Thesis (MMed)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: The Objective: To review the difference in short term neonatal and maternal outcomes among singleton infants with breech presentation delivered by vaginal or elective caesarean section route at term, at Tygerberg Academic Hospital (TBH) in Cape Town. The study design was a retrospective case control study. Method: Part I A total of 120 patients were selected. 60 vaginal breech deliveries and 60 elective caesarean sections for breech presentation (comprising the control group). 60 cases of vaginal deliveries were collected and 60 control cases of planned elective caesarean sections, where the indication for CS was breech presentation, were collected in the same manner. Part II Nineteen registrars completed a questionnaire regarding their subjective experiences of vaginal breech deliveries at Tygerberg Academic Hospital. Results: Part I An analysis of the results found statistically significant differences in maternal ages between the two groups, with younger women delivering by CS; gravidity and parity was lower in the CS group; blood loss was observed to be higher in the CS group with more women requiring a blood transfusion when compared to vaginal delivery; there were more neonatal admissions in the vaginal delivery group as well as more birth trauma, neonatal seizures and death in this group; Apgar scores were higher in the CS group and finally, neonates born by CS were more commonly discharged at the same time as their mothers in the CS group. Part II When analyzing the registrar questionnaire it can be noted that although clinicians are performing an adequate number of breech vaginal deliveries, with an average of 10 deliveries per year, the skills training for clinicians is invaluable. Not all registrars learned skills from a senior clinician and skills training in skills labs are essential for initial and even continual training of these clinicians. It is suggested that these skills training programs be made compulsory for all registrars and that a biyearly attendance and completing of such a course be mandatory for those wishing to work in the labour ward. Conclusions: Although not statistically significant, there was more morbidity and mortality associated with vaginal breech delivery. / AFRIKAANSE OPSOMMING: Doel: Om die korttermyn neonatale en moederlike uitkomste van enkeling swangerskappe met stuitligging wat vaginaal of met elektiewe keisersnee verlos is by die Tygerberg Akademiese Hospitaal in Kaapstad, te bepaal. Die werkstuk is ‘n retrospektiewe gekontroleerde-gevallestudie. Metode: Deel 1 ‘n Totaal van 120 pasiënte is gekies. 60 gevalle van vaginale stuitverlossings en 60 kontrolegevalle van beplande elektiewe keisersnitte waar die indikasie stuitligging was. Deel 2 Negentien kliniese assistente het die vraelys oor hul persoonlike ervaring van vaginale stuitverlossing by die Tygerberg Akademiese Hospitaal ingevul. Resultate: Deel 1 ‘n Ontleding van die resultate wys statisties betekenisvolle verskille in die moederouderdom van die twee groepe, met meer jong vroue wat met keisernit geboorte gee. Graviditiet en pariteit was laer in die keisersnit-groep. Bloedverlies was hoër in die keisersnit-groep en in vergelyking met die vaginale verlossings met meer vroue wat bloedoortapping benodig. In die vaginale verlossingsgroep was meer neonatale toelatings nodig asook meer geboortetrauma, neonatale konvulsies en sterftes. Apgar-tellings was hoër in die keisersnitgroep en neonate wat met ‘n keisersnitte gebore is, is meer dikwels saam met hul moeders ontslaan. Deel II Ontleding van die vraelys vir kliniese assistente wys dat hoewel klinici ‘n genoegsame getal van gemiddeld 10 vaginale stuitverlossings per jaar uitvoer, vaardigheidsopleiding vir klinici van onskatbare waarde sal wees. Nie alle kliniese assistente leer vaardighede by senior klinici nie en opleiding in ‘n vaardigheidslaboratorium is noodsaaklik vir die aanvanklike en selfs voortdurende opleiding van dié kliniese assistente. Dit word voorgestel dat hierdie vaardigheidkursusse verpligtend gemaak word vir alle kliniese asssistente en bywoning en voltooiing van die kursus twee maal per jaar verpligtend moet wees vir diegene wat in ‘n kraamsaal wil werk. Gevolgtrekking: Vaginale stuitverlossings, hoewel nie stastisties betekenisvol nie, het met meer morbiditeit en sterftes gepaardgegaan.

