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Bhullar, Annum. "Obstetric fistula: challenges and approaches." Thesis, Boston University, 2012. https://hdl.handle.net/2144/31508.
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Thesis (M.A.)--Boston UniversityPLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.
Obstetric Fistula (OF) is a devastating condition, normally caused by obstructed labor, which results in uncontrollable urinary and fecal incontinence and affects thousands of women every year. Most of the women affected by OF reside in small isolated, rural villages, creating challenges to diagnosis and treatment. Due to lack of standardization of therapy approaches, many women undergoing OF-repair often redevelop incontinence or other complications. This paper analyzes both vaginal and abdominal approaches to OF, evaluating their outcomes and the challenges they present. The therapies analyzed are: the Latzko approach, the layered-closure, and the Martius flap procedure. The goal of this paper is to determine which procedure is most appropriate to use for specific types of OF in order to establish therapeutic standardization. This study reviewed a significant amount of literature evaluating all three therapy approaches. It was determined that the Latzko approach should be utilized as the first approach to vesicovaginal fistula (WF) and vesicouterine fistula (VUF) due to its simplicity, avoidance of major operative complications, and successful postoperative repair results. Layered-closure approaches should be refrained from use, unless the Latzko approach is impossible or in specific cases of urethrovaginal fistula. Due to its more extensive operation and post-operative follow-up, the Martius flap procedures should be used only for significantly complex fistulas, such as those that involve multiple organs, are exceptionally large or recurrent. Surgical approaches, however, cannot repair the OF problem on its own, due to a number of challenges and ethical considerations. Therefore, challenges to OF treatment and repair were also considered and analyzed. A final evaluation determined that the creation of permanent infrastructure, such as women's reproductive health and delivery clinics will provide the greatest improvements to the current OF status. By solving problems such as surgeon shortages, cost issues, and the lack of follow-up and mental health services, it was determined that permanent delivery clinics with established transportation methods will produce the most significant reduction of obstructed labor, and therefore OF occurrence, and the most promising OF prevention method as well.
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Mollberg, Margareta. "Obstetric brachial plexus palsy /." Göteborg : Department of Obstetrics and Gynaecology, The Institute of Clinical Sciences, Sahlgrenska Academy at Göteborg University, 2007. http://hdl.handle.net/2077/3191.
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Cattle, Kirsty. "Faecal incontinence : obstetric causality." Thesis, University of Manchester, 2012. https://www.research.manchester.ac.uk/portal/en/theses/faecal-incontinence-obstetric-causality(c98b4d67-566b-4e5c-b17b-6546387d30ea).html.
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Introduction: Faecal incontinence is more common in parous women who have had a difficult vaginal delivery. However, the pathophysiology of the injury resulting in faecal incontinence in such women is incompletely understood. This study therefore aimed to compare anal canal and pelvic floor parameters between continent and incontinent women and measure these during pregnancy and after delivery in order to more fully understand the initial insult to the pelvic floor. Methods: Anal manometry and fatigue (using a water-filled microballoon) and pelvic floor strength and fatigue (using an air-filled vaginal probe connected to a Peritron) were measured in 30 primiparous women at booking, end of pregnancy and 6 months post partum. Ten of these women also underwent measurement of pelvis size using ultrasound. A further 61 women, 39 incontinent and 22 continent, also underwent these measurements in order to compare pelvic floor parameters between continent and incontinent women. Results: Voluntary contraction of the external anal sphincter (EAS) was significantly lower 11 weeks post partum than antenatal values (106.5 ± 43.6 cmH2O antenatally vs 75.5 ± 45.6 cmH2O post partum, p < 0.001) but there was no significant difference between antenatal values and those measured 6 months post partum (p = 0.24). Anal fatigue rate was significantly slower 11 weeks post partum (p = 0.001), but by six months post partum the difference is no longer significant (p = 0.053). Pelvic floor muscle (PFM) strength fell with age and was significantly lower in incontinent women (8.97 ± 12.88 cmH2O) than incontinent women (27.17 ± 18.16 cmH2O; p < 0.001). PFM fatigue rate was also significantly slower in incontinent women (p = 0.01). The PFM strength was significantly higher in nulliparous than parous women (p = 0.002) and fatigue rate was faster (p = 0.022). PFM strength (p = 0.006) and fatigue rate (p =0.004) were significantly lower six months post partum when compared with antenatal values. It was shown that pelvis size can be measured using ultrasound and was found to be repeatable, but inaccurate when compared with magnetic resonance imaging. Insufficient numbers were studied to show an effect on pelvic floor function. Conclusion: Vaginal delivery causes impairment of EAS voluntary contraction which appears to have recovered by six months post partum. It also causes impairment of PFM contraction which is persistent at six months post partum. The reduced PFM function seen post partum also occurs in incontinent women, adding to the evidence that childbirth causes the initial insult to the pelvic floor which results in faecal incontinence, either immediately or some years later.
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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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Tyler, Damian J. "Quantitative measurements in obstetric MRI." Thesis, University of Nottingham, 2002. http://eprints.nottingham.ac.uk/13964/.
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This thesis describes the development and application of quantitative echo planar magnetic resonance imaging techniques to the study of human placental development in normal and compromised pregnancies. Initially, a method of rapidly and accurately measuring the transverse relaxation time is proposed using a multi-echo measurement sequence. The method is described, validated on CUS04 phantoms and applied in the study of the human placenta and gastric dilution. It is shown that the inversion provided by sinc pulsesis insufficient to generate an accurate measurement but using adiabatic refocusing pulses yields a measurement that is comparable with a single spin echo. Subsequently, a rapid magnetisation transfer method is presented that allows the quantification of the relative size of the bound proton pool. An experimental pulse sequence is proposed, along with a theoretical model, that permits the investigation of the bound proton pool's transition towards the steady state. The sequence and model are validated using agar gel phantoms and shown to agree well with literature values. When applied in the study of the human placenta, it is shown that there is no significant variation in the fitted value of the bound proton pool size with increasing gestational age or in compromised pregnancies. Finally, several methods of measuring the oxygenation level of blood within the human placenta are investigated. The signal intensities of cardiac gated T~• and T~ weighted images acquired at various points in the maternal cardiac cycle are explored but no significant variation is shown through the cycle. A pulsed gradient spin echo sequence that utilises anti-symmetric sensitising gradients is validated and then applied in the human placenta. Oxygenation measurements with this technique are shown to be unfeasible but the potential of the sequence to monitor blood flow in the placenta is demonstrated.
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Шевченко, Тетяна Володимирівна, Татьяна Владимировна Шевченко, Tetiana Volodymyrivna Shevchenko, and D. M. Horobchenko. "Placental abruption the obstetric emergency." Thesis, Sumy State University, 2014. http://essuir.sumdu.edu.ua/handle/123456789/36585.
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The placenta is a structure that develops in the uterus during pregnancy to nourish the growing baby. If the placenta peels away from the inner wall of the uterus before delivery – either partially or completely – it's known as placental abruption. Placental abruption can deprive the baby of oxygen and nutrients and cause heavy bleeding in the mother. Placental abruption often happens suddenly.
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Giaxa, Thais Erika Peron [UNESP]. "Falso trabalho de parto: compreendendo os motivos da procura precoce à maternidade através da fenomenologia social." Universidade Estadual Paulista (UNESP), 2009. http://hdl.handle.net/11449/96454.
