Hein J. Odendaal

Ethanol and the placenta: A review

Objective. In this paper we review published studies of alcohol exposure on placentation, placenta growth and function. Methods. We searched PubMed using the MeSH terms: placenta, ethanol, fetal alcohol syndrome and prenatal exposure with delayed effects. We searched the years 1996–2006 and used the references from other articles to expand our search. We limited the search to English only and human only. We excluded studies using choriocarcinoma and animal studies. We grouped the 66 papers into seven topic areas for ease of review. Results. Alcohol exposure is associated with placental dysfunction, decreased placental size, impaired blood flow and nutrient transport, endocrine changes, increased rates of stillbirth and abruption, umbilical cord vasoconstriction, and low birth weight. Conclusions. Prenatal alcohol exposure has a broad range of adverse effects on placental development and function. Additional research on placental development from populations with heavy alcohol exposure should be encouraged. A tissue bank of placentas with detailed assessment of exposure to alcohol, smoking and other relevant data should be considered as a repository to support additional research.

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.

Combined effects of cigarette smoking and alcohol consumption on perinatal outcome.

Background: An increase in various congenital abnormalities associated with cigarette smoking and the use of alcohol during pregnancy has been reported in many studies. These exposures also increase the risk of pregnancy complications such as abruptio placentae, unexplained stillbirth, preterm labor and intrauterine growth restriction. However, very few studies have addressed the combined effect of smoking and drinking on pregnancy outcomes. Methods: In this review, the adverse effects of smoking or drinking on pregnancy were obtained from publications in which both substances were addressed in the same study population. A special effort was made to find studies in which the combined effect of these substances was investigated. Results: Preterm labor occurred more frequently in women who drank and smoked during pregnancy. This increased odds ratio was more than the sum of the effects of either smoking or drinking, indicating that the use of both substances by the same woman has a synergistic effect that increases the risk of preterm labor. This synergistic effect was also found for low birth weight and growth restriction. Conclusions: As most of the women who drink during pregnancy also smoke cigarettes, attention should be given to the prevention or reduced use of both substances during pregnancy.

The role of Doppler velocimetry in the management of high risk pregnancies

Objective To determine whether knowledge of the result of Doppler velocimetry of the umbilical artery is beneficial to the management of a high risk pregnancy.

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.

Nifedipine or prazosin as a second agent to control early severe hypertension in pregnancy: a randomised controlled trial.

Objective To determine whether nifedipine or prazosin is the more appropriate second‐line antihypertensive agent in pregnancy.

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.

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.

The effectiveness of adapted, best practice guidelines for smoking cessation counseling with disadvantaged, pregnant smokers attending public sector antenatal clinics in Cape Town, South Africa

Aim and objectives. To evaluate the effect of a smoking cessation intervention, based on best practice guidelines on the quit rates of disadvantaged, pregnant women in Cape Town, South Africa. Design. Quasi‐experimental using a natural history cohort as a control group, consisting of women attending antenatal care in 2006 and an intervention cohort, attending the same clinics a year later. Setting. Four, public sector antenatal clinics in Cape Town staffed and managed by midwives. Population. Pregnant women of low socio‐economic status. Methods. The natural history cohort received usual care, whilst the intervention cohort was offered self‐help quit materials in the context of brief counseling by midwives and peer counselors. Smoking behavior was measured in early, mid and late pregnancy. The equivalence of the groups in terms of smoking profile, self‐reported smoking and demographic variables was assessed at baseline. Main outcome measures. Quit rates measured by urinary cotinine towards the end of pregnancy (36–39 weeks gestation). Results. The two cohorts were comparable at baseline. The difference in quit rates between the two cohorts in late pregnancy was 5.3% (95% CI: 3.2–7.4%, p < 0.0001) in an intention to treat analysis. There was also a significant difference in reduction of smoking of 11.8% (95% CI: 5.0–18.4%, p = 0.0006). Conclusion. A smoking cessation intervention based on best practice guidelines was effective among high risk, pregnant smokers in South Africa.