Dissertations / Theses on the topic 'Obstetric complications'
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McConville, Pauline Mary. "Obstetric complications and functional psychosis." Thesis, University of Edinburgh, 2007. http://hdl.handle.net/1842/24928.
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The main body of the work is a study of the rates of obstetric complications in 492 patients meeting ICD-9 criteria for schizophrenia, affective disorder and other functional psychosis, compared to their 797 non-psychotic siblings and to 2,460 normal controls. The main results, for each of the three diagnostic groups, indicate significant confounding between obstetric complications, maternal marital status and social class. No single obstetric complication remained associated with schizophrenia once these factors had been controlled for. Bleeding in pregnancy was associated with an increased risk of affective disorder compared to controls. A low Apgar score at 5 minutes was associated with an increased risk of affective disorder compared to controls. Low social class and maternal marital status were also associated with the risk of affective disorder. Induction of labour or elective caesarean section was associated with an increased risk of other functional psychosis compared to their non-psychotic siblings. Secondary analyses of the effect of season of birth, age of onset of illness and family history are presented. Schizophrenic patients were more likely to have been born in winter than their siblings but winter-born schizophrenics had similar rates of OCs to those born at other times. An induced labour or elective caesarean section was associated with an increased risk of affective disorder of early onset and of non-familial affective disorder. Bleeding in pregnancy was also associated with an increased risk of non-familial affective disorder. The findings are compared to those of other studies and conclusions are drawn about the importance of obstetric complications in the aetiology of psychotic disorders, with particular emphasis on schizophrenia, and suggestions are made for further research.
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Donohoe, Siobhan. "An investigation of antiphospholipid antibody associated obstetric complications." Thesis, University College London (University of London), 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.312964.
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Hirschi, Budge Kelsey May. "RAGE and Gas6/Axl Signaling in Obstetric Complications." BYU ScholarsArchive, 2020. https://scholarsarchive.byu.edu/etd/8409.
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Current research spans a wide range of objectives whose diversity includes the understanding of global epidemiology and the detailing of molecular interactions leading to specific pathologies. This work aligns more closely with the goal of mechanistic clarity by elucidating several aspects of signaling pathways involved in inflammatory and obstetric pathologies. Prior research has confirmed the role of Receptors for Advanced Glycation End-Products (RAGE) activation in signaling leading to chronic inflammation such as that observed in chronic obstructive pulmonary disease (COPD). RAGE activation has also been identified in other disease states including diabetes, Alzheimer’s disease, osteoarthritis, and cancers. We examined the role of RAGE in the obstetric complication intrauterine growth restriction (IUGR) wherein fetal development is delayed and infants are born at low birthweight. Exposure to tobacco smoke is known to activate RAGE, and smoke exposure also increases risk for IUGR. We confirm a role for RAGE signaling in development of IUGR. RAGE inhibition by semi-synthetic glycosaminoglycan ethers (SAGEs) significantly improved fetal and placental weights and reduced inflammatory signaling molecules. Interactions between RAGE and other signaling pathways have been noted in several research endeavors, and we sought to further understand signaling interactions specifically in obstetric pathologies by examining relationships between RAGE and Gas6/AXL signaling. We confirm that RAGE and Gas6/AXL signaling are not independent. Using tobacco smoke as a means of inducing RAGE, we determined that total AXL is inhibited when RAGE is active, but that phosphorylated AXL is increased. Inhibition of RAGE also increased Gas6 expression. These interactions require further clarification, but provide a foundation to expand upon. We further studied interactions within the Gas6/AXL pathway independent of RAGE. High levels of Gas6 have been noted in the serum of some women with preeclampsia, and early diagnosis and treatment of preeclampsia are currently limited. We demonstrate that, in a rat model, administration of Gas6 during pregnancy is sufficient to induce symptoms of preeclampsia including high blood pressure, increased proteinuria, and decreased trophoblast invasion. This provides a novel model which will further both diagnosis and treatment of preeclampsia. We also demonstrated that trophoblast invasion is influenced in a cell-type dependent manner by Gas6 and mTOR signaling, with decreased trophoblast invasion when Gas6 is high in trophoblast cells, but increased invasion with high Gas6 in a pulmonary adenocarcinoma cell type and in oral squamous cell carcinoma cells. Our work has clarified details of both RAGE and Gas6/AXL signaling that are crucial to further study of the pathways in which they are active, and the pathologies resulting from signaling misregulation.
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Sikder, Shegufta Shefa. "Obstetric complications in rural Bangladesh| Risk factors for reported morbidity, determinants of care seeking, and service availability for emergency obstetric care." Thesis, The Johns Hopkins University, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=3571743.
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Background: In settings such as rural Bangladesh, where the majority of births occur at home, population-based data are lacking on the burden and risk factors for obstetric complications, as well as care-seeking behavior. This dissertation seeks to describe the prevalence and risk factors for obstetric complications, explore factors affecting care seeking for complications, and describe the availability of obstetric care among health facilities in rural Bangladesh.
Methods: We used extant data from a community-randomized maternal micronutrient supplementation trial which ascertained reported morbidities and care seeking among 42,214 pregnant women between 2007 and 2011 in rural northwest Bangladesh. Multivariate multinomial logistic regression was used to analyze the association of biological, socioeconomic, and psychosocial factors with reported obstetric complications and near misses. Multivariate logistic regression of socioeconomic, demographic, perceived need, and service factors on care seeking was performed. Primary data on availability and readiness to provide obstetric services at 14 health facilities was collected through surveys.
Results: Of the 42,214 married women of reproductive age, 73% (n=30,830) were classified as having non-complicated pregnancies, 25% (n=10,380) as having obstetric complications, and 2% (n=1,004) with reported near misses. In multivariate analysis, women's age less than 18 years (Relative Risk Ratio 1.26 95% CI 1.14-1.39), obstetric history of stillbirth or abortion (RRR 1.15 CI 1.07-1.22), and neither partner wanting the pregnancy (RRR 1.33 CI 1.20-1.46) significantly increased the risk of obstetric complications. Out of 9,576 women with data on care seeking, 77% sought any care, with only 23% seeking at least one formal provider. Socioeconomic factors and service factors, such as facility availability of comprehensive obstetric services (OR 1.25 CI 1.16- 1.34), improved care seeking from formal providers. Average facility readiness for emergency obstetric care was 81% in private clinics compared to 67% in public facilities (p=0.045).
Conclusions: These analyses indicate a high burden of obstetric morbidity, with a quarter of women reporting obstetric complications. Policies to reduce early marriage and unmet need for contraception may address risk factors including adolescent pregnancy and unwanted pregnancies. Improvements in socioeconomic factors, coupled with strategies to increase service availability at health facilities, could increase care seeking from formal providers.
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Paparelli, Alessandra. "Obstetric complications, genetic liability and psychosis : a study of Gene X Environment interaction." Thesis, King's College London (University of London), 2014. https://kclpure.kcl.ac.uk/portal/en/theses/obstetric-complications-genetic-liability-and-psychosis(dbe046d3-8191-46d3-a3dd-d971462314d2).html.
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There is no doubt a strong genetic component to psychosis, but family and twin studies have shown that simple genetic transmission is far from the whole story. Furthermore, a number of environmental factors have also been shown to increase risk of psychosis. Among these non genetic causes, Obstetric Complications (OCs) are among the best replicated. In order to get a better insight into the mechanisms by which OCs impact on brain development to increase the risk of psychosis, I employed a Gene X Environment causation model. A total of 377 psychotic patients, 65 controls and 103 unaffected siblings were available for my project. I obtained data concerning clinical and socio-demographic status, obstetric history, together with samples of blood/cheek swabs for genetic analysis from these subjects. I also genotyped most of the subjects (N=399) for selected genetic variants that might have functional significance in relation to the individual’s exposure to OCs (namely AKT1 rs 2494753, rs1130233, rs3803300; BDNF rs2049046, rs56164415; DNMBP1 rs875462; GRM3 rs7808623; AK573765- TWIST2 rs9751357; CACNA1C rs4765905; CEACAM21 rs4803480; CNNM2 rs7914558; CSMD1 rs10503253; Erbb4 rs1851196; ITIH3/4 rs2239547; LOC645434-NMBR rs2066036; LRRFIP1 rs12052937; MIR137 rs1625579; MMP16 rs7004633; NKAPL rs1635; NRG rs12807809; NT5C2 rs11191580; PCLO rs6979348; PLXNA2 rs752016; PGBD1 rs2142731; PCGEM1 rs17662626; RELN rs7341475; SDCCAG8 rs6703335; STT3A rs548181; TCF4 rs17512836; UGT1A1 HJURP rs741160; rs10489202; rs16887244). In a case-control design, I investigated how exposure to OCs influenced the risk of psychotic disorder. Then, I tested, under a multiplicative model, the hypothesis that a range of genetic variants interacted with OCs in increasing the risk of psychotic disorder. Lastly I examined whether rats that had experienced perinatal asphyxia during birth show abnormalities in gene expression and methylation status at various developmental periods. My findings didn’t show any interaction between genes and OCs in increasing the risk of psychosis. On the other hand, in rats following hypoxic insult many of the genes had heterogeneous pattern of expression, suggesting an important role for genes in mediating the reactions of the CNS to environmental stimuli such hypoxia. In general, at post neonatal day CNNM2 was down regulated, whereas CSMD1 and TCF4 were up regulated; at 5 weeks CNNM2, CSMD1, MMP16, STT3a were down regulated, whereas TRIM26 was overexpressed. Hypoxia in the prenatal and perinatal period could regulate the expression of specific genes contributing to the neurodevelopmental alterations later found in schizophrenic patient.
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Siregar, Kemal Nazaruddin. "Social and programme factors influencing maternal morbidity in Indonesia." Thesis, University of Exeter, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.297578.
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Voloshynovych, N. S. "Assessment of the obstetric complications’ risk as a result of surgical treatment of ovaries in anamnesis." Thesis, БДМУ, 2022. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/19742.
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Paulsen, Carrie. "Incidence and nature of complications post primary repair of Obstetric Anal Sphincter Injury (OASI): Retrospective chart review." Master's thesis, Faculty of Health Sciences, 2019. https://hdl.handle.net/11427/31687.
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Background. A multitude of data exists regarding global incidence of OASI as well as its contributing factors and complications. Little to no data exists regarding the incidence of OASI or its complications and the nature of these complications within South Africa. Objective. To describe the rate and nature of complications of OASI that occur within 6 weeks following primary repair of an OASI, followed up at the GSH perineal clinic. Secondarily, to investigate the incidence of OASI and follow up rate post primary repair Methods. This was a retrospective chart review. Participants were identified from theatre record books between January 2014 and December 2015. The charts of those that attended the perineal clinic follow up were reviewed and complications and possible associated risk factors were identified from the clinical notes. Primary aims were to identify the incidence and nature of complications seen in this population as well as possible related risk factors. The secondary aims were to determine the incidence of OASI and follow up rate for complication following primary OASI repair. Results. The mean age of participants was 25.85 years with a mean body mass index of 25.15kg/m2 . The mean birthweight seen was 3382.05 grams. Constipation (10.87%), pain with defaecation (11.96%) and anal incontinence (10.87%) were the most frequently reported complications. Wound infection was found on examination in 3.26% of participants and wound dehiscence was seen in 6.67%. Incidence of OASI in this study group was 8.64 per 1000 vaginal deliveries. The follow up rate of these participants was 26.20%. A total of 374 OASI were repaired within this region during the study period. Only 97 of these attended follow up, for which 93 folders were available to be included in analysis Conclusion. The Incidence of OASI in this Western Cape region is within the range seen worldwide but the proportion of complications seem to be less than global data suggests despite adverse conditions, theatre delays and the fact that repairs were mostly performed by specialists in training. It was not possible to identify any relationship with possible associated factors. There is a very poor follow up rate within this community which needs to be explored and systems need to be put in place to ensure all participants are given the opportunity of follow up.
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Nystedt, Astrid. "Utdragen förlossning : kvinnors upplevelser och erfarenheter." Umeå : Omvårdnad, 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-579.
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Lougue, Siaka. "Methodological approach of the spatial distribution of maternal mortality in Burkina Faso and explanatory factors associated." University of the Western Cape, 2013. http://hdl.handle.net/11394/4368.
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Philosophiae Doctor - PhDMaternal mortality is one of the most important problems related to the reproductive health. This is why the reduction by three quarters of maternal mortality by 2015 has been fixed as target No. 5 of the Millennium Development Goals (MDGs). Achieving this goal requires an annual decline of 5.5% of maternal mortality between 1990 and 2015. Unfortunately, the reduction as estimated in 1997 was less than 1% per year. Africa is the continent most affected by this problem. In 2010, the number of maternal mortality in the world was estimated to 287 000 and Africa was hosting more than 52 % (148 000) of the occurrence in the world In Burkina Faso, maternal mortality ratio decreased from 566 in 1991 to 484 in 1998 and 341 in 2010 according to the DHS data while the census estimate was 307 in 2006 and United Nation agencies provided the number of 300 maternal deaths per 100 000 live births in 2010. Statistics provided by the different sources vary considerably. This situation creates confusion among data users. In addition, researches made on the issue remain very insufficient because of the complexity of the issue, lack of data and poor quality of existing data on maternal mortality. This study has been initiated to fill the gap of knowledge about the determinants and estimates of maternal mortality at national and sub-national levels. Results of this research highlighted explanatory factors of maternal mortality at national and regional level with a focus on factors of regional disparities. Findings also provided estimate by adjusting the census 2006 data from missingness and incoherences, improving the census method and testing different other methods. Finally, projection of maternal mortality level is made from 2006 to 2050.
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Varol, Nesrin. "Towards the abandonment of female genital mutilation – healthcare provision in Australia within the framework of global collaboration on health system response, prevention, and prosecution." Thesis, The University of Sydney, 2016. http://hdl.handle.net/2123/16402.
