3D ultrasound volumes obtained for PhD study of Lou Pistorius from 2006 – 2008. Twenty eight heal... more 3D ultrasound volumes obtained for PhD study of Lou Pistorius from 2006 – 2008. Twenty eight healthy pregnant women were included after a screening ultrasound examination at 20 weeks had demonstrated a singleton pregnancy with no abnormal findings. The gestational (postmenstrual) age was determined by the time from the first day of the last menstruation and confirmed with a crown rump length (CRL) measurement in the first trimester. Women were excluded if there was a discrepancy of seven days or more between the gestational age according to the CRL and the menstrual dating, or if there were risk factors which might influence fetal growth or development, such as maternal disease or previous intra-uterine growth restriction. The study was approved by the local Medical Ethics Committee of the University Medical Centre, Utrecht, The Netherlands. Ultrasound examinations were carried out at two weekly intervals with a General Electric Voluson 730 Expert (General Electric Healthcare, Londo...
Chiari’s network is a remnant of the eustachian valve located in the right atrium. Incomplete inv... more Chiari’s network is a remnant of the eustachian valve located in the right atrium. Incomplete involution of the fetal sinus venosus valves results in ‘‘redundant’’ Chiari’s network, which may compromise cardiovascular function. This report describes a case with the novel finding of prenatal compromise due to redundant Chiari’s network and an uncommon case with significant postnatal symptoms. In both cases, the symptoms (fetal hydrops and postnatal cyanosis) resolved spontaneously. The variety of cardiovascular pathologies described in the literature is believed to be associated with persistence of a Chiari network. Knowledge about this not always harmless structure is important for perinatologists, pediatricians, and pediatric cardiologists alike. The clinical importance of this rare pathology is that prenatal counseling may anticipate a generally positive outcome and that surgical intervention generally should be avoided. Keywords Additional heart sound Chiari’s network Congenital ...
Prenatal genetic screening is an integral part of general antenatal care and is regarded as stand... more Prenatal genetic screening is an integral part of general antenatal care and is regarded as standard of care for all pregnant women. All pregnant women < 20 weeks gestation should be offered some form of genetic screening and this should be discussed in an extensive pre-test counselling session. Late screening (after 20 weeks) may also be offered but will be limited by management options. Cell-free DNA testing has added another dimension to the landscape of prenatal screening but has to be appropriately used for the correct indication. Interpretation of risk for Down’s syndrome is a critical component of the screening process. A guideline would be to regard screening risks in absolute terms as there is no provision made to interpret risk in relative risk terms. An important safeguard to overcome the “relative risk” conundrum would be to inform all patients during pre-test counselling of an intermediate risk category generally between 1:300-1:1000 where cfDNA testing may be consid...
The prevalence of monozygotic (MC) twins (twins developing from a single fertilised oocyte) is co... more The prevalence of monozygotic (MC) twins (twins developing from a single fertilised oocyte) is constant in different populations at around three per 1000 pregnancies.
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2021
The science surrounding cerebral palsy indicates that it is a complex medical condition with mul... more The science surrounding cerebral palsy indicates that it is a complex medical condition with multiple contributing variables and factors, and causal pathways are often extremely difficult to delineate. The pathophysiological processes are often juxtaposed on antenatal factors, genetics, toxins, fetal priming, failure of neuroscientific autoregulatory mechanisms, abnormal biochemistry and abnormal metabolic pathways. Placing this primed compromised compensated brain through the stresses of an intrapartum process could be the final straw in the pathway to brain injury and later CP. It is thus simplistic to base causation of cerebral palsy on only an intrapartum perspective with radiological 'confirmation', as is often the practice in medicolegal cases in South African courts. The present modalities (MRI and CTG when available) that retrospectively attempt to determine causation in courts are inadequate when used in isolation. Unless a holistic scientific review of the case ...
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, Jan 13, 2016
Hypertensive disorders of pregnancy (HDP) affect foetal outcome. Labetalol is frequently used to ... more Hypertensive disorders of pregnancy (HDP) affect foetal outcome. Labetalol is frequently used to lower maternal blood pressure and prolong pregnancy. Conflicting evidence exists for specific neonatal side effects described after maternal labetalol treatment. Our aim was to investigate neonatal effects of foetal exposure to labetalol on cerebral oxygenation and extraction. In a prospective observational study, clinical characteristics, vital parameters and cerebral oxygen delivery and extraction were collected during the first 24 h of life in labetalol-exposed preterm neonates and compared with two control groups. Twenty-two infants with a mean gestational age of 28.9 weeks, born from labetalol-treated mothers with HDP were included and matched with 22 infants with non-labetalol-treated mothers with HDP and 22 infants without maternal HDP. No significant differences between groups were found neither in heart rate, blood pressure and inotropic support, nor in mean regional cerebral ox...
