Approximately 29.1% of South African women of childbearing age tested HIV positive during their first antenatal visit in 2006 (DoH, 2007). This rate of HIV amongst the women of childbearing age reinforces the importance of understanding the management of HIV during pregnancy. During antenatal visits the general health of the woman and her unborn baby is assessed and managed. Management includes antiretroviral therapy to the HIV infected women with a CD4 count below 200 cells/mm3, while women with a CD4 count above 200 cells/mm3 receive a single dose of nevirapine with the onset of labour provided to them by their local clinics. Currently, in Potchefstroom, women receive antenatal care at local primary health-care clinics and antiretroviral drugs at the antiretroviral clinic. There is little or no collaboration between the various clinics and the question arises if the needs of the women are being met. The aim of the research was to promote the health of HIV positive pregnant women by providing insight into the needs of these women and to formulate recommendations for antenatal care. The specific objective is to explore and describe the needs of HIV positive pregnant women regarding antenatal care. An explorative, descriptive, contextual design, following a qualitative approach was used during the research. Semi-structured interviews were used to collect data. Interview questions were compiled from the research problems. Before the commencement of data collection, permission was obtained from the district health manager and Potchefstroom Hospital. A total of sixteen (16) HIV positive women were interviewed after informed consent had been obtained. Data analysis was done after each session and themes were categorised according to the women's needs. From the interviews it was found that each woman has her own specific needs regarding antenatal care. The needs of the participants followed a similar pattern and for this reason it could be divided into various categories. These categories include a need for support, a need for education, a need for improved services and a need for a non-judgemental environment. Conclusions were drawn and recommendations were made for nursing practice, nursing education and nursing research. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2008.

Background: Antenatal depression is relatively a new area of study compared to postnatal depression and the depth and sophistication of this research is yet developing. For instance, very little is reported on the specific role of the risk factors as moderators and mediators to explain the variability in the magnitude of exposure and the causal pathway for depression during pregnancy. Moderators are those variables that are not modifiable (e.g., ethnicity, and gender), or have qualitative character or nominal in nature, and could also often be antecedent to other independent variables (e.g., behavioural and psychosocial) and depression. Mediators are those variables that may be better able to describe the pathway that connects a predictor to an outcome and intervention can be designed targeting mediators as they are causally related to the outcome. This thesis will address this gap in research and provide empirical evidence to increase the understanding of the role of each identified risk factors that could potentially influence maternal mental health interventions. Methods: In this thesis, I have used the Feelings in Pregnancy and Motherhood (FIP) study. This was a longitudinal study and 649 pregnant women participated in the study. Women were interviewed three times over the course of their pregnancy and the immediate postpartum. Depression status was assessed by the Edinburgh Postnatal Depression Scale (EPDS); sociodemographic characteristics, psychosocial and behavioural information were collected at each time point. Depression status in late pregnancy and postpartum were the two outcomes of interest. Non-modifiable sociodemographic risk factors were considered as moderators. Behavioural and psychosocial variables were considered as mediators. Moderators and mediators were tested through series of regression analysis. Results: In modeling moderating effects in late pregnancy, low income women who were in poor marital relationships (β=1.54; p<0.05) and partnered women (married or common law) who reported having used recreational drugs (β= -1.62; p<0.05) were more likely to be depressed. Young mothers with low social support (β= 1.04; p=0.15) and Aboriginal mothers with low social support (β= 1.12; p=0.17) were also almost significantly noted to have depression symptoms in late pregnancy. In mediating analysis for late pregnancy, psychosocial mediators such as stress, social support, and marital satisfaction, and behavioural factors, such as smoking and recreational drug use exerted partial or full mediating effect for depressive symptoms in women in late pregnancy. In moderating analysis for postpartum, Aboriginal women who had never exercised in late pregnancy were found to be depressed at postpartum compared with non Aboriginal mothers who did not exercise. In looking at mediating effects in postpartum, smoking at late pregnancy exerted full mediating effects for ethnicity and marital satisfaction pathways, and partial mediating effects for age, education, and stress pathways in predicting depression in postpartum period among mothers. Conclusion: Depression, particularly during pregnancy and in postpartum, is a top priority for women themselves, their families, care providers, and society in general. This study found that characteristics of women or their psychosocial or behavioural experiences could have specific effects such as either a mitigating or exacerbating role, or a mediating role, in depression in late pregnancy or in postpartum. This information could be strategically used by clinicians or by health promotion professionals to either target or provide tailored programs to women who might experience depression during pregnancy and postpartum.

