Rozprawy doktorskie: „Obstetric intervention”

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Creedy, Debra Kay, i D. Creedy@mailbox gu edu au. "Birthing and the development of trauma symptoms: Incidence and contributing factors". Griffith University. School of Applied Psychology, 1999. http://www4.gu.edu.au:8080/adt-root/public/adt-QGU20030102.101015.

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Background: Little is known about the relationship between women's birthing experiences and the development of trauma symptoms. This study aimed to determine the incidence of acute trauma symptoms and posttraumatic stress disorder (PTSD) in women as a result of their labor and delivery experiences, and identify factors that contributed to the women's psychological distress. Method: Using a prospective, longitudinal design, women in their last trimester of pregnancy were recruited from four public hospital antenatal clinics. Four to six weeks postpartum, telephone interviews were conducted with participants (n = 499) and explored the medical and midwifery management of the birth, perceptions of intrapartum care, and the presence of trauma symptoms. Results: One in three women (33%) identified a traumatic birthing event and reported the presence of at least three trauma symptoms. Twenty-eight women (5.6%) met DSM-IV criteria for acute posttraumatic stress disorder. Antenatal variables were not found to contribute to the development of acute or chronic trauma symptoms. The level of obstetric intervention experienced during childbirth (beta = .351, p <.0001) and the perception of inadequate intrapartum care (beta = .319, p <.0001) during labor were consistently associated with the development of acute trauma symptoms. Conclusions: Posttraumatic stress disorder following childbirth is an under-recognized phenomenon. Women who experienced both a high level of obstetric intervention and were dissatisfied with their intrapartum care were more likely to develop trauma symptoms than women who received a high level of obstetric intervention or women who perceived their care to be inadequate. Such findings should prompt a serious review of intrusive obstetric intervention during labor and delivery, and the psychological care provided to birthing women.

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Creedy, Debra. "Birthing and the development of trauma symptoms: Incidence and contributing factors". Thesis, Griffith University, 1999. http://hdl.handle.net/10072/367663.

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Background: Little is known about the relationship between women's birthing experiences and the development of trauma symptoms. This study aimed to determine the incidence of acute trauma symptoms and posttraumatic stress disorder (PTSD) in women as a result of their labor and delivery experiences, and identify factors that contributed to the women's psychological distress. Method: Using a prospective, longitudinal design, women in their last trimester of pregnancy were recruited from four public hospital antenatal clinics. Four to six weeks postpartum, telephone interviews were conducted with participants (n = 499) and explored the medical and midwifery management of the birth, perceptions of intrapartum care, and the presence of trauma symptoms. Results: One in three women (33%) identified a traumatic birthing event and reported the presence of at least three trauma symptoms. Twenty-eight women (5.6%) met DSM-IV criteria for acute posttraumatic stress disorder. Antenatal variables were not found to contribute to the development of acute or chronic trauma symptoms. The level of obstetric intervention experienced during childbirth (beta = .351, p <.0001) and the perception of inadequate intrapartum care (beta = .319, p <.0001) during labor were consistently associated with the development of acute trauma symptoms. Conclusions: Posttraumatic stress disorder following childbirth is an under-recognized phenomenon. Women who experienced both a high level of obstetric intervention and were dissatisfied with their intrapartum care were more likely to develop trauma symptoms than women who received a high level of obstetric intervention or women who perceived their care to be inadequate. Such findings should prompt a serious review of intrusive obstetric intervention during labor and delivery, and the psychological care provided to birthing women.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Applied Psychology (Health)
Griffith Health
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Ball, Colleen. "Homebirth in WA: Why women make this choice". Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2014. https://ro.ecu.edu.au/theses/1277.

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Background: Homebirths in Western Australia (WA) account for approximately 0.8% of all births. Two consecutive reports from the Perinatal and Infant Mortality Monitoring Committee found increased rates of perinatal mortality in homebirths and recommended a prospective cohort study to assess mortality and morbidity outcomes for women with planned home births in WA. The Homebirth in WA Study, of which this thesis is a component, has been funded by a directed research grant. Aim: The aim of this study was to explore the specific reasons why women in WA choose homebirth. Research on homebirths is focused on perinatal outcomes and comparisons of satisfaction between hospital and homebirth. Based on these comparisons, assumptions are made as to why women choose to have a homebirth or make this choice. There is a paucity of research directly addressing the reasons why women make this choice. Methods: This is a quantitative prospective observational study. Pregnant women planning a homebirth in WA were invited to participate in the study. Women recruited into this study (n=135) were asked about their obstetric history and associated satisfaction with their previous birth experience, and were asked to select from any of 27 options as being their reasons for choosing homebirth, with the option to provide additional reasons of their own. They were also asked to select the three most important reasons. Women were asked to rank their perception of how important it is for them to have a homebirth, their perception of the safety, their level of confidence and the support they have received from their spouse and family and friends for their choice. The women were also invited to share further comments. Results: The majority of women (n=107) received care from the Community Midwifery Program and the remainder (n=28) from privately practicing Midwives. In this study 50 women were nulliparous and 85 multiparous. Women who previously had a homebirth reported a higher level of satisfaction (4.7/5) for the birth experience, compared to women who had hospital births (2.3/5). Avoiding unnecessary intervention was the dominan reason for choosing home birth in 95.5% of participants, regardless of parity, education or previous birth experience; this was followed by the comfort and familiarity of the home (93%) and the freedom to make their own choices (86%). Avoiding unnecessary intervention ranked the highest of the 3 most important reasons. Women reported a high level of support for their choice from their spouse (4.65/5) and substantially less from family and friends (3.68/5). They ranked the safety of homebirth highly and had a high level of confidence. The women who elected to share further comments referred most frequently (28%) to GP’s and obstetricians not presenting homebirth as an option, and also made frequent reference to their negative attitude in relation to the women’s choice. Women also commented on the negative attitudes encountered from family and friends, and additional references reflected their attitudes regarding intervention. Conclusion: Women choosing homebirth in WA do so to avoid unnecessary intervention and have the freedom to make their own choices in the surrounds of the home. They receive limited support for their choice from GP’s and obstetricians as well as friends and relatives. This study underscores the reaction of some women to the current rates of obstetric intervention.

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Mbola, Mbassi Symplice. "Soins obstétricaux d'urgence et mortalité maternelle dans les maternités de troisième niveau du Cameroun : approche évaluative d'une intervention visant à améliorer le transfert obstétrical et la prise en charge des complications maternelles". Thesis, Paris 6, 2014. http://www.theses.fr/2014PA066352/document.

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Malgré de nombreuses initiatives entreprises par le gouvernement au cours des dernières années, la mortalité maternelle demeure un véritable fléau au Cameroun. Pour cette raison, une recherche a été conduite pour déterminer l'ampleur de la mortalité maternelle dans les 7 maternités de troisième niveau du Cameroun, décrire les différentes étapes d'une intervention visant à améliorer le système de référence et la prise en charge des urgences obstétricales et évaluer son effet sur la mortalité maternelle.La recherche a été menée en trois phases. Une revue rétrospective des données agrégées de la période 2004 à 2006 a été réalisée incluant tous les accouchements, les complications obstétricales, les césariennes et les décès maternels. Ensuite une intervention de 33 mois a été mise en place dans 22 maternités périphériques ainsi que dans 3 maternités de troisième niveau où la mortalité maternelle était importante. L'évaluation de l'intervention a été faite à travers la méthode quasi expérimentale combinant l'étude avant-Après à l'étude ici-Ailleurs. Deux ans après l'intervention, les décès maternels enregistrés dans les 3 maternités cibles avaient diminué de plus de la moitié (P=0,000001). Le taux de létalité des complications obstétricales observé dans les mêmes maternités est passé de 2,2 à 0,7% (P=0,000001). Par ailleurs, le nombre de décès observés chez les femmes référées avait diminué et le taux de létalité était inférieur à 1%. Les résultats de la recherche mettent en évidence les conséquences du renforcement des compétences des prestataires, de l'amélioration du système de référence et de la qualité des soins sur la mortalité maternelle
Despite numerous initiatives undertaken by health authorities in the past years, maternal mortality remains a major public health issue in Cameroon. Against this background, research was conducted (i) to determine the maternal mortality patterns in 7 tertiary maternity centers in Cameroon, (ii) to document various stages of an intervention for improving referral system and the management of obstetric emergencies and (ii) evaluate the effect of these measures on maternal mortality and propose future actions. The research was conducted in three phases. A retrospective review of the aggregate data for the period 2004-2006 was performed including all births, obstetric complications, caesarean sections and maternal deaths. Then 33 months intervention has been set up in 22 peripheral maternities and in three tertiary maternity centers where maternal mortality was very high. The evaluation of the intervention was made using the quasi-Experimental design. This method combined the pre- and post- intervention study as well as the study of the maternities where there was intervention compared to the control group. Two years after the intervention, maternal deaths recorded in the target tertiary maternity centers decreased by more than half (P = 0.000001). The case fatality rate decreased from 2.2 to 0.7% in the same group (P = 0.000001). Moreover, the number of deaths among referred women decreased significantly and the case fatality rate was less than 1%. The research findings highlight the impact of capacity building providers, improvement of the referral system and quality of care on maternal mortality

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August, Furaha. "Effect of Home Based Life Saving Skills education on knowledge of obstetric danger signs, birth preparedness, utilization of skilled care and male involvement : A Community-based intervention study in rural Tanzania". Doctoral thesis, Uppsala universitet, Internationell mödra- och barnhälsovård (IMCH), 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-272245.

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Use of skilled care during antenatal visits and delivery is recommended to address the burden of maternal mortality. However there are few facility deliveries and insufficient knowledge of danger signs, especially in rural Tanzania. The aim of this thesis was to explore the perceptions and challenges that the community faces while preparing for childbirth and to evaluate an intervention of the Home Based Life Saving Skills education programme on knowledge of danger signs, facility delivery and male involvement when delivered by rural community health workers in Tanzania. In Paper I, Focus Group Discussions explored the perceptions and challenges that the community encounters while preparing for childbirth. Structured questionnaires assessed men’s knowledge of danger signs and birth preparedness and complication readiness in Paper II. The effect of the Home Based Life Saving Skills education programme in the community was assessed with a before-and-after evaluation in two districts; one intervention and one comparison. Paper III assessed the effect of the programme on knowledge of danger signs and birth preparedness and facility delivery among women, while Paper IV evaluated its effect on male involvement. The community perceived that all births must be prepared for and that obstetric complication demands hospital care; hence skilled care was favoured. Men’s knowledge of danger signs was limited; only 12% were prepared for childbirth and complications. Preparedness was associated with knowledge of obstetric complications (AOR=1.4 95% CI 1.8 – 2.6). The intervention showed women utilizing antenatal care (four visits) significantly more (43.4 vs 67.8%) with a net effect of 25.3% (95% CI: 16.9 – 33.2; p < .0001). The use of facility delivery improved in the intervention area (75.6 vs 90.2%; p = 0.0002), but with no significant net effect 11.5% (95% CI: -5.1 – 39.6; p = 0.123) when comparing the two districts. Male involvement improved (39.2% vs 80.9%) with a net intervention effect of 41.1% (CI: 28.5 – 53.8; p < .0001). Improvements were demonstrated in men’s knowledge level, in escorting partners for antenatal care and delivery, making birth preparations, and shared decision-making. The intervention, in educating this rural community, is effective in improving knowledge, birth preparedness, male involvement and use of skilled care.