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O estudo objetivou compreender os motivos da procura precoce do atendimento hospitalar pelas mulheres no final da gestação conduzidas pelo Serviço de Atendimento Móvel de Urgência. Utilizou-se a abordagem fenomenológica do tipo socioexistencial, proposta por Alfred Schütz considerando o desejo de revelar a característica típica de um grupo social que vive determinada situação. Os sujeitos foram nove gestantes conduzidas à maternidade em falso trabalho de parto. A entrevista foi norteada pelas questões: Quais os motivos que a levaram a procurar a maternidade? Conte-me a sua trajetória até a chegada aqui e qual a sua expectativa quando chegar o momento do trabalho de parto?. Os discursos foram submetidos a análise idiográfica e nomotética, emergindo do fenômeno as categorias: A crença em que está em trabalho de parto devido aos sinais/sintomas percebidos, A influencia de outros na procura pela assistência obstétrica, A dependência dos sistemas de apoio como influência na decisão, A busca pela tranqüilidade devido ao medo e insegurança sentidos, A busca pelo término da gestação e ocorrência do parto. Na relação social intersubjetiva de mulheres inseridas em um espaço comum de experiência, a vivência do final da gestação representa uma transformação no seu fazer cotidiano, seu comportamento e relacionamento social. Ao refletirem seus motivos porque, revelam uma riqueza de valores e crenças pessoais que constituem sua bagagem de conhecimentos adquiridos em suas experiências vividas. A presença da dor ou o temor de sentí-la mobilizam a ação de institucionalizar-se, garantindo a segurança que a relação face a face com os profissionais proporciona. A rede de relacionamento social influenciou sua decisão, bem como o incômodo causado pelas mudanças na rotina dos familiares para o suporte ao parto. Evidenciam conflitos internos na decisão...
The study aimed to understand the causes of the precocious search of the nosocomial service for the women in the end of the gestation driven by the Movable Service of Urgency. The approach made use fenomenológica of the type socioexistencial, proposed by Alfred Schütz considering the wish of revealing the typical characteristic of a social group that survives determined situation. The subjects were nine pregnant women led to the motherhood in false labor. The interview was orientated by the questions: Which the motives that took it looking for the motherhood? Tell to me his trajectory up to the brought near one here and which his expectation when the moment of the labor will arrive? The speeches were subjected the analysis idiográfica and nomotética, when the categories are surfacing of the phenomenon: The belief in which he labors due to the perceived signs / symptoms, influences It of others the search for the obstetric presence, The dependence of the systems of support as influence the decision, The search for the tranquillity due to the fear and insecurity felt, The search for the end of the gestation and incident of the childbirth. In the social intersubjective relation of women inserted in a common space of experience, the existence of the end of the gestation it represents a transformation in his to do daily, his behaviour and social relationship. While reflecting his motives because, they reveal a wealth of values and personal beliefs that constitute his luggage of knowledges acquired in his experiences experienced in life. The presence of the pain or the sentí-woolen fear mobilize the action of institucionalizar-se, when there is guaranteeing the security guard what the relation face to face with the professionals provides. The net of social relationship influenced his decision, as well as the nuisance caused by the changes in the routine of the relatives for the suppor... (Complete abstract click electronic access below)
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Poggenpoel, Elizabeth J. "Primary obstetric ultrasound : comparing a detail ultrasound only protocol with a booking ultrasound protocol." Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/4326.
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Fernando, Ruwan Janaka. "Obstetric anal sphincter injury and its management." Thesis, Keele University, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.483589.
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Tsai, Ya-Fang. "Inflammation and Altered Signaling in Obstetric Pathologies." BYU ScholarsArchive, 2021. https://scholarsarchive.byu.edu/etd/9215.
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The purpose of this research project was to elucidate the molecular interactions and detail the signaling pathways in obstetric pathologies. This work first seeks to understand inflammation related complications relevant to obstetrics. Prior research in our lab identified the implications of the receptor of advanced glycation end products (RAGE) during inflammatory response in the placenta. Current work identified the presence of DNA double-strand breaks (DNA-DSBs) in inflammation associated pregnancy complications of preeclampsia (PE) and preterm labor (PTL) and demonstrated the positive role of RAGE in repairing the damage. The confluent relevance of disrupted mitochondrial function and inflammation has been recognized in the etiology of numerous chronic diseases. Our current studies aim to understand the connections between energy metabolism and inflammation in pathologies of pregnancy complications. Previous research conducted in our laboratory has demonstrated the mediation of the Gas6/Axl pathway on the mechanistic target of rapamycin (mTOR), an important metabolic molecule. We observed the negative regulation of Gas6 treatment on the mTOR pathway and its negative effects on trophoblast cell invasion. In the current study looking at the aspect of energy regulation, we identified the activation of placental mTOR in gestational diabetes mellitus (GDM) and its decrease during PE and intrauterine growth restriction (IUGR). We further evaluated the regulation of mTOR on its downstream effector pyruvate kinase M2 (PKM2). We found that inhibition of mTOR decreased PKM2 activation; while PKM2 activation positively regulated trophoblastic invasion and rescued negative effects observed in our second-hand smoke IUGR murine model. Our work has opened a new direction of placental research, especially in pregnancy complications stemming from genomic instability. We also clarified details of mTOR and PKM2 meditated metabolic signaling that are crucial for future investigation on the dynamic metabolic regulation during pregnancy.
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Khashan, Ali Soubhi. "Maternal stress and psychiatric and obstetric offspring outcomes." Thesis, University of Manchester, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.493921.
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Background: Most societies believe that a mother's psychological state can influence her unbom baby. Stressful events during pregnancy have been consistently associaiea wim mi elevated risk of low birthweight, prematurity and schizophrenia. Such events during the first trimester have also been associated with risk of congenital malformations Objectives: To investigate the association between maternal exposure to severe life events and risk prematurity, reduced infant birthweight and schizophrenia in the offspring. The project focuses on timing of the exposure in relation to pregnancy. Conclusions: Mothers who were exposed to severe adverse life events antenatally have babies with significantly lower birthweight and more likely to be premature. Babies who were exposed to severe life events in the first trimester are more likely to nave schizophrenia later in their life.
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勞子僖 and Tzu-hsi Terence Lao. "The obstetric implications of gestational impaired glucose tolerance." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B31981793.
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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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Rahmatullah, Bahbibi. "Assessment of obstetric ultrasound images using machine learning." Thesis, University of Oxford, 2012. http://ora.ox.ac.uk/objects/uuid:8f8f1796-7c25-43b9-bb14-d8cdc28f6ca2.
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Ultrasound-based fetal biometry is used to derive important clinical information for identifying IUGR (intra-uterine growth restriction) and managing risk in pregnancy. Accurate and reproducible biometric measurement relies heavily on a good standard image plane. However, qualitative visual assessment, which includes the visual identification of certain anatomical landmarks in the image is prone to inter- and intra-reviewer variability and is also time-consuming to perform. Automated anatomical structure detection is the first step towards the development of a fast and reproducible quality assessment of fetal biometry images. This thesis deals specifically with abdominal scans in the development and evaluation of methods to automatically detect the stomach and the umbilical vein within them. First, an original method for detecting the stomach and the umbilical vein in fetal abdominal scans was developed using a machine learning framework. A classifier solution was designed with AdaBoost learning algorithm with Haar features extracted from the intensity image. The performance of the new method was compared on different clinically relevant gestational age groups. Speckle and the low contrast nature of ultrasound images motivated the idea of introducing features extracted from local phase images. Local phase is contrast invariant and has proven to be useful in other ultrasound image analysis application compared with intensity. Nevertheless, it has never been implemented in a machine learning environment before. In our second experiment, local phase features were proven to have higher discriminative power than intensity features which enabled them to be selected as the first weak classifiers with large classifier weight. Third, a novel approach to improving the speed of the detection was developed using a global feature symmetry map based on local phase to select the candidate locations for the stomach and the umbilical vein. It was coupled with a local intensity-based classifier to form a “hybrid” detector. A nine-fold increase in the average computational speed was recorded along with higher accuracy in the detection of both the anatomical structures. Quantitative and qualitative evaluations of all the algorithms were presented using 2384 fetal abdominal images retrieved from the image database study of the Oxford Ultrasound Quality Control Unit of the INTERGROWTH-21st project. Finally, the “hybrid” detection method was evaluated in two potential application scenarios. The first application was clinical scoring in which both the computer algorithm and four experts were asked to record presence or absence of the stomach and the umbilical vein in 400 ultrasound images. The computer-experts agreement was found to be comparable with the inter-expert agreement. The second application concerned selecting the standard image plane from 3D abdominal ultrasound volume. The algorithm was successful in selecting 93.36% of the images plane defined by the expert in 30 ultrasound volumes.
