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1
Dodd, Jodie Michele. "Misoprostol for the induction of labour at term". Title page, table of contents and abstract only, 2005. http://hdl.handle.net/2440/37708.
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Background: The aims of this randomised, double blind, placebo controlled trial were to compare vaginal PGE2 gel with oral misoprostol in the induction of labour at term. Methods: Women randomised to the oral misoprostol group received 20mcg oral misoprostol solution at two hourly intervals and placebo vaginal gel, and those in the vaginal prostaglandin group received vaginal PGE2 gel at six hourly intervals and oral placebo solution. The primary outcome measures were vaginal birth not achieved in 24 hours, uterine hyperstimulation with associated fetal heart rate changes, and caesarean section. Women were asked about their preferences for care, and a cost comparison was performed for the two methods of induction of labour. A nested randomised trial compared health outcomes for the woman and her infant related to morning or evening admission for commencing induction of labour. Results: A total of 741 women were randomised, 365 to the misoprostol group and 376 to the vaginal PGE2 group. There were no differences between women in the oral misoprostol group and women in the vaginal PGE2 group, for the outcomes vaginal birth not achieved in 24 hours (Misoprostol 168/365 (46.0%) versus PGE2 155/376 (41.2%); RR 1.12 95% CI 0.95-1.32; p=0.134), caesarean section (Misoprostol 83/365 (22.7%) versus PGE2 100/376 (26.6%); RR 0.82 95% CI 0.64- 1.06; p=0.127), or uterine hyperstimulation with fetal heart rate changes (Misoprostol 3/365 (0.8%) versus PGE2 6/376 1.6%); RR 0.55 95% CI 0.14-2.21; p=0.401). Women in the misoprostol group were more likely to indicate that they 'liked everything' associated with their labour and birth experience compared with women in the vaginal PGE2 group (Misoprostol 126/362 (34.8%) versus PGE2 103/373 (27.6%); RR 1.26; 95% CI 1.02-1.57; p=0.036). There were no differences in the primary outcomes when considering morning or evening admission to commence induction. The use of misoprostol was associated with a saving of $110.83 per woman induced. Conclusions: The use of oral misoprostol in induction of labour does not lead to poorer health outcomes for women or their infants, women express greater satisfaction with their labour and birth experience, and with misoprostol induction there is a cost saving to the institution.Thesis (Ph.D.)--Department of Obstetrics and Gynaecology, 2005.
2
黎美芳 e Mei-fong Janny Lai. "Management of labour: use of water immersion for pain relief". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B40720937.
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Lai, Mei-fong Janny. "Management of labour use of water immersion for pain relief /". Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B40720937.
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Ngai, Suk-wai Cora. "Clinical applications of misoprostol in obstetrics and gynecology". Hong Kong : University of Hong Kong, 2000. http://sunzi.lib.hku.hk/hkuto/record.jsp?B2180638X.
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倪淑慧 e Suk-wai Cora Ngai. "Clinical applications of misoprostol in obstetrics and gynecology". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2000. http://hub.hku.hk/bib/B31981720.
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Chern, Hughes Betty. "THE EFFECT OF MUSIC ON LABOR ANALOGUE PAIN". Thesis, The University of Arizona, 1985. http://hdl.handle.net/10150/275446.
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Ramstad, Marsha. "The Relationship between Epidural Analgesia during Childbirth and Childbirth Outcomes". Thesis, North Dakota State University, 2004. https://hdl.handle.net/10365/28727.
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Epidural analgesia has increased in usage dramatically in the United States as a means
of comfort for labor pain. Prior studies have connected epidural analgesia to an increase in
cesarean birth rate, an increase in use of instrumentation, an increase in length of labor,
episiotomy rate, and maternal fever. Epidural analgesia has produced additional costs to
the patient and society. The purpose of this study is to examine the relationship between
epidural analgesia during childbirth and childbirth outcomes. The data for this study were obtained from a retrospective patient record review of 200
systematically selected labor patients who delivered in 2002 at a midwestern hospital. The
epidural analgesia rate was 72% at this facility in 2002, a signi?cant increase from the
previous 5 years. Using the Chi-square test of independence, 3 relationship was established
between epidural analgesia and four of the variables examined. A statistically signi?cant
relationship was found to exist between epidural analgesia and cesarean birth rate, pitocin
augmentation, and the ?rst and second stages of labor with the total sample. The results of
the study are important for healthcare providers who are relaying in?uential wellness
information to childbearing women and their partners. The results indicate a need for further education for healthcare providers on alternative methods of pain relief for their patients during childbirth.
8
Duff, Margaret. "A Study of Labour". University of Technology, Sydney. Faculty of Nursing, Midwifery and Health, 2005. http://hdl.handle.net/2100/348.
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The partograph, developed over 50 years ago and based on research conducted by Friedman (1954, 1955 & 1956), has been promoted by the World Health Organisation as the “gold” standard for assessing progress in labour. The basic premise of the partograph is that regular vaginal examinations throughout labour that calculate the extent and rate of cervical dilation will be the most reliable indicator of labour progress. A review of the medical and midwifery literature suggested that the progress of labour can also be assessed by observing women’s behavioural responses to labour. This study set out to describe and test the reliability and consistency of these behavioural cues. These cues were derived from published literature and used to construct a “Labour Assessment Tool” (LAT). The LAT was tested and modified using an expert reference group and results of a pilot test. Inter-rater reliability was established during the pilot study and verified with other experienced midwives as data collectors. The LAT recorded partograph observations as well as labour behaviours. The study was undertaken in two Australian hospitals between 1999 and 2002. Women were given information on the study during regular antenatal visits to the hospitals from 30 weeks gestation and invited to participate during one of their antenatal visits between 37 weeks and 42 weeks of pregnancy. There were 21 women of the 225 women approached who declined to participate. The LAT observations were recorded on 203 participants however only 179 participants (94 nulliparous and 85 multiparous women) who generated 47,768 individual observations were suitable for analysis. There were 59 participants (31 nulliparous and 28 multiparous women) who were induced into labour or had their labours augmented. Women excluded from the study included those with complications of pregnancy and labour. Women were also withdrawn from the study at the time an epidural was commenced but their data to that point were retained for analysis. The data were examined from three perspectives. The first was from a ‘phases of labour’ perspective based on the work of Friedman (1954; 1955). Data obtained at the time the women had an internal cervical assessment were allocated to early labour, active labour, transition or full dilation, based on the results of the cervical measurements. The second perspective examined all the descriptors over the course of labour from admission to hospital or the beginning of an induction of labour, to second stage of labour. Frequencies were again generated for each behaviour from admission to hospital until full dilation. They were compared to the mean dilation generated for both parity groups based on the 279 cervical examinations that were performed on the participants. The third perspective examined behavioural patterns observed within each woman’s labour unrelated to the time to full dilation or Friedman’s phases of labour model. Results indicate that specific behavioural descriptors associated with progress were observed before cervical dilation increased. Descriptors indicating cervical dilation was occurring, or had occurred, and descriptors indicating impending second stage as well as second stage itself, were identified. Differences were observed between the labours of multiparous and nulliparous women and induced labours and non induced labours.
9
Schuster, Mary Francine 1943. "WOMEN'S ADAPTIVE RESPONSES TO EARLY LABOR CONTRACTIONS". Thesis, The University of Arizona, 1987. http://hdl.handle.net/10150/276383.
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Hunter, Cheryl A. "The doula as educator labor, embodiment, and intimacy in childbirth /". [Bloomington, Ind.] : Indiana University, 2007. 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:3278464.
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Thesis (Ph.D.)--Indiana University, Dept. of Educational Leadership and Policy Studies, 2007.Source: Dissertation Abstracts International, Volume: 68-10, Section: A, page: 4215. Adviser: Luise McCarty. Title from dissertation home page (viewed May 19, 2008).
11
Matthews, Amy Procter. "Organized Labor: The Past, Present, and Future of Nurse-Midwifery in America". W&M ScholarWorks, 1990. https://scholarworks.wm.edu/etd/1539625563.
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Sylvester, Kara. "Women's Satisfaction with their Childbirth Experiences: What Influenced Their Satisfaction and What They Wish They Had Been Told". Fogler Library, University of Maine, 2004. http://www.library.umaine.edu/theses/pdf/SylvesterK2004.pdf.
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Koblentz, Jenna A. "Variables in VBAC Success: A Retrospective Review of Trial of Labor After Cesarean (TOLAC) and Labor Support". Scholarship @ Claremont, 2015. http://scholarship.claremont.edu/scripps_theses/560.
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For most of the 20th century, the saying “once a cesarean, always a cesarean” was a rule in the United States. Today, the National Institutes of Health (NIH) opposes the dictum and urges women to consider trial of labor after cesarean (TOLAC). However, the factors that lead to a successful outcome remain unclear, as research continues to be conducted in hopes of creating a predictive model for vaginal birth after cesarean (VBAC) success.
The NIH’s request for more research in this area of obstetrics led to this retrospective cohort study of all TOLACs at Marin General Hospital (MGH) from 2000-2013. All labor trials were studied for patient demographics, details of labor, maternal and neonatal morbidities, insurance, and provider type. After confirming the quality of the data, verifying inclusion criteria and ignoring cases with missing data, a data set of 745 TOLACs with 13 explanatory variables of interest was prepared. A forward stepwise (Likelihood Ratio) binary logistic regression was run in IBM® SPSS® Statistics in order to create a model that could determine which variables were most predictive of delivery outcome in TOLAC patients.
Ultimately, seven variables were predictive and were included in the model. Of the seven, the most predictive variable in determining VBAC success was provider type. The model concluded that a woman’s odds of having a successful VBAC were almost four times greater if she began her delivery with a certified nurse midwife, than if she began her deliver with a physician (odds ratio 0.27, 95% CI 0.17-0.44; < 0.01). The results from this study mimic the results of other models, and introduce labor support as a key factor in predicting VBAC success.