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Dench, Erin. "Maternal decision making in obstetrical interventions". Honors in the Major Thesis, University of Central Florida, 2010. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/1393.

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This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.
Bachelors
Nursing
Nursing

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Claesson, Ing-Marie. "Weight gain restriction for obese pregnant women : An Intervention study". Doctoral thesis, Linköpings universitet, Obstetrik och gynekologi, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-56390.

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Introduction: Obesity is a growing global public health problem and is as prevalent among pregnant women as in the general population. It is well known that obese women have an increased risk for several complications during pregnancy and delivery and this is also true for the neonate. Excessive gestational weight gain among obese women seems to further increase these risks for adverse outcomes. It has not been known up to the time of this study whether a behavioral intervention program designed for obese pregnant women could result in a reduction of gestational weight gain. Aim: The overall aim of the present thesis was to study the effect of an intervention program designed to control weight gain among obese pregnant women during pregnancy and to then observe the outcomes of their pregnancies. In addition we wanted to learn if this behavioral intervention program could result in a weight gain of less than seven kilograms. Material and methods: The intervention group consisted of 155 obese (BMI >30 kg/m2) pregnant women at the antenatal care clinic (ANC) in Linköping; the control group consisted of 193 obese pregnant women in two other cities. The women in the intervention group were offered, in addition to regular care at the ANC, motivational interviewing in weekly visits to support them in making this behavioral change. They were also offered aqua aerobic class once or twice a week. The women in the control group attended the routine antenatal program in their respective ANCs. Outcome measures were: weight in kg, pregnancy-, delivery and neonatal outcomes, prevalence of anxiety- and depressive symptoms and attitudes and experiences of participating in an intervention program. Results: The women in the intervention group had a significantly lower gestational weight gain and also had a lower postnatal weight than the women in the control group. The percentage of women in the intervention group who gained <7 kg was greater than the percentage in the control group. There were no differences between the two groups in pregnancy-, delivery- and neonatal outcomes. In addition, there was no difference in prevalence of symptoms of anxiety and depressions between the intervention- and control group and the gestational weight gain did not have any effect on symptoms of depression or anxiety. The women in the intervention group with gestational weight gain <7 kg, weighed less at the two years follow-up than the women in the control group. Most of the women who participated in the intervention program expressed positive attitudes and were positive towards their experiences with the intervention program and their efforts to manage the gestational weight gain. Conclusion: The intervention program was effective in controlling weight gain during pregnan-cy and did not change the pregnancy, delivery or neonatal outcomes or the prevalence of anxie-ty- and depressive symptoms. The group with a gestational weight gain <7 kg showed the same distribution of complications as the group with a higher weight gain. The intervention program seems to influence the development of weight in a positive direction up to two years after childbirth. The women were also satisfied with their participation in the intervention program.

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Escuriet, Peiró Ramón 1968. "Modelos de organización de los servicios de atención al parto : efecto sobre la provisión de servicios y los resultados". Doctoral thesis, Universitat Pompeu Fabra, 2015. http://hdl.handle.net/10803/319718.

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Existen diferentes modelos para la provisión de servicios de atención al parto y distintos factores relacionados con la organización de los servicios en los que se atiende a las mujeres. En esta tesis se exploran los resultados de la atención al parto en Cataluña, y se comparan los resultados de 64 hospitales en base al tipo de financiación y también al volumen de partos anuales que se atiende en cada centro hospitalario. En este trabajo también se evalúa el impacto de una política sanitaria para implantar un modelo de atención al parto normal, basado en un concepto fisiológico y que promueve un uso racional de los recursos sanitarios disponibles. Para contextualizar el trabajo se ha realizado una exploración de diferentes modelos de atención en varios países industrializados, se han buscado los indicadores más utilizados en Europa, para la evaluación de este tipo de atención, y se han elaborado indicadores específicos y adecuados al contexto catalán. Para la exploración de los diferentes modelos de atención y de los indicadores para la evaluación más utilizados en Europa se ha realizado una revisión crítica de la bibliografía y de diferentes bases de datos. Además se han realizado entrevistas con expertos. Para la comparación de los resultados se han extraído los diagnósticos y procedimientos relacionados del Conjunto Mínimo Básico de Datos (CMBD) registrados en el Servei Català de la Salut. Además, se han agrupado los hospitales según el tipo de financiación y según el volumen de partos atendidos y se han comparado los resultados de todos los partos únicos de entre 37 a 42 semanas de gestación. Las conclusiones más relevantes son que el tipo de financiación y el volumen de partos atendidos en los hospitales tienen un efecto significativo en las intervenciones obstétricas investigadas en Cataluña. Por otra parte, la realización de episiotomía ha descendido de forma significativa y la incidencia de lesiones perineales graves se ha mantenido por debajo del 1% en todos los hospitales de Cataluña.
There are different models of maternity care and also other factors related to the organisation of services in which women are attended to. In this thesis the results of delivery of birth care in Catalonia are investigated, and the outcomes of 64 hospitals are compared according to the type of financing and volume of births attended to in each hospital. This thesis also evaluates the impact of the undertaken maternity care policy for the implementation of the normal childbirth model of care and to promote a rational use of the existing health care resources. For the contextualization of this work, some models of care in different industrialized countries are explored, and also it has been identified the most widely used indicators for the assessment of maternity care in Europe. Then specific and appropriate indicators for the Catalan context have been developed. To get information on different models of care and to know what indicators are used in the European context, it has been conducted a critical review of literature, an exploration on several database and also interviews with experts. A number of selected diagnoses and procedures have been obtained from the Minimum Basic Data Set (MBDS) recorded in the Catalan Health Service for the comparison of outcomes. Hospitals have been grouped by type of financing and by the volume of births attended to. All singleton births between 37 to 42 weeks of pregnancy have been included on the analysis. The most relevant conclusions are the type of funding and the volume of births in hospital have a significant effect on the obstetric interventions investigated in Catalonia. Also episiotomy has decreased significantly, and the incidence of severe perineal trauma has remained below 1% in all hospitals in Catalonia.

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Pless, Mia. "Developmental co-ordination disorder in pre-school children : Effects of motor skill intervention, parents' descriptions, and short-term follow-up of motor status". Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2001. http://publications.uu.se/theses/91-554-4963-8/.

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Larsson, Margareta. "The Adoption of a New Contraceptive Method – Surveys and Interventions Regarding Emergency Contraception". Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4237.

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Evans, Kerry. "Supporting women with mild to moderate anxiety during pregnancy : the development of an intervention to be facilitated by midwives". Thesis, University of Nottingham, 2018. http://eprints.nottingham.ac.uk/51301/.

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Aim: To develop an intervention that could be facilitated by midwives to improve symptoms of mild to moderate anxiety in pregnant women Background: Many women experience symptoms of anxiety during pregnancy. Severe anxiety is associated with negative health outcomes for women and babies. Psychological interventions may be beneficial for pregnant women with mild to moderate symptoms of anxiety. Interventions require evaluation in pregnant populations to strengthen the evidence base. Methods: An intervention was developed according to the Medical Research Council theoretical and modelling phases for developing complex interventions. The study comprised three phases: 1. systematic reviews exploring the effectiveness and acceptability of interventions for pregnant women with anxiety; 2. development of an intervention which comprised individual support from midwives, peer group discussion and self-help resources; 3. a feasibility study of the intervention. Data collection comprised baseline and post-intervention self-report anxiety measures and semi-structured interviews conducted post-intervention. Data analysis used descriptive statistics for the quantitative data and template analysis for the qualitative data. Findings: Ten women participated in the feasibility study. Two midwife facilitators and two midwifery support worker co-facilitators were recruited and trained to facilitate the intervention. Women reported that the intervention was acceptable and beneficial. The findings highlighted how the intervention could be improved to maximise participant recruitment and improve the benefit derived by pregnant women with symptoms of anxiety. Facilitators provided positive comments about their involvement and said they felt prepared to deliver the intervention. Areas were identified where the training of intervention facilitators, study manuals and use of self-help resources could be enhanced to improve performance and fidelity of the intervention. Conclusions: Midwives have the potential to facilitate supportive interventions to enhance the current provision of emotional support in pregnancy. Minor refinements to the intervention are recommended prior to further testing. The next stage of development should be to conduct a randomised pilot trial. This should determine robust research methods and procedures for conducting a main trial to assess the effectiveness of the intervention on self-report symptoms of anxiety in pregnant women.

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Rai, Vibha. "Development and evaluation of educational intervention to promote informed decision making regarding embryo transfer in IVF patients". Thesis, University of Nottingham, 2012. http://eprints.nottingham.ac.uk/12683/.

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Increasing the uptake of elective single embryo transfer is necessary to achieve the 10% HFEA limit for multiple IVF births in 2011. This thesis aims to explore patients’ and clinicians’ attitudes to eSET and to promote effective decision making regarding embryo transfer. Study 1 compared neurobehavioural outcomes between twins and singletons in a prospective study of infants born very preterm (n=233). Despite having older (p=0.025) and higher social class (p=0.023) mothers, twins had the same risk of cognitive impairment at 2 years as singletons. In study 2, a 44 item Attitudes to Twin Pregnancy scale (ATIPS) was developed and administered to a sample of clinicians, medical students and conference delegates (n=411). Item analysis reduced ATIPS to 2 short subscales. A-Twin (12 items) assessed perceptions of risks and benefits associated with a twin birth (α=0.7). A-SET (8 items) assessed attitudes to eSET (α=0.53). Study 3 explored the reliability and validity of ATIPS-R in IVF patients. Exclusion of 2 A-SET items increased alpha to 0.8. Female patients (n=100) had more positive attitudes to a twin birth than clinicians (p=<0.001). Less than a third of patients felt that a twin birth was risky for infants and over 80% of doctors agreed that a twin birth was worth any risks to infants. First cycle IVF patients were more positive about eSET (p=<0.001) than women undergoing repeat cycles. Study-4 developed a decision aid and evaluated its impact in a pilot randomised controlled trial (n=8). Lower decisional conflict in patients at embryo transfer was associated with more positive attitudes to twins at baseline (p=0.024) and less positive attitudes to eSET, (p=0.04). Although the attitudes of patients receiving the DA did not change, partners became more positive towards eSET (p=0.024). Conclusion: Patients and clinicians underestimate the risk of a twin birth for infants and would benefit from educational interventions to promote eSET. The ATIPS-R is a useful measure for assessing the effectiveness of such interventions. Abbreviations: SET- single embryo transfer; HFEA- Human fertility and embryology authority; IVF- In vitro fertilisation; A-Twin- attitude to risks and benefits of twins; ATIP- attitude to twin IVF pregnancy; A-SET attitude to single embryo transfer; eSET- elective single embryo transfer; DET- double embryo transfer; RCT – randomised control trial; DA- decision aid.