Thesis (MPhil (Health ScEd))--University of Stellenbosch, 2010. / No abstract available

Thesis (MMed (Obstetrics and Gynaecology))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Introduction: Hypertensive disease is one of the cardinal causes of maternal morbidity and mortality in South Africa. According to the National Confidential Enquiry into Maternal Deaths (NCEMD) report for 2005-2007, the “big five” causes of maternal death have remained the same as in the previous triennium, with hypertensive disease in second place, being the causative factor in 15.7% of cases.1 Women under 20 years of age were at greater risk of dying due to complications of hypertension. In this light, the early identification and treatment of hypertensive disease remains important priorities in improving maternal care. Various serum markers have been studied to identify women at risk of pre-eclampsia, including biological markers and genetic factors.2 It is also well known that chronic hypertension is one of the major predisposing factors to the development pre-eclampsia.2 A continued search for a genetic screening test to assist in early diagnosis could facilitate a reduction of maternal morbidity and mortality. Aims: The aim of this project is to determine the prevalence of the R563Q mutation of the -subunit of the epithelial sodium channel (-ENaC) gene in a cohort of primigravid women with hypertensive disease in pregnancy and to compare pregnancy outcomes in this group of hypertensive patients to those not identified to be carriers of the mutation. Methodology: A retrospectively collected study cohort of patients with early onset pre-eclampsia, obtained from pooled samples and data from the GAP study (Genetic Aspects of Pre-eclampsia, project number C99/025), was used. The planned sample size was 200, with 200 controls who were ethnic-matched, normotensive women. Exclusion criteria were gestation 34 weeks, multiple pregnancy, known underlying collagen vascular disease and type I Diabetes Mellitus. Outcome criteria: The pregnancy outcomes were analysed with respect to the degree of hypertensive disease and related complications (maternal, placental and neonatal). Results: Blood samples form 104 patients and 80 control samples were analysed. Pre-eclamptic patients were significantly younger than controls (p<0.0001). The presence of the mutation was not significantly increased in the pre-eclamptic group (p=0.33). The mutation bearers did not exhibit a significant tendency towards a specific degree of pre-eclampsia (p=0.51). There were no significant differences in the other studied maternal or fetal outcome measures. A composite outcome (the presence of 1 adverse outcome compared to no adverse outcome) was created which did not differ between the mutation positive and negative pre-eclamptic patients. Data of the index study was combined with the data form a prior relevant study9 and combined odds ratios were calculated. The increased mutation frequency amongst pre-eclamptics compared to healthy controls then remains significant, OR 2.57(95%CI 1.23-5.36). Conclusion: In this study the R563Q mutation of the ß-subunit of the epithelial sodium channel gene was not linked to pre-eclampsia. No significant negative correlation could be established between the presence of the R563Q mutation and the outcomes of pre-eclampsia. Further research aimed at chronic hypertensive patients in pregnancy and unstable pre-eclampsia in larger study groups could shed more light on the relation between the mutation and the pre-eclamptic phenotype. / AFRIKAANSE OPSOMMING: Inleiding: Hipertensie-verwante siektes is een van die hoof oorsake van moederlike morbiditeit en mortaliteit in Suid-Afrika. Volgens die Nasionale Vertroulike Ondersoek insake Moederlike Sterftes (NCEMD) verslag vir 2005-2007, is die “groot vyf” oorsake van moedersterftes dieselfe as in die vorige triënnium, met hipertensie-verwante siektes in tweede plek, as die oorsaak van 15.7 % van die sterfgevalle. 1 Vroue jonger as 20 jaar het ‘n groter risiko om te sterf aan die komplikasies van hipertensie-verwante siektes. In die lig hiervan is die vroeë identifikasie en behandeling van hipertensie-verwante siektes ‘n priorteit in die verbetering van moedersorg. Verskeie serum merkers is al bestudeer met die hoop om vroue met verhoogde risiko vir die ontwikkelling van pre-eklampsie te identifiseer, wat biologiese merkers en genetiese faktore insluit. 2 Dit is ook welbekend dat chroniese hipertensie een van die hoof predisponerende faktore is vir die ontwilkkeling van pre-eklampsie.2 ‘n Voortgesette soektog na ‘n genetiese siftingstoets wat kan bydra tot vroeë identifisering, sou moederlike morbiditeit en mortaliteit kon verminder. Doelwittle: Die doelwit van hierdie projek is om die prevalensie van die R563Q mutasie van die -subeenheid van die epiteliële natrium kanaal (-ENaC) geen te bepaal in ‘n kohort primigravida vroue met hipertensie-verwante siekte in swangerskap en om die swangerskapsuitkomste van hierdie groep te vergelyk met pasiente wat nie draers van die mutasie is nie. Metodologie: ‘n Retrospektief versamelde studie kohort met vroeë aankoms pre-eklampsie, verkry van die monsterbank en data van die GAP studie (Genetic Aspects of Pre-eclampsia, projek nommer C99/025) is gebruik. Die beplande steekproef grootte was 200, met 200 kontroles, wat etnies- en ouderdomvergelykbare normotensiewe vroue was. Uitsluitingskriteria was gestasie 34 weke, onderliggende bindweefselsiekte en tipe I Diabetes Mellitus. Uitkomskriteria: Swangerskap uitkomste was geanaliseer met betrekking tot die graad van hipertensiewe siekte en verwante kompliksies (moederlik, plasentaal en neonataal). Resultate: Bloed monsters van 104 pasiënte en 80 kontroles is ontleed. Pre-eklampsie pasiënte was betekenisvol jonger as kontroles (p<0.0001). Die teenwoordigheid van die mutasie was nie betekenisvol verhoog in die pre-eklampsie groep nie (p=0.33). Die mutasie-draers het nie ‘n geneigdheid tot ‘n spesifieke graad van pre-eklampsie getoon nie (p=0.51). Daar was geen betekenisvolle verskille tussen die ander moederlike of fetale uitkomste wat bestudeer is nie. ‘n Gesamentlike uitkoms (teenwoordigheid van 1 swak uitkoms vergeleke met geen swak uitkoms) is geskep; daar was geen verskil tussen die mutasie-positief en negatiewe pasiënte met pre-eklampsie nie. Data van die indeks studie en relevante data uit ‘n vorige studie9 is saamgevoeg en die gesamentlike kansverhouding is bereken. Die verhoogde mutasie frekwensie onder pasiënte met pre-eklampsie vergeleke met gesonde kontroles was betekenisvol, KV 2.57(95%VI 1.23 - 5.36). Gevolgtrekking: In hierdie projek was daar nie ‘n verband tussen die R563Q mutasie van die -subeenheid van die epiteliële natrium kanaal (-ENaC) geen en pre-eklampsie nie. Geen betekenisvolle negatiewe korrelasie tussen die R563Q mutasie en pre-eklampsie uitkomste kon aangetoon word nie. Verdere navorsing gerig op pasiënte met chroniese hipertensie of akute, onstabiele pre-eklampsie in groter studiegroepe kan die verband tussen die mutasie en die pre-eklampsie fenotipe moontlik beter toelig.