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Dekker, Lida. "A pilot study describing labor pain assessment and management documentation for limited English speaking patients in a community hospital". Online access for everyone, 2006. http://www.dissertations.wsu.edu/Thesis/Fall2006/L_Dekker_120706.pdf.
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Fernandes, Diina. "Midwives' experiences regarding the utilization of partographs in a Namibian Regional Hospital". Thesis, Nelson Mandela Metropolitan University, 2015. http://hdl.handle.net/10948/d1021158.
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Labour has been characterized as the most dangerous journey a woman undertakes. The reason being, that although it is a natural process, many labouring women suffer complications during labour and childbirth including prolonged or obstructed labour. These complications can result in maternal and infant morbidity and mortality. The partograph is a monitoring tool that can provide a continuous pictorial overview and is essential to monitor and manage labour. It is recommended by the WHO for use universally by midwives while monitoring labour. However partographs are poorly utilized and most parameters on the partograph are not monitored and findings after reviewing a labouring woman are not documented on the partograph. It is unclear how midwives working in Namibian Health services experience and utilize the partograph during the monitoring of a woman in labour. These may be the factors that hinder the effective utilization of the partograph. The objective of this study was to explore and describe the experiences of midwives regarding the utilization of the partograph for monitoring a labouring woman in a Namibian regional hospital in order to develop guidelines based on the findings to improve the use of the partograph by midwives in order to improve the management of labour. The research design was qualitative, descriptive, explorative and contextual in nature. The research population consisted of midwives working in a regional hospital in Namibia. A purposive and convenient sampling method was used to select participants. Specific inclusion criteria were met and consent was obtained from the participants and from the Regional Health Directorate Management of the hospital where the research was conducted. Interviews were conducted by an independent interviewer within the Department of Health to ensure an unbiased viewpoint. Data were collected by means of semi-structured in depth interviews with a guide, using an audio tape recorder. Field notes were used to record non- verbal communication. As soon as data were saturated, the interviews were stopped. They were then transcribed, verbatim and analysed using the Tesch’s approach as described in (Creswell, 2009:186). The service of an independent coder was utilized to ensure trustworthiness. Trustworthiness was further ensured by using the strategies suggested by Lincoln and Guba’s model, namely credibility, transferability, dependability and confirmability. Ethical considerations were honoured throughout by adhering to ethical principles during the study. These included ensuring that the participants` rights were respected, they were not harmed and fairness were ensured. On completion of the data analysis a literature control was conducted and existing literature was compared to the findings in order to identify similarities and differences and to verify whether the literature supported the findings. Four main themes that emerged during data analysis are: Theme 1.Midwives found it a positive experience to use the partograph when caring for a woman in labour. Theme 2. When a midwife experienced problems in using the partograph, it may lead to detrimental outcomes. Theme 3. Utilizing the partograph evoked differing emotions in midwives. Theme 4. Midwives` knowledge and skills in the utilization of the partograph should be updated regularly. By describing the lived experienced of midwives in the maternity ward on the use of the partograph, the midwives had a positive attitude to using the partograph, but they also found it difficult to utilize the instrument as was directed by the (WHO) due to challenges experienced such as: unrealistic staff/patient ratio, shortage of staff, time consuming, insufficient knowledge and skills among midwives and lack of appropriate equipment. There is a specific need to prevent further negative emotions by addressing the challenges experienced. Based on the findings, guidelines for partograph utilization which aimed at improving the midwifery care were developed. Recommendations were made regarding midwifery education, clinical midwifery care and midwifery research.
16
Mabenge, Mfundiso Samson. "Perceptions of the doctors working in labour wards related to the use of cardiotocograph as an intrapartum monitoring tool". Thesis, Nelson Mandela Metropolitan University, 2013. http://hdl.handle.net/10948/d1020345.
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Monitoring of women in labour is an important aspect of the practice of the health care professionals working in the labour ward. The pregnancy of a woman mightappear to be normal but it is not possible to predict the positive outcome of labour until the baby is born because foetal distress can occur suddenly or other problems can arise during the course of labour. Doctors need to closely monitor the progress of labour of all the women regardless of whether he pregnancy is rated low risk or not. The use of Cardiotocography (CTG) during labour thus becomes critical. In the current study the perceptions of the doctors working in labour ward units will be explored and described in order to recommend activities that could optimize the use of CTG by doctors as an intrapartum monitoring tool. A qualitative research design will be used and the data collection method will be by means of semi-structured audio-taped one-on-one interviews.
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Fitzmaurice, Ann E. "An exploration of the relationship between termination of a first pregnancy and outcome of subsequent pregnancies". Thesis, University of Aberdeen, 2012. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=186647.
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The impact of a termination on subsequent pregnancy outcomes has been widely studied. It has been suggested that women who terminate a pregnancy are more likely to have an adverse outcome of a subsequent pregnancy, either miscarriage, or a preterm or low birthweight baby. However, the evidence to date is inconclusive and in some cases contradictory. Hypothesis: It is hypothesised that those who had terminated their first pregnancy are more likely to have an adverse outcome of a subsequent pregnancy, (either miscarriage, preterm delivery (<37 weeks), or low birthweight ((<2500g) as a proxy for gestation). They are also more likely to have shorter gestation at miscarriage, and the gestation at miscarriage is associated with method of termination. Also, women are more likely to show a dose-response in three-pregnancy series, with increasing numbers of consecutive terminations associated with increasingly poorer outcomes. Data and Methodology: Setting and Sample: Aberdeen maternity hospital (AMH) is the level III consultant-led maternity unit for NHS North of Scotland Region. It provides care for pregnant women both with and without complications and for sick neonates. The data were extracted from the Aberdeen Maternity and Neonatal Databank (AMND), with the sample restricted to Aberdeen city women in 1970-1999, and only singleton pregnancy events were included. Outcomes The study group was Termination-Birth (TB) and this group was compared to three comparison pregnancy history groups, Miscarriage-Birth (MB), Birth-Birth (BB) and Birth (B). The outcomes are preterm and low birthweight deliveries and the sub-categories of preterm and low birthweight. In addition, miscarriage on the index event is also considered as an outcome. Methods: The distributions of gestation and birthweight were examined between and within study groups for outcomes of preterm and low birthweight deliveries, and logistic and multinomial regression was used to assess the impact of selected potentially confounding socio-demographic and pregnancy related characteristics on the odds of delivering at different levels of preterm and low birthweight by pregnancy history. The gestation at miscarriage of the index subsequent event is also examined between study groups, as is the method of termination for women whose first pregnancy was terminated. In addition, two and three pregnancy sequences are examined to determine if there was a ‘dose-response’ effect of termination of pregnancy. Results: For women from group TB, the overall difference in average adjusted gestation at delivery is approximately 1 day less for women from group TB compared to women from group MB, and only 2 days from women with only a history of births, these results could be considered clinically insignificant. This thesis has shown that compared with women with a previous birth, and after adjusting for possible confounding factors, births after a previous termination were consistently more likely to result in a preterm delivery. Women who terminated a first pregnancy have an increased likelihood of preterm delivery from a public health perspective, with an overall 40% increase in risk for preterm birth for women from group TB when compared to women from group B (OR 1.35 95%CI 1.15, 1.58). These increased odds of preterm delivery for group TB are very similar to those for women from group MB (OR 1.45, 95%CI 1.18, 1.79). Similarly, after adjustment for potential confounding factors, women from group TB were consistently more likely to deliver a low birthweight baby, when compared to women with from group B, (OR 1.18 95%CI 1.00, 1.38). Women from group MB were also significantly more likely to deliver a low birthweight baby after adjustment for possible confounding factors (OR 1.42 95%CI 1.16, 1.72). Few if any of the explanatory variables are directly modifiable, and the PAF associated with women from group TB is relatively small, when compared to other significant potential risk factors. Women who terminated a first pregnancy were significantly more likely, after adjustment for socio-demographic characteristics to miscarry late (OR 1.74, 95%CI 1.07, 2.84), but there was no difference between medical and surgical terminations. Finally, there was no evidence of a dose response of termination for either preterm or low birthweight deliveries, although there was marked evidence of a dose response of miscarriage. Conclusions The results from a clinical and public health point of view may appear to be contradictory, in that there is an approximate 40% increase in relative risk for preterm delivery, but only an adjusted absolute difference of two days lower gestation at birth for women from group TB. PAF findings indicate only a small overall reduction in the number of preterm deliveries if the exposure to the risk factor of a previous termination was eliminated. Women who undergo a termination should therefore receive full information on factors which might have an influence on the outcome of a subsequent pregnancy, and in addition medical information given to the women should cover details about the termination process, including methods of termination, possible complications, post termination follow up and future contraception.
18
Olsson, Carrie 1942. "Father participation in labor and birth expectations vs. experience". Thesis, The University of Arizona, 1991. http://hdl.handle.net/10150/277957.
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This secondary analysis study described the experiences of twelve fathers (out of an original group of 61) whose mates and/or infants were at risk during the pregnancy, labor and birth. The data for the study came from a large project named "Antepartum Stress: Effect on Family Health and Functioning" (Mercer, Ferketich, May, & DeJoseph, 1987). The conceptual framework for the secondary analysis was based on adaptation theory. Fathers' experiences were described in terms of adaptation to fatherhood in four modes: physiologic, self-concept, role function, and interdependence. The data was analyzed by quantitative and qualitative methods. A succinct description of the experience of high-risk fathers is characterized by the phrase one of the fathers used: "like a roller coaster". While 87% of the fathers said they were happy and proud of becoming a father, many expressed fear and concern because their mates and/or infants were at risk. The fathers were present during the labor and delivery of their high-risk infants. The birth was not what they expected but the fathers would not change the experience in retrospect. More exploratory work needs to be done in order to understand the experience of fathers involved in high-risk pregnancy and birth.
