Dissertations / Theses on the topic 'Stillbirth'
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1
Jones, Helen Crispus. "Understanding grief following stillbirth." Thesis, University of Oxford, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.606407.
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Stillbirth is a unique and complex bereavement for parents, with the potential to cause considerable psychological distress, and often characterised by feelings of worthlessness and isolation. Despite dramatic changes to the provision of care practices and interventions to support parents over recent decades, there is limited theoretical or clinical evidence to inform psychological understanding and interventions for grief and distress following stillbirth. A systematic review of quantitative studies aimed to explore the effect of interventions designed to reduce parental distress following stillbirth. Twenty-two studies met inclusion criteria. Tentative support was found for providing mementoes of the baby and information regarding aetiology, support group attendance, and cognitive behavioural interventions for parents with clinical levels of distress. Contradictory findings for the impact of contact with the baby prevent clear conclusions regarding the effect of this practice. However, substantial methodological weaknesses were identified in the reviewed literature, and the current evidence base is not considered able to reliably inform care practices and intervention approaches, with further high quality research evidence needed. The second, empirical paper aimed to assess the application of the cognitive behavioural model of complicated grief to women bereaved by stillbirth. A cross-sectional survey design explored the predictive value of cognitive behavioural variables for explaining variance in grief, both independently and after controlling for demographic, obstetric and loss-related factors. Seventy-eight women bereaved by stillbirth within the preceding two years took part. Negative thoughts about the self, threatening interpretations of grief reactions and depressive avoidance strategies significantly predicted higher grief scores, accounting for 81 % of score variance and all remained significant predictors after controlling for relevant demographic, obstetric and loss-related variables. Findings support the application of the cognitive behavioural model of complicated grief to women bereaved by stillbirth.
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Friedlander, Anne. "Stillbirth : a psychosocial crisis." Master's thesis, University of Cape Town, 1986. http://hdl.handle.net/11427/15835.
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Includes bibliography.This study is an investigation of the psychosocial trauma of stillbirth and the implications of that trauma for case management. Stillbirth is considered a crisis for parents that calls for immediate intervention and constructive management. It strains family coping mechanisms and can overwhelm them if not properly handled. Additionally, a grief response follows a stillbirth which must be recognised, accepted, and treated therapeutically if needed. Parents' problems and needs have not been adequately met by medical, social or community services. There is also little recognition of the training needed by medical personnel in the management of stillbirths. Stillbirth is also a crisis for medical personnel as the delivery of a dead baby evokes feelings of confusion and stress for those dealing with the confinement and aftercare. By highlighting the psychological and emotional sequelae of stillbirths for parents, the needs of parents after the event, and the needs of personnel providing care, the writer intended to contribute to an improved understanding of the issues related to stillbirth and, ultimately, to more compassionate care for those who experience this unhappy event. Issues analyzed and recorded are as follows: The emotional and physical reactions of mothers following a stillbirth; the assistance that parents need in order to adjust constructively; the impact that the stillbirth has upon the family; the mothers' interpretation of their management in hospital; and the hospital and community services rendered and needed to assist with constructive adjustment. Study data was collected over a six month period. Subjects were selected from one hospital and were residents of the municipal areas of Cape Town. Two face-to-face interviews were conducted with each respondent using a semi-structured interview schedule. The first interview, which took place within a week of the mothers' discharge from hospital, gathered data on the reactions of the respondents to stillbirth, the impact of stillbirth on the family, and respondents' interpretation of their management in hospital. This interview was tape-recorded. The second interview followed the interview schedule and obtained information on the needs of families after a stillbirth. Data was coded on the interview schedules and statistical analysis was done by computer. The findings of this study agreed with previous ones, that mothers display typical grief reactions after a stillbirth. The stillbirth was experienced as a disappointment that caused significant distress for the majority of mothers. Management was found to be satisfactory with the exception of post-natal placement. The need for options in this area became evident. A lack of social and psychological services, both within the hospital and in the community, was found. Using knowledge gained from this study, a support organization for parents experiencing stillbirths has been organized with the writer's assistance. A breakdown in communication between the hospital and the local authority health nursing services, in terms of knowledge about the stillbirth, was apparent, and improvement in this area is needed. Recommended guidelines for management based on the research findings and literature review have been proposed. The role of the social worker, doctor and nursing sister have been outlined.
3
Stacey, Tomasina. "Determinants of late stillbirth Auckland 2006-2009." Thesis, University of Auckland, 2011. http://hdl.handle.net/2292/10327.
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Stillbirth is a devastating and too common outcome of pregnancy; globally there are
approximately three million deaths after 28 weeks��� gestation every year. In New
Zealand, as in other high income countries, more than 1 in 200 babies die before birth,
and around 1 in 300 die in the last three months of pregnancy. During the mid
twentieth century there was a dramatic decline in the rate of stillbirth, however this
improvement has not been sustained in recent years. Previous studies have identified
certain causes and risk factors for late stillbirth, but over a third of the deaths remain
unexplained. The current variation in the rate of stillbirths both across and within high
income countries suggests that it is possible to make further improvements in stillbirth
rates. We hypothesised that there would be modifiable, but as yet unidentified risk
factors for late stillbirth.
The Auckland Stillbirth Study was the first case control study to select women with
ongoing pregnancies as gestation matched controls. This study found that the disparity
in rates of late stillbirth in women from different ethnicities in New Zealand could be
attributed to associated factors such as high parity, high body mass index and social
deprivation. Regular utilisation of antenatal care was found to be protective, and
women who attended at least 50% of recommended antenatal visits had a lower risk of
stillbirth compared to those who did not. Antenatal identification of sub-optimal fetal
growth was found to be a possible aspect of the benefit of regular antenatal attendance.
Maternal perception of fetal movements was also identified as an area of importance,
with women who perceived their baby���s movements to decrease in the last two weeks
of the pregnancy being at greater risk of experiencing a stillbirth. In addition this study
found an association between maternal sleep practices and risk of late stillbirth. Most
strikingly, the study found that women who went to sleep on their left side on the last
night (prior to stillbirth/interview) were half as likely to experience a late stillbirth
compared to women who went to sleep in any other position.
This study has added a New Zealand perspective to the existing literature on certain
known risk factors for late stillbirth (such as high body mass index). It has also
identified novel factors that present new possibilities for further research and for the
potential for future reductions in the incidence of late stillbirth.Whole document restricted until Jan. 2013, but available by request, use the feedback form to request access.
4
Campbell-Jackson, Louise. "Exploring the impact of stillbirth on mothers." Thesis, University of Oxford, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.589532.
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Stillbirth is a unique and complex bereavement comprising many losses. Research suggests that the experience of stillbirth may affect the wider family system, including couples relationships or may impact the attachment relationship to the baby born subsequently. Over the last 40 years the psychological impact of perinatal loss on women has been explored. However, less is known about the specific experience of stillbirth. It has been argued that psychological theories have not fully explored stillbirth as a unique loss independent from other losses. The systematic review aimed to explore the psychological impact of stillbirth on mothers. Twenty-six articles (qualitative and quantitative) were reviewed addressing the methodological limitations. Despite methodological limitations the findings suggest that the experience of stillbirth can result in high levels of psychological symptoms for mothers, up to 3 years post loss. The qualitative researched echoed the intense grief and long-lasting impact of stillbirth on women. Some risk factors were identified and social support appeared particularly beneficial for women post loss, however further research into risk and protective factors is needed. The empirical paper employed a qualitative methodology (IPA) to explore the lived experience of mothers of having a child subsequent to stillbirth. Five superordinate themes emerged "living with uncertainty"; "coping with uncertainty"; "relationship with the next child"; "the continuing grief process" and "identity of being a mother". The study highlighted challenges experienced by women during pregnancy that appeared to continue when the subsequent child is born, such as living with uncertainty about their child's wellbeing. For some mothers a process of acceptance of the uncertainty appeared to take place. Mothers' coping strategies and the impact of the experience on their identity was also explored. The findings provided insight into the on-going grieving process described by mothers and identified feelings of maternal guilt, which appeared to underlie many of the themes.
5
Stephansson, Olof. "Epidemiological studies of stillbirth and early neonatal death /." Stockholm, 2002. http://diss.kib.ki.se/2002/91-7349-143-8.
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Devlin, Rosemary. "Miscarriage, stillbirth and neonatal death : a midwifes perspective." Thesis, Queen's University Belfast, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.324953.
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Lean, Samantha. "Advanced maternal age : identifying mechanisms underlying vulnerability to stillbirth." Thesis, University of Manchester, 2016. https://www.research.manchester.ac.uk/portal/en/theses/advanced-maternal-age-identifying-mechanisms-underlying-vulnerability-to-stillbirth(c884a509-287f-4543-aad4-c8ff860d3715).html.