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Female genital mutilation (FGM) refers to all procedures involving removing parts or all of the external female genitalia for non-medical reasons. As a result of migration and asylum seeking from conflict and wars, FGM has become a transnational issue, affecting more than 200 million girls and women worldwide. It is a form of gender-based violence, a health and policy issue, and violates many human rights laws. FGM has serious physical, psychological, sexual, and reproductive consequences to girls and women. As FGM has a complex socio-cultural imperative, an understanding of the driving forces of this harmful practice is key to helping communities abandon it and to providing education to all stakeholders involved from the level of the community, to healthcare professionals, teachers, civil rights, law and policy makers, migration and law enforcement organisations. FGM is on the decline, and many communities do want it to end. Addressing the human rights priorities of communities and providing them power over their own development processes are key to helping them abandon this practice. In this thesis, I address two questions. The first one is, “How do we strengthen the response of the healthcare system in Australia to best care for women and girls with FGM?” The second one is, “Focusing on the socio-cultural imperatives of FGM, how could we change our path in the global abandonment program to help communities stop this harmful practice?” My review of the literature on this topic has shown that two of the main reasons that FGM continues to be practised are pressure of social obligation in communities and lack of discourse in the public arena between men and women. In the first systematic review conducted on the topic I have highlighted the ambiguity of men’s wishes in regards to the continuation of FGM. In general, men wished to abandon it because of the physical and psychosexual complications to both women and men. Education of men was found to be the most important indicator for men’s support for abandonment. Australia is home to many women and girls from countries where FGM is practised. My thesis shows that two to three percent of women, who gave birth in a metropolitan Australian hospital, had FGM. This is the first available data on prevalence of women with FGM in Australia. My analysis also showed that women who received specialised FGM care had similar obstetric and neonatal outcomes to women without FGM. An extension of such services would further alleviate the burden among affected women and reduce healthcare costs for the Government. Accurate data collection on prevalence and complications of FGM is needed in Australia to appropriately allocate funding and develop such services. The literature and my thesis provide evidence that healthcare professionals (HCP) in countries of prevalence and those of migration, including Australia, lack knowledge on and training in the management of women with FGM. Midwives expressed a lack of confidence in clinical knowledge, skills, and data collection, as well as cultural competence in caring for women with FGM. Doctors acknowledged barriers to effective care stemming from uncoordinated care, unclear professional responsibilities, and communication difficulties. There is a need for improved education and training, supportive supervision, and evidence-based best-practice clinical guidelines and policies to address knowledge gaps and provide better management of and prevention of FGM in children. Informed by the research presented in this thesis, I developed an e-learning module for HCP in Australia to improve their knowledge on the medical, cultural, legal, and advocacy aspects. The Australian Government has addressed violence against women as an important area of focus and has been implementing a 12-year National Plan to reduce violence against women and their children 2010 – 2022. In the final paper in this thesis I propose that HCP, teachers, welfare officers, child protection officers, and government and non-government organisations involved in prevention programs on FGM, need to form a network of experts within this national framework to develop, implement and evaluate national policy and guidelines on healthcare provision, protection of girls, and prevention of FGM. The abandonment process may be accelerated through a global collaboration between governments and organisations involved in FGM programs. I have been involved in the establishment of the Africa Centre for the abandonment of FGM (ACCAF) in Kenya in 2012. A similar centre is planned in the Asia Pacific region in a country of FGM prevalence, which would collaborate with ACCAF and its partners to share research and expertise. It is my hope that the research presented in this thesis will support the work of these centres and hasten the abandonment of FGM.
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Byrskog, Ulrica, Eva Eriksson, and Annica Sundell. "Kvinnlig Könsstympning : Litteraturstudie om praktisk handläggning och komplikationsrisker vid förlossning." Thesis, Högskolan Dalarna, Omvårdnad, 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:du-1636.
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Today around 28 000 women originally from countries where FGM is practised, are living in Sweden. Many of them are at childbearing age which means that knowledge about FGM and its consequences is of outmost importance during delivery. The aim of this study is to describe current research on how to manage the delivery, regarding deinfibulation and the following stitching as well as the risk of complications when the labouring woman is mutilated. This review of literature is based on 12 scientific articles published between years 1989 – 2005. Five different databases have been searched with use of a large number of keywords.The review found that no scientific research has been carried out that describes how deinfibulation and following stitching should be managed when the woman is mutilated. All available articles within this area are referring to best practice only. The review also found that the conclusions of the studies are contradictory. The majority, however, show an increased frequency for prolonged labour that could be related to FGM. The three largest studies also show an increased rate of caesarean section among mutilated women. In the few studies that examine haemorrhage, the majorities show an increased tendency to bleed, that could be related to FGM. Several articles emphasize the importance of good routines for deinfibulation to reduce the risk for complications.In summary it can be established that due to methodological problems in many studies, no reliable conclusion can be made that the researched complications exists to a greater extent when the woman is mutilated
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Grälls, Jenny. "Sätesförlossningar : Handläggning och utfall hos mödrar och barn vid vaginal förlossning och kejsarsnitt." Thesis, Uppsala universitet, Institutionen för kvinnors och barns hälsa, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-200521.
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Background: The incidence of caesarean section for breech presentation has reached approximately 90 % in Sweden. In many of these cases, by means of specific selection criteria, it would be as safe to plan for vaginal breech delivery. Aim: The objective of this study was to investigate differences in management and to compare maternal and fetal outcomes according to delivery mode of breech presentation; vaginal vs. caesarian section. The study included breech presentation in full term singleton pregnancies at the UppsalaUniversityHospital, Uppsala, Sweden (UAS). Method: The study was based on medical record data with a retrospective, descriptive, comparative design with quantitative approach. The method for data collection was a manual review of patient records using a structured questionnaire. Results: Of the women with children in breech presentation during the period studied, 11 % gave birth vaginally. Mother's wish was the most common cause of caesarean section. The group with caesarean section included more first-time mothers, longer length of stay at the hospital, increased bleeding and need for pain medication, separation from the child, later lactation and earlier introduction of formula. Vaginally delivered mothers had increased incidence of straight urine catheterization postpartum and of infants with lower Apgar scores. Conclusion: This study does not support the suggestion that it would be safer to give birth by caesarean section for breech presentation in cases where the woman at full term meets strict selection criteria. Instead of applying medical criteria, the decision regarding mode of delivery was more often left up to the mother.
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Hirose, Atsumi. "A cross-sectional study of the first and the second delays among women admitted to a maternity hospital with severe obstetric complications ('near-miss') in Afghanistan." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2010. http://researchonline.lshtm.ac.uk/1649007/.
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In Afghanistan, the majority of women continue to give birth at home because of poverty, difficult access to health facilities, or gender-based restrictions. Women are often brought into hospitals in moribund conditions after the onset of complications at home. A detailed understanding of the determinants of health care seeking delays is necessary in order to help identify strategies which could reduce the incidence of very severe complications and maternal deaths and improve foetal outcomes in complicated pregnancies. Areview of existing studies of care-seeking delays indicated that durations of care-seeking time had not been well explained because of various methodological limitations. The large majority of previous studies were descriptive and fell short in identifying contributing factors that could be eliminated by interventions while analytical studies lacked methodological rigour largely due to sample size limitations associated with rarity of maternal deaths. In this thesis, data from a hospital-based cross-sectional survey conducted among 472 women with severe obstetric complications in Afghanistan were analysed using a refined version of the conceptual framework developed by Thaddeus and Maine (1994). Three types of care-seeking delays were considered: the duration oftime from onset of symptoms to decision to seek care (or 'decision delay'), the duration from the decision to departure for health care facilities, (or 'departure delay') and variation in self-reported travel time from GIS-modelled travel time (or 'travel delay'). The study posited that delayed care-seeking would be best explained by a combination of factors including a woman's health care practice during pregnancy, her family's financial and social resources, geographical accessibility to healthcare and the types of symptoms and signs associated with each complication. It was also postulated that care-seeking delay would be among important determinants of foetal death. Regression techniques were used to identify determinants of the three types of delays, and logistic regression techniques were employed to assess the role of delays on foetal mortality. This study showed that failure to use antenatal care ('ANC') service during pregnancy was associated with an increase in decision delay. Lack of birth plans and absence of a midwife in the locality were also associated with an increased decision delay for ante- and intra-partum women. Awoman's weak relationship with her birth family was associated with an increased decision delay for complication types which did not have clear symptoms while a woman from an impoverished household appeared to experience a long decision delay when she suffered a complication with dramatic symptoms. In addition to seasonal effects, difficult geographical access to healthcare and lack of social capital were found to be positively associated with delay in departure for healthcare facilities. Multi-referrals, low household economic status, lack of community cohesion, and lack of access to vehicle were associated with an increase in travel delay. Finally, decision delay contributed to an increased risk of foetal death. The main conclusion from this work is that ANCinterventions have a significant role to play in facilitating rapid uptake of emergency care, once a complication occurs, in a setting where access to routine and emergency care is socially and geographically difficult. This in turn has implications not only for maternal but also for foetal outcomes. Future research and programmatic efforts should be directed towards understanding and exploiting the roles that social resources could play in facilitating access to emergency obstetric care.
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Mbola, Mbassi Symplice. "Soins obstétricaux d'urgence et mortalité maternelle dans les maternités de troisième niveau du Cameroun : approche évaluative d'une intervention visant à améliorer le transfert obstétrical et la prise en charge des complications maternelles." Thesis, Paris 6, 2014. http://www.theses.fr/2014PA066352/document.
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Malgré de nombreuses initiatives entreprises par le gouvernement au cours des dernières années, la mortalité maternelle demeure un véritable fléau au Cameroun. Pour cette raison, une recherche a été conduite pour déterminer l'ampleur de la mortalité maternelle dans les 7 maternités de troisième niveau du Cameroun, décrire les différentes étapes d'une intervention visant à améliorer le système de référence et la prise en charge des urgences obstétricales et évaluer son effet sur la mortalité maternelle.La recherche a été menée en trois phases. Une revue rétrospective des données agrégées de la période 2004 à 2006 a été réalisée incluant tous les accouchements, les complications obstétricales, les césariennes et les décès maternels. Ensuite une intervention de 33 mois a été mise en place dans 22 maternités périphériques ainsi que dans 3 maternités de troisième niveau où la mortalité maternelle était importante. L'évaluation de l'intervention a été faite à travers la méthode quasi expérimentale combinant l'étude avant-Après à l'étude ici-Ailleurs. Deux ans après l'intervention, les décès maternels enregistrés dans les 3 maternités cibles avaient diminué de plus de la moitié (P=0,000001). Le taux de létalité des complications obstétricales observé dans les mêmes maternités est passé de 2,2 à 0,7% (P=0,000001). Par ailleurs, le nombre de décès observés chez les femmes référées avait diminué et le taux de létalité était inférieur à 1%. Les résultats de la recherche mettent en évidence les conséquences du renforcement des compétences des prestataires, de l'amélioration du système de référence et de la qualité des soins sur la mortalité maternelleDespite numerous initiatives undertaken by health authorities in the past years, maternal mortality remains a major public health issue in Cameroon. Against this background, research was conducted (i) to determine the maternal mortality patterns in 7 tertiary maternity centers in Cameroon, (ii) to document various stages of an intervention for improving referral system and the management of obstetric emergencies and (ii) evaluate the effect of these measures on maternal mortality and propose future actions. The research was conducted in three phases. A retrospective review of the aggregate data for the period 2004-2006 was performed including all births, obstetric complications, caesarean sections and maternal deaths. Then 33 months intervention has been set up in 22 peripheral maternities and in three tertiary maternity centers where maternal mortality was very high. The evaluation of the intervention was made using the quasi-Experimental design. This method combined the pre- and post- intervention study as well as the study of the maternities where there was intervention compared to the control group. Two years after the intervention, maternal deaths recorded in the target tertiary maternity centers decreased by more than half (P = 0.000001). The case fatality rate decreased from 2.2 to 0.7% in the same group (P = 0.000001). Moreover, the number of deaths among referred women decreased significantly and the case fatality rate was less than 1%. The research findings highlight the impact of capacity building providers, improvement of the referral system and quality of care on maternal mortality
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Douteaud, Stéphanie. "Déterminants et effets des trajectoires de stress prénatal sur les issues de la grossesse et la dépression postpartum." Thesis, Montpellier 3, 2014. http://www.theses.fr/2014MON30099.