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Chaves, Anne Fayma Lopes. "Effects of an educational intervention by telephone on the self-efficacy, duration and exclusivity of breastfeeding: controlled randomized clinical test". Universidade Federal do CearÃ, 2016. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=18490.

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This study aimed to evaluate the effects of an educational intervention by telephone to improve maternal self-efficacy in breastfeeding, its duration and exclusivity. This is a Randomized Controlled Clinical Trial that compared two groups: Control Group (CG) (routine care) and Intervention Group (IG) (routine care + educational intervention to promote breastfeeding self-efficacy, following the principles of Motivational Interviewing (MI) by phone, with contacts being held 7, 15 and 30 days after delivery). Study conducted in Fortaleza-CE, Brazil, at the Gonzaga Mota District Hospital in Messejana between May and August 2015. At the end, we obtained a sample of 85 nursing mothers at the second month postpartum, with 41 in the IG and 44 in the CG, and 77 nursing mothers at the fourth month postpartum, 39 in IG and 38 in CG. The study was conducted in three phases: 1. Baseline; 2. Intervention; 3. Evaluation of outcomes at second and fourth month postpartum. For data collection in Phase 1, we used the Form for characterization of nursing mothers and the Breastfeeding Self-Efficacy Scale â Short Form (BSES-SF); in Phase 2, for the intervention, we applied a form containing data about the childâs diet and type of items covered in the session. A form was applied to guide the intervention on the MI approach. Furthermore, to implement the MI technique to inform, it was used an instrument based on the 14 items of the BSES-SF and the Serial Album âI can breastfeed my childâ; in Phase 3, it was applied a form containing the type of breastfeeding, its duration and exclusivity, along with the BSES-SF. Data were analyzed through the Statistical Package for Social Sciences (SPSS) version 20.0 for Windows. Research Ethics Committee approved the study under protocol No. 1,026,156 and it was registered in the Brazilian Clinical Trials Registry (ReBec) platform. As for the characterization, the groups were similar (p>0.05), except for marital status (p=0.018). In the intergroup self-efficacy evaluation, it was identified that the median scores in the breastfeeding self-efficacy scale were the same at the second month in both groups (p=0.773). Nevertheless, at the fourth month, the IG presented higher levels compared with the CG (p=0.011). In the intergroup evaluation of breastfeeding duration, it was evidenced that the educational intervention was able to maintain significantly breastfeeding until the second month (p=0.035) in the IG, while the CG presented a decrease. In the fourth month, it was also possible to identify that the IG maintained breastfeeding for a longer duration than the CG (p=0.109). With regard to the intergroup evaluation of exclusive breastfeeding, it was noted that the IG and CG presented small differences in exclusivity at the second and fourth months (p=0.983/p=0.573). It was found that women with high education and who breastfed immediately after birth were more likely to breastfeed for a longer period. Additionally, women living with a partner are more likely to practice exclusive breastfeeding at the fourth month. Therefore, data showed that the implementation of educational intervention carried out by nurses via telephone focused on breastfeeding self-efficacy and through motivational interviewing increases the self-efficacy of mothers to breastfeed, as well as the duration of breastfeeding, but does not impact its exclusivity.
Objetivou-se avaliar o efeito de uma intervenÃÃo educativa por telefone para a melhoria da autoeficÃcia materna em amamentar, duraÃÃo e exclusividade do aleitamento materno. Trata-se de um Ensaio ClÃnico Randomizado Controlado no qual foram comparados dois grupos: Grupo Controle (GC) (cuidados de rotina) e Grupo IntervenÃÃo (GI) (cuidados de rotina + intervenÃÃo educativa para a promoÃÃo da autoeficÃcia em amamentar, seguindo os princÃpios da Entrevista Motivacional (EM), com o uso do telefone sendo realizado contatos com 7, 15 e 30 dias pÃs-parto). Estudo desenvolvido em Fortaleza-CE, no Hospital Distrital Gonzaga Mota de Messejana entre maio e agosto de 2015. Ao final, obteve-se uma amostra de 85 lactantes aos dois meses pÃs-parto, sendo 41 no GI e 44 no GC e 77 lactantes aos quatro meses pÃs-parto, sendo 39 no GI e 38 no GC. O estudo foi desenvolvido em trÃs fases: 1. Linha de Base; 2. IntervenÃÃo; 3. AvaliaÃÃo dos desfechos aos 2 e 4 meses pÃs-parto. Para a coleta de dados, na Fase 1, utilizou-se o FormulÃrio de caracterizaÃÃo das lactantes e a Breastfeeding Self-Efficacy Scale â Short Form (BSES â SF); na Fase 2, para a intervenÃÃo foi utilizado formulÃrio contendo dados sobre o tipo de dieta da crianÃa e itens abordados na sessÃo. Foi utilizado um formulÃrio para guiar a intervenÃÃo quanto a abordagem da EM. E para utilizar a tÃcnica de informar da EM utilizou-se um instrumento baseado nos 14 itens da BSES-SF e do Ãlbum Seriado âEu posso amamentar meu filhoâ; na Fase 3 foi aplicado um formulÃrio contendo o tipo de aleitamento materno, duraÃÃo e exclusividade da amamentaÃÃo e foi novamente aplicado a BSES-SF. Os dados foram analisados utilizando o Statistical Package for the Social Sciences (SPSS), versÃo 20.0 para Windows. A pesquisa foi aprovada pelo ComitÃ de Ãtica e Pesquisa sob protocolo 1.026.156 e registrado na plataforma de Registro Brasileiro de Ensaios ClÃnicos (ReBEC). Quanto a caracterizaÃÃo, os grupos eram semelhantes (p>0,05), com exceÃÃo do estado civil (p=0,018). Na avaliaÃÃo intergrupo da autoeficacia foi visto que a mediana dos escores da escala de autoeficÃcia em amamentar foi a mesma aos dois meses em ambos os grupos (p=0,773), no entanto, aos quatro meses o GI apresentou nÃveis mais elevados em comparaÃÃo com o GC (p=0,011). Na avaliaÃÃo intergrupo da duraÃÃo do aleitamento materno evidenciou-se que a intervenÃÃo educativa foi capaz de manter o AM atÃ dois meses de forma significativa (p=0,035) no GI, enquanto que no GC houve uma queda. Em relaÃÃo ao quarto mÃs, tambÃm foi possÃvel perceber que o GI manteve maior duraÃÃo do AM do que o GC (p=0,109). Em relaÃÃo a avaliaÃÃo intergrupo da exclusividade do aleitamento materno foi visto que o GI e o GC apresentaram pequenas diferenÃas em relaÃÃo a exclusividade aos dois e quatro meses (p=0,983/p=0,573). Foi possÃvel observar que as mulheres com alta escolaridade e as que amamentaram imediatamente apÃs o parto apresentam maiores chances de amamentar por mais tempo. E que as mulheres que vivem com o parceiro tÃm mais chance de praticar aleitamento materno exclusivo aos quatro meses. Dessa forma, os dados evidenciaram que a aplicaÃÃo de intervenÃÃo educativa realizada pela enfermeira via telefone centrada na autoeficÃcia em amamentar e utilizando a entrevista motivacional eleva a autoeficÃcia das mÃes em amamentar, aumenta a duraÃÃo do AM, porÃm nÃo impacta na exclusividade do AM.

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Wilson, Amie. "Interventions to reduce maternal mortality in developing countries : a systematic synthesis of evidence". Thesis, University of Birmingham, 2014. http://etheses.bham.ac.uk//id/eprint/5147/.

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Background: Every year 287,000 women die from pregnancy related complications. Methods: Systematic reviews of interventions to reduce maternal mortality in developing countries with meta-analysis or meta-synthesis where appropriate. Results: Participatory learning and actions cycles with women’s groups significantly reduce maternal and neonatal mortality, training and supporting TBAs also reduces perinatal mortality. Clinical officers performing caesareans section do not seem to cause any more maternal or perinatal mortalities than doctors. Prophylactic antibiotics reduce infectious morbidity in surgical abortion, yet the effect on miscarriage surgery is unclear. Cell salvage in ectopic pregnancy and caesarean section appear to be a safe and effective alternative in the absence of homologous transfusion. Motivational interviews may have potential to improve contraceptive use short term. Symphysiotomy may be a safe alternative to caesarean section. The anti-shock garment may improve outcomes when used in addition to standard obstetric haemorrhage management. Potential solutions to emergency transport for pregnant women include motorcycle ambulance programmes, collaboration with local minibus taxis services, and community education and insurance schemes. Conclusion: Several interventions reviewed in this thesis can be utilised to aid reduction in maternal mortality, however the level of evidence available within each review varies, some allowing firm inferences with others more tentative.

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Elahi, Maqsood M. "Effects of maternal high fat diet and pharmacological intervention on the developmental origins of metabolic & cardiovascular disease". Thesis, University of Southampton, 2011. https://eprints.soton.ac.uk/372924/.

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A high fat (HF) diet leads to hypercholesterolemia and predisposes the individual to developing cardiovascular disease (CVD). We hypothesised that mother‘s HF diet before and during pregnancy and lactation can also influence predisposition to CVD in offspring fed a similar diet. The thesis sets out to investigate whether (1) the effects of long-term consumption of a HF diet by the mother predisposes her offspring to developing a CVD/ metabolic syndrome in adult life and (2) pharmacological intervention using statin alleviates the detrimental effects of maternal HF diet on the health of the dams and their offspring. Female C57BL/6 mice were fed either a HF diet (45% kcal fat) or standard chow (C; 21% kcal fat) from weaning through pregnancy and lactation. Pregnant C57/BL6 mice on HF diet were further given pravastatin in the drinking water (5 mg/kg of body weight per day) either short-term (2nd half of pregnancy and during lactation) or long-term (from weaning through to pregnancy and lactation) to lower cholesterol and improve post-weaning maternal blood pressure. Weaned female offspring from each group were then fed either a HF or C diets to adulthood. Body weight, blood pressure, plasma cholesterol, C-reactive protein (CRP) and bone marrow derived endothelial progenitor cells (EPC) were measured at 24, 28 and 36 weeks post-weaning in different experiments. Histology of the liver and kidneys were performed. Offspring from hypercholesterolemic mothers on HF diet were significantly obese (bodyweight in grams; 17.2+4.2 vs. 13.8+4.7; P<0.05), hypertensive (SBP mmHg; 134+4.2 vs. 117+3.4; P<0.001), less active (distance in cm; 312 + 31 vs. 563 + 45; P<0.001), demonstrated increased lipid laden vacuoles in liver and kidneys; and showed reduced expression of EPC (P<0.05) than offspring from C dams independent of their postnatal nutrition respectively. Pravastatin therapy in HF mothers resulted in abrogation of these variables in offspring independent of post weaning nutrition (P<0.05). The effects were more permanent when the dams were given long-term statin treatment. The study demonstrates that long-term maternal HF feeding from weaning through pregnancy and lactation predisposes offspring to hypertension, raised plasma lipids, fatty liver, kidney disorders, raised CRP and inhibition of EPC numbers and expression in offspring. Pravastatin treatment of these dams inhibits these effects on the offspring and may reduce their risk of later cardiovascular pathophysiology. The findings may have implications for understanding the effects of the ‗nutritional transition‘ to higher dietary intake of fat which could lead to increased cardiovascular disease in many societies.