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Advanced maternal age (AMA) is defined as childbearing in mothers ≥35 years of age and is becoming increasingly prevalent in high income countries. AMA has been associated with increased risk of adverse pregnancy outcomes, particularly stillbirth. Although AMA mothers have higher rates of chromosomal abnormalities and maternal co-morbidities, AMA remains an independent risk factor for stillbirth. Despite these findings, the etiology behind this increased risk is unknown. We hypothesise that an altered maternal environment, including increased oxidative stress and inflammation, due to ageing causes placental dysfunction which increases AMA mothers’ vulnerability to stillbirth. A holistic approach was applied to investigate placental dysfunction in AMA. Firstly, a systematic review and meta-analysis comprehensively reviewed existing data on AMA and associated adverse pregnancy outcomes. Secondly, Manchester Advanced Maternal Age Study (MAMAS), a multi-centre prospective observational cohort study, was conducted to investigate risk factors for composite adverse pregnancy outcome (CAPO) in AMA. MAMAS utilised both uni- and multivariate analysis on demographic and clinical data, and measuring biomarkers of ageing and placental dysfunction by ELISA in maternal circulation during the third trimester of pregnancy. Utero-placental dysfunction was directly investigated in uncomplicated AMA pregnancies by quantifying placental morphology, placental nutrient transport capabilities and both placental and maternal uterine vascular responses. Finally, a C57BL/6J murine model of AMA was developed and characterised to further investigate maternal age on pregnancy outcome and the role of the placenta. In the meta-analysis, maternal age was linearly associated with increased risk of stillbirth and other adverse outcomes strongly associated with placental dysfunction (fetal growth restriction, preeclampsia and placental abruption). In MAMAS, smoking status and primiparity were predictive of CAPO. After adjustment, AMA mothers had an odd ratio of 2.05-3.43 of CAPO compared to 20-30 year old mothers. AMA mothers showed evidence of increased oxidative stress and pro-inflammatory bias. AMA mothers who suffered CAPO showed reduced placental endocrine capacity seen in placental dysfunction. Placentas from uneventful AMA pregnancies showed evidence of accelerated ageing and placental adaptation with increased nutrient transport, increased placental weight but reduced efficiency, and altered vascular function. AMA mice showed many similar aspects to human AMA with increased fetal loss, fetal growth restriction and increased placental size. These studies provide robust evidence for increased incidence of adverse pregnancy outcome due to placental dysfunction in pregnancies of women of AMA. This finding requires the appropriate recognition in a clinical context, with a greater focus on personalised obstetric care in an attempt to reduce stillbirth rates in this high risk population. By optimising antenatal and obstetric care for AMA mothers, we could reduce stillbirth rates by 4.7% - the population attributable risk due to AMA. These studies highlight key areas of future research that will further understanding into stillbirth risk in AMA pregnancy, test predictive models and test therapies and clinical care interventions an ultimately improve pregnancy outcome in mothers of AMA.
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Chang, Jeani. "Relationship Between Assisted Reproductive Technology and Risk of Stillbirth." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4508.
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Assisted reproductive technology (ART) is an infertility treatment used to assist women to become pregnant. Although the procedure is safe, there are gaps in understanding the association between treatment and adverse pregnancy outcomes (e.g., stillbirth) in the United States. The purpose of this study was to investigate the relationship between stillbirth delivery and ART. The 2 research questions addressed the association between methods of conception (ART versus non-ART) and the delivery of a stillbirth, and the association between multiple gestation pregnancy and risk of stillbirths. Retrospective cohort data from the States Monitoring ART collaborative were analyzed using Pearson's chi squared tests and log binominal regression models. Findings indicated that from 2006 to 2011, the average stillbirth rates were lower among ART-conceived pregnancies than non-ART conceived pregnancies. After controlling for confounding factors, ART-conceived pregnancies did not show increased risks of stillbirths compared to non-ART conceived pregnancies regardless of plurality. This lower risk of stillbirth was particularly significant during early pregnancies, before 28 weeks of gestation. Findings may be used to improve understanding of the use of ART treatment and its associated pregnancy outcomes. Findings may also be used to prevent stillbirths and to improve prenatal care, early stillbirth detection, and effective clinical management of fetal and maternal conditions during pregnancy.
9
Huang, Ling. "Impact of advanced maternal age on the risk of stillbirth." Thesis, University of Ottawa (Canada), 2006. http://hdl.handle.net/10393/27373.
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Since more women are having pregnancies at an older age, there are growing concerns about their pregnancy outcomes. Previous studies reveal an uncertain relationship between maternal age and stillbirth risk. This retrospective cohort study aimed to test the hypothesis that stillbirth risk increases with increasing maternal age. We analyzed data on 3,549,993 births from the birth cohorts of 1985 to 2000 in Canada and used logistic regression to evaluate the relative risk of stillbirth.
A total of 15,905 stillbirths were reported during the study period, giving an overall stillbirth rate of 4.5 per 1,000 births. Stillbirth risk was increased for mothers with advanced age after accounting for the confounders and effect modifiers. The older age effect on stillbirth risk was especially pronounced among nulliparous women. We suggest that careful prenatal surveillance and appropriate obstetrical advice and interventions be provided to women with advanced maternal age at their first delivery.
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Luo, Michael Felix. "Bayesian inference for calving ease and stillbirth in dairy cattle." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp02/NQ43265.pdf.
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King, Michael Q. "Stillbirth: A Phenomenological Exploration of the Clinical Encounter for Couples." DigitalCommons@USU, 2017. https://digitalcommons.usu.edu/etd/6765.
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With approximately 65 stillbirths occurring each day in the United States, a significant number of parents are left to navigate a difficult grieving process. An event like stillbirth presents many individual and relational challenges. For this study, researchers focused on the hospital experience for couples following notification of stillbirth. Interviews were held with 8 couples that had experienced stillbirth within the past 10 years. Researchers wanted to know what similarities and differences existed in how mothers and fathers described the clinical encounter.
The data for this study were collected through interviews. Couples were encouraged to share as much or as little as they’d like about the hospital experience. Couples were also asked to describe how they experienced the clinical encounter as individuals and as a couple. Participants in this study were also given the opportunity to provide feedback on what doctors and other hospital staff could do to assist individuals and couples during this difficult time.
Participants discussed how hospital staff helped to shape the experience. This was done both in their interactions with staff and the accommodations that were made. Some parents described hospital staff as “gems” or their “angels” while others reported the pain of hospital staff invalidating their experience. While similarities existed in how parents experienced the clinical encounter, each participant’s experience was unique. Studies should continue to be conducted in an effort to further develop evidence-based practices in hospitals meant to help parents navigate this difficult experience.
12
Clower, Christen E. "Pregnancy Loss: Disenfranchised Grief and Other Psychological Reactions." Thesis, University of North Texas, 2003. https://digital.library.unt.edu/ark:/67531/metadc4340/.
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It is widely acknowledged in the literature that grief is most intense when it is experienced by parents whose children have died. However, as recently as 20 years ago, mothers whose children died at birth or before the pregnancy had reached full term were often dismissed as merely medical patients, and their psychological reactions were not considered or acknowledged by professionals, their friends, or their families. More recently fields such as psychology have recognized that women who have experienced pregnancy loss have complex psychological reactions to their loss. The present study examined the patterns of grief of women who have had a pregnancy end in spontaneous abortion or stillbirth and the ways in which these women gave meaning to their experiences. Participants were asked to complete several measures including the Perinatal Grief Scale (PGS), the Hogan Grief reaction Checklist (HGRC), the Perceived Social Support Scale (PSS), and the Inventory of Social Support (ISS). The participants also wrote a narrative account of their loss experience. These narratives were content analyzed to delineate common themes. The findings indicated several important factors which may be useful in understanding and assisting in post-loss adjustment.
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Aminu, M. "Cause of, and factors contributing to, stillbirth in sub-Saharan Africa." Thesis, University of Liverpool, 2017. http://livrepository.liverpool.ac.uk/3011454/.
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Background: Every year, an estimated 2.6 million stillbirths occur worldwide, with up to 98% occurring in low- and middle-income countries (LMIC). Most stillbirths are preventable. To develop strategies and take effective actions to end preventable stillbirths, a good understanding of the cause of death and its contributing factors is necessary. There is, however, a paucity of data from most LMIC settings. This study aimed to determine the cause of stillbirth in LMIC using three methods of assessment, and to assess quality of care delivered to mothers who had stillbirth. Methods: The study involved 1,563 stillbirths which occurred in 12 selected secondary and tertiary hospitals in Kenya, Malawi, Sierra Leone and Zimbabwe. The cause of death was determined by: (1) consensus of healthcare providers (HCPs) through stillbirth review; (2) expert review of cases and; (3) computer algorithms. Cause of death was classified using the classification according to Relevant Condition at Death (ReCoDe) and the International Classification of Diseases for Perinatal Mortality (ICD-PM). Quality of antenatal and intrapartum care and health system factors were reviewed using a set of criteria. Results: A total of 1,329 cases were reviewed, of which 1,267 (95.3%) stillbirths met the inclusion criteria. By country, the stillbirth rate ranged from 20.3 (Malawi) to 118.1 (Sierra Leone) per 1,000 births. The distribution of the major causes of stillbirth differed by method of assessment: asphyxia (18.5% – 37.4%), placental disorders (8.4% – 15.1%), hypertensive disorders in the mother (5.1% – 13.6%), infection (4.3% – 9.0%), cord problems (3.3% – 6.5%), and ruptured uterus due to obstructed labour (2.6% – 6.1%). Information was insufficient to assign cause of stillbirth in 17.9% - 26.0% of cases. Significant agreement was observed between cause of stillbirth assigned by the expert panel and by HCP (k=0.69; p < 0.0005) but there was a weaker agreement between expert panel and when using computer algorithms (k=0.34; p < 0.0005). Using ReCoDe, intrapartum events (mainly intrapartum asphyxia) contributed to most of the deaths, followed by maternal diseases (mainly hypertensive disorders and infection), placental and fetal conditions. With application of ICD-PM, 42.0% were antepartum, 50.7% were intrapartum and 7.3% could not be categorised. The major categories accounting for the death were: intrapartum hypoxia and fetal growth restriction. Major contributing maternal conditions in ICD-PM were: M1 (placental, cord and membranes) and M3 (other complications of labour and delivery). Poor quality of care during antenatal care was identified in 97.8% of cases, and only 30.7% of cases of Caesarean section were conducted within one hour of decision. For 414 (37.9%) stillbirths, the outcome could have been different with better care. Conclusion: Stillbirth rate was high, with high variations between countries. HCPs should be encouraged to conduct reviews and act upon findings to improve quality of care. Data requirements of computer algorithms need to be balanced between ability to find a cause and the availability of information. The new ICD-PM could work in LMIC, but there is the need for more guidance on how to handle cases of stillbirths whose time of death cannot be determined.
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Jones, Kerry Sian. "Parental perspectives on grief and loss following stillbirth and neonatal death." Thesis, University of Bristol, 2010. http://hdl.handle.net/1983/b7f9dfed-a7a0-45f3-89be-eefdbc1ab356.