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Introduction : En France, comme ailleurs, la prévalence de la dépression post-partum (DPP) (environ 10% des femmes) n'est pas plus importante que celle d'autres formes de dépression mais elle pose un important problème de dépistage car, les femmes consultent moins rendant difficile sa prévention. Les recherches visant à améliorer la prévention de la DPP s'appuient sur deux modèles principaux, le modèle de la vulnérabilité au stress et le modèle bio-psycho-social. L'un comme l'autre décrivent le stress psychologique prénatal comme étant un important déterminant de la DPP. Néanmoins, si le stress est fréquemment évalué, il n'est mesuré en général qu'une fois et tardivement dans la grossesse. Il n'est donc actuellement pas possible de connaître ni son évolution ni l'effet de cette évolution sur la DPP. En conséquence, un premier objectif de ce travail doctoral est d'identifier et de caractériser des trajectoires de stress afin d'évaluer leurs effets sur la DPP. Par ailleurs, certaines recherches montrent que les complications obstétricales lors de l'accouchement ont un effet délétère sur la santé psychologique des femmes en postpartum et d'autres que le stress prénatal augmente le risque de complications obstétricales. Nous faisons donc l'hypothèse qu'une élévation du stress associée à des complications obstétricales à l'accouchement augmente considérablement le risque de DPP, mais que cela diffère d'une femme à l'autre en fonction du niveau des déterminants du stress.Méthode : La santé des mères, leur trait d'anxiété et des variables socio-économiques ont été relevées chez 164 femmes avant la fin des deux premiers mois de la grossesse. Le stress perçu, l'état d'anxiété, le soutien social et les stratégies de coping ont été évalués à 2, 6 et 9 mois de grossesse pour 163 femmes puis à 1 et 6 mois postpartum pour 91 d'entre elles. Par ailleurs, les résultats du dépistage prénatal des pathologies fœtales, le terme de la grossesse, le poids de naissance du bébé, ses résultats à l'Apgar et le type d'accouchement (dystocique versus eutocique) ont également été relevés. Enfin, la mesure de la DPP a été effectuée 6 mois après l'accouchement. Nous avons calculé des trajectoires individuelles de stress et mesuré l'effet de ces trajectoires sur les variables liées à l'accouchement pour 163 femmes puis sur la DPP pour 91 d'entre elles.Résultats : Trois trajectoires ont été identifiées en prépartum comme en postpartum. Une première où le stress est faible en début de grossesse, augmente jusqu'en début de post-partum et diminue légèrement en fin de période postnatale. Une seconde où le stress est modéré en début de grossesse, diminue jusqu'au milieu de la grossesse, augmente en fin de grossesse et se stabilise en période postnatale. Une dernière où le stress est élevé en début de grossesse, puis diminue jusqu'en fin de grossesse et continue de diminuer en période postnatale. Lorsque le stress suit les trajectoires 2 et 3, la durée de gestation est plus courte, F(2,138) = 3,45, p < 0,05, η2 = 0,048, l'usage de la césarienne est plus fréquent, OR = 2,62,p < 0,05, IC95% = [1,01 – 6,75] ainsi que l'accouchement dystocique, OR = 3,54, p < 0,005, IC95% = [1,18 – 10,52]. En revanche, les trajectoires de stress n'ont pas d'effet sur la DPP.Discussion : Nos résultats sont encourageants et permettent de montrer que l'évolution de la perception du stress pendant la grossesse a un effet sur la durée de gestation, les complications obstétricales et l'usage de la césarienne. En revanche, elle n'en a pas sur la DPP. Cependant nos résultats suggèrent que le stress pourrait avoir un effet uniquement chez les femmes vulnérables et que la DPP s'insèrerait dans un continuum dépressif, alors contigu à la vulnérabilité au stress. Les recherches ultérieures devraient donc évaluer le lien entre des trajectoires individuelles de dépression et de stress du début de la grossesse en fin de postpartum afin de tester cette hypothèseIntroduction : In France, as well as in other countries, the prevalence of postpartum depression (PPD) (about 10% of women) is not more important than other forms of depression, but it is a major problem of screening, because women less consult, making prevention difficult. Researches to improve the prevention of DPP are essentially based on two models, the stress-vulnerability model and the bio-psycho-social model. The both models describe the prenatal psychological stress as an important determinant of the PPD. However, if stress is frequently assessed, it is usually measured only once and late in pregnancy. So, by now, it is not possible to know its evolution or to know its effects on PPD. Accordingly, a primary objective of this doctoral work is to identify and characterize trajectories of stress to assess their effects on the DPP. Moreover, some researches showed that obstetric complications during childbirth have a deleterious effect on the psychological health of postpartum women. Others proved that prenatal stress increases the risk of obstetric complications. So we assume that an elevated stress associated with obstetric complications in childbirth significantly increases the risk of PPD. Neverthless it differs from one woman to another depending on the level of stress determinants.Method: The health of mothers, their anxiety-trait level and socio-economic variables were recorded among 164 women before the end of two months of pregnancy (T0). Perceived stress, state anxiety, social support and coping strategies were evaluated at 2, 6 and 9 months of pregnancy for 163 women and at 1 and 6 months postpartum for 91 of them. Moreover, the results of prenatal screening for fetal pathologies, the term of pregnancy, baby's birth weight, results of Apgar and type of delivery (dystocic versus eutocic) were recorded. Finally, the measurement of the PPD was performed 6 months after delivery. We calculated trajectories of stress and we measured the effect of these trajectories on the variables related to childbirth for 163 women and on DPP for 91 of them.Results: Three trajectories were identified in prepartum and postpartum. A first trajectory where the stress is low in early pregnancy, increases until early postpartum and decreased slightly at the end of the postnatal period. A second where the stress is moderate in early pregnancy decreases until the middle of pregnancy, increases in late pregnancy and postpartum. A final trajectory where stress is high in early pregnancy and then decreases until the end of pregnancy and continues to decrease in postpartum. When the stress follows the paths 2 and 3, the gestation period is shorter, F(2,138) = 3.45, p <0.05, η2 = 0.048, the use of cesarean section is more common, OR = 2.62, p < 0.05, CI 95% = [1.01- 6.75] as well as dystocic labor, OR = 3.54, p <0.005, CI 95% = [1.18-10.52]. In contrast, the trajectories of stress does not have an effect on the PPD.Discussion: Our results are encouraging and show that the perception of stress during pregnancy has an effect on the duration of pregnancy, obstetric complications and the use of cesarean section. However it has no effect on the DPP, but our results suggest that stress may have an effect only among vulnerable women and that the DPP would fit into a depressive continuum, while adjacent to the vulnerability to stress. In conclusion, future researches should assess the link between trajectories of stress and depression from early pregnancy to late postpartum to test this hypothesis
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Urassa, David Paradiso. "Quality Aspects of Maternal Health Care in Tanzania." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distrubutör], 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4221.
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Uustal, Fornell Eva. "Pelvic floor dysfunction : a clinical and epidemiological study /." Linköping : Univ, 2003. http://www.bibl.liu.se/liupubl/disp/disp2003/med822s.pdf.
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Oliveira, Lenice Fortunato de. "Estudo das alterações placentárias de gestantes com síndrome antifosfolípide: correlações anátomo-clínicas." Universidade de São Paulo, 2004. http://www.teses.usp.br/teses/disponiveis/5/5139/tde-13102014-105103/.
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Objetivo: Avaliar as lesões placentárias encontradas em gestantes com SAF e correlacionar com as intercorrências na gestação e repercussões perinatais. Casuística e Método: Foram acompanhadas 72 gestantes com diagnóstico confirmado de SAF, excluídas gestações gemelares e fetos mal-formados. Colhida placenta para análise histológica. O grupo SAF foi distribuído em três subgrupos baseando-se na história clíncia prévia e títulos de aCL e aL, e o risco de desenvolver trombose e insuficiência placentária na gestação, a saber: moderado, A(n=20), alto risco, B(n=37) e alto risco C(n=15). As pacientes foram tratadas com AAS 100mg/dia, suspensa com 36 semanas, e heparina, cuja dose era modificada de acordo com alterações na dopplervelocimetria obstétrica. Anotadas as intercorrências materno-perinatais e os achados no estudo anátomo-patológico das placentas com a aplicação de protocolo terapêutico. Um grupo de 32 gestantes normais serviu de controle. No subgrupo A, as pacientes não apresentavam colagenoses, outras trombofilias nem trombose prévia. No subgrupo B, 17 (46%) tinham LES;15(40%) fenômeno de Raynaud; 13(35%) toxemia; 12(32%) trombose prévia; nove (24,3%) outras trombofilias associadas e sete (19%) HAC. No subgrupo C, 14(93%) tinham tido trombose anterior, 4 (26,6%) LES e 2 (13,3%) outras trombofilias. As perdas fetais prévias eram 86,8%, 83% e 82,7% para subgrupos A, B e C, respectivamente. A média de início pré-natal foi de 11,8 semanas sem predominância entre os grupos. O início de AAS e heparina foi em média de 12,3 e 14,5 semanas de gestação respectivamente, igual nos subgrupos. Resultados: 1. As principais complicações maternas na média geral, foram: TPP (49,3%) e toxemia (25%). 2. Os resultados perinatais apresentaram: partos prematuros 44%; ILA diminuído 41%; SFA 40%; RCF 34%; oligoâmnio 31%.(1) e (2) semelhantes entre os subgrupos e com significância estatística com o grupo-controle. 3. A idade gestacional no parto foi em média de 35,8 semanas, e peso fetal 2493g, sem diferença estatística entre os subgrupos e grupo-controle. 4. Na análise microscópica predominou infartos com 60% das placentas afetadas, correlacionadas com alta incidência de resultados adversos nas gestações, assim como hiperplasia da camada média de ATV, 44,6%, com predomínio de RCF (60%) e prematuros (80%) no subgrupo C, necrose fibrinóide do trofoblasto com predomínio de ILA diminuído (60%) no subgrupo B, deposição maciça de fibrina perivilosa com predomínio de SFA (100%) no subgrupo A, vasculopatia trombótica fetal com predomínio de SFA (100%) e prematuros (75%) no subgrupo A e RCF (77%) no subgrupo B. Todas as lesões com significativa estatística em relação ao grupo-controle. Entre os subgrupos, a deposição maciça de fibrina perivilosa apresentou estatística significativa no subgrupo C em relação aos demais. 5. Conclusões: O protocolo terapêutico foi eficaz, porém ainda é elevado o índice de morbidades na gestação.A alta incidência de infartos e outras complicações trombóticas na placenta confirmam a agressão placentária e a necessidade de adequação nos protocolos de anticoagulaçãoObjective: Evaluate the placental injuries found in pregnant women with SAF and correlate with the morbidity in pregnancy and fetal repercussions. Methods: 72 pregnant women with SAF diagnosis were followed, except the twin pregnancies and inadequate formed fetus. Gathered placenta to histological examination. The SAF group was distributed in three subgroups based on the previous clinic history, aCL and aL titles, risk of thrombosis development and the placentary insuffiency in pregnancy to know: moderated, A (n=20); high risk, B (n=37) and even higher risk, C (n=15). The patients were treated with AAS 100mg/day, suspended within 36 weeks and enoxaparin which portion was modified according to the fetal placental circulation alteration on obstetric dopplervelocimetria. The outcome of pregnancy and placental pathological findings studies with the application of the therapeutic protocol were noted down.32 normal pregnant women were the control group. In subgroup A the patients did not presented any disease colagen or heritable thrombophilia.In subgroup B,17(46%) pacients presented LES; 15(40%) Raynaud phenomena; 13(35%) preeclampsia; 12(32%) had previous thrombosis; nine(24.3%) had other thrombophilia and seven(19%) HAC. In subgroup C, 14 (93%) pacients presented previous thrombosis; 4(26%) LES; 4(26%) HAC; 3(20%) preeclampsia; 3(20%) Raynaud phenomena and 2(13.3%) others thrombophilia. The previous fetus losses were 85%, 80% and 79% to subgroups A, B and C respectively. Prenatal started around 12 weeks with no advantage among the groups. Introduction of AAS and enoxaparin was 12 and 14 weeks respectively the same in subgroups. Results: 1. The main maternal complications in general were: TPP (49%) and toxemia (25%). 2. The fetal results presented: 44% early childbirth; 41% reduced ILA; 40% SFA; 34% RCF; 31% oligohydramnios. (1) e (2) similar between the subgroups and expressive statistic with the control group. 3. The pregnant age was in avarage 35,8 weeks with fetus weigh 2493g with no statistic differences between the subgroups and the control group. 4. In the microscopy analysis predominated infarcts with 60% of the placentas affected, correlated with the high incidence of adverse results in pregnancies, so as 44,6% reduction or obliteration of fetal stem vessels by mural hyperplasia; 60% RCF predominance and 80% early childbirth in subgroup C, fibrinoid necrosis trophoblast with reduced ILA predominance (60%) in subgroup B, massive perivillous fibrin deposition with SFA predominance (100%) in subgroup A, fetal thrombotic vasculopathy with SFA predominance (100%) and early birth (75%) in subgroup A and RCF (77%) in subgroup B. All the placental injuries with statistics significance related to the group control. Among the subgroups the massive perivillous fibrin deposition presented statistic significance in the subgroup C related to the others. Conclusions: The therapeutic protocol was effective, but is still high the morbidity indices among the pregnancies. The high incidences of infarcts and other thrombotic complications in the placenta confirm the placental aggression and the necessity of the adequation in the anticoagulation protocols
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Söderquist, Johan. "Posttraumatic stress after childbirth /." Linköping : Univ, 2002. http://www.bibl.liu.se/liupubl/disp/disp2002/med761s.pdf.
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Östlund, Ingrid. "Aspects of Gestational Diabetes : Screening System, Maternal and Fetal Complications." Doctoral thesis, Uppsala University, Department of Women's and Children's Health, 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3267.
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The appropriateness of universal screening for gestational diabetes mellitus (GDM) has been strongly questioned, since it does not satisfy ethical principles for screening.
The aims of these studies were to determine the prevalence of GDM, expressed in terms of impaired glucose tolerance (IGT) and diabetes mellitus (DM), to evaluate different screening models using traditional anamnestic risk factors and repeated random B-glucose, to determine whether GDM increases risks for maternal complications such as preeclampsia, and to determine whether IGT during pregnancy, if left untreated, is associated with increased maternal or neonatal morbidity.
Of 4,918 pregnant non-diabetic women attending maternal health care, 73.5% agreed to have a 75 g oral glucose tolerance test (OGTT). GDM was diagnosed in 1.7%, IGT in 1.3% and DM in 0.4%. Traditional risk factor criteria were fulfilled by 15.8%. Prior GDM and a prior macrosomic infant showed the highest association with GDM. No selective or two-step universal screening model would have detected all cases of GDM. A constructed model comprising prior GDM, a prior LGA/macrosomic infant, or a cut-off random B-glucose level of 8 mmol/l as an indication for OGTT reduced the need for OGTT to 7.3% compared to the selective screening model with traditional risk factors. Such a universal two-step screening model had 100% sensitivity for DM, and 44.7% sensitivity for IGT.
The Swedish Medical Birth Register was used to evaluate GDM as risk factor for preeclampsia. GDM occurred in 0.8% and preeclampsia in 2.9% of 430,852 singleton pregnancies. There is an independent and significant association between GDM and preeclampsia. Obesity is a major confounding factor, but cannot explain the total excess risk.