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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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Lao, Tzu-hsi Terence. "The obstetric implications of gestational impaired glucose tolerance." Hong Kong : University of Hong Kong, 2002. http://sunzi.lib.hku.hk/hkuto/record.jsp?B24463863.
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Andersson, Liselott. "Implications of psychiatric disorders during pregnancy and the postpartum period - A population-based study." Doctoral thesis, Umeå : Univ, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-369.
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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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Burger, Adrian. "Predictors of difficult intubation in obstetric cohort of patients: an analysis of the prospective obstetric airway management registry (OBAMR) (substudy – R025/2018)." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33677.
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Abstract Background: Hypoxaemia during tracheal intubation in obstetrics remains a lifethreatening complication. This study aimed to identify common clinical preinduction predictors of difficult intubation. Methods: A retrospective analysis was performed of data pertaining to tracheal intubation in patients requiring general anaesthesia for caesarean delivery, with a gestational age from 20 weeks, and until 7 days post-delivery, obtained from an obstetric airway management registry (ObAMR) at the University of Cape Town. Data was entered anonymously into a secure UCT REDCap database. Data categories were: patient and pregnancy characteristics, airway characteristics, details of management, and operator experience. The primary aim of the study was to identify anatomical and physiological risk factors for hypoxaemia. The primary outcome was defined as arterial desaturation to < 90% during obstetric airway management. For this purpose, multivariable binary logistic regression was performed. Hypoxaemia was thus used as a composite indicator of anatomical and physiological difficulty. Results: Data was collected for 1095 general anaesthetics in the ObAMR. Overall, 143/1091 of patients (13.1%, 95%CI 11.1 to 15.4%) experienced peripheral oxygen saturation below 90%. Univariate analysis showed that 91/142 (64.1%) of patients who desaturated were obese (body mass index [BMI]> 30 kg/m2 ), compared with 347/915 (37.9%) who were obese and did not experience desaturation (p< .001). A receiver operating curve (ROC) was constructed post hoc, which showed a cut-point for BMI of 29.76, and a sensitivity of 0.66, and specificity 0.62 for the prediction of hypoxaemia. Desaturation occurred in 17.0% of patients with hypertensive disorders of pregnancy, versus 11.0 % without (p=0.005). Increasing Mallampati class was associated with an increased incidence of hypoxaemia. The incidence of hypoxaemia was 25.8% for interns, compared with 8.0 % for consultant anaesthesiologists (p=0.005). In the multivariate analysis of factors associated with hypoxaemia, body mass index (p< 0.001), room air saturation prior to preoxygenation (p=0.008), and the presence of airway oedema (p=0.027), were independently associated with hypoxaemia. Conclusions: In this study, both anatomical and physiological predictors of hypoxaemia were identified. Using this concept, a predictive tool could be developed to aid in the identification of a difficult airway in obstetrics. Simple interventions such as face mask ventilation and the use of high flow nasal oxygenation, could be introduced to protect the parturient from the consequences of life-threatening hypoxaemia.
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Dolan, Lucia Margaret. "The prevalence and obstetric antecedents of pelvic floor dysfunction." Thesis, University of Newcastle upon Tyne, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.485799.
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It has long been considered that aspects of pregnancy and child birth play a role in the aetiology of pelvic floor dysfunction (PFD). Most women have their first pregnancy in their 20's, yet the peak time for presentation with symptoms is 2 or 3 decades later. The studies embodied in this thesis are designed to examine the prevalence and antecedent risk factors ofPFD in women 20 years after their first delivery. Unique aspects ofthe studies described here are: identification of a consecutive group of women having their first pregnancies over a short time period in a single hospital; the est~blishmentofcurrent contact information for these women 20 years later using the NHS Strategic Tracing System (NSTS); the use ofa robust obstetric database, the Standard Maternity Information System (SMIS) effective at the time of the index pregnancies; and the use of the validated Sheffield Pelvic Floor Assessment Questionnaire (Sheffield-PAQ© v3) to determine current symptoms and their impact on quality of life. Mothers of index cases were also contacted to assess familial risk. PFD was confirmed to be extremely common, with symptoms affecting half of women 20 years after their first pregnancy; 4:10 women reported urinary incontinence (UI), 2:10 had anal incontinence (AI), and 1:8 had prolapse. Symptoms were troublesome in over 50% (prolapse) and over 70% CUI & AI). Logistic regression analyses indicated that caesarean section was protective against UI, faecal incontinence (FI) and mild prolapse. Instrumental delivery was a risk factor for flatal and FI; obesity was a risk factor for all three symptoms. A familial risk for UI and AI was identified. Vaginal birth is a significant risk factor for long term symptoms ofPFD. However, some women may have a predisposition, possibly genetic, to develop symptoms which is independent of obstetric history.
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Wilson, Catherine Mary. "Pharmocokinetic and clinical studies in obstetric anaesthesia and analgesia." Thesis, Queen's University Belfast, 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.484216.
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Leppard, Margaret Janet. "Obstetric care in a Bangladeshi hospital : an organisational ethnography." Thesis, London School of Economics and Political Science (University of London), 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.394080.
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Howard, Steven. "Development of an obstetric training aid for shoulder dystocia." Thesis, Cranfield University, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.396493.
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Hepburn, Mary. "The role of antenatal inpatient care in obstetric practice." Thesis, University of Edinburgh, 1986. http://hdl.handle.net/1842/19839.
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Pitchforth, Emma. "Emergency obstetric care : needs of poor women in Bangladesh." Thesis, University of Aberdeen, 2004. http://digitool.abdn.ac.uk/R?func=search-advanced-go&find_code1=WSN&request1=AAIU178610.
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Background: Ensuring that all women have access to emergency obstetric care (EmOC) in the event of a complication is vital. One well-accepted conceptual model suggests that the three main areas of delay facing women in accessing EmOC are: (1) deciding to seek care; (2) reaching an appropriate health facility; and (3) receiving treatment once at a health facility. This study explores whether poorer women are disadvantaged in receiving treatment once at a health facility. Methods: The mixed-method study is based in a large teaching hospital in Bangladesh. The poverty status of obstetrics patients is assessed and a case note review is conducted for women staying in the hospital longer than 24 hours. Treatment and time waited are then analysed by poverty status. A sub-group of women are followed-up for more indepth interviews after discharge. These interviews explore the experience of women and relatives in using EmOC. Observation and staff interviews are also conducted within the hospital. Findings: Compared to the wider population, the poorest women are not utilising EmOC. Women face considerable costs in receiving treatment but there did not appear to be differences in treatment received by different poverty groups. The main costs were for drugs, blood and other medical supplies. Most families had to sell assets or borrow money to meet these costs. The doctors operated a 'poor fund', which could provide help for the poorest women in immediately life threatening situations. The government funded welfare organization did not operate well in emergency cases. Conclusions: As the provision of EmOC increases, efforts must ensure equitable uptake among women of all socioeconomic status. Sustainable support mechanisms are needed within hospitals as well as community-based programmes promoting uptake of care. Better maternity services and strengthening the role of trained midwives may be important in improving the uptake of EmOC.