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Osterman, Robin Lynn. "Motivational Interviewing Intervention to Decrease Alcohol Use During Pregnancy". University of Cincinnati / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1243021605.

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Mbabazi, Muniirah. "Exploring the efficacy of maternal, child health and nutrition interventions in Uganda". Thesis, University of Nottingham, 2017. http://eprints.nottingham.ac.uk/48215/.

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Introduction and background: Malnutrition, particularly undernutrition remains a major development challenge for sub-Saharan Africa. There has been mixed progress in reducing undernutrition and the numbers remain unacceptably high. However, high impact nutrition interventions have been recommended for implementation in high burden malnutrition countries to address undernutrition. Countries have responded by designing policies and programmes that reflect these recommendations. However, there is limited evidence of what works and how in local contexts. Objectives: This research explored the efficacy of nutrition interventions and modality of delivery of interventions and programmes in Uganda at national, local government and community levels. Specifically this study examined key stakeholders’ experiences of current nutrition interventions at district level in Uganda; assessed the effectiveness of previous nutrition specific and nutrition sensitive interventions on maternal and child health outcomes in Uganda; and examined the relationship between socio demographic and health factors on nutrition outcomes in Uganda. Methods and subjects: Using a combination of methods (mixed methods), this study explored nutrition interventions targeting mothers of reproductive age and children (0-5 years) in three separate studies. A systematic review was conducted to explore existing evidence on the nature of maternal and child health and nutrition interventions; and methods used to deliver them since 1986-2014. Studies were included if they were done in Uganda and reported health and nutrition related outcomes among the study group. Included studies were assessed for quality using the Newcastle Ottawa Scale. Twenty-two predominantly cross-sectional and longitudinal studies were included in the review. A qualitative study covering project implementers and project beneficiaries (n=85) in local communities was conducted using face-to-face interviews. Interviews explored methods used to deliver interventions and implementers’ and community participants’ perspectives and experiences of on-going nutrition interventions at local government (LG) and community level. Community beneficiaries were mothers or caretakers of children aged 0-59 months accessing interventions from two studied projects, while implementers were project staffs or health workers on the same projects. Interviews were transcribed verbatim and thematically analysed. Population based data of the 2011 Uganda demographic and health Survey (DHS) was quantitatively analysed. Logistic regressions analyses were done to establish factors that influence child stunting and anaemia in Uganda. Models were constructed based on 2350 stunted and 2056 child anaemia cases in the data set. Using a multilevel model design of mixed methods research, findings from each study were triangulated to obtain complementary information on the study phenomena. Results: Results suggest that planning and implementation of nutrition interventions in Uganda has transformed from random to systematic implementation since 1986. Nutrition interventions delivered diverse activities to address multiple causes of undernutrition in Uganda. However, activities were predominantly non-integrated delivered specifically at facilities or in communities. Methods of delivering interventions were broad to include community and health system compatible strategies (community mobilisation, outreaches and individual or group nutrition education and counselling) to prevent, manage and treat undernourished cases at facilities and within communities. Results further showed that maternal anaemia status, age of child and geographic factors were associated with stunting and anaemia in children. Further, the qualitative study showed, there was a conducive policy environment to implement multi-sectoral nutrition interventions in Uganda. There were linkages, collaborations and partnerships to delivery multi-sectoral integrated nutrition actions in communities and LG. Results however reveal that the dominance of external partners in implementing nutrition interventions; and absence of functional coordinating structures and mechanisms hinders intervention scale up. Further there was a need to address system and community barriers that affect implementation to improve nutrition outcomes and scale up at LG and community level. Conclusion: There have been great strides towards solving challenges of malnutrition in Uganda. Integrated approaches using community mobilisation and nutrition education and counselling at health facilities were among common delivery methods. However, bottlenecks exist in prioritisation and commitment to scale. There is a need to strengthen integrated approaches to delivering interventions across the LG and communities for multi-sectoral programming and implementation to reduce the number of undernourished Ugandans.

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Israfil-Bayli, Fidan. "Cerclage outcome by the type of suture material (COTS) study : randomised pilot/feasibility study comparing monofilament (intervention) sutures versus multifilament (comparison) for cervical cerclage". Thesis, University of Birmingham, 2018. http://etheses.bham.ac.uk//id/eprint/8565/.

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COTS provided the necessary information for planning a definitive trial investigating the clinical effectiveness of monofilament non-braided suture materials in reducing pregnancy loss rate following cervical cerclage compared to the traditional multifilament braided sutures. COTS study was a stepwise process, which initially involved retrospective data analysis and later was supported by the evidence from national survey and systematic review. Evidence from retrospective analysis and systematic review confirmed that the research question about the suitability of multifilament/braided sutures in cervical cerclage; and that they may be associated with poor obstetric outcome. The Systematic review confirmed that at the time of writing there were no RCTs addressing this issue. Our national survey proved that this scientific question is of significant interest to the Obstetrical community and that the practice with cerclage varies across the country. Based on the findings of COTS trial, funding was sought from the NIHR HTA programme, and we were successful in being awarded £1.2 million (co-applicant) to conduct a multi-centre randomised controlled trial (RCT): The C-STICH trial Cerclage Suture Type for an Insufficient Cervix and its effect on Health outcomes Trial.

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Lundgren, Ingela. "Releasing and relieving encounters : Experiences of pregnancy and childbirth". Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2002. http://publications.uu.se/theses/91-554-5292-2/.

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Wipplinger, Petro. "Is an educational intervention effective in improving the diagnosis and management of suspected ectopic pregnancy in a tertiary referral hospital in South Africa". Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/5241.

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Thesis (MMed (Obstetrics and Gynaecology))--University of Stellenbosch, 2010.
ENGLISH ABSTRACT: Study objective: To investigate whether an educational intervention in the Gynaecology Department of Tygerberg Hospital (TBH) was effective in improving the accuracy of the diagnosis and appropriateness of treatment options offered to women with suspected Ectopic Pregnancy (EP). Methods: A retrospective cross-sectional before-and-after study was performed, including 335 consecutive patients with suspected EP before (1/3 - 30/6/2008) and after (1/9 - 31/12/2008) “the intervention”. From the gynaecological admissions register all pregnant patients with symptoms potentially compatible with EP were selected and these were cross referenced with beta-hCG requests, entries in the theatre register for surgery for possible EP and methotrexate prescriptions for EP in these time periods. “The intervention” consisted of a formal lecture presented to the registrars and consultants regarding the latest evidence-based guidelines concerning the diagnosis and management of EP. An algorithm based on this information was introduced in the emergency unit and ultrasound unit together with a prescribed ultrasound reporting form containing all the pertinent information required to follow the algorithm. Clinical decisions were left to the registrar and consultant on duty. Primary outcomes: Time from presentation to treatment, number and appropriateness of special investigations, surgical procedures or medical management. Secondary outcomes: Number of in-patient days and visits, adherence to the algorithm. Results: There was a non-significant trend towards improved reporting of the uterine content and significantly less reports of definite signs of an intrauterine pregnancy (IUP) (p<0.001, RR 0.46, 95% CI 0.31-0.70) due to stricter ultrasound criteria being followed. There was a significant change in the spectrum of uterine findings (p=0.001), the spectrum of adnexal findings (p=0.006) and the spectrum of free fluid noted (p=0.05). There was a reduction in the total number of beta-hCG levels requested at presentation (patients with no beta-hCG: 24 vs 34, p=0.05, RR 1.60, 95% CI 0.99-2.59) with a significant reduction in the number of inappropriate beta-hCG requests (77 vs 40, p<0.001, RR 0.60, 95% CI 0.43-0.81). There was a significant difference in the spread of the number of beta-hCG tests per patient with less repeat tests in the study group (p=0.021). Significantly less manual vacuum aspirations (MVAs) were performed (47 vs 21, p=0.003, RR 0.51, 95% CI 0.32-0.81) but there was no change in the other treatment modalities offered nor in the time from presentation to treatment, number of visits or in-patient days. Adherence to the algorithm was poor (59 %). Conclusions: Except for a significant decrease in the MVAs performed, with possibly less interrupted early intrauterine pregnancies, the improvement in the use of special investigations after “the intervention” did not translate into fewer inappropriate diagnoses and management. This could be due to frequent non-adherence to the algorithm, and widespread implementation of the algorithm as well as continuous audits would be necessary before a future study could be attempted to assess the efficacy of the algorithm.
AFRIKAANSE OPSOMMING: Studiedoelwit: Die hoofdoel van hierdie studie is om te ondersoek of „n opvoedkundige intervensie in die Ginekologiese afdeling van Tygerberg Hospitaal (TBH) doeltreffend sou wees in die verbetering van die akkuraatheid van diagnose en die gepastheid van behandelingsopsies wat aan vroue gebied word met „n vermoedelike ektopiese swangerskap (ES). Metodes: „n Retrospektiewe, kruisdeursnee voor-en-na studie rakende 335 opeenvolgende pasiënte wat ‟n vermoedelike ES het voor (1/3/2008 – 30/6/2008) en na (1/9/2008 – 31/12/2008) “die intervensie”. Swanger pasiënte is uit die ginekologiese toelatingsregister geselekteer indien hulle simptome gehad het wat moontlik verbind kon word met ES. Hulle is kruisverwys met die beta-hCG‟s aangevra, inskrywings in die teaterregister vir chirurgie vir moontlike ES en ginekologie-pasiënte wat metotrexate vir ES binne hierdie tydperke ontvang het. “Die intervensie” het bestaan uit „n formele lesing aan die kliniese assistente en konsultante ten opsigte van die jongste bewysgebaseerde riglyne rakende die diagnose en hantering van ES. „n Algoritme gegrond op hierdie inligting is in die noodeenheid en ultraklank-afdeling ten toon gestel asook „n voorgeskrewe ultraklank rapporteringsvorm met al die toepaslike inligting wat vereis word om die algoritme te volg. Kliniese besluite is aan die kliniese assistent en konsultant aan diens oorgelaat. Primêre uitkomste: Tydsduur vanaf aanmelding tot behandeling, aantal en gepastheid van spesiale ondersoeke, chirurgiese prosedures en mediese hantering. Sekondêre uitkomste: Die aantal binnepasiëntdae en besoeke, nakoming van die algoritme. Resultate: Daar was „n nie-betekenisvolle neiging tot beter rapportering van die uteriene-inhoud en betekenisvol minder rapportering van definitiewe tekens van „n intra-uteriene swangerskap (IUS) (p<0.001, RR 0.46, 95% CI 0.31-0.70) as gevolg van strenger ultraklankstandaarde gevolg. Daar was „n betekenisvolle verandering in die spektrum van uteriene bevindinge (p=0.001), die spektrum van die adneksale bevindinge (p=0.006) en die spektrum van die vrye vog aangeteken (p=0.05). Daar was „n vermindering in die totale aantal beta-hCG-vlakke aangevra met aanmelding (pasiënte met geen hCG: 24 vs 34, p=0.05, RR 1.60, 95% CI 0.99-2.59) met „n betekenisvolle vermindering in die aantal onvanpaste beta-hCGs aangevra (77 vs 40, p<0.001, RR0.60, 95% CI 0.43-0.81). Daar was „n betekenisvolle verskil in die verspreiding van die aantal beta-hCG-toetse per pasiënt, met minder herhalende toetse in die studiegroep (p=0.021). Betekenisvol minder manuele vakuum aspirasies (MVAs) is uitgevoer (47 vs 21, p=0.003, RR 0.51, 95% CI 0.32-0.81), maar geen verskil in ander behandelingsmodaliteite is aangebied nie, asook geen verskil in die tydsduur vanaf aanmelding, die aantal besoeke of die aantal binnepatiëntdae nie. Nakoming van die algoritme was swak (59%). Gevolgtrekkings: Behalwe vir „n betekenisvolle afname in die MVAs uitgevoer, met moontlik minder onderbroke vroeë IUS, het die verbetering in die gebruik van spesiale ondersoeke ná “die intervensie” nie minder onvanpaste diagnoses en hantering tot gevolg gehad nie. Dit kan die gevolg wees van gereelde nie-nakoming van die algoritme, en uitgebreide implementering van die algoritme asook voortdurende oudits sal nodig wees voor „n verdere studie aangepak kan word om die doeltreffendheid van die algoritme te bepaal.

