Dissertations / Theses on the topic 'Pregnancy Trimester, Third Australia'

Introduction: In 2012, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention expanded their recommendation for the Tdap vaccination to include the antepartum period. Regardless of immunization history, the recommendation states that medical practitioners should administer the Tdap vaccination to every pregnant woman in each occurring pregnancy (Munoz, et al., 2014; Shakib, et al., 2013; Goldfarb, Little, Brown, Riley, 2014). Methods: To describe treatment practices and uptake of Tdap vaccine, a cross-sectional descriptive survey design was utilized. The purpose of survey is to gather information regarding prevalence, distribution, and interrelations of variables within a population (Polit & Beck). In this study, the survey questionnaire was conducted in an online format. Results: Of the six HBM questions included in the study, except for question four, the results of the chi-squared analysis suggest that any single measured dimension of the HBM cannot predict a health behavior, in this case receipt of the Tdap vaccination. The population is split regarding infants' perceived susceptibility to pertussis infection. Strong agreement to the benefit of vaccination was revealed. Question six regarded available information, although the majority were satisfied a significant percentage indicated a desire for more information. Discussion: This Doctorate of Nursing Practice project developed a survey based on the Health Belief Model with the intention of assessing perceived susceptibility, perceived severity, perceived benefits and perceived barriers to the health care preventative action of receiving the Tdap vaccination in the third trimester of pregnancy. Through in-depth literature review, consideration of the updated ACIP guidelines, and support of a developed theoretical framework, an eight-question survey was developed. The data examined in this project may serve to illustrate limitations in provider care that can be immediately improved upon, such as information sharing. The primary limitation of the study is in the sample size of 44 eligible survey responses and the uniform demographics of the population. Despite these limitations, the survey design may be extended to other populations of interest, with greater demographic variation for further study.

Mental health disorder is the leading cause of disease burden in women worldwide. Pregnant women with mental disorder are especially at risk of having offspring with adverse outcomes. This study aimed to investigate risk factors of mental health disorder among Chinese pregnant women in the third trimester. A total of 462 pregnant women in their third trimester completed interviews at three hospitals in Shandong Province, China from July to December, 2010. The Symptom Checklist-90-R (SCL-90-R) was used to evaluate mental health disorder, and was defined as total score ≥160, or scores of any symptom dimensions ≥3, or total of positive symptoms ≥43. Multiple logistic regression was used to examine the risk factors of mental health disorder, and to adjust for covariates. The total score and scores of somatization, obsessive-compulsive, anxiety, and phobic anxiety were higher than corresponding national norm by SCL-90-R assessment (all p<0.05). Multiple logistic regression showed family income, relationship with parents-in-law, concerns about child's health, fear of delivery, and pregnancy complications were negatively associated with mental health disorder (all p<0.05). More specifically, relationship with parents-in-law, fear of delivery, preference on mode of delivery (Caesarean section), and body image concerns were positively associated with anxiety (all p<0.05); Fear of delivery was positively associated with depression (p=0.023). Family income, relationship with parents-in-law, concern about child's health, fear of delivery, and pregnancy complications were identified as potential risk factors of mental health disorder in this Chinese pregnant women population. Strategies to reduce mental health disorder are needed among Chinese pregnant women.

This study was conducted to determine whether or not a significant difference exists in pregnant women among those receiving therapeutic touch, mock therapeutic touch, or no touch on measurements of anxiety and well-being. Thirty third trimester primigravida subjects were tested pre- and postintervention using the State-Anxiety Inventory and a Well-Being Visual Analog; heart and respiratory rates were monitored before, during, and after the treatment. No significant differences were found using analysis of covariance with the pre-test scores as the covariate. The findings indicate that therapeutic touch may not be useful in reducing state anxiety or enhancing subjective well-being in pregnancy. Study limitations include a small sample size, use of an instrument without established reliability and validity, and a study environment that may have increased anxiety.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.
Antepartum suicidal behaviors are a leading cause of maternal injury and death. Previous research has not investigated associations between antepartum suicidal ideation and perinatal complications. Our study objective was to evaluate the relationship of antepartum suicidal ideation with low infant birthweight, small for gestational age, and preterm birth. A cohort study was conducted among 1,108 women receiving prenatal care in Peru. Suicidal ideation was measured using the Patient Health Questionnaire-9 during pregnancy. Birth outcomes were extracted from medical records. Linear regressions and multivariable logistic regressions were used to estimate were used to investigate associations between suicidal ideation and pregnancy outcomes. The prevalence of suicidal ideation was 8.7%, preterm delivery was 5.7%, low birthweight was 4.4%, and small for gestational age was 3.4%. In an adjusted model, infant birthweight was 94.2 grams lower for mothers with antepartum suicidal ideation (95% CI: −183.0, −5.5, p = 0.037) compared with those without suicidal ideation. After adjusting for confounders including depression, participants with suicidal ideation had a nearly four-fold increased odds of delivering a small for gestational age infant (OR: 3.73; 95% CI: 1.59–8.74). These findings suggest suicidal ideation during pregnancy is associated with adverse perinatal outcomes, especially low infant birthweight.
Revisión por pares

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.
Antepartum suicidal behaviors are a leading cause of maternal injury and death. Previous research has not investigated associations between antepartum suicidal ideation and perinatal complications. Our study objective was to evaluate the relationship of antepartum suicidal ideation with low infant birthweight, small for gestational age, and preterm birth. A cohort study was conducted among 1,108 women receiving prenatal care in Peru. Suicidal ideation was measured using the Patient Health Questionnaire-9 during pregnancy. Birth outcomes were extracted from medical records. Linear regressions and multivariable logistic regressions were used to estimate were used to investigate associations between suicidal ideation and pregnancy outcomes. The prevalence of suicidal ideation was 8.7%, preterm delivery was 5.7%, low birthweight was 4.4%, and small for gestational age was 3.4%. In an adjusted model, infant birthweight was 94.2 grams lower for mothers with antepartum suicidal ideation (95% CI: −183.0, −5.5, p = 0.037) compared with those without suicidal ideation. After adjusting for confounders including depression, participants with suicidal ideation had a nearly four-fold increased odds of delivering a small for gestational age infant (OR: 3.73; 95% CI: 1.59–8.74). These findings suggest suicidal ideation during pregnancy is associated with adverse perinatal outcomes, especially low infant birthweight.
Revisión por pares

