Recommendations for the management of birth at the margins of fetal viability - a practical approach for South Africa

Babies born at the lower limits of viability have a poor prognosis in the South African setting. Neonatal intensive and high care units are overburdened, which leads to outbreaks of resistant organisms. An equitable set of interventions, based on available resources and referral pathways is proposed for each level of care to manage pregnancies and babies around the margins of viability. It is envisaged that this will serve as a basis for each province to develop their own guideline.https://journals.co.za/journal/medogam2021Obstetrics and Gynaecolog

Great saves or near misses? Severe maternal outcome in Metro East, South Africa: a region-wide population-based case-control study

Objective To assess the incidence of severe maternal outcome (SMO), comprising maternal mortality (MM) and maternal near miss (MNM), in Metro East health district, Western Cape Province, South Africa between November 2014 and November 2015 and to identify associated determinants leading to SMO with the aim to improve maternity care.Methods Region-wide population-based case-control study. Women were included in the study, if they were maternal deaths or met MNM criteria, both as defined by WHO. Characteristics of women with SMO were compared with those of a sample of women without SMO, matched for age and parity, taken from midwifery-led obstetrical units from two residential areas in Metro East, using multivariate regression analysis.Results Incidence of SMO was 9.1 per 1000 live births, and incidence of MNM was 8.6 per 1000 live births. Main causes of SMO were obstetrical hemorrhage and hypertensive disorders. Factors associated with SMO were HIV (adjusted odds ratio [aOR] 24.8; 95% confidence interval [CI] 10.0-61.6), pre-eclampsia (aOR 17.5; 95% CI 7.9-38.7), birth by cesarean section (aOR 8.4; 95% CI 5.8-12.3), and chronic hypertension (aOR 2.4; 95% CI 1.1-5.1).Conclusion Evaluation of SMO incidence and associated determinants supports optimizing tailored guidelines in Metro-East health district to improve maternal health.Research into fetal development and medicin

Conformational dynamics and internal friction in homopolymer globules: equilibrium vs. non-equilibrium simulations

We study the conformational dynamics within homopolymer globules by solvent-implicit Brownian dynamics simulations. A strong dependence of the internal chain dynamics on the Lennard-Jones cohesion strength ε and the globule size N [subscript G] is observed. We find two distinct dynamical regimes: a liquid-like regime (for ε ε[subscript s] with slow internal dynamics. The cohesion strength ε[subscript s] of this freezing transition depends on N G . Equilibrium simulations, where we investigate the diffusional chain dynamics within the globule, are compared with non-equilibrium simulations, where we unfold the globule by pulling the chain ends with prescribed velocity (encompassing low enough velocities so that the linear-response, viscous regime is reached). From both simulation protocols we derive the internal viscosity within the globule. In the liquid-like regime the internal friction increases continuously with ε and scales extensive in N [subscript G] . This suggests an internal friction scenario where the entire chain (or an extensive fraction thereof) takes part in conformational reorganization of the globular structure.American Society for Engineering Education. National Defense Science and Engineering Graduate Fellowshi

Galaxy bulges and their massive black holes: a review

With references to both key and oft-forgotten pioneering works, this article starts by presenting a review into how we came to believe in the existence of massive black holes at the centres of galaxies. It then presents the historical development of the near-linear (black hole)-(host spheroid) mass relation, before explaining why this has recently been dramatically revised. Past disagreement over the slope of the (black hole)-(velocity dispersion) relation is also explained, and the discovery of sub-structure within the (black hole)-(velocity dispersion) diagram is discussed. As the search for the fundamental connection between massive black holes and their host galaxies continues, the competing array of additional black hole mass scaling relations for samples of predominantly inactive galaxies are presented.Comment: Invited (15 Feb. 2014) review article (submitted 16 Nov. 2014). 590 references, 9 figures, 25 pages in emulateApJ format. To appear in "Galactic Bulges", E. Laurikainen, R.F. Peletier, and D.A. Gadotti (eds.), Springer Publishin

Inherited and acquired thrombophilias and poor pregnancy outcome: Should we be treating with heparin?

