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Zetterström, Karin. "Chronic Hypertension and Pregnancy : Epidemiological Aspects on Maternal and Perinatal Complications." Doctoral thesis, Uppsala University, Department of Women's and Children's Health, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7755.
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<p>These studies were undertaken to investigate risks of maternal and perinatal complications in pregnant women with chronic hypertensive disease, and to investigate future risk of preeclampsia in women born small for gestational age (SGA). Population based cohort studies using the Swedish Medical Birth Register from different years were performed.</p><p>The maternal complications mild and severe preeclampsia, gestational diabetes and abruptio placenta were studied in a population of 681 515 women, with a prevalence of 0,5% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics as age, parity, BMI, ethnicity and smoking habits. Chronic hypertensive women wore found to have significantly increased risks of all complications. </p><p>The perinatal complication SGA was studied in a population of 560 188, with a prevalence of 0,5% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics and for the secondary complications mild and severe preeclampsia. Chronic hypertensive women were found to suffer a significantly increased risk of giving birth to an offspring that is SGA. </p><p>The perinatal complication fetal/infant mortality was studied in a population of 1 222 952 with a prevalence of 0,6% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics and for the complications mild and severe preeclampsia, gestational diabetes, abruptio placenta and offspring being SGA In the analysis an effect modification by gender was included. Chronic hypertensive women were found to have a significantly increased risk for stillbirth and neonatal death in male, but not in female, offspring. Thus a clear gender difference in mortality was revealed. The risk of mortality of offspring was mediated by severe preeclampsia, abruptio placenta and offspring being SGA. Mild preeclampsia and gestational diabetes did not affect the risk. No increased risk of post neonatal mortality was found.</p><p>A generation study was performed in 118 634 girls of which 5.8% were born SGA. Their future risk for mild and severe preeclampsia in first pregnancy was analysed. Risk estimates were adjusted for age, smoking, BMI and for preeclampsia in the mothers while pregnant with the study population. Women who were born SGA were shown to have a significantly increased risk for severe preeclampsia, but not for mild preeclampsia. </p>
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M’Rithaa, Doreen K. M. "A framework for information communication that contributes to the improved management of the intrapartum period." Thesis, Cape Peninsula University of Technology, 2015. http://hdl.handle.net/20.500.11838/1414.
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Dissertation submitted in fulfilment of the requirements for the degree Doctor of Technology: Informatics in the Faculty of Informatics and Design at the Cape Peninsula University of Technology<br>Background: Daily activities within a health care organization are mediated by information communication processes (ICP), which involve multiple health care professionals. During pregnancy, birth and motherhood a woman may encounter different professionals including midwives, doctors, laboratory personnel and others. Effective management requires critical information to be accurately communicated. If there is a breakdown in this communication patient safety is at risk for various reasons such as; inadequate critical information, misconception of information and uninformed decisions being made. Method: Multi method, multiple case study approach was used to explore and describe the complexities involved in the (ICP), during the management of the intrapartum period. During the study the expected ICP, the actual ICP, the challenges involved and the desired ICP were analysed. 24 In-depth interviews with skilled birth attendants were conducted, observer- as- participant role was utilized during the observation, fild notes, reflective diaries and document review methods were used to gather the data. Thematic analysis and activity analysis were applied to analyse the data. Findings: The findings illuminated that there are expectations of accessibility to care of the woman during pregnancy birth and the intrapartum, especially linked to referral processes. The actual ICP focused on documentation and communication of the information within and between organizations. Communication was marked by inadequate documentation and therefore errors in the information communicated. The desires for communication were illuminated by the need to change the current situation. Further a framework for effective information communication was developed: the FAAS framework for the effective management of the intrapartum period. Conclusion: In conclusion what is expected is not what is actually happening. The skilled birth attendants (SBAs) do not necessarily have the answers for change but the challenges were identified as desires for change. I urge that the framework will provide a basis for the evaluation of the effectiveness involved in the ICP for the effective management of the intrapartum period.
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Lee, Lap-chi Angela. "Perinatal care centre." Hong Kong : University of Hong Kong, 1996. http://sunzi.lib.hku.hk/hkuto/record.jsp?B25948192.
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Thesis (M. Arch.)--University of Hong Kong, 1996.<br>Includes special report study entitled: Management on materials handling systems : improvement on the operatio & services of an independent perinatal care centre. Includes bibliographical references.
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McConville, Pauline Mary. "Obstetric complications and functional psychosis." Thesis, University of Edinburgh, 2007. http://hdl.handle.net/1842/24928.
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The main body of the work is a study of the rates of obstetric complications in 492 patients meeting ICD-9 criteria for schizophrenia, affective disorder and other functional psychosis, compared to their 797 non-psychotic siblings and to 2,460 normal controls. The main results, for each of the three diagnostic groups, indicate significant confounding between obstetric complications, maternal marital status and social class. No single obstetric complication remained associated with schizophrenia once these factors had been controlled for. Bleeding in pregnancy was associated with an increased risk of affective disorder compared to controls. A low Apgar score at 5 minutes was associated with an increased risk of affective disorder compared to controls. Low social class and maternal marital status were also associated with the risk of affective disorder. Induction of labour or elective caesarean section was associated with an increased risk of other functional psychosis compared to their non-psychotic siblings. Secondary analyses of the effect of season of birth, age of onset of illness and family history are presented. Schizophrenic patients were more likely to have been born in winter than their siblings but winter-born schizophrenics had similar rates of OCs to those born at other times. An induced labour or elective caesarean section was associated with an increased risk of affective disorder of early onset and of non-familial affective disorder. Bleeding in pregnancy was also associated with an increased risk of non-familial affective disorder. The findings are compared to those of other studies and conclusions are drawn about the importance of obstetric complications in the aetiology of psychotic disorders, with particular emphasis on schizophrenia, and suggestions are made for further research.
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Lee, Lap-chi Angela, and 李立芝. "Perinatal care centre." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1996. http://hub.hku.hk/bib/B31982943.
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Donohoe, Siobhan. "An investigation of antiphospholipid antibody associated obstetric complications." Thesis, University College London (University of London), 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.312964.
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Hirschi, Budge Kelsey May. "RAGE and Gas6/Axl Signaling in Obstetric Complications." BYU ScholarsArchive, 2020. https://scholarsarchive.byu.edu/etd/8409.
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Current research spans a wide range of objectives whose diversity includes the understanding of global epidemiology and the detailing of molecular interactions leading to specific pathologies. This work aligns more closely with the goal of mechanistic clarity by elucidating several aspects of signaling pathways involved in inflammatory and obstetric pathologies. Prior research has confirmed the role of Receptors for Advanced Glycation End-Products (RAGE) activation in signaling leading to chronic inflammation such as that observed in chronic obstructive pulmonary disease (COPD). RAGE activation has also been identified in other disease states including diabetes, Alzheimer’s disease, osteoarthritis, and cancers. We examined the role of RAGE in the obstetric complication intrauterine growth restriction (IUGR) wherein fetal development is delayed and infants are born at low birthweight. Exposure to tobacco smoke is known to activate RAGE, and smoke exposure also increases risk for IUGR. We confirm a role for RAGE signaling in development of IUGR. RAGE inhibition by semi-synthetic glycosaminoglycan ethers (SAGEs) significantly improved fetal and placental weights and reduced inflammatory signaling molecules. Interactions between RAGE and other signaling pathways have been noted in several research endeavors, and we sought to further understand signaling interactions specifically in obstetric pathologies by examining relationships between RAGE and Gas6/AXL signaling. We confirm that RAGE and Gas6/AXL signaling are not independent. Using tobacco smoke as a means of inducing RAGE, we determined that total AXL is inhibited when RAGE is active, but that phosphorylated AXL is increased. Inhibition of RAGE also increased Gas6 expression. These interactions require further clarification, but provide a foundation to expand upon. We further studied interactions within the Gas6/AXL pathway independent of RAGE. High levels of Gas6 have been noted in the serum of some women with preeclampsia, and early diagnosis and treatment of preeclampsia are currently limited. We demonstrate that, in a rat model, administration of Gas6 during pregnancy is sufficient to induce symptoms of preeclampsia including high blood pressure, increased proteinuria, and decreased trophoblast invasion. This provides a novel model which will further both diagnosis and treatment of preeclampsia. We also demonstrated that trophoblast invasion is influenced in a cell-type dependent manner by Gas6 and mTOR signaling, with decreased trophoblast invasion when Gas6 is high in trophoblast cells, but increased invasion with high Gas6 in a pulmonary adenocarcinoma cell type and in oral squamous cell carcinoma cells. Our work has clarified details of both RAGE and Gas6/AXL signaling that are crucial to further study of the pathways in which they are active, and the pathologies resulting from signaling misregulation.
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Wilkerson, Diana Sue. "Perinatal complications as predictors of infantile autism." Virtual Press, 1992. http://liblink.bsu.edu/uhtbin/catkey/833467.
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This study investigated the impact of perinatal complications on the developing child and the relationship of those complications to the development of autism in an individual. The biological mothers of autistic children (N = 183) completed the Maternal Perinatal Scale, a maternal selfreport which surveys complications of pregnancy and medical conditions of the mother. Archival data on normals (N = 209), obtained during previous perinatal investigations, was utilized as a control group.Previous research in this area has been limited, with no definitive conclusions. All previous investigators have declined to state that events identified in previous research were definitely related to the development of autism.An overall multivariate test was performed to determine if significant differences existed between the autistic and normal subjects. Following this exploration of the data, previously identified complications were entered into a stepwise discriminant analysis in the order of theirtheoretical importance to determine the extent of their contribution to autism. Following this analysis, medical conditions of the mothers (items 27-47 as included on the MPS) were entered into the stepwise analysis to determine their contribution, if any, to autism in the sample.The results of this analysis revealed that the two groups differed significantly on three of the ten factors of the MPS. The overall multivariate test was highly significant and revealed that the groups differed on Factor 2 (Gestational Age), Factor 4 (Maternal Morphology), and Factor 8 (Intrauterine Stress). Moreover, five of the six previously identified items were found to be significant. These were: prescriptions raken during pregnancy, length of labor, viral infection,, abnormal presentation at delivery, and low birthweight. Three of the maternal medical conditions examined were also highly significant and contributed to separation between groups. These were: urinary infection, high temperatures, and depression. These were items which have not been identified in previous investigations.Based on discriminant analysis of the 10 factors of the MPS, 65% of the cases were correctly grouped. The MPS would be a useful clinical tool in identification of those children who are at risk for development of autism.<br>Department of Educational Psychology
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Graner, Sophie. "Reproductive outcomes in rural Vietnam. Perspectives and experiences by pregnant women and health care professionals on pregnancy promotion and maternal health care." Doctoral thesis, Umeå universitet, Obstetrik och gynekologi, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-37266.
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Background Reproductive health and health events associated with pregnancy including induced abortions are among the most important factors for the health of fertile women. Adverse outcomes have an impact on women’s reproductive health and their overall health as well as the health of their offspring. Pregnancy and child bearing take place within a cultural context. Risk factors for adverse pregnancy outcomes depend on factors both associated with the individual woman as well as contextual factors. Aims This thesis investigates reproductive health indicators and their determinants for women in a rural district in Vietnam with special focus on adverse pregnancy outcomes and their determinants. In addition, this thesis explores the perspectives and experiences among pregnant women and health care professionals on maternal health care in Vietnam and risks during pregnancy and delivery. Methods The studies used quantitative and qualitative methods. In the quantitative studies a total of 4,396 women reporting 5,838 pregnancies, and 5,521 infants were included. Parametric and non parametric tests and univariate and multivariate logistic regression analysis was performed. For the estimation of small for gestational age a population-specific reference curve was constructed based on the mean birth weight at term in the study population. In the qualitative studies data were collected from eight focus group discussions, four with pregnant women and four with health care professionals. Manifest and latent content analysis was applied. Main findings Women belonging to an ethnic minority or women giving birth at home were at increased risk of stillbirth. The risk of induced abortion increased with maternal age. Neonatal mortality was estimated to 11.6 per 1000 live births and perinatal mortality to 25.0 per 1000 births. The prevalence of small for gestational age was estimated to 6.4%. Risk factors for small for gestational age included women in farming occupations and post-term birth. There was a marked decrease in perinatal mortality after 33 weeks of gestation. Contextual conditions influenced both pregnant women’s use of maternal health care and the performance of the health care professionals. The use of maternal health care was influenced by economical conditions as well as cultural norms that impeded women’s autonomy. Structural constraints included inadequate financing of the health system, including lack of staff, insufficient professional re-training, and inadequate equipment. Pregnant women in rural Vietnam created a strategy to promote a healthy pregnancy through lifestyle adjustments, gathering of information, and seeking timely medical care. Insights in pregnancy-related conditions were sought from various sources and were influenced both by Vietnamese traditions and modern medical knowledge. Conclusions Knowledge about pregnancy complications and their related signs and symptoms, and a high confidence in the maternal health care probably contribute to the relatively good maternal health status and pregnancy outcomes in Vietnam. To improve perinatal and neonatal outcomes there is a need to ensure access for all pregnant women to delivery units with surgical capacity in case of an obstetrical emergency. Also, a higher proportion of premature infants need to be born at units with access to neonatal care. This may be achieved by an improved system for referral including capacity of medical care during transportation. Other desirable improvements include antenatal identification of small for gestational age foetuses. In our study the induced abortion rate increased with maternal age and was highest among married women, indicating that induced abortions may be used as a method for family planning. The cultural norms in Vietnam limit women’s autonomy and reduce their possibility to make independent decisions about their reproductive health. Our studies emphasize the importance of adequate access for all women to maternal health care adjusted for their individual needs. A better understanding is needed of context-specific factors that influence couples’ choice of family planning methods, place of birth, and maternal health care. The communication between pregnant women and health care professionals needs further investigation. This knowledge is essential in order to develop reproductive health services that are accessible, acceptable and affordable to all.