OBJETIVOS: Comparar el valor predictivo de la monitorización antenatal de la F.C.F. respecto al bienestar fetal en función de la patología materna o fetal detectada durante el embarazo, y en función de la edad gestacional en que se realice dicha prueba.MATERIAL Y MÉTODOS: Para evaluar el valor predictivo de la monitoprización antenatal de la F.C.F. en función de la patología materna o fetal detectada durante el embarazo se relacionan de manera retrospectiva los resultados perinatales con el resultado de la prueba realizada la semana antes del parto en 1944 fetos de 1928 gestantes agrupadas según la patología materna o fetal presente. Para evaluar el valor predictivo de la monitorización antenatal en función de la edad gestacional se practican de manera prospectiva y con seguimiento lineal pruebas basales de una hora de duración semanal en 50 fetos desde las 28 a las 34 semanas. También se evaluan los resultados perinatales de 205 fetos, que nacieron entre las 28 y 36 semanas y de 1408 fetos nacidos entre las 37 y 41 semanas de gestación, con los resultados de la monitorización antenatal de la F.C.F. practicada la semana antes del parto. Los criterios de interpretación de la monitorización antenatal son la presencia de aceleraciones transitorias como indicativas de normalidad y la presencia de desaceleraciones o disminución de la variabilidad para la sospecha de pérdida de bienestar fetal. Se consideran como fetos con resultados perinatales desfavorables aquellos que presentan como mínimo una de las siguientes condiciones: Muerte perinatal, pH de arteria umbilical inferior a 7,2 o si la arteria se halla colapsada con un pH de vena umbilical inferior a 7,25, un índice de Apgar inferior a 7 a los 5 minutos de vida y/o presencia de retraso de crecimiento intrauterino y líquido amniótico meconial cuando se práctica cesárea electivaSe realizan estudios de sensibilidad, especificidad, valor predictivo positivo y negativo para los distintos grupos estudiados y análisis comparativos mediante test de Chi cuadrado y test exacto de Fischer.RESULTADOS: Al analizar el valor predictivo de la monitorización de la F.C.f. en todos los grupos estudiados se observa una buena sensibilidad y valor predictivo de un resultado normal con una especificidad y un valor predictivo de un resultado patológico relativamente bajos. Las patologías materno-fetales en que la monitorización de la F.C.F. es más útil son la isoimmunización Rh, la sospecha clínica o ecográfica de retraso de crecimiento, los malos antecedentes obstétricos, los estados hipertensivos del embarazo y en las gestantes diabéticas con hipertensión sobreañadida. Es de poca utilidad en gestantes diabéticas y en gestantes sin patología por su baja especificidad y valor predictivo de un resultado patológico. La monitorización antenatal en los fetos pretérmino, estableciendo unos nuevos criterios interpretativos en función de la edad gestacional, permite obtener una alta sensibilidad y valor predictivo de un resultado normal, con una especificidad y un valor predictivo de un resultado patológico relativamente reducidos. / Predictive value of antenatal fetal heart rate monitoring (AFHRM) related to pathology and gestational ageOBJECTIVE: To compare predictive value of AFHRM related to maternal or fetal pathology detected during pregnancy or to gestational age on which monitoring is done.MATERIAL AND METHODS: Perinatal results in 1944 fetuses out of 1928 pregnant women, grouped according to mother or fetal pathology, are retrospectively related with the result of AFHRM the week before delivery in order to evaluate its predictive value. Fifty fetuses are tested prospectively with AFHRM one hour long on a weekly basis from 28 and 34 weeks. Perinatal results of 205 fetuses born between 28 and 36 weeks gestation and 1408 fetuses born between 37 and 41 weeks gestation are also evaluated and related to AFHRM results within a week before delivery. AFHRM criteria of normality are the presence of transient accelerations and the presence of decelerations or a low variability suggests fetal distress. Perinatal morbidity criteria are: Perinatal death, umbilical arterial pH lower than 7.20, or if artery is collapsed an umbilical vein pH lower of 7.25, Apgar index below 7 at five minutes life and/or presence of intrauterine growth retardation and amniotic meconium staining in elective caesarean.Studies of sensitivity, specificity, positive and negative predictive value and comparative analysis by means of Chi-square and exact Fischer test are made for the different groups studied.RESULTS: A good sensitivity and negative predictive value and a low specificity and positive predictive value are observed on all studied groups. Rh isoimmunization, clinical or ecographical suspicion of fetal growth retardation, poor obstetric history, hypertensive diseases, diabetes plus hypertension are pathologies where AFHRM is most useful. AFHRM looks less useful in diabetes without hypertension and in low risk pregnancies because of its low specificity and positive predictive value. AFHRM before term shows a high sensitivity and negative predictive value, with a low specificity and positive predictive value, as long as new interpretative criteria based on gestational age are clearly set.