Thesis (MPhill)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Background: Community-based placement of students provides an ideal opportunity to develop constructivist learning environments for learning. Students are placed in a low risk obstetric care facility where they required to interview, examine and manage uncomplicated pregnancies under supervision of a lecturer. Aims: The aim of this study was to investigate the appropriateness of using a validated Constructivist Learning Environment Survey (CLES) to gauge the perceptions of students in a community-based health sciences placement. A further aim of the study was to evaluate whether the learning environment was compliant with constructivism. Methods: An adapted CLES was administered to 99 students and 44 students were interviewed using the instrument scales as a schema. Results: The surveys were analysed and mean scores at or above 20 were obtained, where the 5 different scales would have a maximum score of 30 each. No gender or racial differences were elicited from the survey responses. Interview data supported the data of the survey that demonstrated the constructivist nature of the learning environment. Conclusion: The CLES appears to be an appropriate and useful instrument in evaluating a community-based constructivist learning environment in low-risk obstetric care. Practice Points: Learning environment research instruments developed for other settings may be appropriate to use in more specific training in health sciences education. The adapted CLES proved useful in evaluating a constructivist clinical learning environment.

Thesis (MPhil)--University of Stellenbosch, 2011. / Introduction: Objective Structured Clinical Examination (OSCE) examiner training is widely employed to address some of the reliability and validity issues that accompany the use of this assessment tool. An OSCE skills course was developed and implemented at the Stellenbosch Faculty of Health Sciences and the influence thereof on participants (clinicians) was evaluated. Method: Participants attended the OSCE skills course which included theoretical sessions concerning topics such as standard-setting, examiner influence and assessment instruments, as well as two staged OSCEs, one at the beginning and the other at the end of the course. During the latter, each participant examined a student role-player performing a technical skill while being video recorded. Participants‟ behaviour and assessment results from the two OSCEs were evaluated, as well as the feedback from participants regarding the course and group interviews with student role players. Results: There was a significant improvement in inter-rater reliability as well as a slight decrease in inappropriate examiner behaviour, such as teaching and prompting during assessment of students. Furthermore, overall feedback from participants and perceptions of student role-players was positive. Discussion: In this study, examiner conduct and inter-rater reliability was positively influenced by the following interventions: examiner briefing; involvement of examiners in constructing assessment instruments as well as viewing (on DVD) and reflection, by examiners, of their assessment behaviour. Conclusion: This study proposes that the development and implementation of an OSCE skills course is a worthwhile endeavour in improving validity and reliability of the OSCE as an assessment tool.

Thesis (MMed)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Introduction - Accurate computerized analysis of the fetal heart rate (FHR) pattern has become more feasible and clinically relevant in recent years. Taking into account advances in neonatal care resulting in a declining lower limit for fetal viability as well as research into fetal effects of maternal high risk behaviour and escalating intra-uterine exposure to harmful toxins and drugs, fetal heart rate patterns need to be more accurately described in earlier gestations than what is currently available in literature. With advancing technology it is becoming possible to accurately record and interpret the FHR patterns from gestations as early as 20 weeks' gestation. By using the Monica AN24 transabdominal electrocardiographic fetal monitor and product specific software, we analysed early FHR patterns according to the Dawes-Redman criteria, as used in later gestations. Methods - The aim of our study was to describe patterns of FHR (short-term variability, basal heart rate, accelerations and decelerations) at 20-24 weeks' gestation. Physiological data were obtained from the routine second trimester fetal assessment by the Monica AN24 monitor as used in the Safe Passage Study. As of December 31, 2009, 411 participants completed their first fetal assessment and met our inclusion criteria. Because our aim was the description of patterns in pregnancies with a normal outcome, we excluded all adverse neonatal outcomes, preterm deliveries, babies with low birth weights as well as cases where delivery data were lost. After recordings of poor technical quality were also removed from our data pool, 281 recordings remained for analysis. Results - Distinct FHR patterns and quantifiable parameters of heart rate variability were consistently observed. In contrast to what has previously been published, accelerations of the FHR and reassuring baseline variation are present from as early as 20 weeks. Conclusion - Information from this study provides an important foundation for further studies of early FHR patterns and it will help us better assess the fetus at a crucial age for indicators of good outcome at early delivery. / AFRIKAANSE OPSOMMING: Inleiding - Akkurate gerekenariseerde ontleding van die fetale hartpatroon het in die afgelope paar jaar meer tegnologies haalbaar met toenemende kliniese toepassing geword. Tans ervaar ons besondere vooruitgang in neonatale sorg en dus dalende grense vir vroeë lewensvatbaarheid in kliniese praktyk. Daar is ook 'n toename in navorsing oor moederlike hoë risiko gedrag tydens swangerskap en die effek hiervan op die ontwikkeling die fetus asook die neonatale uitkomste. Akkurater beskrywing van fetale hartpatrone in vroeëre gestasies as wat huidiglik in die literatuur beskikbaar is, is dus genoodsaak om die effekte van blootstelling op die fetus waar te neem. Met vooruitgang in tegnologie is dit nou moontlik om deur nie-indringende elektrokardiografie, fetale hartpatrone te registreer en te interpreteer van so vroeg as 'n swangerskapsdurte van 20 weke. Deur die gebruik van die Monica AN24 transabdominale monitor en produk-spesifieke programmatuur, kon ons vroeë fetale hartpatrone ontleed volgens die Dawes-Redman kriteria wat gewoonlik in later swangerskapsduurtes gebruik word. Metodes - Die doel van ons studie was die beskrywing van verskeie fetale hartpatrone (naamlik korttermyn variasie, basale hartspoed, versnellings asook vestadigings) rondom 20 – 24 weke swangerskapsduurte. Fisiologiese data is in die tweede trimester verkry deur die Monica AN24 monitor, soos gebruik word in die voortgaande Veilige Geboorte Studie by Tygerberg hospitaal. Tot en met 31 Desember 2009, het 411 deelnemers hulle eerste fetale evaluasie vir die Veilige Geboorte Studie gehad en ook voldoen aan die insluitingskriteria van hierdie projek. Aangesien ons fokus die beskrywing van hartpatrone in normale swangerskappe was, het ons alle nie-wenslike neonatale uitkomste, voortydse verlossings, babas met lae geboorte gewig asook gevalle waarvan die geboortedata nie beskikbaar was nie, uitgesluit. Alle opnames met sub-standaard tegniese kwaliteit is ook verwyder uit ons finale data vir ontleding, wat ons met 281 opnames gelaat het vir hierdie studie. Resultate - Duidelike fetale hartpatrone en meetbare afmetings is deurgangs opgemerk. In teenstryd met wat voorheen gedokumenteer is, is die teenwoordigheid van versnellings asook gerusstellende basislyn variasie meetbaar vanaf 20 weke gestasie. Samevatting - Informasie vanaf hierdie studie verskaf 'n belangrike grondslag vir verdere projekte in die ontleding van fetale hartpatrone met die fokus op ondersoek van vroeë voorspelling van goeie neonatale uitkomste.

