Dissertationen: „Health Sciences, Obstetrics and Gynecology|Health Sciences, Pharmacy|Health Sciences, Public Health“

1

Shields, Kristine E. „The participation of pregnant women in clinical research| Implications for practice within the U.S. pharmaceutical industry“. The University of North Carolina at Chapel Hill, 2013.

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2

Harper, Emma A. „Young pregnant women's discursive constructions of the body and health“. Thesis, University of Ottawa (Canada), 2011. http://hdl.handle.net/10393/28851.

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The purpose of this thesis was to explore young pregnant women's discursive constructions of the pregnant body and health in the context of the dominant obesity discourse. Conversations with 15 young pregnant women from the Ottawa area were tape-recorded, transcribed, and then analyzed using a thematic and feminist poststructuralist discourse analysis. The results were divided into two articles, the first discussing the women's constructions of health during pregnancy and the second, their constructions of the pregnant body. The narratives reveal that overall the women constitute themselves as neoliberal subjects reproducing dominant patriarchal discourses (e.g., obesity, personal and moral responsibility for health, femininity). Paradoxically, many of these women also show awareness of the contradictions between dominant health and bodily discourses and personal experience, thus leading to alternative and more disruptive subject positions. Impacts, implications, and future research directions are discussed.

3

Sherrard, Adam. „Maternal anthropometric factors and the risk of cesarean delivery“. Thesis, McGill University, 2004. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=81438.

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The cesarean delivery rate in Canada has never been higher than it is now. To identify the contribution of pre-pregnancy adiposity and maternal weight gain to the risk of cesarean delivery, and evaluate to what extent these factors may account for temporal trends in primary cesarean delivery, we conducted an historical hospital-based cohort study of 63 390 deliveries at Montreal's Royal Victoria Hospital from 1978 to 2001. Pregravid adiposity and high net rate of gestational weight gain were associated with primary intrapartum cesarean delivery, and overweight and obese women with a previous cesarean were at higher risk for failing a trial of labour. Overall, women who were obese or overweight were more likely to fail a trial of labour, regardless of whether they had previously delivered by cesarean, but temporal trends in primary cesarean delivery could not be attributed to changes in maternal anthropometric factors.

4

Hagen, Catherine A. „Maternal mortality, fertility, and the utilization of prenatal care in Karachi, Pakistan“. Thesis, McGill University, 1995. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=22736.

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A community health survey was conducted in Karachi, Pakistan, with three objectives: first, to estimate maternal mortality using the sisterhood method; second, to describe current fertility and family planning trends; and third, to determine which factors are associated with the utilization of prenatal care.
The study population of 2,897 households was chosen randomly from the catchment area of the three maternity hospitals of the Aga Khan Health Services of Pakistan. Data were collected using household interviews of all married women less than 55 years of age.
Results show a maternal mortality estimate of 153 deaths per 100,000 live births and perinatal mortality of 30/1000. Strong declining trends in fertility and increased utilization of prenatal care were documented in this urban population, in contrast to recent national survey data. After adjustment for socioeconomic factors and confounding variables, maternal education and perceived importance of prenatal care were found to be important predictors of the utilization of maternal health care. The majority of families in this population utilize the private sector for family planning and pregnancy care.
The study demonstrates the importance of maternal education and attitudes in promoting utilization of adequate maternal health care, and documents the emerging role of the private sector in the provision of maternal health services in Karachi.

5

Haiek, Laura N. „Postpartum weight loss and infant feeding“. Thesis, McGill University, 1994. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=55447.

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It is not yet clear whether women who lactate lose the weight gained during pregnancy faster than their nonlactating counterparts. The primary objective of this study was to look for any important differences in the rate of postpartum weight loss in the first 9 months postpartum according to method of infant feeding.
Two hundred thirty-six women attending two public health clinics in Montreal were weighed in one to four encounters occurring at different stages of the postpartum period but no later than the 9th month postpartum. A questionnaire assessing the method of infant feeding (predominantly breastfeeding, mixed feeding or predominantly bottlefeeding) and potential confounders was administered by telephone after each weighing. An unbalanced multivariate repeated measures analysis revealed no statistically significant differences in the rate of weight loss by category of infant feeding. Gestational weight gain, postpartum smoking and maternal birthplace were important predictors of postpartum weight change.

6

Legocki, Laurie J. „Young women's constructions of meaning within the context of vulvovaginal pain“. [Bloomington, Ind.] : Indiana University, 2008. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3324524.

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Thesis (Ph.D.)--Indiana University, School of Health, Physical Education and Recreation, 2008.
Title from PDF t.p. (viewed on May 13, 2009). Source: Dissertation Abstracts International, Volume: 69-08, Section: B, page: 4704. Adviser: Michael Reece.

7

Kashyap, Sonya. „Assisted reproductive medicine: Systematic reviews and randomized controlled trials“. Thesis, University of Ottawa (Canada), 2005. http://hdl.handle.net/10393/26940.

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The objective for this thesis was to propose a question in the area of reproductive medicine that could be addressed by a clinical trial. In preparation for such a trial we conducted a systematic review of the topic. Our first question was whether metformin is of benefit compared to clomiphene citrate for ovulation induction and achievement of pregnancy in women with polycystic ovarian syndrome (PCOS). We conducted a systematic review (SR) and meta-analysis of the subject before designing and implementing a randomized controlled trial (RCT). The RCT was terminated for recruitment issues. Our PCOS SR led us to develop a novel ovarian stimulation protocol for poor responders. We used the lessons learned from our failed RCT and another systematic review to design and conduct a feasibility randomized controlled trial on the use of aromatase inhibitors to improve pregnancy outcomes for in-vitro fertilization in poor responders. We successfully completed the pilot study and found a trend towards increased clinical pregnancy rates for patients who received the study versus the standard protocol. The pilot study provides recommendations for the definitive trial.

8

Sikder, Shegufta Shefa. „Obstetric complications in rural Bangladesh| Risk factors for reported morbidity, determinants of care seeking, and service availability for emergency obstetric care“. Thesis, The Johns Hopkins University, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=3571743.

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Background: In settings such as rural Bangladesh, where the majority of births occur at home, population-based data are lacking on the burden and risk factors for obstetric complications, as well as care-seeking behavior. This dissertation seeks to describe the prevalence and risk factors for obstetric complications, explore factors affecting care seeking for complications, and describe the availability of obstetric care among health facilities in rural Bangladesh.

Methods: We used extant data from a community-randomized maternal micronutrient supplementation trial which ascertained reported morbidities and care seeking among 42,214 pregnant women between 2007 and 2011 in rural northwest Bangladesh. Multivariate multinomial logistic regression was used to analyze the association of biological, socioeconomic, and psychosocial factors with reported obstetric complications and near misses. Multivariate logistic regression of socioeconomic, demographic, perceived need, and service factors on care seeking was performed. Primary data on availability and readiness to provide obstetric services at 14 health facilities was collected through surveys.

Results: Of the 42,214 married women of reproductive age, 73% (n=30,830) were classified as having non-complicated pregnancies, 25% (n=10,380) as having obstetric complications, and 2% (n=1,004) with reported near misses. In multivariate analysis, women's age less than 18 years (Relative Risk Ratio 1.26 95% CI 1.14-1.39), obstetric history of stillbirth or abortion (RRR 1.15 CI 1.07-1.22), and neither partner wanting the pregnancy (RRR 1.33 CI 1.20-1.46) significantly increased the risk of obstetric complications. Out of 9,576 women with data on care seeking, 77% sought any care, with only 23% seeking at least one formal provider. Socioeconomic factors and service factors, such as facility availability of comprehensive obstetric services (OR 1.25 CI 1.16- 1.34), improved care seeking from formal providers. Average facility readiness for emergency obstetric care was 81% in private clinics compared to 67% in public facilities (p=0.045).

Conclusions: These analyses indicate a high burden of obstetric morbidity, with a quarter of women reporting obstetric complications. Policies to reduce early marriage and unmet need for contraception may address risk factors including adolescent pregnancy and unwanted pregnancies. Improvements in socioeconomic factors, coupled with strategies to increase service availability at health facilities, could increase care seeking from formal providers.

9

Martin, Kelly M. „Are disinfection by-products in tapwater associated with intrauterine growth retardation?“ Thesis, McGill University, 2000. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=31269.