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Van, Niekerk Elizabeth C. "Evaluation of a quality improvement cycle intervention in the provision of PMTCT at a regional hospital". Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/85669.

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Thesis (MMed)-- Stellenbosch University, 2013.
ENGLISH ABSTRACT: The vast majority of new Human Immunodeficiency Virus (HIV) infections in infants and young children occur through mother-to-child-transmission (MTCT), either during pregnancy, labour or delivery or by breastfeeding. Without access to perinatal MTCT (PMTCT) programmes approximately 30% of all babies born annually will be infected with HIV. OBJECTIVES The aim was to implement and audit a quality improvement cycle at the Worcester Obstetric Unit, which comprises of Worcester Hospital, a regional hospital in the Western Cape Province and its level one midwife obstetric Unit (MOU), in order to improve the quality of the PMTCT programme. The intervention included the implementation of easy changes and tools in the Antenatal Clinic, Infectious Diseases Clinic and Labour ward. METHODS The files and antenatal records of all HIV positive patients and patients with an unknown HIV status, who delivered at the Worcester Obstetric Unit during January, February and March of 2010 and 2011, were reviewed. All HIV negative patients and patients that had stillbirths and miscarriages were excluded. The pre-interventional findings of 2010 were compared with the post-interventional findings of 2011. RESULTS At the Worcester Obstetric Unit, for the study time period, there were 907 deliveries in 2010, of which 102 (11.2%) patients were HIV positive and 4 (0.4%) had an unknown HIV status compared to 2011, with 865 deliveries of which 108(12.5%) patients were HIV positive and no patients had an unknown HIV status. Significantly more patients were diagnosed with HIV before they fell pregnant than during pregnancy in the 2011 group, when compared with the 2010 group. A CD4 count was done on 94% of patients who were newly diagnosed with HIV and those with an unknown CD4 count result in the 2010 group, compared to 92% in 2011. There was a significant improvement after the intervention in the time it took from when blood was drawn for a CD4 count until the result was followed up, the median time decreased from 34 to 8 days (p=0.000001). Significantly more patients qualified for highly active antiretroviral therapy (HAART) after the guidelines were changed and the CD4 cut off was increased to 350 cells/l (p=0.001). Prior the intervention 18 patients did not receive the correct management before delivery due to preventable reasons, compared to one at the MOU. After the intervention this decreased significantly to only one patient at Worcester Hospital and none at the MOU (p=0.000001). Before the intervention adherence to the PMTCT protocol at the MOU was significantly better than at the hospital (p=0.0005) and after the intervention there was no significant difference (p=1.0). CONCLUSION Although the audit and quality improvement cycle was performed at a single hospital, with specific changes geared towards their needs, the basic principles can be applied to any Unit in the country providing a PMTCT service. Educating staff, creating awareness and reminding staff of the basic principles of PMTCT, implementing small changes and streamlining processes and setting specific goals or timelines, can lead to significant improvements in care, which ultimately will lead to a decrease in PMTCT of HIV and HIV related maternal and infant morbidity and mortality.
AFRIKAANSE OPSOMMING: Die oorgrote meerderheid (>90%) van nuwe Menslike Immuniteitsgebreksvirus (MIV) infeksies in babas en jong kinders vind plaas deur middel van moeder-na-kind-oordrag, hetsy gedurende swangerskap, die kraamproses of borsvoeding. Sonder toegang tot perinatale voorkomingsprogramme (PMTCT) sal ongeveer 30% van alle babas jaarliks met MIV geïnfekteer word. DOELWITTE Die doel van die studie was om ‘n gehalteverbeteringsiklus by die Worcester Verloskunde Eenheid, wat bestaan uit Worcester Hospitaal, 'n streekshospitaal in die Wes-Kaapprovinsie en sy vlak een vroedvrou verlossingseenheid (VVE), te implementer en daarna te oudit, om sodoende die gehalte van die PMTCT-program te verbeter. Die intervensie het bestaan uit die implementering van eenvoudige veranderinge en prosesse in die voorgeboortekliniek, infeksiesiekte-kliniek en kraamsaal. METODES Die lêers en voorgeboorte rekords van alle MIV-positiewe pasiënte en pasiënte met 'n onbekende MIV-status, wat gedurende Januarie, Februarie en Maart van 2010 en 2011 verlos het by die Worcester Verloskunde Eenheid, is nagegaan. Alle MIV-negatiewe pasiënte en pasiënte met doodgebore babas en miskrame is uitgesluit. Die pre-intervensie bevindings van 2010 is vergelyk met die post-intervensie bevindings van 2011. RESULTATE By die Worcester Verloskunde Eenheid was daar 907 geboortes gedurende die studietydperk in 2010, waarvan 102 (11,2%) pasiënte MIV-positief was en 4 (0,4%) met ‘n onbekende MIV-status. In 2011 was daar 865 geboortes waarvan 108 (12,5%) pasiënte MIV-positief was en geen met 'n onbekende MIV-status. In die 2011-groep is beduidend meer pasiënte gediagnoseer met MIV voor as tydens swangerskap. In die 2010-groep is daar 'n CD4-telling gedoen vir 94% van nuut gediagnoseerde pasiënte en diegene met 'n onbekende CD4-telling, in vergelyking met 92% in 2011. Daar was 'n beduidende verbetering na die intervensie in die tyd wat dit geneem het vandat bloed getrek is vir 'n CD4-telling totdat die resultaat opgevolg is. Die mediane tyd het verminder vanaf 34 na 8 dae (p = 0.000001). Nadat die riglyne vir kwalifisering vir hoogs aktiewe antiretrovirale terapie (HAART) verander is na ‘n CD4 telling 350 selle/l het daar beduidend meer pasiënte gekwalifiseer vir HAART. By Worcester Hospitaal het 18 pasiënte voor die intervensie nie die korrekte behandeling intrapartum ontvang nie weens voorkombare redes, in vergelyking met slegs een pasiënt by die VVE. Na die intervensie was daar ‘n beduidende afname na slegs een pasiënt by Worcester Hospitaal en geen by die MOU (p = 0.000001). Voor die intervensie was die korrekte uitvoering van die PMTCT-protokol by die MOU beduidend beter as by die hospitaal (p = 0,0005) en na die intervensie was daar geen beduidende verskil (p = 1.0). GEVOLGTREKKING Alhoewel die oudit en gehalteverbeteringsiklus uitgevoer is by 'n enkele hospitaal, met spesifieke veranderinge gerig tot hul behoeftes, kan die basiese beginsels toegepas word in enige eenheid in die land wat ‘n PMTCT diens verskaf. Opvoeding van personeel en bewusmaking rakende die basiese beginsels van PMTCT, klein veranderinge en die vaartbelyning van prosesse by die voorgeboorte klinieke en die stel van spesifieke doelwitte of tydlyne, kan lei tot aansienlike verbeteringe in pasiënte sorg. Dit sal uiteindelik lei tot 'n afname in die MIV oordrag van moeder na kind, asook MIV-verwante morbiditeit en mortaliteit in moeders en kinders.

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Boson, Maria, i Sofia Sundlöf. "Skiljer sig interventioner och förlossningsutfall mellan äldre och yngre förstföderskor med spontan värkstart? : en kvantitativ retrospektiv tvärsnittsstudie". Thesis, Högskolan Dalarna, Institutionen för hälsa och välfärd, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:du-38412.

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Bakgrund: Förstföderskors ålder ökar i höginkomstländer och med stigande ålder ökar risken för graviditetsrelaterade komplikationer. Även andelen interventioner som avser att sätta igång, förstärka progressen och övervaka den fysiologiska förlossningsprocessen ökar. Syfte: Syftet med examensarbetet var att undersöka om antalet interventioner och förlossningsutfall vid ett medelstort sjukhus i västra Sverige skiljer sig mellan äldre förstföderskor (≥35 år) och yngre förstföderskor (20–24 år) med spontan värkstart. Metod: Examensarbetet var en kvantitativ retrospektiv tvärsnittsstudie där data samlats in under ett år. Materialet som bestod av 232 förstföderskor bearbetades med deskriptiv och jämförande statistiska analyser. Resultat: Det var vanligare att äldre förstföderskor fick utökad fosterövervakning och att de födde barn som vägde 4500 gram eller mer jämfört med yngre förstföderskor. Oavsett ålder födde förstföderskorna vanligtvis vaginalt och interventioner som värkstimulerande dropp och skalpelektrod användes vid runt hälften av förlossningarna. Slutsats och klinisk tillämpbarhet: Få signifikanta skillnader fanns mellan de jämförda åldersgrupperna. Examensarbete visade att det behövs en individuell bedömning av varje kvinna eftersom åldersförändringar sker gradvis. Som barnmorska måste man beakta att ålder bara är en faktor i bedömningen av den födande kvinnan och vara medveten om att man påverkas av den kulturella kontexten och organisationen.
Background: The age of first-time mothers increases in high-income countries and with increasing age, the risk of pregnancy related complications gets more common. The proportion of interventions that are needed to initiate, strengthen and monitor the psychological birth process is also increasing. Aim: The aim of this study was to investigate if interventions and delivery outcomes differ between older nulliparous women (≥35 years) and younger nulliparous women (20–24 years) with spontaneous onset of labor. Method: We conducted a quantitative retrospective cross-sectional study where data were collected from a hospital in Sweden. The material, which consisted of 232 nulliparous women, was processed with descriptive and comparative statistical analyzes. Results: In our study, we found that older nulliparous women more often received extended fetal monitoring and gave birth to babies weighing 4,500 grams or more compared to younger nulliparous women. Regardless of age, nulliparous gave birth vaginally and interventions such as administration of oxytocin and fetal scalp electrodes were used in around half of the births. Conclusion and clinical implications: There were few significant differences between the compared age groups. Our study didn’t show large differences between the age groups, however, research shows that age is a risk factor. As a midwife, you must consider that age is only one factor in assessing the woman giving birth.