Thesis (MMed)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Background The annual burden of stillbirths is estimated to be more than 3 million deaths globally. Depending on the perinatal classification used, up to two thirds of deaths are reported as unknown.Gardosi, et al (2006) developed the ReCoDe system, which identified the relevant condition at the time of death in utero. The system aims to identify what went wrong in utero, without necessarily indentifying why fetal demise occurred. With comparison to the conventional Wigglesworth classification, the authors were able to reduce the number of unexplained stillbirths from 66.2% to 15.2%. The Perinatal Problem Identification Program (PPIP) is the nationally implemented perinatal classification system in South Africa. The PPIP database recorded approximately 660 000 births from the 1st January 2006 until 31st December 2007. This reflects approximately 40% of all births in health institutions in South Africa during this time period. There were 11742 stillbirths recorded in on the PPIP database for this two year period.Unexplained stillbirths formed 24% of the total perinatal deaths. The Saving Babies Report 2006-2007 has suggested that funding andresearch resources be directed to identifying the causes of deaths in this group. Objective: Our primary objective was to compare the outcomes of the PPIP to the ReCoDe classification system developed by Gardosi, with special attention as to reducing the number of unexplained stillbirths. Methods: We conducted a retrospective descriptive study on the perinatal deaths occurring at or presenting to the Department of Obstetrics and Gynaecology at Tygerberg Hospital, Cape Town, South Africa, for the time period extending from 01 January 2008 to 31 December 2008. A weekly Perinatal Mortality Audit meeting (PNM) is held at Tygerberg Hospital. In attendance at these meetings are General obstetricians, Fetal-maternal specialists, Neonatologists, Pathologists, a Geneticist, Obstetric and Paediatric Registrars. Relevant clinical details are summarised from clinical notes and Perinatal Losses data forms. These forms are specific to Tygerberg Hospital and completed by the attending doctor at first consultation. Placental histology and post-mortem examination would have been performed in certain cases as per the departmental protocol. All perinatal deaths, both stillborn and neonatal deaths weighing more than 499g, are discussed at this forum and consensus then reached on a primary and final cause of death. This information is then entered into the PPIP database, along with any identifiable avoidable factors.The investigators separately reviewed the information available from the Perinatal Losses and the PIPP V2.2 data capture forms and then reclassified each stillbirth according to the ReCoDe hierarchal system Results: We studied the data sheets of 406 stillbirths of babies of whom the deaths had been previously classified according to the PPIP classification. The median maternal age was 25.65 years (range 14 – 45) while the median birth weight was 1127 grams (range 500 – 4100).The vast majority of these stillbirths occurred in singleton pregnancies and are also classified as extremely low birth weight. The three major causes of stillbirth over the study period were antepartum haemorrhage (24.4%), hypertensive disorders (22.4%) and spontaneous preterm labour (11.1%). Within the ReCoDe classification, the leading categories were in the placental group (33.2%), fetal group (21.6%) and the maternal group (20%). The unexplained group (PPIP IUD group), from the index study constitutes 8.1% (33 of 406) of cases, while the number of unclassified stillbirths in the primary ReCoDe classification accounted for 15% (60 of 406) of the total. The main reasons for this difference is that ReCoDe does not incorporate preterm labour as a cause, and uses customised growth charts for identifying fetal growth restriction. Conclusion: PPIP remains the gold standard in Perinatal Audit in South Africa.We would recommend that ReCoDe be evaluated prospectively, alongside the established PPIP system, to better compare their performance outcomes. The development of customized fetal growth potential charts relevant to the local population should be explored. The Perinatal Losses data capture form should be revised to be more comprehensive and relevant. / AFRIKAANSE OPSOMMING: Agtergrond Die jaarlikse las van doodgeboortes word