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This research explores men and women's experience of grief and loss following stillbirth and neonatal death. Utilising existing literature and empirical research with twenty-seven bereaved parents, I argue that stillbirth and neonatal death represents a tragedy to these men and women, yet, its impact has been sequestered both practically and theoretically by medical and psychological and other scholarly discourses of bereavement. Such notions of grief are characterised by their rationality and represented as a series of stages, each comprising of tasks and goals for the bereaved to work through. The data collected about experiences of loss suggests that a way of understanding the impact of such deaths must go beyond professional approaches to grief and instead focus upon the way men and women narrate their experience. I suggest that the meaning given to the experience of loss can be deconstructed by taking account of the varying forms of expressing such experience (such as writing, talking, art, poetry). I demonstrate that men and women experience not only the emotional pain of loss but also struggle with their embodied identity as a parent. I argue that this is mediated by the social networks to which bereaved parents belong and according to the dominant discourses (such as medicine and expected notions of motherhood and fatherhood) and wider political and social structures (such as employment) to which bereaved parents' relate. These findings constitute an understanding of loss which reflects and conflicts with the findings of other research. In so doing, this study contributes to more succinct knowledge concerning perinatal loss, embodied lived experiences and women as well as men's accounts which I argue is overlooked in the literature. The thesis concludes with policy recommendations which include ongoing bereavement training for health professionals, the development of specialist bereavement midwives and for the provision of care which reflects bereaved parent's gendered socio economic and cultural needs.
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Steever, Paul Barton. "Stillbirth the unnoticed death : a study of the felt need among pastors of the Independent Christian Churches in Central Indiana for education in grief initiated by stillbirth /." Theological Research Exchange Network (TREN), 1986. http://www.tren.com.
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Ellis, Matthew Edward. "The public health importance of birth asphyxia in Kathmandu, Nepal." Thesis, University College London (University of London), 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.341882.
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Clauss, Danielle Kerns Geller Pamela A. "Psychological distress following miscarriage and stillbirth : an examination of grief, depression and anxiety in relation to gestational length, women's attributions, perception of care and provision of information /." Philadelphia, Pa. : Drexel University, 2009. http://hdl.handle.net/1860/3070.
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Thiessen, Janice G. "A phenomenological study of parents’ experience following stillbirth or early infant death." Thesis, University of British Columbia, 1985. http://hdl.handle.net/2429/24424.
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This study was designed to discover parents' experience following a stillbirth or early infant death. The conceptualization of the research problem was based on Kleinman's (1978) cultural system model which directed the researcher to elicit directly from clients their explanatory models, or their way of viewing the experience.
The specific research questions were (1) How do couples perceive and interpret their experience following stillbirth or early infant death? and (2) How do couples view the social support they have received at the time of their infant's death?
Six couples, who were recruited primarily from bereavement support groups, participated in the study. Each couple had experienced a stillbirth or early infant death between four months and four years prior to the study. Data were collected from the subjects with the use of unstructured interviews, allowing the experiences to unfold as they were perceived by the participants.
Four main themes that evolved from the data were (1) anticipation of parenthood and the shattering of hopes with the death or knowledge of impending death of the infant; (2) a multidimensional personal grief experience; (3) an interpersonal grief exerience influenced by the social support of health care professionals, of friends and family and of the spouse; and (4) reflection and search for meaning in the experience.
The discovery of couples' perceptions of their bereavement experience and their view of the support received will assist in enhancing the ability to provide more effective nursing care to bereaved families. Implications for nursing practice, research and education are delineated.Applied Science, Faculty of
Nursing, School of
Graduate
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Duchemin-Pelletier, Maelle Jessica. "Stillbirth : medicalisation and social change, 1901-1992, with special reference to Scotland." Thesis, University of Glasgow, 2017. http://theses.gla.ac.uk/8976/.
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In Scotland, medical understanding of, medical practice in relation to, and medical attitudes towards stillbirth, its prevention and management underwent significant changes throughout the twentieth century. This thesis argues that these changes were shaped by technological and scientific advances in medicine, greater specialisation, and changes in public health practices. It also argues, however, that medical developments were closely linked to broader social, legal and religious concerns around the meanings given to stillbirth. This thesis focuses particularly on the ways in which these developments were evident in Glasgow, and locates change more broadly within Scotland, and indeed, Britain as a whole. This thesis underlines the reasons behind the medical attention towards stillbirths and the prevention of stillbirths from the early twentieth century onwards. It also shows how the legislations in regards to stillbirths as well as the societal perspective on stillbirth influenced and were influenced by the changing medical attention. Medical articles and reports on stillbirths in Glasgow, Scotland and the rest of Britain were analysed to investigate the progress and increase knowledge in understanding the causes of stillbirths and how to prevent those stillbirths. It is highlighted how the medical community focused first on purely obstetric causes of stillbirths to then extend their gaze towards broader causes such as social class and nutrition. The thesis also emphasises how the attention towards stillbirth by the medical profession encouraged always greater medicalisation and hospitalisation of childbearing and childbirth, and this trend was accelerated after the establishment of the National Health Service. The welfare system was a promise of a healthy population, in regards to pregnancy and childbirth, of live births. This meant a medical responsibility was felt to offer the best care, skills and technologies available in order to deliver healthy live babies, hence averting any preventable stillbirths. A lower fertility rate, the promise of live birth through highly skilled medical care and the increased use of obstetric ultrasound changed the societal view of fetuses towards them being regarded as babies even during pregnancy, and thus changed societal perceptions of stillbirth. From the late 1970s, the evolution in society’s views towards stillbirth influenced the medical perspective by demanding a change in the management of stillbirth alongside the provision of support to mothers and, where applicable, their families. Medical professionals, for example, stopped telling women to just start planning for a new pregnancy, but emphasis on the loss that was a stillbirth and the need to grieve became central. This is one of the numerous transformations around the management and support to mothers/families that will be highlighted. This thesis also argues that the evolution in the understanding and prevention of stillbirths by the medical profession as well as the changes of the societal view on stillbirth resulted in developments towards the religious perspective on stillbirth in the late twentieth century, with regards to theology and pastoral care. The changes in medical perspectives towards stillbirths are highlighted, and also how they influenced legalisations, and societal and religious views. The evolution throughout the twentieth century, and especially in the late twentieth century, of those different perspectives are the reasons behind our current understanding of stillbirths and the way we respond to stillbirth. This thesis contributes to increase our understanding of the medical developments around stillbirth as well as the inter-relationship between these different aspects influencing stillbirths in twentieth century Scotland and Britain. An example of this would be that the medical advances helped prevent stillbirth as well as increase the fetal viability earlier in pregnancy, explaining the change of the legal definition of stillbirth in 1992 in Scotland, England and Wales.
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Humphry-Baker, Hannah Jane. "How do fathers make sense of their experience of stillbirth after therapy? : an Interpretative Phenomenological Analysis." Thesis, University of Roehampton, 2016. https://pure.roehampton.ac.uk/portal/en/studentthesis/how-do-fathers-make-sense-of-their-experience-of-stillbirth-after-therapy-an-interpretative-phenomenological-analysis(7850cd8f-43f2-49a8-9e55-c7b39184be2d).html.
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This study aimed to address how fathers made sense of their experience of losing their baby due to stillbirth after receiving one-to-one counselling/therapy. An Interpretative Phenomenological Analysis was used to explore the unique lived experience of each father. Eight semi-structured interviews were carried out with fathers of a stillborn baby who had experienced some form of one-to-one counselling/therapy in the aftermath of their loss. The research found that fathers developed an embodied relationship and continued to experience an ongoing relationship with their stillborn child. The fathers were changed by their experience of having a stillborn baby in fundamental and complex ways. The fathers also re-addressed aspects of their ‘masculine selves’ in response to this profound loss. It was meaningful for the fathers when their relationship with their stillborn child was validated and legitimised in their one-to-one counselling/therapy. Moreover, some fathers were able to address the confusion and ambiguity around the nature of their loss and their experience as men. The fathers expressed the unique ways they were transformed by their experience emotionally, psychologically, and existentially. Some fathers could begin to make sense of this and find meaning in their experience when it was recognised in their individual therapy. Finally, a critique of the limitations of the research process and methodology was provided and suggestions for further research were offered.
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Robson, Stephen James Women's & Children's Health Faculty of Medicine UNSW. "The next pregnancy after an unexplained stillbirth : empirical studies of obstetricians' and womens' wishes for management." Publisher:University of New South Wales. Women's & Children's Health, 2009. http://handle.unsw.edu.au/1959.4/43655.
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Background Unexplained stillbirth is the largest contributor to perinatal death, accounting for one third of stillbirths. Although prognostic information is limited, there is no increase in perinatal death rates in subsequent pregnancies after an unexplained stillbirth. However, those pregnancies have increased rates of preterm birth, low birthweight, induced labour, instrumental and caesarean delivery, 'fetal distress,' and postpartum haemorrhage. These outcomes might be iatrogenic, caused by obstetric intervention. Aims 1. To examine obstetricians' and womens' wishes for management in pregnancies subsequent to an unexplained stillbirth, and whether these might contribute to an increase in rates of intervention. 2. To examine whether socio-demographic factors, or how women perceive that an unexplained stillbirth was managed, influence how women want their next pregnancy managed. 3. To assess whether management of unexplained stillbirth differs according to model of care, or country where the event occurred. Methods 1. An anonymous postal survey of all Australian obstetricians to determine recommended management of the next pregnancy after an unexplained stillbirth. 2. An Internet-based survey of women after an unexplained stillbirth, seeking details about their wishes for subsequent pregnancy management. Results 1. Obstetricians' survey Early pregnancy managements were little different from standard care of low-risk pregnancy. Increased 'fetal surveillance' (by ultrasound, cardiotocography, and formal fetal movement charting) in late pregnancy was recommended by most respondents. Induction of labour would be offered by 93% of respondents, as early as 37 weeks by one third. More than one third of obstetricians would offer elective caesarean delivery, with 13% offering this before 38 weeks. 2. Womens'survey 93% of respondents wanted 'testing' over and above normal pregnancy care in their next pregnancy. 81% of respondents wanted early delivery, and 26% wanted a caesarean delivery, irrespective of obstetric indications. These wishes were not influenced by socio-demographic factors, management of the index stillbirth (with the exception of having had a caesarean delivery), or advice received about management of the next pregnancy (with the exception of being advised to have an early or caesarean delivery). Conclusions Both obstetricians and the women they care for wanted increased fetal surveillance and early delivery, but not necessarily elective caesarean section. These practices have the potential to increase the rate of intervention, with consequent adverse maternal and neonatal outcomes.