INTRODUÇÃO: O antecedente de parto prematuro espontâneo em gestação anterior é considerado o principal e mais importante fator de risco clínico para prematuridade, principal causa de morbidade e mortalidade neonatal. Cerca de 25% das pacientes que tiveram parto prematuro apresentarão recorrência. A prevenção secundária consiste na pesquisa de marcadores de maior risco, com o intuito de instituir medidas terapêuticas apropriadas e de evitar tratamentos desnecessários. A hipótese do presente estudo é a de que existe correlação entre os resultados da avaliação do colo uterino e do teste para proteína-1 fosforilada ligada ao fator de crescimento insulina-símile (phIGFBP-1) e que a utilização de ambos em associação possa predizer a ocorrência de parto prematuro com maior sensibilidade. OBJETIVOS: Averiguar a utilidade da medida do comprimento do colo uterino e do teste para phIGFBP-1 na predição do parto prematuro antes de 37 e de 34 semanas, a existência de relação dos testes entre si, o melhor valor de corte da medida do colo em diferentes idades gestacionais e a melhor época de realização de cada um dos exames. MÉTODO: Foram compilados e submetidos a análise secundária os dados de 101 gestantes com antecedente de parto prematuro atendidas no Setor de Baixo Peso Fetal da Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, entre 2003 e 2008. A medida do comprimento cervical e o teste para phIGFBP-1 foram realizados a cada três semanas, entre 24 e 34 semanas de gestação, e comparados com o desfecho de parto prematuro e nascimento com 34 semanas ou menos, e o melhor valor de corte do colo uterino foi estabelecido por meio de curva de características operacionais. RESULTADOS: Das 101 gestações estudadas, 25 (24,8%) terminaram em parto prematuro, das quais 12 (11,9%) ocorreram com 34 semanas ou menos. As idades gestacionais médias de avaliação foram de 24, 27, 30 e 33 semanas, e os valores de corte do colo uterino foram de 22, 21, 20 e 16 mm, respectivamente. A medida do comprimento do colo apresentou maior sensibilidade (cerca de 70%) e foi capaz de predizer o parto prematuro em todas as avaliações. O teste para phIGFBP-1 não foi útil com 24 semanas, porém foi capaz de detectar de forma independente o risco de prematuridade com 27, com 30 e com 33 semanas. Houve associação estatística dos exames entre si, de forma que o comprimento cervical médio foi menor em gestantes com teste positivo para phIGFBP-1. A associação dos exames elevou a sensibilidade e o valor preditivo negativo de forma significativa. CONCLUSÕES: A medida do comprimento do colo pela ultrassonografia transvaginal constitui bom marcador de risco para parto prematuro com 24 semanas, e o teste para phIGFBP-1 é útil após 27 semanas. A associação dos dois exames possui alta sensibilidade e alto valor preditivo negativo em gestantes de alto risco para prematuridade espontânea, e a realização do primeiro com 24 semanas e do segundo com 27 semanas constitui bom modelo preditivo para o parto prematuro
INTRODUCTION: The history of spontaneous preterm birth in a previous pregnancy is considered the main and most important clinical risk factor for preterm birth, the leading cause of neonatal morbidity and mortality. About 25% of these patients will deliver prematurely again. Secondary prevention consists in the search for markers of increased risk, in order to institute appropriate therapeutic actions and to avoid unnecessary treatments. The hypothesis of this study is that there is a correlation between the results of the evaluation of the cervix and the test for phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) and that the use of both in combination can predict the occurrence of preterm delivery with higher sensitivity. OBJECTIVES: To investigate the usefulness of the measurement of the cervical length and phIGFBP-1 rapid test in the prediction of preterm birth before 37 and 34 weeks, the existence of a relationship between the tests themselves, the best cutoff value of cervical length measurement at different gestational ages and the best time to carry out each of the exams. METHODS: Data of 101 women with previous preterm birth assisted at the Obstetrical Clinic of the Hospital das Clínicas, Faculty of Medicine, University of São Paulo between 2003 and 2008 were collected and subjected to secondary analysis. The measurement of cervical length and the phIGFBP-1 test were performed every three weeks, between 24 and 34 weeks gestation, and compared with the outcome of premature birth before 37 and 34 weeks, and the best cutoff value of the cervix was determined by receiver operator characteristic curves. RESULTS: Of the 101 pregnancies studied, 25 (24.8%) ended in preterm birth, of which 12 (11.9%) occurred at 34 weeks or less. The mean gestational age in each evaluation was 24, 27, 30 and 33 weeks, and the cutoff of the cervix were 22, 21, 20 and 16 millimeters, respectively. The measurement of cervical length showed the highest sensitivity (approximately 70%) and was able to predict preterm birth in all evaluations. The phIGFBP-1 test was not useful at 24 weeks, but was able to independently detect the risk of prematurity at 27, 30 and 33 weeks. Statistical association between the exams was observed, so that the mean cervical length was lower in pregnant women testing positive for phIGFBP-1. The combination of both tests significantly increased the sensitivity and negative predictive value. CONCLUSIONS: The measurement of cervical length by transvaginal ultrasound is a good marker of risk for preterm delivery at 24 weeks, and the test for phIGFBP-1 is useful after 27 weeks. The association of the two tests is valuable and shows high sensitivity and high negative predictive value in women at high risk for spontaneous preterm birth, when the first is preformed with 24 weeks, and the second with 27 weeks