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Ameh, Charles. "The effectiveness of emergency obstetric care training in Kenya." Thesis, University of Liverpool, 2014. http://livrepository.liverpool.ac.uk/2008539/.
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Background and introduction: Maternal deaths are highest in low resource countries. Skilled attendance at birth (SBA) and the availability of emergency obstetric care (EmOC) are key strategies to improve maternal health and achieve the millennium development goal number 5. In-service emergency obstetric and newborn care (EmONC) training has been used for many years to improve the quality of skilled attendance at birth and availability of EmOC, however few packages have been properly described and evaluated. There is no published comprehensive evaluation of EmONC in-service training packages in low resourced countries. An evaluation of the effectiveness of an EmONC training intervention in 10 comprehensive EmOC Kenya hospitals was carried out from 2010-2011. Methods: A systematic review was performed based on grading of recommendations assessments development and evaluation (GRADE) guidelines to identify the various EmONC training packages in low and middle income countries, identify literature on the effectiveness of these packages or effectiveness of various components of EmONC training globally. The components of the intervention were training in EmONC, provision of EmOC equipment and supportive supervision. The objective of the intervention was to improve the recognition and treatment of emergency obstetric and newborn complications at all study sites by trained maternity care providers (MCP). A before/after study design and an adapted four level Kirkpatrick framework (level 1: reaction to training, level 2: learning, level 3: behaviour/practice, level 4: EmOC availability, health outcomes and ‘up-skilling’) was used to evaluate the effectiveness of the training package. Mixed research methods (quantitative and qualitative approaches) were used to collect data 3 months before the intervention and at 3 monthly intervals after up to 12 months after the intervention. Quantitative data were analysed using SPSS version 20 and qualitative data was analysed using Nvivo 9. Descriptive statistics and analysis using t-tests were performed for quantitative data (significance in mean difference at 95% confidence) while framework analysis was used for qualitative data. Results: 20 EmONC in-service training programmes implemented in low and middle-income countries were identified. The content of 85% (17) of the programmes identified included EmOC signal functions and 7 programmes were 7 days or more in duration. 50% (10) of the EmONC training packages identified had training reports of which only two studies were evaluated at Kirkpatrick level 3 (behaviour) and there was no evaluation at level 4 (health outcomes) identified. Over 70% of all identified maternity care providers from all 10 hospitals were trained. 83% (328) of the 400 health care workers trained were midwives, 6% (26) were medical doctors, 2% (8) were clinical officers and 3% (11) were obstetricians. At 12 months post training the proportion of MCP trained in each hospital was at least 83% except for Nakuru PGH (23%) and Mbagathi GH (50%). Kirkpatrick level 1: About 95% (380) participants responded to level 1 assessment questionnaire. Trainees reacted positively to all lectures (n=11, mean score was 9.38/100, SD: 0.12) and breakout sessions (n=25, mean score was 9.33/10, SD: 0.14). Kirkpatrick level 2: There was a statistically significant difference between the pre and post training knowledge scores in all modules except preventing obstructed labour 0.10 CI (0.06-0.26) p=0.201. The mean difference between pre and post-test skill scores was statistically significant 3.5 CI (3.3-3.8) P<0.001, n=284. Kirkpatrick level 3: 153 data sources (FGDs, paired interviews, KIIs) were collected over 12 months and analysed. 49% (184) and 129 (34.5%) of health care workers and managers participated. They reported a positive impact of the intervention on communication and teamwork, pre-service midwifery education, reduced treatment time, improved knowledge, skills, improved confidence to perform EmOC, organisation of care and supportive supervision. Availability of EmOC equipment post training and supportive supervisors were factors that facilitated change in practice post training. Barriers to availability of EmOC identified were poor staff deployment and retention policy post training, lack of equipment to perform EmONC, lack of support from obstetricians, senior midwives and nurse/midwifery administrators, lack of training for all MCP (including medical interns, medical officers and staff from lower level health care facilities) and lack of clarity on the scope of practice for nurses/midwives. Kirkpatrick level 4: 16, 764 and 17, 404 deliveries were conducted at baseline and at 12 months post intervention respectively. There was 66.8% increase in obstetric complications recorded and managed at 12 months post training compared to baseline. Health outcome indicators: There was an expected increasing trend for number of complications recorded and treated, availability of SBA and EmOC. There was also an expected decreasing trend in the proportion of newborns admitted to NBU for birth asphyxia, direct obstetric case fatality rate (DOCFR) and stillbirth rate (SBR). There was no change in caesarean section (C/S) rate or Fresh stillbirth rate (FSBR). For the health outcome indicators (DOCFR, SBR, FSBR), when PGH Nakuru was excluded from the analysis, a non-statistically significant reduction but greater effect at 12 months compared to baseline was observed for complications recorded and treated (87.9% vs. 66.8%), DOCFR (47% vs. 35%), SBR (66% vs. 34%) and FSBR (14 vs. 10%). There was 34%, 48%, and 35% mean reduction in the SBR, proportion of newborns admitted to newborn care unit and DOCFR at 12 months post intervention compared to baseline respectively. “Up-skilling” indicators: There was a 53.8%, 80%, 100% mean increase in the proportion of all breech vaginal deliveries, proportion of all vacuum extractions performed and proportion of vacuum extractions performed by non-physician clinicians, at 12 months post intervention compared to baseline. Assisted vaginal delivery by vacuum extraction was the least available EmOC signal function (SF) and medical doctors only performed this SF at baseline. At 12 months post intervention, non-physician clinicians performed this as well, in all study sites. Overall the EmONC training intervention resulted in improved ‘up-skilling’ of maternity care providers, a trend towards improved availability of SBA and EmOC and improved health outcomes. Implications for policy and practice The results of this study are important for designing and implementing evidence based EmONC programmes in resource poor countries. None medical doctors can be ‘up-skilled’, the recognition and management of obstetric and newborn emergencies and the availability of quality EmOC can be improved using similar packages and implementation methods in other resource poor settings. Future research: Evaluation designs that include control groups are needed. Studies to assess the relative importance of supportive supervision for behaviour change after training, the knowledge and skills retention with time post training in resource limited settings should be undertaken.
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Nippita, Tanya Ai Choo. "Variations in obstetric interventions in New South Wales, Australia." Thesis, The University of Sydney, 2017. http://hdl.handle.net/2123/17181.