In a prospective population-based case-control study 213 women with untreated IGT during pregnancy were identified. For each case, four controls were recruited from the same delivery department. The analyses confirmed that maternal and fetal morbidity were increased in the cases in terms of cesarean section rate, pre-term delivery, Erb’s palsy and admission to NICU. There was a marked, independent increase in the proportion of LGA infants (OR 7.3; 95% CI 4.1-12.7). To determine whether treatment has an effect when IGT is diagnosed during pregnancy, a randomized study is required.
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Huang, Pinchia. "Implications of False-Positive Trisomy 18 or 21 Screening Test Results in Predicting Adverse Pregnancy Outcomes." Case Western Reserve University School of Graduate Studies / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=case1247627814.
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Moura, Bárbara Laisa Alves. "Gestantes usuárias do Sistema Único de Saúde no município de São Paulo: desfechos de uma coorte de dados secundários." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/6/6132/tde-23052017-164937/.
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Introdução: Apesar da melhoria dos indicadores da saúde materno infantil, os valores ainda são elevados, com a mortalidade neonatal respondendo pela mortalidade infantil e a mortalidade fetal pela perinatal. Apesar da melhoria da cobertura e qualidade dos dados dos sistemas de informação sobre nascidos vivos e mortalidade, esses não tem informação sobre a morbidade materna e do recém-nascido, disponíveis no Sistema de Informação Hospitalar do SUS e possíveis de serem vinculadas. Objetivo geral: Descrever e analisar o seguimento da gestação, do parto e dos desfechos dos nascimentos das gestantes usuárias do SUS residentes no município de São Paulo no período de 12/08/2011 a 27/01/2013. Objetivos específicos: Obter uma coorte de gestantes SUS com dados secundários. Identificar internações anteriores ao parto por complicações obstétricas, prevalência das gestações de alto risco, tipo de saída após o parto (alta, internação e uso de UTI e óbito materno) e tempo de permanência da internação do parto, no período de 12 de agosto de 2011 a 31 de dezembro de 2012. Caracterizar e estimar a razão de morte fetal e a mortalidade neonatal precoce dos nascidos vivos extraídos da coorte de gestantes SUS no município de São Paulo no período de 01 de junho de 2012 a 27 de janeiro de 2013. Identificar se há diferença da sobrevida dos óbitos neonatais segundo peso ao nascer e uso de UTI neonatal. Identificar potenciais fatores de risco para a mortalidade fetal e neonatal precoce para os nascimentos da coorte de gestante SUS. Metodologia: Tratou-se de um estudo do tipo coorte retrospectiva de população fixa das gestantes cujos nascimentos (nascido vivo e óbito fetal) ocorreram em hospitais da rede SUS no município de São Paulo no período de 01 de junho de 2012 a 31 de dezembro de 2012. Foram investigadas as internações e as readmissões hospitalares das gestantes atendidas nos hospitais SUS ocorridas no período de 12 de agosto de 2011 a dezembro de 2012. Como também, as internações dos recém-nascidos ocorridas no período de 01 de junho de 2012 a 27 de janeiro de 2013. Foram realizadas vinculações pelo método determinístico e probabilístico dos documentos base dos sistemas de informação em saúde (SIS). Foram conduzidas análises de regressão de Cox e regressão logística. Resultados: Foram vinculados 98,3 por cento das declarações de nascidos vivos (DNV) à autorização de internação hospitalar (AIH), 93,8 por cento dos óbitos fetais às AIHs, 93 por cento das AIHs dos recém-nascidos internados ao par anterior e 99,4 por cento dos óbitos neonatais a sequencia de eventos ditas anteriores. 4,3 por cento das gestantes foram internadas prévio ao parto por complicações obstétricas. Maior mortalidade neonatal, razão de morte fetal e internação dos RNs após o nascimento ocorreram em gestantes que internaram por complicações obstétricas. No estudo de sobrevida, houve aumento da sobrevida com o aumento do peso ao nascer. RNs internados em UTIN após o nascimento tiveram menor sobrevida que os RNs não internados. Os fatores de risco para a mortalidade neonatal foram: o número insuficiente de consulta de pré-natal, nascer em hospital de baixo volume de parto, prematuridade, baixo peso ao nascer, APGAR 5º < 7, presença de anomalia congênita e internação após o nascimento. Não realizar consulta de pré-natal, prematuridade extrema (<32 semanas), baixo peso ao nascer (<2499 gramas) e presença de malformação congênita foram fatores de risco comuns aos óbitos fetais e aos neonatais precoces. Raça/cor da mãe não branca e idade materna igual ou superior a 35 anos foram fatores de risco somente para os óbitos fetais. Nascimentos em hospitais com baixo e médio volume de parto foram associados à maior mortalidade neonatal precoce. Conclusão: Gestantes que apresentaram complicações obstétricas tiveram desfechos mais desfavoráveis da gestação, como internação pós-parto e mortalidade materna. Foi identificada também nesse grupo maior readmissão hospitalar dos RNs, maior prevalência de prematuridade e de baixo peso ao nascer, maior mortalidade fetal e neonatal. Internação na gestação e readmissão hospitalar do RN deve ser considerada como eventos sentinelas no monitoramento da assistência ao parto e ao recémnascido na população SUS. A concentração dos óbitos nos primeiros dias de vida refletem as fragilidades na assistência aos recém-nascidos, a gravidade das doenças dos recém-nascidos, as más condições de nascimento e a presença de malformações incompatíveis com a vida. Óbitos fetais e neonatais precoces são influenciados pelas mesmas características proximais dos recém-nascidos. Esforços devem ser direcionados para o aumento da adesão às consultas de pré-natal nas unidades básicas de saúde, com atenção especial para as gestantes não brancasIntroduction: Despite the improvement in maternal and child health indicators, values are still high, with neonatal mortality accounting for infant mortality and perinatal fetal mortality. Despite improved coverage and data quality of information systems on live births and mortality, these do not have information on maternal and newborn morbidity, available in the SUS Hospital Information System and possible to be linked. General objective: Describe and analyze the follow-up of gestation, delivery and outcomes of the births of pregnant women users of SUS residents in the city of São Paulo from August 12, 2011 to January 27, 2013. Specific objectives: Obtain a cohort of SUS pregnant women with secondary data. Identify hospitalizations prior to delivery for obstetric complications, prevalence of high-risk pregnancies, type of delivery after childbirth (discharge, hospitalization and use of ICU and maternal death) and length of hospital stay during the period of August 12, 2011 to December 31, 2012. Characterize and estimate the fetal death rate and early neonatal mortality of live births extracted from the cohort of pregnant women SUS in the city of São Paulo from June 1, 2012 to January 27, 2013. Identify if there is difference in survival of neonatal deaths according to birth weight and neonatal ICU use. Identify potential risk factors for early fetal and neonatal mortality for the births of the SUS pregnant cohort. METHODS: This was a retrospective cohort study of the fixed population of pregnant women whose births (live birth and fetal death) occurred in hospitals of the SUS network in the city of São Paulo from June 1, 2012 to December 31, 2012. The hospitalizations and the hospital readmissions of the pregnant women attended in the SUS hospitals were investigated during the period from August 12, 2011 to December 2012. As well as the hospitalizations of the newborns that occurred in the period from June 1, 2012 to 27 Of January of 2013. Links were made through the deterministic and probabilistic method of the basic documents of the health information systems (SIS). Cox regression and logistic regression analyzes were performed. Results: 98.3 per cent of live birth certificates (DNV) were linked to hospital admission authorization (AIH), 93.8 per cent of fetal deaths to AIHs, 93 per cent of AIHs of newborns hospitalized at the previous pair, and 99, 4 per cent of neonatal deaths in the sequence of events mentioned above. 4.3 per cent of pregnant women were hospitalized prior to delivery due to obstetric complications. Higher neonatal mortality, fetal death rate and hospitalization of newborns after birth occurred in pregnant women hospitalized for obstetric complications. In the survival study, there was an increase in survival with an increase in birth weight. RNs hospitalized at the NICU after birth had lower survival rates than the non-hospitalized NB. The risk factors for neonatal mortality were: insufficient number of prenatal visits, hospital birth with low birth volume, prematurity, low birth weight, APGAR 5 <7, presence of congenital anomaly and hospitalization after birth. Preterm consultation, extreme prematurity (<32 weeks), low birth weight (<2499 grams) and presence of congenital malformation were common risk factors for fetal deaths and early neonatal deaths. Race / color of non-white mother and maternal age equal to or greater than 35 years were risk factors only for fetal deaths. Births in hospitals with low and medium volume of delivery were associated with higher preterm neonatal mortality. Conclusion: Pregnant women who presented obstetric complications had more unfavorable outcomes of pregnancy, such as postpartum hospitalization and maternal mortality. Also in this group, greater readmission of the newborns of the newborns, greater prevalence of prematurity and of low birth weight, greater fetal and neonatal mortality were also identified. Nursing admission and hospital readmission of the newborn should be considered as sentinel events in the monitoring of delivery care and the newborn in the SUS population. The concentration of deaths in the first days of life reflects weaknesses in the care of newborns, the severity of newborn diseases, poor birth conditions and the presence of malformations incompatible with life. Early fetal and neonatal deaths are influenced by the same proximal characteristics of newborns. Efforts should be directed towards increasing adherence to prenatal consultations in basic health units, with special attention to non-white women. Key Words: Linkage, hospital admissions for obstetric complications, neonatal mortality, fetal mortality
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M’Rithaa, Doreen K. M. "A framework for information communication that contributes to the improved management of the intrapartum period." Thesis, Cape Peninsula University of Technology, 2015. http://hdl.handle.net/20.500.11838/1414.
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Dissertation submitted in fulfilment of the requirements for the degree Doctor of Technology: Informatics in the Faculty of Informatics and Design at the Cape Peninsula University of TechnologyBackground: Daily activities within a health care organization are mediated by information communication processes (ICP), which involve multiple health care professionals. During pregnancy, birth and motherhood a woman may encounter different professionals including midwives, doctors, laboratory personnel and others. Effective management requires critical information to be accurately communicated. If there is a breakdown in this communication patient safety is at risk for various reasons such as; inadequate critical information, misconception of information and uninformed decisions being made. Method: Multi method, multiple case study approach was used to explore and describe the complexities involved in the (ICP), during the management of the intrapartum period. During the study the expected ICP, the actual ICP, the challenges involved and the desired ICP were analysed. 24 In-depth interviews with skilled birth attendants were conducted, observer- as- participant role was utilized during the observation, fild notes, reflective diaries and document review methods were used to gather the data. Thematic analysis and activity analysis were applied to analyse the data. Findings: The findings illuminated that there are expectations of accessibility to care of the woman during pregnancy birth and the intrapartum, especially linked to referral processes. The actual ICP focused on documentation and communication of the information within and between organizations. Communication was marked by inadequate documentation and therefore errors in the information communicated. The desires for communication were illuminated by the need to change the current situation. Further a framework for effective information communication was developed: the FAAS framework for the effective management of the intrapartum period. Conclusion: In conclusion what is expected is not what is actually happening. The skilled birth attendants (SBAs) do not necessarily have the answers for change but the challenges were identified as desires for change. I urge that the framework will provide a basis for the evaluation of the effectiveness involved in the ICP for the effective management of the intrapartum period.
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Paiva, Leticia Vieira de. "Estado nutricional em gestações de alta risco: complicações do parto, puerpério e análise do consumo dietético." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/5/5139/tde-13062012-113155/.
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OBJETIVO: Analisar a associação entre o estado nutricional materno em gestações de alto risco e complicações do parto, do puerpério e análise do consumo dietético dessas gestantes. MÉTODOS: Estudo prospectivo e observacional realizado no período de agosto de 2009 a agosto de 2010, com os seguintes critérios de inclusão: puérperas até o quinto dia; idade acima de 18 anos; gestação de alto risco; feto único e vivo no início do trabalho de parto; parto na Instituição; peso materno aferido no dia do parto. O estado nutricional no final da gestação foi avaliado pelo índice de massa corporal (IMC), aplicando-se a curva de Atalah. As pacientes foram classificadas em: baixo peso, adequado, sobrepeso e obesidade. O consumo dietético foi avaliado por aplicação do questionário de frequência do consumo alimentar. As complicações do parto e do puerpério, investigadas durante o período de internação e 30 dias após a alta, foram: tipo de parto, infecção e/ou secreção em ferida cirúrgica, infecção urinária, infecção puerperal, febre, hospitalização, uso de antibióticos e morbidade composta (pelo menos uma das complicações puerperais citadas). RESULTADOS: Foram incluídas 374 puérperas classificadas pelo IMC final em: baixo peso (n=54, 14,4%); adequado (n=126, 33,7%); sobrepeso (n=105, 28,1%) e obesidade (n=89, 23,8%). Não houve diferença significativa na proporção de cesáreas quando comparados os seguintes grupos: baixo peso e adequado (68,3%), sobrepeso (76,2%) e obesidade (78,6%, P=0,201). A obesidade materna apresentou associação significativa com as seguintes complicações do puerpério: infecção de ferida cirúrgica (16,7%, P=0,042), infecção urinária (9,0%, P=0,004), uso de antibiótico (12,3%, P<0,001) e morbidade composta (25,6%, P=0,016). Aplicando-se o modelo de regressão logística, verificou-se que a obesidade no final da gestação é variável independente na predição da morbidade composta (OR: 2,09; IC95%: 1,15 - 3,80, P=0,015). A análise do consumo dietético demonstrou média de consumo energético semelhante nos grupos: baixo peso e adequado (2344 cal/dia), sobrepeso (2433 cal/dia) e obesidade (2450 cal/dia, P=0,640). Não se constatou diferença significativa no consumo médio diário de macro e micronutrientes entre os grupos estudados. CONCLUSÃO: A obesidade materna no final da gravidez, em pacientes de alto risco, está associada, de forma independente, com a ocorrência de complicações infecciosas no puerpério, demonstrando a necessidade de acompanhamento mais eficiente em relação ao ganho de peso materno nessas gestaçõesOBJECTIVE: To assess the association between maternal obesity and the occurrence of delivery and postpartum complications in high risk pregnancies, and to analyze the dietary intake of these pregnant women. METHODS: Prospective and observational study conducted from August 2009 to August 2010, with the following inclusion criteria: admission to the 5th day, maternal age 18-year-old, high-risk pregnancy, single pregnancy, fetus alive at the beginning of labor, birth at the institution, maternal weight measured at birth. Nutritional status in late pregnancy was assessed by body mass index (BMI), and applying the curve Atalah. The patients were classified as: underweight, appropriate, overweight and obesity. The dietary intake was evaluated applying a food frequency questionnaire. The complications of delivery and postpartum, investigated during the hospitalization and 30 days after discharge, were: infection and / or secretion in the surgical wound, urinary tract infection, puerperal infection, fever, hospitalization, antibiotics, and composite morbidity (at least one puerperal complication). RESULTS: We included 374 postpartum women classified by the final BMI: underweight (n=54, 14.4%), appropriate (n=126, 33.7%), overweight (n=105, 28.1%) and obesity (n=89, 23.8%). There was no significant difference in the proportion of cesarean when compared the following groups: underweight and appropriate (68.3%), overweight (76.2%) and obesity (78.6%, P=0.201). Maternal obesity was significantly associated with the following puerperal complications: surgical wound infection (16.8%, P=0.042), urinary tract infection (9.0%, P= 0.004), antibiotic use (12.3%, P<0.001) and composite morbidity (25.6%, P=0.016). The logistic regression model showed that obesity in late pregnancy is an independent variable in predicting the composite morbidity (OR: 2.09, 95% CI: 1.15 to 3.80, P=0.015). The analysis of dietary intake showed average energy consumption similar in the groups: underweight and appropriate (2344 cal/day), overweight (2433 cal/day) and obesity (2450 cal/day, P=0.640). There was no significant difference in the average daily consumption of macro-and micronutrients among the groups studied. CONCLUSION: Maternal obesity at the end of high-risk pregnancy is independently associated with the occurrence of postpartum infectious complications, showing the need for more efficient monitoring of maternal weight gain in these pregnancies
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Bourque, Danielle Kathleen. "Imprinted genes in the placenta and obstetrical complications." Thesis, University of British Columbia, 2010. http://hdl.handle.net/2429/25509.