博士
國立臺灣大學
護理學研究所
94
The overall purpose of this study was to describe, understand and interpret the meaning of body change through the voices of pregnant women in Taiwan during the third trimester of pregnancy. The combination of phenomenology and feminist approach was employed as a methodology to provide the basic foundation informing the study. Eighteen pregnant women participated in the investigation. Eighteen women in the 29th to 39th week of pregnancy receiving prenatal examinations at clinics at a medical center in Taipei, Taiwan participated in this study. In-depth, open-ended interviews concentrating on the women’s reactions to the changes in their bodies were conducted. Two major themes central to women’s experience of their bodies during late pregnancy were identified. One theme, ‘My body: where did it go?’, reflects the women’s use of non-pregnant adult female standards of beauty to assess their pregnant bodies and their hope of regaining their “feminine self” after childbirth. The other theme, ‘My body = my baby’s body’, reflects the women’s view of the changes in their bodies as an indication of their baby’s health and growth and as a sign of their adequacy as mothers. Many of the women clearly expressed a conflict between their concern for ‘my body’ and their concerns for the ‘baby’s body.’ Concerns about ‘my body’ reflect the women’s desire to measure up to the ideal, i.e., thin, body image socially prescribed for women. Concerns about the ‘baby’s body’ reflect their desire to be a ‘good mothers,’ to put the welfare of their child ahead of their own welfare. Women’s experience of body change in the late pregnancy reflects a dialogue of 「me」and 「I」. Moreover, the re-shaped body image, the role and identity transitions of pregnant women reflects the transitions from 「pass self」to 「present self」of this life period. The strength of this study is in presenting the meaning of bodily changes of pregnancy through voices of pregnant women, providing the pregnant women with an opportunity to reflect on their own experiences of body change during the third trimester of pregnancy. Awareness of the complex and possibly conflicting reactions pregnant women have to their bodies may help health professionals be more open to hearing and respecting what pregnant women have to say, help them provide a nondirective environment in which women can feel free to talk any negative feeling they may have thus providing a care model of ‘client- oriented’ for women approaching the end of pregnancy.

碩士
高雄醫學院
護理學研究所
86
The purpose of this research was to investigate the uncertainty, stress, and coping in women with high risk pregnancy during third trimester, and to explore the relationship among these factors and the predictors of coping. Totally 110 subjects of purposive samples were collected from two medical centers and four regional hospitals in Kaohsiung city, Taiwan. Three instruments were utilized to collect the data: (1)the Basic Characteristic Inventory; (2)the Uncertainty - Stress Scale; (3)the Ways of Coping Checklist. The data were analyzed using the Cronbach''s alpha, item analysis, factor analysis, chi-square, t-test, ANCONA, Pearson''s correlation, and Hierarchical multiple regrssion analysis. In this study, the main results were as follows: (1)factors analysis of the uncertainty scores of the Uncertainty-Stress Scale defined two categories, which were labeled Indefiniteness as well as Being unsettled and having doubts about coping; (2)the stress scores of the Uncertainty-Stress Scale were defined by factor analysis as: Stress caused by indefiniteness, and Stress caused by being unsettled and having doubts about coping; (3)using factor analysis, the Ways of Coping Checklist were defined as: Plan and hoping, Seeking social resources, Emotional suppression, and Cognitive suppression; (4)the indefiniteness of the hospitalized high risk pregnant women were significantly higher than those of the out-patient high risk pregnant women; (5)the stress of the hospitalized high risk pregnant women were remarkably higher than those of the out-patient high risk pregnant women; (6)the cognitive suppression of the out-patient high risk pregnant women were significantly higher than those of the hospitalized high risk pregnant women; (7)uncertainty was positively correlated with stress; uncertainty and stress were negatively correlated with plan and hoping, and cognitive suppression; (8)the occupational status, and being unsettled and having doubts about coping, or Stress caused by being unsettled and having doubts about coping were significant predictors of the Plan and hoping; (9)the educational level was an significant predictor of the Seeking social resources; (10)the indefiniteness was an significant predictor of the Cognitive suppression. The results of this study can help the nurses not only to understand uncertainty, stress, and coping of the high risk pregnant women both in hospitalized and out-patient departments, but also to reinforce the role of being educator and supportor. Moreover, it can provide references to Antepartum Home Care Program for the high risk pregnant women, and supply useful information for enhancing obstetric nursing teaching and future research.

碩士
中山醫學大學
護理學系碩士班
101
Regular moderate intensity physical activity has significant benefits for pregnant women and fetal health. Most pregnant women tend to reduce physical activities during pregnancy due to the uncertainty of the amount of moderate-level physical activity. Nurses should continue to guide and answer the concerns of pregnant women and provide appropriate amounts of physical activity based on existing evidence for pregnant women with different stages of pregnancy. However, risk factors and benefits of physical activity during pregnancy remain controversial. Previous studies also show that pre-pregnancy body mass index (BMI) is an important regulatory factor in relationship of gestational weight gain and perinatal outcomes. More attention has been placed on weight management during pregnancy and postpartum health issues. Therefore, it is necessary targeting on Taiwanese pregnant women to clarify the benefits and risks of perinatal outcomes on physical activity during pregnancy and weight management among women of childbearing age. The aims of this study were to explore the different parities of pregnant women in the pre- pregnancy body mass index and gestational weight gain distribution and differentiation, to see whether maternal gestational weight gain affected birth weight and maternal delivery mode, to estimate the associations between maternal pre-pregnancy body mass index and birth weight, and to examine if an association existed between physical activity during the third trimester and birth weight or delivery mode. A longitudinal study was performed. Participants of this study were between 28 to 40 gestational weeks and had a singleton fetus. Data were collected from 123 pregnant women at a medical center in Taichung City by using convenience sampling. The information was collected through the Chinese version of pregnancy physical activity questionnaire. Birth weight and delivery data were retrieved from medical records or by telephone interview. The data were coded and analyzed with SPSS for windows V.18.0. Descriptive analysis, pearson correlation, general linear model, one-way ANOVA, independent-sample t test, and logistic regression were used in this study. The results revealed that primiparous women gained more weight during pregnancy than multiparous women(P =.022). In addition, maternal gestational weight gain was a significant predictor of birth weight (R2 =.048 ; P =.009). Pre-pregnancy body mass index was positively associated with birth weight (R2 =.026 ; P =.043). There was no association between total physical activity and birth weight. There was also no association between intensity of activity and birth weight. Results from logistic regression provided no consistent evidence for an association between maternal gestational weight gain and delivery mode (OR =1.054 ; P >.05) . Although there was no association between total physical activity and delivery mode (OR =.997 ; P >.05); however, with regards to intensity of activity, Moderate -intensity activity of pregnant women increased each 1 MET-hour / week, the odds of vaginal delivery to caesarean section was 1.01 times (OR =.990 ; P =.035). In general , Taiwanese women reduce their physical activity during pregnancy. However, moderate-level physical activity and weight management can reduce the risk of newborn overweight and the caesarean section. In addition to obtaining professional knowledge in physical activity during pregnancy, the findings from this study also can provide solid evidence on health counseling during pregnancy as well as can offer physical activity guidance with more empirical research base, and thus improve the health promotion of antepartum and intrapartum women.

