G J Hofmeyr

University of the Witwatersrand, Johannesburg, Gauteng, South Africa

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Publications (126)404.7 Total impact

  • G J Hofmeyr
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    ABSTRACT: Meconium-stained amniotic fluid is a common occurrence which places the mother at risk of escalating obstetric interventions, and the baby at risk of meconium aspiration syndrome. The Cochrane Library was searched for interventions related to care before delivery with useful evidence on the outcomes 'meconium-stained amniotic fluid' and 'meconium aspiration syndrome'. Curtailment of post-term pregnancy reduces the occurrence of meconium-stained amniotic fluid, and meconium aspiration syndrome. Uterine stimulants, particularly misoprostol, are associated with occurrence of meconium-stained amniotic fluid. Amniotomy during labour may be a risk factor for meconium aspiration syndrome. There is little research evidence on the benefits or otherwise of obstetric interventions such as expedited delivery for meconium-stained liquor without other evidence of fetal distress. Amnioinfusion for meconium-stained amniotic fluid improves neonatal outcome only in settings with limited peripartum surveillance. There is insufficient evidence to support the use of amnioinfusion for meconium-stained liquor in settings with adequate peripartum surveillance.
    Early human development 10/2009; 85(10):611-5. DOI:10.1016/j.earlhumdev.2009.09.010 · 2.12 Impact Factor
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    G J Hofmeyr
    Ultrasound in Obstetrics and Gynecology 10/2009; 34(4):367-70. DOI:10.1002/uog.7352 · 3.56 Impact Factor
  • N Novikova, M Chitnis, V Linder, G J Hofmeyr
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    ABSTRACT: A case of an attempted suicide with atypical antipsychotic (clozapine) in late pregnancy is reported. Toxic effects of clozapine in the mother as well as in the fetus and newborn were observed. It should be remembered as a rare cause of unexplained loss of consciousness in pregnant women, a cause of abnormalities on fetal cardiotocogram as well as a cause of delayed peristalsis in a newborn baby.
    Australian and New Zealand Journal of Obstetrics and Gynaecology 09/2009; 49(4):442-4. DOI:10.1111/j.1479-828X.2009.01017.x · 1.30 Impact Factor
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    ABSTRACT: Summary Introduction The roles of catecholamines and cortisol in human labour are poorly understood. Plasma levels of these hormones increase during labour and are reported to correlate with maternal anxiety and pain (Lederman et al., 1978). Review of 11 random allocation trials of support from a caregiver during labour has shown a wide range of beneficial effects (Hodnett, 1994), including considerable shortening of the duration of labour and reduced incidence of perinatal complications (Sosa et al., 1980; Klaus et al., 1986). To test the hypothesis that companionship in labour may be associated with reduced stress hormone levels, we have measured plasma adrenaline, noradrenaline and dopamine levels and serum cortisol levels in women enrolled in a random trial of companionship during labour.
    Journal of Obstetrics and Gynaecology 07/2009; 15(3):178-179. DOI:10.3109/01443619509015491 · 0.60 Impact Factor
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    ABSTRACT: Summary The objective of the study was to compare platelet activating factor (PAF) concentrations in pre-eclamptic and healthy normotensive pregnant women. Blood samples for measurement of platelet count, urea and creatinine, and of PAF by thin layer chromatography and high performance liquid chromatography were obtained from seven pre-eclamptic and seven healthy primigravidae. The main outcomes were PAF concentrations in the pre-eclampsia and control groups and correlation of PAF concentrations with gestational age. PAF concentration in the pre-eclamptic group was lower than that of the controls (18˙8 versus 36˙0, P = 0˙001). Both groups exhibited a correlation between plasma PAF levels and gestational age (study group, r =-0˙84; control group, r=-0˙79). Decreased circulating PAF levels in the pre-eclamptic group may represent loss of physiological control of vascular reactivity and platelet function by PAF.