geskat op meer as 3 miljoen sterftes wêreldwyd. Afhangende van die perinataleklassifikasiesisteem wat gebruik word, tot twee derdes van sterftes is aangemeld as onbekend. Gardosi, et al (2006) het die ReCoDesisteemontwikkel, wat die betrokke toestand in die tyd van die dood in utero geïdentifiseer. Die sisteem het ten doel om te identifiseer wat verkeerd geloop het in utero, sonder om noodwendig te indentifiseer waarom fetaledood plaasgevind het. Invergelyking met die konvensionele Wigglesworth klassifikasie, was die skrywers in staat om die getal van die onverklaarbare dood geboortes van 66,2% tot 15,2% te verminder. Die Perinataleprobleemidentifikasie Program (PPIP) is die nasionaalgeïmplementeerperinataleklassifikasiesisteemin Suid-Afrika. Die PPIP databasis aangeteken ongeveer 660 000 geboortes van die 1ste Januarie 2006 tot 31 Desember 2007. Dit weerspieël ongeveer 40% van alle geboortes in die gesondheids-instellings in Suid-Afrika gedurende hierdie tydperk. Daar was 11.742 doodgeboortes aangeteken in op die PPIP databasis vir hierdie twee jaartydperk. Onverklaarbaredoodgeboortesvorm 24% van die totaleperinatalesterftes. Die Saving Babies Verslag 2006-2007 het voorgestel dat befondsing en navorsing gerig word aan die identifisering van die oorsake van sterftes in hierdie groep. Doelstelling: Ons primêre doel was om die uitkomste van die PPIP te vergelyk met die ReCoDeklassifikasiesisteem wat deur Gardosiontwikkelis , met spesiale aandag aan die vermindering van die aantal van onverklaarbaredoodgeboortes. Metodes: Ons het'n retrospektiewebeskrywendestudie uitgevoer op die perinatalesterftes wat aangemeld het by die noodeenheid van die Departement Obstetrie en Ginekologie aanTygerberg Hospitaal, Kaapstad, Suid-Afrika, vir die tydperk wat strek vanaf 01 Januarie 2008 tot 31 Desember 2008. 'n Weeklikse Perinatale Mortaliteit Ouditvergadering (PNM) word gehou by Tygerberg Hospitaal. In die bywoning van hierdie vergaderings is Algemene Verloskundiges, Fetale-moederskant Spesialiste, Neonatoloë, Patoloë, 'n Genetikus, Obstetriese en Pediatriese Klienieseassistente. Relevante kliniese inligting is uit die kliniese notas en perinataleverliesedatavorms opgesom. Hierdie vorms is spesifiek na die Tygerberg-hospitaal en deur die dokter by die eerstekonsultasie voltooi. Plasentale histologie en post-mortem ondersoek sou voltooi gewees het in sekere gevalle soos per die departementeleprotokol. Alle perinatalesterftes, beide doodgebore en neonatalesterftes wat meer as 499g, word bespreek op hierdie forum en konsensus bereik oor 'n primêre en finale oorsaak van die dood. Hierdie inligting word dan in die PPIP databasis, saam met 'n identifiseerbare voorkombare faktore. Die navorsers afsonderlik die inligting beskikbaar van die perinataleverliese en die PIPP v2.2 datavasleggingsvorms en dan herklassifiseer elke stilgeboorte volgens die ReCoDehiërargiesestelsel. Results: Ons bestudeer die data velle van 406 doodgeboortes van babas van wie die sterftes voorheen volgens die PPIP klassifikasie geklassifiseer is. Die mediaanmoeder se ouderdom was 25,65jaar (range 14? 45?) Terwyl die mediaangeboortegewig was 1127 gram (reeks 500? 4100). Die oorgrote meerderheid van hierdie doodgeboortes plaasgevind in Singleton swangerskappe en word ookgeklassifiseer as &'n baie lae geboortegewig. Die drie grootste oorsake van doodgeboorte oor die studietydperk was antepartum bloeding (24,4%), die hipertensiewesiektes (22,4%) en &'n voortydsekraam (11,1%). Binne die ReCoDeSistematiek, die voorstekategorieë in die plasentalegroep (33,2%), die fetalegroep (21,6%) en die moedergroep (20%). Die onverklaarbaregroep (PPIP IUD groep), van die indeksstudie behels 8,1% (33 van 406) van gevalle, terwyl die aantal van ongeklassifiseerde doodgeboortes in die primêre ReCoDeSistematiek verantwoordelik vir 15% (60 406) van die totaal. Die belangrikste redes vir die verskil is dat ReCoDenieneemvoortydsekraam as &'n oorsaak, en gebruike aangepasgroeikaarte vir die identifisering van fetalegroeibeperking. Gevolgtrekking: PPIP bly die gouestandaard in Perinataleoudit in Suid-Afrika. Ons sal aanbeveel dat ReCoDe vooruitwerkend geëvalueer word, saam met die gevestigde PPIP stelsel, om beter te vergelyk hulprestasieuitkomste. Die ontwikkeling van persoonlikefetalegroeipotensiaalkaarte met betrekking tot die plaaslike bevolking moet ondersoek word. Die perinataleverliese data capture vorm moet hersien word om meer omvattende en relevant te wees.