碩士
中國醫藥大學
護理學系碩士班
102
Fatigue is common in pregnancy women and important factors that interfere with maternal health and wellbeing.Though the factors and cause of fatigue relevant to pregnancy have been investigated in previous studies, most studies only chose the women of vaginal delivey and normal pregnancy as their participants.There are few studies to investigate high-risk pregnant women. This study investigates the different fatigue types and its physiological, psychological, situational factors affect high- risk pregnancy women . Cross sectional questionnaire survey method was adopted in this research to collect available related data during high-risk pregnancy at the third trimester and complete collection of 103 high-risk pregnant women.The data would be analyzed by Logistic Regression Model to identify the relation between physiological, psychological, and situational factors. The results showed that the high-risk pregnant women suffered from two patterns of fatigue and mostly were in low persistent fatigue levels. (58.25%) Although the fatigue wasn’t in expectation of high , there is a cumulative effect of fatigue. It is recommended that nurses should pay attention to provide interventions to reduce fatigue and to prevent the generation of a high degree of exhaustion. In addition, the study also showed that depress was one predictor of high risk pregnancy women fatigue patterns.The result showed that the high risk pregnancy women with high depress would be prone to high fatigue during the pregnancy(OR:5.10，P<0.001).Overall, the study results would be helpful to construct the nursing of scientific knowledge and to improve the quality of care in clinical practice.

Leung Yee Fong, Vivian.
Thesis (M.Phil.)--Chinese University of Hong Kong, 1997.
Includes bibliographical references (leaves 159-169).
Acknowledgments --- p.i
Legend for figures --- p.ii
Legend for tables --- p.v
List of abbreviations --- p.vii
Abstract --- p.viii
Chapter Ch 1 --- Introduction --- p.1
Chapter 1.1 --- Embryology --- p.1
Chapter 1.1.1 --- Embryology of amniotic cavity --- p.1
Chapter 1.1.2 --- Embryology of kidney and bladder --- p.3
Chapter Ch 2 --- Background: What is already known about amniotic fluid volume? --- p.7
Chapter 2.1 --- Normal physiology --- p.7
Chapter 2.1.1 --- The origin of amniotic fluid: Where does it come from? --- p.8
Chapter 2.1.2 --- Where does the amniotic fluid go? How reabsorbed? --- p.14
Chapter 2.1.3 --- How is amniotic fluid volume controlled? --- p.18
Chapter 2.2 --- Abnormal physiology --- p.26
Chapter 2.2.1 --- Too much liquor: polyhydramnios --- p.26
Chapter 2.2.2 --- Too little liquor: oligohydramnios --- p.28
Chapter 2.2.3 --- Diseases and gender differences that may be related to parity and amniotic fluid volume --- p.30
Chapter 2.3 --- Techniques of measuring amniotic fluid volume --- p.32
Chapter 2.3.1 --- History --- p.32
Chapter 2.3.2 --- Current most popular technique: amniotic fluid index --- p.38
Chapter 2.4 --- Summary of what is known and not yet known about amniotic fluid volume --- p.48
Chapter Ch 3 --- Aims of this study --- p.49
Chapter Ch4 --- Method --- p.50
Chapter 4.1 --- Equipment --- p.50
Chapter 4.2 --- Subject selection criteria --- p.50
Chapter 4.2.1 --- Criteria --- p.50
Chapter 4.2.2 --- Total number of subjects studied --- p.51
Chapter 4.2.3 --- Total number of subjects selected fulfilling all criteria --- p.51
Chapter 4.2.4 --- Subject preparation --- p.52
Chapter 4.3 --- Technique --- p.53
Chapter 4.3.1 --- "Standard measurement of BPD， AC, FL and EFW" --- p.53
Chapter 4.3.2 --- Standard measurement of Doppler --- p.54
Chapter 4.3.3 --- Amniotic fluid index --- p.55
Chapter 4.3.4 --- Bladder volume --- p.59
Chapter 4.3.5 --- Fetal renal pelvis --- p.61
Chapter 4.3.6 --- Intra-observer error techniques and calculation --- p.63
Chapter 4.4 --- Techniques used in analysis --- p.65
Chapter Ch5 --- Results --- p.67
Chapter 5.1 --- Fetal parameters --- p.68
Chapter 5.1.1 --- Fetal biparietal diameter (BPD) --- p.68
Chapter 5.1.2 --- Fetal abdominal circumference (AC) --- p.69
Chapter 5.1.3 --- Fetal femur length (FL) --- p.70
Chapter 5.1.4 --- Pulsatility index values of umbilical artery --- p.71
Chapter 5.1.5 --- Birth weight (BW) --- p.74
Chapter 5.1.6 --- Estimated fetal weight --- p.76
Chapter 5.2 --- Amniotic fluid index --- p.79
Chapter 5.2.1 --- Amniotic fluid index-overall --- p.79
Chapter 5.2.2 --- Amniotic fluid index-male and female --- p.81
Chapter 5.2.3 --- The ten segments of amniotic fluid index distribution --- p.83
Chapter 5.2.4 --- Amniotic fluid index relationship to estimated fetal weight --- p.86
Chapter 5.2.5 --- Amniotic fluid index with gravidity and parity --- p.89
Chapter 5.2.6 --- Amniotic fluid index with estimated fetal weight of different parity (best fit line) for both male and female --- p.93
Chapter 5.3 --- Fetal urinary bladder volume (BV) --- p.96
Chapter 5.3.1 --- Bladder volume-overall --- p.96
Chapter 5.3.2 --- Bladder volume-male and female --- p.97
Chapter 5.3.3 --- Bladder volume with estimated fetal weight- overall --- p.100
Chapter 5.3.4 --- Bladder volume with estimated fetal weight in both male and female --- p.101
Chapter 5.3.5 --- Bladder volume with gravidity and parity --- p.103
Chapter 5.3.6 --- Bladder volume with amniotic fluid index --- p.105
Chapter 5.4 --- Anteroposterior diameter of the fetal renal pelvis --- p.106
Chapter 5.5 --- Hydronephrosis index values --- p.107
Chapter Ch 6 --- Discussion --- p.108
Chapter 6.1 --- Review of the study --- p.108
Chapter 6.2 --- Discussion on subject --- p.111
Chapter 6.2.1 --- Gestational age chosen --- p.111
Chapter 6.2.2 --- Subject preparation --- p.112
Chapter 6.3 --- Discussion of method --- p.114
Chapter 6.3.1 --- Equipment --- p.114
Chapter 6.3.2 --- Technique --- p.117
Chapter 6.4 --- Discussion on results --- p.128
Chapter 6.4.1 --- Normality of population --- p.128
Chapter 6.4.2 --- Low birth weight/ IUGR in Chinese and Caucasian --- p.129
Chapter 6.4.3 --- Cut-off points to detect oligohydramnios and polyhydramnios --- p.132
Chapter 6.4.4 --- Amniotic fluid index-relationship with fetal weight --- p.143
Chapter 6.4.5 --- Amniotic fluid index-relationship to parity --- p.145
Chapter 6.4.6 --- "Relationship between gender, estimated fetal weight and amniotic fluid index" --- p.147
Chapter 6.4.7 --- Parity and cut-off points for oligohydramnios and polyhydramnios --- p.150
Chapter 6.4.8 --- Relationship of amniotic fluid volume to urinary function --- p.152
Chapter Ch 7 --- Conclusions --- p.157
References --- p.159

