Globally, there is an alarming increase in the incidence of Type II diabetes mellitus (T2DM). It is well recognized that women who develop gestational diabetes (GDM) in their pregnancies are at increased risk of T2DM in later life. In addition, poor glycaemic control in pregnancy impacts adversely on the neonatal outcome, as well as the long term disease risks of that child. The risk of these outcomes increases continuously as maternal fasting plasma glucose levels increases. Several adverse outcomes have been associated with DM during pregnancy. These include pre-eclampsia, polyhydramnios, fetal macrosomia, fetal hepatomegaly and cardiomegaly, birth trauma, operative delivery, perinatal mortality and neonatal respiratory problems and metabolic complications such as hypoglycaemia, hyperbilirubinaemia, hypocalcaemia and polycythaemia. Despite five decades of research there is little consensus regarding the optimal approach to screening for GDM. Recently most international organisations have recommended that all women should be screened for GDM. South Africa is a diverse multi-racial society with an increasing burden of non-communicable diseases. The health system is already overburdened, and the optimal approach to screening for GDM remains unclear. A prospective cohort observational study was conducted at the Eyethu Yarona clinic (Lion Park Clinic), in Johannesburg, South Africa (SA). One thousand (1000) consecutive non-diabetic women who were less than 26 weeks pregnant were recruited. At recruitment the women completed a demographic questionnaire, and had a random glucose and glycated haemoglobin (HbA1c) drawn. A fasting blood glucose was assessed within 2 weeks, and a serum specimen was frozen at -40°C for further testing at a later stage. Patients had a 75 g 2-hour oral glucose tolerance test (OGTT) and HbA1c between 24 – 28 weeks gestation. All glucose measurements were done at the laboratory using standardized tests (venous blood) and on a Roche Accuchek Active® glucometer (Roche Diagnostics, Mannheim, Germany) (capillary blood). GDM was diagnosed according to the International Federation of Gynecology and Obstetrics (FIGO) criteria, i.e. any one abnormal reading was diagnostic of GDM: 0-hour ≥5.1 mmol/l, 1-hour ≥10 mmol/l, or 2-hour ≥8.5 mmol/l. Thereafter a nested cohort study of HIV negative patients was conducted to investigate the association between the concentrations of biomarkers associated with glucose homeostasis and GDM in a South African population. C-reactive protein (CRP), adiponectin, and fasting insulin were measured on the stored serum samples. The Insulin Sensitivity Index (HOMA-IR = fasting insulin (microU/L) x fasting glucose (mmol/L) / 22.5), and Quantitative Insulin Sensitivity Check Index (QUICKI = 1 / [log (I0) + log (G0)]) were calculated for further evaluation of markers of insulin sensitivity. The significance of this research was to assess the burden of disease of GDM in a South African population. The different diagnostic criteria were also compared, as well as the universal versus the traditional risk-factor based screening approach to GDM. Screening methods were compared so as to propose a simple, effective, cost efficient screening and diagnostic tool that may be implemented at primary health care level, which will in turn identify those pregnant women who warrant referral to a high care obstetric unit, thus improving both maternal and neonatal outcomes in our population. / Thesis (PhD) - University of Pretoria, 2017. / SEMDSA / SASA / Roche / Obstetrics and Gynaecology / PhD / Unrestricted

The aim of this study was to compare pubertal development between the two main ethnic groups in the Cape, controlling for social class. This study aimed to investigate: 1. The age of menarche and other stages of pubertal development of white and coloured school girls living in greater Cape Town. 2. The relationship between the age of menarche and the other stages of pubertal development, social class and race. 3. The influence of home environment (childminder, sibling number, maternal education) on onset of menarche and breast development. This data further contributes to a larger study on pubertal development of all representative ethnic groups and social classes in the Cape. Our hypothesis is that social class, and not race, is a major determinant of pubertal development.

