Haemolytic Disease of the Foetus and Newborn (HDFN) and Foetal and Neonatal Alloimmune Thrombocytopenia (FNAIT) are the most clinically relevant alloimmune disorders of pregnancy caused by maternal alloimmunisation to paternally derived foetal red blood cell (RhD) and platelet antigens (HPA-1a) respectively. Recombinant Fc-modified antibodies have been designed as inert potential biotherapeutics to compete with maternal alloantibodies and reduce foetal mortality. Fc-modified anti-D (Fog1G1 Δnab) and anti-HPA-1a (B2G1Δnab & B2G1Δnac) have been evaluated for their materno-foetal transport capacity using human placental models. For future in vivo efficacy, Fc-modified antibodies should transport at similar rates to wild-type antibodies (Fog1G1 and B2G1). The placental perfusion model showed that the Δnab mutation appeared to lower the transport capability of anti-D and anti-HPA-1a across the placenta. In a Human Umbilical Endothelial Vein Cell (HUVEC-c) cell culture model, transport of HPA-1a was favoured in a basal to apical direction and was statistically significant at hours 12 and 24 (p=0.002 & p=0.010 respectively). The relative order of transport was B2G1Δnac > B2G1 > B2G1Δnab implying the Δnac mutation enhances transport across the foetal endothelium. Since approximately 40% of RhD negative women give birth to RhD negative babies, these women currently receive anti-D prophylaxis unnecessarily. Foetal DNA was successfully extracted from maternal plasma and genotyped for foetal RhD status using Real-Time PCR. Foetal genotyping results revealed 96% and 98% concordance with cord blood serology for maternal blood samples taken at booking (~16 weeks) and at 28 weeks gestation respectively. Two-dimensional Difference in Gel Electrophoresis (2-D DiGE) was used to evaluate the normal placental proteome of syncytiotrophoblast membrane particles (STBMs) generated from placental perfusion. Eleven differentially expressed protein species were identified when comparing different STBM samples. Future work aims to compare the normal placental proteome with the proteome of placentas from complicated pregnancies (e.g. PE, IUGR, PTL and Trisomies 13, 18 and 21) to discover potential biomarkers for screening.

This mini-dissertation was submitted in partial compliance with the requirements for the Master's Degree in Technology: Homoeopathy, Durban Institute of Technology, 2006. / This study sought to determine the perceptions that currently exist amongst pregnant women towards homoeopathy, in light of the fact that drug use during pregnancy is limited. This study aimed at identifying myths and misconceptions that currently exist towards homoeopathy by looking at the attitudes and perceptions held by this target group. This information can be used to develop future homoeopathic education initiatives for this target group. This study was carried out using the survey method with a questionnaire as the measurement tool. The 'Perceptions in Pregnancy' questionnaire was adapted from Moys (1996), and administered to pregnant adults attending private antenatal facilities. The questionnaire was divided into three sections: A) Demographic data; B) Knowledge and attitudes towards homoeopathy; C) Previous health care experience. This sample was obtained from private antenatal facilities through convenience sampling. Antenatal class instructors within the greater Durban area were approached and briefed about the study. Willing instructors were asked to sign a 'Letter of Permission' (see Appendix A) agreeing to allow the study to be conducted within their classes. Instructors were asked to hand out copies of the 'Participant Information Letter' (see Appendix B) within the class informing potential candidates of the study. Subjects willing to participate were then given a copy of / M

Migraine is associated with a number of cardiometabolic risk factors including abnormalities in lipid metabolism. However, little is known about these associations among pregnant migraineurs. We conducted the present study to evaluate the extent to which altered lipid profiles are associated with history of migraine among pregnant women.

This is a study of families that had pregnancies while they were recipients or potential recipients of public assistance.