Thesis (MMed)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Background - Preeclampsia is a multi-system disease characterized by hypertension and proteinuria in pregnant women at greater than 20 weeks of gestational age. It remains one of the leading causes of maternal and foetal mortality and morbidity. While the cause of preeclampsia is essentially unknown, the important theories strongly implicate disturbed placental function in early pregnancy. Additionally, some researchers have investigated the possibility of a seasonal relationship with the incidence of preeclampsia. Differences in incidences of preeclampsia, examined exclusively on the basis of delivery timing, have also been noted to have seasonal variation, but results have been inconsistent. Objective - Our primary objective was to investigate the seasonal variation in preeclampsia in relation to the timing of conception and the timing of presentation with clinical disease over the period of one year. Methods - We performed a retrospective descriptive study of all women with preeclampsia who delivered at Tygerberg Hospital in 2010. Preeclampsia was diagnosed as hypertension associated with proteinuria after the 20th week of gestation. Names of patients were identified from labour ward records and data was collected and recorded on a data-sheet. Data were primarily analysed in relation to the season of delivery and also the season of the last menstruation. Summer was diagnosed as lasting from summer solstice to autumn equinox, autumn as lasting from autumn equinox until winter solstice, winter as lasting from winter solstice until spring equinox and spring as lasting from spring equinox until summer solstice. The data was analysed using the SPSS software (Statistical Package for Social Science). Discrete data was compared by calculating relative risks with 95% confidence limits, as well as the chi2 test. Fisher‘s exact test was used to compare ratios where the expected value in any cell of a two-by-two table is less than five. The means of normally distributed continuous data was compared by analysis of variance, while the medians of continuous data which are not distributed normally, where calculated using the non-parametric Mann Whitney u test. A p-value of < 0.05 was considered to be statistically significant, where applicable. Results - The peak incidence of preeclampsia was during winter with 32.2% of all cases occurring during this season. This was significantly higher than during the summer when only 169 (17.17%) cases of preeclampsia were delivered. When we analysed the data looking at the timing of menstruation (and therefore conception), we found that 292 (29.7%) patients that developed preeclampsia had their last menstrual period in the spring, with November the month of peak incidence. The lowest incidence was found in winter, with only 218 (22.2%) patients. Conclusion - We have confirmed a previous finding of a seasonal variation in the occurence of preeclampsia in Tygerberg Hospital. We have also confirmed that this seasonal variation is not only influenced by the timing of delivery, but also by the timing of conception. / AFRIKAANSE OPSOMMING: Agtergrond - Preeklampsie is ‘n multi-sisteem siekte wat gekenmerk word deur hipertensie en proteinurie. Dit word slegs gedurende swangerskap aangetref - gewoonlik na 20 weke. Dit is steeds een van die voorste oorsake van moederlike en fetale morbiditeit en mortaliteit. Terwyl die oorsaak van preeklampsie steeds onbekend is, dui die belangrikste teorië op versteurde plasentale ontwikkeling en funksionering vroeg in swangerskap. Sekere navorsers het ook die moontlikheid van ‘n seisonale patroon in die voorkoms van preeklampsie ondersoek. ‘n Seisonale patroon is wel identifiseer, maar dit is slegs gebasseer op die datum van verlossing en die resultate tussen studies wissel. Doel - Ons primêre doel was om die seisonale patroon in die insidensie van preeklampsie te ondersoek oor ‘n tydperk van een jaar en dan die datum van bevrugting te vergelyk met die datum van diagnose en verlossing. Metodiek - Ons het ‘n retrospektiewe beskrywende studie gedoen oor al die pasiënte met preeklampsie wat tydens 2010 by Tygerberg Hospitaal verlos is. Preeklampsie is gediagnoseer as hipertensie met geassosieerde proteinurie met aankoms na 20 weke. Die name van die pasiënte is verkry uit die kraamsaal-registers en data is versamel en op ‘n datastel aangebring. Data is primer geanaliseer in terme van die seisoen van verlossing en die seisoen waartydens die laaste maandstonde plaasgevind het. Die seisoene is as volg geklassifiseer : somer vanaf die summer solstice to autumn equinox, autumn as lasting from autumn equinox until winter solstice, winter as lasting from winter solstice until spring equinox and spring as lasting from spring equinox until summer solstice. Die data is geanaliseer met die SPSS sagteware (Statistical Package for Social Science). Diskrete data is vergelyk deur die relatiewe risiko’s te bereken met vertrouensintervalle van 95%, sowel as die chi2 toets. Fisher se eksakte toets is gebruik om ratios te vergelyk waar die verwagte waarde van enige sel in ‘n 2-by-2 tabel minder as 5 is. Die gemiddeldes van normaal-verspreide aaneenlopende data is vergelyk deur die analise van variance. Die mediane van aaneenlopende data wat nie normaal versprei was nie, is bereken met die non-parametriese Mann-Whitney-U-toets. ‘n P-warde van <0,05 is beskou as statisties betekenisvol, waar van toepassing. Resultate - Die piek –insidensie van preeklampsie was gedurende die wintermaande, met 32.2% van alle gevalle. Dit was betekenisvol hoër as die gedurende die somer, waar slegs 169 (17.17%) van gevalle verlos is. Toe ons die data analiseer na gelang van die datum van laaste menstruasie (en gevolglik bevrugting), het ons gevind dat 292 (29.7%) van die pasiënte wat preeklampsie ontwikkel het, het hul laaste maandstonde gedurende die lente ervaar. Die piek-insidensie was gedurende November. Daarteenoor is die laagste insidensie gevind in pasiënte met ‘n laaste menstruasie in die winter, met slegs 218 (22.2%) pasiënte. Gevolgtrekking - Ons het die vorige bevinding by Tygerberg Hospitaal van ‘n seisonale patroon in die ontwikkeling van preeklampsie bevestig. Ons het ook bevestig dat dit nie die datum van diagnose en verlossing is wat’n rol speel nie, maar wel die datum van laaste maandstonde en bevrugting.