Pregnancy can be a very difficult time of transition for some women as they have to adapt, change and prepare for the role and responsibility that awaits them after their baby is born. This is especially challenging for first-time mothers as they experience higher levels of anxiety and uncertainty than more experienced mothers. From a fortogenic perspective, pregnancy can be viewed as a developmental opportunity for maturation and growth. With high levels of psychological well-being the new mother will be able achieve optimal functioning by being a sensitive and responsive and confident in her abilities to care for her new-born baby. There is substantial evidence to show that spirituality is strongly associated with psychological well-being, but the lived experiences of first-time mothers have not yet been explored. Therefore this study aims to explore a group of first-time mothers‟ experiences of meaningfulness during their third trimester of pregnancy by focusing on their spirituality. Qualitative research and a phenomenological design were used to gain in-depth understanding of the experiences of first-time mothers. The Mmogo-Method® and reflective journals were used as data-gathering techniques and visual and textual data were captured. The data were analysed by using thematic analysis (textual) and comparing the symbolic values (visual) with the research question. This group of first-time mothers expressed a very personal and intimate relationship with a Divine reality that they rely on and from it they derive a sense of meaningfulness. This sense of meaning stems from their belief that the Divine reality is the giver of life; they were given a responsibility to carry new life. Unconditional trust in the Divine reality makes them willing to surrender control of their lives and accept the responsibility they were given. They find meaning, which potentially has implications for higher levels of psychological well-being. The findings of this research provide the basis for developing interventions for mothers-to-be to make sense of their pregnancy by relying on their pre-existing spiritual frameworks.
MA (Research Psychology), North-West University, Potchefstroom Campus, 2014

碩士
國立台北護理學院
護理助產研究所
92
Purpose: The objectives of this study were to develop a set of Yoga exercise for pregnant women at their third trimester in Taiwan and further evaluate the effects of this application. Methods: This is a quasi-experimental study that included a total of eighty-eight subjects with pregnancy at 26 to 28 weeks of gestation. All subjects had no regular exercise for more than one year and without medical or obstetric complications as well. Forty-five women were entered into study group. A Yoga exercise VCD was provided and the study group subjects practice Yoga exercise 3 times a week for a 30 min of duration and kept practicing for 12 weeks. In the control group, there were forty-three subjects who did not do Yoga exercise. Questionnaires for pregnant discomfort were given to control and study groups in both pre-test and post-test periods in order to compare the effects of yoga and CBSEI questionnaires were given after delivery. Statistics: SPSS/Windows 11.0 was used in this study. Descriptive statistics were presented with frequencies, percentages, means, and standard deviations (SD), Chi-square test, t-test, Mann-Whitney U Test, and Wilcoxon Signed Ranks Test were used for evaluating the effects of Yoga on delivery. Results: Women who practiced Yoga exercise showed less pregnant discomfort and higher CBSEI during delivery (p<.05). They also showed better confidence in facing labor and performed better relaxing techniques and breathing methods of self-adjustment in facing the pressures from laboring. This result proved that Yoga exercise is effective and health-care systems may provide it for pregnant women.

碩士
國立陽明大學
臨床護理研究所
94
The purposes of this research were to examine the effects of sleep quality, depressive symptoms, and physical activities on pregnancy outcomes among pregnant women in their third trimester. With prospective and descriptive correlational design, the subjects of this research were 220 pregnant women in their third trimester. At antepartum outpatient clinics, a face-to-face interview with structured questionnaires was conducted toward the subjects. The study variables included socio-demographic characteristics, sleep quality, depressive symptoms, and physical activities. The data was analyzed by descriptive statistics, t-test, one way ANOVA, chi-square, pearson correlation and logistic regression. The results showed: （1）Most of women in the research had positive pregnancy outcomes. Non-plan cesarean section and vacuum vaginal delivery only took 8.7% and 20.2% respectively. The rate of preterm birth and low birth weight were 3.2% and 4.1% respectively. Average gestational age of newborn was 39.03±1.30 weeks. Average birth weight was 3177 ± 424 grams.（2）79.5% pregnant women had poor sleep quality problems. The main problem was sleep disturbance.（3）34.5% of research subjects had serious depressive symptoms. The most severe of all was somatic complaints.（4）The research subjects had nearly the same energy expenditure on record of ordinary days, holidays, and 3 days. They were 38.54 kcal/kg/day、38.58 kcal/kg/day、38.56 kcal/kg/ day respectively. The main moderate-to-vigorous physical activities of pregnant women were strolling, shopping, and climbing stairs.（5）The sleep quality and depressive symptoms of the research subjects were positively correlated, which indicated that the better the sleep quality, the less the depressive symptoms. No significant correlations are found between sleep quality and depressive symptoms, and the amount of physical activities on ordinary days, holidays, and the 3 days. However, negative correlations were evident in moderate-to-vigorous physical activities on holidays and the 3 days. That indicated pregnant women need a certain amount of energy expenditure in moderate-to-vigorous physical activities to improve sleep quality and reduce depressive symptoms.（6）Examined factors related to non-plan cesarean section, the results revealed that primipara, poor sleep quality, and low physical activities took more risk of non-plan cesarean section. Further examined the correlation between individual sleep variables and non-plan cesarean section, it showed that women who suffered from non-plan cesarean section have had fewer sleep hours, more sleep disturbance, and fewer moderate-to-vigorous physical activities. （7）Sleep quality (PSQI) and physical activities are important predictive factors of non-plan cesarean section. It indicated that pregnant women who had poor sleep quality and low physical activities had higher risk of non-plan cesarean section. （8）Depressive symptoms was a related factor of vacuum vaginal delivery. 58.8% of pregnant women who suffered from vacuum vaginal delivery have severe depressive symptoms. From this research it was found that a higher risk of non-plan cesarean section was found in pregnant women who experienced poorer sleep quality and less amount of physical activities. 60% of pregnant women who adopted for vacuum vaginal delivery suffered from serious depressive symptoms. Only moderate-to-vigorous physical activities could improve sleep quality and depressive symptoms. Thus, it is recommended that health practitioners should encourage pregnant women to do some moderate-to-vigorous activities, such as stroll, and antepartum exercise. Pregnant women should avoid static activities to improve sleep quality, decrease depressive symptoms, and decrease negative pregnancy outcomes.