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Aims To describe variation in caesarean section (CS) and induction of labour (IOL) rates and outcomes; determine ways of classifying IOL; describe variation in current IOL methods. Methods A systemic review examined different methods of IOL classification. Variation in hospital CS and IOL rates and outcomes used two linked population datasets and multilevel logistic regression models. To understand clinical decision-making around IOL, interviews were conducted in New South Wales (NSW) hospitals. Midwifery unit managers completed surveys for current IOL methods. Results For nulliparae at term in NSW, overall variation in hospital CS rates decreased by 78% for prelabour CS, 52% for intrapartum CS following spontaneous labour and 9% following IOL after adjustment. Severe maternal and neonatal morbidity rates were not significantly different between hospitals. A 10 group classification system for IOL was developed based on parity, previous CS, gestational age, number and presentation of the fetus. In NSW 2010-2011, there was high unexplained variation in hospital IOL rates despite adjusting for patient factors. The greatest variation was for hospital rates of IOL among nulliparae at full term. There was generally no relationship between hospital IOL rate and adverse outcomes or intrapartum CS rates. Variation in decision-making was based on the obstetrician’s perception of risk, their relationship with the woman, and resource availability. There was wide variation in clinical decision-making practices of obstetricians and less accountability for decision-making in hospitals with high IOL rates. From 2008 to 2014, for district hospitals, there was an increase in balloon catheter use for cervical ripening and a significant increase in use of postmaturity protocols for IOL but no difference in use of prostaglandin protocols. For both district and tertiary hospitals, there was a reduction in the variation in the minimum and maximum oxytocin dosages. Conclusion There was much unexplained variation in hospital CS and IOL rates in NSW, which did not appear to result in differences in adverse outcomes. A novel classification system for women having an IOL was developed to allow similar populations of women having an IOL to be compared for research and quality improvement. Increased accountability and less variation in decision-making were associated with a lower hospital IOL rate. Increased use of protocols was associated with a reduction in practice variation, but it is uncertain whether it translates to better outcomes for mothers and babies.
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Edwards, Julie. "Doctors' perspective on obstetric ultrasound : concept, knowledge and practice." Thesis, Sheffield Hallam University, 2012. http://shura.shu.ac.uk/17101/.
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Problems arise when women attend for obstetric ultrasound scans, not always fully aware of the purpose of the examinations they have chosen to opt for and sometimes experience anxiety, as their expectations are not met. This study has explored, through in-depth interviews and ‘framework’ analysis, whether doctors are actively engaged in unbiased information sharing with pregnant women during their consultations. Through exploration of the literature on women’s and health professionals’ perspective on the use of obstetric ultrasound, a gap is seen in the knowledge regarding the medical perspective on ultrasound use in pregnancy. Results of this study revealed three themes relating to the doctor’s experiences of offering obstetric ultrasound: doctors’ knowledge and understanding, their views on the practice of obstetric ultrasound use and their ideas on the concept of ultrasound. These themes been considered alongside the writings on power/knowledge, govemmentality and self-surveillance through risk theory, by the philosopher Michel Foucault (1926-84), as his ideas have been central to this research question. The conclusion reached is that, although making changes to doctors’ in house training may increase their knowledge of obstetric ultrasound, it may still be the case that their professional position within society will still create a barrier to women making informed decisions when requiring to consider opting for ultrasound scans during their pregnancy.
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Eriksson, Carola. "Förlossningsrelaterad rädsla : en studie av kvinnors och mäns erfarenheter /." Umeå : Umeå universitet, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-889.
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Eidson, Robert P., and Maurice F. O'Moore. "Determining optimal allocation of naval obstetric resources with linear programming." Thesis, Monterey, California: Naval Postgraduate School, 2013. http://hdl.handle.net/10945/38922.
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Approved for public release; distribution is unlimited.The U.S. Navy Bureau of Medicine and Surgery allocates funding for obstetric staffing resources such as doctors, nurses, and midwives. Furthermore, these resources operate within a fixed number of labor/delivery and postpartum rooms, thereby establishing a theoretical maximum capacity of delivery volume. This study identifies the expected delivery volume created by the facility capacity of four major naval military treatment facilities (MTF) within the United States. Based on the calculated volume, this thesis utilizes a linear programming model to determine the optimum mix of doctors, nurses, and midwives to achieve the target delivery numbers. This is achieved while concurrently incorporating all relevant constraints within military medical treatment facilities. As a result, the model allows hospitals to meet target delivery volumes while simultaneously utilizing their allocated resources in the most effective manner. Additionally, the model can accommodate changes in the inputs and constraints and can be used to provide support for similar resource allocation decision problems.
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Webb, Sara Samantha. "An investigation of subsequent birth after obstetric anal sphincter injury." Thesis, University of Birmingham, 2017. http://etheses.bham.ac.uk//id/eprint/7807/.
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Obstetric anal sphincter injuries (OASIS) are serious complications of vaginal birth with a reported average worldwide incidence of 4%-6%. They are a recognised major risk factor for anal incontinence resulting in concern amongst women who sustain such injuries when considering the most suitable mode of birth in a subsequent pregnancy. This thesis contains three studies; a systematic review and meta-analysis of the published literature exploring the impact of a subsequent birth and it’s mode on bowel function and/or QoL for women with previous OASIS, a follow-up study on the long-term effects of OASIS on bowel function and QoL and finally a prospective cohort study of women with previous OASIS to assess the impact of subsequent birth and its mode on change in bowel function. The work in this thesis demonstrated an increase in incidence of bowel symptoms in women with previous OASIS over time and that short-term bowel symptoms were significantly associated with bowel symptoms and QoL. This thesis also showed that the mode of subsequent birth was not significantly associated with bowel symptoms or QoL and for women with previous OASIS who have normal bowel function and no anal sphincter disruption a subsequent vaginal birth is a suitable option.
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Patel, D. "Anal sphincters, support structures and atrophy in major obstetric injury." Thesis, University College London (University of London), 2012. http://discovery.ucl.ac.uk/1378555/.
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Mechanical anal sphincter trauma and traction pudendal neuropathy secondary to vaginal childbirth represent the most frequent aetiological factors in the development of faecal incontinence in women. More recently it has been speculated that vaginal childbirth may damage pelvic support structures, thereby contributing to faecal incontinence. Anal sphincter and pelvic floor atrophy resulting from degenerative pudendal neuropathy is thought to also play an important aetiopathogenic role. Measurement of puborectalis function is therefore essential in providing a baseline assessment and observing response to treatment of puborectalis muscle strength in pelvic floor dysfunction disorders. Until recently there has been difficulty in understanding the role of puborectalis function due to the absence of a standardised measurement technique. So far, Magnetic Resonance Imaging (MRI) has been proposed for accurate structural assessment however, no consensus has yet been reached on the ‘gold standard’ for the physiological measurement of puborectalis strength. This thesis primarily looked at finding novel structural and physiological measures of puborectalis in a cohort of asymptomatic nulliparous controls, women with clinically reported obstetric anal sphincter injuries and women with idiopathic faecal incontinence. The first technique I used was vaginal manometry to quantify the constrictor function of puborectalis. I was unable to show the previously reported specific high pressure vaginal zone in either study groups and I found poor agreement between vaginal and anorectal manometry in the measurement of pelvic floor squeeze. The second technique I used was the 2 point Dixon fat water decomposition MRI technique to quantify fatty atrophy of the anal sphincter complex and puborectalis. I was able to demonstrate a relationship between external anal sphincter percentage fat content with both patient symptom load and subjective atrophy score demonstrating it as a promising objective measure of fatty atrophy.
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Barnett, Richard. "Obstetric anaesthesia and analgesia in England and Wales 1945-1975." Thesis, University College London (University of London), 2007. http://discovery.ucl.ac.uk/1444068/.