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Feketshane, Anthony M. "The effect of misoprostol on fetal heart rate parameters during induction of labour from 38 weeks gestation : a retrospective audit". Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/85819.
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Thesis (MMed)-- Stellenbosch University, 2013.ENGLISH ABSTRACT: Misoprostol is often used for the purpose of induction of labour. However, its effect on fetal heart rate has not been systematically studied. Objective To assess the effect of misoprostol on fetal heart rate parameters during induction of labour from 38 completed weeks in women with previous intrauterine death or postterm pregnancy. Study design A retrospective descriptive study of 127 women for a period of 18 months. Method Women who underwent induction of labour with misoprostol for either previous intrauterine death or postterm pregnancy at Tygerberg hospital were eligible. The selected process of induction of labour happened according to the departmental protocol. The primary outcomes were changes in fetal heart rate (variability, accelerations and decelerations) pre-and post-administration of misoprostol. Secondary outcomes were neonatal highcare or intensive care unit (ICU) admissions. Results There was no statistical difference in the mean fetal heart rate and baseline variability in relation to time recordings after administration of misoprostol. There were no statistically significant differences in the distribution of accelerations and decelerations in different time intervals before and after administration. There were more reactive patterns at all time intervals after the administration of misoprostol, but these differences did not quite reach statistical significance. In both study groups no neonatal complications or intensive care admissions were reported. Conclusion In the absence of contra indications, 50mcg of oral misoprostol can be given to mothers for induction of labour as no harmful fetal heart tracing abnormalities were found for 45 minutes; however large prospective randomized controlled trials are still needed to confirm effectiveness and evaluate further maternal and neonatal safety issues. Optimal dose and frequency also still need robust interrogation. Based on this thesis it does appear that misoprostol is probably not harmful to the fetus under these circumstances.
AFRIKAANSE OPSOMMING: Misoprostol word dikwels gebruik vir induksie van kraam. Die effek daarvan op fetale hartspoed is egter nie sistematies ondersoek nie. Doel Om die effek van misoprostol op fetale hartspoedparameters gedurende die induksie van kraam van 38 voltooide weke in vroue met vorige intra-uteriene dood or oortyd swangerskap te evalueer. Studei-ontwerp „n Retrospektiewe beskrywende studie van 127 vroue oor „n periode van 18 maande. Metode Vroue wat induksie van kraam met misoprostol ondergaan het vir of vorige intra-uteriene dood of oortyd swangerskap by Tygerberg Hospitaal is ingesluit. Die proses van induksie van kraam is volgens departementele protokol uitgevoer. Die primêre uitkomste was veranderinge in fetale hartspoed (variasie, versnellings en verstadigings) pre- en post-toediening van misoprostol. Neonatale hoësorg of intensiewe sorg toelatings was sekondêre uitkomste. Resultate Ons het geen statistiese verskille in gemiddelde fetale hartspoed en basislynvariasie in verhouding tot die tyd na toediening van misoprostol gevind nie. Daar was geen statisties betekenisvolle verskille in die verspreiding van versnellings en verstadigings in verskillende tydsintervalle nie. Daar was meer reaktiewe patrone gedurende alle tydsintervalle na die toediening van misoprostol, maar hierdie verskille was nie statisties betekenisvol nie. In beide studiegroepe was daar geen neonatale komplikasies of intensiewe sorg toelatings nie. Gevolgtrekking In die afwesigheid van kontra-indikasies kan 50 mcg misoprostol aan moeders toegedien word vir induksie van kraam aangesien geen skadelike fetale hartsped abnormaliteite gevind is nie. Groot prospektiewe gerandomiseerde gekontroleerde studies word steeds benodig om effektiwiteit te bevestig en om moederlike en fetale veiligheidskwessies verder te evalueer. Optimale dosis en frekwensie benodig ook robuuste ondersoek. Gebaseer op hierdie tesis kom dit voor of misoprostol waarskynlik nie skadelik vir die fetus onder hierdie omstandighede nie.
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Shokane, Morogwana Anna. "The utilization of the partograph by midwives in Lebowakgomo and Zebediela level 1 hospitals in the Capricorn District of the Limpopo Province, South Africa". Thesis, University of Limpopo (Turfloop Campus), 2011. http://hdl.handle.net/10386/627.
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Thesis (M.Cur.) --University of Limpopo, 2011Introduction and aim: Globally it is of paramount importance that all pregnant women in labour are monitored by midwives utilizing a partograph so that a live baby is delivered. Midwives seemed not to utilize the partograph correctly when monitoring women in labour. The purpose of this study was to determine the utilization of the partograph by midwives in the labour wards of Lebowakgomo and Zebediela level 1 hospitals in the Capricorn District of the Limpopo Province, South Africa. The research question was, “What skills and knowledge do midwives have on the utilization of the partograph for monitoring pregnant women in labour”. The objectives of this study were to explore and describe the utilization of the partograph by midwives in Lebowakgomo and Zebediela level 1 hospitals in the Capricorn District of the Limpopo Province, and to develop guidelines that would assist midwives to effectively utilize the partograph hence provision of quality midwifery care. Research Design and method: The research design was qualitative, descriptive, explorative and contextual in nature. The population comprised all midwives registered with the South African Nursing Council and practicing as such in Lebowakgomo and Zebediela level 1 hospitals. A purposive sampling technique was used to select 15 participants. Data were collected using semi-structured in–depth interviews with a guide. The semi-structured in-depth interviews were conducted until data were saturated. Trustworthiness was ensured by credibility, dependability, transferability and confirmability. Ethical clearance to conduct the study was obtained from the University of Limpopo and from the Department Health and Social Development. The principles of informed consent, confidentiality and anonymity were observed during the study. Data were analyzed using the Tesch’s approach as described by Creswell (1994) cited in de Vos (2005:333). Conclusions: The following themes emerged during data analysis: monitoring of foetal status during intrapartum, monitoring of the progress of labour during intrapartum, monitoring of the maternal status during intrapartum, and shortage of staff in the labour wards. Guidelines which aimed at improving midwifery care were formulated.
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Shaw-Battista, Jenna Cleave. "Optimal outcomes of labor and birth in water compared to standard maternity care". Diss., Search in ProQuest Dissertations & Theses. UC Only, 2009. 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:3378507.
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Neal, Jeremy L. "Physiological Factors Influencing Labor Length". The Ohio State University, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=osu1218220309.
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Niven, Catherine A. "Factors affecting labour pain". Thesis, University of Stirling, 1985. http://hdl.handle.net/1893/2572.
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The labour pain experienced by 101 women giving birth in a Scottish hospital was assessed by the McGill Pain Questionnaire and Visual Analogue Scales during active first stage labour and post-natally. Labour pain was found to be on average severe, but not intensely negatively affective. Its intensity varied considerably and was related to parity and the duration of the first stage of labour reflecting underlying differences in levels of noxious stimulation. Other obstetric and pharmacological factors which might affect noxious stimulation were not significantly related to pain scores. Induction was related to higher,and complications of pregnancy, to lower levels of pain attributable to psychological modulation. The desirability of pregnancy, positive and accurate expectations of birth, ante-natal training and the welcomed presence of the husband at the birth were associated with significantly lower levels of labour pain, particularly of non-sensory pain. A few subjects had very minimal previous experience of pain. These subjects had the lowest levels of pain in childbirth, perhaps because they were relatively insensitive to noxious stimulation. Subjects whose previous experience of pain had been extensive had significantly lower levels of labour pain than subjects whose previous pain experience had been more limited. Subjects who had extensive experience of pain used a larger number of strategies to cope with that pain than subjects whose experience had been more moderate. They used more strategies during labour, a greater proportion of which they had used previously. The use of a number of strategies in labour, either in combination or in sequence was related to lower levels of labour pain but not to painless childbirth. So too was the use of strategies which had been previously utilised. The relationship between previous pain experience and levels of labour pain was mediated by the differential use of coping strategies.
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Jones-Worthing, Chandra Evette. "REM Initiative to Develop Educational Strategies for Inductions of Labor". ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5090.
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Inductions of labor that occur prior to 39 weeks' gestation can pose increased risks for the mother-baby dyad. In the target setting, there is a gap in knowledge among the pregnant women about options for delivery, hospital policies and procedures, and what to expect in the labor and delivery experience. Because of this gap in knowledge, the pregnant patient is unable to make informed decisions regarding her needs, expectations, and care. This lack of knowledge has resulted in a 40-50% rate of inductions of labor at the target site, which is well above the 2014 national average of 25%. In response to this gap, an evidence-based initiative was developed that focused on appropriate use of inductions of labor to increase safety and quality of care of the pregnant patient in a suburban women's hospital located in southeastern Georgia. The design used for this project was the development of an evidence-based, theory-supported educational initiative that underwent a formative and summative evaluation by a 10 member, interdisciplinary expert panel. Watson's theory of human caring provided the theoretical basis for the educational program. The interdisciplinary expert panel found that the initiative was educationally sound. The materials were found suitable for the intended audience and easy to understand. It is projected that the initiative will not only benefit the pregnant woman but will also increase the interaction, collaboration, and respect of members of the healthcare team. Implications for positive social change include the development of an educational program that will result in patients being more informed and becoming active participants in their care which will result in better outcomes for the mother and baby dyad.
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Fyfe, Elaine Maria. "Sexual abuse prevalence and association with adverse labour and birth outcomes a thesis submitted to Auckland University of Technology in partial fulfilment of the degree of Master of Health Science, 2005". Full thesis. Abstract, 2005.
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26
Lehrman, Ela-Joy. "A theoretical framework for nurse-midwifery practice". Diss., The University of Arizona, 1988. http://hdl.handle.net/10150/184546.