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Introduction. Chlorination of surface water for human consumption results in a number of potentially toxic by-products. Recent investigation of the effects of these by-products on reproductive outcomes has demonstrated small increases in the risk of both intrauterine growth retardation and low birthweight with increasing exposure.
Objective. The primary objective of this study was to examine the relationship between one group of disinfection by-products, trihalomethanes, and intrauterine growth retardation. The secondary objective was to compare the relationship found with the commonly used estimate of exposure, THM concentration, to that found with aggregate exposure measures.
Methods. A case-control study was carried out with 200 cases and 200 matched controls. The risk of THM exposure was estimated using conditional logistic regression, controlling for the confounding effect of maternal smoking, prepregnancy weight and education.
Results. A small, but imprecise, increase in the risk of IUGR was found with increasing levels of the brominated THMs, particularly bromoform. A decrease in the odds ratio was observed with increasing exposure information in the aggregate measures.
Conclusions. The results of this study support previous studies demonstrating a relationship between THMs and intrauterine growth retardation, particularly the brominated THMs. However, the small sample size does not allow any firm conclusions to be drawn about this relationship.

10

Taylor, Dorcas S. G. „The association between pre-pregnancy body mass index and caesarean section in two developing countries in South America /“. Thesis, McGill University, 2005. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=84080.

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An association between body mass index (BMI) and caesarean section has been documented in the literature in developed countries. The causal factors leading to this association are not known, therefore it is unknown whether this association could be extended to developing countries. This study will examine BMI as a risk factor for caesarean section in women in a developing country.
This study included a cohort of 290,124 births in Uruguay, from the years 1992 to 2001, and a cohort from Pelotas, Brazil with 8,475 births, from 1982 and 1993. Three statistical methods were used to deal with missing data in the logistic regression analysis: casewise deletion, use of a missing data indicator, and multiple imputation.
BMI showed a strong relationship to caesarean section, with increasing risk of caesarean with increasing BMI, except in women with previous caesarean section in Pelotas. Other important risk factors included level of education, diabetes, hypertensive diseases and primiparity. Risks differed by labour type and history of caesarean section.

11

Disney, Jody Annette. „The context of women's childbirth decisions regarding vaginal birth after cesarean section“. Diss., The University of Arizona, 1998. http://hdl.handle.net/10150/288799.

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The purpose of this study was to investigate the influences, both internal and external, identified by women in their choice of vaginal birth after a previous cesarean section (VBAC) or repeat cesarean section (RCS). The rate of cesarean section (C/S) is currently approximately one in four to five births in the United States. Thus the stakes in obstetrical decision making both financially and philosophically, have become enormous (Keeler & Brodie, 1993). The method for this descriptive study combined 6 focus group interviews (n=19) with development and pilot-testing of the Cesarean Decision Making Questionnaire (C/S DMQ) to measure influences on method of delivery choice (N=31). Women who chose VBAC or RCS comprised the focus group sample. An additional 12 women were recruited to complete the questionnaires by mail. Factors identified in the literature and supported by clinical experience as influencing the decision making process constituted dimensions and items of the C/S DMQ developed for this study and served as the initial framework for content analysis of the focus groups. It was evident from the qualitative data that childbirth model and influence of health care providers (primarily physicians), along with perceptions of risk to baby, followed by risk to self, most influenced women's decisions regarding their method of delivery. Desire for control of decisions and childbirth practices was very important for the women who chose VBAC as compared to women who chose RCS. The C/S DMQ pilot results contained several dimensions or aspects with respectable internal consistencies. These included Childbirth Models, Desire for Control, Health Care Providers, and Social Support. Other dimensions with less internal consistency were Perceptions of Risk and Vulnerability, Uncertainty, and Demographics. The concepts of Risk and Uncertainty require further conceptualization for adequate instrumentation. Low internal consistency of Demographics may reflect the variety of demographic variables measured. The difference between women who chose VBAC and RCS was reflected in the dimension of Childbirth Models as a mediating variable for risk, supporting the social model for women who choose VBAC.

12

Boundy, Ellen O'Neal. „Determinants of Global Maternal and Neonatal Morbidity and Mortality“. Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:16121139.

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In 2013, approximately 289,000 women died from pregnancy-related causes and 2.8 million newborns died within the first 28 days of life. The vast majority of these deaths occur in resource-limited settings. This work examines risk and protective factors for the development of several perinatal complications that put mothers and their infants at risk for adverse health outcomes. We explored determinants of preeclampsia and gestational hypertension among women in Dar es Salaam, Tanzania. We also examined the effects of pregnancy spacing intervals on perinatal outcomes in that group of women. We used log binomial regression to obtain risk ratios and 95% confidence intervals for the development of the adverse pregnancy outcomes of interest. We also looked at the efficacy of an intervention aimed at improving neonatal outcomes by conducting a systematic review and meta-analysis of the effects of kangaroo mother care on neonatal morbidity and mortality. We found that nulliparity, history of hypertension, urinary tract infection, low calcium intake, history of preeclampsia, and history of preterm birth were associated with an increased risk of developing preeclampsia among women in Dar es Salaam. Risk factors for gestational hypertension included a history of diabetes, elevated blood pressure at study enrollment, increased mid-upper arm circumference, high hematocrit, low mean corpuscular volume, a history of miscarriage or stillbirth, and older age at first pregnancy. Twin gestation and increased body mass index were risk factors for both types of hypertensive disorders of pregnancy among women in Tanzania. After a live birth, inter-pregnancy intervals less than six months were associated with an increased the risk of having a low birth weight baby in the next pregnancy; while after a stillbirth, short inter-pregnancy intervals were associated with increased risk of stillbirth and perinatal death. Providing kangaroo mother care to infants after birth was associated with decreased neonatal morbidity and mortality and increased likelihood of exclusive breastfeeding when compared to conventional care. These findings can help identify women and infants at increased risk for developing pregnancy-related complications and contribute to informing development of evidence-based maternal, newborn, and family planning programs and policies.
Epidemiology

13

Huang, Ling. „Impact of advanced maternal age on the risk of stillbirth“. Thesis, University of Ottawa (Canada), 2006. http://hdl.handle.net/10393/27373.

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Since more women are having pregnancies at an older age, there are growing concerns about their pregnancy outcomes. Previous studies reveal an uncertain relationship between maternal age and stillbirth risk. This retrospective cohort study aimed to test the hypothesis that stillbirth risk increases with increasing maternal age. We analyzed data on 3,549,993 births from the birth cohorts of 1985 to 2000 in Canada and used logistic regression to evaluate the relative risk of stillbirth. A total of 15,905 stillbirths were reported during the study period, giving an overall stillbirth rate of 4.5 per 1,000 births. Stillbirth risk was increased for mothers with advanced age after accounting for the confounders and effect modifiers. The older age effect on stillbirth risk was especially pronounced among nulliparous women. We suggest that careful prenatal surveillance and appropriate obstetrical advice and interventions be provided to women with advanced maternal age at their first delivery.

14

Chorny, Yelena. „Routinization of prenatal screening: Women's perspectives on decision making about screening uptake“. Thesis, University of Ottawa (Canada), 2006. http://hdl.handle.net/10393/27341.

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Background. Prenatal screening programs, in which screening is routinely offered to all pregnant women, have been implemented in a number of regions in Canada and other countries. Such programs are typically marketed as having the goal of providing women with the opportunity to make an informed choice about screening. Studies have suggested, however, that structural and cultural factors related to the rise of surveillance medicine have combined to effectively routinize the offer and uptake of prenatal screening, potentially hindering the capacity to ensure true autonomy and informed choice for women. Purpose. This study was conducted to explore the concept of the routinization of prenatal screening by examining women's accounts of their decision making about accepting or declining prenatal screening and what judgments they made about the value of prenatal screening for themselves and others. Methods. This was a descriptive, exploratory study using qualitative research methods for data collection and analysis. Data were collected from 18 women who had delivered healthy babies using semi-structured interviews. Both data collection and analysis were conducted using methods of Grounded Theory. Results. Routine uptake of prenatal screening was described by many women. Themes arising from interviews included: the recognition of choice and/or the need for deliberation; the ways in which prenatal screening is presented; the value placed on the information provided by screening; varying conceptions of risk; and the relationships between prenatal screening, abortion, disability, and responsibility. Conclusions. Factors contributing to the routinization of prenatal screening operate at a variety of levels: individual, structural, and cultural. Further research is needed to clarify and quantify the effects of routine acceptance of screening on women and their families, and to determine the most effective and appropriate ways of ensuring that women's choices are truly informed and deliberated.