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Each year, many pregnancies are associated with obstetrical complications such as maternal pre-eclampsia (PET) and fetal intrauterine growth restriction (IUGR). Poor placentation is thought to contribute to these complications, but specific causes are largely unknown. Mouse models suggest that epigenetic mechanisms, in particular genomic imprinting, that alter gene regulation may help regulate placental development and embryonic growth. The first goal of this thesis is to examine if epigenetic modifications (i.e. DNA methylation) and altered expression of imprinted genes in the human placenta are contributing factors to PET and IUGR. The second goal of this thesis is to identify imprinted loci that are useful in the diagnosis of placental pathologies that associated with abnormal imprinting, including triploidy, hydatidiform moles, and placental mesenchymal dysplasia.
I found that DNA methylation at the imprinting control region 1 (ICR1) on chromosome 11p15.5 was significantly decreased in IUGR placentas (p < 0.001), but not in those associated with pre-eclampsia. Methylation at ICR2 (KvDMR1) was not significantly altered in PET or IUGR. No significant changes in expression levels were observed in the genes controlled by these ICRs. There were no significant methylation changes observed in any candidate imprinted gene evaluated by the Illumina array. LINE-1 methylation, a marker of whole genome methylation, was also similar in all groups. The establishment of biomarkers that could be used to accurately identify those women at an increased risk for pre-eclampsia or IUGR would be a major step forward in antenatal care.
All placental pathologies (triploidy, hydatidiform moles or placental mesenchymal dysplasia) were associated with altered ICR2 (KvDMR1) methylation. Pyrosequencing assays for SGCE, SNRPN, and MEST were also compared for their utility in diagnosing parental genomic imbalance in placental samples. SGCE showed the clearest separation between groups. The combined use of KvDMR1 and SGCE assays could provide a potentially valuable diagnostic tool in the rapid screening of methylation errors in placental disorders. These results also demonstrate the maintenance of imprinting status at these loci in the human placenta, even in the presence of abnormal pathology.
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Zetterström, Karin. "Chronic Hypertension and Pregnancy : Epidemiological Aspects on Maternal and Perinatal Complications." Doctoral thesis, Uppsala University, Department of Women's and Children's Health, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7755.
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These studies were undertaken to investigate risks of maternal and perinatal complications in pregnant women with chronic hypertensive disease, and to investigate future risk of preeclampsia in women born small for gestational age (SGA). Population based cohort studies using the Swedish Medical Birth Register from different years were performed.
The maternal complications mild and severe preeclampsia, gestational diabetes and abruptio placenta were studied in a population of 681 515 women, with a prevalence of 0,5% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics as age, parity, BMI, ethnicity and smoking habits. Chronic hypertensive women wore found to have significantly increased risks of all complications.
The perinatal complication SGA was studied in a population of 560 188, with a prevalence of 0,5% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics and for the secondary complications mild and severe preeclampsia. Chronic hypertensive women were found to suffer a significantly increased risk of giving birth to an offspring that is SGA.
The perinatal complication fetal/infant mortality was studied in a population of 1 222 952 with a prevalence of 0,6% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics and for the complications mild and severe preeclampsia, gestational diabetes, abruptio placenta and offspring being SGA In the analysis an effect modification by gender was included. Chronic hypertensive women were found to have a significantly increased risk for stillbirth and neonatal death in male, but not in female, offspring. Thus a clear gender difference in mortality was revealed. The risk of mortality of offspring was mediated by severe preeclampsia, abruptio placenta and offspring being SGA. Mild preeclampsia and gestational diabetes did not affect the risk. No increased risk of post neonatal mortality was found.
A generation study was performed in 118 634 girls of which 5.8% were born SGA. Their future risk for mild and severe preeclampsia in first pregnancy was analysed. Risk estimates were adjusted for age, smoking, BMI and for preeclampsia in the mothers while pregnant with the study population. Women who were born SGA were shown to have a significantly increased risk for severe preeclampsia, but not for mild preeclampsia.
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Elliott, Catherine. "Complications of anticoagulation in pregnant women with mechanical heart valves." Master's thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/3043.
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Majoko, Franz. "Assessing Antenatal Care in Rural Zimbabwe." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-6018.
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Butt, Jennifer Leigh. "Hysterectomy at a tertiary hospital in South Africa : indications, pathology and complications." Master's thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/3033.
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Morgan, Vera Anne. "Intellectual disability co-occurring with schizophrenia and other psychiatric illness : epidemiology, risk factors and outcome." University of Western Australia. School of Psychiatry and Clinical Neurosciences, 2008. http://theses.library.uwa.edu.au/adt-WU2008.0209.
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(Truncated abstract) The aims of this thesis are: (i) To estimate the prevalence of psychiatric illness among persons with intellectual disability and, conversely, the prevalence of intellectual disability among persons with a psychiatric illness; (ii) To describe the disability and service utilisation profile of persons with conjoint disorder; (iii) To examine, in particular, intellectual disability co-occurring with schizophrenia; and (iv) To explore the role of hereditary and environmental (specifically obstetric) risk factors in the aetiology of (i) intellectual disability and (ii) intellectual disability co-occurring with psychiatric illness. This thesis has a special interest in the relationship between intellectual disability and schizophrenia. Where data and sample sizes permit, it explores that relationship at some depth and has included sections on the putative nature of the link between intellectual disability and schizophrenia in the introductory and discussion chapters. To realise its objectives, the thesis comprises a core study focusing on aims (i) (iii) and a supplementary study whose focus is aim (iv). It also draws on work from an ancillary study completed prior to the period of candidacy...This thesis found that, overall, 31.7% of persons with an intellectual disability had a psychiatric illness; 1.8% of persons with a psychiatric illness had an intellectual disability. The rate of schizophrenia, but not bipolar disorder or unipolar major depression, was greatly increased among cases of conjoint disorder: depending on birth cohort, 3.7-5.2% of individuals with intellectual disability had co-occurring schizophrenia. Down syndrome was much less prevalent among conjoint disorder cases despite being the most predominant cause of intellectual disability while pervasive developmental disorder was over-represented. Persons with conjoint disorder had a more severe clinical profile including higher mortality rates than those with a single disability. The supplementary study confirmed the findings in the core body of work with respect to the extent of conjoint disorder, its severity, and its relationship with pervasive development disorder and Down syndrome. Moreover, the supplementary study and the ancillary influenza study indicated a role for neurodevelopmental insults including obstetric complications in the adverse neuropsychiatric outcomes, with timing of the insult a potentially critical element in defining the specific outcome. The supplementary study also added new information on familiality in intellectual disability. It found that, in addition to parental intellectual disability status and exposure to labour and delivery complications at birth, parental psychiatric status was an independent predictor of intellectual disability in offspring as well as a predictor of conjoint disorder. In conclusion, the facility to collect and integrate records held by separate State administrative health jurisdictions, and to analyse them within the one database has had a marked impact on the capacity for this thesis to estimate the prevalence of conjoint disorder among intellectually disabled and psychiatric populations, and to understand more about its clinical manifestations and aetiological underpinnings.
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Bortolotto, Maria Rita de Figueiredo Lemos. "Estudo dos fatores relacionados à determinação da via do parto em gestantes portadoras de cardiopatias." Universidade de São Paulo, 2006. http://www.teses.usp.br/teses/disponiveis/5/5139/tde-18042007-112300/.
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Os objetivos deste estudo foram: avaliar as freqüências de partos vaginais e cesáreas em mulheres portadoras de cardiopatias, bem como a distribuição dos partos nos diferentes subgrupos de doenças cardíacas: arritmias (A), cardiopatias congênitas (CC) e cardiopatias adquiridas (CA); analisar os fatores clínicos e obstétricos que estiveram relacionados à determinação da via de parto no grupo total de cardiopatas e também nos subgrupos, e avaliar a associação entre o tipo de parto e complicações clínicas e obstétricas. Foram analisados retrospectivamente os dados referentes a 571 gestações de 556 mulheres internadas para parto na Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo entre 2001 e 2005. A composição dos grupos foi: A - 57 casos (10%), CC - 163 casos (28,6%) e CA - 351 casos (61,4%). A taxas de cesárea foram 57,2% (total), 45,6% (A), 64,2% (CC) e 55,7% (CA). A indicação da cesárea foi obstétrica em 77% dos casos. Analisando os 425 casos sem cesáreas anteriores, as taxas de cesárea foram: 47,1% (total), 37,8% (A), 57,8% (CC) e 43,3% (CA). A probabilidade de parto cesáreo esteve relacionada à presença de cesárea anterior, idade gestacional no parto inferior a 37 semanas, presença de intercorrências obstétricas, diagnóstico de cardiopatia congênita, insuficiência cardíaca classe funcional (CF) III ou IV, e uso de medicamentos de ação cardiovascular. A paridade maior ou igual a um diminuiu a probabilidade de cesárea. A presença de cesárea anterior foi o principal fator relacionado à probabilidade de parto cesáreo nesta população. Nos subgrupos de cardiopatia (sem cesárea anterior) a probabilidade de cesárea esteve aumentada na presença dos seguintes fatores: A - uso de medicação cardiovascular; CC - CF III/IV e intercorrências obstétricas; CA -intercorrências obstétricas e idade gestacional no parto inferior a 37 semanas. A ocorrência de complicações obstétricas foi 6,8% (total), sendo maior em A (18,6%) e nos partos vaginais (10,7%); complicações clínicas maiores ocorreram em 2,5% dos casos e foram mais freqüentes nos casos de cesárea (3,8%). Conclusão: As taxas de cesárea observadas em gestante com cardiopatia foram elevadas (em especial nos casos de cardiopatia congênita) e correlacionadas à presença de cesárea anterior, insuficiência cardíaca CF III/IV, uso de medicamentos de ação cardiovascular, presença de intercorrências obstétricas e idade gestacional no parto inferior a 37 semanas.This study reviewed the data of 571 pregnancies in 556 pregnant women with heart disease admitted for delivery in a tertiary university hospital between 2001 and 2005. The objectives were to assess the prevalence of cesarean sections and vaginal births among the whole group of cases and in three subgroups: patients with arrhythmias (A - 57 cases / 10%), congenital diseases (CD - 163 cases / 28,6%) and acquired diseases (AD - 351 cases / 61,4%), and to determine the clinical and obstetrical factors related to the mode of delivery in the whole population and in the subgroups, as well as the association between the mode of delivery and clinical and obstetrical complications. The frequencies of cesarean sections were: 57,2% (whole population), 45,6% (A), 64,2% (CD) and 55,7% (AD); the cesarean sections were performed due to obstetrical reasons in 77% of the cases. In the 425 cases with no previous cesarean sections, the frequencies of c-sections deliveries were 47,1% (whole group), 37,8% (A), 57,8% (CD) and 43,3% (AD). The factors related to a higher probability of cesarean section were: previous cesarean section, gestational age at delivery of less than 37 weeks, presence of obstetrical events, diagnosis of congenital heart disease, heart failure (NYHA functional class III/IV) and use of cardiovascular drugs. The parity above 1 was related to a lesser probability of csections, and previous cesarean was the main factor related to the risk of abdominal delivery. In the cases with no previous cesarean sections, according to the subgroups of heart disease, the probability of cesarean section was heightened in the presence of the following factors: group A: use of cardiovascular drugs, CD: functional class III/IV and obstetrical events and AD: obstetrical events and gestational age in delivery less than 37 weeks. The rate of obstetrical complications was 6,8%, most of them in group A and in vaginal birth. Major clinical complications occurred in 2,5% of the cases, and were more related to cesarean sections (3,8%). Conclusion: the rates of cesarean sections observed in pregnant women with heart disease were high (mainly in the CD group), and related to previous cesarean sections, heart failure, use of cardiovascular drugs, presence of obstetrical events and gestational age at delivery less than 37 weeks.