    Journal of Obstetrics and Gynaecology 07/2009; 15(5):288-291. DOI:10.3109/01443619509030919 · 0.60 Impact Factor
  • G J Hofmeyr, M Mathai, A Shah, N Novikova
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    ABSTRACT: Rates of caesarean section (CS) have been rising globally. It is important to use the most effective and safe technique. To compare the effects of complete methods of caesarean section; and to summarise the findings of reviews of individual aspects of caesarean section technique. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (August 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 3) and reference lists of identified papers. Randomised controlled trials of intention to perform caesarean section using different techniques. Two review authors independently assessed studies and extracted data. 'Joel-Cohen based' compared with Pfannenstiel CS was associated with: less blood loss, (five trials, 481 women; weighted mean difference (WMD) -64.45 ml; 95% confidence interval (CI) -91.34 to -37.56 ml); shorter operating time (five trials, 581 women; WMD -18.65; 95% CI -24.84 to -12.45 minutes); postoperatively, reduced time to oral intake (five trials, 481 women; WMD -3.92; 95% CI -7.13 to -0.71 hours); less fever (eight trials, 1412 women; relative risk (RR) 0.47; 95% CI 0.28 to 0.81); shorter duration of postoperative pain (two comparisons from one trial, 172 women; WMD -14.18 hours; 95% CI -18.31 to -10.04 hours); fewer analgesic injections (two trials, 151 women; WMD -0.92; 95% CI -1.20 to -0.63); and shorter time from skin incision to birth of the baby (five trials, 575 women; WMD -3.84 minutes; 95% CI -5.41 to -2.27 minutes). Serious complications and blood transfusions were too few for analysis.Misgav-Ladach compared with the traditional method (lower midline abdominal incision) was associated with reduced: blood loss (339 women; WMD -93.00; 95% CI -132.72 to -53.28 ml); operating time (339 women; WMD-7.30; 95% CI -8.32 to -6.28 minutes); time to mobilisation (339 women; WMD -16.06; 95% CI -18.22 to -13.90 hours); and length of postoperative stay for the mother (339 women; WMD -0.82; 95% CI -1.08 to -0.56 days). Misgav-Ladach compared with modified Misgav-Ladach methods was associated with a longer time from skin incision to birth of the baby (116 women; WMD 2.10; 95% CI 1.10 to 3.10 minutes). 'Joel-Cohen based' methods have advantages compared to Pfannenstiel and to traditional (lower midline) CS techniques, which could translate to savings for the health system. However, these trials do not provide information on mortality and serious or long-term morbidity such as morbidly adherent placenta and scar rupture.
    Cochrane database of systematic reviews (Online) 02/2008; DOI:10.1002/14651858.CD004662.pub2 · 5.94 Impact Factor
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    ABSTRACT: To test the hypothesis that calcium supplementation inhibits the underlying pathological processes in women with preeclampsia. Seven hundred and eight nulliparous women were enrolled in a WHO randomized double-blind trial, who received 1.5 g of calcium or placebo from 20 weeks of pregnancy or earlier. Platelet count, serum urate, and urinary protein/creatinine ratio were measured at or near 35 gestational weeks. No difference was detected in rates of abnormal platelet count (relative risk [RR] 1.18; 95% confidence interval [CI], 0.63 to 2.18), serum urate level (1.0; 0.64 to 1.57) or urine protein/creatinine ratio (1.01; 0.76 to 1.34). This was consistent with the main trial finding of no difference in the incidence of 'dipstick' proteinuria between women receiving calcium and those receiving placebo (8312 women; RR, 1.01; 95% CI, 0.88 to 1.15). An effect of calcium supplementation in the second half of pregnancy on the rate of abnormal laboratory measures associated with preeclampsia was not demonstrated.