15

Ladha, Rishma. „South Asian Women's Perspectives about Pregnancy Needs and Utilization of Canadian Prenatal Health Services“. Thesis, University of Ottawa (Canada), 2010. http://hdl.handle.net/10393/28775.

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Context: South Asians are the largest immigrant group in Ontario, Canada. They may express perceptions of pregnancy that differ from the dominant cultures influencing mainstream health care. Prenatal services are underutilized by immigrant women in part due to language barriers and issues of racism. Purpose: To explore and understand South Asian Canadian women's pregnancy needs and experiences in utilizing prenatal health services in Ottawa, Canada. Method: Ten women were recruited to participate in semi-structured interviews. Data were analyzed using content and thematic analysis following a descriptive exploratory qualitative approach. An anti-racist approach was used to gain insights about these women's perspectives on the use of prenatal health services. Results: All women expressed that their husbands provided support and nurturance. Female elders including mothers, South Asian neighbours, and friends played an important role in providing pregnancy information and support. Almost all participants were not aware of available community-based resources, including prenatal programs. Almost all women expressed that they were given different treatment, ignored by administrative staff and/or perceived that health care providers spent less time with them compared to other Canadians. Some health care providers did not understand and respect cultural and religious rituals. Conclusions: Providing information about the availability of community resources is a vital step. Exploring South Asian husband's perspectives, the potential use of internet resources and creating interpreter networks through Indo-Canadian organizations are recommended. The Canadian health care system needs to address barriers and racism encountered by South Asian women to provide culturally sensitive health care.

16

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

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

17

Bommaraju, Aalap. „Determinants of Contraceptive Choice| Factors Affecting Contraceptive Nonuse among Urban Women Utilizing Title X Services“. Thesis, University of Cincinnati, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=1548538.

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Background: Disparities in unintended pregnancy are partially due to ineffective contraceptive method choice among vulnerable populations. Improved understanding of the ecological, individual, and health system related determinants of contraceptive choice can provide guidance for how to reduce ineffective contraceptive method choice among women at high risk for unintended pregnancy.

Objectives: Secondary data analysis is performed on visit data from women utilizing Title X Family Planning services at the Cincinnati Health Department’s Reproductive Health & Wellness Program (RHWP) to determine the significance of predisposing factors (age, African- American race, education), enabling factors (income, health insurance status, socio-behavioral risks), need factors (having had a recent birth, number of living children) on choosing an ineffective contraceptive method. Mediation analysis is performed to determine if health system factors mediated the effect of these explanatory variables.

Methods: Using data from 1,119 RHWP clients who were not seeking pregnancy, multinomial logistic regression is used to compare pill, patch, and ring users, depot medroxyprogesterone acetate (DMPA) users, and long-acting reversible contraception (LARC) users with a reference group of ineffective method users. Multinomial logistic regression is first performed with all independent variables except health system mediation. Then, it is performed with inclusion of health system mediation. Multiple linear regression analysis is performed to determine significant relationships between independent factors and health system mediation. Mediation analysis is performed for any independent variable that is significantly correlated with both contraceptive method choice and health system mediation for the purpose of determining if any witnessed mediation effect is statistically significant.

Results: The model including health system mediation is found to account for more variance in the data than the model excluding health system mediation (Nagelkerke R-squared = 0.195 and 0.158, respectively). Through both models, and in all three comparisons, higher age is found to reduce the odds of choosing a more effective method with only minor mediation effects. Having more children results in higher odds of both DMPA and LARC uptake in both models and is unmediated by the health system. Being of African-American race results in lower odds of LARC use in both models – a finding that is also not mediated by the health system. Health system mediation effects are found in the LARC and DMPA comparisons and not in the pills, patch, or ring comparison. In the DMPA comparison, inclusion of health system mediation eliminates income and insurance status as significant explanatory variables. In the LARC comparison, inclusion of health system mediation eliminates the explanatory significance of having a recent birth.

Conclusions: Analysis of the role of health system mediation suggests that health system level factors play a large role in explaining contraceptive choice among contraceptive methods that require increased health care utilization. The impact of health system mediation on the significance of other predisposing, enabling, and need variables implies that health care access, utilization, and quality are important factors that should be included in future models for understanding contraceptive choice.

18

Yuan, Hongbo. „Fetal deaths in the United States, 1997 vs 1991“. Thesis, McGill University, 2003. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=84858.

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Objective. To examine the temporal change in fetal death risk in the U.S. from 1991 to 1997 and to assess the extent to which changes in registration practices and labor induction have contributed to that change. Setting. United States. Design. Cohort study. Participants. All singleton pregnancies 20--43 weeks of gestation in 1991 and 1997. Main outcome measure. Fetal death risk (fetal deaths per 10,000 fetuses at risk at each completed gestational week).
Results. From 1991 to 1997, the overall fetal death rate fell from 77.7 to 67.8 per 10,000 total births. However, fetal deaths at 20--22 weeks as a proportion of total births increased from 14.5 to 16.9 per 10,000. In a Cox regression analysis, the crude period effect (1997 vs 1991) at 40--43 weeks was 0.87 (95% CI 0.80--0.94) and remained virtually unchanged (HR 0.88, 95% CI 0.81--0.96) after adjustment for maternal sociodemographic, medical, and lifestyle risk factors. In ecologic (Poisson regression) analysis based on states as the unit of analysis, the crude period effect in non-Hispanic Whites (RR 0.79, 95% CI 0.74--0.84) disappeared (RR 0.98, 95% CI 0.82--1.16) after adjusting for induction of labor. No such effect of induction was observed in Blacks.
Conclusions. Increased registration is probably responsible for an increase in fetal death risk at 20--22 weeks of gestation, whereas the increasing trend toward routine labor induction at and after term appears to have reduced the risk of fetal death, at least among Whites.

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Jilozian, Ani. „Listening to women's voices| Perceptions & experiences with contraception & abortion in rural Armenia“. Thesis, Icahn School of Medicine at Mount Sinai, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=1551611.

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Background: Abortion is the principle method of birth control in Armenia. There are few qualitative studies in the literature concerning family planning utilization and abortion practices, and only two studies carried out over a decade ago have addressed the larger social context in which family planning and abortion decision-making occurs.

Objectives: The purpose of the following research project was to investigate women's perceptions and experiences with contraception and abortion and elucidate the multifaceted and complex factors that influence family planning decisions and abortion seeking behavior among women of reproductive age in Armenia.

Methods and materials: Convenience sampling was used to recruit women and health providers for the study. In-depth interviews were carried out with all participants and content analysis was employed to analyze the data.

Results: Natural methods of contraception were primarily used over modern means due to socio-economic barriers; familial and peer influence; and negative perceptions. The use of induced abortion was primarily due to socio-economic conditions; a desire for birth spacing; and a desire to limit family size. Participants expressed that married couples generally share decision-making power regarding contraception and abortion with the exception of sex-selective abortions, in which husbands and/or the husband's family primarily make the decision. Reasons for son preference were tied to socio-economic conditions and the Armenian mentality regarding relative value of gender. The misuse of medical abortion was tied to socio-economic conditions; fear of surgical abortion; and misperceptions.

Discussion: Initiatives to reduce the unmet need for family planning should focus on education; expanding availability and accessibility of contraceptives; and empowerment of women. In regards to preventing unsafe abortion, initiatives should focus on health provider training and monitoring; making Cytotec available in pharmacies by prescription only; lowering the price of medical abortion at hospitals; and educating health providers and women about best practices. Concerning sex selection, policy changes should take place alongside initiatives that empower women and advance socio-economic well being.

20

Johnson, Kenneth Clark. „First trimester anticonvulsant therapy and the risk of congenital malformation in the offspring of women with epilepsy“. Thesis, McGill University, 1992. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=39555.

