3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item A study of vaccination status, weights and birthplace of children aged 12 to 23 months in the Mosvold Health Ward of KwaZulu(1992) Buchmann, Eckhart JohannesThe objective of the research reported in this thesis was to describe the vaccination coverage of children aged 12 to 23 months in the Mosvold Health Ward of northern Kwa-Zulu. The Expanded Programme on Immunisation cluster sample technique was used. Simultaneous measurements of the children's weights and arm circumferences were done, and their birthplaces noted. Vaccination coverage rates were generally low; 74 to 83 per cent of the children had had BCG, 47 to 56 per cent had had three doses of DPT, 48 to 57 per cent had had three doses of polio and 47 to 56 per cent had had one dose of measles vaccine. Forty-eight per cent of the children had been born at home. Fifteen per cent had weights which Were more than two standard deviations below the median weight-for-age according to NCHS curves, 11 per cent had arm circumferences of 13,5 centimetres or less. The results are compared with other findings from else Where in southern Africa. Relevant literature on vaccination coverage improvement and the measurement thereof, is reviewed. Recommendations are made for increasing coverage rates in the Mosvold Health Ward) •Item The predictive ability of clinical palpation for estimating amniotic fluid volume in suspected prolonged pregnancy(2013-04-11) Buchmann, Eckhart JohannesBackground and objectives In low resource settings, ultrasound scans may not be available for amniotic fluid volume (AFV) assessment as part of fetal evaluation for suspected prolonged pregnancies (≥41 weeks’ gestation). The objectives of this study were: 1) to describe AFV measurements using ultrasound in women with suspected prolonged pregnancies, and to relate these measurements to maternal and fetal factors; 2) to evaluate different clinical palpation methods for estimating AFV; and 3) to determine the ability of clinical palpation to estimate AFV and predict oligohydramnios, using ultrasound-based amniotic fluid index (AFI) as a gold standard, accounting for the influence of maternal and fetal factors. Methods The study included women referred to Chris Hani Baragwanath Academic Hospital from midwife-run antenatal clinics because of concern about prolonged pregnancy (gestational age ≥41 weeks). On arrival at hospital, the women had real-time ultrasound assessment of AFI by an experienced ultrasonographer. The researcher, blinded to the AFI result, estimated AFV by abdominal palpation using ballottability of fetal parts, uterine fluctuance, uterine irritability, easily felt fetal parts, and a general impression of AFV. After recording the palpation findings, the researcher made a best estimate of gestational age for each woman based on the last menstrual period, early pregnancy ultrasound scans if available, or other relevant clinical information. Oligohydramnios was defined as an AFI <5 cm. Results One hundred women participated, of whom 45 had a best estimate gestational age ≥41 weeks. The mean AFI was 8.1±4.3 cm; 23 women had an AFI <5 cm. Twenty women were HIV infected. In univariable and multivariable linear regression analysis, HIV infection and gestational age were inversely associated with AFI at a P value <0.05. On abdominal palpation, the symphysis-fundal height, uterine fundal fetal parts ballottement, and presenting part ballottement were significantly positively associated with AFI on univariable and multivariable linear regression analysis. For the binary outcome of oligohydramnios, only presenting part ballottement was associated with an AFI <5 cm (negatively), both crudely, and adjusted for gestational age and HIV infection using logistic regression analysis. For women with a fetal head fully palpable (‘five fifths’) above the pubic symphysis (n=55), an inability to ballot the presenting part had a sensitivity of 73%, specificity of 64%, and a negative predictive value of 90% for an AFI <5 cm. Conclusion While fetal part ballottement and symphysis-fundal height measurement showed significant associations with AFI, the predictive value of clinical palpation for oligohydramnios was poor. However, in settings where real-time ultrasound technology is unavailable, the assessment of presenting part ballottement may be of value in women with suspected prolonged pregnancy. In clinical settings similar to those in this study, a ballottable fetal head gives 90% assurance of normal AFV.Item Head descent, moulding and other intrapartum clinical findings in the prediction of cephalopelvic disproportion(2008-07-15T12:58:40Z) Buchmann, Eckhart JohannesABSTRACT Cephalopelvic disproportion (CPD) is a common and serious obstetric condition, especially in sub-Saharan Africa. Recognition relies on clinical observations, such as cervical dilatation, head descent, moulding, and size of fetus, all made in a trial of labour. No prospective studies have investigated intrapartum clinical observations and their predictive value for CPD. The objectives of this research were 1) to determine the association of intrapartum clinical findings, especially level of head and moulding, with the outcome of CPD, 2) to determine inter-observer agreement of these findings between clinicians, and 3) to compare intrapartum clinical palpation with symphysis-fundal height (SFH) measurement in the prediction of birth weight. A prospective cross-sectional comparative study was done in the Chris Hani Baragwanath labour ward, a large referral centre. The subjects were women at term, in the active phase of labour, with vertex presentations. The author, blinded to previous clinical or ultrasound findings, performed clinical assessments at the same time as the women’s attending clinicians. His observations were not divulged to the clinicians and he did not participate in obstetric management of the women. The primary outcome measures were CPD, defined as caesarean section for poor progress, and birth weight. Five hundred and eight women were examined, of whom 113 (22.2%) had CPD. Multivariate analysis identified short maternal stature, increased SFH, lesser cervical dilatation, long duration of labour, high degree of parieto-parietal moulding, and high degree of caput succedaneum as independent predictors for CPD. Fetal position and occipito-parietal moulding were not predictive, and level of head, by fifths and by station, was poorly predictive. Inter-observer agreement between the author and attending clinicians was moderate for cervical dilatation, engagement of the head in fifths, and caput succedaneum, and poor for engagement of the head by station. SFH measurement was a slightly better predictor of birth weight than clinical fetal weight estimation. The clinical observations that were shown to be predictive for CPD may be useful adjuncts in the management of a trial of labour. Inter-observer agreement of these findings is at best moderate. Measurement of SFH deserves more attention as an intrapartum predictor of birth weight.