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2002
To determine the accuracy of near-patient and laboratory-based fetal lung maturity tests in predi... more To determine the accuracy of near-patient and laboratory-based fetal lung maturity tests in predicting the need for neonatal ventilation. A prospective descriptive study. One hundred high-risk obstetric patients where confirmation of fetal lung maturity would initiate delivery. Fetal weight estimation, placental maturity grading, and amniocentesis were performed. The investigators examined the amniotic fluid visually, and performed the tap test and shake test. Laboratory technicians estimated the lecithin-sphingomyelin (L/S) ratio, determined the presence of a phosphatidyl glycerol (PG) band on gel electrophoresis, and the optical density at 650 nm. Neonates delivered within 1 week of amniocentesis were included in the analysis. The primary end-point was the ability of the lung maturity tests to predict the need for neonatal ventilation. Twelve of 100 neonates required ventilation. The tap test and optical density (OD) shift at 650 nm predicted the need for neonatal ventilation with...
Hydranencephaly is a fetal central nervous system disorder in which most of the cerebral hemisphe... more Hydranencephaly is a fetal central nervous system disorder in which most of the cerebral hemispheres are damaged and largely replaced with cerebrospinal fluid. We present susceptibility-weighted imaging findings in an infant with hydranencephaly, who showed foci of signal loss mainly at the peripheral portion of the thalamus and falx cerebri. Although the exact cause of hydranencephaly has not been established, these findings suggest previous hemorrhage and parenchymal destructive changes.
In medicine, it seems that technology and pharmacology are inspiring each other with the same syn... more In medicine, it seems that technology and pharmacology are inspiring each other with the same synergism as computer hardware and software. As example of this, the survival of smaller and smaller babies has steadily been increasing over the past few decades. Very low birth weight (below 1500g) has had to be redefined to include extremely low birth weight (below 1000g), and severe prematurity (below 32 weeks) to include extreme prematurity (below 28 weeks).
3D ultrasound volumes obtained for PhD study of Lou Pistorius from 2006 – 2008. Twenty eight heal... more 3D ultrasound volumes obtained for PhD study of Lou Pistorius from 2006 – 2008. Twenty eight healthy pregnant women were included after a screening ultrasound examination at 20 weeks had demonstrated a singleton pregnancy with no abnormal findings. The gestational (postmenstrual) age was determined by the time from the first day of the last menstruation and confirmed with a crown rump length (CRL) measurement in the first trimester. Women were excluded if there was a discrepancy of seven days or more between the gestational age according to the CRL and the menstrual dating, or if there were risk factors which might influence fetal growth or development, such as maternal disease or previous intra-uterine growth restriction. The study was approved by the local Medical Ethics Committee of the University Medical Centre, Utrecht, The Netherlands. Ultrasound examinations were carried out at two weekly intervals with a General Electric Voluson 730 Expert (General Electric Healthcare, Londo...
Chiari’s network is a remnant of the eustachian valve located in the right atrium. Incomplete inv... more Chiari’s network is a remnant of the eustachian valve located in the right atrium. Incomplete involution of the fetal sinus venosus valves results in ‘‘redundant’’ Chiari’s network, which may compromise cardiovascular function. This report describes a case with the novel finding of prenatal compromise due to redundant Chiari’s network and an uncommon case with significant postnatal symptoms. In both cases, the symptoms (fetal hydrops and postnatal cyanosis) resolved spontaneously. The variety of cardiovascular pathologies described in the literature is believed to be associated with persistence of a Chiari network. Knowledge about this not always harmless structure is important for perinatologists, pediatricians, and pediatric cardiologists alike. The clinical importance of this rare pathology is that prenatal counseling may anticipate a generally positive outcome and that surgical intervention generally should be avoided. Keywords Additional heart sound Chiari’s network Congenital ...