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The purpose of this thesis is two-fold: (1) to refine understanding of the relationship between anticonvulsant therapy during the first trimester of pregnancy in women with epilepsy and the risk of congenital malformation among their offspring; and (2) to assess the utility of the Saskatchewan Prescription Drug and Hospital Services databases for studies of maternal drug use and certain reproductive outcomes.
In the first meta-analysis the malformation risks associated with the use of anticonvulsants in general by women with epilepsy were quantified and clarified. Comparison of the congenital malformation risk among offspring of mothers with epilepsy with first trimester anticonvulsant exposure ("exposed") relative to offspring of non-epileptic parents yielded a summary estimate of relative risk (RR) of 2.6 (95% confidence interval (CI) 2.1-3.2). (All RR's in this abstract are study-stratified Mantel-Haenszel summary estimates.) Congenital malformation risk among the offspring of exposed women with epilepsy compared to unexposed women with epilepsy yielded a summary RR of 2.9 (CI = 2.0-4.2). No evidence of increased risk to unexposed women with epilepsy compared to non-epileptic women was evident (RR = 0.9, CI = 0.5-1.6).
In the second meta-analysis the risks associated with specific types of anticonvulsant therapy were qualitatively synthesized. The analysis demonstrated the inadequacies of many study reports--vague descriptions of methods often restricted assessment of study quality and incomplete reporting of results as largely responsible for restricting the analysis to 31 studies. Women with epilepsy treated with anticonvulsant monotherapy experienced increased risk of congenitally malformed children relative to both unexposed women with epilepsy (RR = 1.8, CI = 0.8-4.8), and unexposed non-epileptic women (RR = 2.5, CI = 1.8-4.0). Insufficient data were available to demonstrate statistically significant differences in malformation risk among specific commonly-used anticonvulsant monotherapies, although phenobarbital and carbamazepine appeared to have the lowest risks. Two-drug therapy was associated with a 20% increase in risk relative to monotherapy, but three-drug therapy was associated with more than twice the risk of one-drug therapy (RR = 2.2, CI = 1.3-3.7). Although the potential role of confounding by type and severity of epilepsy could not be evaluated, the analysis suggests that avoiding therapy with three or more anticonvulsants during the first trimester would be prudent.
The second component of the thesis was a large record linkage study utilizing information from the databases of Saskatchewan Health. An essentially population-based database of maternal drug use and reproductive outcomes was created which included 104,534 livebirths and 13,685 non-livebirth outcomes occurring between April 1977 and March 1984 linked to 299,152 prescriptions dispensed to the mothers in the year preceding the pregnancy outcome. A study of anticonvulsant use during pregnancy and birth outcome was completed using the created database. The study yielded results with respect to congenital malformation risk generally consistent with the conclusions or the meta-analyses.
Evaluation of the database of maternal drug use and reproductive outcomes raised questions about the utility of Saskatchewan Health's databases for pharmacoepidemiologic research into congenital malformations. (Abstract shortened by UMI.)

21

De, Vera Noemi Zabala. „Saving women's lives by spacing births: A qualitative study“. Diss., The University of Arizona, 2004. http://hdl.handle.net/10150/290062.

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The purpose of this descriptive ethnographic study was to explore the perceptions about, and the various factors that influence birth spacing decisions by rural Filipino husbands and wives. Short birth intervals of less than two years are a high risk factor for women in the Philippines. Attempts have been made to improve the women's health status and rights in various aspects however, a large number of women in developing countries such as the Philippines, still suffer to a great extent in regard to their health and reproductive health conditions. Fourteen Filipino husbands and wives participated in in-depth interviews over a six month period in rural Philippines. The Household Production of Health nested within the Ecological Model were the conceptual models that guided this research. Data analysis was directed towards identifying themes and sub-themes organized into categories and sub categories answered the four research questions. Eleven domains were identified from the data. Two major cultural themes emerged from the ethnographic data: (1) "Because life today is so difficult, it is important to space births"; and (2) "She's my wife...of course, I have to take care of her, we have to take care of each other." The participants integrated birth spacing and the internal and external factors influencing decision making into a complex process. The participants described their roles in maintaining and promoting health. In addition to their roles in health maintenance, participants also identified a variety of health producing and help seeking behaviors that were contextualized throughout their cultural lives and were consistent with their perceptions. This research has significance for nursing in four aspects: (a) it explicates the importance of having a broader and deeper understanding of how birth spacing and maternal health are perceived by people of different cultural background; (b) it provides a framework for community health nurses and transcultural nurses to analyze the entirety of birth spacing decision processes that do not only occur within the household but within the community and the whole country; (c) it suggests the importance of focusing health education of women's reproductive health such as spacing pregnancies; and (d) it encourages nurses around the world to empower men and women to create change in health policy regarding family planning.

22

Matala, Erik John. „Molecular and biological characterization of human immunodeficiency virus type 1 envelope gp120 associated with maternal-fetal transmission“. Diss., The University of Arizona, 1999. http://hdl.handle.net/10150/298765.

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Vertical transmission of HIV-1 represents a major, global health concern with particular regard to developing areas of the world, and perinatally acquired infections account for the majority of all pediatric HIV-1 cases. Maternal-fetal transmission of HIV-1 occurs at three stages: prepartum, intrapartum, and post-partum, however the mechanism of this transmission is not yet clearly defined. Additionally, the rate of transmission is estimated at ∼30%, leaving ∼70% of infected mothers who do not transmit to their infants. While several maternal factors including viral load, clinical stage of the mother, low CD4 counts, recent infection, and the maternal immune response to infection have been implicated in transmission, the viral factors which may influence transmission are not known. In this study, we have investigated the molecular and biological properties associated with the env V3 region and the entire env from both transmitting and non-transmitting mothers. Our results show that the minor genotypes of the mothers' heterogeneous viral populations are transmitted to their infants, the biological properties associated with the transmitted variants' V3 regions appear to be macrophage tropic (R5) and non-syncytium inducing, and the transmitted variants are initially maintained in the infants with the same properties. In addition, the molecular analyses of the env of non-transmitting mothers, including the variable regions V1-V2, V3, and V4-V5 were found to be significantly more homogeneous than that of transmitting mothers, suggesting that a limited heterogeneity within an infected mother may prevent vertical transmission. Since effective therapies should target the specific properties of transmitted variants, these results provide significant insight into the molecular mechanisms of maternal-fetal transmission, aiding the development of effective therapies for prevention of transmission and treatment of disease.

23

Gagnon, Anita J. (Anita Jeannette). „The effect of an early postpartum discharge program on competence in mothering : a randomized controlled trial“. Thesis, McGill University, 1994. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=28750.

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Objective. To compare the risks and benefits of an Early Postpartum Discharge Program vs standard postpartum care. Design. Randomized controlled trial. Setting. 637-bed university-affiliated urban hospital. Participants. 175 healthy women recruited at 32-38 wks from MD and hospital ultrasound offices. Interventions. Early Postpartum Discharge Program: discharge 6-36 hours postpartum and nursing care by telephone and/or at home at 34-38 weeks gestation, $ leq$48 hours postpartum and 3, 5, and 10 days postpartum. Control. Postpartum stay of 48-72 hours and follow-up as determined by the woman's physician. Measurement/Results. At 1 month follow-up, no significant differences were seen overall in an established scale of perceived maternal competence (experimental-control = 4.3 points (95% confidence interval $-$7.7, 16.3)); infant weight gain (1.2 g/day ($-$2.8, 5.2)); identification of significant neonatal hyperbilirubinemia (rate ratio 0.50 (0.10, 2.51)); infant utilization of health services (rate ratio 0.88 (0.45, 1.73)); or predominant breastfeeding (adjusted odds ratio 1.25 (0.88, 1.75)). Early Postpartum Discharge Program participants, however, had significantly less frequent infant bilirubin testing (rate ratio 0.39 (0.17, 0.94)). The Early Postpartum Discharge Program also enhanced maternal competence in recent immigrants (26.9 points (2.7, 51.5)). Conclusion. The Early Postpartum Discharge Program leads to no apparent harm and may yield important benefits for some mothers and infants.

24

Boulware, Nakisha Rene'e. „The Influence of Obstetrician and Gynecologists' Avoidance Behaviors on Maternal Morbidities“. ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6173.