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Gray, Jeffrey W. "Assessment of perinatal complications with a maternal self report : the maternal perinatal scale." Virtual Press, 1987. http://liblink.bsu.edu/uhtbin/catkey/536300.
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The present study was an effort to empirically subtype children's learning disabilities. A review of the literature was presented with a focus on current and historical subtyping attempts. A cluster analysis was performed on 1144 school-age learning disabled children who had completed extensive neuropsychological, intellectual, and achievement measures. Four interpretable clusters emerged which were seen as (1) Verbal-Sequential-Arithmetic Deficits, (2) Motor Speed and Cognitive Flexibility Deficits, (3) Mixed Language/Perceptual Deficits, and a (4) No Deficit Subtype. Not only did these clusters indicate unique profiles for each subtype across the sample, but developmental differences were also apparent between all four clusters. The current investigation suggested the utility of an empirical-neuropsychological approach to subtyping children's learning disabilities, while also portraying the importance of neurodevelopmental considerations of subtypes. Future directions in research were discussed.<br>Department of Educational Psychology
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Alghamdi, Amal. "The associations between poor sleep in pregnancy and obstetric, perinatal and neonatal outcomes." Thesis, University of Leeds, 2017. http://etheses.whiterose.ac.uk/18998/.
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Background: Sleep has a complex nature that is thought to make it a risk factor for many health concerns, which have recently included poor pregnancy outcomes. Aim: Studying the association between sleep and poor pregnancy outcomes in pregnant women. Methods: To achieve this aim, several studies were done. First, the literature was searched to examine and critically evaluate the quality of current evidence in regards to sleep and pregnancy outcomes. Second, the latent complex nature of sleep was defined using latent class analysis and the UKHLS data set before examining the association between the generated patterns and socio-demographic features and health. Third, sleep events present in the UKHLS sleep module and the generated latent sleep patterns were examined in women from the UK population who were presented in the UKHLS study, and in women at risk of gestational diabetes (GDM) presented in the Scott/Ciantar study, in relation to poor pregnancy outcomes. Results: In the literature there was ‘positive’ evidence of an association between sleep and poor pregnancy outcomes. However, the evidence suffered from limitations, and the complex nature of sleep was not considered. Our definition of sleep as a latent variable revealed six latent sleep patterns which were associated with individual socio-demographic features and health. Sleep events and latent patterns did not always elevate the risk of poor pregnancy outcomes in women from the UK population or women at risk of GDM, as sleep lowered the risk on some occasions. Conclusion: Sleep might increase the risk of poor pregnancy outcomes, according to evidence from the literature review and the two empirical studies. However, the current evidence had many limitations, and further research is required in this area.
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Fernandes, Alessandra Fernandez. "Valvopatia mitral em gestantes: repercusões maternas e perinatais." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/5/5139/tde-27052010-164816/.
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Os objetivos deste estudo foram correlacionar o tipo de lesão valvar mitral com eventos maternos e neonatais. É um estudo retrospectivo, observacional, realizado na Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina de São Paulo. Foram coletados dados de 117 gestações em 111 mulheres com valvopatia mitral e 117 recém-nascidos resultantes destas gestações. No grupo estudado, foram observados 71 casos de gestantes portadoras de insuficiência mitral e 46 casos de gestantes portadoras de estenose mitral e seus 117 recém-natos. O tipo de lesão valvar, a estenose mitral, esteve significantemente relacionado piores classes funcionais (com predominância de CF III/IV), a maior necessidade de uso de medicamentos cardiovasculares, à maior freqüência de internação para compensação do quadro cardíaco, a maiores índices de parto cesárea, a menor média ponderal ao nascimento e a maior incidência de RNs pequenos para idade gestacional. Entretanto, a lesão valvar predominante não influiu com relevância estatística quanto à presença de complicações obstétricas, presença de co-morbidades clínicas, a complicações fetais, índice de Apgar < 7, e necessidade de UTI neonatal. A presença de valvopatia mitral na gravidez, principalmente a estenose mitral, acompanha-se de riscos maternos e perinatais<br>PURPOSE: To evaluate the maternal (clinical e obstetrical) and perinatal events related to the predominant valvar lesion in pregnant women with mitral valve disease. This is a Observational and retrospective study of 117 pregnancies in 111 patients with mitral disease, followed in a single tertiary center from January 2004 until August 2008. Clinical and obstetrical data were reviewed and analyzed according to the main type of valvar lesion (stenosis or insufficiency). The statistical analysis of the results was performed by chi-square test, Fishers exact test, and Mann-Whitney test. Among the 117 pregnancies (and neonates), there were 71 cases of predominant mitral regurgitation (MR group) and 46 with predominant mitral stenosis. The MS group presented more severe heart failure symptoms (functional class III and IV) during pregnancy, received more cardiovascular drugs and needed more hospital admissions due to cardiac reasons . Concerning perinatal events, MS presented higher rates of cesarean sections, smaller birthweight and higher incidence of SGA (small for gestational age, babies. Nevertheless, the predominant valvar lesion was not significantly related to other clinical co-morbidities, obstetrical or perinatal complications. Mitral valve disease in pregnancy is related to clinical and perinatal events, especially in patients with predominant mitral stenosis
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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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<p><b>Background:</b> 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. </p><p> <b>Methods:</b> 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. </p><p> <b>Results:</b> 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). </p><p> <b>Conclusions:</b> 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. </p>
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Siregar, Kemal Nazaruddin. "Social and programme factors influencing maternal morbidity in Indonesia." Thesis, University of Exeter, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.297578.
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Paparelli, Alessandra. "Obstetric complications, genetic liability and psychosis : a study of Gene X Environment interaction." Thesis, King's College London (University of London), 2014. https://kclpure.kcl.ac.uk/portal/en/theses/obstetric-complications-genetic-liability-and-psychosis(dbe046d3-8191-46d3-a3dd-d971462314d2).html.
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There is no doubt a strong genetic component to psychosis, but family and twin studies have shown that simple genetic transmission is far from the whole story. Furthermore, a number of environmental factors have also been shown to increase risk of psychosis. Among these non genetic causes, Obstetric Complications (OCs) are among the best replicated. In order to get a better insight into the mechanisms by which OCs impact on brain development to increase the risk of psychosis, I employed a Gene X Environment causation model. A total of 377 psychotic patients, 65 controls and 103 unaffected siblings were available for my project. I obtained data concerning clinical and socio-demographic status, obstetric history, together with samples of blood/cheek swabs for genetic analysis from these subjects. I also genotyped most of the subjects (N=399) for selected genetic variants that might have functional significance in relation to the individual’s exposure to OCs (namely AKT1 rs 2494753, rs1130233, rs3803300; BDNF rs2049046, rs56164415; DNMBP1 rs875462; GRM3 rs7808623; AK573765- TWIST2 rs9751357; CACNA1C rs4765905; CEACAM21 rs4803480; CNNM2 rs7914558; CSMD1 rs10503253; Erbb4 rs1851196; ITIH3/4 rs2239547; LOC645434-NMBR rs2066036; LRRFIP1 rs12052937; MIR137 rs1625579; MMP16 rs7004633; NKAPL rs1635; NRG rs12807809; NT5C2 rs11191580; PCLO rs6979348; PLXNA2 rs752016; PGBD1 rs2142731; PCGEM1 rs17662626; RELN rs7341475; SDCCAG8 rs6703335; STT3A rs548181; TCF4 rs17512836; UGT1A1 HJURP rs741160; rs10489202; rs16887244). In a case-control design, I investigated how exposure to OCs influenced the risk of psychotic disorder. Then, I tested, under a multiplicative model, the hypothesis that a range of genetic variants interacted with OCs in increasing the risk of psychotic disorder. Lastly I examined whether rats that had experienced perinatal asphyxia during birth show abnormalities in gene expression and methylation status at various developmental periods. My findings didn’t show any interaction between genes and OCs in increasing the risk of psychosis. On the other hand, in rats following hypoxic insult many of the genes had heterogeneous pattern of expression, suggesting an important role for genes in mediating the reactions of the CNS to environmental stimuli such hypoxia. In general, at post neonatal day CNNM2 was down regulated, whereas CSMD1 and TCF4 were up regulated; at 5 weeks CNNM2, CSMD1, MMP16, STT3a were down regulated, whereas TRIM26 was overexpressed. Hypoxia in the prenatal and perinatal period could regulate the expression of specific genes contributing to the neurodevelopmental alterations later found in schizophrenic patient.
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Zetterström, Karin. "Chronic hypertension and pregnancy : epidemiological aspects on maternal and perinatal complications /." Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7755.
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Ma, Xue Jie. "Perinatal complications as predictors of neuropsychological outcome in children with learning disabilities." Virtual Press, 1996. http://liblink.bsu.edu/uhtbin/catkey/1036813.
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A prospective study was conducted on a group of 160 students from 9 to 14 years of age with learning disabilities to predict neuropsychological outcome using perinatal information as predictors. Perinatal information was obtained from the Maternal Perinatal Scale (MPS) (Dean & Gray, 1985). Subjects' neuropsychological functioning was assessed by the Short Neuropsychological Screening Device (SNSD) (Reitan & Herring, 1985). Information concerning subjects' intelligence was obtained from the Wechsler Intelligence Scale for Children-III (WISC-III) administered within the past two years. Hollingshead's Four Factor Index of Social Status was employed to determine subjects' socioeconomic status. A stepwise multiple regression analysis yielded a regression model that contained a subset of 7 perinatal risk factors, involving: (1) Obstetric History; (2) Gestational Age; (3) Psychosocial Events; (4) Delivery; (5) Intrauterine Stress; (6) Teratogenic Stress; and (7) Fetal Oxygenation. A hierarchical regression analysis was further performed to examine if adding socioeconomic and intellectual information to the regression model could increase the prediction of neuropsychological outcome. Results showed that up to 82% of the variability in the neuropsychological outcome was explained by the linear composite of the 7 risk factors. When socioeconomic and intellectual information were added to the regression model, the prediction of neuropsychological outcome was significantly improved. About 201 of the students with learning disabilities in the present study were found to display symptoms similar to minimal brain damage (MBD) relating to poor visual-motor integration, underdeveloped language skills, and aphasic conditions. The results support the theory of a "continuum of reproductive casualty" proposed by Pasamanick et al. (1956). The importance of detecting early indicators of neuropsychological deficits in at risk children was further suggested by the present study.<br>Department of Educational Psychology
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Hill, S. Kristian. "Maternal perinatal events as predictors of sensory-motor functioning in normal children." Virtual Press, 1998. http://liblink.bsu.edu/uhtbin/catkey/1117100.
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The relationship between perinatal complications and sensory-motor functions was examined. Information from the Maternal Perinatal Scale (MPS) was used to predict factor scores of the Dean Sensory-Motor Battery (DSMB). Participants were 187 normal nonreferred children who were administered the DSMB while their mothers completed the MPS. Using MPS items as predictors, separate stepwise regression analyses for each DSMB factor found that 11 - 16% of variance could be accounted for in sensory-motor performance. At least three MPS items significantly contributed to the prediction of each DSMB factor. Predictors of Sensory and Simple Motor functions (DSMB Factor I) included maternal bleeding during pregnancy, delay between membrane rupture (water break) and onset of labor, and evidence of hypoxia. Evidence of hypoxia, maternal bleeding during pregnancy, and delay between water break and labor onset were predictive of Motor and Complex Sensory functions (DSMB Factor II). In addition, gender of the child joined maternal bleeding during pregnancy, amount of swelling during pregnancy, and mother's height in predicting Subcortical Motor functions (DSMB Factor III). Additional analyses using a canonical correlation confirmed the results of the regression analyses. A linear composite of sensory and motor variables was primarily defined by DSMB factors I and II. The linear composite of perinatal information was defined primarily by the same items that emerged as significant predictors of sensorymotor functions in the regression analyses. Most notably, a redundancy analysis indicated that about 20% of variance in DSMB factor scores could be accounted for by a linear composite of perinatal information. In general, sensory-motor performance decreased as severity of perinatal complications increased. Results were discussed in terms of the implications of using a normal non-referred population. More importantly, the present data suggested the possibility that 1) the relationship between perinatal complications and sensory-motor functions may exist on a continuum rather than the dichotomous diagnosis/no diagnosis, and 2) the synergistic influence of multiple perinatal complications may contribute to the manifestation of clinically significant behaviors. The role of sensory-motor functions as a foundation for more complex behaviors is also discussed.<br>Department of Educational Psychology
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Siebritz, Mark. "A comparative review of the outcomes of two different perinatal mortality classification systems at an Obstetric unit in Cape Town, South Africa." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/71772.
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Thesis (MMed)--Stellenbosch University, 2012.<br>ENGLISH ABSTRACT: Background
The annual burden of stillbirths is estimated to be more than 3 million deaths globally. Depending on the perinatal classification used, up to two thirds of deaths are reported as unknown.Gardosi, et al (2006) developed the ReCoDe system, which identified the relevant condition at the time of death in utero. The system aims to identify what went wrong in utero, without necessarily indentifying why fetal demise occurred. With comparison to the conventional Wigglesworth classification, the authors were able to reduce the number of unexplained stillbirths from 66.2% to 15.2%.
The Perinatal Problem Identification Program (PPIP) is the nationally implemented perinatal classification system in South Africa. The PPIP database recorded approximately 660 000 births from the 1st January 2006 until 31st December 2007. This reflects approximately 40% of all births in health institutions in South Africa during this time period. There were 11742 stillbirths recorded in on the PPIP database for this two year period.Unexplained stillbirths formed 24% of the total perinatal deaths. The Saving Babies Report 2006-2007 has suggested that funding andresearch resources be directed to identifying the causes of deaths in this group.