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Eaglen, Sophie. "Genetic evaluation of calving traits in the United Kingdom." Thesis, University of Edinburgh, 2013. http://hdl.handle.net/1842/8074.
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The consequences of complications during calving are currently costing the UK dairy cattle industry approximately £110 for a calving of moderate difficulty and £400 for one that is severe. With incidences of difficult first calvings reaching 24% and 4% for a moderate and severe difficult calving respectively, reducing calving complications would be of great benefit to the UK dairy cattle industry. This PhD evaluates (i) the importance, (ii) the most optimal way, and (iii) the potential consequences of genetically selecting for two main traits associated with calving complications, calving ease (CE) and stillbirth (SB). For this, approximately 50.000 first parity and 300.000 later parity national calving data records were kindly provided by two major milk recording organisations in the UK. The work carried out shows that detrimental effects following a difficult first calving are long-lasting as subsequent performance of both the dam and the calf involved is worsened. Fertility of the dam is negatively affected by a difficult calving resulting in an increased calving interval and decreased ability to conceive. A reduction in milk production of a veterinary assisted dam, compared to a non-assisted dam, was detected in the first part of lactation. Veterinary assisted born calves showed a significantly lower milk yield, compared to farmer assisted calves, throughout their first lactation as adult heifers suggesting that the physiological effects, or causes underlying a difficult birth, are long lived. The study advises that genetic parameters of calving traits are to be estimated with an extended sire multi-trait model (accuracy vs. practicality). On average, direct and maternal heritabilities for calving traits are low. A highly heritable indicator trait such as gestation length (GL) can aid in the estimation of genetic parameters for CE and SB although genetic correlations of these traits with GL are moderate. A significant negative genetic direct-maternal correlation was found for CE in first parity recommending farmers to consider both direct and maternal genetic merit for CE when making a selection decision. CE and SB are highly positively correlated traits. GL is maternally correlated to SB in first parity and directly to CE in later parities, both correlations are positive. Estimated genetic correlations with other important traits in dairy cattle breeding show that CE and GL are both directly and maternally related to important selection traits which need to be taken into account if implementation into breeding indices occurs. Results advise limiting the use of GL to benefit the prediction of parameters for low heritable calving traits rather than selecting on GL itself. Genetic correlations suggest that individuals born easily are genetically prone to high milk yield and have reduced fertility in first lactation. Difficult calving heifers are likely to be associated with being wide and deep and high producing animals with a reduced ability to subsequently conceive. Individuals that are born relatively early are associated with good genetic merit for milk production. And finally, individuals carrying their young longer are genetically associated with being wide and large animals that were born relatively early themselves. Lastly, an extension of the current univariate genomic model to a bivariate model, which allows for a possible genetic direct-maternal covariance, shows that improvement in accuracy of genomic breeding values can be gained from use of a bivariate genomic model for maternal traits such as CE. Further development of the model is however recommended prior to the publication of genomic proofs for CE or any other maternal trait. Genetic selection can serve as a tool in the reduction of difficult calvings. The results of this thesis serve to let this happen in a controlled and sustainable manner.
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Cartwright, James. "Functional studies of genetic variants in TRPM7 and AKAP9 : two candidate genes for stillbirth." Thesis, Queen Mary, University of London, 2018. http://qmro.qmul.ac.uk/xmlui/handle/123456789/53903.
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For every 200 births in the UK, one will end in a stillbirth. Stillbirth is classified as a baby born dead after 24 weeks gestation. Mutations in genes that cause ion channelopathies are known to cause sudden cardiac death in adults and children. Prenatal diagnosis of LQT has been possible for decades, creating a disease spectrum where channelopathies may fatally influence pregnancy. We sequenced 35 candidate genes in 70 unexplained stillbirth cases. Thirty-nine cases harboured a predicted damaging protein missense variant. Two novel and two rare variants were observed in the transient receptor potential melastatin 7 (TRPM7) gene and five rare genetic variants were found in A-kinase anchor protein 9 (AKAP9). The aim of this PhD was to perform functional studies of these variants in TRPM7 and AKAP9. TRPM7 is an ion channel indispensable for mouse cardiogenesis. Two TRPM7 variants (p.G179V and p.T860M) showed significantly reduced current compared to wild-type channels. Conversely, cells expressing p.R494Q TRPM7, had a significant increase in current compared to WT channels, but only in CHO-K1 cells. Western blot analyses failed to detect full length TRPM7 in cells transfected with either p.G179V or p.T860M compared to wild-type expressing cells. Proteosomal inhibition using MG132 produced a small but visible band in p.T860M transfected cells. Expression of TRPM7 in iPSC-derived cardiomyocytes increases during cell maturation, and TRPM7-like current was measured in 20-23 day old cardiomyocytes. AKAP9 is required to couple adrenergic stimulation in the heart with faster cardiac repolarisation. Cells expressing WT AKAP9 alongside the KCNQ1/KCNE1 potassium channel responded to β-adrenergic stimulation, however those transfected with p.A3043T AKAP9 did not respond to treatment with forskolin. Our analyses supports two deleterious variants in TRPM7 and one in AKAP9 in unexplained stillbirth cases. These heterozygous variants could lead to haploinsufficiency and may be a cause of stillbirth.
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Steinbock, Lena. "Comparative aspects on genetics of stillbirth and calving difficulty in Swedish dairy cattle breeds /." Uppsala : Dept. of Animal Breeding and Genetics, Swedish University of Agricultural Sciences, 2006. http://epsilon.slu.se/10135579.pdf.
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Human, Melanie. "Psychosocial implications of stillbirth for the mother and her family : a crisis-support approach." Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/80068.
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Thesis (M Social Work)--Stellenbosch University, 2013.ENGLISH ABSTRACT: According to South African annual statistics, stillbirth is a relevant issue and National health policies, social welfare services and health care providers should place special focus on pregnant women to avoid the possible occurrence of a negative pregnancy outcome such as a stillbirth. An event that should have been a joyous birth, ended in a tragic death, forcing the mother to deal with the emotions of birth and death simultaneously. The bereaved mother needs to receive special care and support as soon as possible and the crisis intervention approach is seen as being helpful to regain a sense of equilibrium in her and the family’s life before starting to adapt to the new situation. This study explores and describes the lived experience of 25 mothers who experienced a stillbirth. Focus was given to the psychosocial implications of stillbirth on mothers and their families. This study examined the mothers’ feelings about the stillbirth six months or longer after the event, as well as its impact on relationships with partners and other children. By adopting a crisis intervention approach, the effectiveness of crisis intervention shortly after the stillbirth could be investigated. This study used a combination of quantitative and qualitative research approaches and assumed an exploratory and descriptive research design to provide a detailed description of the phenomenon being studied, i.e. the psychosocial implications of stillbirth. A questionnaire was used to obtain demographic (quantitative) data and a semi-structured questionnaire – the design based on information from literature - was administered during individual interviews. Obtained data was both measurable and rich in description and revealed that mothers still longed for their stillborn babies after a period of six or more months had passed. It also indicated that the father or partner of the baby and other children were affected by a stillbirth. Gender differences in how stillbirth is experienced by each partner, consequently adds extra tension on the relationship. Most of the mothers experienced the stillbirth as a crisis and found support in their mothers, family and a counsellor. Significantly, mothers felt crisis-intervention was beneficial, but preferred that crisis intervention be followed by on-going therapy. The stillbirth also resulted in feelings of alienation from community, friends and family - who did not know how to approach them. Generally, mothers were satisfied with medical care received but several issues regarding autopsy consent and guilt feelings surrounding this are highlighted. Important recommendations resulting from the study indicate that the crisis-intervention approach as method in social work is effective when rendering service for bereaved mothers and families after a stillbirth. It helps to regain a sense of equilibrium, but further intervention is recommended to facilitate the grief process. In addition, the study emphasizes the importance of social workers being aware that the stillbirth causes tension in partner- and family relationships. Receiving social work intervention is not only highly effective, but allows bereaved mothers to feel empowered and encouraged to openly grieve for their stillborn babies - much needed in an environment where a stillbirth is seen as a silent birth.