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The prevalence of maternal morbidities continues to increase in U.S. women of lower socioeconomic status and non-Hispanic Black women despite the efforts of health care practitioners to reduce the disparities. Two decades of research has shown that physicians avoid patients based on insurance and socioeconomic status or their malpractice history. Reducing maternal illness and complications is one of the federal government's top 10 maternal health indicators in the Healthy People 2020 initiative. The purpose of this study was to evaluate the influence of malpractice allegations on patients at high-risk for maternal morbidity. Supported by the theoretical foundation of human factor theory, the focus of the research questions was on the relationship between obstetrics-related malpractice allegations and maternal and severe maternal morbidities in Black/African American women or women who have Medicaid or Medicare. The study involved a retrospective secondary analysis of data from the National Practitioner Data Bank, years 2006 and 2007 and the National Hospital Discharge Survey, years 2006-2008, from the Inter-University Consortium for Political and Social Research, as well as National Plan and Provider data from the Centers for Medicare and Medicaid Services. A logistic regression analysis indicated an association between bed size and days of care with maternal morbidities and severe maternal morbidities; however, no association with malpractice allegations was found. This study contributes to social change by raising awareness of continued morbidity disparities in women of lower social economic status and non-Hispanic Black women and contributes to the current literature.

25

Heywood, Joanna S. „Prevention of Ovarian and Endometrial Cancer by Combined Oral Contraceptives: A Demographics Study“. Scholarship @ Claremont, 2017. http://scholarship.claremont.edu/cmc_theses/1530.

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Endometrial cancer is the most common gynecologic cancer with 54,870 cases occurring in the United States in 2015 and causing 10,170 deaths, an 18.5% mortality rate (Elit and Reade, 2015). Ovarian cancer, while less common, is much more fatal. In 2015 in the United States, 21,290 cases occurred and resulted in 14,180 deaths, a 66.6% mortality rate. This mortality rate makes ovarian cancer the fifth most deadly cancer for women in the United States, which is largely explained by ineffective screening strategies and limited treatment possibilities (Cramer, 2012). Thus, developing effective prevention strategies is especially important to saving the lives of women who will develop ovarian or endometrial cancer. Women taking combined oral contraceptives (COCs), a type of hormonal birth control, have shown a significant reduced risk of developing ovarian and endometrial cancer. However, the Centers for Disease Control and Prevention (CDC) does not currently recommend taking COCs for the prevention gynecologic cancer (CDC, 2014a). Since the efficacy of COCs for reducing risk of ovarian and endometrial cancer is well established, guidelines need to be determined for populations of women that should take hormonal birth control to minimize cancer risk. This paper highlights the current understanding of ovarian and endometrial cancer, populations of women at highest risk for developing either of these two cancers, and then proposes a case-control study to help determine which populations of women should take hormonal birth control to reduce their gynecologic cancer risk.

26

Clutter, Carmen Marie. „The Moms2B Program: A Qualitative Evaluation of Participants’ Perceptions of the Program and its Impact on their Diet, Lifestyle, and Behaviors“. The Ohio State University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=osu1366011071.

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27

Rossheim, Brooke W. „Predictors of Primary Elective Cesarean Delivery Among Apparently Healthy Pregnant Women in Virginia“. VCU Scholars Compass, 2006. http://hdl.handle.net/10156/1942.

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28

Lindquist, Anthea Clare. „The impact of socioeconomic position on outcomes of severe maternal morbidity amongst women in the UK and Australia“. Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:3ec55671-e8b8-42c6-a777-fb7667b33e6e.

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Aims: The aims of this thesis were to investigate the risk of severe maternal morbidity amongst women from different socioeconomic groups in the UK, explore why these differences exist and compare these findings to the setting in Australia. Methods: Three separate analyses were conducted. The first used UK Obstetric Surveillance System (UKOSS) data to assess the incidence and independent odds of severe maternal morbidity by socioeconomic group in the UK. The second analysis used quantitative and qualitative data from the 2010 UK National Maternity Survey (NMS) to explore the possible reasons for the difference in odds of morbidity between socioeconomic groups in the UK. The third analysis used data from the Victorian Perinatal Data Collection (VPDC) unit in Austra lia to assess the incidence and odds of severe maternal morbidity by socioeconomic group in Victoria. Results: The UKOSS analysis showed that compared with women from the highest socioeconomic group, women in the lowest 'unemployed' group had 1.22 (95%CI: 0.92 - 1.61) times greater odds associated with severe maternal morbidity. The NMS analysis demonstrated that independent of ethnicity, age and parity, women from the lowest socioeconomic quintiJe were 60% less likely to have had any antenatal care (aOR 0.40; 95%CI 0.18 - 0.87), 40% less likely to have been seen by a health professional prior to 12 weeks gestation (aOR 0.62; 95%CI 0.45 - 0.85) and 45% less likely to have had a postnatal check with their doctor (aOR 0.55; 95%CI 0.42 - 0.70) compared to women from the highest quintile. The Victorian analysis showed that women from the lowest socioeconomic group were 21% (aOR 1.21 ; 95% CI 1.00 - 1.47) more likely and that Aboriginal and Torres Strait Islander women were twice (aOR 2.02; 95%CI 1.32 - 3.09) as likely to experience severe morbidity. Discussion: The resu lts suggest that women from the lowest socioeconomic group in the UK and in Victoria have increased odds of severe maternal morbidity. Further research is needed into why these differences exist and efforts must be made to ensure that these women are appropriately prioritised in the future planning of maternity services provisio n in the UK and Australia.

29

Sexson, Tejtel Sara Kristen. „Is Ohio approaching Healthy People 2010 objectives a birth certificate data analysis /“. Columbus, Ohio : Ohio State University, 2006. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=osu1149023375.

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30

Farland, Leslie V. „A Prospective Study of Endometriosis and Breast Health: Findings From the Nurses' Health Study II“. Thesis, Harvard University, 2016. http://nrs.harvard.edu/urn-3:HUL.InstRepos:27201744.

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Endometriosis is a chronic gynecologic disease affecting approximately ten percent of women in the United States. Endometriosis lesions depend on estrogen for growth and maintenance and it is hypothesized that women with endometriosis have an altered hormonal and inflammatory state. Emerging evidence suggests that women with endometriosis may be at increased risk of breast cancer. Using data from the Nurses’ Health Study II, a prospective cohort of 116,430 women, this thesis investigates endometriosis and breast health. Specifically we investigated whether endometriosis influences risk of breast cancer and benign breast disease and alters mammographic density. Lastly, we investigated whether breastfeeding duration influenced endometriosis risk. Across all analyses, endometriosis was confirmed using laparoscopy, considered the clinical diagnostic gold standard. Information on breast cancer and benign breast disease was collected every two years and confirmed by medical record or pathology slides respectively. Mammographic density was measured from mammograms of a subset of participants without breast cancer using a computer assisted thresholding technique. Detailed breastfeeding information was collected between 1997-2001. Cox proportional hazard models were used to calculate Hazard Ratios (HR) and 95% confidence intervals (CI) and linear regression using generalized estimating equations was used to estimate difference in mammographic density measurements. We found that while women with endometriosis were not at increased risk of overall breast cancer (HR:1.05, CI:0.95-1.16), they did appear to be at an increased risk of ER+/PR- tumors (HR:1.72, CI:1.27-2.32). Endometriosis moderately increased risk of biopsy confirmed benign breast disease, both proliferative (HR:1.23, CI:1.01-1.51) and non-proliferative lesions (HR:1.25, CI:0.93-1.69). Endometriosis did not significantly alter mammographic density. History of breastfeeding was inversely associated with endometriosis (P-value, test for linear trend: <0.0001), which was partially, but not fully mediated through postpartum amenorrhea. Our findings report novel associations with endometriosis and ER+/PR- breast tumors and benign breast disease lesions and no difference in mammographic density. This may elucidate avenues of research on how endometriosis lesions may alter chronic disease risk. Given the debilitating symptoms and few known modifiable risk factors of endometriosis, our findings of an inverse relationship with breastfeeding and endometriosis may inform treatments and prevention strategies for endometriosis in the future.

31

Bensimon, Arielle. „Using Empirical Data to Evaluate Strategies to Improve Women's Health“. Thesis, Harvard University, 2016. http://nrs.harvard.edu/urn-3:HUL.InstRepos:33493260.