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Massawe, Siriel Nanzia. "Anaemia in women of reproductive age in Tanzania : A study in Dar es Salaam". Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2002. http://publications.uu.se/theses/91-554-5308-2/.

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Umscheid, Dana Marie. "A comparison of two modes of delivery of an educational intervention to encourage compliance with American College of Obstetrics and Gynecology recommendations regarding the gynecological exam among sorority women". [Bloomington, Ind.] : Indiana University, 2008. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3324541.

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Thesis (Ph.D.)--Indiana University, School of Health, Physical Education and Recreation, 2008.
Title from PDF t.p. (viewed on May 14, 2009). Source: Dissertation Abstracts International, Volume: 69-08, Section: B, page: 4707. Adviser: Nancy T. Ellis.

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Machado, Angélica Pontes. "Fatores que influenciam a produção de colostro em porcas". reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2014. http://hdl.handle.net/10183/94614.

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O colostro é fonte de energia e imunidade aos leitões neonatos. Para que a ingestão de colostro seja satisfatória, de modo a garantir a sobrevivência e ganho de peso dos leitões, as porcas devem produzir colostro suficiente para suprir as necessidades de toda a leitegada. O objetivo deste estudo foi avaliar fatores relacionados à fêmea, à leitegada e ao trabalho de parto que poderiam influenciar a produção de colostro em suínos. Foram utilizadas 96 matrizes suínas Camborough 25® com ordem de parto 1 a 7 e parição espontânea. As fêmeas e as leitegadas foram acompanhadas até 24 h após o início do parto. A produção de colostro foi estimada pela soma do consumo individual dos leitões, baseado no ganho de peso durante o primeiro dia de vida. O modelo de regressão múltipla explicou 28% da produção de colostro, sendo 24% explicados pelo peso total dos leitões nascidos vivos e 4% pela largura do primeiro par de tetos. O peso total dos leitões nascidos vivos foi correlacionado com o número total de leitões nascidos (r= 0,73) e nascidos vivos (r= 0,83). Quando separadas em duas classes de produção de colostro (ALTAPCOL; >3,4 kg; n = 50 vs BAIXAPCOL; ≤3,4 kg; n = 46), as fêmeas BAIXAPCOL tiveram menor número de leitões nascidos vivos e menor peso da leitegada viva (P<0,05). Por análise de regressão logística, foi verificado que fêmeas de OP 1, 2 e >3 apresentaram maior chance (P≤0,05) de estar no grupo BAIXAPCOL do que as fêmeas de OP 3. Fêmeas com mais de uma intervenção obstétrica no parto tiveram maior chance (P<0,05) de serem fêmeas BAIXAPCOL, em comparação ao grupo de fêmeas sem intervenções no parto. Este estudo evidenciou que o fator que mais influencia a produção de colostro é o peso total da leitegada viva, indiretamente representando o número de leitões amamentados pela porca.
Colostrum provides newborn piglets with energy and with passive immunity. An adequate colostrum intake, in order to fulfill the needs of piglets and then ensure their survival and weight gain, depends on sow’s ability to produce enough colostrum for the whole litter. The aim of this study was to evaluate factors involved on colostrum yield variability related to the sow, the litter and farrowing process. The experiment was conducted with 96 Camborough 25® sows of parities one to seven whose farrowing was spontaneous. Sows and their litters were followed until 24 h after farrowing onset. Colostrum production was estimated by summing up colostrum intake of each piglet of the litter. Colostrum ingestion by individual piglets was estimated using piglet weight gain during the first 24 h of life. The multiple regression model explained 28% of variation in colostrum yield, with 24% and 4% of variation being explained by the litter weight at birth and the width of first mammary glands, respectively. Litter weight at birth was positively correlated with the number of total born (r = 0.73) and liveborn piglets (r = 0.83).When separated into two classes of colostrum yield (HIGHPROD; >3.4 kg; n= 50 vs LOWPROD; ≤3.4 kg; n= 46), LOWPROD sows had lighter litters and fewer total born and liveborn piglets (P < 0.05). The logistic regression analysis showed that sows from parities 1, 2 and >3 had greater odds (P ≤ 0.05) to be in the LOWPROD group than parity 3. Sows with two or more obstetrical interventions had higher odds (P < 0.05) of belonging to the LOWPROD group than sows without interventions at farrowing. This study showed that litter weight at birth is the most important factor involved in colostrum yield variability, indirectly representing the number of piglets nursed by the sow.

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Stanley, Leisa J. "Association among neonatal mortality, weekend or nighttime admissions and staffing in a Neonatal Intensive Care Unit". [Tampa, Fla.] : University of South Florida, 2008. http://purl.fcla.edu/usf/dc/et/SFE0002421.

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Ferriols, Pérez Elena. "Efecto de una intervención educativa sobre la frecuencia y adecuación de la asistencia a urgencias de las embarazadas de nuestra área". Doctoral thesis, Universitat Autònoma de Barcelona, 2015. http://hdl.handle.net/10803/325158.

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Las visitas inadecuadas a urgencias, que podrían ser resueltas en atención primaria, son frecuentes, y suponen un gasto sanitario que podría reducirse. Los objetivos de nuestro trabajo son: Describir la adecuación de las visitas de las mujeres embarazadas al servicio de urgencias de nuestro centro, tratando de identificar los factores de riesgo para la generación de visitas inadecuadas; elaborar y validar un tríptico informativo sobre los posibles síntomas que pueden aparecer durante el embarazo y qué hacer si aparecen y conocer la eficacia, para reducir las visitas inadecuadas y la frecuentación a urgencias de esta intervención educativa, mediante un estudio de intervención aleatorizado. Se revisaron 1743 visitas a urgencias de obstetricia, clasificándose los motivos de consulta de acuerdo con los tres niveles de adecuación: adecuados, medianamente adecuados e inadecuados. Estos motivos fueron adecuados en los 38,9%, moderadamente adecuados en el 46,7% e inadecuados en el 14,4%. Aquellas pacientes con antecedentes de una muerte perinatal o una gestación de mayor riesgo tendieron a distribuir sus motivos de consulta en los grupos de motivos moderadamente adecuados e inadecuados (marginalmente significativo). Se encontró una tendencia hacia los motivos de consulta más apropiados en embarazos más evolucionados, y menos adecuados en gestaciones más tempranas. El número de fetos a término, pretérmino y abortos previos, se mostraron como variables que no modificaban el nivel de adecuación de forma estadísticamente significativa. Nuestros datos demuestran que la cantidad de visitas inadecuadas y moderadamente adecuadas podría reducirse en un 61% mediante la aplicación de diferentes intervenciones, lo que reduciría de igual modo el gasto sanitario. El tríptico fue validado por cuatro expertos en Obstetricia y por un grupo de 19 gestantes y puérperas. Éste fue repartido en un grupo caso de 209 pacientes embarazadas, aprovechando la primera ecografía de seguimiento y fue comparado a un grupo control de 216 pacientes. No se hallaron diferencias significativas entre los grupos caso y control con respecto a la variable principal Nivel de Adecuación, tampoco en la frecuentación a urgencias entre ambos grupos, siendo de 1,83 visitas de media para ambos grupos. Se hallaron diferencias estadísticamente significativas en el requerimiento de ecografía (mayor en el grupo caso), sin embargo no se hallaron diferencias estadísticamente significativas en la necesidad de ingreso, de sedimento, analítica, ni de registro cardiotocográfico. En análisis a corto plazo no se observaron más diferencias, la herramienta no demostró ser efectiva tampoco a corto plazo. Las visitas inadecuadas tenían lugar con mayor frecuencia por la mañana y por la noche. A mayor edad gestacional se observó una tendencia a generar visitas más adecuadas. En conclusión tras validar un tríptico informativo sobre los posibles síntomas que pueden aparecer durante la gestación y realizar una sencilla y económica intervención educativa sobre una población de gestantes, que ya había demostrado un alto grado de inadecuación en sus motivos de consulta a urgencias, no hemos podido demostrar su eficacia.
Inadequate emergency visits which could be resolved in primary care are frequent. Moreover, they are an unnecessary healthcare service outlay, which could be reduced. There are several aims of this study. First, we would like to describe the adequacy of the emergency visits by pregnant women in our Hospital and to identify the risk factors for an inappropriate visit. Secondly, we intend to develop and validate a leaflet about the symptoms that may occur during pregnancy and instructions for treatment should they appear. Finally, we will analyze the effectiveness of the leaflet to reduce inappropriate visits and attendance to the emergency room by a randomized intervention study. Specifically, out of a sample of 1,743 visits to the Gynecology and Obstetrics emergency, we classified the reasons for consultation according to the three levels of adequacy: adequate, moderately adequate and inadequate. Our findings show consultation motivations were adequate in 38.9% of the cases, moderately adequate in 46.7% and inadequate in 14.4 %. Several factors shaped variations in results. Patients with a history of stillbirth, death child or higher gestational risk tended to distribute their reasons of consultation in groups of moderately adequate and inadequate (marginally significant). We found a trend towards more appropriate reasons for consultation in more developed pregnancies while it was less adequate in the earlier gestations. The number of children at term or preterm and miscarriages are variables that didn´t change the level of adequacy in a statistically significant number. This shows that the amount of inadequate and moderately adequate visits to the emergency department could be reduced by 61 % by implementing different interventions. Therefore, unnecessary expense could be reduced. The leaflet was validated by four obstetricians’ experts and a group of 19 pregnant and puerperal women. The leaflet was committed in a group of 209 pregnant women, during their first ultrasound, and they were compared to a control group of 216 pregnant women. Adequacy level was not different between the case and the control group. No significant differences were found in the primary endpoint: "level of adequacy", between the case group and control group. Every pregnant woman went to emergency room 1.83 times in each group. We found significant differences in ultrasound requirement (the case group required more sonography) but not in hospitalization requirement, urine sediment requirement, "fetal non-stress test" requirement or blood test requirement. No significant differences were found in the short-term analysis; the tool neither proves to be effective in the short term. The inadequacy visits were more frequent during morning and nights. The higher gestational age was, the more appropriate were the visits. In conclusion we validated a leaflet about the symptoms that may occur during pregnancy and used it to make a simple and economic educational intervention in the pregnant woman population. Although we have demonstrated their high level of inappropriate visits to the emergency department, we could not demonstrate efficacy of the educational intervention under these conditions.

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Lushiku, Lunganga Toms. "Profile of obstetric cardiac patients delivered with an anaesthetic intervention at an academic hospital". Thesis, 2018. https://hdl.handle.net/10539/26674.