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This thesis addresses the history of obstetric anaesthesia and analgesia in England and Wales between 1945 and 1975. It is based on an analysis of archival material from the Ministry of Health Department for Health and Social Security, the Central Midwives Board, the Medical Research Council, the Royal College of Obstetricians and Gynaecologists, the Obstetric Anaesthetists' Association and the National Birthday Trust Fund. Other sources used include the popular and medical press, British governmental publications, oral history interviews and a prosopography of the Obstetric Anaesthetists' Association. In this period the management and elimination of the pain of childbirth became the subject of great interest not only for mothers and anaesthetists, but also for obstetricians, midwives, clinical scientists, healthcare administrators, politicians and the press. Broadly speaking, existing work on the history of obstetric anaesthesia and analgesia treats this subject in two contrasting ways. Practitioner-historians of anaesthesia have characterised it as one of co operation between mothers and medical practitioners, but many historians of obstetrics and midw ifery have preferred to emphasise the role of obstetric anaesthetists in medicalising and hospitalising birth. This thesis places the development of obstetric anaesthesia and analgesia in the context of three related narratives. These narratives emerged in the first half of the twentieth century, but after 1948 operated within wider debates over the centralisation and hospitalisation of state healthcare under the NHS. First, the emergence and consolidation of anaesthesia as a hospital- based clinical speciality. Second, the demographic shift from home to hospital birth. Third, arguments over the role of midwives in birth. It uses four case-studies to explore these narratives: the Analgesia in Childbirth Bill, 1949 the development of new analgesics for use by unsupervised midwives obstetric anaesthesia and analgesia in the governmental Reports on Confidential Enquiries into Maternal Deaths and the early history of the Obstetric Anaesthetists' Association and its role in debates over epidural analgesia.
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Ogbodo, A. K., and O. P. Onwughara. "Difference in frequency obstetric fistula in nigerian and european women." Thesis, Sumy State University, 2017. http://essuir.sumdu.edu.ua/handle/123456789/58730.
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An obstetric fistula is an abnormal opening between the vagina and organs of pelvis.Each year, more than a quarter million women in Nigeria die in pregnancy and childbirth, of those that do not perish, suffer from obstetric fistula (OF).OF caused by of obstructed labor, without timely medical intervention or Cesarean section. During this time, the soft tissues of the pelvis are compressed between the baby’s head and the mother’s pelvic bones. The lack of blood flow causes tissue to die, creating a hole between the mother’s vagina and organs of pelvis .
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Isaksson, Rita. "Unexplained infertility : studies on aetiology, treatment options and obstetric outcome." Helsinki : University of Helsinki, 2002. http://ethesis.helsinki.fi/julkaisut/laa/kliin/vk/isaksson/.
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Mayson, Eleni. "Investigating Obstetric Blood Transfusion Practice in New South Wales (NSW)." Thesis, The University of Sydney, 2015. http://hdl.handle.net/2123/13846.
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Aims to investigate obstetric blood transfusion practice at maternity hospitals in NSW with a range of geographical locations, clinical settings and obstetric transfusion rates including the antepartum use of intravenous (IV) iron and postpartum use of single unit red blood cell (RBC) transfusions. Methods A qualitative research study using semi-structured interviews was conducted. Nine maternity hospitals were chosen to cover a range of clinical settings and obstetric transfusion rates in NSW. Interviews were conducted in person with haematologists, obstetricians and midwives. Results There were 5 high-transfusing and 4 low-transfusing hospitals. 125 interviews were conducted, 61 with doctors: 42 with obstetric training and 19 with haematology training. High-transfusing hospitals were more likely to be rural or geographically isolated, have fewer staff numbers, smaller blood inventories and less stringent blood product regulation. Hospital/pharmaceutical, clinician and patient factors influenced the decision to use IV iron. Clinician-based and external factors influenced single unit transfusion use. Most doctors with obstetric training (54%) would initiate transfusion with two RBC units. Conclusion Hospital, clinician and patient-level factors influenced obstetric transfusion practice. Clinical context, resource availability, clinician knowledge and experience, and perceptions of utility of specific interventions were important. The findings have implications for clinician education, blood product provision and inventory management.
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Ampt, Amanda Jane. "Trends and predictors of obstetric anal sphincter injury at childbirth." Thesis, The University of Sydney, 2015. http://hdl.handle.net/2123/13702.
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Aims Aims of this PhD study were to: examine temporal trends in obstetric anal sphincter injury (OASI) in New South Wales (NSW) Australia, and associated risk factors; determine recurrence risk; evaluate the impact of data sources; and identify perineal support practices used by midwives. Methods Analysis of linked NSW population-based administrative data (NSW Perinatal Data Collection [‘birth data’] and the Admitted Patient Data Collection [‘hospital data’]) was undertaken using logistic regression, predictive modelling and agreement statistics. Midwifery practice was investigated by cross-sectional survey and descriptive analysis. Results Vaginal OASI rates rose from 2.2% (2001) to 3.3% (2011), with significant increases among women having a non-instrumental birth or forceps birth with episiotomy. Risk factors included primiparity, instrumental births, Asian maternal country of birth and high birthweight, but changes in their prevalence did not explain OASI increase. Recurrence risk was 5.7%. OASI ascertainment was higher using hospital data. Midwives preferred a ‘hands poised’ approach. Conclusions These results can help inform clinical decisions and highlight both the importance of using linked hospital data in OASI research, and the need for ongoing research to identify drivers of increased OASI risk.
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Singh, S. "Referral systems and transport for emergency obstetric care in India." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2018. http://researchonline.lshtm.ac.uk/4647889/.
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Background: Institutional delivery rates in India have improved in the past decade, but maternal mortality remains high. The aim of this study was to describe current referral pathways and transport services for pregnant women in the Indian public health sector to identify strategies for strengthening the referral system for emergency obstetric care. Methods: I conducted three literature reviews; a health provider’s KAP survey of staff in primary level public health facilities from two states; analyses of ‘108’ ambulance service data from six states; and telephone interviews of women who called this service in two states. Results: The reviews found no standard protocols or guidelines for referral of women with obstetric high-risk or complications in India, and over half of pregnant women attending primary level health facilities were referred. There was poor quality institution referral care and no studies on the effectiveness of transport interventions. The KAP study found staff had sub-optimal knowledge and practice for screening common high-risk conditions and complications, and low confidence and resources to manage emergency situations. Less than a quarter of pregnancies and institutional deliveries in the study populations used ‘108’ ambulances. Most women called the service for normal labour: only 4.3% had an obstetric emergency and 5.8% were inter-facility transfers. Of pregnant callers to the ‘108’ service, one third reported a high-risk condition or early complication in pregnancy. Women transported using other means were more likely to use private facilities than those transported by ‘108’. Conclusion: The quality of obstetric care at peripheral health centres is suboptimal and the high proportion of referrals could be avoided. The ‘108’ ambulance service is underused, especially in emergency situations. India’s health systems should improve the provision of obstetric care by standardising services at each level of health care. Strategies are required to increase the use of ‘108’ services for obstetric emergencies.
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Lydon-Rochelle, Mona Theresa. "Method of delivery and risk of subsequent adverse maternal health outcomes /." Thesis, Connect to this title online; UW restricted, 1999. http://hdl.handle.net/1773/7286.
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Zhao, Lan. "The impact of medical malpractice reforms on hospital-based obstetric services." College Park, Md. : University of Maryland, 2005. http://hdl.handle.net/1903/2896.
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Thesis (Ph. D.) -- University of Maryland, College Park, 2005.Thesis research directed by: Economics. Title from t.p. of PDF. Includes bibliographical references. Published by UMI Dissertation Services, Ann Arbor, Mich. Also available in paper.
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Skippen, Mark William. "Obstetric practice and cephalopelvic disproportion in Glasgow between 1840 and 1900." Thesis, University of Glasgow, 2009. http://theses.gla.ac.uk/1237/.