[Truncated abstract] In obstetric practice, pregnant women at risk of pre-term delivery between 24 and 34 weeks of gestation are administered synthetic glucocorticoids (betamethasone or dexamethasone) to induce fetal organ maturation. During this gestational period, the fetal kidney is undergoing a phase of rapid organogenesis with an increase in renal growth and active nephrogenesis occurring. The studies comprising this thesis examine the effects of prenatal betamethasone exposure on the fetal and adult ovine kidney. The central hypothesis of these studies was that exposure of the fetal kidney to betamethasone in late gestation would change renal structure and induce long-term alterations in the expression of glucocorticoid-sensitive genes and proteins. In the fetal studies, pregnant Merino ewes bearing single fetuses received single or repeated-weekly intra-muscular (i.m.) injections of betamethasone (0.5 mg/kg body weight) or saline commencing on day 104 of gestation (term is 150 days). Kidneys were collected from fetuses at 109, 116, 121 and 146 days of gestation (d). Using gold standard unbiased stereological techniques, the physical disector/fractionator method, total glomerular (nephron) number and glomerular volume were determined in 146 d fetal kidneys exposed to repeated maternal saline or betamethasone administration. In the adult study, kidneys were collected from 3.5-year-old sheep that had been exposed to ... In this thesis I have demonstrated that renal growth restriction as a result of betamethasone exposure is associated with a reduction in fetal nephron endowment. Although betamethasone does not appear to consistently alter nephron number or glomerular size, it may indirectly affect total nephron endowment through effects on renal growth. I have also provided evidence which suggests that lategestation betamethasone exposure in sheep does not program permanent alterations in the renal expression of genes or proteins involved in glucocorticoid hormone action or components of the renin-angiotensin system. Therefore, exposure of the fetal kidney to betamethasone during nephrogenesis may alter renal structure if kidney growth is perturbed; however, there are no persistent alterations in the expression of glucocorticoid-sensitive genes. These findings are consistent with the preservation of normal basal blood pressure in the adult sheep I studied and with the limited results from human studies of late-gestation maternal glucocorticoid administration.

Thesis (M.A.(Population and Reproductive Health Research))--Mahidol University, 2005. / LICL has E-Thesis 0005 ; please contact computer services.

Thesis (M.P.H.M. (Primary Health Care Management))--Mahidol University, 2007.