碩士
國立臺北護理健康大學
護理助產研究所
99
Abstract This study examined the effect of doing birth ball exercises on reducing prenatal discomfort and lower back pain in expectant mothers during the second and third trimester of pregnancy. The researcher first recruited a team of experts to develop a prenatal birth ball exercise program. Team members included a committee member of the Federation of International Sports, Aerobics and Fitness Inc. (FISAF), an FISAF Taiwan education and training director, a professional instructor and examiner, an author of national Bureau of Health Promotion self-help exercise manuals for expectant mothers, and prenatal low-impact exercise trainer Ms. Ya-chi Hung. The researcher then tested the effectiveness of the developed exercise program in reducing expectant mothers’ prenatal discomfort and lower back pain. The researcher used a quasi-experimental design. Pre- and post-test data were collected for comparison. A convenience sample was recruited from a district hospital OB/GYN department in Northern Taiwan. Subjects included primiparae who were in their 20th to 26th week of pregnancy with normal pregnancy diagnoses. The 95 subjects recruited were assigned to either the experimental or control group by self-selected. Six subjects did not complete the full program due to premature delivery or lost contact, giving valid datasets for 89 subjects. Apart from receiving normal prenatal care and instruction, subjects in the experimental group (n=45) received the DVD entitled Visual Nursing Care Guide to Prenatal Birth Ball Exercise, and were asked to do the 30 minute exercise program at least three times each week until delivery. They were further asked to do the exercise program once each week in the hospital to allow the researcher to assess progress. The control group (n=44) received routinely prenatal care and instruction only. Research instruments included basic demographic and obstetric datasheets, a Pregnancy Discomfort Scale, Brief Pain Inventory of lower back pain, and Exercise Support Scale. The researcher processed and analyzed data using SPSS 17.0 software. Slightly more than half (50.6~55.1%) of all subjects did prenatal exercise during the 20th to 36th week of pregnancy. This percentage dropped significantly to 43.4% during the 36th to 40th weeks, with both groups exercising relatively less in the final weeks. Pre-test data collected during the 20th to 26th week found no significant difference between the two groups in terms of prenatal discomfort or previous-week lower back pain (p>.05). Support for prenatal exercise was higher in the experimental than in the control group (t=-2.129, p<.05). After using a generalized estimated equation (GEE) model to control potential confounding variables (i.e., age, weight gain during pregnancy, and prior exercise behavior), the researcher examined the group-time interaction effect and found both group and time as factors of influence on lower back pain. After twelve weeks, lower back pain scores in the experimental group averaged 1.968 points less than those in the control group (p=.034). Data also showed a positive correlation between week of pregnancy and increased lower back pain (p<.001). However, after considering the group-time interaction effect, the researcher found diminished lower back pain over time in the experimental group and elevated lower back pain over time in the control group (p<.001). Significant factors of influence identified in terms of prenatal discomfort included group, time, and group-time interaction. After twelve weeks, prenatal discomfort scores averaged 0.709 points less in the experimental group than in the control group (p=.806). Data also showed a positive correlation between week of pregnancy and increased prenatal discomfort (p<.05). After accounting for the group-time interaction effect, a significant 10.479 point drop in prenatal discomfort scores was found between earlier (weeks 20~26) and later (weeks 36~40) weeks for the experimental group and a gradual increase in prenatal discomfort scores for the control group. Group, time, and group-time interaction were all identified as significant factors of influence in terms of exercise support. After twelve weeks, support for birth ball exercise ranked 6.109 points higher in the experimental group than in the control group (p<.001). While the researcher noted a trend in support of exercise that rose with number of weeks pregnant, it was not statistically significant (p>.05). After accounting for the group-time interaction effect, the researcher found a significant 7.280 rise (p<01) in exercise support scores between earlier (weeks 20~26) and later (weeks 36~40) weeks for the experimental group and a gradual decrease in exercise support scores for the control group. Significant factors of influence identified in terms of lower back pain impact on daily life included group, time, and previous exercise habit. Experimental group scores averaged 3.611 points lower than control group scores (p=.043). Lower back pain impact on daily life scores correlated positively with weeks pregnant (p<.01). After accounting for the group-time interaction effect, the researcher found a moderating effect over time on the impact of lower back pain on daily life for the experimental group and a gradually rising trend over time for the control group (p<.001). Subjects reporting a previous exercise habit scored an average 3.854 points less for impact of lower back pain on daily life than those who did not (p=.05). Easy for expectant mothers to do at home, birth ball exercises can help alleviate prenatal discomfort and should be promoted as part of prenatal education. Expectant mothers should consult with their physician prior to beginning any exercise program and an outpatient assessment system should be created to provide appropriate exercise information, ensure safety, and promote effective and enjoyable exercise. The author recommends incorporating prenatal exercise formally into the health education curricula as well as providing appropriate settings and trained nurses to deliver proper clinical guidance. Spouses should be encouraged to participate in the exercise learning and practice process in order to give essential support and encouragement.