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The purpose of this research was to test the predicted relationships among a component of nurse-midwifery care, psychosocial health outcomes and other maternal psychosocial variables. The theoretical framework for the research was the Intrapartum Care Level of the Nurse-Midwifery Practice Model, a middle range theory. Previous nurse-midwifery research had been based on theories and models not specific to nurse-midwifery practice. A nonexperimental, correlational design was used, with measures in the last trimester of pregnancy and the first month following birth. The psychosocial variables measured were prenatal care satisfaction, personable environment, positive presence, labor support, transcendence, labor satisfaction and enhanced self-concept. Purposive sampling was used at a birth center in a Southwestern city where women received nurse-midwifery care for pregnancy, labor and birth. The sample of 89 women consisted of 35 primiparas and 54 multiparas, with a mean age of 29 years; 46.1% gave birth at the birth center and 53.9% gave birth at a local hospital. The primary instruments for the research included the Prenatal Satisfaction Questionnaire, the Attitude Toward Issues in Choice of Childbirth Scale, the Positive Presence Index, the Labor and Birth Support Inventory, the Coping in Labor and Delivery Scale, the Labor and Delivery Satisfaction Questionnaire, and the Self-Confidence Scale of the Adjective Check List. The secondary instruments, used for the evaluation of construct validity, included the Positive Presence Index - Alternate Format, the Labor and Birth Coping Index, the Labor and Birth Satisfaction Index, and the Self-Concept Index - Alternate Format. Acceptable levels of reliability and validity were obtained for the instruments. The predicted relationships from the Model were tested with causal analysis using multiple regression and residual analysis. The empirical rather than the theoretical model was supported by the data. Prenatal care satisfaction, personable environment, positive presence and transcendence explained 66% of the variance in labor satisfaction, with an additional 2% explained variance with the addition of the situational variable of consultation. Positive presence had the greatest direct effect (B =.70) and also explained 5% of the variance in enhanced self-concept. The empirically significant relationships were clinically relevant.
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Low, Lenora W. Y. "Promoting Shared Decision Making Through Patient Education of Labor Inductions". ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/1905.
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The induction of labor is medically indicated for many conditions in which delivering the baby outweighs the risk of continuing the pregnancy. Patients admitted for the induction of labor require adequate information to actively participate in decision making that affects their plan of care. The purpose of this quality improvement project was to improve the quality of healthcare delivery and promote patient engagement by providing consistent education using a teaching tool. The project question addressed the impact of a labor-induction teaching tool on improving patient education, participation, and overall satisfaction. The Plan-Do-Study-Act (PDSA) model was used to plan, implement, and evaluate the labor-induction teaching tool in a 9-room labor and delivery unit that averages approximately 1,500 births per year. The teaching tool content was obtained from existing patient education information from the organization's resource library. The nurses piloted the teaching tool for all patients admitted for the induction of labor for 3 weeks. Patient comments supported the use of the teaching tool to improve knowledge, increase participation in decision making, and enhance overall satisfaction. The nurses voluntarily completed an online survey that indicated the teaching tool was easy to use, positively impacted workflow, and supported informed choice. Patient charts were audited and showed a 94% compliance with documentation of education. The success of the teaching tool in improving patient education and decision-making capacity supports the development of other teaching tools, encourages patient and family-centered care, and improves the delivery of quality care.
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Bridges, Margie Allyn. "Cesarean Births Rates After Implementation of Labor Management Guidelines". ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4776.
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Cesarean birth rates are associated with increased maternal morbidity. This project evaluated a quality improvement (QI) initiative implemented to reduce cesarean births among Nulliparous Term Singleton Vertex (NTSV) obstetric populations, the largest contributor to cesarean births. Variations in labor management practice contribute to cesarean birth rate; implementation of labor management bundles have been endorsed to influence practice- and system-level changes in the promotion of vaginal births. The problem addressed in this project was an organizational NTSV cesarean section rate of 30%. The purpose of the project was to use secondary data to evaluate a previously implemented labor management bundle at a large hospital in the northwestern United States. The model of improvement was used as a framework for the QI initiative and this evaluation project. The practice-focused question asked in this project was: Did NTSV cesarean birth rates change after implementation of an evidenced-based standardized labor management bundle? Archived data were collected on cesarean birth rates for 3 time periods: prebaseline, 1 year postimplementation, and 2 years postimplementation. Chi-squareï? tests compared the differences between observed and expected results of data following implementation of labor management bundles. Results show no statistically significant difference between the pre- and post- implementation periods in the NTSV laboring population. Results suggest use of labor management practice bundles alone may not lead to expected outcomes improvements and that operationalization of such practices are sensitive to institutional and/or patient population contexts. This project may serve to promote positive social change by framing evidence-based practice as a process that must attend to contextual considerations.
29
Romano, Margaret Ellen. "Recent jurisprudence and the future of 'b̲o̲n̲u̲m̲ p̲r̲o̲l̲i̲s̲'". Theological Research Exchange Network (TREN), 2005. http://www.tren.com.
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Coyle, Karen. "Women's perceptions of birth centre care: A qualitative approach". Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1998. https://ro.ecu.edu.au/theses/1004.
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The purpose of this exploratory study was to describe women's perceptions of the care they received in a birth centre, compared to their previous experiences in a hospital. Australian statistics indicate that five percent of childbearing women now choose to receive care in a birth centre setting. Clinical outcomes of birth centre care are now well documented, but there is limited empirical data about women's experiences of this model of care. Seventeen women, who had recently given birth in a birth centre, and had previously experienced care in a hospital setting, were interviewed about their care experiences. Using content analysis, the primary patterns in the data were coded and categorised into the four key themes of : Beliefs about Pregnancy and Birth, Nature of the Care Relationship, Care Interactions and Care Structures. The underlying clinical issues were those relating to philosophies of care, control over childbirth, and continuity of carer. Women wanted carers who viewed birth as a natural process rather than as an illness, and who engaged in a sharing, rather than a controlling, relationship. Finally women preferred to know, and be known by their carers. These findings are important for midwives, in terms of their education and practice. They also have implications for hospital administrators, health planning agencies, and the medical profession.
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Cheyne, Helen L. "The development and testing of an algorithm to support midwives’ diagnosis of active labour in primiparous women". Thesis, University of Stirling, 2008. http://hdl.handle.net/1893/494.
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The research in this thesis aimed to develop an algorithm to support midwives’ diagnosis of active labour in primiparous women and to compare the effectiveness of the algorithm with standard care in terms of maternal and neonatal outcomes. Four linked studies are presented following the template suggested by the Medical Research Council (MRC 2000) Framework for development and evaluation of randomised controlled trials (RCT) for complex interventions to improve health. Study one Aim: To develop an algorithm for diagnosis of active labour in primiparous women. Methods: An informal telephone survey was conducted with senior midwives to assess the need for a decision support tool for the diagnosis of active labour. A literature review identified the key cues for inclusion in the algorithm which was then drafted. Focus group interviews were conducted with midwives to ascertain the cues used by midwives in diagnosing active labour. Findings: Thirteen midwives took part in focus groups. They described using informational cues which could be separated into two categories: those arising from the woman (Physical signs, Distress and coping, Woman's expectations and Social factors) and those from the institution (Midwifery care, Organisational factors and Justifying actions). Study Two Aim: Preliminary testing of the algorithm Methods: Vignettes and questionnaires were used to test the consistency of midwives’ judgements (inter-rater reliability), the content of the algorithm and its acceptability to midwives (face and content validity). The study was conducted in two stages: the first stage (23 midwives) involved vignettes and questionnaires and the second stage (20 midwives) involved vignettes only. Findings: In the first stage a Kappa score of 0.45 indicated only moderate agreement between midwives using the algorithm. After modifying the algorithm, the Kappa score in stage two was 0.86, indicating a high level of agreement. While the majority of the midwives reported that the algorithm was easy to complete, most were able to identify snags or make suggestions for its improvement. Based on the findings of this study the algorithm was modified and the final version was developed. Study three Aim: To assess the feasibility of carrying out a cluster randomised trial (CRT) of the algorithm, in Scotland. Specifically, to identify maternity units potentially willing to participate in a CRT, to test the implementation strategy for the trial and to collect baseline data to inform the sample size calculation. Methods: A questionnaire and interviews were used. The CRT methods were piloted in two maternity units and the algorithm was used for a three-month period in order to test its acceptability and provide estimates of compliance and consent rates. Results: All maternity units surveyed expressed an interest in the proposed study. Midwives’ compliance with study protocol differed between units, although the consent rate of women was high (89% and 84%). Ultimately, one unit achieved 100% of the required sample and the other 60%. The midwives reported that the algorithm was acceptable and was a useful tool, particularly for teaching inexperienced midwives. Study four Aim: To compare the effectiveness of the algorithm for diagnosis of active labour in primiparous women with standard care in terms of maternal and neonatal outcomes. Method: A cluster randomised trial Participants: Fourteen maternity units in Scotland. Midwives in experimental sites used the algorithm to assist their diagnosis of active labour. Seven experimental units collected data from 1029 women at baseline and 896 post intervention. The seven control units had 1291 women at baseline and 1287 after study implementation. Outcomes: The primary outcome was the percentage use of oxytocin for augmentation of labour. Secondary outcomes were medical interventions in labour, labour admission management, unplanned out of hospital births and clinical outcomes for mothers and babies. Results: There was no significant difference between groups in percentage use of oxytocin for augmentation of labour or for the use of medical interventions in labour. Women in the algorithm group were more likely to be discharged from the labour suite following their first labour assessment and subsequently have more pre-labour admissions. Conclusion The studies presented in this thesis represent the full process of developing and testing a complex healthcare intervention (the algorithm). The final study, a national cluster randomised trial, demonstrated that the use of the algorithm did not result in a reduction in the number of women who received oxytocin for augmentation or the use of medical interventions in labour. The results suggest that misdiagnosis of labour is not the main reason for higher rates of intervention experienced by women admitted to labour wards while not yet in active labour. These studies contribute significantly to the debate on care of women in early labour, the organisation of maternity care and to maternity care research.