    Hypertension in Pregnancy 02/2008; 27(3):299-304. DOI:10.1080/10641950701826802 · 0.93 Impact Factor
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    ABSTRACT: Induction of labor is common in clinical practice. Many different medical and mechanical methods have been used, but the current gold standard is vaginal dinoprostone. Misoprostol has been used for the induction of labor since 1987. In early studies with large misoprostol doses (e.g. 200 microg) there were high rates of uterine hyperstimulation. Cochrane meta-analysis, however, shows that when used in low doses it is as effective as vaginal dinoprostone and with no excess of hyperstimulation. 25 microg vaginal misoprostol 4-hourly, 50 microg oral misoprostol 4-hourly or 20 microg oral misoprostol solution 2-hourly are all safe and effective regimens. Reports of uterine rupture in women with previous cesarean sections mean that it remains contraindicated in this group.
    International Journal of Gynecology & Obstetrics 01/2008; 99 Suppl 2:S194-7. DOI:10.1016/j.ijgo.2007.09.011 · 1.56 Impact Factor
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    G J Hofmeyr, L Duley, A Atallah
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    ABSTRACT: Calcium supplementation during pregnancy may reduce the risk of hypertensive disorders of pregnancy. We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Central Register of Controlled Trials (March 2006). Randomised trials comparing at least 1 g of calcium daily during pregnancy with placebo. Eligibility and trial quality were assessed. Data were extracted and analysed using Review Manager software. Twelve studies (15,528 women) were included, all of good quality. Most women were at low risk and had low dietary calcium. High blood pressure was reduced with calcium supplementation rather than placebo (11 trials, 14,946 women: relative risk [RR] random effects model 0.70; 95% CI 0.57-0.86), as was pre-eclampsia (12 trials, 15,206 women: RR 0.48; 95% CI 0.33-0.69). The effect was greatest for women at high risk (five trials, 587 women: RR 0.22; 95% CI 0.12-0.42) and for those with low baseline calcium intake (seven trials, 10,154 women: RR 0.36; 95% CI 0.18-0.70). There was heterogeneity, with less effect in the larger trials. The composite outcome maternal death or serious morbidity was reduced (four trials, 9732 women: RR 0.80; 95% CI 0.65-0.97). The syndrome of haemolysis, elevated liver enzymes and low platelets was increased (two trials, 12,901 women: RR 2.67; 95% CI 1.05-6.82). There was no overall effect on the risk of preterm birth or stillbirth or death before discharge from hospital. Calcium supplementation appears to reduce the risk of pre-eclampsia and to reduce the rare occurrence of the composite outcome 'maternal death or serious morbidity'. There were no other clear benefits or harms. We present the hypothesis that adequate dietary calcium before and in early pregnancy may be needed to prevent the underlying pathology responsible for pre-eclampsia. We suggest that the research agenda be redirected towards calcium supplementation at a community level.
    BJOG An International Journal of Obstetrics & Gynaecology 09/2007; 114(8):933-43. DOI:10.1111/j.1471-0528.2007.01389.x · 3.76 Impact Factor
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    M Mathai, G J Hofmeyr
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    ABSTRACT: Caesarean section is the commonest major operation performed on women worldwide. Operative techniques, including abdominal incisions, vary. Some of these techniques have been evaluated through randomised trials. To determine the benefits and risks of alternative methods of abdominal surgical incisions for caesarean section. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 April 2006). Randomised controlled trials of intention to perform caesarean section using different abdominal incisions. We extracted data from the sources, checked them for accuracy and analysed the data. Four studies were included in this review. Two studies (411 participants) compared the Joel-Cohen incision with the Pfannenstiel incision. Overall, there was a 65% reduction in reported postoperative morbidity (relative risk (RR) 0.35, 95% confidence interval (CI) 0.14 to 0.87) with the Joel-Cohen incision. One of the trials reported reduced postoperative analgesic requirements (RR 0.55, 95% CI 0.40 to 0.76); operating time (weighted mean difference (WMD) -11.40, 95% CI -16.55 to -6.25 minutes); delivery time (WMD -1.90, 95% CI -2.53 to -1.27); total dose of analgesia in the first 24 hours (WMD -0.89, 95% CI -1.19 to -0.59); estimated blood loss (WMD -58.00, 95% CI -108.51 to - 7.49 ml); postoperative hospital stay for the mother (WMD -1.50, 95% CI -2.16 to -0.84); and increased time to the first dose of analgesia (WMD 0.80, 95% CI 0.12 to 1.48) compared to the Pfannenstiel group. No other significant differences were found in either trial. Two studies compared muscle cutting incisions with Pfannenstiel incision. One study (68 women) comparing Mouchel incision with Pfannenstiel incision did not contribute data to this review. The other study (97 participants) comparing the Maylard muscle-cutting incision with the Pfannenstiel incision, reported no difference in febrile morbidity (RR 1.26, 95% CI 0.08 to 19.50); need for blood transfusion (RR 0.42, 95% CI 0.02 to 9.98); wound infection (RR 1.26, 95% CI 0.27 to 5.91); physical tests on muscle strength at three months postoperative and postoperative hospital stay (WMD 0.40 days, 95% CI -0.34 to 1.14). The Joel-Cohen incision has advantages compared to the Pfannenstiel incision. These are less fever, pain and analgesic requirements; less blood loss; shorter duration of surgery and hospital stay. These advantages for the mother could be extrapolated to savings for the health system. However, these trials do not provide information on severe or long-term morbidity and mortality.
    Cochrane database of systematic reviews (Online) 02/2007; DOI:10.1002/14651858.CD004453.pub2 · 5.94 Impact Factor
  • S Hunter, G J Hofmeyr, R Kulier
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    ABSTRACT: Lateral and posterior position of the baby's head (the back of the baby's head facing to the mother's side or back) may be associated with more painful, prolonged or obstructed labour and difficult delivery. It is possible that certain positions adopted by the mother may influence the baby's position. To assess the effects of adopting a hands and knees maternal posture in late pregnancy or during labour when the presenting part of the fetus is in a lateral or posterior position compared with no intervention. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (July 2007) and the Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 2). Randomised trials of hands and knees maternal posture compared to other postures or controls. Two review authors assessed trial eligibility and quality. Three trials (2794 women) were included. In one trial (100 women), four different postures (four groups of 20 women) were combined for the comparison with the control group of 20 women. Lateral or posterior position of the presenting part of the fetus was less likely to persist following 10 minutes in the hands and knees position compared to a sitting position (one trial, 100 women, relative risk (RR) 0.26, 95% confidence interval (CI) 0.18 to 0.38). In a second trial (2547 women), advice to assume the hands and knees posture for 10 minutes twice daily in the last weeks of pregnancy had no effect on the baby's position at delivery or any of the other pregnancy outcomes measured. The third trial studied the use of hands and knees position in labour and involved 147 labouring women at 37 or more weeks gestation. Occipito-posterior position of the baby was confirmed by ultrasound. Seventy women, who were randomised in the intervention group, assumed hands and knees positioning for a period of at least 30 minutes, compared to 77 women in the control group who did not assume hands and knees positioning in labour. The reduction in occipito-posterior or -transverse positions at delivery and operative deliveries were not statistically significant. There was a significant reduction in back pain. Use of hands and knees position for 10 minutes twice daily to correct occipito-posterior position of the fetus in late pregnancy cannot be recommended as an intervention. This is not to suggest that women should not adopt this position if they find it comfortable. The use of position in labour was associated with reduced backache. Further trials are needed to assess the effects on other labour outcomes.