Objective:
Our primary objective was to compare the outcomes of the PPIP to the ReCoDe classification system developed by Gardosi, with special attention as to reducing the number of unexplained stillbirths.
Methods:
We conducted a retrospective descriptive study on the perinatal deaths occurring at or presenting to the Department of Obstetrics and Gynaecology at Tygerberg Hospital, Cape Town, South Africa, for the time period extending from 01 January 2008 to 31 December 2008.
A weekly Perinatal Mortality Audit meeting (PNM) is held at Tygerberg Hospital. In attendance at these meetings are General obstetricians, Fetal-maternal specialists, Neonatologists, Pathologists, a Geneticist, Obstetric and Paediatric Registrars. Relevant clinical details are summarised from clinical notes and Perinatal Losses data forms. These forms are specific to Tygerberg Hospital and completed by the attending doctor at first consultation. Placental histology and post-mortem examination would have been performed in certain cases as per the departmental protocol. All perinatal deaths, both stillborn and neonatal deaths weighing more than 499g, are discussed at this forum and consensus then reached on a primary and final cause of death. This information is then entered into the PPIP database, along with any identifiable avoidable factors.The investigators separately reviewed the information available from the Perinatal Losses and the PIPP V2.2 data capture forms and then reclassified each stillbirth according to the ReCoDe hierarchal system
Results:
We studied the data sheets of 406 stillbirths of babies of whom the deaths had been previously classified according to the PPIP classification. The median maternal age was 25.65 years (range 14 – 45) while the median birth weight was 1127 grams (range 500 – 4100).The vast majority of these stillbirths occurred in singleton pregnancies and are also classified as extremely low birth weight. The three major causes of stillbirth over the study period were antepartum haemorrhage (24.4%), hypertensive disorders (22.4%) and spontaneous preterm labour (11.1%). Within the ReCoDe classification, the leading categories were in the placental group (33.2%), fetal group (21.6%) and the maternal group (20%).
The unexplained group (PPIP IUD group), from the index study constitutes 8.1% (33 of 406) of cases, while the number of unclassified stillbirths in the primary ReCoDe classification accounted for 15% (60 of 406) of the total. The main reasons for this difference is that ReCoDe does not incorporate preterm labour as a cause, and uses customised growth charts for identifying fetal growth restriction.
Conclusion:
PPIP remains the gold standard in Perinatal Audit in South Africa.We would recommend that ReCoDe be evaluated prospectively, alongside the established PPIP system, to better compare their performance outcomes. The development of customized fetal growth potential charts relevant to the local population should be explored. The Perinatal Losses data capture form should be revised to be more comprehensive and relevant.<br>AFRIKAANSE OPSOMMING: Agtergrond
Die jaarlikse las van doodgeboortes word geskat op meer as 3 miljoen sterftes wêreldwyd. Afhangende van die perinataleklassifikasiesisteem wat gebruik word, tot twee derdes van sterftes is aangemeld as onbekend. Gardosi, et al (2006) het die ReCoDesisteemontwikkel, wat die betrokke toestand in die tyd van die dood in utero geïdentifiseer. Die sisteem het ten doel om te identifiseer wat verkeerd geloop het in utero, sonder om noodwendig te indentifiseer waarom fetaledood plaasgevind het. Invergelyking met die konvensionele Wigglesworth klassifikasie, was die skrywers in staat om die getal van die onverklaarbare dood geboortes van 66,2% tot 15,2% te verminder. Die Perinataleprobleemidentifikasie Program (PPIP) is die nasionaalgeïmplementeerperinataleklassifikasiesisteemin Suid-Afrika. Die PPIP databasis aangeteken ongeveer 660 000 geboortes van die 1ste Januarie 2006 tot 31 Desember 2007. Dit weerspieël ongeveer 40% van alle geboortes in die gesondheids-instellings in Suid-Afrika gedurende hierdie tydperk. Daar was 11.742 doodgeboortes aangeteken in op die PPIP databasis vir hierdie twee jaartydperk. Onverklaarbaredoodgeboortesvorm 24% van die totaleperinatalesterftes. Die Saving Babies Verslag 2006-2007 het voorgestel dat befondsing en navorsing gerig word aan die identifisering van die oorsake van sterftes in hierdie groep.
Doelstelling:
Ons primêre doel was om die uitkomste van die PPIP te vergelyk met die ReCoDeklassifikasiesisteem wat deur Gardosiontwikkelis , met spesiale aandag aan die vermindering van die aantal van onverklaarbaredoodgeboortes.
Metodes: Ons het'n retrospektiewebeskrywendestudie uitgevoer op die perinatalesterftes wat aangemeld het by die noodeenheid van die Departement Obstetrie en Ginekologie aanTygerberg Hospitaal, Kaapstad, Suid-Afrika, vir die tydperk wat strek vanaf 01 Januarie 2008 tot 31 Desember 2008.
'n Weeklikse Perinatale Mortaliteit Ouditvergadering (PNM) word gehou by Tygerberg Hospitaal. In die bywoning van hierdie vergaderings is Algemene Verloskundiges, Fetale-moederskant Spesialiste, Neonatoloë, Patoloë, 'n Genetikus, Obstetriese en Pediatriese Klienieseassistente. Relevante kliniese inligting is uit die kliniese notas en perinataleverliesedatavorms opgesom. Hierdie vorms is spesifiek na die Tygerberg-hospitaal en deur die dokter by die eerstekonsultasie voltooi. Plasentale histologie en post-mortem ondersoek sou voltooi gewees het in sekere gevalle soos per die departementeleprotokol. Alle perinatalesterftes, beide doodgebore en neonatalesterftes wat meer as 499g, word bespreek op hierdie forum en konsensus bereik oor 'n primêre en finale oorsaak van die dood. Hierdie inligting word dan in die PPIP databasis, saam met 'n identifiseerbare voorkombare faktore. Die navorsers afsonderlik die inligting beskikbaar van die perinataleverliese en die PIPP v2.2 datavasleggingsvorms en dan herklassifiseer elke stilgeboorte volgens die ReCoDehiërargiesestelsel.
Results: Ons bestudeer die data velle van 406 doodgeboortes van babas van wie die sterftes voorheen volgens die PPIP klassifikasie geklassifiseer is. Die mediaanmoeder se ouderdom was 25,65jaar (range 14? 45?) Terwyl die mediaangeboortegewig was 1127 gram (reeks 500? 4100). Die oorgrote meerderheid van hierdie doodgeboortes plaasgevind in Singleton swangerskappe en word ookgeklassifiseer as &'n baie lae geboortegewig. Die drie grootste oorsake van doodgeboorte oor die studietydperk was antepartum bloeding (24,4%), die hipertensiewesiektes (22,4%) en &'n voortydsekraam (11,1%). Binne die ReCoDeSistematiek, die voorstekategorieë in die plasentalegroep (33,2%), die fetalegroep (21,6%) en die moedergroep (20%).
Die onverklaarbaregroep (PPIP IUD groep), van die indeksstudie behels 8,1% (33 van 406) van gevalle, terwyl die aantal van ongeklassifiseerde doodgeboortes in die primêre ReCoDeSistematiek verantwoordelik vir 15% (60 406) van die totaal. Die belangrikste redes vir die verskil is dat ReCoDenieneemvoortydsekraam as &'n oorsaak, en gebruike aangepasgroeikaarte vir die identifisering van fetalegroeibeperking.
Gevolgtrekking: PPIP bly die gouestandaard in Perinataleoudit in Suid-Afrika. Ons sal aanbeveel dat ReCoDe vooruitwerkend geëvalueer word, saam met die gevestigde PPIP stelsel, om beter te vergelyk hulprestasieuitkomste. Die ontwikkeling van persoonlikefetalegroeipotensiaalkaarte met betrekking tot die plaaslike bevolking moet ondersoek word. Die perinataleverliese data capture vorm moet hersien word om meer omvattende en relevant te wees.
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Challis, Kenneth. "Monitoring pregnancy for improved perinatal outcome in Mozambique /." Stockholm, 2002. http://diss.kib.ki.se/2002/91-7349-406-2/.
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Spadafore, Lori. "Relationship between perinatal complications and attention deficit hyperactivity disorder and other behavioral characteristics." Virtual Press, 1997. http://liblink.bsu.edu/uhtbin/catkey/1115716.
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The present study was undertaken to determine the relationship between perinatal complications and subsequent development of Attention Deficit Hyperactivity Disorder (ADHD) and other behavioral characteristics. The biological mothers of 74 children diagnosed with ADHD and 77 children displaying no characteristics of the disorder completed the Maternal Perinatal Scale (MPS), the Behavior Assessment System for Children-Parent Rating Scales (BASC-PRS), and a demographic survey. In addition, the biological mothers of 120 children with no characteristics of ADHD or any other behavior disorders completed only the MPS so that exploratory factor analysis of the MPS could be completed.Following factor analysis, stepwise discriminant analysis of the resulting five factors was utilized to explore the nature of the relationship between such perinatal factors and ADHD. Results of this analysis indicated that emotional factors, or the amount of stress encountered during pregnancy and the degree to was planned, were the items that maximized the separation between the ADHD and Non-ADHD groups. Additional discrimination between the groups was attributed to the extent of insult or trauma to the developing fetus and the outcome of prior pregnancies. ADHD children were also found to have experienced twice as many behavioral, social, or medical problems, and were more likely to reach developmental milestones with delays.Stepwise discriminant analysis also revealed the Attention Problems and Hyperactivity scales of the BASC-PRS were most significant in differentiating between the ADHD and Non-ADHD subjects. Using the BASC-PRS resulted in approximately 90% of the total sample being correctly classified as ADHD or NonADHD. Canonical correlation analysis indicated that emotional factors and the general health of both the mother and the developing fetus were the best predictors of later behavioral patterns reported on the BASC-PRS.<br>Department of Educational Psychology
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Elliott, Catherine. "Perinatal outcome in mothers with heart disease attending the combined Obstetric and Cardiology Clinic at Groote Schuur Hospital." Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/13115.
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Includes bibliographical references.<br>ith the advances made in the management of cardiac conditions, much importance has been placed on the maternal outcome in pregnancies complicated by heart disease. However, to enable attending clinicians to provide suitable counseling and manage the pregnancy appropriately, the potential complications arising in the fetus and neonate also require attention. Adverse neonatal and perinatal outcome is more common in pregnant women with cardiac disease. Analysis of the available data pertaining to the South African population is important, as this population’s profile, like that of Africa, differs from that of industrialized countries. The relevance of maternal heart disease is highlighted by the National Committee for the Confidential Enquiries into Maternal Deaths (NCCEMD) in South Africa ( http://www.doh.gov.za/docs/reports/2012/Report_on_Confidential_Enquiries_into_ Maternal_Deaths_in_South_Africa ). Objectives To describe the perinatal outcome in women with heart disease and to determine whether there is an associated adverse outcome related to babies born to mothers with heart disease. Methods 82 patients were collected serially over 18 months. Neonatal outcome was recorded. Adverse neonatal outcome was defined as perinatal mortality, admission to NICU and the need for delivery room resuscitation. Results Perinatal mortality rate in this cohort was good, and better than the rate in the general population from whence this cohort came, but was linked to a high rate of obstetric intervention. The rate of adverse neonatal outcome is better than the rate in industrialized countries. Conclusion Perinatal outcome is good when mothers with heart disease are managed in a multidisciplinary clinic.
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Voloshynovych, N. S. "Assessment of the obstetric complications’ risk as a result of surgical treatment of ovaries in anamnesis." Thesis, БДМУ, 2022. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/19742.
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Gould, Albert William. "The role of prematurity and associated perinatal complications in the determination of academic achievement." Diss., The University of Arizona, 1991. http://hdl.handle.net/10150/185427.
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This research was conducted to obtain information to clarify the nature of the relationship between degree of prematurity and associated perinatal complications and academic achievement. Previous investigations have suggested that children born prematurely do experience academic deficits, however, significant relationships between prematurity and achievement have not consistently been reported. Advances in neonatal medical care in the past 20 years has ensured the survival of extremely fragile premature infants that previously would have perished. There has been great interest in the developmental progress of these premature survivors. In spite of this interest, questions still remain about academic progress. The present sample included 188 first grade students who were born prematurely. All students were enrolled in a prospective longitudinal follow-up program upon graduation from the neonatal intensive care nursery. Structural equation model testing (LISREL) was used to examine the structure of the relationships between the independent variables and academic achievement. Independent variables included the following; degree of prematurity, perinatal illness, socioeconomic status, ethnicity, and preschool experience. Structural equation model testing revealed that none of the eleven models tested provided a good fit for the data. Hierarchical model testing indicated that one model was preferred over the others. The model that provided the most parsimonious representation of the data specified that there was no direct relationship between degree of prematurity and achievement nor was there a direct relationship between perinatal illness and achievement. This model also included direct relationships between ethnicity, socioeconomic status, and preschool experience and achievement. This analysis revealed that within this sample of premature survivors of neonatal intensive care, neither degree of prematurity nor perinatal illness were significantly related to academic achievement. The significance of socioeconomic status has been well documented in the literature and is supported by this investigation. While preschool experience was significantly related to achievement, the relationship was not in the anticipated direction. That is, children with preschool experience had lower achievement scores than children with no preschool experience. These unexpected results were discussed in terms of the lack of sensitivity of the preschool measure.
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Paulsen, Carrie. "Incidence and nature of complications post primary repair of Obstetric Anal Sphincter Injury (OASI): Retrospective chart review." Master's thesis, Faculty of Health Sciences, 2019. https://hdl.handle.net/11427/31687.