The aim of this study was to examine the maternal immune response to paternal antigens expressed by the fetus and identify the antigen inducing the response. Sera removed from responder female mice were tested for activity against paternal target cells using a cellular ELISA. Avtivity was first detectable at day 10 of a first pregnancy. The antibody detected in this way was shown to be non-cytotoxic, consisting of the IgGl subclass, directed against a class I antigen that could not be found on target erythrocytes. Sera removed at different stages of pregnancy exhibited varying degrees of cross-reactivity. To provide a source of pregnancy-induced antibody spleens from mice were removed during pregnancy and fused with rat or mouse myelomas. Antibody-secreting hybridomas were sought by means of CELISA with paternal cells as targets. Four hybridomas were isolated, producing antibody of the IgGl subclass, directed against a class I antigen and with limited cross-reactivity. The target antigen for both pregnancy sea and monoclonal antibody was examined for H-2 linkage, using the Lod score. The results obtained were unusual. Combination of the scores for four separate sera suggested an MHC-linked target. Individual scores suggested that two sera were directed against a linked and two against an unlinked antigen. Three of the monoclonal antidbodies were directed against H-2-linked antigens. Both sera and monoclonal antibody were immunoblotted against paternal, maternal and control cells. Pregnancy sera was seen to blot a 45-kD antigen present on paternal strain cells and cells from a mouse sharing the maternal haplotype. Only one hybridoma could be successfully blotted, revealing a 45-kD target. Immunisation with third-party lymphocytes has been used to treat recurrent spontaneous abortion. In twenty two couples treated in this way immunisation proved to be beneficial but there was no evidence for importance of an immune response or HLA sharing.

Listeria monocytogenes and the closely related species L ivanovii, L innocua, L welshimeri and L seeligeri are Gram-positive diphtheroid-like bacteria widespread in nature. L monocytogenes causes human infections infrequently, usually during the perinatal period and in immunocompromised adults. L innocua, L welshimeri and L seeligeri are non pathogenic and L ivanovii is usually associated with ovine abortions. Serological diagnosis of infection with L monocytogenes is at present unsatisfactory, mainly because of extensive serological cross-reactions with other bacterial pathogens. As a first step in the development of a specific serological assay, monoclonal antibodies directed against L monocytogenes were produced by fusion of a myeloma cell line with splenic lymphocytes from mice immunized with an ultrasound/EDTA extract of the organism. Eighteen hybridoma clones were selected all of which secreted antibody strongly reactive with all Listeria species, except L denitrificans, but not with Staphylococcus aureus, Streptococcus faecalis, Bacillus subtilis and Escherichia coli. These putative Listeria-specific antibodies, which show at least 4 different antigen specificities in an immunoblot, should prove helpful in the identification and purification of diagnostically useful reagents. The taxonomic relationships of L monocytogenes, L ivanovii, L innocua, L welshimeri and L seeligeri are not fully understood. To investigate their relationships, whole-cell proteins of these species were examined by SDS-PAGE. The polypeptide profiles of L monocytogenes (40 strains), L ivanovii (5 strains), L innocua (4 strains), L welshimeri (1 strain) and L seeligeri (4 strains) were all very similar. Although some differences between the species were observed, they were not greater than the level of intraspecies variation. The classification of these 5 species may, therefore, require further examination. Foetal infection with L monocytogenes may originate from carriage of the organism in the GI tract, the lower genital tract and the pharynx. To investigate the effect of pregnancy on listerial carriage, faecal samples along with cervico-vaginal and oropharyngeal swabs were collected from 54 healthy pregnant women and 60 healthy non-pregnant women, and examined for listeriae by cold-enrichment and repeated subculture on selective media containing acriflavin, nalidixic acid and potassium thiocyanate. L monocytogenes was isolated from the faeces of 1 pregnant woman (2%) and 2 non-pregnant women (3.4%). L innocua was isolated from the faeces of 1 pregnant woman (2%) and 1 non-pregnant woman (1.7%). L seeligeri was isolated from the faeces of 1 non-pregnant woman (1.7%). No listeriae were isolated from cervico-vaginal or oropharyngeal samples. The results indicate that pregnancy does not predispose to colonization, and thus infection, with L monocytogenes, and that faecal, but not cervico-vaginal or oropharyngeal, carriage of pathogenic and non-pathogenic Listeria species occurs in a small percentage of healthy women.