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Bennett, Kelly Angela. "A masked randomized comparison of oral and vaginal administration of misoprostol for labour induction". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0031/MQ62369.pdf.
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Nascimento, Maria Laura Costa do 1979. "Auditoria e feedback : efeitos sobre a pratica obstetrica e os resultados da atenção a saude". [s.n.], 2008. http://repositorio.unicamp.br/jspui/handle/REPOSIP/310056.
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Orientadores: Jose Guilherme Cecatti, Helaine Maria Besteti Pires MilanezDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: Introdução: Auditoria e Feedback, estratégia de intervenção na prática médica, sendo um resumo da atuação durante certo período, com posterior formulação de recomendações para a melhoria do serviço estudado. Sua efetividade ainda é incerta em Obstetrícia. Objetivo: Estudar o processo de Auditoria e Feedback em Obstetrícia e implementar o uso do material da Reproductive Health Library. Avaliar o possível efeito da intervenção sobre as taxas de parto por cesárea, com a utilização da classificação de Robson. Métodos: coleta prospectiva de dados sobre os seis parâmetros obstétricos selecionados segundo publicações baseadas em evidência, antes e depois de um período de intervenção, preparado após análise dos índices de prevalência de cada prática: episiotomia seletiva, cardiotocografia contínua durante o trabalho de parto em gestações de baixo risco, antibioticoprofilaxia no parto por cesárea, uterotônico no terceiro período do parto, indução de parto às 41 semanas em gestações de baixo risco e suporte contínuo durante o trabalho de parto. Realizado agrupamento de todos os partos segundo a classificação de Robson, em 10 grupos, levando em conta o antecedente obstétrico, tipo de gestação, curso do trabalho de parto e idade gestacional. Resultados: os dois períodos foram similares quanto às características obstétricas gerais. Com relação aos parâmetros selecionados, foi observada redução significativa do uso de episiotomia seletiva (RR 0.84 IC95% 0.73-0.97), embora o mesmo não tenha ocorrido entre as primigestas (p=0,315), aumento na presença de acompanhante durante o trabalho de parto (RR 1.42; 1.24-1.63) e adequação de uso de uterotônico (ocitocina 10UI) no terceiro período (p<0,0001). Segundo a classificação de Robson, não ocorreu alteração no índice global de partos cesárea nos dois períodos estudados (respectivamente 45.5% e 43.3%). Houve predomínio do Grupo 3 (multipara sem cesárea anterior, feto único, cefálico, de termo, trabalho de parto espontâneo) com índices de 28.5 e 26.8% respectivamente. O segundo mais prevalente foi o Grupo 1 (nulípara, feto único, cefálico, termo e trabalho de parto espontâneo), com 25.5 e 22.6% do total de partos, seguido pelo Grupo 5 (multípara com cesárea prévia, feto único, cefálico, gestação de termo), com taxas de 22.9 e 21.3% respectivamente. O Grupo 5 foi também responsável pela maior contribuição ao número total de cesáreas (36.4 e 34.6% nos dois períodos). Os Grupos 2 (nulípara, feto único, cefálico, de termo, em trabalho de parto induzido ou cesárea antes de trabalho de parto) e 4 (multípara, feto único, cefálico, de termo, em trabalho de parto induzido ou cesárea antes de trabalho de parto), embora tenham pouca contribuição ao número total de partos, demonstraram altos índices de cesárea dentro do seus grupos. O grupo 10, composto por prematuros, foi o quarto mais prevalente, também com altos índices de cesárea no seu grupo, porém com redução significativa entre os períodos pré e pós-intervenção (p=0.0058). Conclusão: o processo de Auditoria e feedback pode ser utilizado como mecanismo de implementação em obstetrícia, sobretudo quando a equipe é receptiva a mudanças.
Abstract: Background: Audit and feedback is a widely used strategy to improve professional practice and can be defined as any summary of clinical performance of health care over a period of time, which may include recommendations for clinical action. Its effectiveness is still uncertain in Obstetrics. Objectives: to assess the effects of audit and feedback on the practice of healthcare professionals and patient outcomes and to implement the use of RHL material as a routine in medical practice; to evaluate the effect of the intervention over the incidence of caesarean sections, according to the Robson's classification, in 10 groups. Methods: The study proposed has an audit and feedback design and was conducted in the obstetric Unit of the University of Campinas, Brazil, between the years 2007- 2008. It started by providing up to date estimates of prevalence rates of six audit standards underwritten by evidence-based recommendations: selective episiotomy; continuous electronic fetal monitoring during uncomplicated labour of low risk pregnant women; antibiotic prophylaxis for women undergoing caesarean section; use of oxytocin after delivery as one of the procedures of active management of third stage of labour; routine induction of labour at 41 weeks for uncomplicated pregnancies and continuous support for women during childbirth. The results were then analyzed and presented as feedback to clinical practice. Active information based on the WHO Reproductive Health Library (RHL) was prepared to remind important and reliable health care interventions during meetings with the whole maternity staff. After four months, the same practices were again measured and analyzed to compare data and assess if the intervention was effective. All caesarean sections were evaluated according to Robson's Classification to study a possible effect of the intervention on caesarean rates. Results: both periods studied showed equivalency in the total number of deliveries, vaginal and caesarean births, forceps and deliveries in nulliparous. Considering the obstetric practices evaluated, there was a significant reduction in selective episiotomy (RR 0.84 95%CI 0.73-0.97), but not in nulliparous (p=0.315); an increase in continuous support for women during childbirth (RR 1.42; 1.24-1.63). There was also a change in the institution protocol for the use of uterotonic (oxitocyn) during third stage of labor, with a shift to the WHO recommended dosage of 10UI (p<0.0001). There was no change observed in the use of continuous electronic fetal monitoring, routine induction of labour at 41 weeks for uncomplicated pregnancies and antibiotic prophylaxis in caesarean sections. Considering caesarean sections, there was no prevalence change after intervention. Robson's classification was applied and Group 3 (multiparous excluding previous CS, single, cephalic, =37 weeks, spontaneous labour) accounted for the largest proportion of deliveries, 28.5% and 26.8% in both periods. Group 1 (nulliparous, single, cephalic, =37 weeks, spontaneous labour) was the second largest one, with 25.5% and 22.6% respectively, while Group 5 (previous caesarean section, single, cephalic, =37 weeks) was the third, with percentages of 22.9% and 21.3% respectively. Group 5 also represented the most prevalent when considering only caesarean sections, accounting for 36.4% and 34.6% in both periods. Groups 2 (nulliparous, single, cephalic, =37 weeks, induction or CS before labour) and 4 (multiparous excluding previous CS, single, cephalic, =37 weeks, induction or CS before labour) had low contribution for the total number of deliveries, however they had higher rates of caesarean sections within each group. Group 10 (all single, cephalic, = 36 weeks, including previous CS) represented the fourth largest among all deliveries, with respectively 6.6% and 8.6%. Within its group, the rate of caesarean section was high, with a significant decrease from 70.5% to 42.6%, from pre to post intervention period (p=0.0058). Conclusion: Audit and feedback can be used as a successful implementation tool in obstetrics, especially when the medical staff is open and receptive to change.
Mestrado
Tocoginecologia
Mestre em Tocoginecologia
34
Guerra, Glaucia Virginia de Queiroz Lins. "Indução do trabalho de parto na America Latina : inquerito hospitalar". [s.n.], 2008. http://repositorio.unicamp.br/jspui/handle/REPOSIP/310041.