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Background. A multitude of data exists regarding global incidence of OASI as well as its contributing factors and complications. Little to no data exists regarding the incidence of OASI or its complications and the nature of these complications within South Africa. Objective. To describe the rate and nature of complications of OASI that occur within 6 weeks following primary repair of an OASI, followed up at the GSH perineal clinic. Secondarily, to investigate the incidence of OASI and follow up rate post primary repair Methods. This was a retrospective chart review. Participants were identified from theatre record books between January 2014 and December 2015. The charts of those that attended the perineal clinic follow up were reviewed and complications and possible associated risk factors were identified from the clinical notes. Primary aims were to identify the incidence and nature of complications seen in this population as well as possible related risk factors. The secondary aims were to determine the incidence of OASI and follow up rate for complication following primary OASI repair. Results. The mean age of participants was 25.85 years with a mean body mass index of 25.15kg/m2 . The mean birthweight seen was 3382.05 grams. Constipation (10.87%), pain with defaecation (11.96%) and anal incontinence (10.87%) were the most frequently reported complications. Wound infection was found on examination in 3.26% of participants and wound dehiscence was seen in 6.67%. Incidence of OASI in this study group was 8.64 per 1000 vaginal deliveries. The follow up rate of these participants was 26.20%. A total of 374 OASI were repaired within this region during the study period. Only 97 of these attended follow up, for which 93 folders were available to be included in analysis Conclusion. The Incidence of OASI in this Western Cape region is within the range seen worldwide but the proportion of complications seem to be less than global data suggests despite adverse conditions, theatre delays and the fact that repairs were mostly performed by specialists in training. It was not possible to identify any relationship with possible associated factors. There is a very poor follow up rate within this community which needs to be explored and systems need to be put in place to ensure all participants are given the opportunity of follow up.
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Maticorena, Quevedo Diego Alejandro, and clark Javier Alejandro Okumura. "La edad materna como factor predisponente de complicaciones en el emabrazo de gestantes adolescentes y adultas. Estuido de corte transversal en el hospital María Auxiliadora, Lima, Perú." Bachelor's thesis, Universidad Peruana de Ciencias Aplicadas (UPC), 2014. http://hdl.handle.net/10757/620964.
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Objetivo: Determinar si la edad materna está asociada a un aumento o disminución de riesgo de complicaciones obstétricas y perinatales, ajustándola por diversas variables confusoras.
Métodos: Estudio de cohorte retrospectiva de 67 693 gestantes en Lima, entre enero del 2000 a diciembre del 2010, usando la base de datos del Sistema informático perinatal del Hospital Nacional María Auxiliadora. Las complicaciones fueron comparadas entre gestantes adolescentes (< 20 años) y gestantes adultas (20-35 años); el grupo adolescente se clasificó en adolescentes tardías (15-19 años) y adolescentes tempranas (< 15 años). Se obtuvieron los Odds Ratio ajustados con la regresión logística simple y múltiple.
Resultados: Al ajustar las diversas variables, se encontró mayor riesgo de cesárea e infección puerperal en las adolescentes menores de 15 años, así como mayor riesgo de episiotomía en el grupo total de adolescentes. Asimismo, se identificó un menor riesgo del embarazo adolescente para preeclampsia, hemorragia de la 2da mitad del embarazo, ruptura prematura de membranas, amenaza de parto pretérmino y desgarro vaginal.
Conclusiones: Se encontró al embarazo adolescente como factor de riesgo para complicaciones obstétricas. Por lo tanto, se recomienda un control prenatal multidisciplinario para éste grupo etario.<br>Objective: To determine whether maternal age is associated with increased or decreased risk of obstetric and perinatal outcomes, adjusting by several factors.
Metods: Retrospective cohort study of 67 693 pregnant women in Lima, from January 2000 to December 2010, using the perinatal database computer system from the Hospital Nacional María Auxiliadora. Outcomes were compared among pregnant adolescents (< 20 years) and adults (20-35 years); in addition, the adolescent group was divided in late adolescents (15-20 years), and early adolescents (<15 years). Adjusted odds ratios were obtained through logistic regression analysis.
Results: Adjusting by several factors, an increased risk of cesarean and puerperal infection in adolescents less than 15 years was found, as well as an increased risk of episiotomy in the total group of adolescents. In addition, this study identified a lower risk of preeclampsia, 2nd half-pregnancy bleeding, premature rupture of membranes, preterm labor and vaginal tearing among adolescent mothers.
Conclusion: Teenage pregnancy was found as a risk factor for adverse obstetric outcomes; hence, a multidisciplinary prenatal care for this group of adolescent is recommended.
Key Word: Adolescent pregnancy, obstetric outcomes, perinatal outcomes
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Caldwell, Christina Hubbert. "Perinatal risk indicators and developmental abilities : examining children with phonological disorders." Virtual Press, 1994. http://liblink.bsu.edu/uhtbin/catkey/902505.
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The purposes of this study were to determine which perinatal risk variables arecorrelated with phonological disorders and to determine how preschoolers' developmental functioning is related to phonological impairment. Subjects were 101 low SES boys (n=46) and girls (n=55) randomly selected from a county Head Start program in north-central Indiana. The mean age of the preschoolers was 65 months. Information about perinatal risks and developmental abilities was obtained from mothers or primary caregivers. Using the Maternal Perinatal Scale (Dean, 1985) and the Bankson Bernthal Test of Phonology (Bankson & Bernthal, 1990), it was found that three moderate inverse correlations existed between perinatal risk items and phonological scores (mothers' weight before pregnancy, the number of pregnancies prior to the birth of the child that resulted in death, and the number of medical conditions experienced by mothers before or during pregnancy). Hierarchical multiple regressions indicated that developmental scales of the Minnesota Preschool Inventory (Ireton & Thwing, 1979) significantly accounted for phonological ability in these children, with the scales of Letter Recognition, Self-Help, Expressive Language, and Fine Motor contributing the most unique variance. Implications of these findings are discussed relative to the developmental apraxia of speech debate.<br>Department of Educational Psychology
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Mittendorfer, Rutz Ellenor. "Perinatal and familial risk factors of youth suicidal behaviour /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-476-7/.
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Lougue, Siaka. "Methodological approach of the spatial distribution of maternal mortality in Burkina Faso and explanatory factors associated." University of the Western Cape, 2013. http://hdl.handle.net/11394/4368.
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Philosophiae Doctor - PhD<br>Maternal mortality is one of the most important problems related to the reproductive health. This is why the reduction by three quarters of maternal mortality by 2015 has been fixed as target No. 5 of the Millennium Development Goals (MDGs). Achieving this goal requires an annual decline of 5.5% of maternal mortality between 1990 and 2015. Unfortunately, the reduction as estimated in 1997 was less than 1% per year. Africa is the continent most affected by this problem. In 2010, the number of maternal mortality in the world was estimated to 287 000 and Africa was hosting more than 52 % (148 000) of the occurrence in the world In Burkina Faso, maternal mortality ratio decreased from 566 in 1991 to 484 in 1998 and 341 in 2010 according to the DHS data while the census estimate was 307 in 2006 and United Nation agencies provided the number of 300 maternal deaths per 100 000 live births in 2010. Statistics provided by the different sources vary considerably. This situation creates confusion among data users. In addition,
researches made on the issue remain very insufficient because of the complexity of the issue, lack of data and poor quality of existing data on maternal mortality. This study has been initiated to fill the gap of knowledge about the determinants and estimates of maternal mortality at national and sub-national levels. Results of this research highlighted explanatory factors of maternal mortality at national and regional level with a focus on factors of regional disparities. Findings also provided estimate by adjusting the census 2006 data from missingness and incoherences, improving the census method and testing different other methods. Finally, projection of maternal mortality level is made from 2006 to 2050.
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Dutra, Maria Virgínia Peixoto. "Avaliação da qualidade da assistência perinatal : um exercício." Universidade do Estado do Rio de Janeiro, 1993. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=6477.
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A relação da qualidade da prática médica assistencial com os indicadores de saúde tem sido objeto de controvérsia. A possibilidade de avaliar o estado de saúde do recém-nascido em função do cuidado recebido, facilita o estudo desta relação, principalmente na área perinatal onde a expectativa é o nascimento de um bebê saudável ao final de uma gestação sem fatores de riscos acompanhados segundo as normas obstétricas vigentes. Neste estudo, examina-se a adequação do acompanhamento do trabalho de parto em uma maternidade pública do Estado do Rio de Janeiro, sob a ótica de avaliação de qualidade pela abordagem de processos e resultados através de critérios explícitos supondo que os fatores selecionados como componentes do processo de assistência ao trabalho de parto determinariam o resultado. Observa-se tais relações através da metodologia epidemiológica optando por um estudo caso-referente ou um estudo caso-controle, com definição primária da base. Selecionou-se como determinantes da qualidade da prática obstétrica intraparto a duração do trabalho de parto, percepção de alterações durante o trabalho de parto, prontidão para intervenção, número de exames realizados e intervalo entre o último exame e hora do parto. O resultado neonatal adverso caracterizou-se por óbito intra-útero, óbito neonatal e presença de um conjunto de sinais clínicos anormais no período neonatal imediato, com alto valor preditivo para o futuro dano neurológico. O risco de um resultado adverso foi estimado pela razão dos produtos cruzados aodds ratio (OR) numa população de 34 casos e 124 controles. A duração do trabalho de parto maior que doze horas esteve associada a um OR igual a 3,48 (1,28-9,43), idade da gestante, dilatação cervical do colo uterino à admissão e peso ao nascer modificaram o efeito desta associação, que também foi confundida pela paridade e pelo uso da ocitocina contrariando hipótese inicial. A percepção de alterações resultou num OR= 14,73 (4.24-54,27) e, à medida que o tempo de intervenção se prolongava os riscos aumentavam obedecendo a uma tendência linear. Discutem-se as dificuldades de aplicação metodologia epidemiológica ao campo da avaliação da qualidade, essencialmente no que se refere as exigências quantitativas, para garantir precisão e confiabilidade. A observação da interação e o controle do confundimento apontam o cuidado necessário nos trabalhos desta natureza para alcançar consistência e validade.<br>The connection between the quality of health care practice and its outcomes has been a controversial matter in many different fields. Chiefly in the perinatal area, where at the end of a pregnancy without risk factors being monitored in accordance with valid obstetric standards, the birth of healthy babies is expected. The objective of this study has been to assess the relationship among the quality of obstetrical care in pregnancies free of risk factors during the intrapartum death, neonatal death and evidences of adverse clinical signs at an early neonatal period, with high predictive values for later neurological disability such as seizures and other signs of asphyxia constitute the neonatal adverse outcomes. The quality of obstetrical practice during the intrapartum period was gauged by the duration of labour, the observation of abnormalities during labour, the time elapsed between observation and intervention, the number of examinations performed and the time between the last obstetric visit and labour. Concerned with perinatal care in public maternities in the State of Rio de Janeiro, this study presumed that under the quality assessment view the selected factors, as components of the process of labour care, should be associated with their
outcomes. This study was aimed at developing such comprehension, through epidemiological methodology, adopting a case referent or a case-control study with
primary definition of the base where the above mentioned factors were determinant of neonatal adverse outcome occurrence and the odds ratio (OR) was the parameter
of interest. A labour duration which exceeded 12 hours has been associated to a crude OR of 3.48 (CI: 1.28-9.43) for neonatal adverse outcome. The mothers age, the degree of cervical dilation admission and the birth weight modified the effect of such association which was expressed by an OR of 14.73 (CI; 4.23-54.27). As the time of intervention grew larger, the risk increased, following a linear tendency. Some studied factors could supply indicators for further investigations of the relationship between the quality of intrapartum care and neonatal adverse outcomes.
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Karanika, Vassiliki Lekea. "Greek national perinatal survey : the associations between socioeconomic characteristics of the family, maternal obstetric history, antenatal care features and pregnancy outcome." Thesis, University of Bristol, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.385731.
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Mathai, Elizabeth. "Genital and urinary tract infections in pregnancy in southern India : diagnosis, management and impact on perinatal outcome /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7140-129-6/.
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Hall, Heather Lynne. "Early teller acuity card estimates as predictors of long-term visual outcome in children with perinatal complications." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp01/MQ55507.pdf.
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Gondo, Danielle Cristina Alves Feitosa [UNESP]. "Resultado perinatal de gestantes submetidos à busca ativa de infecção genital." Universidade Estadual Paulista (UNESP), 2014. http://hdl.handle.net/11449/123285.