M.Med. (Obstetrics and Gynaecology), Faculty of Health Sciences, University of the Witwatersrand,2008 / The aim of this study was to assess the demographic characteristics and contraceptive practices of women requesting termination of pregnancy (TOP) at Chris Hani Baragwanath Hospital (CHBH). The study will provide insight into the reasons for contraceptive „failure‟ or non-use. Methods This is a cross sectional questionnaire survey. Subjects for the study were recruited from clients requesting TOP at the Gynaecology clinic (ward 54), CHBH. They included women between 13 to 49 years, who were referred from their local clinic or General practitioner with a positive pregnancy test or a pregnancy confirmed on sonar, and were less than 20 weeks pregnant. Consenting women completed a self-administered questionnaire which assessed their demographic details, current contraceptive use, past contraceptive experience, future contraceptive plans, knowledge of emergency contraceptive pill, and the current status of the relationship, initial intention with regard to the pregnancy, and the number of sexual partners they had in the last year. The data was analysed using the Epi Info 6 software programme. Results There were 780 requests for TOP during the study period. Two hundred and twenty nine women were approached to participate in the study and 203 questionnaires were analysed, i.e. an 89% analysable response rate. The mean age of the respondents was 25 years (range 13 - 42 years), the mean parity was 1.3 (range 0 to 9), 35% were still in school, 28% were unemployed and 70% were financially dependent on their parents, partners, or other relatives. A total of 56% of the respondents reported that they were using contraception when they conceived. Only 11% of the respondents knew of the emergency contraception pill. Eighty two percent of the respondents knew where to obtain contraceptives and only 7% had experienced actual difficulty in obtaining contraception. However, 46% thought they received „too little‟ information about contraception at their local clinic and 26% said that the contraceptive method they received was the healthcare provider‟s choice. Up to 47% of the respondents were either unsure of the contraceptive method they would use or would not use any contraception following the TOP. However, 43% would use a highly reliable contraceptive method (the oral contraceptive pill, injectable contraceptive, or sterilisation). Regarding the status of the relationship which resulted in the pregnancy, 44% were no longer in a permanent relationship (41% were and 11% never were). Twenty two percent of the respondents initially wanted the pregnancy. Conclusions Twenty two percent of the respondents initially wanted the pregnancy and would not have been helped by better provision of contraception. A large number of respondents reported contraceptive failure. Knowledge of emergency contraception was poor, and its use should be better promoted for cases of contraceptive failure. It is alarming that up to 47% of the clients could not use contraception in the future. Perhaps more time should be spent on contraceptive counselling and initiation of a method on site, with referral and follow-up at primary health clinics to improve uptake of contraception. Only 2.5% of the respondents were having a repeat TOP.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science in Medicine in Bioethics and Health Law Johannesburg, 2015 / Generally, consensual adolescent sexual intercourse is fraught with a number of negative outcomes such as socio-economically, where unplanned pregnancies occur, and medically with the spread of sexually transmitted diseases that require treatment. The Sexual Offences and Related Matters Amendment Act 32 of 2007, hereunder referred to as the Sexual Offences Act (“SOA”), criminalised consensual sexual intercourse between adolescents aged from 12 to less than16 years. Since the inception of the SOA in 2007, there seemed to have been relatively little evaluation of the practical effect of sections 15 and 16 of the SOA on society. This changed in 2011 when two non-profit organisations, The Teddy Bear Clinic for Abused Children and RAPCAN (Resources Aimed at the Prevention of Child Abuse and Neglect) who were the first and second applicants respectively, challenged the constitutionality of certain sections of the SOA. These sections are: - section 15 – entitled “Acts of consensual sexual penetration with certain children (statutory rape)”; - section 16 – entitled “Acts of consensual sexual violation with certain children (statutory sexual assault); and - section 56(2) – which deals with defences in respect of sections 15 and 16. In October 2013, the Constitutional Court declared sections 15 and 16 inconsistent with the Constitution. That declaration was suspended for a period of 18 months to enable Parliament to correct the defects in the statute. It is widely known that adolescents still engage in consensual sex with each other regardless of the law. The issues invite an evaluation of the current legislation in the context of the health and social issues that surround them. In addition, the impact of the current applicable legislation on the present realism needs to be scrutinised. It is essential for alternative interventions to be established which will aid in reducing the negative impact of consensual adolescent sexual intercourse. This research report looks at interventions that could be introduced to prevent adolescent sexual intercourse and alleviate the negativity of outcomes. Furthermore, the report aims to suggest an ethical, structured approach to reduce the current negative outcomes of adolescent sexual intercourse. In order to accomplish this I first describe the legislation that applies to consensual adolescent sexual intercourse of children between the ages of 12 and 16 years old. This brought to the fore the health practitioner’s practical experiences of problems associated with this legislation. In addition, I identify and discuss some ethical problems that health practitioners are confronted with in relation to consensual adolescent intercourse, in terms of having to balance their professional legal and ethical obligations. Finally, I propose some recommendations that will inform educational organisations on the relevant information to be included in sexual and reproductive health education campaigns. Furthermore, recommendations are made to relevant national policy-making departments to make strategic decisions regarding health and social interventions for adolescent sexual and reproductive health services. / MT2016