    Cochrane database of systematic reviews (Online) 02/2007; DOI:10.1002/14651858.CD001063.pub3 · 5.94 Impact Factor
  • Mangesi L, G J Hofmeyr
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    ABSTRACT: Fetal movement counting is a method by which a woman quantifies the movements she feels to assess the condition of the baby. The purpose is to try to reduce perinatal mortality by alerting caregivers when the baby might have become compromised. This method may be used routinely, or only in women who are considered at increased risk of complications in the baby. Some clinicians believe that fetal movement counting is a good method as it allows the clinician to make appropriate interventions in good time. On the other hand, fetal movement counting may cause anxiety to women. To assess outcomes of pregnancy where fetal movement counting was done routinely, selectively or was not done at all; and to compare different methods of fetal movement counting. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2006), the Cochrane Central Register of Controlled Trials (The Cochrane Library) and the reference lists of relevant papers. Randomised controlled trials. Trials were excluded where allocation concealment was inadequate and no measures were taken to prevent bias were excluded. The interventions included routine fetal movement counting, selective fetal movement counting, and studies comparing different fetal assessment methods. We assessed the methodological quality of included studies and extracted data from studies. Four studies, involving 71,370 women, were included in this review; 68,654 in one cluster-randomised trial. All four trials compared formal fetal movement counting. Two trials compared different types of counting with each other; one with no formal instruction, and one with hormonal analysis. Women in the formal fetal movement counting group had significantly fewer visits to the hospital antenatally than those women randomised to hormone analysis (relative risk (RR) 0.26, 95% confidence interval (CI) 0.20 to 0.35), whereas there were fewer Apgar scores less than seven in five minutes for women randomised to hormone analysis (RR 1.72, 95% CI 1.01 to 2.93). There was a significantly higher compliance with the Cardiff 'count to ten' method than with the formal fetal movement counting method (RR 0.25, 95% CI 0.19 to 0.32).All other outcomes reported were non significant. This review does not provide enough evidence to influence practice. In particular, no trials compared fetal movement counting with no fetal movement counting. Robust research is needed in this area.
    Cochrane database of systematic reviews (Online) 02/2007; DOI:10.1002/14651858.CD004909.pub2 · 5.94 Impact Factor
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    G J Hofmeyr, A N Atallah, L Duley
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    ABSTRACT: Pre-eclampsia and eclampsia are common causes of serious morbidity and death. Calcium supplementation may reduce the risk of pre-eclampsia through a number of mechanisms, and may help to prevent preterm labour. To assess the effects of calcium supplementation during pregnancy on hypertensive disorders of pregnancy and related maternal and child outcomes. We searched the Cochrane Pregnancy and Childbirth Group Trials Register (February 2006), the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2005, Issue 4), and contacted study authors. Randomised trials comparing at least one gram daily of calcium during pregnancy with placebo. We assessed eligibility and trial quality, extracted and double-entered data. Twelve studies of good quality were included. The risk of high blood pressure was reduced with calcium supplementation rather than placebo (11 trials, 14,946 women: relative risk (RR) 0.70, 95% confidence interval (CI) 0.57 to 0.86). There was also a reduction in the risk of pre-eclampsia associated with calcium supplementation (12 trials, 15,206 women: RR 0.48, 95% CI 0.33 to 0.69). The effect was greatest for high-risk women (5 trials, 587 women: RR 0.22, 95% CI 0.12 to 0.42), and those with low baseline calcium intake (7 trials, 10,154 women: RR 0.36, 95% CI 0.18 to 0.70). The composite outcome maternal death or serious morbidity was reduced (4 trials, 9732 women; RR 0.80, 0.65 to 0.97). Almost all the women in these trials were low risk and had a low calcium diet. Maternal deaths were reported in only one trial. One death occurred in the calcium group and six in the placebo group, a difference which was not statistically significant (RR 0.17, 95% CI 0.02 to 1.39). There was no overall effect on the risk of preterm birth (10 trials, 14,751 women: RR 0.81, 95% CI 0.64 to 1.03), or stillbirth or death before discharge from hospital (10 trials 15,141 babies; RR 0.89, 95% CI 0.73 to 1.09).Blood pressure in childhood has been assessed in one study: childhood systolic blood pressure greater than 95th percentile was reduced (514 children: RR 0.59, 95% CI 0.39 to 0.91). Calcium supplementation appears to almost halve the risk of pre-eclampsia, and to reduce the rare occurrence of the composite outcome 'death or serious morbidity'. There were no other clear benefits, or harms.