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000816181.pdf: 1313890 bytes, checksum: 785f61dc5b28f498e5dd5476b29eaed5 (MD5)<br>O objetivo geral deste estudo foi analisar o resultado perinatal de gestantes submetidas a busca ativa de infecção genital inferior. Para alcance deste objetivo foram realizados três subprojetos, apresentados em capítulos. Capítulo I- Infecção do trato genital inferior e repercussões perinatais: revisão integrativa da literatura, teve por objetivo identificar, na produção científica dos últimos 10 anos, evidências sobre as condições dos neonatos ao nascimento, quando a mãe apresentou infecção do trato genital inferior na gravidez. Os resultados foram variados, sendo que os estudos apontaram associação de determinado tipo de infecção a alguns desfechos e não a outros. A associação mais frequentemente buscada foi entre vaginose bacteriana e prematuridade, tendo sido apontada associação em seis estudos e ausência em três. Capítulo II - Resultado perinatal de gestantes submetidas à busca ativa de infecção do trato genital inferior: estudo observacional e analítico, teve por objetivo analisar o resultado perinatal de gestantes de baixo risco submetidas à busca ativa de infecção genital. Observou-se que a chance do índice de Apgar de primeiro minuto ser inferior a sete pontos foi significativamente menor entre as gestantes que passaram pela busca ativa e esse grupo teve recém-nascidos com peso ao nascer em média 350 gramas maior. Capítulo III: Resultado perinatal de mulheres com história de trabalho de parto prematuro e submetidas à busca ativa de infecção do trato genital inferior, objetivou comparar a frequência de prematuridade e de índice de Apgar de primeiro minuto de vida inferior a sete em gestantes submetidas ou não a busca ativa de infecções do trato genital inferior e tratamento etiológico. Estudo controlado, não randomizado, não encontrou relação significativa entre busca ativa e menores taxas de prematuridade e melhores índices de Apgar. Conclui-se que, pela relevância do tema para ...<br>This paper aimed at evaluate perinatal results of pregnant women who were submitted to an active search of inferior genital infection. Three sub-projects were developed in chapters in order to reach this objective. Chapter 1 - Infection of the lower genital tract and perinatal outcomes: a literature review. The purpose was to identify in 10 years scientific production, evidences of neonatal conditions at birth when the mother presented genital tract infection during pregnancy. The results differed. The studies showed an association of certain types of infection in some outcomes and not in others. The most frequently searched association was among bacterial vaginitis and prematurity, present in six cases and absent in three of them. Chapter II - Perinatal outcome of pregnant women submitted to an active search of the lower genital tract infection; observational and analytical study. The purpose was to evaluate the perinatal result of low risk pregnant women submitted to an active search of genital infection. In this case, the chance of first minute Agpar score to be less than 7 points was significantly smaller among pregnant women who underwent an active search. Newborns in this group weighed 350 grams more. Chapter III - Perinatal results of women who experienced premature labor and were submitted to an active search of inferior genital tract infection. The purpose was to compare prematurity frequency and first minute Apgar score, inferior to seven, in pregnant women submitted or not to an active search of the inferior genital tract and etiological treatment. The study was controlled and non randomized. A significative relationship between an active search and lower prematurity indexes and better Agpar scores was found. The study leads to the conclusion that considering the relevance of the subject for public health, the results should be seen as a first approach. Further investigations on special controlled studies with larger ...
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Pacagnella, Rodolfo de Carvalho 1974. "Morbidade materna grave : explorando o papel das demoras no cuidado obstétrico." [s.n.], 2011. http://repositorio.unicamp.br/jspui/handle/REPOSIP/310052.
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Orientador: José Guilherme Cecatti<br>Tese ( doutorado ) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas<br>Made available in DSpace on 2018-11-09T15:32:48Z (GMT). No. of bitstreams: 1
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Previous issue date: 2011<br>Resumo: Introdução: Embora a maioria das causas das mortes maternas seja evitável, não podem ser previstas, mesmo nos melhores contextos, mesmo onde haja pré-natal adequado, educação adequada e bom suporte nutricional. Contudo, embora as complicações no parto e puerpério não sejam previsíveis e nem preveníveis, os indicadores de mortalidade materna são extremamente sensíveis à instituição de cuidados obstétricos adequados e o tempo na obtenção de cuidados adequados é o fator mais importante relacionado às mortes maternas. A partir dessa observação um modelo "three delays" que avalia as demoras na assistência obstétrica tem sido amplamente utilizado como referencial teórico para a pesquisa sobre mortalidade materna. Seu uso tem sido intensificado a partir da utilização do conceito de near-miss materno, uma alternativa à mortalidade materna. Objetivos: Avaliar a associação entre demoras na obtenção de cuidados obstétricos adequados e diferentes desfechos maternos segundo o modelo "three delays". Método: foi realizada ampla revisão bibliográfica e elaboração de um ensaio abordando o marco conceitual sobre o tema e um estudo de corte transversal multicêntrico para vigilância prospectiva e coleta de dados para a identificação dos casos com morbidade materna grave (MMG) e condições potencialmente ameaçadoras da vida (CPAV) segundo critérios previamente definidos pela OMS. Dados sobre as demora foram colhidos dos prontuários médicos e por informações com a equipe assistente. Resultados: Os dados da literatura permitiram inferir que o uso da análise de demoras na assistência obstétrica com o modelo "three delays" pode ser extremamente útil na avaliação dos determinantes da mortalidade materna, especialmente se associada à investigação do near-miss materno. Os dados obtidos no estudo transversal permitiram a comparação entre diferentes desfechos maternos e com isso observou-se uma associação crescente entre a identificação de alguma demora no atendimento obstétrico e desfechos maternos adversos extremos (near-miss materno e óbito). Observou-se 54% de demoras em geral, 52% de demoras nas mulheres apenas com condições potencialmente ameaçadoras da vida, 68,4% no grupo de near-miss materno e 84,1% no grupo de com óbito materno. Conclusão: O modelo "Three delays" é um importante referencial teórico para o estudo dos casos de near-miss materno. A freqüência de demoras na assistência obstétrica está diretamente relacionada ao pior desfecho materno<br>Abstract: Introduction: Although the majority of causes of maternal deaths are preventable they cannot be predicted, even in the best settings, where there is adequate antenatal care, education and good nutritional support. However, maternal mortality indicators are extremely sensitive to the adequate obstetric care and time in getting appropriate care is the most important factor related to maternal deaths. Considering this, the "three delays model", which evaluates the delays in obstetric care, has been widely used as a theoretical framework for research on maternal mortality. Its use has been intensified since the use of the concept of maternal near-miss, a proxy of maternal mortality. Objectives: To evaluate the association between delays in obtaining adequate obstetric care and different maternal outcomes according to the "three delays model". Methods: We performed an extensive literature review and preparation of an essay addressing the conceptual framework on the issue and a multicenter cross-sectional study for prospective surveillance and data collection of cases with maternal near-miss (MNM) and potentially life threatening conditions (PLTC) according to previously defined criteria by WHO. Data on delay were collected from medical records and interviews with the staff. Results: The literature data allowed inferring that the use of the analysis of delays in obstetric care using the "three delays model" can be extremely useful in assessing the determinants of maternal mortality, especially if associated with the investigation of maternal near-miss. The data provided by the crosssectional study allowed comparison between different maternal outcomes and it was observed that there was a growing association between the identification of some delay in obstetric care and extreme maternal adverse outcomes (nearmiss and maternal death). In general, there was a frequency of 54% delays, 52% of delays in women only with potentially life-threatening conditions, 68.4% in the maternal near-miss group and 84.1% in the group with maternal death. Conclusion: The "Three Delays model" is an important theoretical framework for the study of near-miss cases. The frequency of delays in obstetric care is directly related to worse maternal outcome<br>Doutorado<br>Saúde Materna e Perinatal<br>Doutor em Ciências da Saúde
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Gondo, Danielle Cristina Alves Feitosa. "Resultado perinatal de gestantes submetidos à busca ativa de infecção genital /." Botucatu, 2014. http://hdl.handle.net/11449/123285.
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Orientador: Cristina Maria Garcia de Lima Parada<br>Coorientador: Márcia Guimarães da Silva<br>Banca: Maria Antonieta de Barros Leite Carvalhaes<br>Banca: Marli Terezinha Cassamassimo Duarte<br>Banca: Sandra Marisa Pelloso<br>Banca: Flávia Gomes-Sponhoz<br>Resumo: O objetivo geral deste estudo foi analisar o resultado perinatal de gestantes submetidas a busca ativa de infecção genital inferior. Para alcance deste objetivo foram realizados três subprojetos, apresentados em capítulos. Capítulo I- Infecção do trato genital inferior e repercussões perinatais: revisão integrativa da literatura, teve por objetivo identificar, na produção científica dos últimos 10 anos, evidências sobre as condições dos neonatos ao nascimento, quando a mãe apresentou infecção do trato genital inferior na gravidez. Os resultados foram variados, sendo que os estudos apontaram associação de determinado tipo de infecção a alguns desfechos e não a outros. A associação mais frequentemente buscada foi entre vaginose bacteriana e prematuridade, tendo sido apontada associação em seis estudos e ausência em três. Capítulo II - Resultado perinatal de gestantes submetidas à busca ativa de infecção do trato genital inferior: estudo observacional e analítico, teve por objetivo analisar o resultado perinatal de gestantes de baixo risco submetidas à busca ativa de infecção genital. Observou-se que a chance do índice de Apgar de primeiro minuto ser inferior a sete pontos foi significativamente menor entre as gestantes que passaram pela busca ativa e esse grupo teve recém-nascidos com peso ao nascer em média 350 gramas maior. Capítulo III: Resultado perinatal de mulheres com história de trabalho de parto prematuro e submetidas à busca ativa de infecção do trato genital inferior, objetivou comparar a frequência de prematuridade e de índice de Apgar de primeiro minuto de vida inferior a sete em gestantes submetidas ou não a busca ativa de infecções do trato genital inferior e tratamento etiológico. Estudo controlado, não randomizado, não encontrou relação significativa entre busca ativa e menores taxas de prematuridade e melhores índices de Apgar. Conclui-se que, pela relevância do tema para ...<br>Abstract: This paper aimed at evaluate perinatal results of pregnant women who were submitted to an active search of inferior genital infection. Three sub-projects were developed in chapters in order to reach this objective. Chapter 1 - Infection of the lower genital tract and perinatal outcomes: a literature review. The purpose was to identify in 10 years scientific production, evidences of neonatal conditions at birth when the mother presented genital tract infection during pregnancy. The results differed. The studies showed an association of certain types of infection in some outcomes and not in others. The most frequently searched association was among bacterial vaginitis and prematurity, present in six cases and absent in three of them. Chapter II - Perinatal outcome of pregnant women submitted to an active search of the lower genital tract infection; observational and analytical study. The purpose was to evaluate the perinatal result of low risk pregnant women submitted to an active search of genital infection. In this case, the chance of first minute Agpar score to be less than 7 points was significantly smaller among pregnant women who underwent an active search. Newborns in this group weighed 350 grams more. Chapter III - Perinatal results of women who experienced premature labor and were submitted to an active search of inferior genital tract infection. The purpose was to compare prematurity frequency and first minute Apgar score, inferior to seven, in pregnant women submitted or not to an active search of the inferior genital tract and etiological treatment. The study was controlled and non randomized. A significative relationship between an active search and lower prematurity indexes and better Agpar scores was found. The study leads to the conclusion that considering the relevance of the subject for public health, the results should be seen as a first approach. Further investigations on special controlled studies with larger ...<br>Doutor
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Varol, Nesrin. "Towards the abandonment of female genital mutilation – healthcare provision in Australia within the framework of global collaboration on health system response, prevention, and prosecution." Thesis, The University of Sydney, 2016. http://hdl.handle.net/2123/16402.
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Female genital mutilation (FGM) refers to all procedures involving removing parts or all of the external female genitalia for non-medical reasons. As a result of migration and asylum seeking from conflict and wars, FGM has become a transnational issue, affecting more than 200 million girls and women worldwide. It is a form of gender-based violence, a health and policy issue, and violates many human rights laws. FGM has serious physical, psychological, sexual, and reproductive consequences to girls and women. As FGM has a complex socio-cultural imperative, an understanding of the driving forces of this harmful practice is key to helping communities abandon it and to providing education to all stakeholders involved from the level of the community, to healthcare professionals, teachers, civil rights, law and policy makers, migration and law enforcement organisations. FGM is on the decline, and many communities do want it to end. Addressing the human rights priorities of communities and providing them power over their own development processes are key to helping them abandon this practice. In this thesis, I address two questions. The first one is, “How do we strengthen the response of the healthcare system in Australia to best care for women and girls with FGM?” The second one is, “Focusing on the socio-cultural imperatives of FGM, how could we change our path in the global abandonment program to help communities stop this harmful practice?” My review of the literature on this topic has shown that two of the main reasons that FGM continues to be practised are pressure of social obligation in communities and lack of discourse in the public arena between men and women. In the first systematic review conducted on the topic I have highlighted the ambiguity of men’s wishes in regards to the continuation of FGM. In general, men wished to abandon it because of the physical and psychosexual complications to both women and men. Education of men was found to be the most important indicator for men’s support for abandonment. Australia is home to many women and girls from countries where FGM is practised. My thesis shows that two to three percent of women, who gave birth in a metropolitan Australian hospital, had FGM. This is the first available data on prevalence of women with FGM in Australia. My analysis also showed that women who received specialised FGM care had similar obstetric and neonatal outcomes to women without FGM. An extension of such services would further alleviate the burden among affected women and reduce healthcare costs for the Government. Accurate data collection on prevalence and complications of FGM is needed in Australia to appropriately allocate funding and develop such services. The literature and my thesis provide evidence that healthcare professionals (HCP) in countries of prevalence and those of migration, including Australia, lack knowledge on and training in the management of women with FGM. Midwives expressed a lack of confidence in clinical knowledge, skills, and data collection, as well as cultural competence in caring for women with FGM. Doctors acknowledged barriers to effective care stemming from uncoordinated care, unclear professional responsibilities, and communication difficulties. There is a need for improved education and training, supportive supervision, and evidence-based best-practice clinical guidelines and policies to address knowledge gaps and provide better management of and prevention of FGM in children. Informed by the research presented in this thesis, I developed an e-learning module for HCP in Australia to improve their knowledge on the medical, cultural, legal, and advocacy aspects. The Australian Government has addressed violence against women as an important area of focus and has been implementing a 12-year National Plan to reduce violence against women and their children 2010 – 2022. In the final paper in this thesis I propose that HCP, teachers, welfare officers, child protection officers, and government and non-government organisations involved in prevention programs on FGM, need to form a network of experts within this national framework to develop, implement and evaluate national policy and guidelines on healthcare provision, protection of girls, and prevention of FGM. The abandonment process may be accelerated through a global collaboration between governments and organisations involved in FGM programs. I have been involved in the establishment of the Africa Centre for the abandonment of FGM (ACCAF) in Kenya in 2012. A similar centre is planned in the Asia Pacific region in a country of FGM prevalence, which would collaborate with ACCAF and its partners to share research and expertise. It is my hope that the research presented in this thesis will support the work of these centres and hasten the abandonment of FGM.