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This thesis examines obstetric practice associated with cephalopelvic disproportion in Glasgow between 1840 and 1900. Disproportion is a complication of labour, which occurs when there is a physical disparity between the size of the fetus and the size of the birth canal. The majority of these cases involved women who had suffered from rickets as a child, and had a deformed pelvis as a result. During this period the number of children affected by rickets appeared to increase, and as a consequence more cases of disproportion were encountered towards the end of the century. Descriptions of these cases found in a wide-range of published and unpublished materials have been used to analyse changes to obstetric practice in Glasgow. The complex nature of medical decision-making in cases of disproportion is shown. Methods available for the treatment of disproportion included caesarean section, craniotomy, forceps, induction of premature labour, symphysiotomy, and turning. Medical practitioners’ decisions were subject to social, medical and scientific factors. Practitioners’ choices were influenced by their experience, reports of successful cases both abroad and at home, the severity of the pelvic deformity, innovations in medical technique, perceptions of the value of the mother compared to her unborn child, location, and the decisions of the women and their friends and family. After the 1870s there was an increase in the number of women who were delivered by one of these forms of intervention at the Glasgow Maternity Hospital. This change can be attributed to an increase in the prevalence of this condition, but it also reflected a shift from women being admitted on social grounds to medical reasons. This change was in response to an acknowledgement that selecting cases earlier improved the chances of a successful outcome, as evidenced by Murdoch Cameron’s work with caesarean section. In addition, as obstetrics emerged as a specialism, obstetric practitioners claimed these difficult cases for themselves. It was stressed that general practitioners and midwives should send women to obstetric physicians as soon as they were aware of complications, and that obstetric specialists were to replace general surgeons as the operator in severe cases of disproportion when caesarean section was required.
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Jackson, Ruth Anne. "Midwives' experiences of caring for women during obstetric emergencies in labour." Thesis, University of Surrey, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.616935.
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This study explores the experiences of a group of midwives when caring for women who are having obstetric emergencies in labour. The study aimed to investigate the experiences of midwives to answer the research question 'What is the lived experience of caring for women during obstetric emergencies in labour, as perceived through the experiences of midwives?' The study utilised a descriptive phenomenological approach in which midwives were asked to recount their experiences during a non-directed interview. The data were analysed using a modified version of Colaizzi's (1978) framework. The study was conducted in two maternity units within National Health Service Trusts in the East of England. The participants comprised a convenience sample of eleven midwives with between six months and twenty-five years experience, all of whom had given care during obstetric emergencies in labour - in either acute or midwifery led units, or in the community setting. Four theme categories and twelve associated theme clusters were identified. The four theme categories were: learning to care; involvement; coping; and valuing and respecting. The study suggests that caring in obstetric emergencies is a demanding and, at times, exhausting reciprocal partnership between the midwife and the woman. The midwife-mother relationship is characterised by varying degrees of involvement. Caring is initiated in response to actual or perceived needs or wants, and is communicated through physical presence and an intense emotional connection. The woman and her family are valued and respected, which facilitates the connection. The ability to care and to cope in these difficult clinical situations is influenced by a number of factors, including the level of perceived support from colleagues and events in the midwife's' personal life. Caring is enhanced by an extended experiential knowledge base and can be ii ~~---------- extended beyond personally determined boundaries if either of these two factors is enhanced. The study offers insight into a previously unexplored aspect of midwifery practice, and has ramifications for both undergraduate preparation of student midwives, and the support and continuing professional development of qualified staff.
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Nicol, Marine Wyn. "An exploration of firt-time mothers' approach to the obstetric scan." Thesis, Lancaster University, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.536050.
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Degge, Hannah Mafo. "Experiences of women with obstetric fistula in Nigeria : a narrative inquiry." Thesis, University of Hull, 2018. http://hydra.hull.ac.uk/resources/hull:16588.
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Obstetric Fistula is an abnormal opening between the vagina and rectum resulting from prolonged and obstructed labour. It occurs mostly in developing countries and is a neglected maternal health issue in Nigeria. Women’s experiences of living with fistula often reflect gender inequities. This study explored how women attending a reintegration service described their experiences of living with fistula. Using narrative inquiry methodology, 15 women (treated and rehabilitated) were interviewed. Data were analysed using the core story creation and emplotment method of narrative analysis. A reconstructed narrative provided plot headings of ‘fistula ordeal, treatment process, and returning to life’. Fistula formation was linked to the influence of others, geographical remoteness and transport and poor health systems. Fistula survivors and families facilitated access to treatment; aided to cope with incontinence that triggered stigma issues. Negative identity changes through incontinence were: ‘Leaking’ identity, ‘Masu yoyon fitsari’ (the leakers of urine identity), and ‘spoiled’ identity. Attending the repair centre conferred hope and relief through mutual survivors (‘Masu yoyon fitsari’) support. ‘Spoiled’ identity reflected the challenges of the ‘leaking’ identity in the face of ‘failings’ as a woman with respect to sexual and reproductive responsibilities. Reversing the negative identities was pivotal in the women’s resilience in seeking a cure. The ‘improved’ identity achieved after fistula repair and rehabilitation provided continence control and improved financial status. This research is the first known comprehensive empirical study of the experiences of treated and rehabilitated obstetric fistula survivors in Nigeria. The prevalence of fistula in Nigeria reflects inequitable distribution of health care compounded by socio-cultural practices. This research is the first application to women’s health in the African context using Frank’s narrative typology. The study contributes to the empirical evidence of women’s pathway through developing fistula, to treatment, and rehabilitation into family and community life in Nigeria.
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Banke-Thomas, A. O. "Social return on investment for emergency obstetric care training in Kenya." Thesis, University of Liverpool, 2018. http://livrepository.liverpool.ac.uk/3019150/.
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Background: Globally, there has been increasing interest to demonstrate value-for-money of interventions using various approaches including social return on investment, which is a form of social cost-benefit analysis. This study pioneered its application in maternal and newborn health. Specifically, the methodology was used to assess the social impact and value-for-money of an emergency obstetric care training intervention for health care providers in Kenya. Methods: Qualitative methods and literature review were used to identify key stakeholders who were direct beneficiaries of the training; and map, evidence and financially value its outcomes. These qualitative findings were triangulated with quantitative evidence from existing literature and programmatic data, which helped to establish impact. Quantitative methods were also used to account for the financial investment (input) used to implement the intervention and output produced. Both qualitative and quantitative findings were incorporated into the impact map, to estimate the social return on investment ratio. Sensitivity analyses were done to test assumptions and the pay-back period estimated. Stakeholders who were not deemed direct beneficiaries were engaged to establish strengths, weaknesses, opportunities and threats of the intervention. Results: Multiple numbers of key stakeholders of the training were engaged via 28 focus group discussions, 18 interviews, and three paired interviews. Trained health care providers, women who received care from them and their newborns are training primary beneficiaries. From the thematic analysis, key emerging themes were that training led to positive outcomes including improved knowledge, skills and attitude with patients. However, there were concomitant negative outcomes including increased workload because of new patient expectation and frustration from inability to practise what was learnt. Women had positive opinions concerning the quality of care that they received. They expected positive outcomes including avoiding maternal and newborn morbidity and mortality. However, women affirmed that negative outcomes could occur, attributable to health care providers, themselves or simply due to chance. These outcomes experienced by both health care providers and women who received care from them have been mostly reported in the literature and evidenced from programme data. However, ‘increased workload’ is reported as increased care provision in the literature and ‘increased frustration due to inability to practise what had been learnt following training’ had not been directly linked to training previously. Based on programmatic data, total implementation costs was £1,079,383 for the 2,965 HCPs that were trained across 93 courses. The cost per trained HCP per day was £72.80. The total social impact for one year was valued at £13,747,173.78, with women benefitting the most from the intervention (73%). For beneficiaries, estimation of attribution, duration, and financial value of these outcomes by the beneficiaries was difficult and variable. Though beneficiaries provided insight for subsequent literature search for values. SROI ratio was calculated as £11.02: £1 and net SROI was £10.02: £1. The payback period for the investment was about one month. Based on the multiple one-way sensitivity analyses, the intervention guaranteed VfM in all scenarios except when all the trainers were paid consultancy fees and the least amount of outcomes occurred. Implications for policy and research: SROI provides critical additional insight when used to assess value-for-money of EmOC training. However, there are methodological improvements required. In implementing and researching EmOC training, consideration needs to be given to both intended positive and unintended negative outcomes of the intervention. Evidently, to achieve the best results from training, other factors such as optimal human resource distribution and availability of equipment need to be addressed. Use of volunteer trainers, particularly those who work locally, to deliver the training is a critical driver in achieving value-for-money for investments made.