    Cochrane database of systematic reviews (Online) 02/2006; DOI:10.1002/14651858.CD001059.pub2 · 5.94 Impact Factor
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    E K Hutton, G J Hofmeyr
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    ABSTRACT: External cephalic version (ECV) of the breech fetus at term (after 37 weeks) has been shown to be effective in reducing the number of breech presentations and caesarean sections, but the rates of success are relatively low. This review examines studies initiating ECV prior to term (before 37 weeks' gestation). To assess the effectiveness of a policy of beginning ECV before term (before 37 weeks' gestation) for breech presentation on fetal presentation at birth, method of delivery, and the rate of preterm birth, perinatal morbidity, stillbirth or neonatal mortality. We searched the Cochrane Pregnancy and Childbirth Group Trials Register (April 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2005), MEDLINE (1965 to April 2005), EMBASE (1988 to April 2005), and Controlled Clinical Trials randomised controlled trials registry (April 2005). Randomised trials of ECV beginning before term (before 37 weeks' gestation) compared with a control group in women with breech presentation before term. Two review authors independently assessed eligibility and trial quality and extracted data. Three studies are included. One study reported on ECV that was undertaken and completed before 37 weeks' gestation compared to no ECV. No difference was found in the rate of non-cephalic presentation at birth. One study reported on a policy of ECV that was initiated before term (33 weeks) and up until 40 weeks' gestation and which could be repeated up until delivery compared to no ECV. This study showed a decrease in the rate of non-cephalic presentation at birth (relative risk 0.59, 95% confidence interval 0.45 to 0.77). One study reported on ECV started at between 34 to 35 weeks' gestation compared to beginning at 37 to 38 weeks' gestation. Although findings were not statistically significant, a 9.5% decrease in the rate of non-cephalic presentation at birth and a 7% decrease in the caesarean section rate were reported when ECV was started early. Compared with no ECV attempt, ECV commenced before term reduces non-cephalic births. Compared with ECV at term, beginning ECV at between 34 to 35 weeks may have some benefit in terms of decreasing the rate of non-cephalic presentation, and caesarean section. Further trials are needed to confirm this finding and to rule out increased rates of preterm birth, or other adverse perinatal outcomes. A large pragmatic trial is ongoing (www.utoronto.ca/miru/eecv2).
    Cochrane database of systematic reviews (Online) 02/2006; DOI:10.1002/14651858.CD000084.pub2 · 5.94 Impact Factor
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    ABSTRACT: Caesarean section rates are progressively rising in many parts of the world. One suggested reason is increasing requests by women for caesarean section in the absence of clear medical indications, such as placenta praevia, HIV infection, contracted pelvis and, arguably, breech presentation or previous caesarean section. The reported benefits of planned caesarean section include greater safety for the baby, less pelvic floor trauma for the mother, avoidance of labour pain and convenience. The potential disadvantages, from observational studies, include increased risk of major morbidity or mortality for the mother, adverse psychological sequelae, and problems in subsequent pregnancies, including uterine scar rupture and greater risk of stillbirth and neonatal morbidity. An unbiased assessment of advantages and disadvantages would assist discussion of what has become a contentious issue in modern obstetrics. To assess, from randomised trials, the effects on perinatal and maternal morbidity and mortality, and on maternal psychological morbidity, of planned caesarean delivery versus planned vaginal birth in women with no clear clinical indication for caesarean section. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (December 2005), MEDLINE (1974 to April 2005), EMBASE (1974 to April 2005), CINAHL (1982 to April 2005) and PsycINFO (1887 to April 2005). We also performed a manual search of the references of all retrieved articles, sought unpublished papers and abstracts submitted to international conferences and contacted expert informants. All comparisons of intention to perform caesarean section and intention for women to give birth vaginally; random allocation to treatment and control groups; adequate allocation concealment; women at term with single fetuses with cephalic presentations and no clear medical indication for caesarean section. We identified no studies that met the inclusion criteria. There were no included trials. There is no evidence from randomised controlled trials, upon which to base any practice recommendations regarding planned caesarean section for non-medical reasons at term. In the absence of trial data, there is an urgent need for a systematic review of observational studies and a synthesis of qualitative data to better assess the short- and long-term effects of caesarean section and vaginal birth.