Objectives: The purpose of this study was to examine rural women s access to maternal health information and its impact on levels of skilled healthcare utilization. Method: A qualitative study involving twenty five (25) pregnant women,five (5) Skilled healthcare providers and five (5) Traditional Birth Attendants (TBAs) was conducted in Chamwino District in Dodoma Region, Tanzania for a period of six months. Due to time and resource limitation the researcher selected two (2) of the 32 wards in the district where the problem of maternal mortality and non-utilization of skilled healthcare was most prominent. The two selected wards were Msanga and Buigiri wards. The researcher used The Health Belief Model and Theory of Planned Behaviour to develop interview questions and focus group guides as well as the interpretation of the findings. The researcher examined how variable factors e.g. maternal health literacy, individual perceptions, local knowledge and care provider-related factors affect pregnant women s health behaviours and utilization of skilled maternal services. The Data was analysed thematically using the 6-stage guide to thematic data analysis with the help of NVIvo Software. Results: The inadequate conditions of the health facilities and the poor working conditions of the care providers affected the provision of quality of maternal services and health information to pregnant women in the study area. The limited access to skilled maternal health information from skilled healthcare providers and lack of alternative sources of reliable health information led pregnant women to seek health information from their Mothers-in-laws, TBAs and other women in the society. However, there was a shortcoming of information inaccuracy as their health advice was not based on previous expert advice but rather on the personal opinion and attitude towards skilled maternal services. The limited access to maternal health information caused majority of pregnant women to underestimate the risks of pregnancy related complications and how they responded to pregnancy danger signs and other ill-health conditions that raised during pregnancy. The majority of pregnant women reported not to seek and kind of care when experienced a health problem. It was also found that during labour some would go to the TBA for childbirth and later go to the dispensary when the TBA failed while others would just go for TBAs opinion and confirmation that it was real labour then go to the health facility. This delayed women s timely access to obstetric care which is essential for positive outcome when a pregnant woman experiences a pregnancy or childbirth complications. Conclusion: The improvement of the quality of skilled healthcare services in rural areas is a prerequisite for achieving desired outcomes in maternal mortality reduction efforts in Tanzania. However, improvement of quality itself is not a panacea if pregnant women are not aware of the services, hence the healthcare providers should also focus in increasing provision of maternal health information to pregnant women. The findings show that the limited access to skilled maternal health information from healthcare providers and lack of alternative sources for reliable health information has constrained majority of these women from becoming maternal health literate hence affecting their levels of utilization of skilled maternal services. The healthcare providers and policy makers should focus on meeting the health information needs of general rural populations and enable them to become well-informed and knowledgeable to make better and well-informed maternal health decisions.

The diploma thesis topic: Pregnant women education at the antenatal preparation, thein regimen and exercises during the gravidity period. This diploma thesis contains pieces of knowledge from the specialized literature that could be useful for women who want to improve their awareness of the regimen and exercises during the gravidity period. The main aim of this thesis was a research which was supposed to find out informatik women know about the diet, the regimen, suitable exercises during the gravidity period and about the educational materials. This thesis is dividend into tw oparts theoretical and practical part. The theoretical part contains a brief characteristics of physiological gravidity, the mothers organism changes, the regimen during gravidity, suitable and unsuitable sports for pregnantwomen. The practical part sums up and evaluates the questionnaire survey results. The thesis could be considered a manual for pregnant women.

The study investigated the beliefs and practices of Sotho antenatal women. The aim was to describe the beliefs and practices of Sotho antenatal women in order to contribute to the identification of guidelines for a teaching programme for both midwives and traditional birth attendants. A non-experimental, qualitative research approach, which was exploratory-descriptive and contextual in nature, guided the researcher to explore and describe the beliefs and practices of Sotho antenatal women. Semi-structured interviews were conducted with the Sotho antenatal women as well as traditional birth attendants. Six themes emerged from the study through the interviews: &#61623; the nature of pregnancy &#61623; prescriptive practices &#61623; restrictive practices &#61623; sexual activity &#61623; the practice of clinic attendants &#61623; the practice of attending traditional birth attendants / Health Studies / M.A (Department of Health Studies)