A prospective study was carried out to assess whether, in first and second trimester abortions, the clinical diagnosis together with the macroscopic appearance of the curettings was an accurate guide to the correct diagnosis, and whether routine histological examination of all curettings was therefore necessary. The study included 1 464 consecutive patients presenting to the Gynaecology Department at Groote Schuur Hospital, Cape Town with clinically diagnosed abortions during the period 1st February 1988 to 31st December 1988. The correlation between the macroscopic appearance and histological examination compatible with the diagnosis of abortion was found to be 86%. Where the diagnosis was in doubt this correlation was lower. The sensitivity of using the macroscopic appearance as a screening test for the diagnosis of abortion was 96%, with a positive predictive value of 91%. The kappa statistic of agreement between macroscopic appearance and histology was 0,26. The incidence of gestational trophoblastic disease in this series was 0.06%. The diagnosis of ectopic pregnancy was not aided by the use of routine histology.

Thesis (MScMedSc (Obstetrics and Gynaecology))--University of Stellenbosch, 2005. / CHAPTER 1 presents comprehensive background information regarding all aspects addressed in this thesis. Special attention was given to literature on paternal influences on embryonic development, the role of sperm RNA, sperm chromatin and sperm functional aspects i.e. morphology and acrosomal status and size. The experimental design and all relevant methods used during the study as well as the material that were used are presented in CHAPTER 2. The results of the different techniques and evaluations are provided in CHAPTER 3. It was found that 70% of the embryos that showed no developmental potential were Y-chromosome bearing embryos. The sperm selection process for ICSI based on the approach of choosing the “best looking“ spermatozoon in the ejaculate seem to provide cells that can be classified as normal based on the length width ratio set by the WHO for normal cells. The chromatin packaging quality of the sperm correlated significantly and negatively with the percentage normal cells in the ejaculates. CHAPTER 4 comprises of a general discussion of the results and short summary of the major findings during the project. The discussion section focused on the paternal influence on the embryonic development and provided a suggestion for future research that can possibly lead to the use of X-chromosome bearing sperm in case of severe male factor cases. CHAPTER 5 contains the bibliographical information of the study.

Thesis (MMed (Obstetrics and Gynaecology))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Study objective: To investigate whether an educational intervention in the Gynaecology Department of Tygerberg Hospital (TBH) was effective in improving the accuracy of the diagnosis and appropriateness of treatment options offered to women with suspected Ectopic Pregnancy (EP). Methods: A retrospective cross-sectional before-and-after study was performed, including 335 consecutive patients with suspected EP before (1/3 - 30/6/2008) and after (1/9 - 31/12/2008) “the intervention”. From the gynaecological admissions register all pregnant patients with symptoms potentially compatible with EP were selected and these were cross referenced with beta-hCG requests, entries in the theatre register for surgery for possible EP and methotrexate prescriptions for EP in these time periods. “The intervention” consisted of a formal lecture presented to the registrars and consultants regarding the latest evidence-based guidelines concerning the diagnosis and management of EP. An algorithm based on this information was introduced in the emergency unit and ultrasound unit together with a prescribed ultrasound reporting form containing all the pertinent information required to follow the algorithm. Clinical decisions were left to the