    Cochrane database of systematic reviews (Online) 02/2006; DOI:10.1002/14651858.CD004660.pub2 · 5.94 Impact Factor
  • G.J. Hofmeyr, R. Kulier
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    ABSTRACT: Background:  Lateral and posterior position of the baby's head (the back of the baby's head facing to the side or the mother's back) may be associated with more painful, prolonged or obstructed labour and difficult delivery. It is possible that certain positions adopted by the mother may influence the baby's position.Objectives:  The objective of this review is to assess the effects of adopting a hands and knees maternal posture in late pregnancy or during labour when the presenting part of the fetus is in a lateral or posterior position, compared with no intervention.Search strategy:  We searched the Cochrane Pregnancy and Childbirth Group Trials Register (November 2004) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2004).Selection criteria:  Randomised trials of hands and knees maternal posture compared to other postures or controls.Data collection and analysis:  Both review authors assessed trial eligibility and quality.Main results:  Two trials of hands and knees posture during pregnancy were included. In one trial involving 100 women, four different postures (four groups of 20 women) were combined for the comparison with the control group of 20 women. Lateral or posterior position of the presenting part of the fetus was less likely to persist following 10 minutes in the hands and knees position compared to a sitting position (one trial, 100 women, relative risk (RR) 0.25, 95% confidence interval (CI) 0.17 to 0.37). In a second trial including 2547 women, advice to assume the hands and knees posture for 10 minutes twice daily in the last weeks of pregnancy had no effect on the baby's position at delivery or any of the other pregnancy outcomes measured. No trials of hands and knees posture during labour were included.Authors’ conclusions:  Use of hands and knees position for 10 minutes twice daily to correct occipitoposterior position of the fetus in late pregnancy cannot be recommended as an intervention. This is not to suggest that women should not adopt this position if they find it comfortable. The use of this position during labour has not been addressed in this review. In view of the promising short-term effects of the technique and its simplicity, further trials are justified to determine whether encouraging the use of hands and knees posture during rather than before labour, has any effect on substantive outcomes.
    Birth 08/2005; 32(3):235 - 236. DOI:10.1111/j.0730-7659.2005.00377.x · 2.93 Impact Factor
  • G J Hofmeyr
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    ABSTRACT: Routine care in normal labour may range from supportive care at home to intensive monitoring and multiple interventions in hospital. Good evidence of effectiveness is necessary to justify interventions in the normal process of labour. Inadequate evidence is available to support perineal shaving, routine enemas, starvation in labour and excluding the choice for home births. Evidence supports continuity of care led by midwives, companionship in labour, restricting the use of episiotomy, and active management of the third stage of labour, including routine use of 10 units of oxytocin. Both benefits and risks are associated with routine amniotomy, continuous electronic fetal heart rate monitoring, epidural analgesia, and oxytocin-ergometrine to prevent postpartum haemorrhage. More evidence is needed regarding the emotional consequences of labour interventions, home births, vaginal cleansing, opioid use, the partograph, second-stage labour techniques, misoprostol for primary prevention of postpartum haemorrhage, and strategies to promote evidence-based care in labour.
