predictive value of only 20%. It is concluded that the roll over test is of no value in the prediction of PIH.

Female↗