registrar and consultant on duty. Primary outcomes: Time from presentation to treatment, number and appropriateness of special investigations, surgical procedures or medical management. Secondary outcomes: Number of in-patient days and visits, adherence to the algorithm. Results: There was a non-significant trend towards improved reporting of the uterine content and significantly less reports of definite signs of an intrauterine pregnancy (IUP) (p<0.001, RR 0.46, 95% CI 0.31-0.70) due to stricter ultrasound criteria being followed. There was a significant change in the spectrum of uterine findings (p=0.001), the spectrum of adnexal findings (p=0.006) and the spectrum of free fluid noted (p=0.05). There was a reduction in the total number of beta-hCG levels requested at presentation (patients with no beta-hCG: 24 vs 34, p=0.05, RR 1.60, 95% CI 0.99-2.59) with a significant reduction in the number of inappropriate beta-hCG requests (77 vs 40, p<0.001, RR 0.60, 95% CI 0.43-0.81). There was a significant difference in the spread of the number of beta-hCG tests per patient with less repeat tests in the study group (p=0.021). Significantly less manual vacuum aspirations (MVAs) were performed (47 vs 21, p=0.003, RR 0.51, 95% CI 0.32-0.81) but there was no change in the other treatment modalities offered nor in the time from presentation to treatment, number of visits or in-patient days. Adherence to the algorithm was poor (59 %). Conclusions: Except for a significant decrease in the MVAs performed, with possibly less interrupted early intrauterine pregnancies, the improvement in the use of special investigations after “the intervention” did not translate into fewer inappropriate diagnoses and management. This could be due to frequent non-adherence to the algorithm, and widespread implementation of the algorithm as well as continuous audits would be necessary before a future study could be attempted to assess the efficacy of the algorithm. / AFRIKAANSE OPSOMMING: Studiedoelwit: Die hoofdoel van hierdie studie is om te ondersoek of „n opvoedkundige intervensie in die Ginekologiese afdeling van Tygerberg Hospitaal (TBH) doeltreffend sou wees in die verbetering van die akkuraatheid van diagnose en die gepastheid van behandelingsopsies wat aan vroue gebied word met „n vermoedelike ektopiese swangerskap (ES). Metodes: „n Retrospektiewe, kruisdeursnee voor-en-na studie rakende 335 opeenvolgende pasiënte wat ‟n vermoedelike ES het voor (1/3/2008 – 30/6/2008) en na (1/9/2008 – 31/12/2008) “die intervensie”. Swanger pasiënte is uit die ginekologiese toelatingsregister geselekteer indien hulle simptome gehad het wat moontlik verbind kon word met ES. Hulle is kruisverwys met die beta-hCG‟s aangevra, inskrywings in die teaterregister vir chirurgie vir moontlike ES en ginekologie-pasiënte wat metotrexate vir ES binne hierdie tydperke ontvang het. “Die intervensie” het bestaan uit „n formele lesing aan die kliniese assistente en konsultante ten opsigte van die jongste bewysgebaseerde riglyne rakende die diagnose en hantering van ES. „n Algoritme gegrond op hierdie inligting is in die noodeenheid en ultraklank-afdeling ten toon gestel asook „n voorgeskrewe ultraklank rapporteringsvorm met al die toepaslike inligting wat vereis word om die algoritme te volg. Kliniese besluite is aan die kliniese assistent en konsultant aan diens oorgelaat. Primêre uitkomste: Tydsduur vanaf aanmelding tot behandeling, aantal en gepastheid van spesiale ondersoeke, chirurgiese prosedures en mediese hantering. Sekondêre uitkomste: Die aantal binnepasiëntdae en besoeke, nakoming van die algoritme. Resultate: Daar was „n nie-betekenisvolle neiging tot beter rapportering van die uteriene-inhoud en betekenisvol minder rapportering van definitiewe tekens van „n intra-uteriene swangerskap (IUS) (p<0.001, RR 0.46, 95% CI 0.31-0.70) as gevolg van strenger ultraklankstandaarde gevolg. Daar was „n betekenisvolle verandering in die spektrum van uteriene bevindinge (p=0.001), die