    Bailli&egrave re s Best Practice and Research in Clinical Obstetrics and Gynaecology 03/2005; 19(1):103-15. DOI:10.1016/j.bpobgyn.2004.10.009 · 3.00 Impact Factor
  • G J Hofmeyr, R Kulier
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    ABSTRACT: Lateral and posterior position of the baby's head (the back of the baby's head facing to the side or the mother's back) may be associated with more painful, prolonged or obstructed labour and difficult delivery. It is possible that certain positions adopted by the mother may influence the baby's position. The objective of this review is to assess the effects of adopting a hands and knees maternal posture in late pregnancy or during labour when the presenting part of the fetus is in a lateral or posterior position, compared with no intervention. We searched the Cochrane Pregnancy and Childbirth Group Trials Register (November 2004) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2004). Randomised trials of hands and knees maternal posture compared to other postures or controls. Both review authors assessed trial eligibility and quality. Two trials of hands and knees posture during pregnancy were included. In one trial involving 100 women, four different postures (four groups of 20 women) were combined for the comparison with the control group of 20 women. Lateral or posterior position of the presenting part of the fetus was less likely to persist following 10 minutes in the hands and knees position compared to a sitting position (one trial, 100 women, relative risk (RR) 0.25, 95% confidence interval (CI) 0.17 to 0.37). In a second trial including 2547 women, advice to assume the hands and knees posture for 10 minutes twice daily in the last weeks of pregnancy had no effect on the baby's position at delivery or any of the other pregnancy outcomes measured. No trials of hands and knees posture during labour were included. Use of hands and knees position for 10 minutes twice daily to correct occipitoposterior position of the fetus in late pregnancy cannot be recommended as an intervention. This is not to suggest that women should not adopt this position if they find it comfortable. The use of this position during labour has not been addressed in this review. In view of the promising short-term effects of the technique and its simplicity, further trials are justified to determine whether encouraging the use of hands and knees posture during rather than before labour, has any effect on substantive outcomes.
    Cochrane database of systematic reviews (Online) 02/2005; DOI:10.1002/14651858.CD001063.pub2 · 5.94 Impact Factor
  • W R Holmes, G J Hofmeyr
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    ABSTRACT: To provide recommendations for the management of breech presentation in areas of high prevalence of human immunodeficiency virus (HIV) infection. Review of relevant literature. Studies show that elective cesarean section (CS) is safer than vaginal delivery for breech presentation, external cephalic version (ECV) at term increases the chance of vaginal cephalic delivery. Although there are no studies of the risk of mother-to-child transmission of HIV from ECV, indirect evidence suggests that any increased risk is likely to be very small. Where CS is available and safe, HIV-positive women, or women who might be at risk of HIV, with a fetus at term with breech presentation, should be offered elective CS to reduce the risks of both vaginal breech delivery and mother-to-child HIV infection. HIV-negative women can be offered ECV at term to try to avoid CS. Where women do not have access to a safe CS, or prefer vaginal delivery, the benefit for both mother and child of attempting ECV at term is likely to outweigh the theoretical, very small, risk of facilitating HIV transmission.
    International Journal of Gynecology & Obstetrics 01/2005; 87(3):272-6. DOI:10.1016/j.ijgo.2004.08.009 · 1.56 Impact Factor

Publication Stats

3k Citations
404.70 Total Impact Points

Institutions

  • 1983–2009
    • University of the Witwatersrand
      • Department of Obstetrics and Gynaecology
      Johannesburg, Gauteng, South Africa
  • 2000–2008
    • Fort Hare University
      Alice, Eastern Cape, South Africa
    • Hôpitaux Universitaires de Genève
      • Département de gynécologie et d'obstétrique
      Genève, GE, Switzerland
  • 2003–2007
    • World Health Organization WHO
      • Department of Reproductive Health and Research (RHR)
      Genève, Geneva, Switzerland
    • Mediclinic
      Stellenbosch, Western Cape, South Africa
  • 2006
    • University of British Columbia - Vancouver
      • Department of Family Practice
      Vancouver, British Columbia, Canada
  • 2000–2004
    • United Nations Development Programme
      New York, New York, United States
  • 2001
    • University of Adelaide
      Tarndarnya, South Australia, Australia
  • 1987–2000
    • Johannesburg Hospital
      Johannesburg, Gauteng, South Africa
  • 1998
    • Chris Hani Baragwanath Hospital
      Johannesburg, Gauteng, South Africa