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Chilopora, Garvey Chiliro. "Clinical Officers in Malawi: Expanding access to comprehensive emergency obstetric care." Master's thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/3035.
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Background: Clinical officers perform much of major emergency surgery in Malawi, in the absence of medical officers. The aim of this study was to validate the advantages and disadvantages of delegation of major obstetric surgery to non-doctors. Methods: During a three month period, data from 2131 consecutive obstetric surgeries in 38 district hospitals in Malawi were collected prospectively. The interventions included caesarean sections alone and those that were combined with other interventions such as subtotal and total hysterectomy repair of uterine rupture and tubal ligation. All these surgeries were conducted either by clinical officers or by medical officers. Results: During the study period, clinical officers performed 90% of all standard caesarean sections, 70% of those combined with subtotal hysterectomy, 60% of those combined with total hysterectomy and 89% of those combined with repair of uterine rupture. A comparable profile of patients was operated on by clinical officers and medical officers, respectively. Postoperative outcomes were almost identical in the two groups in terms of maternal general condition = both immediately and 24 hours postoperatively - and regarding occurrence of pyrexia, wound infection, wound dehiscence, need for re-operation, neonatal outcome or maternal death. Conclusion: Clinical officers perform the bulk of emergency obstetric operations, including complicated procedures, at district (level 1) hospitals in Malawi. The postoperative outcomes of their procedures are comparable to those of medical officers. Clinical officers constitute a crucial component of the health care team in Malawi for saving maternal and neonatal lives given the scarcity of physicians.
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Deboutte, Danielle J. E. "Cost-effectiveness analysis of emergency obstetric services in a crisis environment." Thesis, University of Liverpool, 2011. http://livrepository.liverpool.ac.uk/4453/.
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The study investigated the cost-effectiveness of caesarean section (CS) as the major component of Emergency Obstetric Care (EMOC) in a humanitarian context. Research was conducted from December 2007 until June 2008 in Bunia, in the north-east of the Democratic Republic of Congo. Methods A case-control study explored the factors determining whether a woman had a CS or a vaginal delivery. Cases (n=178) were randomly selected from women who had delivered by CS. Controls (n=180) were women who had delivered vaginally within two weeks of a case and were matched by place of residency. Face-to face interviews in the local language used a structured questionnaire about obstetric and socio-economic factors. Obstetric care was assessed during repeat visits to health structures using checklists. Provider cost of CS was calculated for four hospitals, of which one provided free emergency healthcare. Information about cost allocation to CS was collected from hospital managers, maternity staff, and administrators. Costs were verified with local entrepreneurs, international organisations and UN agencies. The social cost of maternal death was discussed in focus groups, which also obtained user cost information additional to the data from the case-control study. Results CS constituted 9.7% of expected deliveries in the Bunia Health Zone. During the study period, the humanitarian hospital performed 75% of all CS. There were no elective CSs in the study sample. The study found no evidence of obstetric surgery for non-medical reasons. Previous CS and prolonged labour during this delivery were the strongest predictive factors for CS. The risk increased with age of the mother and decreased with the number of children alive. Fifteen obstetric deaths were reported to the research team, three among them were women who had a CS. After adjusting the observed number for missed pregnancy-related and late post-partum deaths, the estimated number of maternal deaths avoided by humanitarian EMOC, compared to expected mortality without additional services, ranged from 20 to 228. Compared to recent estimates for the DRC, perinatal deaths avoided ranged from 237 to 453. Cost-effectiveness was expressed as cost per year of healthy life expectancy (HALE) gained. The estimated cost of adding one year of HALE by providing CSs in a humanitarian context ranged from 3.77 USD to 9.17 USD. Comparison of the cost of EMOC and the social cost of maternal death was complicated by the existence of local customs such as “sororate”. The user capacity to pay for health insurance was found to be low. Conclusion Caesarean sections as part of humanitarian assistance were cost-effective. To keep EMOC accessible during and following the transition from emergency relief to development, a change in the national financing policy for health services is advisable.
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Grant, Therese Marie. "The management of preterm labor with tocolytics in general obstetric practice /." Thesis, Connect to this title online; UW restricted, 1999. http://hdl.handle.net/1773/10867.
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Zerucelli, Rucell Jessica. "Obstetric violence & colonial conditioning in South Africa's reproductive health system." Thesis, University of Leeds, 2017. http://etheses.whiterose.ac.uk/20747/.
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This dissertation outlines the relationship between obstetric violence, and colonial era conditioning. Examining South Africa’s post-1994 public health system, I argue societal norms, political-economic arrangements, health systems, and their policies, have established structural violence which generates and spreads a continuum of violent practices within reproductive health services. The rationalisation and obfuscation of violence against Black women throughout the colonial and apartheid periods, including coercive contraception protocols, indexes more than simply gender-based violence in health services. I propose a theoretical underpinning: obstetric structural violence to explain what I argue is a particular type of violence against women. I interrogate the systematic violation of sexual and reproductive health rights enacted by health systems, resulting in: 1) non-consensual constraint of reproductive autonomy, 2) preventable maternal and neonatal disability, 3) mortality. Part 1 analyses the colonial conditioning that led to health services becoming constitutive of racial, and gendered structural violence. Historical stereotypes of sexuality are linked to rationalisations of contemporary obstetric violence. Examining the political-economy of the democratic period, Part 2, demonstrates how constant reform and limited power undermine low-level managers capacity to ensure the functioning of accountability, thereby propagating obstetric violence. Drawing on extensive qualitative fieldwork within seven primary–tertiary hospitals, I describe how routine, as well as episodic, physical and psychological forms of direct obstetric violence are pervasive. I argue these outcomes prove the connection between obstetric violence, adverse health, and obstetric malpractice, a fact often absent from related literature. Lastly, I argue the resultant case law and individual awards from obstetric malpractice for incurred patient harms, encourages the invisibility of obstetric, and obstetric structural violence.
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Zazzaron, Laura <1992>. "Obstetric Violence as Violence Against Women: A Focus on South America." Master's Degree Thesis, Università Ca' Foscari Venezia, 2018. http://hdl.handle.net/10579/12353.
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Obstetric violence is considered as a particular type of mistreatment which can hurt physically, mentally and psychologically a pregnant woman and it occurs in both public hospital and private health facilities. It is performed by health personnel that, through abuses and mistreatments during the pregnancy and the post-partum cares, violate some human rights of women such as the right to information and autonomous consensus, the right to life and health and to privacy.
In this thesis, obstetric violence is analysed from the juridical point of view and it is showed why it should be considered as another category of violence against women even though there is still not an unanimous consensus at international level. It has been demostrated that many of the practices normally performed to accelerate a birth, are considered dangerous by the WHO. At least one in five women has suffered from obstetric violence and in some case, that leds to maternal death.
From Venezuela 2007 (the first time the term is used in a national law) to the latest projects of law and judgements by international courts, this thesis explains why international bodies should finally recognise obstetric violence as a type of violence against women and give it an international recognisition.