spektrum van die adneksale bevindinge (p=0.006) en die spektrum van die vrye vog aangeteken (p=0.05). Daar was „n vermindering in die totale aantal beta-hCG-vlakke aangevra met aanmelding (pasiënte met geen hCG: 24 vs 34, p=0.05, RR 1.60, 95% CI 0.99-2.59) met „n betekenisvolle vermindering in die aantal onvanpaste beta-hCGs aangevra (77 vs 40, p<0.001, RR0.60, 95% CI 0.43-0.81). Daar was „n betekenisvolle verskil in die verspreiding van die aantal beta-hCG-toetse per pasiënt, met minder herhalende toetse in die studiegroep (p=0.021). Betekenisvol minder manuele vakuum aspirasies (MVAs) is uitgevoer (47 vs 21, p=0.003, RR 0.51, 95% CI 0.32-0.81), maar geen verskil in ander behandelingsmodaliteite is aangebied nie, asook geen verskil in die tydsduur vanaf aanmelding, die aantal besoeke of die aantal binnepatiëntdae nie. Nakoming van die algoritme was swak (59%). Gevolgtrekkings: Behalwe vir „n betekenisvolle afname in die MVAs uitgevoer, met moontlik minder onderbroke vroeë IUS, het die verbetering in die gebruik van spesiale ondersoeke ná “die intervensie” nie minder onvanpaste diagnoses en hantering tot gevolg gehad nie. Dit kan die gevolg wees van gereelde nie-nakoming van die algoritme, en uitgebreide implementering van die algoritme asook voortdurende oudits sal nodig wees voor „n verdere studie aangepak kan word om die doeltreffendheid van die algoritme te bepaal.

Thesis (MMed)--Stellenbosch University, 2001. / ENGLISH ABSTRACT: The aim of the study was to conduct a structured review of the literature published on the use of normal sperm morphology, as an indicator of male fertility potential in intrauterine insemination (M) programs. Published literature in which normal sperm morphology was used to predict pregnancy outcome in lUI during the period 1984 - 1998 was reviewed. Four hundred and twenty one articles were identified. Eighteen provided data that could be tabulated and analyzed. Eight of the analyzed studies provided sufficient data for statistical analysis. Six studies used the Tygerberg strict criteria and two the WHO guidelines (1987, 1992). A meta-analysis of the six studies in the strict morphology group yielded a risk difference (RD) between the pregnancy rates achieved in the patients below and above the 4% strict criteria threshold of -0.07 (95% CI: -0.11 to -0.03; p< 0.001). WHO criteria group (1987,1992) had insufficient data to be analysed. Meta-analysis showed a significant improvement in pregnancy rate above 4% threshold for strict criteria. Accurate evaluation of normal sperm morphology results should be an integral part of evaluating the male factor. / AFRIKAANSE OPSOMMING: Die doel van die studie was om 'n gestruktureerde literatuuroorsig van die gepubliseerde data oor normale sperm morfologie uit te voer om vas te stelof dit enige waarde het as voorspeller van manlike fertiliteitspotensiaal in intra uteriene inseminasie (lUI) programme. Gepubliseerde literatuur waar normale sperm morfologie gebruik IS om swangerskapsuitkoms te voorspel met IUI in die tydperk 1984 - 1998 is nagegaan. Vierhonderd een en twintig artikels is geïdentifiseer. Agtien het genoeg data gehad om te kan tabuleer en analiseer. Agt van die geanaliseerde studies het voldoende data gehad vir statistiese analise. Ses studies het die Tygerberg streng kriteria gebruik en twee die WGO (1987, 1992) riglyne. 'n Meta-analise van die ses studies in die streng kriteria groep het 'n risiko verskil tussen swangerskapstempo in pasiënte onder en bo die 4% streng kriteria afsnypunt, van -0,07 (95% betroubaarheidsindeks: -0.11 tot -0.03; p<O.OOl) getoon. Die WGO kriteria (1987,1992) groep het onvoldoende data gehad om te kan analiseer. Meta-analise het 'n bekenisvolle verbetering in swangerskapuitkoms bo die 4% afsnypunt getoon vir die streng kriteria. Akkurate evaluasie van normale sperm morfologie resultate behoort 'n integrale deel te wees van die proses om die manlike faktor in infertilteitsbehandeling volledig te evalueer.