Prenatal genetic screening is an integral part of general antenatal care and is regarded as stand... more Prenatal genetic screening is an integral part of general antenatal care and is regarded as standard of care for all pregnant women. All pregnant women < 20 weeks gestation should be offered some form of genetic screening and this should be discussed in an extensive pre-test counselling session. Late screening (after 20 weeks) may also be offered but will be limited by management options. Cell-free DNA testing has added another dimension to the landscape of prenatal screening but has to be appropriately used for the correct indication. Interpretation of risk for Down’s syndrome is a critical component of the screening process. A guideline would be to regard screening risks in absolute terms as there is no provision made to interpret risk in relative risk terms. An important safeguard to overcome the “relative risk” conundrum would be to inform all patients during pre-test counselling of an intermediate risk category generally between 1:300-1:1000 where cfDNA testing may be consid...
The prevalence of monozygotic (MC) twins (twins developing from a single fertilised oocyte) is co... more The prevalence of monozygotic (MC) twins (twins developing from a single fertilised oocyte) is constant in different populations at around three per 1000 pregnancies.
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2021
The science surrounding cerebral palsy indicates that it is a complex medical condition with mul... more The science surrounding cerebral palsy indicates that it is a complex medical condition with multiple contributing variables and factors, and causal pathways are often extremely difficult to delineate. The pathophysiological processes are often juxtaposed on antenatal factors, genetics, toxins, fetal priming, failure of neuroscientific autoregulatory mechanisms, abnormal biochemistry and abnormal metabolic pathways. Placing this primed compromised compensated brain through the stresses of an intrapartum process could be the final straw in the pathway to brain injury and later CP. It is thus simplistic to base causation of cerebral palsy on only an intrapartum perspective with radiological 'confirmation', as is often the practice in medicolegal cases in South African courts. The present modalities (MRI and CTG when available) that retrospectively attempt to determine causation in courts are inadequate when used in isolation. Unless a holistic scientific review of the case ...
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, Jan 13, 2016
Hypertensive disorders of pregnancy (HDP) affect foetal outcome. Labetalol is frequently used to ... more Hypertensive disorders of pregnancy (HDP) affect foetal outcome. Labetalol is frequently used to lower maternal blood pressure and prolong pregnancy. Conflicting evidence exists for specific neonatal side effects described after maternal labetalol treatment. Our aim was to investigate neonatal effects of foetal exposure to labetalol on cerebral oxygenation and extraction. In a prospective observational study, clinical characteristics, vital parameters and cerebral oxygen delivery and extraction were collected during the first 24 h of life in labetalol-exposed preterm neonates and compared with two control groups. Twenty-two infants with a mean gestational age of 28.9 weeks, born from labetalol-treated mothers with HDP were included and matched with 22 infants with non-labetalol-treated mothers with HDP and 22 infants without maternal HDP. No significant differences between groups were found neither in heart rate, blood pressure and inotropic support, nor in mean regional cerebral ox...
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2002
To determine the accuracy of near-patient and laboratory-based fetal lung maturity tests in predi... more To determine the accuracy of near-patient and laboratory-based fetal lung maturity tests in predicting the need for neonatal ventilation. A prospective descriptive study. One hundred high-risk obstetric patients where confirmation of fetal lung maturity would initiate delivery. Fetal weight estimation, placental maturity grading, and amniocentesis were performed. The investigators examined the amniotic fluid visually, and performed the tap test and shake test. Laboratory technicians estimated the lecithin-sphingomyelin (L/S) ratio, determined the presence of a phosphatidyl glycerol (PG) band on gel electrophoresis, and the optical density at 650 nm. Neonates delivered within 1 week of amniocentesis were included in the analysis. The primary end-point was the ability of the lung maturity tests to predict the need for neonatal ventilation. Twelve of 100 neonates required ventilation. The tap test and optical density (OD) shift at 650 nm predicted the need for neonatal ventilation with...
Hydranencephaly is a fetal central nervous system disorder in which most of the cerebral hemisphe... more Hydranencephaly is a fetal central nervous system disorder in which most of the cerebral hemispheres are damaged and largely replaced with cerebrospinal fluid. We present susceptibility-weighted imaging findings in an infant with hydranencephaly, who showed foci of signal loss mainly at the peripheral portion of the thalamus and falx cerebri. Although the exact cause of hydranencephaly has not been established, these findings suggest previous hemorrhage and parenchymal destructive changes.
In medicine, it seems that technology and pharmacology are inspiring each other with the same syn... more In medicine, it seems that technology and pharmacology are inspiring each other with the same synergism as computer hardware and software. As example of this, the survival of smaller and smaller babies has steadily been increasing over the past few decades. Very low birth weight (below 1500g) has had to be redefined to include extremely low birth weight (below 1000g), and severe prematurity (below 32 weeks) to include extreme prematurity (below 28 weeks).
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