Thesis (MScMedSc)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Male factor infertility is a general term that describes couples in which an inability to conceive is associated with a problem identified in the male partner. Intrauterine insemination (IUI) together with ovulation induction has been shown to be an effective treatment method for male factor infertility. Oocyte production by the ovaries is stimulated by the use of fertility drugs. A prepared sperm sample is then injected into the uterus through the vagina using an IUI catheter which brings the oocytes and spermatozoa into close proximity. Semen preparation is an integral part of an IUI cycle. In a developing country, a simple inexpensive semen preparation method for IUI procedures, not necessitating a lot of equipment, is essential. An example of such a method, the Sep-D Kit (Surelife Sep-D Kit, Surelife Media Technologies Pty Ltd, Singapore) has been proposed as a possible preparation method. In a pilot study performed by the principal investigator (Roxanne Gentis), comparing the Sep-D Kit and standard swim-up preparation methods, it was found that the Sep-D Kit compared very well with the swim-up method regarding most pre- and post-preparation semen parameters. The Sep-D Kit method, however, still needed further testing to see whether or not pregnancy rates resulting from the method are comparable with that resulting from the standard swim-up method, as this ultimately is the required result of an IUI. The primary aim of this study was to compare the Sep-D Kit method to the standard swim-up method with regards to biochemical pregnancy outcome, post-preparation sperm count, motility, total motile count (TMC), morphology, DNA compaction and fragmentation (CMA3 and TUNEL). The secondary aim was to evaluate which variables, male and female, affect biochemical pregnancy outcome. The study took place at Drs Aevitas Fertility Clinic, Vincent Pallotti Hospital, Pinelands. The study was a prospective analytical study and was conducted from December 2010 until October 2012. A total of 473 IUI cycles were evaluated. Results showed that the Sep-D Kit semen preparation method was non-inferior to the standard swim-up method with regards to biochemical pregnancy rates, post-preparation count and TMC. The swim-up method produced samples with a significantly higher post-preparation motility compared to the Sep-D Kit method, however both methods still managed to produce similar biochemical pregnancy rates (10.39% for the swim-up group versus 11.57% for Sep-D Kit group). For the total cohort of cycles analysed the only female parameter which significantly predicted biochemical pregnancy outcome in this study was age. Sperm motility (post-preparation) was the only male parameter that significantly affected biochemical pregnancy outcome. The Sep-D Kit method is more cost effective and also time saving compared to the swim-up method. There is also no need for expensive laboratory equipment or a trained embryologist using the Sep-D Kit preparation method. The Sep-D Kit may therefore be used with confidence as a standard semen preparation method, and may be implemented in developing countries for use in routine IUI procedures. / AFRIKAANSE OPSOMMING: Manlike faktor infertiliteit is 'n algemene term wat gebruik word om paartjies te beskryf wat 'n onvermoë toon om swanger te raak as gevolg van 'n probleem wat geassosieer word met die man. Die kombinasie van intra-uteriene inseminasie (IUI) en ovulasie induksie kan doeltreffend gebruik word om manlike faktor infertiliteit te behandel. Vrugbaarheidsmiddels word gebruik om oösietproduksie in die die eierstokke te stimuleer en 'n voorbereide spermmonster word dan transvaginaal in die baarmoeder ingespuit om sodoende die spermatozoa en oösiete na-aan mekaar te bring. Semenvoorbereiding is 'n integrale deel van 'n IUI siklus en in 'n ontwikkelende land is 'n eenvoudige, goedkoop semenvoorbereidingsmetode – wat die gebruik van duur toerusting uitsluit – noodsaaklik. Die Sep-D Kit metode (Surelife Sep-D Kit, Surelife Media Technologies Pty Ltd, Singapore) is 'n voorbeeld van so 'n voorbereidingsmetode. 'n Loodsstudie, uitgevoer deur die hoofnavorser, (Roxanne Gentis), het gewys dat die Sep-D Kit en standaard opswem voorbereidingmetodes goed vergelyk ten opsigte van meeste semenparameters voor- en na voorbereiding. Dit is egter ook noodsaaklikheid vir verdere navorsing om vas te stel of swangerskapuitkoms na die gebruik van die twee semenvoorbereidingsmetodess vergelykbaar is, aangesien dit die uiteindelike, verlangde uitkoms van 'n IUI is. Die primêre doel van hierdie studie was om die Sep-D Kit metode te vergelyk met die standaard opswemmetode met betrekking tot biochemiese swangerskapuitkoms asook spermtelling, motiliteit, totale motiele spermtelling (TMS), morfologie, DNA kompaksie en fragmentering (CMA3 en TUNEL) na spermvoorbereiding. Die sekondêre doel was om te evalueer watter veranderlikes, manlik en vroulik, die bichemiese swangerskapuitkoms beïnvloed. Die studie is uitgevoer by die Drs Aevitas Fertiliteitskliniek, Vincent Pallotti Hospitaal, Pinelands. Die studie was prospektief analities en het gestrek vanaf Desember 2010 tot en met Oktober 2012. 'n Totaal van 473 IUI siklusse is evalueer en ontleed. Die resultate van die studie het getoon dat die Sep-D Kit semenvoorbereidingsmetode nie ondergeskik aan die opswemmetode was ten opsigte van biochemiese swangerskap, spermtelling en TMS na semenvoorbereiding nie, Spermmotiliteit was betekenisvol hoër vir die opswemmetode vergelykend met die Sep-D Kit, maar ten spite van die verskil was die biochemiese swangerskapsyfers in die twee groepe nie verskillend nie (10.39% in die opswem groep en 11.57% in Sep-D Kit groep). In die totale kohort siklusse wat ontleed is was dit net die ouderdom van die vrou wat 'n betekenisvolle effek op biochemiese swangerskapuitkoms gehad het. Die enigste manlike faktor wat 'n betekenisvolle effek op biochemiese swangerskapuitkoms gehad het was die motiliteit na semenvoorbereiding. Die Sep-D Kit metode is meer koste-effektief en tydbesparend as die standard opswemmetode. Die uitvoer van die Sep-D Kit metode vereis ook ook geen duur apparaat of 'n opgeleide embrioloog nie. Die Sep-D Kit metode kan dus met vertroue gebruik word as 'n standaard semenvoorbereidingsmetode en kan in ontwikkelende lande vir gebruik tydens roetine IUI prosedures geïmplementeer word.