Thesis (MMed (Obstetrics and Gynaecology))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: OBJECTIVE: The aim of this study was to compare the accuracy of non-invasive blood pressure measurements, using automated and manual devices, against invasive intra-arterial blood pressure measurements in patients with pre-eclampsia, during a hypertensive blood pressure peak. STUDY DESIGN: In this prospective study, women admitted to the Obstetrics Critical Care Unit, with confirmed pre-eclampsia and acute severe hypertension, who had an intra-arterial line in situ, were asked to participate. During an intra-arterial blood pressure peak, both an automated oscillometric and a blinded manual aneroid sphygmomanometric blood pressure was recorded. These two methods of blood pressure measurements were compared to intra-arterial blood pressure measurements. The accuracy of a mean arterial pressure (MAP) ≥ 125mmHg in detecting a systolic blood pressure (SBP) ≥ 160mmHg, using all three methods, was also determined. RESULTS: There was poor correlation between intra-arterial SBP and automated and manual SBP (r = 0.34, p < 0.01; r = 0.41, p < 0.01 respectively). The mean differences between automated and manual SBP compared to the intra-arterial SBP was 24 ± 17mmHg (p < 0.01) and 20 ± 15 mmHg (p < 0.01) respectively. There was better correlation between intra-arterial diastolic blood pressure (DBP) and automated and manual DBP (r = 0.61, p < 0.01; r = 0.59, p < 0.01 respectively). The mean differences of the automated and manual DBP was not statistically significant when compared to the intra-arterial DBP. There was poor correlation between the intra-arterial MAP and the automated MAP (r = 0.44, p < 0.01) and good correlation with the manual MAP (r = 0.56, p < 0.01). The mean differences of the automated and manual MAP were statistically significant (5 ± 13mmHg, p < 0.01; 8 ± 11mmHg, p < 0.01 respectively). The sensitivity of automated and manual methods in detecting a SBP ≥ 160mmHg was 23.4% and 37.5% respectively. A MAP ≥ 125mmHg in detecting a SBP ≥ 160mmHg, when using intra-arterial, automated and manual methods of blood pressure measurements showed low sensitivity (35.9%, 21.9% and 17.2% respectively). CONCLUSION: This study demonstrated that both the automated and manual methods of blood pressure measurements were not an accurate measure of the true systolic intra-arterial blood pressure, when managing pre-eclamptic patients with acute severe hypertension. In such situations, intra-arterial blood pressure monitoring should be used when possible. When this is not possible, manual aneroid sphygmomanometry is recommended. Underestimating blood pressure, particularly SBP, may lead to severe maternal morbidity and mortality. / AFRIKAANSE OPSOMMING: DOELWIT: Die doel van hierdie studie is om die akuraatheid van nie invasiewe bloeddruk metings, wanneer geneem met outomatiese en manuele aparate, te vergelyk met intra-arteriele bloed druk metings in pasiente met pre-eklampsie, gedurende ‘n hipertensiewe bloeddruk piek. STUDIE ONTWERP: In hierdie prospektiewe beskrywende dwarssnit studie, was pasiente wat toegelaat was tot die Obstetriese Kritieke Sorg Eenheid met pre-eklampsie, akute erge hipertensie en ‘n intra-arteriele lyn in situ gevra om deel te neem. Gedurende ‘n intra-arteriele erge hipertensiewe piek is beide die outomatiese ossilometriese en die geblinde aneroide sfigmometer lesing neergeskryf. Hierdie twee metodes van non invasiewe bloed druk lesings is vergelyk met intra-arteriele bloed druk lesings. Die akuraatheid van ‘n gemiddelde arteriele bloeddruk ≥ 125mmHg om ‘n sistoliese bloeddruk ≥ 160mmHg op te tel met gebruik van al die drie metodes is ook uitgewerk. RESULTATE: Daar was swak korrelasie tussen intra-arteriele sistoliese bloed druk (SBD) metings en outomatiese en manuele SBD (r = 0.34, p < 0.01; r = 0.41, p < 0.01 onderskeidelik). Die gemiddelde verskille tussen outomatiese en manuele SBD wanneer vergelyk met intra-arteriele SBD was 24 ± 17mmHg (p < 0.01) en 20 ± 15 mmHg (p < 0.01) onderskeidelik. Beter korrelasie was gevind tussen intra-arteriele diastoliese bloed druk (DBD) en outomatiese en manuele DBD (r = 0.61, p < 0.01; r = 0.59, p < 0.01 onderskeidelik). Die gemiddelde verskille tussen outomatiese en manuele DBD wanneer dit vergelyk was met intra-arteriele DBD was nie statisties betekenisvol nie. Daar was swak korrelasie tussen intra arteriele gemiddelde arteriele bloeddruk en outomatiese gemiddelde arteriele bloeddruk (r = 0.44, p < 0.01) en beter korrelasie met manuele gemiddelde arteriele bloeddruk (r = 0.56, p < 0.01). Die gemiddelde verskille van outomatiese en manuele gemiddelde arteriele bloeddruk was betekenisvol (5 ± 13mmHg, p < 0.01; 8 ± 11mmHg, p < 0.01 onderskeidelik). Die sensitiwiteit van outomatiese en manuele metodes om ‘n intra-arteriele SBD ≥ 160mmHg op te tel was 23.4% en 37.5% onderskeidelik. Die vermoë van ‘n gemiddelde arteriele bloeddruk ≥ 125mmHg om ‘n SBD ≥ 160mmHg op te tel, gemeet deur intra-arterieel, outomatiese en manuele metodes het lae sensitiwiteit getoon (35.9%, 21.9% en 17.2% onderskeidelik). GEVOLGTREKKING: Hierdie studie het gedemonstreer dat outomatiese en manuele metodes van bloeddruk meting nie akurate metodes is om ware intra-arteriele sistoliese bloeddruk te meet in pasiente met erge pre-eklampsie tydens ‘n erge hipertensiewe episode nie. In hierdie omstandighede moet intra-arteriele bloeddruk gemeet word indien beskikbaar. Indien dit nie beskikbaar is nie moet die manuele aneroiede sfigmomanometer gebruik word. Onderskatting van bloeddruk, veral sistoliese bloeddruk, kan lei tot erge moederlike morbiditeit en mortaliteit.

Thesis (MMed)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: OBJECTIVE The purpose of the study is to establish the best method of wound closure with regards to patient satisfaction that includes wound cosmesis and pain. STUDY DESIGN One hundred patients were randomised to two groups for the closure of abdominal wounds; one group had subcuticular sutures and the other staples. They were followed up at 6 weeks. The primary outcome was patient satisfaction that includes wound cosmesis and pain. The secondary outcome was wound complications. RESULTS In women undergoing abdominal operations there was no difference as regards the patient satisfaction in both the groups, subcuticular sutures n= 51 vs. staples n=49 (P = 0.76). CONCLUSION Our study suggest that there is no statistically significant difference in the methods of wound closure, subcuticular sutures vs. staples as regards the patient satisfaction and the appearance of the scar leaving the decision in the hands of the surgeon to choose any method according to their own personnel preference and availability. / AFRIKAANSE OPSOMMING: NAVORSINGSDOEL Die fokus van hierdie projek is om vas te stel wat die beste metode van vel sluiting is ten opsigte van pasiënt bevrediging ten opsigte van wond voorkoms en pyn. METODES Een honderd pasiënte is ewekansig verdeel tot velsluiting van abdominale wonde met subkutane oplosbare steke of velhakies. Evaluasie is gedoen tydens ‘n opvolg besoek 6 weke na chirurgie. Die hoof uitkoms was pasiënt tevredenheid. Evaluasie van wond komplikasies is as sekondêre uitkoms beskryf. RESULTATE Vroulike pasiënte wat ‘n Pfannenstiel velinsnyding ondergaan toon geen verskil in pasiënt tevredenheid wanneer subkutane steke (n = 51) met velhakies (n = 49) vergelyk word nie (P = 0.76). SAMEVATTING Ons projek het geen statisties beduidende verskil getoon ten opsigte van pasiënt tevredenheid of wond voorkoms met 6 weke opvolg nie. Dit laat dus die besluit by die chirurg om metode van velsluiting te kies afhangend van voorkeur en toerusting beskikbaarheid.

