South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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The mechanism of episodes of fetal bradycardia during epidural analgesia is unknown in the majority of cases. This retrospective study considers the relationship between prolonged fetal bradycardia and epidural analgesia during labour. Of 705 cardiotocographs recorded during administration of epidural analgesia for patients in labour, 207 were suitable for analysis. ⋯ It is concluded that administration of epidural analgesia is significantly associated with episodes of prolonged fetal bradycardia, but that there is usually a return to pre-epidural patterns. The fetal heart rate should be monitored during epidural block administration to confirm the return to baseline rate and normal variability. Episodes of fetal bradycardia that return to a normal pattern do not necessitate early delivery.
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Fractures of the occipital condyle are rare and occur when the head is severely injured; they may be associated with fractures of the skull and the cervical spine. Conservative management appears to give satisfactory results.
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The prevalence of sexually transmitted pathogens in two groups of women was studied: 50 women with clinical diagnoses of acute pelvic inflammatory disease (PID) and 50 asymptomatic women attending a family planning clinic (FPC). Genital specimens, collected by non-invasive procedures, were examined. Endocervical Neisseria gonorrhoeae was present in 62% of the PID group and 10% of the FPC group (P less than 0.0001). ⋯ Antibody to the human immunodeficiency virus was not detected in any of the 100 women. The high prevalence of recognised sexually transmitted pathogens underlines the need for appropriate antimicrobial agent(s) active against N. gonorrhoeae, C. trachomatis and M. hominis in patients with PID. In view of the high prevalence of penicillinase-producing strains of N. gonorrhoeae, routine use of an antibiotic active against such strains is desirable.
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In a study of 200 patients with chest wounds in whom the need for referral to a centre with radiographic facilities was not obvious, careful clinical examination (pulse, blood pressure, respiratory rate, haemoglobin value and chest auscultation) was found to be a reliable triage tool. The sensitivity of one or more positive signs was 99.2% with a false-positive rate of 16% and a false-negative rate of 2%. The positive predictive value of two or more positive signs was found to be 99.1%.