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My three papers evaluate the effectiveness and cost-effectiveness of clinical and policy strategies to improve women’s health, focusing on human papillomavirus (HPV) vaccination in the U.S. and maternal health care in a developing country context. Paper 1 presents a claims-based econometric analysis of the U.S.’s Patient Protection and Affordable Care Act provision requiring the elimination of cost-sharing for recommended preventive care. I evaluate the effect of this value-based insurance design intervention on HPV immunization rates among girls and young women enrolled in private insurance plans. My regression approach uses variation in the intensity and timing of the intervention across plans to distinguish policy effects from background trends. I find that the policy was associated with modest increases in age-specific vaccination rates. Increases in vaccination per dollar reduction in cost-sharing were notably larger among beneficiaries in socioeconomically disadvantaged areas. Nevertheless, vaccination rates under free preventive care were well below federal targets, highlighting the need for additional interventions to increase HPV vaccine coverage. In Paper 2, I undertake a comparative effectiveness analysis of HPV vaccination by dose level within a U.S. cohort of adolescent girls and young women. Rates of screening-detected cervical abnormalities in claims are compared among recipients of zero, one, two, or three doses, using a marginal structural model approach to adjust for a broader set of potential confounders than would be possible with conventional regression methods. Findings from these analyses complement prior evidence from immunogenicity trials, and although protective effects appear greatest with three doses, support the value of HPV vaccination even when incomplete. Vaccine effect estimates are largest with respect to high-grade lesions that are precursors to cervical cancer. Using primary data from a randomized experiment, Paper 3 examines the cost-effectiveness of pay-for-performance interventions among obstetric care providers in rural Karnataka, India. I construct a decision analytic model to quantify incremental costs and life years under alternative policy scenarios, combining obstetric complication outcomes and program expenditures from the trial with published evidence on complication-related mortality and medical costs. Results suggest that an incentive program based on input quality is not cost-effective in its current form, but could become economically attractive if program activities can be adjusted to reduce costs while maintaining similar health effects. Performance data collection costs were substantial in this resource-limited setting and represent a key barrier to cost-effectiveness.
Health Policy

32

Webster, Barbara Anne. „Maternal fatigue during the postpartum period“. Thesis, McGill University, 1994. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=22528.

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The purpose of this study was to describe maternal fatigue during the first six weeks postpartum. Forty-eight healthy, primiparous mothers who experienced uncomplicated vaginal births in a large urban hospital were asked to complete the Maternal Piper Fatigue Scale during their hospital stay, and at two and six weeks postpartum. Fatigue intensity was relatively high at two days and two weeks, but had significantly declined to a relatively "normal" level by six weeks postpartum. However, 25% of the mothers were still reporting "severe" fatigue at six weeks. The contributing factors most frequently identified by the mothers were labour and delivery issues (2 days), sleep pattern disturbances, and infant care issues (2 & 6 weeks). Rest, sleep, and instrumental support were consistently identified by mothers as helping alleviate their fatigue during the first six weeks postpartum.

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Haddad, Elias K. „Study of the role of macrophage activation and macrophage derived cytoxic factors in early embryo loss“. Thesis, McGill University, 1997. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=42023.

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Using murine models of spontaneous and induced embryo resorption, we have investigated the role of macrophages in the mechanism of early embryo loss. The results showed that macrophage derived nitric oxide was associated with embryo resorption, and that decidual macrophages could be triggered by lipopolysaccharide (LPS) to produce nitric oxide, indicating that the decidual mononuclear cells were primed in situ. Using double immunostaining, we have shown that macrophages were the cellular source of the inducible nitric oxide production. We further showed that embryo abortion can be significantly decreased by inhibiting the production of nitric oxide in vivo. The results presented strongly suggested a role for nitric oxide as an effector molecule in mediating early embryo loss and showed that the in situ activation of decidual macrophages was an early event preceding spontaneous abortion.
It is known that interferon-$ gamma$ (IFN-$ gamma$) is the major cytokine responsible for the priming of macrophages and that LPS can trigger primed macrophages to produce nitric oxide. Therefore, the observation that exogenous LPS induced embryo abortion in most strains of pregnant mice suggested that the decidual macrophages have been previously primed in situ. To investigate the role of IFN-$ gamma$ as a potential priming signal for decidual macrophage activation, we studied the effect of the depletion of IFN-$ gamma$ on LPS induced pregnancy loss. The results showed that IFN-$ gamma$ deficient mice were more resistant to LPS induced abortion than control mice. This suggested that IFN-$ gamma$ was essential for the priming of decidual macrophages and that decidual macrophages from IFN-$ gamma$ deficient mice could not be activated when exposed to LPS both in vivo and in vitro. Our results also showed increased IFN-$ gamma$ mRNA expression simultaneously in the same embryos that also expressed elevated iNOS mRNA, a macrophage activation marker. This suggested that macrophage activation, subsequent nitric oxide production, and spontaneous embryo loss could be a consequence of local IFN-$ gamma$ over production.
While LPS serves as an exogenous triggering factor, endogenous TNF-$ alpha$ is known to trigger NO production by primed macrophages. Therefore, we investigated the role of TNF-$ alpha$, as a second signal, in mediating embryo loss. Our studies showed that the frequency of embryos with significantly increased TNF-$ alpha$ mRNA expression corresponded to the incidence of murine embryo abortion. In addition, the results showed that increased TNF-$ alpha$ mRNA was simultaneously expressed with iNOS mRNA suggesting a potential role for TNF-$ alpha$ in the triggering of decidual macrophages.
In summary, we demonstrated the presence of activated decidual macrophages in murine placentas, and that inducible nitric oxide produced by these macrophages was responsible for embryo death. We further showed that IFN-$ gamma$ was responsible for the priming of decidual macrophages, and that the expression of TNF-$ alpha$, a potential secondary signal was associated with decidual macrophage activation, NO production, and subsequent embryo loss.

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Pinard, Genevieve. „Cytotoxic activities of murine decidual macrophages in early embryo loss“. Thesis, McGill University, 2000. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=30829.

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Early embryo losses are characterized by a large infiltration of cnacrophages and NK-cells in the decidua surrounding resorbing embryos. This infiltration is combined with a high expression of interferon gamma (IFNgamma), tumor necrosis factor alpha (TNFalpha), and inducible nitric oxide mRNA in the maternal tissue. After receiving proper priming (IFNgamma) and triggering signal (lipopolysaccharide (LPS) or TNFalpha), decidual macrophages can secrete TNFalpha, nitric oxide (NO) and other cytotoxic molecules that could potentially damage placental cells and consequently compromise embryo survival. The objective of this study was to evaluate the cytotoxic effects of activated decidual macrophages on the fetoplacental unit. High and low loss murine mating models have been used to perform cytotoxicity assays. Our results show that: (1) decidual cells from the high loss model have a greater capacity to kill YAC-1 targets than those from the low loss model; (2) when decidual macrophages and NK cells are separated, both cells demonstrate cytotoxic activity by inducing lysis of the YAC-1 targets; (3) decidual macrophage-mediated killing of YAC-1 cells is not related to NO and TNFalpha production but is inhibited by the oxyradical scavenger N-acetyl-l-cysteine in a dose-dependent manner: (4) murine trophoblast cells are resistant to decidual cell-mediated lysis in vitro and inhibit decidual cell-mediated lysis of YAC-1 targets. Taken together, these results confirm that decidual macrophages and NK cells could be cytotoxic effectors at the maternal/fetal interface, demonstrate that trophoblasts are properly adapted to resist decidual cell-mediated lysis, and suggest that certain reactive oxygen intermediate, might damage cells other than trophoblasts around the fetoplacental unit.

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Chevalier, Isabelle. „Effect of caffeine intake during pregnancy on the risk of intrauterine growth retardation“. Thesis, McGill University, 2001. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=31210.

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We estimated the effect of caffeine intake from tea, coffee, and colas on the risk of mild and severe intrauterine growth retardation (IUGR) through a case-control study in 500 live singleton infants born at Sainte-Justine Hospital, in Montreal, between May 1998 and July 2000. Cases of IUGR as well as one sex, race and gestational age-matched control per case were identified at birth. Data were abstracted from medical charts and post-delivery questionnaires, and were analysed using conditional logistic regression. Average caffeine intake in pregnancy was not a significant predictor of mild or severe IUGR (for mild IUGR, OR for >300 mg/day of caffeine vs. none:1.21, 95%CI [0.33, 4.40]; trend: p = 0.28). Moderate first-trimester caffeine use significantly increased the risk of mild (OR 2.41, 95%CI [1.01, 5.75]), but not severe, IUGR. Reduction of caffeine use at the onset of pregnancy was protective for mild and severe IUGR (OR 0.34, 95%CI [0.13, 0.92], and 0.55, 95%CI [0.32, 0.94], respectively).