Thesis (MMed)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: OBJECTIVE: The aim of this study was to compare the accuracy of non-invasive brachial blood pressure measurements, using automated and manual devices, to invasive brachial intra-arterial blood pressure measurements in patients with preeclampsia, during acute severe hypertension. STUDY DESIGN: A prospective descriptive cross sectional study was conducted in the Obstetrics Critical Care Unit (OCCU) of Tygerberg Hospital. Pre-eclamptic patients with acute severe hypertension, who required the placement of brachial intra-arterial lines due to failed radial intra-arterial line placement, were included in the study. Both automated oscillometric and blinded manual aneroid sphygmomanometric blood pressures were recorded during hypertensive peaks and after stabilization of BP using intravenous Labetalol or Nepresol. These two noninvasive methods of blood pressure measurements were compared to brachial intraarterial blood pressure measurements. RESULTS: There was weak correlation between manual and intra-arterial SBP (r = 0.27, p = 0.048) for SBP≥160mmHg. The calculated mean difference between manual SBP compared to the intra-arterial SBP in this group was -23.19mmHg (+/- 19.40). There was moderate correlation between automated and intra-arterial SBP (r = 0.69, p < 0.05). The calculated mean difference between automated SBP compared to the intra-arterial SBP in this group was -16.85mmHg (+/- 11.58). CONCLUSION: This study of pre-eclamptic women demonstrated that both non-invasive methods of BP measurement were inaccurate measures of the true systolic intra-arterial BP and significantly underestimated SBP≥160mmHg when compared to brachial intra-arterial measurements. The SBP was also underestimated, to a lesser degree, for mild moderate hypertension. This study also demonstrated that direct invasive BP monitoring using the brachial artery is a safe method for accurate haemodynamic monitoring. We recommend the use of intra-arterial BP monitoring in pre-eclamptic women with acute severe hypertension. Radial arterial cannulation should be used as the first option and the brachial artery should be used if the first option fails. / AFRIKAANSE OPSOMMING: DOELWIT: Die doel van hierdie studie was om die akuraatheid van nie indringende bragiale bloeddruk metings, wat met outomatiese en manuele aparate geneem is, te vergelyk met bragiale intra-arteriele bloeddruk metings gedurend akute erge hipertensie in pasiente met pre-eklampsie, STUDIE ONTWERP: ʼn Prospektiewe beskrywende dwarssnit studie was in die Obstetriese Kritiese Sorg Eenheid (OCCU) van Tygerberg Hospitaal uit gevoer. Preeklamptiese pasiente met akute erge hipertensie, wat bragiale intra-arteriele lyne nodig gehad het, as gevolg van gefaalde radiale intra-arteriele lyn plasing, was in hierdie studie ingesluit. Beide outomatiese ossilometriese en geblinde aneroide sfigmomanometriese bloeddrukke, tydens hipertensiewe pieke en na stabilisering van bloeddrukke met binneaarse Labetalol of Nepresol, was aangeteken, Die twee nie indringende metodes van bloeddruk meting was met bragiale intra-arteriele bloeddruk metings vergelyk. RESULTATE: Daar was ʼn swak korrelasie tussen manuele en intra-arteriele sistoliese bloedrukke SBP (r = 0.27, p = 0.048) vir SBP≥160mmHg. Die berekende gemiddelde verskil tussen manuele SBP en intra-arteriele SBP was -23.19mmHg (+/- 19.40) in hierdie groep. Daar was ʼn matige korrelasie tussen outomatiese en intra-arteriele SBP (r = 0.69, p < 0.05). Die berekende gemiddelde verskil tussen