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Maia, Carolina Bastos. "Predição do resultado perinatal em gestações trigemelares." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/5/5139/tde-26082014-114541/.
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O presente estudo tem como objetivo descrever a mortalidade perinatal em gestações trigemelares, e analisar os fatores preditores dos seguintes desfechos: número de crianças vivas no momento da alta hospitalar, nenhuma criança viva no momento da alta hospitalar (desfavorável) e pelo menos uma criança viva no momento da alta hospitalar (favorável). Realizado de forma retrospectiva, envolveu pacientes com gestações trigemelares que apresentavam três fetos vivos na primeira ultrassonografia realizada após 11 semanas, no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), no período de 1998 a 2012. Foram incluídas 67 pacientes das quais 77,6% referiam concepção espontânea. Quanto à corionicidade, 49,2% eram tricoriônicas e 50,8% eram não tricoriônicas; 16,4% apresentavam antecedente clínico prévio à gestação e 49,2% eram nulíparas. Em relação às intercorrências, a incidência de complicações obstétricas e/ou clínicas na gestação foi de 52,2%, e de intercorrências fetais, 25,2%, dentre as quais: 13,4% mal formações, 7,5% sindrome da transfusão feto fetal (STFF), 5,9% óbito fetal (OF), 4,5% insuficiência placentária, 4,4% fetos unidos, 1,5% feto acárdico. A idade gestacional média do parto foi de 31,9 ± 3,1 semanas, dos quais 83,5% foram cesáreas. O peso médio dos recém-nascidos vivos de 1.683 ± 508 g. Em relação à discordância de peso ao nascer: 57% apresentaram até 20%, 23,2% entre 20 e 30% e 19,6% acima de 30%. A taxa de óbitos fetais foi de 31,7%o nascimentos (IC95%: 11,7 - 67,8) e a mortalidade perinatal 249%o nascimentos (IC95%: 189 - 317). O tempo médio de internação dos recém-nascidos, que foram de alta vivos, foi de 29,3 ± 24,7 dias. A predição dos desfechos foi investigada por meio de regressão logística \"stepwise\", e incluiu as seguintes variáveis: idade materna, paridade (nulípara ou um ou mais partos anteriores), antecedente clínico, idade gestacional do primeiro ultrassonografia no HCFMUSP, corionicidade (gestações tricoriônicas e gestações não tricoriônicas), presença de complicação obstétrica ou clínica durante a gestação, intercorrência fetal e idade gestacional do parto. O nível de significância estatística utilizado foi de 0,005. Foram fatores significativos para predição do número de crianças vivas no momento da alta hospitalar: presença de intercorrência fetal (OR 0,1, IC95%: 0,03 - 0,36; p < 0,001) e idade gestacional do parto (OR 1,55, IC95%: 1,31-1,85; p < 0,001). Para a predição dos desfechos favoráveis e desfavoráveis a idade gestacional do parto apresentou significância estatística (OR 1,84, IC95%: 1.26 - 2.7; p=0,002 e OR 0.54, IC 95%: 0.37-0.79; p=0.002, respectivamente)<br>The present study, involving triplet pregnancies, describes perinatal mortality and investigates predictors of the following outcomes: number of children alive, no child alive (unfavorable outcome) and at least one child alive (favorable outcome) at hospital discharge. It is a retrospective study involving triplet pregnancies with live fetuses at the first ultrasound scan, performed after 11 weeks of gestation, at the Department of Obstetrics and Gynecology, São Paulo University Medical School Hospital, between 1998 and 2012. Final sample included 67 women, 77.6% reported spontaneous conception. Regarding the chorionicity, 49.2% were trichorionic; 16.4% had a medical complication prior to pregnancy, and 49.2% were nulliparous. The incidence of obstetric and/or clinical complications during pregnancy was 52.2%, and fetal complications occurred in 25.2%, (13.4% of major fetal abnormalities, 7.5% twin-to-twin transfusion syndrome, 5.9% stillbirth, 4.5% placental insufficiency, 4.4% conjoined twins and 1.5% acardic twin). The average gestational age at delivery was 31.9 ± 3.1 weeks, and 83.5% were cesarean. The average birthweight was 1683 ± 508 g and birth weight discordance up to 20% occurred in 57% of the cases; 23,2% had 20 to 30% discordance and 19.6%, was greater than 30%. The rate of stillbirth was 31.7%o births (95%CI: 11.7 - 67.8) and the perinatal mortality was 249%o births (95%CI: 189 - 317). The average hospital stay was 29.3 ± 24.7 days amongst children that were discharged alive. Stepwise logistic regression analysis was used to investigate prediction according to: maternal age, parity (nuliparous/multiparous), prior clinical history, gestational age at the first ultrasound scan at HCFMUSP, pregnancy chorionicity (trichorionic/non trichorionic), occurrence of clinical and/or obstetric complications during pregnancy, occurrence of fetal complications and gestational age at delivery. Significance level was set at 0.05. The number of children alive at hospital discharge was correlated with the occurrence of fetal complications (OR 0,1, 95%IC: 0,03 - 0,36; p < 0,001) and gestational age at delivery (OR 1,55, IC95%: 1,31-1,85; p < 0,001). Whereas favorable and unfavorable outcome were associated with gestational age at delivery (OR 1.84, 95%CI: 1.26 - 2.7-; p=0,002 and OR 0.54, 95%CI: 0.37-0.79; p=0.002, respectively)
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Baptista, Fernanda Spadotto. "Associação da presença de trombofilias com resultados maternos e fetais em pacientes com formas graves de pré-eclâmpsia." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/5/5139/tde-04012018-082306/.
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OBJETIVO: Avaliar se as trombofilias pioram os desfechos maternos e fetais entre pacientes com formas graves de pré-eclâmpsia (PE). MÉTODO: De outubro/2009 a outubro/2014, foi realizada uma coorte retrospectiva de gestantes com PE grave diagnosticada antes de 34 semanas e seus recém-nascidos (RNs), internados no Hospital das Clínicas da FMUSP. Foram incluídas pacientes que tinham ausência de cardiopatias, nefropatias, diabetes pré-gestacional, moléstia trofoblástica gestacional, malformação fetal, gemelidade e que realizaram pesquisa de trombofilias no período pós-natal. Foram excluídas gestações subsequentes de uma mesma paciente no período de estudo, confirmação de alteração morfológica, genética ou cromossômica fetal, após o nascimento, e ainda as que realizaram uso de heparina ou ácido acetil salicílico durante a gestação. Foram pesquisados: fator V de Leiden, a mutação G20210A da protrombina, antitrombina, proteína C, proteína S, homocisteína, anticoagulante lúpico e anticorpos anticardiolipina IgG e IgM. Compararam-se os grupos com e sem trombofilia em relação a parâmetros clínicos e laboratoriais maternos e desfechos perinatais. Esta pesquisa foi aprovada pela Comissão de Ética para Análise de Projetos de Pesquisa da FMUSP. RESULTADOS: Entre as 127 pacientes selecionadas, 30 (23,6%) apresentaram diagnóstico de pelo menos uma trombofilia, hereditária ou adquirida. Entre as pacientes com trombofilia, tivemos mais pacientes da raça branca (p= 0,036). A análise de parâmetros maternos mostrou uma tendência das trombofílicas terem mais plaquetopenia (p=0,056) e evidenciou piora de parâmetros laboratoriais quando analisados em conjunto (aspartato aminotransferase >= 70 mg/dL, alanina aminotransferase>=70 mg/dL, plaquetas < 100.000/mm3, creatinina sérica >= 1,1 mg/dL); p=0,017. Não houve diferença quanto aos achados perinatais fetais. CONCLUSÃO: A presença de trombofilia associa-se à piora em parâmetros laboratoriais maternos, em pacientes com formas graves de PE, sem, contudo, piorar os desfechos perinatais, ao menos na amostra estudada<br>OBJECTIVE: To evaluate whether thrombophilia worsens maternal and foetal outcomes among patients with severe preeclampsia (PE). METHOD: From October 2009 to October 2014, a retrospective cohort study was performed on pregnant women with severe PE diagnosed before 34 weeks of gestation and their newborns hospitalized at the Clinics Hospital, FMUSP. Patients who had no heart disease, nephropathies, pre-gestational diabetes, gestational trophoblastic disease, foetal malformation, or twin pregnancy and who underwent thrombophilia screening during the postnatal period were included. Subsequent pregnancies of the same patient during the study period; cases of foetal morphological, genetic, or chromosomal abnormalities after birth; and women who used heparin or acetylsalicylic acid during pregnancy were excluded. Factor V Leiden, G20210A prothrombin mutation, antithrombin, protein C, protein S, homocysteine, lupus anticoagulant, and anticardiolipin IgG and IgM antibodies were analysed. The groups with and without thrombophilia were compared regarding their maternal clinical and laboratory parameters and perinatal outcomes. This research was approved by the Ethics Committee for the Analysis of Research Projects of FMUSP. RESULTS: Of the 127 patients selected, 30 (23.6%) had a diagnosis of at least one thrombophilia, either hereditary or acquired. Among the patients with thrombophilia, we observed more white patients (p = 0.036). Analysis of maternal parameters showed a tendency of thrombophilic women to have more thrombocytopenia (p = 0.056) and showed worsening of laboratory parameters when analysed jointly (aspartate aminotransferase >= 70 mg/dL, alanine aminotransferase >= 70 mg/dL, platelets < 100,000/mm3, serum creatinine >= 1.1 mg/dL; p = 0.017). There were no differences in foetal perinatal findings. CONCLUSION: The presence of thrombophilia is associated with worsening of maternal laboratory parameters in patients with severe forms of PE but not with the worsening of perinatal outcomes, at least in the sample studied
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Byrskog, Ulrica, Eva Eriksson, and Annica Sundell. "Kvinnlig Könsstympning : Litteraturstudie om praktisk handläggning och komplikationsrisker vid förlossning." Thesis, Högskolan Dalarna, Omvårdnad, 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:du-1636.
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Today around 28 000 women originally from countries where FGM is practised, are living in Sweden. Many of them are at childbearing age which means that knowledge about FGM and its consequences is of outmost importance during delivery. The aim of this study is to describe current research on how to manage the delivery, regarding deinfibulation and the following stitching as well as the risk of complications when the labouring woman is mutilated. This review of literature is based on 12 scientific articles published between years 1989 – 2005. Five different databases have been searched with use of a large number of keywords.The review found that no scientific research has been carried out that describes how deinfibulation and following stitching should be managed when the woman is mutilated. All available articles within this area are referring to best practice only. The review also found that the conclusions of the studies are contradictory. The majority, however, show an increased frequency for prolonged labour that could be related to FGM. The three largest studies also show an increased rate of caesarean section among mutilated women. In the few studies that examine haemorrhage, the majorities show an increased tendency to bleed, that could be related to FGM. Several articles emphasize the importance of good routines for deinfibulation to reduce the risk for complications.In summary it can be established that due to methodological problems in many studies, no reliable conclusion can be made that the researched complications exists to a greater extent when the woman is mutilated
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Grälls, Jenny. "Sätesförlossningar : Handläggning och utfall hos mödrar och barn vid vaginal förlossning och kejsarsnitt." Thesis, Uppsala universitet, Institutionen för kvinnors och barns hälsa, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-200521.
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Background: The incidence of caesarean section for breech presentation has reached approximately 90 % in Sweden. In many of these cases, by means of specific selection criteria, it would be as safe to plan for vaginal breech delivery. Aim: The objective of this study was to investigate differences in management and to compare maternal and fetal outcomes according to delivery mode of breech presentation; vaginal vs. caesarian section. The study included breech presentation in full term singleton pregnancies at the UppsalaUniversityHospital, Uppsala, Sweden (UAS). Method: The study was based on medical record data with a retrospective, descriptive, comparative design with quantitative approach. The method for data collection was a manual review of patient records using a structured questionnaire. Results: Of the women with children in breech presentation during the period studied, 11 % gave birth vaginally. Mother's wish was the most common cause of caesarean section. The group with caesarean section included more first-time mothers, longer length of stay at the hospital, increased bleeding and need for pain medication, separation from the child, later lactation and earlier introduction of formula. Vaginally delivered mothers had increased incidence of straight urine catheterization postpartum and of infants with lower Apgar scores. Conclusion: This study does not support the suggestion that it would be safer to give birth by caesarean section for breech presentation in cases where the woman at full term meets strict selection criteria. Instead of applying medical criteria, the decision regarding mode of delivery was more often left up to the mother.
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Sanches, Cristiane Prugovechi. "Intercorrências perinatais em indivíduos com transtorno invasivos do desenvolvimento." Universidade Presbiteriana Mackenzie, 2010. http://tede.mackenzie.br/jspui/handle/tede/1749.