Dissertação de mestrado apresentada ao ISPA - Instituto Universitário
Problema: Perante uma sociedade dinâmica, fruto de alterações e transformações no papel da mulher em relação à gravidez e a todo o seu processo inerente, denotam-se consequências na sua organização psicológica das quais emerge uma necessidade, também ela recorrente, de aprofundarmos um conjunto de questões intrínsecas a estes processos. Objetivo: O presente estudo assume como objetivo aceder, através de narrativas, à identificação, descrição e compreensão das representações maternas de grávidas que se encontram no terceiro trimestre de gravidez. Método: Esta investigação enquadra-se numa metodologia qualitativa, de natureza descritiva e exploratória. A amostra é caraterizada por 10 grávidas de nacionalidade portuguesa (6 primíparas e 4 multíparas), com uma média de idades de 32 anos e que se encontram no terceiro trimestre de gravidez. Como materiais de estudo foram utilizados um questionário sociodemográfico e uma entrevista semiestruturada designada por Interview of Maternal Representations during Pregnancy – Revised Version (IRMAG-R, Ammaniti & Tambelli, 2010), da qual se procedeu a uma análise de conteúdo. Resultados: Criaram-se sete categorias de análise - conteúdos representativos; conteúdos percetivos de relação; conteúdos percetivos de mudança; conteúdos afetivos; conteúdos fantasiosos; conteúdos referenciadores e conteúdos comparativos. Os conteúdos enquadraram-se como parte componente da representação que a grávida desenvolve, de forma diferenciada, sobre si enquanto mãe e sobre o seu filho. Tanto no plano percetual como no plano imaginário as representações sobre o bebé apresentaram maior expressividade. A sua representação enquanto mãe assumiu uma maior prevalência no plano fatual, observando-se uma tendência elevada da grávida em diferenciar-se da sua mãe no que diz respeito às suas caraterísticas e ao que ambiciona para o seu papel materno. Entre outros resultados, concluiu-se a presença um envolvimento afetivo predominantemente positivo que nos reflete a existência de uma relação entre a mãe e o bebé.
ABSTRACT: Problem: In a dynamic society, characterized by changes and transformations in the women´s role related to the pregnancy and all its inherent process, consequences in its psychological organization are identified, which of a necessity emerges, also recurrent it, to deepen a set of intrinsic questions about these processes. Objective: The present study assumes as objective to access, through narratives, the identification, description and understanding of the representations maternal of pregnant women in the third trimester of pregnancy. Method: This inquiry fits in a qualitative methodology of descriptive and exploratory nature. The sample is characterized by 10 pregnant of Portuguese nationality (6 primiparous and 4 multiparous), with an average of 32 years old and that are in the third trimester of pregnancy. As study material, a social and demographic questionnaire as well as a semi structuralized interview were used, referred as Interview of Maternal Representations during Pregnancy - Revised Version (IRMAG-R, Ammaniti & Tambelli, 2010), from which proceeded to a content analysis. Results: Seven categories of analysis were created - representative contents; perceptive contents of relation; perceptive contents of change; affective contents; fanciful contents; contents; comparative and reference contents. The contents fit as component party of the representation that the pregnant woman develops, of differentiated form, on herself as a mother and about her son. As much in the perceptual as in the imaginary plan the representations concerning the baby presented greater expression. Its representation as a mother assumed a bigger prevalence in the factual plan, observing as a high trend, a differentiation of herself from her mother in what concerns the characteristics and ambitions for the maternal role. Among others results, it was concluded the existence of an predominantly positive affective involvement which reflects the existence of a relationship between the mother and baby.

Dissertação de Mestrado apresentada ao ISPA - Instituto Universitário
Problema: Ao longo do tempo ocorreram mudanças significativas na conceção do papel da mulher na sociedade, que implicaram transformações a nível das questões psicológicas associadas ao processo gravídico, que permaneceram até à atualidade. O conhecimento acumulado centra-se principalmente na observação clínica e não tanto em investigações sistemáticas, sendo as existentes essencialmente do século XX. Objetivo: Pretende-se explorar e descrever as representações expressas pelas grávidas, no terceiro trimestre, sobre esta fase final da gestação. Método: Consiste numa investigação qualitativa exploratória descritiva, com uma amostra de 30 grávidas portuguesas, em que a média de idades é de 32 anos. São gestações no terceiro trimestre de gravidez, designadas principalmente por gravidezes normais. Preencheu-se um questionário sociodemográfico e realizou-se uma entrevista semi-directiva intitulada Interview of Maternal Representations during Pregnancy – Revised Version (IRMAG-R, Ammaniti & Tambelli, 2010) Resultados: A representação da grávida enquanto mãe é estruturada essencialmente por uma dimensão fatual, em que se diferencia da sua figura materna e influenciada, principalmente, pelas representações partilhadas por grávidas e mulheres que já foram mães. A representação sobre o seu filho é baseada essencialmente numa dimensão de emergência de fantasias que se centram principalmente em características psicológicas e comportamentais. A ressonância afetiva da vivência da gravidez é descrita principalmente como positiva, afirmando que nesta fase, existe uma relação consolidada entre si e o bebé. O envolvimento afetivo caracteriza-se pela presença da temática das preocupações, existindo nesta fase uma projeção ativa sobre o futuro, principalmente sobre a saúde do bebé e sobre as suas competências maternas.
ABSTRACT: Problem: Over time there have been significant changes in the conception of women's role in society that resulted in changes relating to psychological issues associated with pregnancy. The gathered data focuses mainly on clinical observation rather than on systematic research. Objective: The aim is to explore and describe the representations expressed by pregnant women, in third trimester, about this final stage of gestation. Method: It consists of a qualitative descriptive and exploratory research based on a sample of 30 pregnant Portuguese whose average age is 32 years old. All of them are on the third trimester of their pregnancy that is designated mainly as being normal. A socio-demographic questionnaire and a semi-directive interview entitled Interview of Maternal Representations During Pregnancy – Revised Version (IRMAG-R, Ammaniti & Tambelli, 2010) were carried out. Results: The representation of the pregnant as a mother is mainly structured by a factual dimension that is distinct from her mother figure and primarily influenced by representations shared by pregnant and women who have already been mothers. The representation of her child is primarily based on a dimension of emergent fantasies that focus primarily on psychological and behavioral characteristics. The emotional resonance of the experience of pregnancy is described mainly as positive, stating at this stage, there is an established relationship between the pregnant and her baby. The emotional state involves thematic concerns, especially on the health of the baby and on her skills as a mother. At this stage there is an active projection of the future.