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A research report submitted to the faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Anaesthesiology, Johannesburg 2018
Background Pregnant women with cardiac disease present some of the greatest challenges to the anaesthesiologist. Data from South Africa as to the incidence, the type of anaesthetic technique used as well as maternal cardiac and obstetric outcomes of these patients is scanty. Therefore, the aim of this study is to describe the profile of obstetric cardiac patients who delivered with an anaesthetic intervention at Chris Hani Baragwanath Academic Hospital. Methods A retrospective audit using consecutive convenience sampling was done by reviewing the labour ward admission books, the cardiac obstetric anaesthetic assessment forms, the intraoperative anaesthetic forms and the labour epidural forms from January 2014 to December 2015. Results Two hundred and three (0.49%) patients were identified with underlying cardiac disease and 83 met the criteria for inclusion. Acquired cardiac disease was most prevalent (65%) and rheumatic valvular cardiac disease being the most dominant (41%) lesion. Pulmonary hypertension was present in 19% of patients. Eighteen percent of patients were included in mWHO class 4 where pregnancy is not advised. Neuraxial anaesthesia was used in 57% of deliveries. Intraoperative complications were present in 8 (10%) patients. Two (2%) patients had cardiac complications. There was no maternal death recorded in the first 24 hours post-delivery. iv Conclusions This audit demonstrated that acquired cardiac diseases were more prevalent than congenital and rheumatic valvular disease is still the most common cause of acquired cardiac disease in pregnancy. Neuraxial anaesthesia was the most used anaesthetic technique for delivery in these patients
XL2019

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"The effect of a theory-based intervention on promoting self-efficacy for childbirth among pregnant women in Hong Kong". Thesis, 2005. http://library.cuhk.edu.hk/record=b6074077.

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Confirmatory factor analysis provided empirical support for the existence of the hypothesized constructs assessed by the CBSEI-C32. Doubly MANOVA indicated that the experimental group was significantly more likely than the control group to demonstrate higher self-efficacy for childbirth and lower perceived anxiety and pain in the early and middle phase of labour. The effects of the programe on anxiety and pain during labour differed according to different phase of labour. Independent samples t test also demonstrated a significantly higher level of coping behaviour performed by the experimental group as compared with the control group. (Abstract shortened by UMI.)
The aim of this study was to test the effectiveness of an educational intervention, based on Self-efficacy theory (Bandura, 1989); to promote women's self-efficacy for childbirth and their coping ability for reducing anxiety and pain during labour. The study consisted of two phases: the 1st phase was to establish the validity and reliability of the primary outcome measure of the phase 2 study: a short form of the Chinese version of the Childbirth Self-efficacy Inventory (CBSEI-C32). The confirmatory factor analysis (CFA) was used to establish the construct validity of the CBSEI-C32. In the 2nd phase, the focus was to test the effectiveness of educational intervention to promote women's self-efficacy for childbirth and their coping behaviour during labour. The researcher used an experimental design with random assignment of eligible participants into experimental (n = 54) or control (n = 62) group that completed one pre-test (baseline at 32--34 weeks of gestation) and three posttest surveys (post-intervention at 37 weeks of gestation and within 48 hours and 6 weeks after delivery). The experimental group received two 90-minute sessions of an educational program offered at 33--35 weeks of gestation based on Bandura's (1986) self-efficacy theory. The primary outcome measures were the two subscales of the CBSEI-C32: outcome expectancy (OE-16) and efficacy expectancy (EE-16). The secondary measures included psychological morbidity (GHQ12), pain and anxiety during labour (VAS) and performance of coping behaviour during labour (CCB). Physiological labour outcomes in terms of mode of delivery, length of labour, types of analgesia used, Apgar scores of newborn and neonatal admission were also extracted from the participants' medical record.
Ip Wan Yim.
"June 2005."
Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 3717.
Thesis (Ph.D.)--Chinese University of Hong Kong, 2005.
Includes bibliographical references (p. 159-191).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
School code: 1307.

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Kyei-Nimakoh, Minerva. "Management and Referral of Obstetric Complications: a Study in the Upper East Region of Ghana". Thesis, 2017. https://vuir.vu.edu.au/35051/.

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Women in West and Central Africa have the highest lifetime risk of maternal death of 1 in 27, compared to a ratio of 1 in 180 globally, and 1 in 2,000 in Central and Eastern Europe. Like many West African countries, Ghana made insufficient progress in efforts to meet the Millennium Development Goals. In 2015, Ghana’s maternal mortality ratio was 319 per 100,000 live births with a lifetime risk of maternal death of 1 in 74. This PhD study examined the management and referral of obstetric complications in the Upper East Region of Ghana.

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Derbie, Engida Yisma. "Obstetrical interventions during labour and birth: an examination of effects on breastfeeding, neonatal mortality and children’s educational outcomes". Thesis, 2020. https://hdl.handle.net/2440/135370.

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Background Obstetrical interventions during labour and birth are essential for perinatal care as part of any contemporary obstetric practice. Various underlying biological mechanisms have been proposed in linking obstetrical interventions during labour and birth with breastfeeding, infant’s health and children’s neurodevelopmental outcomes at later life. These mechanisms include changes in the gut microbiota composition, exposure to different levels of physical stress and stress hormone surges during labour and delivery, as well as epigenetic alteration of gene expression. The available evidence regarding the effect of obstetrical interventions during labour and birth on short-and long-term outcomes is limited. For instance, much of the available evidence was generated from high-income countries. Moreover, many of the previous studies were hampered by non-longitudinal study designs, small sample sizes and inconsistent findings, which may be due to suboptimal control of confounders and other biases. This thesis addresses these issues and utilises data from low-, middle- and high-income country settings. Aims The overarching aim of this thesis is to examine the effect of obstetrical interventions during labour and birth on breastfeeding indicators (early initiation of breastfeeding, exclusive breastfeeding under 6 months, and children ever breastfed), neonatal mortality and children’s educational outcomes at eight years of age. Specifically, the aims include: -To estimate the prevalence and examine sociodemographic factors associated with caesarean section in Ethiopia. -To examine the changing temporal association between caesarean birth and neonatal death in Ethiopia from 2000 to 2016 as well as to provide an interpretation of the associations using the ‘Three Delays Model’ in the context of Ethiopia. -To investigate the effect of caesarean section on breastfeeding indicators—early initiation of breastfeeding (within 1 hour), exclusive breastfeeding under 6 months and children ever breastfed (at least once)—in each of the 33 countries in sub-Saharan Africa, as well as to summarise the magnitude of these within-country effects in an overall estimate using random-effects meta-analyses. -To examine the effect of Apgar scores of 0-5, 6, 7, 8 and 9 (compared with 10) on children’s educational outcomes at eight years of age. -To estimate the effect of elective induction of labour at 39 weeks of gestation as compared with expectant management on children’s educational outcomes at eight years of age. Methods Data for this thesis were drawn from the Demographic and Health Surveys (DHS) and the South Australian Early Childhood Data Project (SAECDP). The DHS are widely available high-quality data sources from low- and middle-income countries. The SAECDP is an established project that encompasses high-quality whole-of-population linked administrative data from state and federal sources in South Australia. The DHS data from 33 low- and middle-income countries in sub-Saharan Africa were used for the first three studies while the SAECDP data from South Australia were used for the final two studies in this thesis. The use of these two different data sources allowed this thesis to capture the effects of obstetrical interventions during labour and birth on women’s breastfeeding practices, neonatal health and children’s educational outcomes across diverse health system resource settings. For each study, the potential confounding was identified based on a priori subject matter and expert knowledge as well as through the use of the Directed Acyclic Graphs (DAGs). The analytic approaches to answer the aims of this thesis included the modified Poisson regression (Log-Poisson regression), augmented inverse probability weighed (AIPW) estimator, negative control outcome (a tool for detecting confounding and bias), random-effects meta-analysis as well as an application of the ‘Three Delays Model’. Results In the first study, the national caesarean section rate increased from 0.7% in 2000 to 1.9% in 2016, with increases across 7 of the 11 administrative regions in Ethiopia. In the adjusted analysis, women who gave birth in a private health facility had a 78.0% higher risk of caesarean section (adjusted prevalence ratio (aPR) (95% CI) 1.78 (1.22 to 2.58) when compared to women who gave birth in public health facility. Having four or more births was associated with a lower risk of caesarean section compared to first births (aPR (95% CI) 0.36 (0.16 to 0.79)). In the second study, in Ethiopia, the adjusted prevalence ratios (aPR) for neonatal death among neonates born via caesarean section versus vaginal birth increased over time, from 0.95 (95% CI, 0.29 to 3.19) in 2000 to 2.81 (95% CI, 1.11 to 7.13) in 2016. The association between caesarean birth and neonatal death was stronger among rural women (aPR (95% CI) 3.43 (1.22 to 9.67)) and among women from the lowest quintile of household wealth (aPR (95% CI) 7.01 (0.92 to 53.36)) in 2016. On the other hand, the aggregate-level analysis revealed that increased caesarean section rates were correlated with a decreased proportion of neonatal deaths. In the third study, the within-country analyses in sub-Saharan Africa showed, compared with vaginal birth, caesarean section was associated with aPR for early initiation of breastfeeding that ranged from 0.24 (95% CI, 0.17 to 0.33) in Tanzania to 0.89 (95% CI, 0.78 to 1.00) in South Africa. The aPR for exclusive breastfeeding under 6 months ranged from 0.58 (95% CI; 0.34 to 0.98) in Angola to 1.93 (95% CI; 0.46 to 8.10) in Cote d'Ivoire, while the aPR for children ever breastfed ranged from 0.91 (95% CI, 0.82 to 1.02) in Gabon to 1.02 (95% CI, 0.99 to 1.04) in Gambia. The meta-analysis combining effect estimates from 33 countries in sub-Saharan Africa showed caesarean section was associated with a 46% lower prevalence of early initiation of breastfeeding (pooled aPR, 0.54 (95% CI, 0.48 to 0.60)). However, the pooled effects indicated there was little association with exclusive breastfeeding under 6 months (pooled aPR, 0.94 (95% CI; 0.88 to 1.01) and children ever breastfed (pooled aPR, 0.98 (95% CI; 0.98 to 0.99) among caesarean versus vaginally born children. In the fourth study, after adjusting for confounding, the risk differences comparing five-minute Apgar scores of 0-5 with Apgar score of 10 for children scoring at/below the national minimum standard (NMS) on the National Assessment Program—Literacy and Numeracy (NAPLAN) tests for each domain were: reading (0.07 (95% CI -0.16 to 0.29)), writing (0.27 (95% CI -0.14 to 0.68)), spelling (0.15 (95% CI -0.10 to 0.40)), grammar (0.04 (95% CI -0.21 to 0.29)) and numeracy (0.21 (95% CI -0.04 to 0.45)). Risk differences for children performing at/below the NMS were also evident when Apgar score of 6 were compared with Apgar score of 10. In the fifth (last) study, after adjusting for confounding, the average treatment effects (ATEs) comparing elective induction of labour at 39 weeks of gestation with expectant management for children scoring at/below the NMS on each domain were: reading (0.01 (95% CI -0.02 to 0.03)), writing (0.02 (95% CI -0.00 to 0.04)), spelling (0.01 (95% CI -0.01 to 0.04)), grammar (0.02 (95% CI -0.01 to 0.04)) and numeracy (0.03 (95% CI 0.00 to 0.05)). Conclusions The findings from this thesis present a comprehensive analyses of the effect of obstetrical interventions during labour and birth on breastfeeding, neonatal mortality and children’s educational outcomes at eight years of age by utilising data from low-, middle-, and high-income countries. The findings of Study 1 highlighted that there were large disparities in caesarean section use in Ethiopia, demonstrating unequal access. The results from Studies 2, 3 and 4 suggest that obstetrical interventions during labour and birth (caesarean section and Apgar score) have an influence on neonatal mortality, breastfeeding and children’s educational outcomes at later age. However, the findings of Study 5 suggest that elective induction of labour at 39 weeks of gestation as compared with expectant management did not affect children’s educational outcomes at eight years of age.
Thesis (Ph.D.) -- University of Adelaide, School of Public Health, 2020

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Bressler, Kaylee. "Etiology and treatment of postpartum hemorrhage in low- and middle-income countries". Thesis, 2020. https://hdl.handle.net/2144/41180.