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Medicine in Obstetrics and Gynaecology MMed (O&G) Johannesburg January 2017 / Background and objectives Pregnancy can be associated with life threatening complications of pregnancy specific disease and delivery, as well as the exacerbation of preexisting comorbid disease, which requires multidisciplinary critical care. Studies have shown that advancement in medical care and access to intensive care units have been instrumental in the global decline in maternal mortality rates, particularly in developed countries. The aim of this study was to describe the admissions to ICU of all pregnant women including those with pregnancy related complications at CHBAH tertiary hospital in South Africa. Methods The study was a retrospective review of pregnant women, including pregnancy related complications, admitted to CHBAH ICU for the year of 2012. Baseline demographic data, admission diagnosis, laboratory information and acute physiological and chronic health evaluation score (APACHE II), intervention and outcomes were recorded using ICU records and general hospital records. Descriptive statistical analysis employed. Results In 2012 there were 21765 deliveries at CHBAH with 76 pregnancy related admissions to the ICU. Complete ICU data was available in 73 women. The incidence of ICU admission at the hospital was 3.5 per 1000 deliveries. The mortality rate in this group in ICU was 8.2%. The most common indication for admission was haemorrhage (43.8%) followed by medical and surgical disorders (23.3%), then sepsis (21.9%) and hypertensive disorders of pregnancy (11%). The majority of the women (98.3%) were admitted in the postpartum period. Mechanical ventilation was required in 77% of the women, inotropic support in 29% and 59% received blood transfusion products. APACHE II scoring system overestimated the possible mortality rate giving a predicted mortality rate of 15%. Conclusion Haemorrhage was the most common indication for admission to ICU. This does not concur with previous South African studies where hypertension was the most common reason for admission followed by haemorrhage. The study showed an overall mortality concurrent with some first world studies and significantly lower than cited South African studies. / MT2017

A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master of Medicine (In the branch of Anaesthesiology). February 2013 / BACKGROUND AND OBJECTIVES: Local anaesthetic agent mixed with an opioid provides effective, fast and reliable onset of regional analgesia. However, the intrathecal use of opioids may have undesirable effects, one of which is pruritus (itching). The main objectives of this study were to assess the incidence and severity of fentanyl-induced pruritus in patients who received spinal anaesthesia for caesarean section at Chris Hani Baragwanath Academic Hospital, and to determine the influence of factors such as dosage of fentanyl, age, race, and socio-economic status on the perception of pruritus. METHODS: This was a prospective observational study of obstetric patients delivered by elective caesarean section under spinal anaesthesia at Chris Hani Baragwanath Academic Hospital. Regional anaesthesia was performed following a departmental protocol where patients received 0.5% bupivacaine with dextrose mixed fentanyl. The departmental protocol was used as a guideline for the mixture but the different anaesthetists were not restricted to it. Based on their practice, a range of fentanyl doses were used. The participants were observed for pruritus directly intraoperatively by the researcher, and again at approximately one hour after spinal anaesthetic administration. This last observation was complemented by means of a structured interview. Severity was assessed using a visual analogue scale. For descriptive analysis, to show a 95% confidence interval of no more than 10% around an observed percentage of patients with pruritus, a sample size of 96 participants was chosen. Page | 6 RESULTS: The overall incidence of pruritus in 96 participants who received intrathecal fentanyl was 54.2%. Pruritus occurred in 48 participants (50.0%) during the caesarean section. Four participants (4.2%), who had no pruritus intraoperatively, developed it one hour after the spinal anaesthetic was administered. The part of the body commonly affected was the nose. The severity of pruritus was more than tolerable in 6 participants (6.3%), with two of them perceiving it as unbearable. No participant reported pruritus 24 hours after the spinal anaesthetic. There was no statistically significant association between the frequency of pruritus and the dose of fentanyl, age, race and socio-economic status indicators. CONCLUSION: Pruritus is a common symptom in women undergoing caesarean section using fentanyl-containing neuraxial block. However, most cases are mild and not related to dosage. Women who complain of intraoperative or postoperative pruritus can be informed that the symptom is transient and of no serious clinical consequence.