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Orientador: Jose Guilherme CecattiTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: Objetivo: Avaliar a prevalência da indução médica e eletiva do trabalho de parto, métodos utilizados, índice de sucesso, fatores associados e resultados maternos e perinatais em oito países da América Latina. Método: Foi realizada a análise referente à indução do trabalho de parto no banco de dados da Pesquisa "2005 WHO global survey on maternal and perinatal health", referente a oito países aleatoriamente selecionados da América Latina. Obtiveram-se os dados individuais de todas as mulheres que tiveram seus partos em 120 instituições, no período do estudo. Avaliaram-se as indicações de indução por país, a taxa de sucesso por método, os fatores associados à indução e os resultados maternos e perinatais comparativamente aos partos iniciados espontaneamente (primeira abordagem). Após foi feita uma análise independente da indução eletiva comparada com o início espontâneo do trabalho de parto entre gestações de baixo risco, para avaliar os fatores associados a essa prática e seus resultados maternos e perinatais (segunda abordagem). Foram estimados os odds ratios (OR) para os possíveis fatores associados à indução e as razões de risco (RR) para os resultados maternos e perinatais, com seus respectivos intervalos de confiança (IC95%). Posteriormente, foram aplicados os modelos de regressão logística múltipla para o ajuste dos riscos estimados. Resultados: Do total de 97.095 partos do inquérito, 11.077 (11,4%) foram induzidos. Os hospitais públicos foram responsáveis por 74,2% das induções. A ruptura prematura das membranas (25,3%) e a indução eletiva (28,9%) foram as indicações mais freqüentes. A taxa de sucesso de parto vaginal foi de 70.4%, com 69.9% para a ocitocina e 74.8% para o misoprostol, os principais métodos isoladamente utilizados. O risco de indução do parto foi maior em mulheres com mais de 35 anos, com companheiro, nulíparas, sem cesárea no parto anterior, com rotura de membranas, hipertensão arterial, baixa altura uterina, diabetes, anemia grave, com menor número de consultas de pré-natal, pós-datismo, apresentação cefálica e naquelas que deram a luz em hospitais do seguro social. As complicações maternas mais associadas com a indução do parto foram a necessidade de uterotônicos no período pós-parto, laceração perineal, histerectomia, admissão em unidade de terapia intensiva, permanência hospitalar maior que 7 dias e maior necessidade de procedimentos analgésicos. Já os resultados perinatais desfavoráveis mais freqüentes foram Apgar menor que sete ao quinto minuto, ocorrência de muito baixo peso, admissão em UTI neonatal e início mais tardio da amamentação. Em relação à análise da indução eletiva entre gestantes de baixo risco, não foi encontrada diferença na taxa de cesariana e nos resultados perinatais, porém ocorreu maior necessidade do uso de uterotônico no pós-parto, risco cinco vezes maior de histerectomia pós-parto e maior necessidade de procedimentos de anestesia/analgesia. Conclusão: Na América Latina a taxa global de indução do trabalho de parto foi um pouco maior que 10%, enquanto a de indução eletiva entre gestantes de baixo risco foi de 4,9%. A taxa de sucesso para o parto vaginal foi elevada independentemente do método e da indicação da indução. Há, contudo, alguns riscos maternos e perinatais associados com essa prática, seja ela eletiva ou não
Abstract: Objective: To evaluate the prevalence of both medical and elective labor induction as well as employed methods, success rates, associated factors and maternal and perinatal outcomes in eight Latin American countries. Methods: it was performed an analysis on labor induction in the database of the "2005 WHO global survey on maternal and perinatal health" on deliveries occurring in eight randomly allocated Latin American countries. Data of all women who gave birth to children in the 120 included institutions during the period of the study were collected. The indications for labor induction according to the country, the success rate for each method, the factors associated with labor induction as well as maternal and perinatal outcomes were compared with deliveries with spontaneous onset of labour (Approach 1). A second independent analysis on elective induction compared with spontaneous onset of labor in low-risk pregnancies was performed in order to evaluate factors associated with elective labor induction and also maternal and perinatal outcomes (Approach 2). The odds ratios (OR) for possible factors associated with labor induction and the risk ratios (RR) for maternal and perinatal outcomes, with respective confidence interval (95%CI) for all types of labor induction and for elective induction were estimated. Additionally, multiple logistic regressions were applied to adjust the estimated risks. Results: Among the total 97,095 deliveries included in the survey, 11,077 (11.4%) underwent labor induction. Public hospitals accounted for 74.2% of them. Premature rupture of membranes (25.3%) and elective induction (28.9%) were the most frequent indications. The success rate in obtaining vaginal delivery was 70.4%. Oxitocin and misoprostol - the most employed methods - had success rates of 69.9% and 74.8%, respectively. Labor induction occurred more frequently in women older than 35 years, with a partner, nulipara, without cesarean section in the last pregnancy, ruptured membranes, hypertension, low fundal height, diabetes, severe anemia, vaginal bleeding, few prenatal visits, post term, cephalic presentation and those who gave birth in social security hospitals. The most frequent maternal complications associated with labor induction were need for uterotonic agents in postpartum period, perineal laceration, need for hysterectomy, and admission to intensive care unit, length of hospital stay above seven days and increased need of anesthetic/analgesic procedures. The most frequent adverse perinatal outcomes were low 5-minute Apgar score, very low birth-weight, admission to neonatal intensive care unit and delayed initiation of breastfeeding. Concerning elective induction in low-risk pregnancies there was no difference in cesarean section rate or perinatal outcome. However, there were increased needs for uterotonic agents in the postpartum period and for analgesic/anesthetic procedures, and a further than fivefold risk for postpartum hysterectomy. Conclusions: In Latin America, the overall labor induction rate was slightly more than 10%, while for elective indication among low risk pregnancies it was 4.9%. The vaginal delivery rate was high irrespective of the method or indication. However, there are some maternal and perinatal risks associated with this intervention, in spite of medically or electively indicated.
Doutorado
Tocoginecologia
Doutor em Tocoginecologia
35
Jantjes, Louisa. "Inter-level health service referral of women in labour". Thesis, Nelson Mandela Metropolitan University, 2008. http://hdl.handle.net/10948/986.
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Although it is considered an everyday occurrence, childbirth is nonetheless an important and dramatic experience in the life of every woman. Childbirth, a normal physiological state in the life of a woman, can be an awe-inspiring and exciting experience, but sometimes disconcerting experiences may also occur. Women sometimes see labour as the end to a long drawn out process following pregnancy and therefore attribute great significance to all occurrences during labour. When complications occur in a usually uncomplicated process of labour, the health care provider must be able to make quick and effective management decisions and implement appropriate interventions. This may include the referral of women in labour to a level of care where complications can be dealt with more effectively, thereby ensuring the best maternal and neonatal outcomes. Patient referral is regarded as a fundamental component of the health care system therefore a well functioning system should ensure that patients are treated in the appropriate manner at the appropriate place at the lowest possible cost to the health system. The goal of this research study was to explore and describe the inter-level health service referral of women in labour by midwives, in order to design guidelines for midwives and other relevant health care providers involved in inter-level health service referral of women in labour in the South African public health care sector. The research design used for this study is a combination of qualitative and quantitative approaches. The paradigmatic perspective of this study was based on the World Health Organization’s Health for All Model. Appropriate data collection and analysis strategies were used for the different stages of the study. Data collection commenced only after permission to conduct the research had been obtained from relevant authorities and University of Port Elizabeth and the Nelson Mandela Metropolitan University structures. Informed consent was obtained from participants included in the study. In stage 1 of this research project, a profile of midwives at lower level maternity care centres was compiled and the perceptions and experiences of midwives working at lower level maternity services, who are responsible for inter-level health referrals of women in labour, were described. Stage 2 described, by means of analysis of maternity case records, aspects of the inter-level referral of women in labour including the profiles of women admitted to midwife obstetric units (MOUs) who are v referred to higher levels of care. Of significance in this study is the appropriateness of midwifery referrals and the maternity care implemented by health care providers during inter-level health service referral of women in labour. In stage 3 clinical guidelines for midwives and other relevant maternity care providers, to assist them in the inter-level health service referral of women in labour, were developed. Findings from stage 1 of this research study revealed that midwives were generally well qualified and sufficiently experienced in the management of women in labour who need referral. Disconcerting findings relating to human and material resource shortages were discovered; these included major problems with patient transportation and difficulties with communication relating to inter-level health service referral of women. These shortages adversely affected midwives’ ability to efficiently care for women during the inter-level health service referral of women in labour in the research area. Stage 2 of the study yielded results of questionable standards of care to women and infants included in the study. A further disturbing finding from the study is the poor state of record keeping. The development of the provisional guidelines in stage 3 of the study was informed by the four main themes identified from the research findings. Before embarking on guideline development, the researcher familiarized herself with theory related to the clinical guidelines. These included clarifying the concept ‘clinical guidelines’, justifying the need for developing clinical guidelines as well as giving consideration to concerns about clinical guidelines. The research findings as well as literature related to these findings informed the researcher on the development of the guidelines. Provisional guidelines were therefore developed on responsibilities of role players in inter-level health service referral of women in labour at first level of referral, namely the midwife obstetric units, transport personnel and maternity care providers at the referral hospital. Steps were taken throughout the study to adhere to ethical standards of research. The researcher will ensure that the research report is available to all health authorities involved, the participants included in the study and the health care providers who may benefit from the research findings.
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Pathanapong, Poonsri. "Childbirth pain communicative behaviors among selected laboring Thai women". Diss., The University of Arizona, 1990. http://hdl.handle.net/10150/185186.
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The purpose of this study is to describe characteristics of childbirth pain communicative behaviors among laboring Thai women, determine mode of pain communication, and determine relationships among behaviors and parturients, age, parity, education, and occupation. This study employed an exploratory description design. Direct structural observation was used to collect data. The study was conducted at a general hospital in Bangkok, Thailand, with 32 subjects participating. The "Observation Checklist of Laboring Women's Behavior" was used to record the subjects' behaviors. Descriptive statistics, the t test, and Pearson product moment correlation were used to analyze data. Data analysis indicated that the subjects of this study communicated pain via nonverbal channels and in a quiet manner. The range of nonverbal behaviors ranked from the greatest to the least frequent occurrences and included tactual, facial, lips, body movements, eyes, and respiratory behaviors. The range of verbal reports ranked from the greatest to the lowest frequencies and included reports of sensation, self evaluation of tolerance of pain, asking for information, requesting help and comfort, and asking for permission. Reports of pain were the most predominant of all the verbal reports. There were no statistically significant differences between behaviors and age, parity, education, and occupation. Pain behaviors were more prevalent among primiparae. Subjects who were younger or had fewer years of education ask for more information relating to the childbirth process compared with their counterparts. The younger subjects tended to communicate their pain via verbal mode; the older subjects tended to communicate their pain through nonverbal channels. Information derived from this study contributed to clinical practice, research, and theoretical knowledge of nursing. The information will help nurses understand about pain communication among the Thai women. Findings also will serve as empirical data for future investigations and can be used as a basis for childbirth pain assessment. The findings of this study are not generalizable because subjects were not randomly selected and the sample size was small. Recommendations for future study include the use of larger sample sizes, refinement of the checklist, and the use of multiple methods to collect the data.
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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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Arbour, Megan Wood. "An Innovative Strategy to Understand and Prevent Premature Delivery: The Pre-Pregnancy Health Status of Women of Childbearing Age". Columbus, Ohio : Ohio State University, 2008. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=osu1221839682.
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Lewis, Megan J. "An Investigation of the Effects of Pitocin for Labor Induction and Augmentation on Breastfeeding Success". Scholarship @ Claremont, 2012. http://scholarship.claremont.edu/scripps_theses/109.
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Rates of labor induction and augmentation have been increasing in recent decades (Glantz, 2005). According to the Listening to Mothers II survey, half of all labors in the U.S. are induced or augmented with Pitocin or other synthetic form of the hormone oxytocin (Declercq et al., 2006). Oxytocin, a naturally occurring hormone released in the pituitary gland, is involved in the stimulation of uterine contractions during labor and in the milk ejection reflex during breastfeeding, and research suggests it also has various effects on the brain, such as eliciting maternal behavior. However, studies have shown that exogenous oxytocin can interfere with the natural production and regulation of oxytocin and can have adverse effects on the fetus and mother. Therefore, I predict that the induction or augmentation of labor with Pitocin will negatively affect breastfeeding following birth. The proposed study will compare LATCH scores, used in hospitals to measure postpartum breastfeeding success, of dyads exposed to intravenous Pitocin prior to birth with control dyads that had no exposure to Pitocin during labor. It is hypothesized that dyads exposed to Pitocin will have significantly lower LATCH scores than controls. Given the countless health benefits of breastfeeding for both mother and infant, the results of this study will have important implications for the evaluation of common practices during labor and birth.