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Cluver, Catherine Anne. "Maternal position during caesarean section for preventing maternal and neonatal complications : a cochrane review." Thesis, Stellenbosch : Stellenbosch University, 2011. http://hdl.handle.net/10019.1/17831.
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Thesis (MMed)--Stellenbosch University, 2011.ENGLISH ABSTRACT: Background: During caesarean section mothers can be in different positions. Theatre tables could be tilted laterally, upwards, downwards or flexed and wedges or cushions could be used. There is no consensus on the best positioning at present. Objectives: We assessed all available data on positioning of the mother to determine if there is an ideal position during caesarean section that would improve outcomes. Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (September 2009), PubMed (1966 to 14 September 2009) and manually searched the references of retrieved articles. Selection criteria: Randomised trials of women undergoing caesarean section comparing different positions. Data collection and analysis: Two authors assessed eligibility, trial quality and extracted data. Results: We identified 17 studies with a total of 683 woman included. We included nine studies and excluded eight studies. Included trials were of variably quality with small sample sizes. Most comparisons had data from single trials. This is a shortcoming and applicability of results is limited. The incidence of air embolism was not affected by head up versus horizontal position (risk ratio (RR) 0.91; 95% confidence interval (CI) 0.65 to 1.26). We found no change in hypotensive episodes when comparing left lateral tilt (RR 0.11; 95% CI 0.01 to 1.94), right lateral tilt (RR 1.25; 95% CI 0.39 to 3.99) and head down tilt (mean difference (MD) -3.00; 95% CI -8.38 to 2.38) with horizontal positions or full lateral tilt with 15-degree tilt (RR 1.20; 95% CI 0.80 to 1.79). Hypotensive episodes were decreased with manual displacers (RR 0.11; 95% CI 0.03 to 0.45), a right lumbar wedge compared to a right pelvic wedge (RR 1.64; 95% CI 1.07 to 2.53) and increased in right lateral tilt (RR 3.30; 95% CI 1.20 to 9.08) versus left lateral tilt. Position did not affect systolic blood pressure when comparing left lateral tilt (MD 2.70; 95% CI -1.47 to 6.87) or head down tilt (RR 1.07; 95% CI 0.81 to 1.42) to horizontal positions, or full lateral tilt with 15-degree tilt (MD -5.00; 95% CI -11.45 to 1.45). Manual displacers showed decreased fall in mean systolic blood pressure compared to left lateral tilt (MD -8.80; 95% CI -13.08 to -4.52). Position did not affect diastolic blood pressures when comparing left lateral tilt versus horizontal positions. (MD-1.90; 95% CI -5.28 to 1.48). The mean diastolic pressure was lower in head down tilt (MD -7.00; 95% CI -12.05 to -1.95) when compared to horizontal positions. There were no statistically significant changes in maternal pulse rate, five-minute Apgars, maternal blood pH or cord blood pH when comparing different positions. Authors' conclusions There is limited evidence to support or clearly disprove the value of the use of tilting or flexing the table, the use of wedges and cushions or the use of mechanical displacers. Larger studies are needed.
AFRIKAANSE OPSOMMING: Agtergrond: Tydens keisersnitte kan moeders in verskillende posisies wees. Teater tafels kan lateraal, opwaarts, afwaarts of gebuig word, of 'n wig en kussings kan gebruik word. Op die oomblik is daar geen konsensus oor die beste posisie nie. Doelwitte: Ons het alle beskikbare data oor die plasing van die moeder ondersoek, met die doel om 'n ideale posisie vir 'n verbeterde uitkoms tydens 'n keisersnit vas te stel. Metodes: Ons het die “Cochrane Pregnancy and Childbirth Group's Trials Register“ (September 2009), PubMed (1966 tot 14 September 2009) deursoek en die herwinde artikels se verwysings per hand nagegaan. Keuringskriteria: Gerandomiseerde proewe van vroue wat keisersnitte ondergaan het, is in verskillende posisies vergelyk. Data insameling en analise: Twee outeurs het die kwaliteit, die geskiktheid en data van die studie beoordeel. Resultate: Ons het 17 studies geidentifiseer wat 'n totaal van 683 vroue ingesluit het. Ons het nege studies ingesluit en agt uitgesluit. Die ingeslote studies was van wisselvallige gehalte en die monster groepe was klein. Die meeste vergelykings het data van enkele studies gegee. Dit is 'n tekortkoming en die bruikbaarheid van die resultate is beperk. Die plasing van kop-op teenoor horisontale posisie het die voorkomssyfer van lug embolisme nie geaffekteer nie.(risiko verhouding RR 0.91;95% 95% vertroue interval Cl 0.65 tot 1.26). Daar is geen hipotensiewe veranderinge gevind toe 'n vergelyking gemaak is tussen linker laterale kantel (RR 0.11; 95% Cl 0.01 tot 1.94) regter laterale kantel (RR 1.25; 95% Cl 0.39 tot 3.99) en kop-af kantel (“mean difference” MD -3.00; 95%Cl -8.38 tot 2.38) teenoor horisontale posisies of volle laterale kantel met 'n 15 grade kantel nie (RR 1.20;95% Cl 0.8. tot 1.79). Hipotensiewe episodes het verminder met hand verplasers (RR 0.11; 95% Cl 0.03 tot 0.45), 'n regter lumbale wig in vergelyking met 'n regter bekken wig (RR 1.64; 95% Cl 1.07 tot 2.53) en 'n vermeerdering van die regter laterale kantel (RR3.30; 95% Cl 1.20 tot 9.08) teenoor die linker laterale kantel. In die vergelyking tussen die posisie van linker laterale kantel (MD 2.70; 95% Cl -1.47 tot 6.87) of kop-af kantel (RR 1.07; 95% Cl 0.81 tot 1.42) teenoor horisontale posisies, of volle laterale kantel met 15 grade kantel (MD -5.00; 95% Cl -11.45 tot 1.45) het die posisie nie die sistoliese bloeddruk geaffekteer nie. Hand verplasers het 'n verminderde daling in gemiddelde sistoliese bloeddruk veroorsaak in vergelyking met linker laterale kantel plasing (MD -8.80;95% Cl-13.08 tot -4.52). In die vergelyking tussen linker laterale kantel en horisontale posisie was daar geen effek op die diastoliese bloeddruk nie (MD -1.90; 95% Cl -5.28 tot1.48). Die gemiddelde diastoliese druk was laer in die kop-af kantel (MD -7.00; 95% Cl -12.05 tot -1.95) in vergelyking met horisontale posisies. In die vergelyking tussen die verskillende posisies was daar geen betekenisvolle statistiese veranderinge in die moeder se polstempo, vyf minute Apgartellings, moederlike bloed pH of naelstringbloed pH nie. Outeur se gevolgtrekkings: Daar is beperkte getuienis om die waarde van kantel, buiging van tafel, die gebruik van wieë en kussings of die gebruik van maganiese verplasers te ondersteun of totaal te verwerp. Groter studies is nodig.
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Womack, Lindsay Shively. "Severe Maternal Morbidity in Florida: Risk Factors and Determinants of the Increasing Rate." Scholar Commons, 2017. http://scholarcommons.usf.edu/etd/6783.
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Severe maternal morbidity generally refers to the most severe complications of pregnancy and includes: hemorrhage, embolism, acute renal failure, stroke, acute myocardial infarction, and other complications. These complications affect more than 50,000 women in the United States every year, with rates significantly increasing from 1998 to 2011. In an effort to reduce these increasing complication rates, clinicians and researchers have emphasized the need to identify potential modifiable risk factors for severe maternal morbidity, and the need to study the relationships between these risk factors and severe maternal morbidity. The overall goal of this study is to improve the understanding of the increasing rates of severe maternal morbidity.
The objective of the first study is to examine the association between prepregnancy BMI and severe maternal morbidity in women residing in Florida who had a live birth during 2007-2014. Additionally, the specific association between prepregnancy BMI and the most common individual conditions that comprise the composite measure of severe maternal morbidity will also be examined. We conducted a population-based retrospective cohort study using Florida’s linked birth certificate and maternal hospital discharge data for the years 2007-2014. The risk of severe maternal morbidity associated with BMI was then estimated by odds ratios (OR) and 95% confidence intervals (CI) derived using generalized estimating equations (GEE) for logistic regression. This final model was rerun separately for the most common conditions that comprise severe maternal morbidity as the outcome measure to assess differences by type of condition. Unadjusted rates of severe maternal morbidity increased with increasing BMI; however, after risk adjustment overweight and obese women had slightly protective odds of severe maternal morbidity when compared with normal weight women. The association between prepregnancy BMI and severe maternal morbidity differs by types of severe maternal morbidity. A protective dose-response relationship was seen for blood transfusion and disseminated intravascular coagulation, with the odds of morbidity decreasing with increasing BMI. The odds of heart failure, adult respiratory distress syndrome, and ventilation all increased with increasing BMI. This study shows that severe maternal morbidity is a complex measure and not just a single condition. In future studies, it will be imperative to analyze severe maternal morbidity as a composite measure and as individual conditions to identify modifiable risk factors to focus on for interventions.
The objective of the second study is to identify potential determinants of the increase in the rate of severe maternal morbidity among women residing in Florida who had a live birth during 2005-2014. We examined severe maternal morbidity rates and related risk factors in live births to Florida women between 2005 and 2014, using Florida’s linked birth certificate and hospital discharge data. We initially conducted a Kitagawa analysis to evaluate the components of the increased rate of severe maternal morbidity between 2005 and 2014. Additionally, we performed a multivariable regression analysis to estimate the contribution of the multiple factors to differences in the rate of severe maternal morbidity in 2005 and 2014. The rate of severe maternal morbidity in 2014 was 19.3 per 1,000 live births, which was 1.65 times higher than the rate in 2005. Nearly all of the excess severe maternal morbidity and blood transfusions in 2014 can be explained by differences in the rate of severe maternal morbidity and blood transfusion between the two time periods. In total, sociodemographic factors, medical factors, and individual and hospital health service factors explained 9.1% of the overall severe maternal morbidity increase in 2014 compared with 2005, and only explained 2.5% of the increase in blood transfusions during this time period. Our study findings indicate that the increase in the rate of severe maternal morbidity is comprised almost entirely by an increase in the rate of blood transfusions. Further research will need to be conducted to explain the increase in the rate of severe maternal morbidity and blood transfusions.
Consistent with national trends, the rates of severe maternal morbidity have been increasing in Florida. This increase is driven almost entirely by blood transfusions and cannot be explained by traditional factors that are readily available in current datasets. In addition to the differences between the trends of blood transfusions and the 20 severe maternal morbidity conditions, there are also differences in risk factors associated with these different conditions. Prepregnancy overweight and obesity is associated with a protective effect with blood transfusions and disseminated intravascular coagulation that is not seen in the other conditions. Therefore, initiatives to decrease the rates of severe maternal morbidity will need to take these differences into account.
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Shokane, Morogwana Anna. "The utilization of the partograph by midwives in Lebowakgomo and Zebediela level 1 hospitals in the Capricorn District of the Limpopo Province, South Africa." Thesis, University of Limpopo (Turfloop Campus), 2011. http://hdl.handle.net/10386/627.
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Thesis (M.Cur.) --University of Limpopo, 2011Introduction and aim: Globally it is of paramount importance that all pregnant women in labour are monitored by midwives utilizing a partograph so that a live baby is delivered. Midwives seemed not to utilize the partograph correctly when monitoring women in labour. The purpose of this study was to determine the utilization of the partograph by midwives in the labour wards of Lebowakgomo and Zebediela level 1 hospitals in the Capricorn District of the Limpopo Province, South Africa. The research question was, “What skills and knowledge do midwives have on the utilization of the partograph for monitoring pregnant women in labour”. The objectives of this study were to explore and describe the utilization of the partograph by midwives in Lebowakgomo and Zebediela level 1 hospitals in the Capricorn District of the Limpopo Province, and to develop guidelines that would assist midwives to effectively utilize the partograph hence provision of quality midwifery care. Research Design and method: The research design was qualitative, descriptive, explorative and contextual in nature. The population comprised all midwives registered with the South African Nursing Council and practicing as such in Lebowakgomo and Zebediela level 1 hospitals. A purposive sampling technique was used to select 15 participants. Data were collected using semi-structured in–depth interviews with a guide. The semi-structured in-depth interviews were conducted until data were saturated. Trustworthiness was ensured by credibility, dependability, transferability and confirmability. Ethical clearance to conduct the study was obtained from the University of Limpopo and from the Department Health and Social Development. The principles of informed consent, confidentiality and anonymity were observed during the study. Data were analyzed using the Tesch’s approach as described by Creswell (1994) cited in de Vos (2005:333). Conclusions: The following themes emerged during data analysis: monitoring of foetal status during intrapartum, monitoring of the progress of labour during intrapartum, monitoring of the maternal status during intrapartum, and shortage of staff in the labour wards. Guidelines which aimed at improving midwifery care were formulated.
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Hsu, Lorena. "The comparison of obstetric complication histories of individuals with childhood-onset schizophrenia vs. adult-onset schizophrenia, a multi-site feasibility study." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape9/PQDD_0006/MQ45907.pdf.
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Viljoen, J. E. (Johanna E. ). "The R563Q mutation of the β-subunit of the epithelial sodium channel gene associated with hypertensive disease and related complications in pregnancy." Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/5443.