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Previous issue date: 2010-02-08<br>Pervasive Developmental Disorders (PDD) are complex developmental multifactorial disorders with high rate of herdability. In this context, prenatal and perinatal risk factors also have been documented, such as maternal and fetal hypotiroidism, fetal exposition to alcohol, thalidomide; misoprostol and valproic acid, MMR vaccine among others. Epidemiological prospective studies accumulate evidences suggesting that advanced parental age; obstetric complications and intrapartum hypoxia are the main risk factors. Clinical and experimental evidences points out that if the fetus is exposed to antenatal maternal stress the child are more likely to have developmental problems including the autism spectrum disorders phenotype. This study evaluated the frequency of 50 perinatal complications and 36 psychological stressors in 44 pregnancies of the 19 PDD patient´s mothers. All the subjects were assisted at APAE from the Barueri municipality in the State of São Paulo. The main results of the study were: a) lower mean maternal and paternal age among non-PDD pregnancies; b) 19% and mean of 9,4 perinatal complications in PDD gestations versus 14,6% and mean of 7,5 for non-PDD gestations; c) more CNS insults among PDD gestations; d) expressive occurrence of psychological stressors in the life of these women, in PDD gestations or not; e) increased psychological stressors number in PDD gestations. There was no statistically significance in the pointed differences.<br>Os Transtornos Invasivos do Desenvolvimento (TID) são entendidos como transtornos de origem multifatorial com alto grau de herdabilidade. No entanto, causas ambientais devem também participar na gênese deste complexo distúrbio do desenvolvimento. Diversas intercorrências gestacionais têm sido apontadas como fator de risco possivelmente associado aos TID: hipotiroidismo materno; hipotiroidismo congênito; ingestão de álcool durante a gestação; uso de medicamentos como talidomida, misoprostol e ácido valpróico; vacinação contra rubéola, sarampo e caxumba (vacina tríplice) em crianças pequenas. Estudos com melhores desenhos metodológicos indicam como fatores de risco: idade materna e paterna; baixo peso ao nascimento e anóxia perinatal. Outra linha de investigação, com respaldo em estudos experimentais, aponta a exposição a estressores psicológicos durante a gestação como possível associação para facilitar o desenvolvimento de algum fenótipo dentro do espectro dos transtornos autísticos. O presente estudo investigou em uma amostra de 19 mães de indivíduos com diagnóstico de TID atendidos na APAE do município de Barueri, São Paulo, a ocorrência de 50 eventos agravantes perinatais e 38 estressores psicológicos nas 44 gestações destas mulheres. Os agravos positivos foram depois identificados se ocorreram nas gestações TID ou não TID. A análise comparativa entre os grupos mostrou: a) média das idades maternas e paternas menores nas gestações não TID; b) 19% e média de 9,4 intercorrências perinatais em gestações TID contra 14,6% e média de 7,5 em não TID; c) concentração maior de eventos possivelmente danosos ao SNC nas gestações TID; d) expressiva ocorrência de estressores psicológicos fora das gestações; nas gestações TID e não TID; e) número maior de estressores nas gestações TID contra gestações não TID. As diferenças apontadas não foram estatisticamente significativas.
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Druguet, Serra Mònica. "Impacto psicológico de la pérdida perinatal en una gestación gemelar monocorial." Doctoral thesis, Universitat de Barcelona, 2019. http://hdl.handle.net/10803/670634.
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ANTECEDENTES. Un embarazo gemelar monocorial es un hecho poco frecuente, que conlleva ciertas complicaciones, con un aumento del riesgo de muerte de uno o los dos fetos. Ante la pérdida de un feto durante un embarazo múltiple, el duelo, junto a la presencia de sintomatología ansiosa y depresiva, es una respuesta común y normal (López, 2011). Sin embargo, por la complejidad intrínseca a esta condición, en muchos casos este duelo puede ser más complejo e intenso y puede derivar en un proceso de duelo complicado, así como estos síntomas ansiosos, depresivos y de estrés postraumático, pueden ser más acusados o generar la aparición de un trastorno psicopatológico (Ellis et al., 2016; Hutti, Armstrong, Myers y Hall, 2015 y Lisy, Peters, Riitano, Jordan y Aromataris, 2016). Esto hace necesario estudiar en mayor profundidad las características y los factores que pueden intervenir en la elaboración de este tipo de pérdidas.
OBJETIVOS. El objetivo principal de esta tesis es conocer las características del proceso de duelo cuando se produce una pérdida perinatal en una gestación gemelar monocorial. Este objetivo principal se desplegó en diferentes objetivos específicos. En primer lugar, se analizó el impacto psicológico de la pérdida perinatal en las mujeres y se estudiaron las variables sociodemográficas, psicológicas y clínicas que podían influir en la elaboración del duelo, así como la vulnerabilidad psicológica ante este proceso. Y a continuación, se analizó la influencia de los rituales de despedida en el desarrollo del duelo.
MÉTODO. Estudio con un diseño correlacional y descriptivo. Las participantes fueron mujeres atendidas en la Unidad de Medicina Materno-Fetal del Departamento de Obstetricia del Hospital Universitario de la Vall d’Hebron de Barcelona entre febrero de 2009 y mayo de 2012. Todas ellas cumplían los siguientes criterios de inclusión: 1) Mujeres que habían sufrido una pérdida de uno o de los dos bebés en la gestación gemelar monocorial tras la cirugía fetal por complicaciones, y 2) Mujeres de nacionalidad española, raza caucásica y con dominio del idioma castellano, con un nivel de estudios mínimos para rellenar el material requerido para la investigación.
Se realizó una entrevista individual con cada participante donde se recogían los datos sociodemográficos, antecedentes psiquiátricos, datos clínicos sobre la gestación y las prácticas de rituales de despedida realizadas. Y se administraron los siguientes cuestionarios: Spanish Short Version Perinatal Grief Scale (SpSVPGS), Cuestionario de Ansiedad Estado-Rasgo (STAI), Inventario de Depresión de Beck (BDI) y Escala Revisada de Impacto del Estresor (Impact of Event Scale- Revised, IES-R).
RESULTADOS. Los síntomas de duelo tras una pérdida perinatal en la gestación gemelar monocorial con complicaciones estaban relacionados con síntomas depresivos, ansiosos y de estrés postraumático. La intensidad del duelo no dependía de la semana de gestación en que se produjo la pérdida, los antecedentes de pérdidas gestacionales, la supervivencia de un gemelo, la presencia de hijos previos ni las variables sociodemográficas consideradas. Por el contrario, tener antecedentes de haber recibido atención terapéutica psicológica y/o psicofarmacológica resultaron predictores de mayor intensidad del duelo. La ausencia de la realización de rituales de despedida tampoco se relacionó con una mayor intensidad de la sintomatología del duelo.
DISCUSIÓN Y CONCLUSIONES. La pérdida perinatal en un embarazo gemelar monocorial supone una situación de gran impacto emocional que coloca a la madre en una situación de mayor vulnerabilidad psicopatológica. La presencia de un hijo superviviente o de hijos previos no garantizan una mejor salud mental para la madre en duelo, así como tampoco la realización de rituales de despedida. Estas madres presentan unas necesidades específicas y complejas, que pueden complicar el proceso de duelo, especialmente en aquellas mujeres con mayor vulnerabilidad psicológica.<br>BACKGROUND. Monochorionic twin pregnancy is a relatively uncommon phenomenon, but its associated complications are severe and may result in the loss of one or both fetuses. Grief, together with feelings of anxiety and depression, is a normal and common response to perinatal loss during a multiple pregnancy (López, 2011). However, the inherent complexity of such a loss means that the grief experienced is often more intense and complicated, and symptoms of anxiety, depression, and/or post-traumatic stress may develop into a full-blown psychological disorder (Ellis et al., 2016; Hutti, Armstrong, Myers, & Hall, 2015; Lisy, Peters, Riitano, Jordan, & Aromataris, 2016). It is therefore important to understand the factors which may influence a woman’s ability to work through and come to terms with a loss of this kind.
AIMS. The overall aim of this thesis was to explore and describe the characteristics of the grieving process in the case of perinatal loss during a monochorionic twin pregnancy. More specifically, the aims were: 1) To analyze the emotional impact of perinatal loss on the mother, 2) to study the sociodemographic, psychological, and clinical variables that may influence her grieving process, as well as the impact of previous psychological vulnerability, and 3) to examine the influence of farewell rituals in relation to the grief experienced.
METHOD. The research used a correlational and descriptive design. Participants were a sample of women recruited from among those attending the maternity unit of the Vall d’Hebron University Hospital in Barcelona between February 2009 and May 2012. They all met the following inclusion criteria: 1) Having lost one or both fetuses in a monochorionic twin pregnancy following fetal surgery due to complications, and 2) Spanish nationality and White ethnicity, with a level of education and command of the Spanish language that was sufficient for completion of the questionnaires.
Individual interviews were used to collect sociodemographic information, data about the woman’s psychiatric and obstetric history, and information about any farewell rituals performed. The following questionnaires were also administered: Spanish Short Version of the Perinatal Grief Scale (SpSVPGS), State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI), and the Impact of Event Scale—Revised (IES-R).
RESULTS. High levels of grief following the loss of a fetus during a complicated monochorionic twin pregnancy were associated with higher levels of depression, anxiety, and post-traumatic stress. The intensity of grief did not depend on the point in the pregnancy at which the loss occurred, a history of miscarriage, the survival of one of the twins, the presence of living children, or any of the sociodemographic variables considered. A history of psychological and/or psychopharmacological treatment was, however, associated with a more intense grief reaction. There was no significant relationship between farewell rituals and the intensity of the grief experienced.
DISCUSSION AND CONCLUSIONS. Perinatal loss during a monochorionic twin pregnancy has a major emotional impact on the mother and leaves her vulnerable to psychological problems. The survival of one of the twins or the presence of living children is no guarantee that the grieving mother’s mental health will be less affected, and neither do farewell rituals seem to have a significant protective effect. Women who have experienced a loss of this kind have specific and complex needs, and those with a history of psychological vulnerability are particularly at risk of complicated grief.
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Hirose, Atsumi. "A cross-sectional study of the first and the second delays among women admitted to a maternity hospital with severe obstetric complications ('near-miss') in Afghanistan." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2010. http://researchonline.lshtm.ac.uk/1649007/.
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In Afghanistan, the majority of women continue to give birth at home because of poverty, difficult access to health facilities, or gender-based restrictions. Women are often brought into hospitals in moribund conditions after the onset of complications at home. A detailed understanding of the determinants of health care seeking delays is necessary in order to help identify strategies which could reduce the incidence of very severe complications and maternal deaths and improve foetal outcomes in complicated pregnancies. Areview of existing studies of care-seeking delays indicated that durations of care-seeking time had not been well explained because of various methodological limitations. The large majority of previous studies were descriptive and fell short in identifying contributing factors that could be eliminated by interventions while analytical studies lacked methodological rigour largely due to sample size limitations associated with rarity of maternal deaths. In this thesis, data from a hospital-based cross-sectional survey conducted among 472 women with severe obstetric complications in Afghanistan were analysed using a refined version of the conceptual framework developed by Thaddeus and Maine (1994). Three types of care-seeking delays were considered: the duration oftime from onset of symptoms to decision to seek care (or 'decision delay'), the duration from the decision to departure for health care facilities, (or 'departure delay') and variation in self-reported travel time from GIS-modelled travel time (or 'travel delay'). The study posited that delayed care-seeking would be best explained by a combination of factors including a woman's health care practice during pregnancy, her family's financial and social resources, geographical accessibility to healthcare and the types of symptoms and signs associated with each complication. It was also postulated that care-seeking delay would be among important determinants of foetal death. Regression techniques were used to identify determinants of the three types of delays, and logistic regression techniques were employed to assess the role of delays on foetal mortality. This study showed that failure to use antenatal care ('ANC') service during pregnancy was associated with an increase in decision delay. Lack of birth plans and absence of a midwife in the locality were also associated with an increased decision delay for ante- and intra-partum women. Awoman's weak relationship with her birth family was associated with an increased decision delay for complication types which did not have clear symptoms while a woman from an impoverished household appeared to experience a long decision delay when she suffered a complication with dramatic symptoms. In addition to seasonal effects, difficult geographical access to healthcare and lack of social capital were found to be positively associated with delay in departure for healthcare facilities. Multi-referrals, low household economic status, lack of community cohesion, and lack of access to vehicle were associated with an increase in travel delay. Finally, decision delay contributed to an increased risk of foetal death. The main conclusion from this work is that ANCinterventions have a significant role to play in facilitating rapid uptake of emergency care, once a complication occurs, in a setting where access to routine and emergency care is socially and geographically difficult. This in turn has implications not only for maternal but also for foetal outcomes. Future research and programmatic efforts should be directed towards understanding and exploiting the roles that social resources could play in facilitating access to emergency obstetric care.
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Mbola, Mbassi Symplice. "Soins obstétricaux d'urgence et mortalité maternelle dans les maternités de troisième niveau du Cameroun : approche évaluative d'une intervention visant à améliorer le transfert obstétrical et la prise en charge des complications maternelles." Thesis, Paris 6, 2014. http://www.theses.fr/2014PA066352/document.
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Malgré de nombreuses initiatives entreprises par le gouvernement au cours des dernières années, la mortalité maternelle demeure un véritable fléau au Cameroun. Pour cette raison, une recherche a été conduite pour déterminer l'ampleur de la mortalité maternelle dans les 7 maternités de troisième niveau du Cameroun, décrire les différentes étapes d'une intervention visant à améliorer le système de référence et la prise en charge des urgences obstétricales et évaluer son effet sur la mortalité maternelle.La recherche a été menée en trois phases. Une revue rétrospective des données agrégées de la période 2004 à 2006 a été réalisée incluant tous les accouchements, les complications obstétricales, les césariennes et les décès maternels. Ensuite une intervention de 33 mois a été mise en place dans 22 maternités périphériques ainsi que dans 3 maternités de troisième niveau où la mortalité maternelle était importante. L'évaluation de l'intervention a été faite à travers la méthode quasi expérimentale combinant l'étude avant-Après à l'étude ici-Ailleurs. Deux ans après l'intervention, les décès maternels enregistrés dans les 3 maternités cibles avaient diminué de plus de la moitié (P=0,000001). Le taux de létalité des complications obstétricales observé dans les mêmes maternités est passé de 2,2 à 0,7% (P=0,000001). Par ailleurs, le nombre de décès observés chez les femmes référées avait diminué et le taux de létalité était inférieur à 1%. Les résultats de la recherche mettent en évidence les conséquences du renforcement des compétences des prestataires, de l'amélioration du système de référence et de la qualité des soins sur la mortalité maternelle<br>Despite numerous initiatives undertaken by health authorities in the past years, maternal mortality remains a major public health issue in Cameroon. Against this background, research was conducted (i) to determine the maternal mortality patterns in 7 tertiary maternity centers in Cameroon, (ii) to document various stages of an intervention for improving referral system and the management of obstetric emergencies and (ii) evaluate the effect of these measures on maternal mortality and propose future actions. The research was conducted in three phases. A retrospective review of the aggregate data for the period 2004-2006 was performed including all births, obstetric complications, caesarean sections and maternal deaths. Then 33 months intervention has been set up in 22 peripheral maternities and in three tertiary maternity centers where maternal mortality was very high. The evaluation of the intervention was made using the quasi-Experimental design. This method combined the pre- and post- intervention study as well as the study of the maternities where there was intervention compared to the control group. Two years after the intervention, maternal deaths recorded in the target tertiary maternity centers decreased by more than half (P = 0.000001). The case fatality rate decreased from 2.2 to 0.7% in the same group (P = 0.000001). Moreover, the number of deaths among referred women decreased significantly and the case fatality rate was less than 1%. The research findings highlight the impact of capacity building providers, improvement of the referral system and quality of care on maternal mortality
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Nystedt, Astrid. "Utdragen förlossning : kvinnors upplevelser och erfarenheter." Umeå : Omvårdnad, 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-579.
