Presentation and outcomes of Listeria-affected pregnancies in Johannesburg tertiary hospitals: A 2-year review.

OBJECTIVE: To describe maternal risk factors, presentations, peripartum findings, and pregnancy outcomes in Listeria monocytogenes-infected women. METHODS: A retrospective descriptive case review. The records of 51 pregnant women infected with listeriosis who delivered infants between February 1, 2016 and February 28, 2018 at three academic hospitals in Johannesburg, South Africa, were included. The diagnosis of listeriosis was made on maternal/neonatal-sampled blood or tissue cultures. RESULTS: Forty-eight (82.3%) Listeria infections of maternal and neonatal listeriosis were diagnosed on blood culture. The median gestational age at diagnosis was at a preterm gestation of 33 (20-43) weeks. Twenty-eight women (54.9%) had normal vaginal deliveries. Precipitous labor was described in 18 (39%) of these women. Fetal distress was the indication for cesarean section in 22 (41.2%) women. Meconium-stained amniotic fluid was found in 21 (61.7%) women at the time of delivery. The category of very low birth weight had 14 (27.4%) neonates with an Apgar score of less than 7 at 5 min. Maternal morbidities included chorioamnionitis (3 [5.8%]) and puerperal infections (7 [13.7%]). The HIV-positive anemic women had a tendency towards listerial infections. CONCLUSIONS: Symptoms of listeriosis were non-specific and diagnosis was detected on blood culture sampling. Risk factors included HIV seropositivity and were associated with puerperal infections and anemia.

"Suction Tube Uterine Tamponade" for treatment of refractory postpartum hemorrhage: Internal feasibility and acceptability pilot of a randomized clinical trial.

OBJECTIVE: To assess feasibility and acceptability of a novel, low-cost "Suction Tube Uterine Tamponade" (STUT) treatment for refractory postpartum hemorrhage (PPH). METHODS: We allocated patients with refractory PPH by randomly ordered envelopes to STUT or routine uterine balloon tamponade (UBT, Ellavi free-flow system) in 10 hospitals in South Africa. In the STUT group, a 24FG Levin stomach tube was inserted into the uterine cavity and vacuum created with a vacuum pump or manual vacuum aspiration syringe. RESULTS: For this internal pilot study, 12 participants were allocated to STUT and 12 to UBT. Insertion failed in one of each group and was recorded as difficult in 3/10 STUT and 4/9 UBT insertions respectively (five missing data). There were two laparotomies and one intensive care unit admission in the UBT group. Pain during STUT insertion was graded as none/mild in 9/10 and severe in 1/10. The experience of the STUT procedure was graded as fine in 4/11 and "uncomfortable but acceptable" in 7/11. CONCLUSION: STUT is feasible and acceptable, justifying continuation of our trial. These data will also inform a large World Health Organization trial to test effectiveness of uterine tamponade methods. The numbers are too small to support any clinical recommendation.

Maternal outcomes before and after new oxytocin protocol at cesarean delivery.

OBJECTIVE: The primary objective was to describe the incidence of post-partum hemorrhage at cesarean delivery before and after implementation of a new high dose oxytocin protocol at Chris Hani Baragwanath Academic Hospital. METHODS: This was a cross sectional retrospective record review 3 months before and 3 months after the implementation of a high dose oxytocin protocol. The study included all women that underwent cesarean delivery between 1 November 2016 and 30 April 2017 with a gestation of >24 weeks. RESULTS: A total of 4604 Cesarean deliveries were performed during the study period, 2162 before the implementation of the new protocol and 2442 after. The incidence of post-partum hemorrhage was 4.8% (n = 91) in the Before group and 3.9% (n = 89) in the After group (P = 0.17). There was a 17.9% change in incidence of postpartum hemorrhage between the groups (P = 0.17). There was no significant difference in uterine atony between the Before and After groups (21.8% and 30.1%, P = 0.30). CONCLUSION: There was no difference in the incidence of postpartum hemorrhage at cesarean delivery after the implementation of a high dose oxytocin protocol.

Nuchal translucency as a method of first-trimester screening for aneuploidy.

OBJECTIVE: To determine the effectiveness of nuchal translucency (NT) screening in predicting aneuploidy and structural abnormalities in a South African population. STUDY DESIGN: Descriptive study. Setting. Chris Hani Baragwanath Hospital fetal medicine unit. OUTCOME MEASURES: An adjusted risk was derived from the combination of maternal age-related risk and the risk derived from NT screening. A positive screen was denoted by an adjusted risk of more than 1/300 and a negative screen by an adjusted risk of less than 1/300. In order to determine the number of undiagnosed abnormalities in the group, all babies were examined by a paediatrician at birth to detect and describe dysmorphic features. RESULTS: A total of 428 patients underwent first-trimester screening between July 2003 and July 2005. Three per cent were lost to follow-up. Of the 415 patients analysed, 59 screened positive and 356 screened negative. The mean age for both groups of patients was 30.1 years. Of the 57 patients who screened positive, 24 elected to have chorionic villus sampling (CVS). This resulted in the detection of 6 chromosomal abnormalities and 2 structural abnormalities. Among the remaining 356 patients, who had screened negative, 2 had an increase in the adjusted risk when the risk was compared with the background risk, and 1 chromosomal abnormality was detected in this group; 8 elected to have CVS because of a previous history of a chromosomal abnormality, and there were no abnormalities among them. CONCLUSIONS: The use of these screening methods has enabled prenatal karyotyping to become cost effective, and allows concentration on pregnancies at highest risk for chromosomal abnormalities, regardless of age.