Introdução: a anemia ferropriva na gestação caracteriza-se como um importante problema de Saúde Pública. A partir de junho de 2004, o governo brasileiro tornou obrigatória a fortificação das farinhas com ferro, atendendo às recomendações internacionais e com intuito de minimizar a anemia na população em geral. Objetivo: estudar a prevalência de anemia em gestantes atendidas em um serviço de pré-natal de uma maternidade social da cidade de São Paulo, antes e após a fortificação das farinhas com ferro. Método: estudo transversal retrospectivo com dados coletados de prontuários de atendimento de pré-natal de 2003 (Grupo Não Fortificado) e 2006 (Grupo Fortificado), de janeiro a maio de 2008. Das 931 gestantes selecionadas, 458 eram do Grupo Não Fortificado (Grupo NF) e 473 do Grupo Fortificado (Grupo F). A anemia foi definida pela concentração de hemoglobina (Hb) menor do que 11g/dL, segundo o critério da Organização Mundial da Saúde. Os dados foram armazenados em duas planilhas de Excel Microsoft 2003 e analisados pelos softwares EpiInfo for Windows e Statistical Package for Social Sciences 16.0. Para o tratamento estatístico, foram utilizados o teste do Qui-quadrado para as comparações entre as variáveis dos dois grupos estudados e a associação da anemia e as suas variáveis relacionadas; e a análise de variância, para a comparação entre as médias da concentração de Hb. O nível de significância adotado foi de 5% (p=0,05). Resultados: dentre aquelas variáveis que se apresentaram semelhantes em ambos os grupos, observou-se que a média da idade das gestantes foi 24 anos, um pouco mais de metade delas vivia com companheiro, menos de 40% exerciam ocupação remunerada. Houve diferença estatística significativa no nível de escolaridade (p<0,001) e na inserção precoce no cuidado de pré-natal (p<0,001), em 2006 (Grupo F). A prevalência de anemia no Grupo NF foi de 29,5% e no Grupo F, 20,9%, diferença estatística significativa (p=0,003). Em relação à época da coleta do exame de Hb, os grupos apresentaram diferença estatística significativa (p<0,001), 42,5% das gestantes do Grupo F e somente 15,9% do Grupo NF realizaram a coleta no primeiro trimestre da gestação, o que provavelmente corroborou para a diminuição de prevalência de anemia do Grupo F, além de melhor escolaridade e início precoce da assistência de pré-natal. A análise de variância mostrou que as médias de Hb não apresentaram diferença estatística significativa (p>0,05), constatando que, aparentemente, não houve efeito da fortificação na concentração de Hb entre os grupos estudados. Conclusão: a prevalência de anemia foi menor no grupo fortificado, mas não foi possível comprovar o efeito da fortificação nos níveis da concentração de hemoglobina das gestantes estudadas / Introduction: iron deficiency anemia during pregnancy is characterized as a major public health problem. Since June 2004, the Brazilian government established that flour was fortified with iron following the international recommendations in order to minimize the anemia in the general population. Objective: To study the prevalence of anemia in pregnant women in an antenatal care service in the city of São Paulo, before and after fortification of flour with iron. Method: A cross sectional study with retrospective data collection from medical records of pregnant women attended in an antenatal care service in 2003 (non-fortified group) and 2006 (fortified group). Data were collected from January to May, 2008. The sample was composed by 931 pregnant women, 458 women were from non-fortified group (Group NF) and the other 473 from fortified group (Group F). It was adopted the anemia definition of World Health Organization, hemoglobin concentration (Hb) < 11g/dl. Data were storaged in two Microsoft Excel spreadsheets, 2003 and analysed by Epi Info and Statistical Package for Social Science 16.0. For statistical treatment it was used the Chi-square test for comparisons between variables of two groups and the association of anemia and its related variables, and analysis of variance for comparison between the average concentration of Hb. The significance level was 5% (p = 0.05). Results: Among those variables that showed similar in both groups, it was observed that the average age of women was 24 years, just over half of them lived with a partner, and less than 40% had paid occupation. The difference was statistically significant higher level of education (p <0001) and greater proportion of women with early inclusion in prenatal care (p <0001) in 2006 (Group F). The prevalence of anemia in the Group NF was 29.5% and in Group F was 20.9%, statistically significant difference (p = 0003). Regarding the time of blood collection to verify the Hb, the groups showed statistically significant difference (p <0001), with 42.5% of pregnant women in Group F and only 15.9% of Group NF performed the collection in the first trimester of pregnancy, which probably confirmed for the lower prevalence of anemia in Group F, in addition to better education and early pre-natal. The analysis of variance showed that the mean Hb do not show a statistically significant difference (p> 0.05), noting that, apparently, there was no effect of fortification on the concentration of Hb between the groups. Conclusion: The prevalence of anemia was lower in the fortified group, but was unable to demonstrate the effect of fortification on hemoglobin levels in pregnant women who were recruited in the study