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Vääräsmäki, M. (Marja). "Care and outcome of Finnish diabetic pregnancy." Doctoral thesis, University of Oulu, 2001. http://urn.fi/urn:isbn:951426469X.
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Abstract
The aim of this study was to evaluate the treatment, course and outcome of pregnancy in Finland using two cohorts of diabetic women. The clinical
cohort
consisted of data from all 210 women with Type 1 diabetes and their 296 pregnancies managed between 1986 and 1995 in the two northernmost provinces of
Finland. The register-based study population included all 1442 mothers with a singleton birth who had insulin treatment during pregnancy in 1991-1995
according to the Medical Birth Register. Of these mothers, 954 (66%) had pre-existing diabetes.
Insulin-treated diabetes complicated 4.5/1000 births in Finland in 1991-1995, the prevalence of Type 1 diabetes being 2.9/1000 in the whole country and
3.3/1000 in Northern Finland. In the 1990's the care of these women shifted from tertiary level only to include the secondary level hospitals as well, and
was more often carried out on an out-patient basis. This care policy in association with the self-monitoring of blood glucose levels contributed to an
obvious improvement in glycaemic control during pregnancy. Despite that, the high proportion (73%) of women entering pregnancy with unsatisfactory
glycaemic control did not decrease during the study period.
Retinopathy complicated 134 (45.3%) diabetic pregnancies, while clinical nephropathy was found in 23 (7.8%) cases. Although retinopathy was more often
aggravated during the first pregnancy, the occurrence of retinopathy or its severe form was not increased at the beginning of consecutive pregnancies. Of
the mothers, 50 (16.9%) had pre-eclampsia during pregnancy, and in 28% of these cases it was classified as superimposed. It was found more often among
primiparous than multiparous (25.6% vs. 11.0%, respectively), and its occurrence rose with the severity of diabetes.
In both cohorts, the rates of preterm deliveries, Caesarean sections and large for gestational age (LGA) infants were significantly (p < 0.001) higher
in
Type 1 diabetic pregnancies than in the background population. The rates of congenital anomalies (CA) were 540-629/10000 in two study populations, both
being 2-3-fold as compared to the background population. Cardiac malformations were most common, with anomalies in the genitourinary tract and the
musculoskeletal organs being next in frequency. Sixty-three percent of malformed infants were boys.
Though pregnancy itself was not found to worsen the prognosis of diabetes, at least in the short term, pregnancy in diabetic women still remains a high
risk state with an increased rate of prematurity, operative deliveries, CAs and peri- and neonatal mortality. In order to decrease the mortality rate in
diabetic births, attention should be directed at both the prevention of CA and at identifying the foetuses at risk for intrauterine death. The postneonatal
mortality rate is also high, reflecting a shift in the deaths from the early neonatal period to a later age. Therefore, a combined mortality, including
induced abortions, stillborns and infant deaths, would give a more realistic idea of the outcomes in diabetic pregnancies.
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Douteaud, Stéphanie. "Déterminants et effets des trajectoires de stress prénatal sur les issues de la grossesse et la dépression postpartum." Thesis, Montpellier 3, 2014. http://www.theses.fr/2014MON30099.
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Introduction : En France, comme ailleurs, la prévalence de la dépression post-partum (DPP) (environ 10% des femmes) n'est pas plus importante que celle d'autres formes de dépression mais elle pose un important problème de dépistage car, les femmes consultent moins rendant difficile sa prévention. Les recherches visant à améliorer la prévention de la DPP s'appuient sur deux modèles principaux, le modèle de la vulnérabilité au stress et le modèle bio-psycho-social. L'un comme l'autre décrivent le stress psychologique prénatal comme étant un important déterminant de la DPP. Néanmoins, si le stress est fréquemment évalué, il n'est mesuré en général qu'une fois et tardivement dans la grossesse. Il n'est donc actuellement pas possible de connaître ni son évolution ni l'effet de cette évolution sur la DPP. En conséquence, un premier objectif de ce travail doctoral est d'identifier et de caractériser des trajectoires de stress afin d'évaluer leurs effets sur la DPP. Par ailleurs, certaines recherches montrent que les complications obstétricales lors de l'accouchement ont un effet délétère sur la santé psychologique des femmes en postpartum et d'autres que le stress prénatal augmente le risque de complications obstétricales. Nous faisons donc l'hypothèse qu'une élévation du stress associée à des complications obstétricales à l'accouchement augmente considérablement le risque de DPP, mais que cela diffère d'une femme à l'autre en fonction du niveau des déterminants du stress.Méthode : La santé des mères, leur trait d'anxiété et des variables socio-économiques ont été relevées chez 164 femmes avant la fin des deux premiers mois de la grossesse. Le stress perçu, l'état d'anxiété, le soutien social et les stratégies de coping ont été évalués à 2, 6 et 9 mois de grossesse pour 163 femmes puis à 1 et 6 mois postpartum pour 91 d'entre elles. Par ailleurs, les résultats du dépistage prénatal des pathologies fœtales, le terme de la grossesse, le poids de naissance du bébé, ses résultats à l'Apgar et le type d'accouchement (dystocique versus eutocique) ont également été relevés. Enfin, la mesure de la DPP a été effectuée 6 mois après l'accouchement. Nous avons calculé des trajectoires individuelles de stress et mesuré l'effet de ces trajectoires sur les variables liées à l'accouchement pour 163 femmes puis sur la DPP pour 91 d'entre elles.Résultats : Trois trajectoires ont été identifiées en prépartum comme en postpartum. Une première où le stress est faible en début de grossesse, augmente jusqu'en début de post-partum et diminue légèrement en fin de période postnatale. Une seconde où le stress est modéré en début de grossesse, diminue jusqu'au milieu de la grossesse, augmente en fin de grossesse et se stabilise en période postnatale. Une dernière où le stress est élevé en début de grossesse, puis diminue jusqu'en fin de grossesse et continue de diminuer en période postnatale. Lorsque le stress suit les trajectoires 2 et 3, la durée de gestation est plus courte, F(2,138) = 3,45, p < 0,05, η2 = 0,048, l'usage de la césarienne est plus fréquent, OR = 2,62,p < 0,05, IC95% = [1,01 – 6,75] ainsi que l'accouchement dystocique, OR = 3,54, p < 0,005, IC95% = [1,18 – 10,52]. En revanche, les trajectoires de stress n'ont pas d'effet sur la DPP.Discussion : Nos résultats sont encourageants et permettent de montrer que l'évolution de la perception du stress pendant la grossesse a un effet sur la durée de gestation, les complications obstétricales et l'usage de la césarienne. En revanche, elle n'en a pas sur la DPP. Cependant nos résultats suggèrent que le stress pourrait avoir un effet uniquement chez les femmes vulnérables et que la DPP s'insèrerait dans un continuum dépressif, alors contigu à la vulnérabilité au stress. Les recherches ultérieures devraient donc évaluer le lien entre des trajectoires individuelles de dépression et de stress du début de la grossesse en fin de postpartum afin de tester cette hypothèse<br>Introduction : In France, as well as in other countries, the prevalence of postpartum depression (PPD) (about 10% of women) is not more important than other forms of depression, but it is a major problem of screening, because women less consult, making prevention difficult. Researches to improve the prevention of DPP are essentially based on two models, the stress-vulnerability model and the bio-psycho-social model. The both models describe the prenatal psychological stress as an important determinant of the PPD. However, if stress is frequently assessed, it is usually measured only once and late in pregnancy. So, by now, it is not possible to know its evolution or to know its effects on PPD. Accordingly, a primary objective of this doctoral work is to identify and characterize trajectories of stress to assess their effects on the DPP. Moreover, some researches showed that obstetric complications during childbirth have a deleterious effect on the psychological health of postpartum women. Others proved that prenatal stress increases the risk of obstetric complications. So we assume that an elevated stress associated with obstetric complications in childbirth significantly increases the risk of PPD. Neverthless it differs from one woman to another depending on the level of stress determinants.Method: The health of mothers, their anxiety-trait level and socio-economic variables were recorded among 164 women before the end of two months of pregnancy (T0). Perceived stress, state anxiety, social support and coping strategies were evaluated at 2, 6 and 9 months of pregnancy for 163 women and at 1 and 6 months postpartum for 91 of them. Moreover, the results of prenatal screening for fetal pathologies, the term of pregnancy, baby's birth weight, results of Apgar and type of delivery (dystocic versus eutocic) were recorded. Finally, the measurement of the PPD was performed 6 months after delivery. We calculated trajectories of stress and we measured the effect of these trajectories on the variables related to childbirth for 163 women and on DPP for 91 of them.Results: Three trajectories were identified in prepartum and postpartum. A first trajectory where the stress is low in early pregnancy, increases until early postpartum and decreased slightly at the end of the postnatal period. A second where the stress is moderate in early pregnancy decreases until the middle of pregnancy, increases in late pregnancy and postpartum. A final trajectory where stress is high in early pregnancy and then decreases until the end of pregnancy and continues to decrease in postpartum. When the stress follows the paths 2 and 3, the gestation period is shorter, F(2,138) = 3.45, p <0.05, η2 = 0.048, the use of cesarean section is more common, OR = 2.62, p < 0.05, CI 95% = [1.01- 6.75] as well as dystocic labor, OR = 3.54, p <0.005, CI 95% = [1.18-10.52]. In contrast, the trajectories of stress does not have an effect on the PPD.Discussion: Our results are encouraging and show that the perception of stress during pregnancy has an effect on the duration of pregnancy, obstetric complications and the use of cesarean section. However it has no effect on the DPP, but our results suggest that stress may have an effect only among vulnerable women and that the DPP would fit into a depressive continuum, while adjacent to the vulnerability to stress. In conclusion, future researches should assess the link between trajectories of stress and depression from early pregnancy to late postpartum to test this hypothesis
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Uustal, Fornell Eva. "Pelvic floor dysfunction : a clinical and epidemiological study /." Linköping : Univ, 2003. http://www.bibl.liu.se/liupubl/disp/disp2003/med822s.pdf.
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Shub, Alexis. "Periodontal disease and adverse pregnancy outcomes." University of Western Australia. School of Women's and Infants' Health, 2007. http://theses.library.uwa.edu.au/adt-WU2007.0184.
Full textAbstract:
[Truncated abstract] Periodontal disease is a common and underdiagnosed disease in humans that may have adverse effects on pregnancy outcomes. The aim of this thesis was to investigate the effects of periodontal disease in pregnancy by means of two observational human studies and the development of animal models of fetal and uterine exposure to periodontopathic bacteria and lipopolysaccharide. I performed a prospective study examining the rates of preterm birth, small for gestational age neonates and neonatal inflammation in 277 women who had undergone a detailed antenatal periodontal examination and oral health questionnaire. Periodontal disease was associated with small for gestational age neonates, and increased CRP levels in umbilical cord blood, but no effect was seen on the rate of preterm birth. Maternal oral health symptoms predicted both periodontal disease and newborn biometry. In a retrospective case control study, I examined the role of periodontal disease in perinatal mortality. Participants included 53 women who had experienced a perinatal loss for which no cause could be found after thorough investigation, and 111 control women. Women who had experienced a perinatal loss were more than twice as likely as controls to have periodontal disease. The incidence of periodontal disease was even higher in women in whom the perinatal loss was due to extreme prematurity. In contrast to my prospective study, risks to the pregnancy could not be predicted by maternal oral health behaviours or oral health symptoms. In order to better understand the mechanisms regulating the associations described in the human studies, two animal models were developed; one to investigate acute exposure and the second to investigate long-term exposure to periodontal pathogens. The first study examined the effects of administration of a bolus of periodontopathic bacteria and lipopolysaccharide to the pregnant sheep. Injection of bacteria and lipopolysaccharide in the amniotic fluid of the pregnant preterm sheep caused a high rate of fetal lethality, disturbance of fetal acid base status and inflammation of the fetus and membranes. Given the circumstances of exposure to periodontopathic pathogens in human periodontal disease, a model investigating long-term exposure to periodontopathic lipopolysaccharide on pregnancy outcomes was developed. ... Overall, I have demonstrated that maternal periodontal disease is associated with adverse pregnancy outcomes including fetal growth restriction and possibly perinatal loss. Mechanisms regulating these effects are likely to be mediated by fetal adaptations to intrauterine inflammation resulting in altered fetal development, growth or survival. Randomised controlled trials that are currently in progress will provide further information on the effects of periodontal disease in human pregnancy, and the efficacy of treatment to reduce these adverse outcomes.