AFRIKAANSE OPSOMMING: Volgens jaarlikse Suid-Afrikaanse statistieke, is stilgeboorte ‘n relevante onderwerp en die Nasionale gesondheidsbeleid, maatskaplike welsynsdienste en gesondheidssorgverskaffers moet fokus op swanger vroue ten einde moontlike negatiewe swangerskapuitkomstes, soos stilgeboorte, te voorkom. Tydens ‘n stilgeboorte, eindig die heuglike vooruitsig van ‘n geboorte in die tragiese afsterwe van die baba en word die moeder geforseer om emosies van geboorte en sterfte gelyktydig te hanteer. Sulke moeders benodig spesiale versorging asook ondersteuning so spoedig moontlik. Krisis intervensie is ‘n effektiewe metode om die moeder te help om ‘n mate van balans in haar en haar gesin se lewe te herwin voordat hulle kan begin aanpas by die nuwe situasie. Hierdie studie ondersoek en beskryf ervarings van 25 moeders wat ‘n stilgeboorte ervaar het. Fokus word geplaas op die psigososiale effek van stilgeboorte op moeders en hul gesinne. Moeders se gevoelens rakende die stilgeboorte ses maande of langer na die geboorte, is ondersoek, asook die effek daarvan op hul verhoudings met lewensmaats en ander kinders. Deur die krisis intervensie benadering te gebruik, kon die effektiwiteit daarvan kort na die stilgeboorte ondersoek word. Kwantitatiewe en kwalitatiewe navorsingsmetodes is in hierdie studie gebruik. Die studie veronderstel ʼn verkennende en beskrywende navorsingsontwerp om sodoende ʼn uitvoerige beskrywing van die psigososiale implikasie van stilgeboorte te verskaf. Data word verkry deur ʼn vraelyste - demografiese (kwantitatiewe) data, asook semigestruktureerde vraelyste (kwalitatief) wat tydens individuele onderhoude toegedien is. Die ontwerp van die semi-gestruktureerde vraelys is gebaseer op inligting vanuit die literatuurstudie. Die bevindinge van die empiriese ondersoek dui aan dat moeders na ses maande of langer steeds hunker na hul stilgebore babas. Geslagsverskille rakende die wyse waarop moeders en vaders die stilgeboorte ervaar dra gevolglik by tot ekstra spanning in die verhouding. Die meeste moeders het die stilgeboorte as ‘n krisis ervaar en het ondersteuning gevind by hulle moeders, gesinne en ‘n berader/maatskaplike werker. ‘n Beduidende bevinding was dat moeders krisis intervensie as voordelig beskou het, maar verkies dat dit opgevolg moet word deur deurlopende terapie. Die stilgeboorte veroorsaak ook dat die moeders ‘n gevoel van vereensaming van die gemeenskap, vriende en familie ervaar het. Volgens hulle was mense te bang en onseker in hoe om hulle te benader. In die algemeen was moeders tevrede met die mediese sorg wat hulle ontvang het, maar kwessies rakende toestemming en skuldgevoelens rondom nadoodse ondersoeke word uitgelig. Belangrike aanbevelings dui aan dat krisis intervensie as metode in maatskaplike werk effektief is ten opsigte van dienslewering vir ‘n moeder en haar gesin na ‘n stilgeboorte. Dit help om ‘n mate van balans te herstel, maar verdere intervensie word aanbeveel om die rouproses te fasiliteer. Die studie beklemtoon ook dat dit belangrik is dat maatskaplike werkers bewus moet wees dat ‘n stilgeboorte spanning veroorsaak in huweliks- en gesinsverhoudings. Die ontvangs van maatskaplike werk intervensie is nie net hoogs effektief nie, maar bemagtig en motiveer moeders om openlik te rou vir hulle stilgebore babas, iets wat nodig is in ‘n samelewing waar stilgeboorte as ‘n geboorte beskou word waaroor daar nie gepraat word nie.
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Menichetti, Bernardo Thomas. "Effect of Prepartum Energy Status and Lying Time on Stillbirth in Transition Dairy Cows." The Ohio State University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=osu1523460186946735.
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Hrabálková, Lenka. "The importance of poly(A)-binding protein 4 (PABP4) in healthy pregnancy." Thesis, University of Edinburgh, 2016. http://hdl.handle.net/1842/22923.
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Healthy pregnancy requires a tightly regulated materno-fetal dialogue for processes such as embryo implantation, endometrial decidualisation (in the mouse), placentation and maternal adaptation to occur. Disruption of placental development as well as maternal adaptation can lead to fetal intrauterine growth restriction (IUGR) which increases the risk of late miscarriage/stillbirth (e.g. 53% of preterm stillbirth and 26% of term stillbirth are found to be IUGR). Furthermore, IUGR is a risk factor for neurodevelopmental conditions in childhood and for a spectrum of related adult health disorders such as cardiovascular disease and type II diabetes, often termed metabolic syndrome. Despite these pregnancy disorders being common (e.g. 1 in 200 pregnancies results in stillbirth in the UK) the molecular lesion(s) underlying their pathophysiology are poorly understood and in particular those with placental and/or maternal aetiologies most frequently remain unexplained. Here we investigate the hypothesis that poly(A)-binding protein 4 (PABP4) is required for healthy pregnancy in mice. PABP4 is an RNA-binding protein and a member of the PABP family which are central regulators of mRNA translation and stability. Using all four permutations of wild-type and knock-out crosses, we find that maternal PABP4-deficiency results in a reduced litter size and IUGR. The number of implantations at e8.5 were not reduced in Pabp4-/- females, implying that the reduced litter size was not a consequence of decreased ovulation, fertilisation or implantation frequency. Further longitudinal analysis (at e13.5, e15.5 and e18.5) reveals that fetal death primarily occurred between e18.5 and birth, suggesting these mice may provide a unique opportunity to inform on the maternal causes of stillbirth. The onset of IUGR, which was found to be symmetrical in nature, was established by e15.5 preceding the majority of fetal death. During pregnancy, a materno-fetal dialogue directs and responds to changes in gene expression to give rise to the placenta and adapt the maternal physiology. Defects in these processes may result in reduced growth and/or fetal death and were examined in Pabp4-/- mice to shed light on the mechanistic basis of these related phenotypes. Fetal to placental (F:P) weight ratio, whose changes can be indicative of placental insufficiency or placental adaptation in an attempt to aid fetal growth, was found to be increased in Pabp4-/- dams at e15.5 and e18.5 due to the presence of IUGR fetuses with placentas of normal weight. Consistent with this observation, placental volume was unchanged at e18.5. Total placental weight and volume alone fails to discriminate potential differences in the individual placental zones which include the labyrinth zone, where materno-fetal gas and nutrient exchange occur; the junctional zone, which has endocrine functions including those that promote maternal adaptation; and the decidua basalis, derived from the maternal endometrium and is the site of trophoblast invasion and maternal vascular remodelling in early pregnancy. Therefore, volumetric analysis of these zones and the maternal blood spaces, which transcend the decidua basalis and junctional zone, was undertaken. This showed no change in the maternal blood spaces or the labyrinth, the latter being the zone whose size is most frequently altered in IUGR. Critically however, the size of the maternally-derived decidua basalis was increased with a concurrent decrease in the size of the junctional zone. These morphological changes may play a causative role either through directly affecting placental function and/or by the reduced junctional zone failing to promote appropriate maternal adaptation. Alternatively, they may reflect compensatory adaptations to a primary defect elsewhere in the mother. Complementing these morphological studies, functional studies were undertaken: remodelling of maternal vasculature and the resistance index of vessels delivering blood to the fetus were assessed; as was delivery of nutrients to the fetus (measured by fetal glucose); and systemic maternal adaptations (maternal hormonal profile, circulating glucose levels and organ weights). Uterine, umbilical and decidual spiral arteries were examined, but displayed no apparent differences suggestive of normal blood supply to the fetus. However fetal blood glucose was reduced suggesting a reduced delivery of nutrients important for fetal growth. This was not due to lower circulating maternal blood glucose levels, and mRNA levels of the placental glucose transporters Glut-1 and Glut-3 were not reduced but upregulated, suggestive of an attempt to compensate for reduced fetal glucose. Furthermore, upregulation of at least one system A amino acid transporter mRNA, Snat-2, was observed. The maternal physiological state of PABP4-deficient dams showed deviations in some organ weights (e.g. spleen weight is reduced at e13.5 and e15.5) and the levels of some circulating hormones (e.g. estradiol is deceased whereas progesterone is increased at e18.5). However, future work will be required to determine which, if any, of these changes are primary defects rather than downstream consequences and to identify which mis-regulated mRNAs/pathways within in the materno-fetal dialogue underlie the phenotype. Taken together, my results suggest that the regulation of mRNA translation/stability by PABP4 is critical to achieving the correct pattern of gene expression within the materno-fetal dialogue to enable appropriate placentation and maternal adaptation. Furthermore, my results suggest that Pabp4-/- mice provide a unique opportunity to further understand the maternal causes of a spectrum of related pregnancy complications including IUGR, late miscarriage and stillbirth.
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Marrazzo, Joseph. "Gender considerations in the phenomenon of transgenerational grief." Laramie, Wyo. : University of Wyoming, 2008. http://proquest.umi.com/pqdweb?did=1798480861&sid=1&Fmt=2&clientId=18949&RQT=309&VName=PQD.
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Casson, Karen. "Socio-demographic Inequalities in Low Birthweight, Stillbirth and Infant Mortality in Northern Ireland 1991-2002." Thesis, University of Ulster, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.516438.
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Paranaguá, Pedro. "The development agenda for WIPO: another stillbirth?: A batttle between access to knowledge and enclousure." reponame:Repositório Institucional do FGV, 2009. http://hdl.handle.net/10438/2794.
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This paper has been produced as part of the examination in order to obtain a Master degree in Law (LLM), in Intellectual Property, at Queen Mary & Westfield College, University of London.Submitted by Pedro Mizukami (pedro.mizukami@fgv.br) on 2009-09-17T18:43:17Z No. of bitstreams: 1 The_Development_Agenda_for_WIPO_A_Battle_Between_Access_to_Knowledge_and_Enclosure.pdf: 512224 bytes, checksum: 6f7f71a4d7fbe4ea7027244068663639 (MD5)
Approved for entry into archive by Pedro Mizukami(pedro.mizukami@fgv.br) on 2009-09-17T18:43:41Z (GMT) No. of bitstreams: 1 The_Development_Agenda_for_WIPO_A_Battle_Between_Access_to_Knowledge_and_Enclosure.pdf: 512224 bytes, checksum: 6f7f71a4d7fbe4ea7027244068663639 (MD5)
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The private sector has played and continues to play a decisive role in the shaping of policy-making concerning knowledge-based goods. The result is an unequal battle between access to knowledge and enclosure favouring the latter over the former. Such an unbalanced scenario chiefly affects the South, but has implications for the public everywhere. The Development Agenda being proposed for adoption by the World Intellectual Property Organization (WIPO), and which has been advocated for and designed by developing countries governments in collaboration with a coalition of governments, academics, civil society and public interest NGOs from both North and South, is the latest attempt to bring a balance to this scenario. However, the Development Agenda is encountering opposition and despite the unique nature of the coalition backing it, the outcome is uncertain.