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Thesis (MMed (Obstetrics and Gynaecology))--University of Stellenbosch, 2010.ENGLISH ABSTRACT: Introduction: Hypertensive disease is one of the cardinal causes of maternal morbidity and mortality in South Africa. According to the National Confidential Enquiry into Maternal Deaths (NCEMD) report for 2005-2007, the “big five” causes of maternal death have remained the same as in the previous triennium, with hypertensive disease in second place, being the causative factor in 15.7% of cases.1 Women under 20 years of age were at greater risk of dying due to complications of hypertension. In this light, the early identification and treatment of hypertensive disease remains important priorities in improving maternal care. Various serum markers have been studied to identify women at risk of pre-eclampsia, including biological markers and genetic factors.2 It is also well known that chronic hypertension is one of the major predisposing factors to the development pre-eclampsia.2 A continued search for a genetic screening test to assist in early diagnosis could facilitate a reduction of maternal morbidity and mortality. Aims: The aim of this project is to determine the prevalence of the R563Q mutation of the -subunit of the epithelial sodium channel (-ENaC) gene in a cohort of primigravid women with hypertensive disease in pregnancy and to compare pregnancy outcomes in this group of hypertensive patients to those not identified to be carriers of the mutation. Methodology: A retrospectively collected study cohort of patients with early onset pre-eclampsia, obtained from pooled samples and data from the GAP study (Genetic Aspects of Pre-eclampsia, project number C99/025), was used. The planned sample size was 200, with 200 controls who were ethnic-matched, normotensive women. Exclusion criteria were gestation 34 weeks, multiple pregnancy, known underlying collagen vascular disease and type I Diabetes Mellitus. Outcome criteria: The pregnancy outcomes were analysed with respect to the degree of hypertensive disease and related complications (maternal, placental and neonatal). Results: Blood samples form 104 patients and 80 control samples were analysed. Pre-eclamptic patients were significantly younger than controls (p<0.0001). The presence of the mutation was not significantly increased in the pre-eclamptic group (p=0.33). The mutation bearers did not exhibit a significant tendency towards a specific degree of pre-eclampsia (p=0.51). There were no significant differences in the other studied maternal or fetal outcome measures. A composite outcome (the presence of 1 adverse outcome compared to no adverse outcome) was created which did not differ between the mutation positive and negative pre-eclamptic patients. Data of the index study was combined with the data form a prior relevant study9 and combined odds ratios were calculated. The increased mutation frequency amongst pre-eclamptics compared to healthy controls then remains significant, OR 2.57(95%CI 1.23-5.36). Conclusion: In this study the R563Q mutation of the ß-subunit of the epithelial sodium channel gene was not linked to pre-eclampsia. No significant negative correlation could be established between the presence of the R563Q mutation and the outcomes of pre-eclampsia. Further research aimed at chronic hypertensive patients in pregnancy and unstable pre-eclampsia in larger study groups could shed more light on the relation between the mutation and the pre-eclamptic phenotype.
AFRIKAANSE OPSOMMING: Inleiding: Hipertensie-verwante siektes is een van die hoof oorsake van moederlike morbiditeit en mortaliteit in Suid-Afrika. Volgens die Nasionale Vertroulike Ondersoek insake Moederlike Sterftes (NCEMD) verslag vir 2005-2007, is die “groot vyf” oorsake van moedersterftes dieselfe as in die vorige triënnium, met hipertensie-verwante siektes in tweede plek, as die oorsaak van 15.7 % van die sterfgevalle. 1 Vroue jonger as 20 jaar het ‘n groter risiko om te sterf aan die komplikasies van hipertensie-verwante siektes. In die lig hiervan is die vroeë identifikasie en behandeling van hipertensie-verwante siektes ‘n priorteit in die verbetering van moedersorg. Verskeie serum merkers is al bestudeer met die hoop om vroue met verhoogde risiko vir die ontwikkelling van pre-eklampsie te identifiseer, wat biologiese merkers en genetiese faktore insluit. 2 Dit is ook welbekend dat chroniese hipertensie een van die hoof predisponerende faktore is vir die ontwilkkeling van pre-eklampsie.2 ‘n Voortgesette soektog na ‘n genetiese siftingstoets wat kan bydra tot vroeë identifisering, sou moederlike morbiditeit en mortaliteit kon verminder. Doelwittle: Die doelwit van hierdie projek is om die prevalensie van die R563Q mutasie van die -subeenheid van die epiteliële natrium kanaal (-ENaC) geen te bepaal in ‘n kohort primigravida vroue met hipertensie-verwante siekte in swangerskap en om die swangerskapsuitkomste van hierdie groep te vergelyk met pasiente wat nie draers van die mutasie is nie. Metodologie: ‘n Retrospektief versamelde studie kohort met vroeë aankoms pre-eklampsie, verkry van die monsterbank en data van die GAP studie (Genetic Aspects of Pre-eclampsia, projek nommer C99/025) is gebruik. Die beplande steekproef grootte was 200, met 200 kontroles, wat etnies- en ouderdomvergelykbare normotensiewe vroue was. Uitsluitingskriteria was gestasie 34 weke, onderliggende bindweefselsiekte en tipe I Diabetes Mellitus. Uitkomskriteria: Swangerskap uitkomste was geanaliseer met betrekking tot die graad van hipertensiewe siekte en verwante kompliksies (moederlik, plasentaal en neonataal). Resultate: Bloed monsters van 104 pasiënte en 80 kontroles is ontleed. Pre-eklampsie pasiënte was betekenisvol jonger as kontroles (p<0.0001). Die teenwoordigheid van die mutasie was nie betekenisvol verhoog in die pre-eklampsie groep nie (p=0.33). Die mutasie-draers het nie ‘n geneigdheid tot ‘n spesifieke graad van pre-eklampsie getoon nie (p=0.51). Daar was geen betekenisvolle verskille tussen die ander moederlike of fetale uitkomste wat bestudeer is nie. ‘n Gesamentlike uitkoms (teenwoordigheid van 1 swak uitkoms vergeleke met geen swak uitkoms) is geskep; daar was geen verskil tussen die mutasie-positief en negatiewe pasiënte met pre-eklampsie nie. Data van die indeks studie en relevante data uit ‘n vorige studie9 is saamgevoeg en die gesamentlike kansverhouding is bereken. Die verhoogde mutasie frekwensie onder pasiënte met pre-eklampsie vergeleke met gesonde kontroles was betekenisvol, KV 2.57(95%VI 1.23 - 5.36). Gevolgtrekking: In hierdie projek was daar nie ‘n verband tussen die R563Q mutasie van die -subeenheid van die epiteliële natrium kanaal (-ENaC) geen en pre-eklampsie nie. Geen betekenisvolle negatiewe korrelasie tussen die R563Q mutasie en pre-eklampsie uitkomste kon aangetoon word nie. Verdere navorsing gerig op pasiënte met chroniese hipertensie of akute, onstabiele pre-eklampsie in groter studiegroepe kan die verband tussen die mutasie en die pre-eklampsie fenotipe moontlik beter toelig.
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Сухарєв, Анатолій Борисович, Анатолий Борисович Сухарев, and Anatolii Borysovych Sukhariev. "Клініко-імунологічні аспекти післяпологових гнійно-запальних захворювань." Thesis, Видавництво СумДУ, 2004. http://essuir.sumdu.edu.ua/handle/123456789/9020.
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Hesselman, Susanne. "Caesarean Section : Short- and long-term maternal complications." Doctoral thesis, Uppsala universitet, Obstetrik & gynekologi, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-327934.
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Caesarean section is a common major surgical procedure and long-term complications have not been fully investigated. By longitudinal population based register studies, based on National health registers and medical data records, maternal complications after caesarean delivery at subsequent labour (N=7 683), among extremely preterm births (N=406), and at remote gynaecologic surgery (N=25 354) were explored. In Paper I, uterine closure was investigated in respect to uterine rupture in a subsequent delivery after caesarean section. Uterine rupture occurred in 1.3 % of women with a previous caesarean section. There was no increased risk of uterine rupture with single compared with double layers for closure of the uterus (adjusted Odds Ratio 1.17, 95 % CI 0.78-1.70). Modifiable risk factors of uterine rupture in a trial of labour after caesarean section included induction of labour and use of epidural analgesia. In Paper II, maternal outcomes and surgical aspects of caesarean section in the extremely preterm period were assessed. Maternal complications were more frequently reported in extremely preterm- compared with term caesarean delivery. No increase in short-term morbidity was observed at 22-24 compared with 25-27 gestational weeks, but uterine corporal incisions were performed more frequently (18.1 % vs. 9.6 %, p=0.02). Furthermore, risk factors for abdominal adhesions after caesarean section and organ injury in remote gynaecologic surgery were analysed (Paper III and IV). Numbers of prior caesarean sections were the most important factor for formation of adhesions. Advanced maternal age, obesity, infection and delivery year 1997-2013 were factors associated with adhesions in conjunction with caesarean section. Organ injury occurred in 2.2 % of women undergoing benign hysterectomy. A history of caesarean section increased the risk (adjusted Odds Ratio 1.74, 95 % CI 1.41-2.15), but was only partly explained by the presence of adhesions. The organ affected depended on medical history; prior caesarean predisposed for bladder injury, prior bowel/pelvic surgery for bowel injury and endometriosis was associated with ureter injury at time of hysterectomy. In conclusion; data from National health registers indicates that caesarean delivery is associated with long-term complications, although the absolute risk of severe complications for the woman is low.
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Duhn, Lenora Jane. "The impact of a maternity cooperative care program on maternal and infant complications, maternal competence, social support, and stress." Thesis, McGill University, 1996. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=23999.
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The purpose of this study was to assess the impact of a Maternity Cooperative Care Program (MCCP) on the prevalence of maternal and infant complications, maternal competence, social support, stress, and first-time-mothers' descriptions of their postpartum experience. Forty-one healthy, primiparous mothers who participated in a MCCP and forty-three healthy, primiparous mothers who received traditional maternity care were asked to complete the Perceived Competence Questionnaire, the Personal Resource Questionnaire, "The Help I Get" Questionnaire (spousal support), and three numerical rating scales relating to stress in general, as well as self- and infant-care stress 24-48 hours postpartum while in hospital and over the telephone at two weeks postpartum. Ten randomly selected mothers from each group also answered twelve open-ended questions during a home visit at 2-3 weeks postpartum. There were no statistically significant differences between the two groups for any of the outcome variables assessed. For both groups, competence with self- and infant-care increased over the two weeks postpartum, while support and stress remained stable. Interviews with the mothers revealed that the number of stressors increased once at home, while support continued to be of value in relieving stress and helping maternal adjustment and confidence. Results of a qualitative comparison between the groups suggests that the MCCP mothers felt more prepared to be discharged home, and identified their partner more often as an active participant during hospitalization.
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Masters, Heather R. "Maternal Obesity is an Independent Risk Factor for ICU Admission during Hospitalization for Delivery." University of Cincinnati / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1491559250082122.
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Lundgren, Ingela. "Releasing and relieving encounters : Experiences of pregnancy and childbirth." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2002. http://publications.uu.se/theses/91-554-5292-2/.
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Wipplinger, Petro. "Is an educational intervention effective in improving the diagnosis and management of suspected ectopic pregnancy in a tertiary referral hospital in South Africa." Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/5241.
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Thesis (MMed (Obstetrics and Gynaecology))--University of Stellenbosch, 2010.ENGLISH ABSTRACT: Study objective: To investigate whether an educational intervention in the Gynaecology Department of Tygerberg Hospital (TBH) was effective in improving the accuracy of the diagnosis and appropriateness of treatment options offered to women with suspected Ectopic Pregnancy (EP). Methods: A retrospective cross-sectional before-and-after study was performed, including 335 consecutive patients with suspected EP before (1/3 - 30/6/2008) and after (1/9 - 31/12/2008) “the intervention”. From the gynaecological admissions register all pregnant patients with symptoms potentially compatible with EP were selected and these were cross referenced with beta-hCG requests, entries in the theatre register for surgery for possible EP and methotrexate prescriptions for EP in these time periods. “The intervention” consisted of a formal lecture presented to the registrars and consultants regarding the latest evidence-based guidelines concerning the diagnosis and management of EP. An algorithm based on this information was introduced in the emergency unit and ultrasound unit together with a prescribed ultrasound reporting form containing all the pertinent information required to follow the algorithm. Clinical decisions were left to the registrar and consultant on duty. Primary outcomes: Time from presentation to treatment, number and appropriateness of special investigations, surgical procedures or medical management. Secondary outcomes: Number of in-patient days and visits, adherence to the algorithm. Results: There was a non-significant trend towards improved reporting of the uterine content and significantly less reports of definite signs of an intrauterine pregnancy (IUP) (p<0.001, RR 0.46, 95% CI 0.31-0.70) due to stricter ultrasound criteria being followed. There was a significant change in the spectrum of uterine findings (p=0.001), the spectrum of adnexal findings (p=0.006) and the spectrum of free fluid noted (p=0.05). There was a reduction in the total number of beta-hCG levels requested at presentation (patients with no beta-hCG: 24 vs 34, p=0.05, RR 1.60, 95% CI 0.99-2.59) with a significant reduction in the number of inappropriate beta-hCG requests (77 vs 40, p<0.001, RR 0.60, 95% CI 0.43-0.81). There was a significant difference in the spread of the number of beta-hCG tests per patient with less repeat tests in the study group (p=0.021). Significantly less manual vacuum aspirations (MVAs) were performed (47 vs 21, p=0.003, RR 0.51, 95% CI 0.32-0.81) but there was no change in the other treatment modalities offered nor in the time from presentation to treatment, number of visits or in-patient days. Adherence to the algorithm was poor (59 %). Conclusions: Except for a significant decrease in the MVAs performed, with possibly less interrupted early intrauterine pregnancies, the improvement in the use of special investigations after “the intervention” did not translate into fewer inappropriate diagnoses and management. This could be due to frequent non-adherence to the algorithm, and widespread implementation of the algorithm as well as continuous audits would be necessary before a future study could be attempted to assess the efficacy of the algorithm.