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Rousseau, Marie-Claude 1969. „Risk factors for incident cervical human papillomavirus infection in women in a high-risk area for cervical cancer“. Thesis, McGill University, 1998. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=20282.

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Human papillomavirus (HPV) is the sexually-transmitted etiologic agent of cervical cancer. Despite screening programs, cervical cancer remains too common, particularly in developing countries. Various correlates of prevalent infections have been identified. However, the determinants of incident infections have never been studied.
Data were collected during a prospective cohort study conducted in Brazil. Incidence density rates of infection were calculated and determinants of incident infection were identified using Cox regression models. Analyses were done for HPV types classified into low-risk and high-risk depending on their association with cervical neoplasia.
The incidence density rates were 9.3 and 7.6 per 1000 women-months respectively for low-risk and high-risk HPV infection. Independent positive associations were found between the time of first occurrence of low-risk infection and age, number of sexual partners in the past 5 years, education level and use of non-commercial hygienic absorbents. The first occurrence of high-risk infection was independently predicted by age, age at first sexual intercourse, condom use (negative associations) and by the number of sexual partners in the past year (positive association). Elucidation of the dynamics of infection is a first step towards implementation of public health programs for reducing the risk of cervical cancer.

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Duhn, Lenora Jane. „The impact of a maternity cooperative care program on maternal and infant complications, maternal competence, social support, and stress“. Thesis, McGill University, 1996. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=23999.

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The purpose of this study was to assess the impact of a Maternity Cooperative Care Program (MCCP) on the prevalence of maternal and infant complications, maternal competence, social support, stress, and first-time-mothers' descriptions of their postpartum experience. Forty-one healthy, primiparous mothers who participated in a MCCP and forty-three healthy, primiparous mothers who received traditional maternity care were asked to complete the Perceived Competence Questionnaire, the Personal Resource Questionnaire, "The Help I Get" Questionnaire (spousal support), and three numerical rating scales relating to stress in general, as well as self- and infant-care stress 24-48 hours postpartum while in hospital and over the telephone at two weeks postpartum. Ten randomly selected mothers from each group also answered twelve open-ended questions during a home visit at 2-3 weeks postpartum. There were no statistically significant differences between the two groups for any of the outcome variables assessed. For both groups, competence with self- and infant-care increased over the two weeks postpartum, while support and stress remained stable. Interviews with the mothers revealed that the number of stressors increased once at home, while support continued to be of value in relieving stress and helping maternal adjustment and confidence. Results of a qualitative comparison between the groups suggests that the MCCP mothers felt more prepared to be discharged home, and identified their partner more often as an active participant during hospitalization.

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Camarano, Loretta. „Risk of preterm delivery and low birth weight in singleton pregnancies conceived by women with and without a history of infertility“. 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:3378528.

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Kulaga, Sophie. „Determinants of incident precursor lesions of cervical cancer“. Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0006/MQ44199.pdf.

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40

Greaves, Kathryn Anne 1959. „High-density lipoprotein metabolism in post-menopausal women“. Diss., The University of Arizona, 1996. http://hdl.handle.net/10150/282267.

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There is a large decrease in endogenous estrogen production with menopause associated with increases in severity of risk factors for coronary heart disease (CHD), including lower high density lipoprotein cholesterol (HDL-C) concentrations. Exogenous estrogen is administered to decrease the risk of CHD. This project was designed to examine the influence of hormone replacement therapy (HRT), ethnicity, and body composition on cholesterol ester transfer protein (CETP) and lecithin:cholesterol acyltransferase (LCAT) activities, two enzymes involved in HDL metabolism. 205 women participated, 32% of Hispanic origin and 52% not presently undergoing HRT (58% Anglo, 39% Hispanic). CETP and LCAT activities were quantified by a mass transfer method and body composition variables were measured by dual energy x-ray absorptiometry and anthropometry. There were no significant differences in plasma lipids and lipoproteins among HRT groups (non-users, unopposed estrogen, combined therapy). Hispanic women had lower HDL-C concentrations and total plasma cholesterol to HDL-C ratio, and higher triglyceride concentrations and greater susceptibility of low density lipoprotein particles to oxidation. CETP activity was elevated in Hispanic women when compared to Anglo women. The ethnic difference in CETP activity was eliminated once IAAT or measures of trunk fat, but not total body fatness, were controlled. No differences in CETP or LCAT activities were found among HRT groups. Women not undergoing HRT tended to have greater abdominal fat compared to women undergoing either hormone therapy, however differences were not significant. Hispanic women had significantly greater amounts of abdominal fat than did Anglo women, even after adjusting for total body fat. CETP and LCAT activities were positively related to plasma lipids, lipoproteins (exception: negative association with HDL-C), and body composition. Correlations were higher with regional fat measures than with total body fat measures. In conclusion, HRT did not affect CETP or LCAT activities. Results suggest that associations between HRT use and decreased risk of CHD involve other mechanisms. Hispanic women had higher CETP activities and greater distribution of abdominal body fat suggesting that they are at greater risk for CHD compared to Anglo women.

41

Pickens, Kimberly J. „A pilot project to establish a collaborative| Developing a shared database for perinatal nurse sensitive indicators“. Thesis, Northern Kentucky University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3622601.

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The National Database of Nurse Quality Indicators (NDNQI) contains many nurse sensitive indicators for benchmarking adult medical/surgical patient outcomes but no perinatal nurse sensitive indicators. Project objectives were to form a collaborative, identify a perinatal nurse sensitive indicator, metrics that would contribute to its success and methods to measure and report them. The researcher developed a theoretical framework and three phase process to support the formation of the collaborative based on empowerment theory, collective impact and the Plan, Do, Study, Act cycle. Seven Midwest magnet organizations participated and identified breastfeeding as the indicator, along with three metrics that promote it: baby to breast in the first 60 minutes, non-separation of mom and baby, and skin-to-skin contact during the recovery period. Methods to document, measure and report metrics were developed and a database was selected for data comparison. While all objectives were met, only three organizations remained at project completion.

42

Vazquez, Juan C. „The opinions and attitudes of obstetricians in the city of Havana, Cuba towards use of Cesarean section“. Thesis, University of Ottawa (Canada), 2008. http://hdl.handle.net/10393/27738.

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Cesarean section rates have increased worldwide in the last decades. It has had important implications for the health system, such as the increase in maternal morbidity and mortality. An anonymous survey was administered to 132 obstetricians in the City of Havana to identify their opinions regarding the cesarean section rates; to determine what are the causes for such increase and what possible interventions could stop that trend; and the obstetricians' preferences when facing some clinical situations. Most of participants considered the cesarean section rate to be high. Previous caesarean sections, administrative pressures and new technologies were pointed out as possible causes. Asking for a second opinion, the use of the partograph and try a VBAC are interventions probably useful to reduce such rates. Future research should investigate the ideal cesarean section rate and potential measures to decrease it, as well as the barriers that hinder professionals in implementing such interventions.

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Lafrance, Josee. „Mother-baby togetherness: A survey of women's postpartum experiences in four maternity units“. Thesis, University of Ottawa (Canada), 2003. http://hdl.handle.net/10393/26506.

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Purpose. To describe women's postpartum experiences with mother-baby togetherness in hospital, and the concordance of their experiences with the recommendations from Health Canada (2000a) on family-centred maternity and newborn care (FCMNC). Design. Descriptive study based on secondary analysis of a telephone survey conducted at one week and six weeks postnatally. Five elements reported by women were examined: the timing of first physical contact, physical proximity during the first few hours, transfer together to postnatal unit, rooming-in, and combined mother-baby care. Setting. Four maternity units in Ottawa (Ontario, Canada) including two level I units, one level II and one level III unit. A proportionate sample was drawn from each unit. The overall response rate to both interviews was 88.3%. Participants. Women (N = 552) who returned home with their babies within the first postnatal week, between October 2000 and March 2001. Findings. While in hospital, 95.8% of mothers and babies were separated. Combined care was reported by 84.7% of women and rooming-in by only 33.9% of women. Only 8.8% of women experienced all five FCMNC recommended practices. Practices varied between the units (p < .001). Women who had a caesarean birth were more likely to be separated from their infants than those who had a vaginal birth. Routine procedures performed in the nursery was the most frequently reported reason (55.8%) for the first separation of mothers and babies. Conclusion. Few women reported receiving care based on the FCMNC recommendations about mother-baby togetherness. Hospital practices varied considerably. It is recommended that healthy newborns receive care at their mothers' bedside. Further research is recommended to study the relationship between unit policy, actual practices, nurses' beliefs and women's preferences about the elements of mother-baby togetherness.

