D. Grové

Expectant management of early onset, severe pre-eclampsia: maternal outcome

Objective To evaluate the safety and outcome of women undergoing expectant management of early onset, severe pre‐eclampsia.

Expectant management of early onset, severe pre-eclampsia: perinatal outcome.

Objective To evaluate the perinatal outcome of expectant management of early onset, severe pre‐eclampsia.

Luteal phase support in in vitro fertilization : Meta-analysis of randomized trials

Objective: To determine if luteal phase support improves the pregnancy rate in in vitro fertilization (IVF) cycles. Design: A meta-analysis of randomized trials of luteal phase support was carried out with the main outcome measure being the pregnancy rate per cycle. Results: Fifty-nine trials were evaluated. Eighteen trials met the inclusion criteria. Five main themes were identified: human chorionic gonadotropin (hCG) versus progesterone; progesterone versus progesterone and hCG; progesterone versus placebo; hCG versus placebo, and hCG versus progesterone versus no support. Conclusion: Luteal phase support is definitely indicated in IVF treatment cycles. This meta-analysis favored hCG above progesterone as luteal phase support with respect to pregnancy rates. Further prospective randomized trials are needed to determine a definite consensus with respect to the duration of luteal phase support in IVF cycles.

Are Early and Late Preeclampsia Distinct Subclasses of the Disease—What Does the Placenta Reveal?

Objective. To compare histopathological differences in placentas from early- and late-onset preeclampsia, as well as late-onset preeclampsia and normal term deliveries. Methods. This prospective study was performed at Tygerberg Hospital, a secondary and tertiary referral center in South Africa. Placentas from 100 women, 25 each with early and late-onset preeclampsia, and an equal number of controls matched for gestational age, underwent routine preparation and were evaluated independently by two pathologists in a strictly predetermined, standardized manner. Results. Compared to late preeclampsia, placentas in the early preeclampsia group were smaller (p < 0.01), had more infarction (odds ratio [OR] = 4.03, 95% confidence interval [CI] = 1.2–13.5) and inappropriate maturation (OR = 16.62, 95% CI = 4.1–68.0). Placentas from the late-onset preeclampsia group showed increased decidual arteriopathy (OR = 5.09, 95% CI = 1.45–17.92) and abruptio placentae (OR = 5.41, 95% CI = 1.01–28.79) compared to controls. Conclusions. The early- and late-onset preeclampsia placentas showed clear histopathological differences, whereas late-onset preeclampsia and normal term placentas differed less. These findings support the contention that early- and late-onset preeclampsia are different subclasses of disease.

Specific exercises to treat pregnancy‐related low back pain in a South African population

To investigate the effect of an exercise program, including specific stabilizing exercises, on pain intensity and functional ability in women with pregnancy‐related low back pain.

A community‐based obstetric ultrasound service

Objectives: To investigate the impact of an ultrasound dating service on obstetric services. Methods: A prospective trial with 3009 unselected women presenting for antenatal care at two Midwife Obstetric Units in a socioeconomically deprived urban area, South Africa. In the study unit, student ultrasonographers provided a basic ultrasound service. In the control unit, obstetric ultrasound was only available for specific indications. The main outcome measures were number of antenatal visits and referrals for fetal surveillance. Results: The two cohorts were comparable except for the number of primigravidas but stratified analysis according to parity did not affect the results. Ultrasonography did not alter pregnancy outcome but reduced the number of perceived preterm labors/ruptured membranes (12.0 vs. 16.7%, P<0.003), post‐term deliveries (8.1 vs. 10.8%, P<0.04) and referrals for fetal surveillance [15.9 vs. 29.6%, P<0.000, RR 0.79 (0.71–0.88)]. Conclusions: This community‐based basic ultrasound service significantly reduced referrals to a regional center for fetal surveillance and delivery.

Early onset severe pre‐eclampsia: expectant management at a secondary hospital in close association with a tertiary institution

Objectives  Early onset severe pre‐eclampsia is ideally managed in a tertiary setting. We investigated the possibility of safe management at secondary level, in close co‐operation with the tertiary centre.

Urinary protein excretion and expectant management of early onset, severe pre-eclampsia

Objective: To evaluate the importance of proteinuria in the expectant management of early onset, severe pre‐eclampsia. Methods: In this prospective series of 340 women, 24‐h urine collections were performed and monitored twice weekly in a high‐care ward. Results: Seventy‐four women with at least two 24‐h urine collections were grouped into women with a proteinuria increase of ≥2 g (n=29) and with women whose proteinuria decreased, or increased by <2 g (n=45). Major maternal complications, prolongation of gestation, and perinatal outcomes were comparable. Fifty‐six (75%) women experienced an increase in proteinuria. When patients with heavy proteinuria (n=83) were compared to those with moderate proteinuria (n=257), maternal and perinatal outcomes were comparable. More days were gained before delivery in the heavy proteinuria group than in the moderate (12 vs. 9; P<0.001). Conclusion: Most patients experienced increased proteinuria. Neither the rate of increase nor the amount of proteinuria affected maternal and perinatal outcomes.

Primipaternity and duration of exposure to sperm antigens as risk factors for pre-eclampsia

Objective: To establish whether primipaternity and duration of unprotected sexual cohabitation is associated with an increased risk of pre‐eclampsia. Method: At a tertiary referral center, the study had a case and control group of 60 multigravid women each, as well as a case and control group of 50 primigravid women each. Information was compiled by means of a confidential questionnaire. Result: After multiple logistic regression analysis using age, smoking, hypertension in previous pregnancies, change of paternity and duration of unprotected sexual cohabitation as predictors, the regression coefficients for change of paternity and sexual cohabitation of longer than 6 months in multigravid women were −0.4 (P=0.15) and −1.4 (P=0.03), respectively. Conclusion: Multigravid women with a period of unprotected sexual cohabitation of longer than 6 months had a decreased risk of pre‐eclampsia. Primipaternity was not a significant risk factor for pre‐eclampsia.

The Profile and Complications of Women with Placental Abruption and Intrauterine Death

The aim of this study was to evaluate the profile and outcome of patients with placental abruption and intrauterine death. It was a retrospective study over 2 years from 1 January 1999 to 31 December 2000. All women (n = 96) presenting with placental abruption and intrauterine death at a tertiary referral center were identified from the records of weekly perinatal mortality meetings. Data were reviewed by a single researcher. Hypertensive disorders were diagnosed in 75 per cent (n = 72) women, most often at admission once intrauterine death had already occurred. Thirty-nine per cent had a previous history of hypertensive disease during pregnancy, placental abruption, intrauterine death, or preterm delivery. Twenty-two per cent of patients (n = 21) were unbooked. Major maternal complications occurred in 53 per cent of women. There were no maternal deaths. In conclusion, previous obstetric history and hypertensive disorders are important factors in women with placental abruption causing intrauterine death. Severe complications are common but careful management in a tertiary center can reduce their impact.