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Windrim, Rory. "A randomized controlled trial of oral Misoprostol in the induction of labour at term /". St. John's, NF : [s.n.], 1999.
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Olefile, Kabelo Monicah. "Misoprostol for prevention and treatment of postpartum hemorrhage : a systematic review". Thesis, Stellenbosch : Stellenbosch University, 2011. http://hdl.handle.net/10019.1/17900.
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Thesis (MCur)--Stellenbosch University, 2011.ENGLISH ABSTRACT: Background: Misoprostol, a prostaglandin E1 analogue with its uterotonic properties has entered as an integral part of management of the third stage of labour, helping to prevent postpartum haemorrhage (PPH). Objective: To assess evidence on the effectiveness of misoprostol compared to a placebo for the prevention and treatment of postpartum haemorrhage. Methods: Databases searched included; MEDLINE, Google Scholar and Cochrane Central Register of Controlled Trials (CENTRAL). Other sources were also searched. All articles were screened for methodological quality by two reviewers independently by standardized instrument. Data was entered in Review Manger 5.1 software for analysis. Results: Three Misoprostol studies were included (2346 participants), Oral (2 trials) and sublingual (1 trial). Misoprostol has shown not to be effective in reducing PPH (RR 0.65: 95% CI 0.40-1.06). Only one trial reported on need for blood transfusion (RR 0.14; 95% CI 0.02-1.15). Misoprostol use is associated with significant increases in shivering (RR 2.75; 95% CI 2.26-3.34) and pyrexia (RR 5.34; 95% CI 2.86-9.96) than with placebo. No maternal deaths were reported in included trials. Compared to placebo, misoprostol was coupled with less hysterectomies and additional used of uterotonics (RR 0.45; 95%CI 0.21-0.96) compared to placebo. Conclusion: Results of this review shows that the use of misoprostol in combination with some components of active management was not associated with any significant reduction in incidence of PPH. However oral administration showed a significant reduction in incidence of PPH. For its use for treatment of postpartum haemorrhage, there is a need for research focus in optimal dose and route of administration for a clinically significant effect and acceptable side effects.
AFRIKAANSE OPSOMMING: Agtergrond: Misoprostol, 'n prostaglandien E1 analoog met sy uterotonic eienskappe het ingeskryf as' n integrale deel van die bestuur van die derde stadium van kraam, help postpartum bloeding (PPH) te voorkom. Doelwit: Om bewyse oor die effektiwiteit van Misoprostol in vergelyking met 'n placebo vir die voorkoming en behandeling van postpartum bloeding te evalueer. Metodes: Databases gesoek ingesluit, Medline, CINHAL, Google Scholar en Cochrane Sentrale Register van gecontroleerde studies (Sentraal). Ander bronne is ook deursoek. Alle artikels is gekeur vir die metodologiese kwaliteit deur twee beoordelaars onafhanklik deur die gestandaardiseerde instrument. Data is opgeneem in Review Manger 5.1 sagteware vir ontleding. Hoof Resultate: Drie Misoprostol studies were ingesluit (2346 deelnemers). Mondeling (2 proe) en sublinguale (1 verhoor). Misoprostol het getoon nie doeltreffend te wees in die vermindering van PPH (RR 0,65: 95% CI 0,40-1,06). Slegs een verhoor berig oor die noodsaaklikheid vir 'n bloedoortapping (RR 0,14, 95% CI 0,02-1,15). Misoprostol gebruik word geassosieer met 'n aansienlike toename in bewing (RR 2,75, 95% CI 2,26- 3,34) en koors (RR 5,34, 95% CI 2,86-9,96) as met' n placebo. Geen moederlike sterftes is aangemeld in proewe. In vergelyking met placebo, was Misoprostol tesame met minder hysterectomies en addisionele gebruik van uterotonics (RR 0,45, 95% CI,21-,96) in vergelyking met placebo. Gevolgtrekking: Resultate van hierdie studie toon dat die gebruik van Misoprostol in kombinasie met 'n paar komponente van aktiewe bestuur is wat nie verband hou met' n beduidende afname in die voorkoms van PPH. Vir die gebruik vir die behandeling van postpartum bloeding, daar is 'n behoefte vir navorsing fokus in die optimale dosis en die roete van administrasie vir' n klinies beduidende uitwerking en aanvaarbare neweeffekte.
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Cederholm, Maria. "Consequences of amniocentesis and chorionic villus sampling for prenatal diagnosis". Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2002. http://publications.uu.se/theses/91-554-5225-6/.
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Ehrling, Malin. "Kvinnans individuella upplevelse av förlossningssmärta : En begreppsanalys". Thesis, Högskolan Dalarna, Vårdvetenskap, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:du-25623.
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Bakgrund: Förlossningssmärta är ett begrepp som används inom barnmorskeutbildningen och hälso- och sjukvård där kvinnor vårdas under graviditet och på förlossningsavdelningar. Begreppet är odefinierat i litteraturen och hur och vad som innefattas av begreppet är brett. Förlossningssmärta har stor plats inom mödrahälsovården men just som begrepp finns lite information. Syfte: Syftet var att beskriva begreppet förlossningssmärta genom en begreppsanalys. Metod: En begreppsanalys med kvalitativ design. Först utfördes en litteratursökning, den teoretiska fasen, och sedan blev fem barnmorskor identifierade genom ett bekvämlighetsurval och intervjuades i fältstudiefasen. Resultatet från fältstudiefasen sammanställdes med resultatet från den teoretiska fasen. Resultat: Analysen av begreppet förlossningssmärta mynnade ut i ett resultat med flera dimensioner där den unika upplevelsen är konklusionen. De tre huvuddimensionerna är sensorisk, affektiv och kognitiv upplevelse av förlossningssmärta. Där det sensoriska står för fysiologin, det affektiva för det vi bär med oss in i smärtupplevelsen och det kognitiva för hur vi tänker kring smärtupplevelsen. Referens-ramen för begreppet bestäms av dess förutsättningar och konsekvenser. Förlossningssmärtan är en unik upplevelse och endast den födande kvinnan vet hur den känns. Förlossningssmärta är en upplevelse som tolkas olika och uttrycket är individuellt. Slutsats: Förlossningssmärta kan ses som ett komplext begrepp som anpassas till varje gravid utifrån de definierade dimensionerna. Klinisk tillämpbarhet: Begreppet förlossningssmärta är viktigt att klargöra för barnmorskestudenter under utbildning.Background: Labor pain is a term used in education and healthcare, where women are cared for during pregnancy and in maternity wards. How the concept is defined is described in literature and how and what is covered by the concept is wide. Labor pain has great location within maternity care but as a concept it is relatively undefined. Aim: The aim was to describe the concept of labor pain through a concept analysis. Methods: A concept analysis with qualitative design. Five midwives were selected trough a convenience sampling and were interviewed; earlier a literature review was conducted. The result from the field study phase was brought together with the result from the theoretical phase. Results: After the analysis of the concept of labor pain the main results is that it is truly one unique experience of labour pain. Defined three dimensions sensory, affective and cognitive. The sensory dimension stands for physiology, the affective dimension for earlier experiences and the cognitive dimension for how a person thinks about pain and the experience of it. Pain in labour is a unique experience. Only the woman in labour knows how it feels like. Pain during labour is an individual experience and just like all other experience it has its unique and individual interpretation for the person involved. Conclusion: Labor pain can be identified as a complex concept adapted to each pregnancy based on the defined dimensions. Clinical applicability: Clarification of the concept is important in education of midwifery students.
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Smit, Ilze. "n Evaluering van die voorkoms van perineale trauma tydens verlossings in openbare gesondheidsinstellings in die Wes-Kaap : 'n verpleegkundige perspektief". Thesis, Stellenbosch : Stellenbosch University, 2003. http://hdl.handle.net/10019.1/53518.
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Thesis (MCur)--Stellenbosch University, 2003ENGLISH ABSTRACT: It appears that registered midwives prefer not to cut episiotomies which results in an increase in perineal tears. This may be the case as a result of current controversies regarding episiotomies, lack of suturing skills due to insufficient training and evaluation, or the fact that the necessity of an episiotomy are not recognised timeously. In light of this the incidence of perineal trauma during deliveries in public healthcare institutions in the Western Cape was evaluated from a nursing perspective. The midwife can playa significant role in the prevention of unnecessary perineal trauma by applying particular precautions in practice. Triangulation was used as the research method. Seven public healthcare institutions in the Western Cape were included in this study. Nurses completed 45 questionnaires while 33 deliveries and 25 cases of suturing of perineal wounds were evaluated according to a pre-compiled checklist. Semi-structured interviews were conducted with registered midwives and medical practitioners involved in the training of nursing students. According to findings it appears that nurses do not recognise the risk factors to be contributory causes of perineal tears. Furthermore, it appeared that 46% of registered midwives did not feel competent enough to suture perineal wounds. Disparities were identified pertaining to the training of student nurses as well as the continuous training and evaluation of registered midwives regarding the suturing of perineal wounds. It is recommended that a uniform policy should be formulated concerning guidelines for the cut and suturing of episiotomies and lacerations. Furthermore, a uniform classification system regarding perineal trauma should be formulated as well as a uniform system to evaluate the competency of midwives.