Purpose of review: The most important acquired thrombophilia related to poor pregnancy outcome is probably antiphospholipid syndrome. Inherited thrombophilias that have been implicated in venous thromboembolism and poor pregnancy outcome and for which standard tests are generally available are antithrombin III deficiency, the factor V Leiden mutation, prothrombin G20210A mutation and the C677T polymorphism in the methylenetetrahydrofolate reductase system implicated in mild hyperhomocysteinaemia. The management of antiphospholipid syndrome with previous fetal losses is well documented and substantiated by small clinical trials. It is the purpose of this review to investigate new contributions to this field since June 2002. Recent findings: Only one randomized trial was published during the review period, but a Cochrane review and several excellent review articles appeared detailing management. Summary: There is a dire lack of randomized trials in the literature on the efficacy of heparin or other coagulation modulators on pregnancy outcome in patients with inherited thrombophilias. There is consensus on thrombo-prophylaxis for antiphospholipid syndrome. Protocols for the management of venous thromboembolism and pulmonary emboli related to pregnancy are well established. © 2003 Lippincott Williams & Wilkins.Purpose of review: The most important acquired thrombophilia related to poor pregnancy outcome is probably antiphospholipid syndrome. Inherited thrombophilias that have been implicated in venous thromboembolism and poor pregnancy outcome and for which standard tests are generally available are antithrombin III deficiency, the factor V Leiden mutation, prothrombin G20210A mutation and the C677T polymorphism in the methylenetetrahydrofolate reductase system implicated in mild hyperhomocysteinaemia. The management of antiphospholipid syndrome with previous fetal losses is well documented and substantiated by small clinical trials. It is the purpose of this review to investigate new contributions to this field since June 2002. Recent findings: Only one randomized trial was published during the review period, but a Cochrane review and several excellent review articles appeared detailing management. Summary: There is a dire lack of randomized trials in the literature on the efficacy of heparin or other coagulation modulators on pregnancy outcome in patients with inherited thrombophilias. There is consensus on thrombo-prophylaxis for antiphospholipid syndrome. Protocols for the management of venous thromboembolism and pulmonary emboli related to pregnancy are well established. © 2003 Lippincott Williams & Wilkins.ReviewRevie

Advanced extra-uterine pregnancy - A case of fimbrial expulsion of the fetus with complete placental development in the fallopian tube

A case report is presented of a 30-year-old woman, gravida 3 para 2, presented with an advanced extra-uterine pregnancy with complete development of the placenta in the fallopian tube. Copyright (C) 1999 Elsevier Science Ireland Ltd.Articl

Bleeding in early and late pregnancy

Vaginal bleeding during pregnancy is always a cause for concern, for both the woman and her doctor. As the pregnancy advances, the clinical significance of the bleeding increases. It may, in addition to threatening the pregnancy, eventually also cause maternal morbidity and even mortality. The woman should be reassured about the well-being of the fetus or fully informed as to the possible complications. As soon as the fetus is viable or nearly viable, it is very important to pinpoint the optimal time of delivery. Valuable gestational age will be lost by doing an unnecessarily early delivery; on the other hand, a severe haemorrhage may cause fetal death if distress is not detected in time. All related factors have to be evaluated carefully, in order to make the best possible decision about the management of the pregnancy.Revie

Group a beta-haemolytic streptococcal toxic shock syndrome presenting as suspected ileo-femoral thrombosis in the puerperium

[No abstract available]Articl

Combined heterozygosity for methylenetetrahydrofolate reductase (MTHFR) mutations C677T and A1298C is associated with abruptio placentae but not with intrauterine growth restriction

Objective: This study was undertaken to investigate the involvement of MTHFR gene mutations C677T and A1298C implicated in vascular disease, in patients with abruptio placentae and intrauterine growth restriction (IUGR). Study Design: DNA was extracted from blood samples of 54 patients with placental vasculopathy (18 patients with abruptio placentae and 36 with IUGR) and 114 control patients and amplified by the polymerase chain reaction (PCR). The resulting fragments were subjected to restriction enzyme analysis and resolved by gel electrophoresis. Results: A significant association could be demonstrated between mutation A1298C and both abruptio placentae and IUGR. Combined heterozygosity for mutations C677T and A1298C was detected in 22.2% of abruptio placentae cases. Conclusions: Combined heterozygosity for MTHFR mutations C677T and A1298C may represent a genetic marker for abruptio placentae. Copyright © 2001 Elsevier Science Ireland Ltd.Objective: This study was undertaken to investigate the involvement of MTHFR gene mutations C677T and A1298C implicated in vascular disease, in patients with abruptio placentae and intrauterine growth restriction (IUGR). Study Design: DNA was extracted from blood samples of 54 patients with placental vasculopathy (18 patients with abruptio placentae and 36 with IUGR) and 114 control patients and amplified by the polymerase chain reaction (PCR). The resulting fragments were subjected to restriction enzyme analysis and resolved by gel electrophoresis. Results: A significant association could be demonstrated between mutation A1298C and both abruptio placentae and IUGR. Combined heterozygosity for mutations C677T and A1298C was detected in 22.2% of abruptio placentae cases. Conclusions: Combined heterozygosity for MTHFR mutations C677T and A1298C may represent a genetic marker for abruptio placentae. Copyright © 2001 Elsevier Science Ireland Ltd.ArticleArticl

Collection of fetal cells in cervical secretions without ultrasound guidance

[No abstract available]Articl