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Derricott, Hayley. "Villitis of Unknown Etiology (VUE) : unravelling placental dysfunction and causes of stillbirth and fetal growth restriction." Thesis, University of Manchester, 2016. https://www.research.manchester.ac.uk/portal/en/theses/villitis-of-unknown-etiology-vue-unravelling-placental-dysfunction-and-causes-of-stillbirth-and-fetal-growth-restriction(1ae67afa-e02d-4b3e-b679-69fb7124fd53).html.
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Many researchers in the academic and clinical communities theorise that inflammation may underpin the placental dysfunction to which the majority of fetal growth restriction (FGR) and stillbirth cases are attributed. Villitis of unknown etiology (VUE) is an inflammatory condition of the placenta characterised by lesions of macrophages and T cells in the villous stroma. This study addressed the hypothesis that VUE is a maternal-mediated immune reaction that contributes to FGR and stillbirth by detrimentally affecting placental function. The hypothesis was tested by: 1) completing a systematic review of the literature to confirm implied links of VUE to poor pregnancy outcome, 2) performing a detailed characterisation of the cellular phenotype of VUE in stillbirth, 3) developing an in vitro model of VUE and 4) examining the functional effects of VUE using this model. A systematic review of the literature revealed that VUE occurred in 28.6% of placentas from FGR pregnancies compared to 15.6% of placentas from appropriately grown infants (p < 0.0001), confirming the implied association. There were insufficient published studies to be able to corroborate a link with stillbirth. Elevated numbers of macrophages, CD4 and CD8 T cells were quantified in VUE lesions. There were significant increases in pan-placental CD4 and CD8 T cell presence in placentas from stillborn infants with VUE (p < 0.0001). A greater staining area of pro-inflammatory cytokines interleukin (IL)-2 (p < 0.05) and IL-12 (p < 0.0001) was recorded in VUE lesions and a reduction in the anti-inflammatory cytokine IL-4 in the stillbirth with VUE cohort. Dual immunofluorescence of cell markers and cytokines implies that the immune response in VUE is directed towards Th1-type cell-mediated immunity. An in vitro model of VUE was developed that enabled co-culture of explants with fluorescently labelled T cells isolated from matched maternal whole blood samples. Placental tissue and T cells could be maintained in culture for the required duration of the experiment and placental function was not affected by preparation and culture conditions. In vitro co-culture with maternal T cells resulted in a significant reduction in placental function as measured by hCG secretion (p=0.015). There were significant increases in culture supernatant concentrations of IL-1β (p=0.008), IL-10 (p=0.02), interferon-γ (p=0.02) and IL-1Ra (p=0.05) and tissue lysate concentrations of IL-6 (p=0.008) and IL-1β (p=0.02). Culture of explants with a combination of IL-2, IL-12 and anti-IL-4 significantly reduced hCG secretion compared to control (p=0.03).These studies indicate that VUE involves a Th1-type immune response that may affect placental function, the impact of which might be impaired fetal growth that could contribute to stillbirth. The novel in vitro model facilitates future investigations into the pathophysiology of VUE.
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Rodrigues, Márcia Maria Coelho. "A experiência da mãe por ter um filho natimorto." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/7/7141/tde-11012010-144032/.
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Natimorto é a morte do produto da gestação, antes da expulsão do corpo materno. Para a mãe, a notícia da morte do filho ainda durante o período da gestação é traumática que, na expectativa de uma vida, encontra o desespero e a tristeza. Este estudo teve como objetivo compreender a experiência da mãe diante do filho natimorto. O referencial teórico adotado foi a teoria do luto e como referencial metodológico, o interacionismo interpretativo para análise das narrativas das nove mães que passaram pela experiência de ter um filho natimorto. Os eventos que marcaram a história das mães neste cenário foram: SENDO SURPREENDIDA PELA MÁ NOTÍCIA, TENDO UM PARTO SEM SENTIDO, SAINDO DE MÃOS VAZIAS E ENFRENTANDO O LUTO SOCIAL. Os dados analisados possibilitaram a compreensão da experiência das mães diante da morte de seu filho durante a gravidez. A morte do bebê no final da gestação, quando caracterizado como natimorto, é incompreensível para a mãe. Ela fica exausta, tem uma profunda dor emocional, acompanhada de um sentimento de vulnerabilidade que a impede de pensar no futuro ou na possibilidade de uma nova gestação. Ver o filho natimorto é um momento significativo e nem sempre a mãe consegue verbalizar o desejo de conhecer, tocar, segurar no colo o seu filho que agora está morto. O processo de luto é vivido de maneira solitária, porque sua tristeza não é compartilhada com a família e amigos, havendo uma preferência para o isolamento devido sentir-se envergonhada por não ter conseguido gerar um filho sadio e por chorar o tempo inteiro. O estudo reforça a necessidade de inserção de informações e conhecimentos dos profissionais de saúde, ainda no ensino de graduação, acerca do processo de luto pertinente a essas mães para oferecer-lhes algum controle sobre a experiência, resgatando, assim, sua autonomia e propiciando-lhes a prevenção de sua saúde física e mentalStillbirth is the death of the product of gestation, before the expulsion of the maternal body. For the mother, the news of his son\'s death during the period of pregnancy is traumatic, since instead of an expectation of a life, she finds desperation and sadness. This research aimed to understand the mothers experience of having a stillbirth child. The theoretical framework adopted was the grief theory. Interpretative Interactionism was the methodological referential for the biographical narrative analysis of nine mothers who had the experience of having a stillbirth child. The events that determined the mothers history in this scenario were: BEING SURPRISED BY THE BAD NEWS, GIVING A NON SENSE BIRTH, LEAVING WITH EMPTY HANDS AND FACING THE SOCIAL MOURNING. The analyzed data enabled an understanding of mothers experience face to death of her child during pregnancy. The death of the baby in late pregnancy, when characterized as a stillbirth, is incomprehensible to the mother. She becomes exhausted, has a deep emotional pain, followed by a feeling of vulnerability that prevents her from thinking about the future or the possibility of a new pregnancy. To see the stillbirth child is a significant moment and not always the mother can verbalize her desire to know, to touch, to hold her child who is now dead. The grieving process is experienced in a lonely way, since her sadness is not shared with family and friends. They prefer to be alone due to feeling shame for failing to produce a healthy child and they cry all the time. The study reinforces that it is necessary to insert information and knowledge concerning the grief process relevant to these mothers to health professionals, even in undergraduate courses. This would allow them to give those mother some control over the experience, thus recovering their autonomy and allowing them to prevent their physical and mental health
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CANTARUTTI, ANNA. "Maternal and Child Health." Doctoral thesis, Università degli Studi di Milano-Bicocca, 2017. http://hdl.handle.net/10281/158179.
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Secondo l'Organizzazione Mondiale della Sanità (OMS), ogni giorno, in tutto il mondo, circa 1.000 donne muoiono per cause legate alla gravidanza o al parto e, ogni anno, più di otto milioni di bambini nei paesi a basso e medio reddito muoiono prima di raggiungere i cinque anni di vita. L'OMS è stata chiara: la salute materno-infantile è un tema di enorme importanza sanitaria e richiede investimenti, progetti, energie e impegno, rappresentando una componente fondamentale della salute pubblica delle popolazioni umane.
Migliorando l'approccio e l'accesso alle cure sanitarie, rendendo più disponibili assistenza qualificata, trattamenti farmacologici e la formazione degli operatori, ma anche semplici interventi preventivi durante la gravidanza, nel corso della gravidanza, del parto e dei primi anni di vita del bambino è possibile, infatti, prevenire le morti evitabili.
A fronte della complessità dell’insieme dei temi e delle problematiche relative al percorso nascita e alla salute materno-infantile, ho ritenuto di suddividere in più fasi il mio progetto sviluppando diversi profili, come quello socio-economico, farmacologico, e clinico.
Sono state utilizzate diverse metodologie statistiche a seconda dell’obiettivo dello studio. Le associazioni tra le diverse esposizioni della madre, prima e/o durante la gravidanza, e gli esiti neonatali selezionati, sono state valutate attraverso modelli di regressione logistica. In alcuni studi c’è stata la necessità di imputare i dati mancanti. Vista la natura di questi ultimi, arbitrary missing data pattern, è stato utilizzato il modello “fully conditional specification (FCS)”, ipotizzando l'esistenza di una distribuzione congiunta per le variabili mancanti. Per rendere le stime più robuste, a seguito della presenza di confondenti non misurati, è stato utilizzato l'approccio rule-out descritto da Schneeweiss. Per valutare il ruolo che gli eventi avversi neonatali alla nascita svolgono nel rapporto tra l’esposizione della madre durante la gravidanza e gli esiti neonatali in questione, ho utilizzato la “mediation analysis” descritta da VanderWeele e Vansteelandt. Infine, a seguito dell’utilizzo di dati osservazionali, le caratteristiche basali di esposti e non esposti potrebbero essere sbilanciate. Ho quindi utilizzato la tecnica del “propensity score startification” che permette di creare gruppi di pazienti con simile probabilità di ricevere il trattamento. Il propensity score è stato stimato sia attraverso il metodo classico della regressione logistica, sia utilizzando l’algoritmo “high-dimensionale propensity score” per valutare le centinaia di diagnosi, procedure, e prescrizioni più significative.
Lo scopo della mia tesi è quello di identificare i possibili fattori per sviluppare e migliorare la salute materno-infantile da un aspetto socio-demograficho, farmacologico, e clinico.