AFRIKAANSE OPSOMMING: Dit blyk dat geregistreerde vroedvroue nie graag 'n episiotomie knip nie, met 'n gevolglike toename in perineale skeure. Dit is moontlik as gevolg van die huidige kontroversie betreffende episiotomies, óf hegtingsvaardighede wat nie voldoende is nie te wyte aan gebrekkige opleiding en evaluering, óf die noodsaaklikheid van 'n episiotomie word nie betyds ingesien nie. In die lig hiervan is die voorkoms van perineale trauma tydens verlossings in openbare gesondheidsinstellings in die Wes- Kaap vanuit 'n verpleegkundige perspektief geëvalueer. Die vroedvrou kan 'n beduidende rol speel in die voorkoming van onnodige perineale trauma deur die toepassing van sekere maatreëls in haar praktykvoering. Triangulasie is as navorsingsmetode gebruik. Sewe openbare gesondheidsinstellings in die Wes-Kaap is in hierdie studie ingesluit. Vyf-en-veertig vraelyste is deur verpleegkundiges voltooi terwyl 33 bevallings en 25 hegtings van perineale wonde volgens 'n voorafopgestelde kontrolelys geëvalueer is. Semi-gestruktureerde onderhoude is gevoer met geregistreerde vroedvroue en geneeshere wat by die opleiding van verpleegstudente betrokke is. Volgens die bevindings blyk dit dat verpleegkundiges nie die risikofaktore as aanleidende oorsake van perineale skeure herken nie. Hulle verkies ook om nie episiotomies te knip nie en sal eerder 'n perineale skeur heg. Dit het verder geblyk dat 46% van die geregistreerde vroedvroue nie bevoeg gevoel het om perineale wonde te heg nie. Leemtes is geïdentifiseer ten opsigte van die opleiding van studentverpleegkundiges asook voortgesette opleiding en evaluering van geregistreerde vroedvroue ten opsigte van hegtingstegnieke. Aanbevelings sluit in dat 'n eenvormige beleid geformuleer moet word ten opsigte van die riglyne vir die knip en hegtings van episiotomies en skeure, 'n eenvorminge klassifikasiesisteem van perineale trauma asook 'n stelsel van evaluering van geregistreerde vroedvroue se bevoegdheid.
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Berg, Marie. "Genuine Caring in Caring for the Genuine : Childbearing and high risk as experienced by women and midwives". Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2002. http://publications.uu.se/theses/91-554-5299-X/.
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Mauricio, Gabriela Fogagnolo. "Avaliação do grau de satisfação materna na assistência ao parto do HC-FMB UNESP". Universidade Estadual Paulista (UNESP), 2017. http://hdl.handle.net/11449/152368.
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Objetivo: Avaliar o grau de satisfação das parturientes na assistência ao parto prestada no serviço da Maternidade do Hospital das Clinicas da Faculdade de Medicina de Botucatu. Material e métodos: Realizou-se estudo observacional transverso com puérperas que receberam assistência ao parto. Foram aplicados dois questionários, sendo um referente a expectativa e o outro com relação a experiência das parturientes, ambos aplicados no puerpério, 48h após o parto, para avaliar a satisfação das pacientes em relação ao tratamento realizado e a expectativa prévia. Foi realizada ainda a análise quantitativa dos resultados apresentados em porcentagem, média e desvio padrão. Resultados: Das puérperas selecionadas, observamos uma população com idade média de 26 anos, uma porcentagem relevante tanto de nulíparas 33%, como de multíparas (um a cinco partos prévios) 58%. As pacientes apresentaram baixo grau de escolaridade, 53,49% encontravam-se no grupo que abrangia alfabetizada até o ensino fundamental completo, e 72,09% consideraram estar em um relacionamento estável. Ao realizarmos a analise das questões, estas foram subdivididas em três áreas abrangentes. Observamos na área abrangente um, relacionada ao estresse, uma ansiedade bem acentuada nas parturientes, bem como o relato destas terem se sentido angustiadas durante o parto, fatores que contribuem para piora no grau de satisfação das pacientes, o que pode estar relacionado a diversos fatores, tais como falta de informação e dor durante o trabalho de parto. Pudemos observar ainda que na área abrangente dois, relacionada ao ambiente e a equipe profissional, a satisfação foi muito positiva, embora tenha sido o oposto do que imaginávamos em relação ao ambiente e infraestrutura. Acredita-se que isso se deva ao fato das mulheres tenderem a se sentirem aliviadas após o nascimento de uma criança saudável compensando qualquer experiência negativa, ou até mesmo pela condição de moradia que a grande maioria de nossas pacientes possuem. Por fim, na área abrangente três, relacionada a atribuição materna, percebemos uma divergência de respostas, devido a falta de conhecimento das parturientes com relação aos tipos de procedimentos, condutas a serem tomadas e vivência particular de cada uma durante este processo. Conclusão: Concluímos que embora alguns parâmetros não obtiveram resultados condizentes com uma boa satisfação, o questionamento relacionado as três esferas abrangentes, de uma maneira geral, foi avaliado positivamente pelas pacientes, o que resultou em um bom grau de satisfação. Palavras-chave: gestação, trabalho de parto, parto, grau de satisfação materna.
Objective: The purpose of this study was to evaluate the degree of satisfaction of parturients in childbirth care provided by the Maternity Service of the Hospital das Clinicas, Faculdade de Medicina de Botucatu. Material and methods: A prospective, cross-sectional study was carried out on parturients who received childbirth care. Two questionnaires were applied, one referring to expectation and the other regarding the experience of the parturients, both applied in the puerperium, 48 hours after the birth, in order to evaluate the patients' satisfaction regarding the treatment performed and the previous expectation. A quantitative analysis of the results was performed, presented as percentage, mean and standard deviation. Results: Of the pos partum selected, we observed a population with a mean age of 26 years, a relevant percentage of nulliparous 33%, and multiparous (one to five previous births) 58%. The patients had a low level of schooling, 53.49% were in the group that had literate until full elementary education, and 72.09% considered themselves to be in a stable relationship. When we analyzed the questioning, they were subdivided into three broad areas. We observed in the comprehensive area one, related to stress, a very accentuated anxiety in the parturient, as well as the report of these that they felt distressed during the birth, factors that contributes to bring down the level of satisfaction of the patients which can be related to several factors such as lack of information and pain during labor. We observe that in the comprehensive area two, related to the environment and the professional staff, the satisfaction was very positive, although it was the opposite of what we imagined in relation to the environment and infrastructure. This is believed to be due to the fact that women tend to feel relieved after the birth of a healthy child offsetting any negative experience or even the housing condition that the vast majority of our patients have. Finally, in the area three, related to maternal attribution, we could perceive a divergence of responses, due to the lack of knowledge of the parturients regarding the types of procedures, behaviors to be taken and the particular experience of each one during this process. Conclusion: We could conclude that although some parameters did not achieve satisfactory results, the questioning related to the three broad spheres was generally evaluated positively by the patients, which resulted in a good degree of satisfaction. Key words: gestation, labor, birth, degree of satisfaction.
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"Quantification of force applied during external cephalic version". Thesis, 2005. http://library.cuhk.edu.hk/record=b6074169.
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External cephalic version (ECV) involves turning a fetus in utero by manipulation through the maternal abdomen and the uterine wall.Many clinicians and patients, however, still decline ECV in favour of Caesarean section. This could be due to the lack of experience of ECV, and fear of complications or pain during the version.
Summary. The force applied during ECV can be measured and analysed using a customized pair of gloves incorporating piezo-resistive pressure sensors and suitable analytical software. The degree of force required for a successful version is highly variable. Failure of version is not usually due to insufficient force. Uterine tone is the most important factor affecting the degree of force applied during a version attempt. The degree of force applied is associated with the changes in fetal cerebral blood flow after ECV, and the amount of pain perceived by the patients. (Abstract shortened by UMI.)
The lack of information in this area is primarily due to the lack of a suitable device that would allow measurements of the force applied without interfering with the ECV. A suitable device would therefore have to be sufficiently robust so that it could be worn on the hands, durable so that it could be used repeatedly, incorporate multiple individual sensors, each of which is capable of making dynamic and mutually independent measurements during the version procedure.
There is no report in the literature on quantification of the force applied during ECV. It is also unknown whether the degree of force applied is related to the version outcome. In particular, it is unclear whether a failed attempt is related to insufficient force, or whether an increase in force may help to achieve version after a failure. Furthermore, it is also not known if any patients' factors may influence how much force is applied through the operator's hands. Although the chance of successful version could be predicted by some clinical factors, whether these factors may also affect the degree of applied force is not known.
This thesis reports on the design and development of a suitable measuring device fulfilling the requirements described above. In addition, it will test a number of hypotheses relating to the degree of force applied during ECV and clinical feto-maternal parameters and outcomes, in a study cohort of 92 patients.
Leung Tak Yeung.
"April 2005."
Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 3717.
Thesis (M.D.)--Chinese University of Hong Kong, 2005.
Includes bibliographical references (p. 155-174).
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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Barisich, Donna. "The use of comfort measures in labor the role of women's expectations and provider group : a report submitted in partial fulfillment ... for the degree of Master of Science (Parent-Child Nursing/Nurse-Midwifery) ... /". 1997. http://catalog.hathitrust.org/api/volumes/oclc/68799608.html.
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Hines, Sandra. "Is there a relationship between duration and management of second stage of labor or of perineal disruption in second stage of labor and the extent of recalled postpartum perineal pain? a research report submitted in partial fulfillment ... for the degree of Master of Science (Parent-Child Nursing) ... /". 1995. http://catalog.hathitrust.org/api/volumes/oclc/68798744.html.
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Doezema, Mary B. "A comparison of expectant vs. active management of premature rupture of membranes at term in a nurse midwifery service a report submitted in partial fulfillment ... for the degree of Master of Science, Nurse-Midwifery Track, Parent-Child Nursing ... /". 1995. http://catalog.hathitrust.org/api/volumes/oclc/68798798.html.
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