A avaliação da estimativa do peso fetal (EPF) durante o exame ecográfico do terceiro trimestre na gravidez de baixo risco, e considerada o método mais eficaz de diagnostico de restrição do crescimento fetal (RCF), permitindo uma adequada vigilância e programação do parto. Contudo, não existe consenso relativamente a necessidade de um exame ecográfico de rotina, durante o terceiro trimestre da gravidez de baixo risco, com o objetivo de rastreio de RCF, nem de qual será a melhor idade gestacional para a sua realização. Até a data, a realização deste exame não demonstrou vantagens em termos de desfechos perinatais. Não obstante, os casos de RCF tardias não diagnosticados anteparto representam uma proporção significativa de mortes fetais no termo e estão associados a um maior risco de desfechos neonatais adversos, comparativamente aos casos de RCF diagnosticados durante a gravidez. O objetivo global desta tese foi a investigação quanto ao melhor método de rastreio de RCF tardia, em gravidas de baixo risco, incluindo-se para tal cinco projetos. O projeto I consistiu num estudo retrospetivo em que foi comparada a via de parto e a taxa de admissão de recém-nascidos nas unidades de cuidados intensivos neonatais, entre aqueles com peso adequado para a idade gestacional e os leves para a idade gestacional, de gestações de termo e de baixo risco. Um total de 1429 gravidas foi incluído, com uma taxa de 11% de leves para a idade gestacional (LIG), definidos como recém-nascidos ³ 37 semanas com peso ao nascimento < percentil 10. Os LIG associaram-se a maior taxa de cesariana por suspeita de hipoxia fetal intraparto (18/151 vs 8/1202, p < 0,001) e maior taxa de admissão nas unidades de cuidados intensivos neonatais (16/151 vs 18/1202, p < 0,001). Entre os LIG, verificamos que os que foram diagnosticados por ecografia anteparto apresentaram menor taxa de parto instrumental/cesariana por suspeita de hipoxia fetal intraparto comparativamente com o grupo de LIG que não foram diagnosticados anteparto (3/31 vs 39/120, p = 0,01). O projeto II correspondeu a um estudo prospetivo que avaliou a reprodutibilidade das biometrias fetais ecográficas (diâmetro biparietal, perímetro cefálico, perímetro abdominal e comprimento do fémur) realizadas as 35-37 semanas de gestação. Um total de 197 gravidas foi incluído e cada uma foi submetida a três avaliações ecográficas sucessivas, uma por um ecografista e duas por um outro ecografista, correspondendo a um total de 591 avaliações ecográficas. Registaram-se coeficientes de correlação intra e inter-observador muito elevados para todas as medidas avaliadas (todos com valores superiores a 0,85), demonstrando-se elevada reprodutibilidade intra e inter-observador da ecografia do terceiro trimestre realizada as 35-37 semanas de gestação. O projeto III foi um estudo prospetivo observacional que teve como objetivo comparar o conhecimento e pratica clinica entre os Ginecologistas-Obstetras (GOs) e os médicos de Medicina Geral e Familiar (MGF) portugueses relativamente ao rastreio de RCF em gravidas de baixo risco, através da aplicação de questionários, tendo-se conseguido um total de 573 respostas. Verificamos que uma maior proporção de GOs (38%) selecionaram a ecografia as 35-37 semanas como o melhor momento no terceiro trimestre para rastreio de RCF, comparativamente com a proporção de médicos de MFG (10%) (p < 0,001). O projeto IV consistiu num estudo prospetivo aleatorizado que comparou a acuidade diagnostica e os desfechos perinatais entre um grupo de controlo, que realizou apenas a ecografia de rotina no terceiro trimestre, as 30-33 semanas de gestação, e um grupo de estudo que realizou uma ecografia adicional as 35-37 semanas, incluindo-se um total de 1093 gravidas de baixo risco. A ecografia realizada as 35-37 semanas registou uma acuidade diagnostica global para rastreio de RCF de 94%. O coeficiente de correlação de Spearman foi superior entre o percentil da EPF as 35-37 semanas e o percentil do peso ao nascimento (ρ = 0,75), comparativamente com o coeficiente de correlação entre o percentil da EPF as 30-33 semanas e o percentil do peso ao nascimento (ρ = 0,44). O grupo de estudo registou também melhores desfechos perinatais, nomeadamente uma menor taxa de partos vaginais instrumentados por suspeita de hipoxia fetal intraparto (24,4% vs 39,3%, p = 0,005) e menor taxa de cesarianas por suspeita de hipoxia fetal intraparto (16,8% vs 38,8%, p < 0,001), comparativamente com o grupo de controlo. O projeto V constou de um estudo prospetivo com o objetivo de investigar se a neurossonografia permite detetar alterações da substância branca e cinzenta na RCF. Com um total de 318 fetos submetidos ao estudo neurossonográfico, foi possível demonstrar que as RCF tardias apresentam diferenças em termos de desenvolvimento cortical e do corpo caloso, comparativamente com os casos de controlo, sugerindo que a neurossonografia permite demonstrar algumas diferenças de reorganização cerebral na RCF. Em conclusão, um exame ecográfico mais tardio durante o terceiro trimestre (35-37 semanas de gestação) tem precisão e maior correlação com o percentil do peso ao nascimento do que um exame mais precoce no terceiro trimestre, podendo ainda contribuir para diminuir desfechos perinatais adversos. As diferenças nos padrões neurossonográficos entre fetos com crescimento adequado para a idade gestacional e com RCF reforçam o conceito de que uma abordagem combinada que inclua biometrias fetais, bem como outros marcadores clínicos, biológicos e/ou imagiológicos, pode contribuir para otimizar o rastreio de RCF e os desfechos perinatais.