Thesis (MScMedSc)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: CHAPTER 1 A review of the application of traditional semen parameters for the investigation and diagnosis of male infertility and the role of predictive values in assisted reproductive techniques (ART) is presented. The importance of sperm morphology, with special emphasis on sperm morphology evaluation, is discussed. Also presented is an overview of the physiology of sperm DNA, the process of spermatogenesis, as well as the contribution of the spermatozoon to the embryo. The different causes of sperm DNA damage and techniques to determine DNA damage in spermatozoa are described. A survey is presented of the correlation of sperm DNA with sperm morphology. CHAPTER 2 All the materials and methods applicable to this study are described. Sperm morphology assessment and two different sperm DNA tests, the chromomycin A3 (CMA3) staining test and the terminal deoxynucleotidyl transferase (TdT)-mediated deoxyuridine triphosphate (dUTP) nick-end labelling (TUNEL) assay, are discussed in detail. CHAPTER 3 Results obtained in this study are presented. Results include the prevalence of abnormal sperm DNA and association with sperm morphology, specifically in the p-pattern and g-pattern morphology groups. Further results include the correlation of sperm morphology and sperm DNA with fertilization in vitro, embryo quality and pregnancy outcome. The percentage CMA3 positive spermatozoa (abnormal DNA) and percentage TUNEL positive spermatozoa (abnormal DNA) had a significant negative association with normal sperm morphology. P-pattern and g-pattern morphology groups differed significantly from each other for both CMA3 and TUNEL. A significant positive association between CMA3 and TUNEL was observed. No association between the percentage normal sperm morphology, percentage CMA3 positive spermatozoa and percentage TUNEL positive spermatozoa and IUI pregnancy outcome was observed. A significant negative association between the percentage TUNEL positive spermatozoa and IVF/ICSI pregnancy outcome was established. The percentage CMA3 positive spermatozoa had a significant positive (unexpected) association with IVF/ICSI pregnancy outcome. There was no association between the three variables and IVF/ICSI fertilization rates. A significant positive association between the percentage normal sperm morphology and IVF/ICSI embryo quality was found. There was a significant positive association between the percentage CMA3 positive spermatozoa and IVF/ICSI embryo quality (unexpected). The percentage TUNEL positive spermatozoa and IVF/ICSI embryo quality was negatively associated. CHAPTER 4 Interpretation of the results and future perspectives are discussed. The CMA3 staining test and TUNEL assay has a limited ability to distinguish between the p-pattern and g-pattern morphology groups. P-pattern spermatozoa are more likely to possess poor chromatin packaging and show increased levels of DNA fragmentation, but some p-pattern patients also may have normal DNA and g-pattern patients abnormal DNA. It is recommended that a sperm DNA test should be implemented routinely in andrology laboratories for the clinical diagnosis of sperm DNA damage in patients. / AFRIKAANSE OPSOMMING: HOOFSTUK 1 'n Samevatting wat handel oor die toepassing van tradisionele semen parameters vir die evaluasie en diagnose van manlike infertiliteit, asook die rol van voorspellingswaardes in kunsmatige voortplantingstegnieke word voorgelê. Die belangrikheid van sperm morfologie, met die klem op sperm morfologie evaluering, word ook bespreek. 'n Oorsig van sperm DNS fisiologie, die proses van spermatogenese, sowel as die sperm se bydrae tot die embrio word hier aangebied. Die verskillende oorsake van sperm DNS skade en die tegnieke om sperm DNS skade vas te stel, asook die die korrelasie tussen sperm DNS en sperm morfologie word ook bespreek. HOOFSTUK 2 Alle materiale en metodes wat van toepassing is op hierdie studie word beskryf. Sperm morfologie evaluering en twee verskillende sperm DNS toetse, die chromomycin A3 (CMA3) kleuringstoets en die “terminal deoxynucleotidyl transferase (TdT)-mediated deoxyuridine triphosphate (dUTP) nick-end labelling (TUNEL)" toets, word ook in meer besonderhede aangebied. HOOFSTUK 3 Resultate wat verkry is tydens hierdie studie word hier uiteengesit. Resultate behels die voorkomsyfer van abnormale DNS en die assosiasie met sperm morfologie, spesifiek in die p-patroon en g-patroon. Verdere resultate sluit die korrelasie van sperm morfologie en sperm DNS met bevrugting in vitro, embriokwaliteit en swangerskap uitkomste in. Die persentasie CMA3 positiewe sperme (abnormale DNS) en persentasie TUNEL positiewe sperme (abnormale DNS) het 'n betekenisvolle negatiewe assosiasie met normale sperm morfologie getoon. P-patroon en g-patroon morfologie groepe het betekenisvol van mekaar verskil vir beide CMA3 en TUNEL. 'n Betekenisvolle positiewe assosiasie is tussen CMA3 en TUNEL waargeneem. Geen assosiasie is tussen die persentasie normale sperm morfologie, persentasie CMA3 positiewe sperme en persentasie TUNEL positiewe sperme en IUI swangerskap uitkomste waargeneem nie. 'n Betekenisvolle negatiewe assosiasie is tussen die persentasie TUNEL positiewe sperme en IVB/ICSI swangerskap uitkomste vasgestel. Die persentasie CMA3 positiewe sperme het 'n betekenisvolle positiewe (onverwags) assosiasie met IVB/ICSI swangeskap uitkomste opgewys. Daar was geen assosiasie tussen die drie veranderlikes en IVB/ICSI bevrugting nie. 'n Betekenisvolle positiewe assosiasie is tussen die persentasie normale sperm morfologie en IVB/ICSI embryo kwaliteit waargeneem. Daar was 'n betekenisvolle positiewe assosiasie tussen die persentasie CMA3 positiewe sperme en IVB/ICSI embrio kwaliteit (onverwags). Die persentasie TUNEL positiewe sperme het 'n negatiewe assosiasie met IVB/ICSI embrio kwaliteit getoon. HOOFSTUK 4 Interpretasie van die resultate en toekomstige vooruitsigte is bespreek. Die CMA3 kleuringstoets en TUNEL toets het 'n beperkte vermoë om tussen die p-patroon en g-patroon morfologie groepe te onderskei. P-patroon spermatozoa sal heel waarskynlik oor swakker chromatien verpakking en meer DNS fragmentasie beskik. Sommige p-patroon pasiënte mag egter normale DNS toon, terwyl g-patroon pasiënte abnormale DNS het. Die implementering van 'n sperm DNS toets in andrologie laboratoriums, vir die kliniese diagnose van sperm DNS skade in pasiënte, word aanbeveel.