Ho strutturato la mia tesi in diverse sezioni. Procederò in prima istanza, dando una panoramica dei metodi utilizzati nei vari studi effettuati durante il mio dottorato, procedendo con una descrizione dettagliata di questi ultimi.According to the World Health Organization (WHO), every day, worldwide, about 1,000 women die due to causes related to pregnancy or childbirth and, every year, more than eight million children in low and middle income countries die before reaching five years of age. The WHO was clear: maternal and child health is a topic of enormous medical importance and requires investments, projects, energy and commitment; it is an essential part of the public health of human populations. Improving the approach and access to health care, making qualified assistance, drug treatment and training of the operators more available, but also elementary preventive interventions during pregnancy, childbirth and the early years of a child's life, can prevent avoidable deaths and reduce several neonatal outcomes. Given the complexity of all the issues and problems concerning births and maternal and child health, through this thesis I propose a path divided into several stages which covers various topics starting from the socio-economic profile of the mother, moving to the pharmacological profile of pregnancy, up to the prevention of stillbirths. Several statistical methods were implemented to answer the different questions depending on the aim of each study. Log-binomial regression was used for estimating the association between the mother’s exposure during pregnancy and the selected neonatal outcomes. The fully conditional specification (FCS) model was performed to generate appropriate values of missing data for those women with missing covariates. The rule-out approach described by Schneeweiss was implemented to make our estimates, which might be affected by unmeasured confounder, more robust. The mediation analysis described by VanderWeele and Vansteelandt was used to assess the role that some adverse neonatal events at presentation (mediator) play in the relationship between the mother’s exposure during pregnancy (exposure) and adverse neonatal events later in life (outcome). Lastly, the Propensity Score Stratification derived from the predicted probability of treatment estimated in a logistic-regression model, as well as the high-dimensional propensity score algorithm to evaluate hundreds of inpatient diagnosis, procedures, and pharmacy claims, were completed to account for all potential confounders. The aim of my thesis is to identify factors to develop and improve the health care related to maternal- fetal and maternal-child world (before and after birth, respectively) from a sociodemographic, farmacoepidemiology, and clinical point of view. The layout of the thesis has been divided into different sections. I will proceed in the first instance by giving an overview of the methods used in the various studies carried out during my PhD, proceeding with a detailed description of the latter.
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Thompson, Susannah Ruth. "Birth pains : changing understandings of miscarriage, stillbirth and neonatal death in Australia in the Twentieth Century." University of Western Australia. School of Humanities, 2008. http://theses.library.uwa.edu.au/adt-WU2008.0150.
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Feminist and social historians have long been interested in that particularly female ability to become pregnant and bear children. A significant body of historiography has challenged the notion that pregnancy and childbirth considered to be the acceptable and 'appropriate' roles for women for most of the twentieth century in Australia - have always been welcomed, rewarding and always fulfilling events in women's lives. Several historians have also begun the process of enlarging our knowledge of the changing cultural attitudes towards bereavement in Australia and the eschewing of the public expression of sorrow following the two World Wars; a significant contribution to scholarship which underscores the changing attitudes towards perinatal loss. It is estimated that one in four women lose a pregnancy to miscarriage, and two in one hundred late pregnancies result in stillbirth in contemporary Australia. Miscarriage, stillbirth and neonatal death are today considered by psychologists and social workers, amongst others, as potentially significant events in many women's lives, yet have received little or passing attention in historical scholarship concerned with pregnancy and motherhood. As such, this study focuses on pregnancy loss: the meaning it has been given by various groups at different times in Australia's past, and how some Australian women have made sense of their own experience of miscarriage, stillbirth or neonatal death within particular social and historical contexts. Pregnancy loss has been understood in a range of ways by different groups over the past 100 years. At the beginning of the twentieth century, when alarm was mounting over the declining birth rate, pregnancy loss was termed 'foetal wastage' by eugenicists and medical practitioners, and was seen in abstract terms as the loss of necessary future Australian citizens. By the 1970s, however, with the advent of support groups such as SANDS (Stillbirth and Neonatal Death Support) miscarriage and stillbirth were increasingly seen as the devastating loss of an individual baby, while the mother was seen as someone in need of emotional and other support. With the advent of new prenatal screening technologies in the late twentieth century, there has been a return of the idea of maternal responsibility for producing a 'successful' outcome. This project seeks to critically examines the wide range of socially constructed meanings of pregnancy loss and interrogate the arguments of those groups, such as the medical profession, religious and support groups, participating in these constructions. It will build on existing histories of motherhood, childbirth and pregnancy in Australia and, therefore, also the history of Australian women.
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Conry, Jennifer Robyn. "Mothers' experiences of accessing services following the death of a baby through stillbirth or neonatal death." Diss., Pretoria : [s.n.], 2006. http://upetd.up.ac.za/thesis/available/etd-04172007-122705.
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Vergnano, S. "Verbal autopsy for stillbirth and neonatal deaths : comparing population cause specific mortality fraction using two methods." Thesis, University College London (University of London), 2012. http://discovery.ucl.ac.uk/1349291/.
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Background: Every year 3.2 million infants are stillborn and 3.6 million die within the first month. Up to 98% of these deaths occur in countries with inadequate or non-existent vital registration systems, where cause of death data are sparse and mostly derived from verbal autopsies (VA). It has been advocated that VA are included in routine national statistics. This thesis proposes and compares the strengths and limitations of methodologies to collect and interpret VA data for stillbirths and neonatal deaths. Methods: Data were derived from three research areas in Malawi, Nepal and Mumbai. The development of classifications, diagnostic algorithms and questionnaires for VA, suitable for physician review interpretation is described. A probabilistic method to analyse all age deaths (InterVA) was adapted for stillbirths and neonatal deaths. Cause specific mortality fractions were compared using physicians’ review and InterVA. Results: Neonatal mortality rate in Malawi was 25/1000 livebirths (LB), in Nepal 31/1000 LB and in Mumbai 16/1000 LB. A total of 922 VA including both live and stillbirths were analysed to establish causes of death. Stillbirths accounted for 44-54% of deaths. Of neonatal deaths, in Malawi the majority were attributed to severe infections according to physician review (55%) and InterVA (46%); in Nepal (43%) and Mumbai (61%) perinatal asphyxia was most common according to InterVA. In Nepal however, physician review ascribed the majority of neonatal deaths to severe infections (50%). Kappa statistics for individual agreement comparing both methods was 0.60 (CI 0.567-0.702) in Malawi, 0.62(CI 0.59- 0.65) in Nepal and 0.48(0.40 - 0.50) in Mumbai. Discussion: Different VA interpretation methods exist, however standardised procedures are necessary for international comparison. The role of physician review in interpreting VA is changing while computerised methods are becoming more widespread. The modified InterVA model provides a rapid and consistent method to establish causes of stillbirths and neonatal deaths, however it requires further refinements and ultimately a validation study using a comparison other than physician review.
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Barragan, Adrian A. "EFFECT OF CALVING MANAGEMENT PRACTICES ON STILLBIRTH IN HOLSTEIN DAIRY COWS WITH EMPHASIS IN CONFINEMENT SYSTEMS." The Ohio State University, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=osu1433500476.
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Wallbank, Sonya. "Obstetric & gynaecology in-patient staff responses to miscarriage, stillbirth and neonatal loss experienced by their patients." Thesis, University of Leicester, 2008. http://hdl.handle.net/2381/4151.
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Christou, Aliki. "Towards Improved Data and Understanding of Stillbirth Determinants in Low- and Middle-Income Countries: Insights from Afghanistan." Thesis, The University of Sydney, 2018. http://hdl.handle.net/2123/21161.
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The limited availability and low-quality of national-level data to understand stillbirth determinants in low- and middle-income countries is a major barrier to stillbirth prevention efforts globally. Data for producing stillbirth estimates in these settings generally come from national household surveys due to the high proportion of women that give birth at home, and because of inadequate or absent civil and vital registration systems. There are several quality concerns with stillbirth data from household surveys, particularly around under-reporting and misclassification, which affect the reliability of estimates. What also remains underexplored is to what extent social and cultural factors affect the disclosure and reporting of stillbirth, as these have important implications for stillbirth data quality. This thesis sought to review the availability of country-level data on stillbirth from nationally-representative household surveys in low- and middle-income countries to outline what data exists, where the limitations are, and potential for improvement. Analysis of data from a national mortality survey in Afghanistan is used to describe the key determinants of stillbirth in this setting and demonstrate how better data could be generated to understand stillbirth risk factors globally. Qualitative methods are used to further explore how community and healthcare provider experiences, perceptions and practices might impact stillbirth data quality and contribute to pathways leading to stillbirth in Afghanistan. The findings of this thesis can inform future efforts to improve stillbirth data in low- and middle-income countries and identifies where interventions can begin to focus to facilitate stillbirth reduction in Afghanistan.
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Malm, Mari-Cristin. "Fetal Movements in late Pregnancy : Categorization, Self-assessment, and Prenatal Attachment in relation to women’s experiences." Doctoral thesis, Uppsala universitet, Institutionen för kvinnors och barns hälsa, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-271429.
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Aim: To explore how pregnant women experience fetal movements in late pregnancy. Specific aims were: to study women’s experiences during the time prior to receiving news that their unborn baby had died in utero (I), to investigate women’s descriptions of fetal movements (II), investigate the association between the magnitude of fetal movements and level of prenatal attachment (III), and to study women’s experiences using two different self-assessment methods (IV). Methods: Interviews, questionnaires, and observations were used. Results: Premonition that something had happened to their unborn baby, based on a lack of fetal movements, was experienced by the participants. The overall theme “something is wrong” describes the women’s insight that the baby’s life was threatened (I). Fetal movements that were sorted into the domain “powerful movements” were perceived in late pregnancy by 96 % of the participants (II). Perceiving frequent fetal movements on at least three occasions per 24 hours was associated with higher scores of prenatal attachment in all the three subscales on PAI-R. The majority (55%) of the 456 participants reported average occasions of frequent fetal movements, 26% several occasions and 18% reported few occasions of frequent fetal movements, during the current gestational week. (III). Only one of the 40 participants did not find at least one method for monitoring fetal movements suitable. Fifteen of the 39 participants reported a preference for the mindfetalness method and five for the count-to-ten method. The women described the observation of the movements as a safe and reassuring moment for communication with their unborn baby (IV). Conclusion: In full-term and uncomplicated pregnancies, women usually perceive fetal movements as powerful. Furthermore, women in late pregnancy who reported frequent fetal movements on several occasions during a 24-hour period seem to have a high level of prenatal attachment. Women who used self-assessment methods for monitoring fetal movements felt calm and relaxed when observing the movements of their babies. They had a high compliance for both self-assessment methods. Women that had experienced a stillbirth in late pregnancy described that they had a premonition before they were told that their baby had died in utero.