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Postpartum hemorrhage (PPH) is the leading direct cause of maternal mortality worldwide, with the majority of deaths taking place in the least developed countries of the world. Low- and middle-income countries (LMICs) have increased rates of PPH due to lack of access to healthcare, inadequate number of care providers and availability of interventions and resources needed. PPH has four main etiologies: uterine atony, trauma, retained placenta and coagulopathy. The most common and challenging to treat is uterine atony, where a lack of uterine contractility leads to massive hemorrhage postpartum. Specific risk factors have been identified that increase a woman’s risk of developing PPH. Risk factors of PPH can be categorized as biological, demographical and social risk factors. Many people in LMICs experience a lot of the social risk factors like lack of providers, skilled facilities and resources available to them in case of an obstetric emergency. Home births are also a common practice in many LMICs, placing a woman further from any resources she may have had access to if she was at a health facility. PPH can also occur in women without risk factors and requires that providers always be prepared to treat it. Interventions to treat PPH are well known and encompass both pharmacological and non-pharmacological interventions that are usually tried in a least to most invasive order. The first line of intervention is often to administer a uterotonic drug, preferably oxytocin. This poses a challenge to LMICs because oxytocin requires a cold-chain storage, which many LMICs countries lack. Therefore, uterotonics and non-pharmacologic interventions have increasingly been used in these regions. The final and ultimate life saving measure to stop bleeding is a hysterectomy, which is often not available in these rural places where home births take place, and has led to higher mortality rates. Prevention measures of PPH include increasing antenatal care (ANC) use and practicing active management of the third stage of labor (AMTSL) with all pregnancies. Use of ANC and ultrasound technology can help identify the biological risk factors that make a woman more likely to experience PPH. Solutions to lowering the occurrence of PPH in LMICs involve increasing resources and access to healthcare. An important part to increasing access is increasing the number of skilled health facilities and health providers. Community health workers (CHW) and skilled birth attendants (SBA) are vital to increasing the amount and acceptability of care in these regions. These workers are trusted members of the community that can help educate and bring resources to women, as well as women to the resources. Solutions to stopping PPH need to consider the affordability, acceptability and accessibility in order to reach people in remote areas with limited resources. Both immediate short-term interventions and long-term, longitudinal healthcare reform are necessary to save mothers in LMICs.

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Van, Busum Kelly M. ""Nobody asked if I was ok:" C-section experiences of mothers who wanted a birth with limited medical intervention". Thesis, 2014. http://hdl.handle.net/1805/5585.

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Indiana University-Purdue University Indianapolis (IUPUI)
This thesis project aims to address the following question: How do women who were planning a vaginal birth with limited medical intervention experience an unplanned c-section? Specifically, this research project involved: completing in-depth interviews with 15 women who planned a vaginal birth with limited medical intervention but instead experienced an unplanned c-section between six months and two years ago; discovering and describing the nature of the birth the mothers originally envisioned for their child; exploring the women’s experiences with, and feelings about, the birth itself and how it might differ from what they envisioned; developing a better understanding of how these experiences and feelings affected the women during the first two years following the birth; describing any challenges they faced and how, if at all, they managed such challenges; and identifying strategies that could be used to improve the experience of women recovering from an unplanned c-section who envisioned a vaginal birth with limited medical intervention.

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"A comparison of two modes of delivery of an educational intervention to encourage compliance with American College of Obstetrics and Gynecology recommendations regarding the gynecological exam among sorority women". INDIANA UNIVERSITY, 2009. http://pqdtopen.proquest.com/#viewpdf?dispub=3324541.

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Bieda, Janine. "Certified nurse-midwives and physicians a study of their clients' origins of locus of control and preferences for medical interventions throughout pregnancy and during labor : a research report submitted in partial fulfilllment ... Master of Science (Nurse-Midwifery) ... /". 1992. http://catalog.hathitrust.org/api/volumes/oclc/68796080.html.

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Jean-Baptiste, Elisa. "Estimation de la macrosomie fœtale chez les populations Cris de l’Est de la Baie-James". Thèse, 2016. http://hdl.handle.net/1866/19155.

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Objectifs : Évaluer l’incidence de la macrosomie fœtale en fonction des différentes définitions (poids de naissance >4000g, >4500g, ≥90ième percentile de Kramer) en vigueur et comparer la prévalence de la morbidité maternelle et périnatale associée à la macrosomie entre les populations Cris et les populations du Québec. Des courbes postnatales spécifiques aux Cris de l’Est de la Baie-James seront proposées. Devis : Comparaison de deux cohortes prospectives Cris et Québec. La cohorte des populations Cris de l’Est de la Baie-James, comporte 2546 femmes recrutées de 2000-2010, au cours de l’étude sur la macrosomie fœtale chez les Cris de l’Est de la Baie James. La cohorte du Québec est composée de 97475 femmes et provient de l’essai clinique randomisé multicentrique QUARISMA, 2008-2010, cette étude promulguant la réduction du taux d’accouchement par césarienne. Méthodes : Les risques de macrosomie fœtale et de la morbidité maternelle et périnatale sont évalués par des modèles de régression logistique d’équations d'estimation généralisées (EEG) ajustés et comparés selon l’ethnicité, Cris et Québec. GEE. Le groupe de référence étant les femmes du Québec. Les courbes de croissance spécifiques aux Cris sont construites par régression quantile. Résultats : Plus du tiers, soit 36,76%, des Cris et 9,329% des nouveau-nés du Québec, ont un poids de naissance >4000g. Les résultats attestent montrent que 10,92% des Cris de l’Est de la Baie-James ont un poids de naissance de plus de 4500g, ce taux est de 1,23% au Québec. La définition de la macrosomie fœtale, par un poids néonatal ≥90ième percentile de Kramer, identifie 40,02% des bébés Cris, pour 8,83% des nourrissons du Québec, comme macrosomes. Les Cris sont plus à risque de macrosomie fœtale, comparativement à la population générale du Québec, ces associations sont statistiquement significatives : RC=5,22; 95% IC (4,66-6,05,98), pour un poids de naissance >4000g, RC=8,10; 95% IC (6,22-10,77), pour un poids de naissance >4500g et RC=6,22; 95% IC (5,77-6,72), pour un poids de naissance ≥90ième percentile de Kramer. Le risque de la morbidité périnatale majeure, de la macrosomie fœtale, est généralement moins important pour les Cris que pour la population générale du Québec : 0,76; 95% IC 0,62-0,94. La macrosomie fœtale devrait être décrite par un poids de naissance≥95ième percentile de Kramer, pour les Cris, mais préférablement au 90ième percentile des courbes postnatales spécifiques aux Cris de l’Est de la Baie-James. Les poids de naissance diagnostique spécifiques aux Cris de l’Est de la Baie-James, au 90ième percentile de la 40ième semaine d’aménorrhée, sont de 4 417g pour les filles et 4 488g pour les garçons. Conclusions : Les courbes de Kramer diagnostiquent systématiquement plus de macrosomes chez les Cris que dans la population du Québec. Par contre, le risque de morbidité périnatale majeure est inférieur pour ces communautés autochtones, aux différents seuils décrivant la macrosomie fœtale, ce qui suggère l’utilisation de courbes spécifiques aux Cris et permettrait de diminuer les interventions obstétricales non nécessaires chez les gros bébés Cris, donc non-macrosomes.
Objective: Assess the impact of fetal macrosomia based on definitions (birth weight> 4000 g,> 4500g, ≥90ième percentile Kramer) currently used in Quebec and compare the prevalence of maternal and perinatal morbidity associated with macrosomia between the Cree populations of Eastern James Bay and the general population of Quebec. Specific postnatal curves for the Cree will be constructed. Design: Comparison of two prospective cohort Cree and Quebec. Cohort of Cree populations of eastern James Bay, has recruited 2546 women from 2000 to 2010, during the study of fetal macrosomia in the Cree of eastern James Bay. Quebec cohort consisted of 97,475 women and comes from the multicenter randomized clinical trial QUARISMA 2008-2010, this study promulgates the reduction of caesarean delivery rate. Methods: The risk of fetal macrosomia, maternal and perinatal morbidity, by ethnicity, Cree and Quebec, are evaluated by generalized estimating equations models (GEE). GEE models were adjusted to control for potentially confounding factors. The reference group is Quebec women. The specific growth curves of the Cree are built by quantile regression. Results: More than a third, 36.8%, of Cree populations of Eastern James Bay and 9.3% of newborns in Quebec have a birth weight> 4000g. For a birth weight> 4500g, the results show that 10.9% of the Cree, have a birth weight of more than 4500g, the rate is 1.2% in Quebec. The definition of fetal macrosomia by neonatal birth weight≥90th percentile of Kramer identifies 40.02% Cree’s for 8.8% of infants of Quebec as macrosomic. The Cree population are more at risk of fetal macrosomia, compared to the general population of Quebec, these associations were statistically significant: OR = 5.2; 95% CI (4.6 to 6.0) for birth weight> 4000g, OR = 8.1; 95% CI (6.2 to 10.7) for birth weight> 4500g and OR = 6.2; 95% CI (5.7 to 6.7) for birth weight percentile ≥90th Kramer. The risk of major perinatal morbidity associated with fetal macrosomia, is generally less important for the Cree than for the general population of Quebec: 0.76; 95% CI 0.62-0.94. Fetal macrosomia should be described by birth weight ≥95th percentile of Kramer, for the Cree, but preferably at the 90th percentile of the specific postnatal curves of Cree populations of Eastern James Bay. The specific Cree birth weight thresholds for diagnosing fetal macrosomia, at the 90th percentile of the 40th week of gestation, are 4 417g for the girls and 4 488g for the boys. Conclusion: Kramer’s curves diagnose systematically too much macrosomic Cree babies compare to the general population of Quebec. Futhermore, the risk of major maternal and perinatal morbidity is lower for these indigenous communities, at the different definitions of fetal macrosomia, suggesting the use of specific curves for the Cree, to reduce obstetrics interventions not required in large, but non macrosomic, Cree babies.

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