AFRIKAANSE OPSOMMING: Studiedoelwit: Die hoofdoel van hierdie studie is om te ondersoek of „n opvoedkundige intervensie in die Ginekologiese afdeling van Tygerberg Hospitaal (TBH) doeltreffend sou wees in die verbetering van die akkuraatheid van diagnose en die gepastheid van behandelingsopsies wat aan vroue gebied word met „n vermoedelike ektopiese swangerskap (ES). Metodes: „n Retrospektiewe, kruisdeursnee voor-en-na studie rakende 335 opeenvolgende pasiënte wat ‟n vermoedelike ES het voor (1/3/2008 – 30/6/2008) en na (1/9/2008 – 31/12/2008) “die intervensie”. Swanger pasiënte is uit die ginekologiese toelatingsregister geselekteer indien hulle simptome gehad het wat moontlik verbind kon word met ES. Hulle is kruisverwys met die beta-hCG‟s aangevra, inskrywings in die teaterregister vir chirurgie vir moontlike ES en ginekologie-pasiënte wat metotrexate vir ES binne hierdie tydperke ontvang het. “Die intervensie” het bestaan uit „n formele lesing aan die kliniese assistente en konsultante ten opsigte van die jongste bewysgebaseerde riglyne rakende die diagnose en hantering van ES. „n Algoritme gegrond op hierdie inligting is in die noodeenheid en ultraklank-afdeling ten toon gestel asook „n voorgeskrewe ultraklank rapporteringsvorm met al die toepaslike inligting wat vereis word om die algoritme te volg. Kliniese besluite is aan die kliniese assistent en konsultant aan diens oorgelaat. Primêre uitkomste: Tydsduur vanaf aanmelding tot behandeling, aantal en gepastheid van spesiale ondersoeke, chirurgiese prosedures en mediese hantering. Sekondêre uitkomste: Die aantal binnepasiëntdae en besoeke, nakoming van die algoritme. Resultate: Daar was „n nie-betekenisvolle neiging tot beter rapportering van die uteriene-inhoud en betekenisvol minder rapportering van definitiewe tekens van „n intra-uteriene swangerskap (IUS) (p<0.001, RR 0.46, 95% CI 0.31-0.70) as gevolg van strenger ultraklankstandaarde gevolg. Daar was „n betekenisvolle verandering in die spektrum van uteriene bevindinge (p=0.001), die spektrum van die adneksale bevindinge (p=0.006) en die spektrum van die vrye vog aangeteken (p=0.05). Daar was „n vermindering in die totale aantal beta-hCG-vlakke aangevra met aanmelding (pasiënte met geen hCG: 24 vs 34, p=0.05, RR 1.60, 95% CI 0.99-2.59) met „n betekenisvolle vermindering in die aantal onvanpaste beta-hCGs aangevra (77 vs 40, p<0.001, RR0.60, 95% CI 0.43-0.81). Daar was „n betekenisvolle verskil in die verspreiding van die aantal beta-hCG-toetse per pasiënt, met minder herhalende toetse in die studiegroep (p=0.021). Betekenisvol minder manuele vakuum aspirasies (MVAs) is uitgevoer (47 vs 21, p=0.003, RR 0.51, 95% CI 0.32-0.81), maar geen verskil in ander behandelingsmodaliteite is aangebied nie, asook geen verskil in die tydsduur vanaf aanmelding, die aantal besoeke of die aantal binnepatiëntdae nie. Nakoming van die algoritme was swak (59%). Gevolgtrekkings: Behalwe vir „n betekenisvolle afname in die MVAs uitgevoer, met moontlik minder onderbroke vroeë IUS, het die verbetering in die gebruik van spesiale ondersoeke ná “die intervensie” nie minder onvanpaste diagnoses en hantering tot gevolg gehad nie. Dit kan die gevolg wees van gereelde nie-nakoming van die algoritme, en uitgebreide implementering van die algoritme asook voortdurende oudits sal nodig wees voor „n verdere studie aangepak kan word om die doeltreffendheid van die algoritme te bepaal.
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Massawe, Siriel Nanzia. "Anaemia in women of reproductive age in Tanzania : A study in Dar es Salaam." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2002. http://publications.uu.se/theses/91-554-5308-2/.
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Pereira, Caetano. "Task-shifting of major surgery to midlevel providers of health care in Mozambique and Tanzania a solution to the crisis in human resources to enhance maternal and neonatal survival /." Stockholm, 2010. http://diss.kib.ki.se/2010/978-91-7409-826-6/.
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Jantjes, Louisa. "Inter-level health service referral of women in labour." Thesis, Nelson Mandela Metropolitan University, 2008. http://hdl.handle.net/10948/986.
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Although it is considered an everyday occurrence, childbirth is nonetheless an important and dramatic experience in the life of every woman. Childbirth, a normal physiological state in the life of a woman, can be an awe-inspiring and exciting experience, but sometimes disconcerting experiences may also occur. Women sometimes see labour as the end to a long drawn out process following pregnancy and therefore attribute great significance to all occurrences during labour. When complications occur in a usually uncomplicated process of labour, the health care provider must be able to make quick and effective management decisions and implement appropriate interventions. This may include the referral of women in labour to a level of care where complications can be dealt with more effectively, thereby ensuring the best maternal and neonatal outcomes. Patient referral is regarded as a fundamental component of the health care system therefore a well functioning system should ensure that patients are treated in the appropriate manner at the appropriate place at the lowest possible cost to the health system. The goal of this research study was to explore and describe the inter-level health service referral of women in labour by midwives, in order to design guidelines for midwives and other relevant health care providers involved in inter-level health service referral of women in labour in the South African public health care sector. The research design used for this study is a combination of qualitative and quantitative approaches. The paradigmatic perspective of this study was based on the World Health Organization’s Health for All Model. Appropriate data collection and analysis strategies were used for the different stages of the study. Data collection commenced only after permission to conduct the research had been obtained from relevant authorities and University of Port Elizabeth and the Nelson Mandela Metropolitan University structures. Informed consent was obtained from participants included in the study. In stage 1 of this research project, a profile of midwives at lower level maternity care centres was compiled and the perceptions and experiences of midwives working at lower level maternity services, who are responsible for inter-level health referrals of women in labour, were described. Stage 2 described, by means of analysis of maternity case records, aspects of the inter-level referral of women in labour including the profiles of women admitted to midwife obstetric units (MOUs) who are v referred to higher levels of care. Of significance in this study is the appropriateness of midwifery referrals and the maternity care implemented by health care providers during inter-level health service referral of women in labour. In stage 3 clinical guidelines for midwives and other relevant maternity care providers, to assist them in the inter-level health service referral of women in labour, were developed. Findings from stage 1 of this research study revealed that midwives were generally well qualified and sufficiently experienced in the management of women in labour who need referral. Disconcerting findings relating to human and material resource shortages were discovered; these included major problems with patient transportation and difficulties with communication relating to inter-level health service referral of women. These shortages adversely affected midwives’ ability to efficiently care for women during the inter-level health service referral of women in labour in the research area. Stage 2 of the study yielded results of questionable standards of care to women and infants included in the study. A further disturbing finding from the study is the poor state of record keeping. The development of the provisional guidelines in stage 3 of the study was informed by the four main themes identified from the research findings. Before embarking on guideline development, the researcher familiarized herself with theory related to the clinical guidelines. These included clarifying the concept ‘clinical guidelines’, justifying the need for developing clinical guidelines as well as giving consideration to concerns about clinical guidelines. The research findings as well as literature related to these findings informed the researcher on the development of the guidelines. Provisional guidelines were therefore developed on responsibilities of role players in inter-level health service referral of women in labour at first level of referral, namely the midwife obstetric units, transport personnel and maternity care providers at the referral hospital. Steps were taken throughout the study to adhere to ethical standards of research. The researcher will ensure that the research report is available to all health authorities involved, the participants included in the study and the health care providers who may benefit from the research findings.
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August, Furaha. "Effect of Home Based Life Saving Skills education on knowledge of obstetric danger signs, birth preparedness, utilization of skilled care and male involvement : A Community-based intervention study in rural Tanzania." Doctoral thesis, Uppsala universitet, Internationell mödra- och barnhälsovård (IMCH), 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-272245.
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Use of skilled care during antenatal visits and delivery is recommended to address the burden of maternal mortality. However there are few facility deliveries and insufficient knowledge of danger signs, especially in rural Tanzania. The aim of this thesis was to explore the perceptions and challenges that the community faces while preparing for childbirth and to evaluate an intervention of the Home Based Life Saving Skills education programme on knowledge of danger signs, facility delivery and male involvement when delivered by rural community health workers in Tanzania. In Paper I, Focus Group Discussions explored the perceptions and challenges that the community encounters while preparing for childbirth. Structured questionnaires assessed men’s knowledge of danger signs and birth preparedness and complication readiness in Paper II. The effect of the Home Based Life Saving Skills education programme in the community was assessed with a before-and-after evaluation in two districts; one intervention and one comparison. Paper III assessed the effect of the programme on knowledge of danger signs and birth preparedness and facility delivery among women, while Paper IV evaluated its effect on male involvement. The community perceived that all births must be prepared for and that obstetric complication demands hospital care; hence skilled care was favoured. Men’s knowledge of danger signs was limited; only 12% were prepared for childbirth and complications. Preparedness was associated with knowledge of obstetric complications (AOR=1.4 95% CI 1.8 – 2.6). The intervention showed women utilizing antenatal care (four visits) significantly more (43.4 vs 67.8%) with a net effect of 25.3% (95% CI: 16.9 – 33.2; p < .0001). The use of facility delivery improved in the intervention area (75.6 vs 90.2%; p = 0.0002), but with no significant net effect 11.5% (95% CI: -5.1 – 39.6; p = 0.123) when comparing the two districts. Male involvement improved (39.2% vs 80.9%) with a net intervention effect of 41.1% (CI: 28.5 – 53.8; p < .0001). Improvements were demonstrated in men’s knowledge level, in escorting partners for antenatal care and delivery, making birth preparations, and shared decision-making. The intervention, in educating this rural community, is effective in improving knowledge, birth preparedness, male involvement and use of skilled care.
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Olefile, Kabelo Monicah. "Misoprostol for prevention and treatment of postpartum hemorrhage : a systematic review." Thesis, Stellenbosch : Stellenbosch University, 2011. http://hdl.handle.net/10019.1/17900.
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Thesis (MCur)--Stellenbosch University, 2011.ENGLISH ABSTRACT: Background: Misoprostol, a prostaglandin E1 analogue with its uterotonic properties has entered as an integral part of management of the third stage of labour, helping to prevent postpartum haemorrhage (PPH). Objective: To assess evidence on the effectiveness of misoprostol compared to a placebo for the prevention and treatment of postpartum haemorrhage. Methods: Databases searched included; MEDLINE, Google Scholar and Cochrane Central Register of Controlled Trials (CENTRAL). Other sources were also searched. All articles were screened for methodological quality by two reviewers independently by standardized instrument. Data was entered in Review Manger 5.1 software for analysis. Results: Three Misoprostol studies were included (2346 participants), Oral (2 trials) and sublingual (1 trial). Misoprostol has shown not to be effective in reducing PPH (RR 0.65: 95% CI 0.40-1.06). Only one trial reported on need for blood transfusion (RR 0.14; 95% CI 0.02-1.15). Misoprostol use is associated with significant increases in shivering (RR 2.75; 95% CI 2.26-3.34) and pyrexia (RR 5.34; 95% CI 2.86-9.96) than with placebo. No maternal deaths were reported in included trials. Compared to placebo, misoprostol was coupled with less hysterectomies and additional used of uterotonics (RR 0.45; 95%CI 0.21-0.96) compared to placebo. Conclusion: Results of this review shows that the use of misoprostol in combination with some components of active management was not associated with any significant reduction in incidence of PPH. However oral administration showed a significant reduction in incidence of PPH. For its use for treatment of postpartum haemorrhage, there is a need for research focus in optimal dose and route of administration for a clinically significant effect and acceptable side effects.
AFRIKAANSE OPSOMMING: Agtergrond: Misoprostol, 'n prostaglandien E1 analoog met sy uterotonic eienskappe het ingeskryf as' n integrale deel van die bestuur van die derde stadium van kraam, help postpartum bloeding (PPH) te voorkom. Doelwit: Om bewyse oor die effektiwiteit van Misoprostol in vergelyking met 'n placebo vir die voorkoming en behandeling van postpartum bloeding te evalueer. Metodes: Databases gesoek ingesluit, Medline, CINHAL, Google Scholar en Cochrane Sentrale Register van gecontroleerde studies (Sentraal). Ander bronne is ook deursoek. Alle artikels is gekeur vir die metodologiese kwaliteit deur twee beoordelaars onafhanklik deur die gestandaardiseerde instrument. Data is opgeneem in Review Manger 5.1 sagteware vir ontleding. Hoof Resultate: Drie Misoprostol studies were ingesluit (2346 deelnemers). Mondeling (2 proe) en sublinguale (1 verhoor). Misoprostol het getoon nie doeltreffend te wees in die vermindering van PPH (RR 0,65: 95% CI 0,40-1,06). Slegs een verhoor berig oor die noodsaaklikheid vir 'n bloedoortapping (RR 0,14, 95% CI 0,02-1,15). Misoprostol gebruik word geassosieer met 'n aansienlike toename in bewing (RR 2,75, 95% CI 2,26- 3,34) en koors (RR 5,34, 95% CI 2,86-9,96) as met' n placebo. Geen moederlike sterftes is aangemeld in proewe. In vergelyking met placebo, was Misoprostol tesame met minder hysterectomies en addisionele gebruik van uterotonics (RR 0,45, 95% CI,21-,96) in vergelyking met placebo. Gevolgtrekking: Resultate van hierdie studie toon dat die gebruik van Misoprostol in kombinasie met 'n paar komponente van aktiewe bestuur is wat nie verband hou met' n beduidende afname in die voorkoms van PPH. Vir die gebruik vir die behandeling van postpartum bloeding, daar is 'n behoefte vir navorsing fokus in die optimale dosis en die roete van administrasie vir' n klinies beduidende uitwerking en aanvaarbare neweeffekte.
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Tong, Stephen. "Investigation of novel endocrine markers of early pregnancy and later pregnancy health." Monash University, Dept. of Obstetrics and Gynaecology, 2004. http://arrow.monash.edu.au/hdl/1959.1/9689.
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Berg, Marie. "Genuine Caring in Caring for the Genuine : Childbearing and high risk as experienced by women and midwives." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2002. http://publications.uu.se/theses/91-554-5299-X/.
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