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Reinhold, Caroline. „The use of endovaginal sonography and Doppler ultrasound in the detection of endometrial carcinoma in women presenting with postmenopausal bleeding“. Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp03/MQ64436.pdf.

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Tillett, Marsha Jane 1952. „The effect of postpartum home teaching on knowledge of infant care“. Thesis, The University of Arizona, 1992. http://hdl.handle.net/10150/278075.

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This study investigated the effect of postpartum home teaching on primiparous women's knowledge of infant care. Twenty-one low-risk primigravidae women were randomly placed in a control or experimental group. Subjects in the experimental group viewed a videotaped program on infant care a second time, at home on the third day postpartum. Tests were administered prior to hospital discharge, on the third day postpartum, and at 28-32 days postpartum. A short interview was conducted to obtain opinions regarding videotaped educational materials. The subjects (n = 21) retained most of the information presented after the first viewing and expressed satisfaction with the educational format. The results were not statistically significant, though mean test scores increased over the three test intervals.

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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).

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Alseaidan, Mohammad. „Maternal, Behavioral, and Environmental Risk Factors for Gestational Diabetes and Preterm Birth Among Pregnant Women“. Thesis, Harvard University, 2016. http://nrs.harvard.edu/urn-3:HUL.InstRepos:27201755.

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Background: Lifestyle changed in Kuwait with the rapid development and economic expansion and the Americanization of the Kuwaiti market. Fast food and sedentary lifestyle became very prevalent. Environmental exposures such as passive tobacco smoke and extreme temperatures are common in Kuwait where the prevalence of chronic conditions is increasing. We describe a Kuwait based pregnancy-birth cohort and examine the associations between perinatal exposures and the risk of chronic disease. Methods: We recruited women from antenatal clinics in Kuwait and administered baseline questionnaires then followed the women postnatally. We examined maternal and lifestyle risk factors of gestational diabetes mellitus (GDM). We examined the association between passive tobacco smoke exposure and gestational diabetes, and finally we examined the association between preterm delivery with heat and humidity in Kuwait Results: We successfully enrolled 2,478 women and followed 2,254 to delivery. Overall, frequencies of stillbirth, preterm birth, and small for gestational age were comparable to other developed countries. The incidence of self-reported gestational diabetes was within the expected range worldwide. After past GDM history, pre-pregnancy obesity was the strongest maternal risk factor associated with GDM. We observed patterns suggestive of a positive association between home passive tobacco smoke exposure and GDM among primiparous women. Finally, high relative humidity but not temperature was associated with an increased risk of preterm delivery. Conclusions: We successfully established a large pregnancy birth cohort in Kuwait. There are several social and environmental challenges in Kuwait that may increase the risk of chronic disease such as diabetes, which is already very prevalent in Kuwait. Our results should be replicated and the results used to inform interventions to reduce the rates of chronic disease in Kuwait.

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Gabaldon, Nikolas P. „Health education for pregnant women| An influential factor“. Thesis, California State University, Long Beach, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=1526910.

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Healthy nutrition is essential for everyone but in some periods, including pregnancy, people are more susceptible and demand attention for nutrition. According to the United States Food and Drug Administration (FDA), approximately 300 extra calories are needed daily to maintain a healthy pregnancy for women. This study analyzes the effects of health education that is provided to pregnant women who are either seeking an office visit for routine or high-risk pregnancy. This study predicted there is no difference in being referred for any type of health education offered to pregnant women between those who received routine pregnancy care and those with high-risk care. It also predicted there is no difference in whether pregnant women are offered nutrition health education/exercise for receiving routine prenatal care and high-risk care. The Statistical Package for Social Services (SPSS) was applied to analyze the 2010 National Ambulatory Medical Care Survey (NAMCS) data using Chi Square statistics. The results from this study indicated no significant relationship between pregnant women who are either seeking an office visit for routine or high-risk pregnancy, as it relates to health education. These results reassure the importance of health education.

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Oguni, Miyako. „Trends in pregnancy outcome in epileptic women over two decades : relationship to maternal anticonvulsant therapy“. Thesis, McGill University, 1990. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=59839.

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The prevalence of abnormal pregnancy outcomes in the offspring of 103 epileptic women followed prospectively during pregnancy between 1982 and 1989 was compared with that in the previous study of 119 pregnancies by Dansky et al. from the same institution.
Our results have shown a significant decrease in the prevalence of major malformations, as compared with the previous study: 8.8% vs. 24.1% (P $<$ 0.01). Monotherapy was more frequent and the mean number of drugs used during pregnancy was significantly smaller in the present study. Phenytoin, phenobarbital and primidone were prescribed less frequently in the present study, whereas carbamazepine and valproic acid were used more frequently. Plasma levels of valproic acid during pregnancy were higher in mothers of malformed babies. In the present study, plasma folate levels were significantly higher, and more patients were taking folate supplements during pregnancy.
In conclusion, the type and number of drugs used during pregnancy, as well as the plasma concentrations and serum folate levels, may determine the frequency of abnormal outcomes.

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Piedimonte, Sabrina. „Reducing the burden of tests in an early detection program for ovarian cancer“. Thesis, McGill University, 2012. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=110582.

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Prospective evaluation of symptomatic women with CA-125 and transvaginal ultrasound scan (TVUS) in the DOvE pilot project has resulted in a higher prevalence of invasive ovarian cancer as compared to screening the general population. The detected cancers also showed a trend of diagnosis in completely resectable stages. However, the false positive rate was high; 19% of patients underwent further investigation in absence of malignancy. Our objective was to limit the number of further interventions among false positive symptomatic women in DOvE.We developed a predictive model to help determine who, among patients testing positive in the first instance, required further investigation. The model was subsequently validated prospectively in 58 women.CA-125, endometrial thickness, postmenopausal bleeding, solid area within an ovarian mass and age predicted the need for further investigation. Upon ROC analysis, this model was 92% sensitive and 84.8% specific in predicting those patients with positive CA-125 and TVUS that truly required further investigation, at an optimal cutoff probability of 0.069. To maximize sensitivity (100%), the cutoff probability was 0.027, and the specificity 66.8%. When applied prospectively, the model was 100% sensitive and 82% specific by ROC analysis.Although a baseline false positive rate is inevitable given the limitations of such tests, our model can be used to triage symptomatic women with positive CA-125 and/or TVUS and has potential to alleviate the burden of false positive results.
L'évaluation des femmes symptomatiques avec un prélèvement sanguin pour le CA-125 et une échographie transvaginale dans le cadre du projet pilote DOvE a pu dépister un plus grand nombre de cancers ovariens invasifs comparé au dépistage de la population générale. De plus, ces cancers ont une plus grosse chance d'être diagnostiqués en stades complètement opérables. Par contre, le taux de faux positifs était élevé ; 19% des patientes ont du passer des tests supplémentaires suite à un résultat positif aux tests de dépistage en absence de cancer. L'objectif de l'étude courante est de limiter le nombre d'interventions supplémentaires chez les femmes symptomatiques ayant un test positif dans le cadre de l'étude DOvE. Nous avons développé un modèle prédictif pour aider à déterminer qui, parmi les patientes ayant un test positif en premier lieu, nécessitait vraiment des interventions supplémentaires. Ce modèle a ensuite été validé prospectivement sur une cohorte de 58 femmes. Le niveau de CA-125, l'épaisseur de l'endomètre, le saignement post-ménopause, une masse ovarienne présentant des régions solides et l'âge sont des prédicteurs significatifs du besoin d'investiguer plus loin un résultat positif. D'après l'analyse ROC, ce model est 92% sensitif et 84.8% spécifique pour prédire les patientes ayant un CA-125 et/ou échographie transvaginale qui nécessitent d'autres tests, et ce, a une probabilité optimale de 0.069. En l'appliquant prospectivement, ce modèle est 100% sensitif et 82% spécifique par analyse ROC. Malgré du fait qu'un taux de faux positifs de base soit inévitable étant donné les limites de ces deux tests, notre modèle pourrait être utile pour le triage des femmes symptomatiques ayant un CA-125 et/ou ETV positif et pourrait ainsi réduire le fardeau des résultats faux positifs.

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