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Dryfhout-Ferguson, Vicki L. "Racial Disparities in Pregnancy Outcomes." University of Cincinnati / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1273167016.
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Kint, Esther Lea. "Women’s experiences of pregnancy loss: An interpretative phenomenological analysis." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2015. https://ro.ecu.edu.au/theses/1723.
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Over the past three decades, research has proliferated on the incidence of grief severity following pregnancy loss, with many research studies citing the existence of ‘complicated’ and ‘unresolved’ grief. It is argued that this emphasis on grief severity has overshadowed other aspects of the bereavement experience that might differ from grief as it has been defined. Understanding the experience of loss in pregnancy instead of categorising it, would allow for new and varied understandings of the meaning women attribute to their experience of losing a baby. Furthermore, paying attention to women’s interpretations and understandings of pregnancy loss provides valuable insight into care that is perceived as meaningful and supportive.
Utilising interpretative phenomenological analysis (IPA), a qualitative research method, the current study explored the experience of pregnancy loss among nineteen bereaved women with a history of miscarriage or stillbirth. The findings revealed that bereaved women struggle with a unique, complex and pervasive bereavement experience, that is largely unacknowledged and misunderstood. Women conveyed a strong desire for others to acknowledge and validate their loss, and to facilitate rather than suppress their grief. In addition, women identified a need to remain connected to their deceased baby, and for others to recognise the profound and enduring nature of their grief. Perceptions of support were identified as a critical catalyst in determining women’s bereavement experiences, and revealed both positive and negative attributions of professional and social support. In particular, women identified a need for increased public awareness of pregnancy loss, more sensitive and empathic care, continued support to facilitate contact with the baby, improved continuity of care to support grieving, and enhanced support in the subsequent pregnancy to assist with anxiety management. The implications of these findings for future research and practice are discussed.
The study provides a context within which women’s experiences can not only be recognised as widespread and rational emotional processes following pregnancy loss, but that those suffering can also receive appropriate, specialised professional support and social acceptance by the wider community.
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Pearce, Mark Stephen. "Investigation of stillbirth risk among the offspring of male radiation workers at the Sellafield nuclear installation, west Cumbria." Thesis, University of Newcastle Upon Tyne, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.311219.
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Williamson, Melissa Grace. "Exploring midwives' experiences of managing patients' perinatal loss at a maternity hospital in the Western Cape, South Africa." University of the Western Cape, 2016. http://hdl.handle.net/11394/5645.
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Magister Curationis - MCurPerinatal deaths are emotion-laden events not only for the mothers, but also for physicians and midwives. Hence, mothers experiencing the phenomenon need support to overcome the experience. If the loss occurs in a health institution, the responsibility of supporting the woman is borne by healthcare providers, particularly midwives. However, limited information exists on how midwives manage patients who experience perinatal loss in health institutions. Consequently, this study on midwives' experiences of managing patients' perinatal loss at a maternity hospital in the Western Cape, South Africa was conducted. The aim of the study was to explore midwives' management of patients with perinatal loss. The study utilised a qualitative research design and employs a phenomenological approach. Purposive sampling was used to select eight registered midwives to participate in the study. Data was collected by means of in-depth unstructured interviews, which were audio-recorded. It was then analysed by utilising Colaizzi's (1978) steps of phenomenological data analysis. Four themes emerged from the data, namely, knowledge of perinatal loss, challenges when managing patients, managing perinatal loss, and getting emotionally involved. Themes were informed by several subthemes. In addition, implication on practice indicates that improving support to mothers with pregnancy loss requires a multi-disciplinary approach or teamwork from various professionals in order to enhance mutual collaboration between families and healthcare workers. The study concludes that nursing education programmes should be reviewed to ensure that they include midwives' needs in the area of managing clients experiencing a perinatal loss. Hence, student midwives should be given more clinical experience of caring for bereaved couples under supervision, as well as compassionate support, which would assist them to develop these skills before they graduate.
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Fjeldstad, Gullborg. "Intrauterin fosterdød hos innvandrerkvinner og svenske kvinner – en svensk registerstudie." Thesis, Nordic School of Public Health NHV, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:norden:org:diva-3203.
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Bakgrunn: Intrauterin fosterdød er en hendelse som har ringvirkninger langt utover den rammede kvinnen og hennes familie. Det handler i sin ytterste mening om kvinner og barns helse og likhet i helse for alle. Utviklingen mot et flerkulturelt samfunn innebærer andre utfordringer enn tidligere i forhold til kultur, kommunikasjon, kvinne-og familieperspektiv, livsstil og medisinske problemstillinger. Formål: Denne studiens formål har vært å kartlegge forekomsten av intrauterin fosterdød (IUFD) hos innvandrerkvinner sammenlignet med svenske kvinner, og å undersøke faktorer som kan være assosiert med IUFD. Materiale og metode: Registerdata på 904 646 fødte og deres mødre i perioden 1992-2001 ble undersøkt med bivariate analyser. Det ble også gjort en systematisk litteraturgjennomgang av relevant nasjonal og internasjonal forskning på feltet. Resultat: Analysen viser en økt risiko for IUFD hos innvandrerkvinnene sammenlignet med svenske kvinner. IUFD forekommer oftere hos de ikke-europeiske innvandrerkvinnene;OR:1,45(95% CI 1,28-1,63). Litteraturgjennomgangen viser at ikke-europeiske innvandrerkvinner har 2-3 ganger så høy risiko for IUFD sammenlignet med totalpopulasjonen, men også at lav sosio-økonomisk status (SøS), alder, inngifte, røyking, reduksjon av medisinske risikofaktorer og kvaliteten på den antenatale omsorgen påvirker den perinatale dødeligheten. Konklusjon: En forbedret folkehelse i Norden de siste tiårene har bidratt til en reduksjon av den perinatale dødeligheten. Men ikke alle befolkningsgrupper har fått tatt del av denne utviklingen. De ikke-europeiske innvandrerkvinnene har signifikant høyere odds for IUFD. De har ofte lav SøS, hvilket i seg selv er assosiert med IUFD. Kunnskap om ulikheter i helse og sykdom blant ulike kategorier mennesker i samfunnet vårt er viktig og kan bidra til en mer tilpasset omsorg og en bedre medisinsk behandling. Det er behov for videre forskning fra flere fagområder for å kunne kartlegge livsstil, levekår og effekten av språkbarrierene og for å få en oppfatning om hvordan ulikheter i helse kan utjevnes.Background: Stillbirths or intrauterine fetal death have wide effects on families. This is about women’s and children’s health as well as equity in health for all. As Sweden becomes more multicultural, new challenges in equity on women’s and children’s health develope related to culture, communication, women –and family matters, lifestyle and medical issues. Aim: The aim of this study was to assess the occurence of stillbirths in immigrant women compared to Swedish women and investigate factors related to stillbirths. Method: Data from 904 646 newborns and their mothers during the period 1992-2001 was analysed using bivariat analyses. A literature study was undertaken with a systematic appraisal of relevant national and international research in the field. Results: The analyses showed that stillbirth was more common in non-European immigrant women. OR: 1,45 (95% CI 1,28-1,63). Non-European immigrant women in Sweden had higher odds of stillbirths compared to the background population. The litterature showed that non-European immigrant women have 2-3 times the risk of stillbirths, and the risk of stillbirths is also increased in women of lower socioeconomic status (SES). Other risk factors indicated to be important are age, consanguinity, smoking and the quality of perinatal care. Conclusions: Non-European immigrant women in Sweden have higher odds of stillbirths compared to the background population. These women also have an increased risk of low SES, which is itself a riskfactor of stillbirth. Appropriate knowledge of difference in health needs in different groups in the community is important for filling the health care needs and improving the medical treatments. Further research is needed from different sectors to assess the importance of lifestyle, language limitations and how these women are treated by the health care system.
ISBN 978-91-85721-30-6
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Moe, Thomas. "Ministry to families bereaved by miscarriage, still birth, and neo-natal death." Theological Research Exchange Network (TREN), 1993. http://www.tren.com.
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Willis, Lucy. "A comparison of grief responses and physical health changes in Caucasian and African-American women following a third trimester stillbirth." The Ohio State University, 1991. http://rave.ohiolink.edu/etdc/view?acc_num=osu1300468994.
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Wood, Stephen L. "Prediabetes and perinatal mortality, perinatal mortality and stillbirth in pregnancies before the onset of diabetes in women with adult onset diabetes." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp01/MQ38618.pdf.
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Bradley, A. Mark. "The dangerous ritual baptism of the dead /." Online full text .pdf document, available to Fuller patrons only, 1999. http://www.tren.com.
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Ellis, Zina. "An analysis of the antecedents of unexplained stillbirths in Western Australia (1980-1993)." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2008. https://ro.ecu.edu.au/theses/199.
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Aim: To determine whether antecedents or combinations of antecedents are associated with stillbirths that are currently considered to be unexplained. Background: Between 1980 -1993 in Western Australia. 2569 babies were delivered stillborn. No sufficient cause of death could be identified for 1291 of these babies. This is a significant health issue that warranted further investigation. The objective of such a review was to provide baseline evidence that could be used to recommend the development of preventative strategies such as health promotion programs that could be implemented to potentially reduce or prevent the number of unexplained stillborn babies. The development of such strategies required a detailed analysis of the antecedents to currently unexplained stillbirth.