outomaties SBP vergelyk met intra-arteriele SBP was -16.85mmHg (+/- 11.58) in hierdie groep. GEVOLGTREKKING: Hierdie studie van pre-eklamptiese vrouens, het getoon dat beide nie indringende metodes van bloeddruk meting, nie akurate metings van ware sistoliese intraarteriele bloeddruk is nie, en SBP≥160mmHg word aansienlik onderskat wanneer dit met bragiale intra-arteriele metings vergelyk word. Die SBP was ook tot ʼn minder mate onderskat vir matige hipertensie. Die studie het ook getoon dat die direkte bragiale intra-arteriele metode van bloeddruk monitering, ʼn veilige metode van hemodinamiese monitering is. Ons beveel die gebruik van intra-arteriele bloeddruk monitering aan, in preeklamptiese vrouens met akute erge hipertensie. Radiale arteriele kanulasie moet gebruik word as die eerste opsie en die bragiale arterie moet gebruik word as die eerste opsie faal.

Thesis (PhD)--Stellenbosch University, 2002. / ENGLISH ABSTRACT: Infertility is a very common problem worldwide. Recent data have shown that disorders of the male represent the most common single defined cause of infertility. This proposal examines the clinical significance and fundamental physiological aspects of human gamete interaction. These studies are focused on the assessment of the cellular-molecular mechanisms involved in human sperm binding to its homologous zona pellucida resulting in the physiologic induction of the acrosome reaction. We have developed and validated in vitro bioassays that assess specific steps of the fertilization process that are critical for early embryo development. The results of our translational research have already had a significant impact on the overall evaluation of male infertility and on the clinical management of the infertile man in the assisted reproduction arena. Furthermore, the unveiling of the basic mechanisms involved in human gamete interaction will ultimately allow for both (i) the development of new male reproductive diagnostic capabilities and (ii) the design of improved and safer therapies aiding conception in childless couples suffering from male infertility. / AFRIKAANSE OPSOMMING: Menslike onvrugbaarheid is 'n algemene wêreldwye probleem en onlangse data toon aan dat die manlike factor die grootste enkel bydraende factor tot hierdie toestand is. Die werk loods 'n intensiewe ondersoek na die kliniese betekenis en basiese fisiologiese aspekte wat 'n rol tydens spermsel en eisel interaksie speel. Hoofstuk 3 fokus op die sellulêre en molekulêre meganismes wat betrokke is tydens spermsel en eisel binding wat gevolglik lei tot akrosoomreaksie van die spermsel. Die werk verteenwoordig die resultate van 10 jaar se navorsing tussen die kandidaat en die promoter. Dit gee oorsprong aan 'n reeks bio-toetse wat die bevrugtingsproses koriografiese ontleed en verskaf dus 'n stap-vir-stap uiteenseting van menslike bevrugting en gevolglike embrio ontwikkeling. Die resultate in Hoostuk 4 bring vernuwing in die begrippe van die manlike faktor en die rol in die kinderlose huwelik. Die resulate soos in Hoofstuk 3 en 4 uiteengesit, vorm nie net die basis vir die moontlike ontwikkeling van nuwe diagnostiese benaderings tot die hantering van die man nies maar speel oojk 'n rol die daarstelling van verbeterde terapeutiese hantering van die kinderlose egpaar. Hoofstuk 5 gee kortliks riglyne en aanbevelings tot opsigte van die gebruik van die spermsel-zona pellucida bindingstoets en akrosomreaksie. Die kandidaat bevel aan dat die genoemde twee bio-toetse deel van die laboratorium ondersoeke van die man gebruik moet word.