No description available.

No description available.

Reproductive success, the birth of a healthy child, may be seen in mechanical terms as the uncomplicated filling, enlargement and subsequent emptying of the uterus: a quite remarkable organ. Much clinical activity by obstetricians concerns the need to prevent premature emptying of the uterus and in turn causing it to expel the fetus at the appropriate time. Many believe a successful conclusion preferably includes the expulsion of the fetus safely per via naturales. Currently concern is expressed in many countries about the increasing frequency of Caesarean birth. An understanding of uterine activity is important for effective management of several pregnancy complications. However, this thesis is restricted to the birth process itself: the intra partum period. Several investigations have documented uterine activity at various times. However, detailed analysis correlated with the various phases of labour had not been undertaken. Previous workers had omitted to study normal events before abnormal ones effectively working without a normal range. The progress of labour has to be understood within the context of the nature of its onset and subsequent documentation of dilatation of the uterine cervix on a partogram: a graphic representation of labour. Preliminary work was undertaken to clarify types of labour progress and subsequent outcome of the labour according to the cervical dilatation pattern (cervimetric progress). The next step complemented this with a study of intrauterine pressure changes and the evolution adequately undertaken bearing in mind the important variables of parity and actual cervical dilatation at the time. Uterine activity profiles during labour were generated and significant differences shown according to parity. Induced labour was then studied documenting comparative profiles and the cumulative uterine activity as labour progressed. This led to the development of the concept of the total uterine activity in labour reflecting the resistance to the fetus passing through the birth canal: the cervical and pelvic tissue resistance. These results may be applied in the rational management of difficult labours permitting the appropriate use of oxytocic drugs and providing the data to determine the appropriate use of Caesarean delivery.

No description available.

No description available.

No description available.

No description available.

This thesis describes an intensive, longtitudinal study of a small group of women who were expecting their first babies, in an attempt to describe what it was like for them to be pregnant. The sample were mainly the wives of manual workers who fell outside the managerial ranks (as defined by the Socio-Economic classifications). The work relies upon detailed analysis of three semi-structured tape-recorded interviews per woman, conducted at different periods of their pregnancy. Through giving an overall picture of first pregnancy, I have tried to highlight the variety of reactions to it, and elucidate the range of experiences and definitions that the women had of the situation. The underlying theme of the thesis is the problem of uncertainty, and many of the issues discussed are manifestations of this theme. The first part of the analysis looks at the question of identity. This is closely related to the discussion of body image which follows. The women's perceptions of their identity and body image led many of them to feel embarrassed by certain aspects of their obstetric care. The thesis then considers one of the women's central preoccupations: the management of pain during labour. The second part of the analysis begins by discussing their images of babies, and considers how they coped with their children during their early days as mothers. It goes on to suggest that their reactions to motherhood could be expressed as a continuum based predominantly on their images of themselves and their bodies. In conclusion, the women's perceptions of the meaning of the transition to motherhood are then discussed, and the thesis ends with a summary of some of the implications which the study holds for the maternity services.

The aim of the study was to test an intervention aimed at reducing fat intake in type 1 diabetic children. Method: The intervention involved an individual assessment of the child's dietary intake and a personalised behavioural approach which included the setting of goals to facilitate appropriate food choices. Several quantitative measures were used to assess dietary intake, blood indices, knowledge and perceptions, at the intervention and one year thereafter. Results: Total fat intake in these children was lower than expected before the intervention, probably because dietary changes had occurred following the diagnosis of diabetes. Nevertheless, following the intervention, a modest but statistically significant, decrease in fat intake of 1.4% of total energy was achieved from 36.3% to 34.9%. Other measurable and desirable changes were found in food choices and most foods chosen as dietary goals. Some of these changes were statistically significant. Individuals who reported the achievement of all dietary goals accomplished the greatest fat reduction (2.1% of total energy). The consumption of high fibre foods, including fruit and vegetables was low. No changes were observed in serum lipoproteins or glycaemic control. Knowledge of healthy eating principles was good but appeared to be superficial, as the perception of fat intake was not related to actual intake. The majority of participants did not perceive that the intervention made a substantial difference to their fat intake. Conclusion: In the absence of a contemporaneous control group it is difficult to disentangle the effects of background secular trends. However, the overall findings suggest that fat intake can be reduced through an individualised, focused and practical approach to dietary education in motivated children with diabetes. Recommendations are made to improve the intervention and to target groups with specific dietary needs.

Plasma AEA levels were measured by ultra-performance liquid chromatography and mass-spectrometry throughout the menstrual cycle in healthy women both cross-sectionally and longitudinally. Plasma and follicular fluid (FF) AEA levels were also determined in women undergoing in-vitro fertilisation and embryo transfer (IVF-ET) and correlations between FF AEA and follicle size and oocyte maturity were undertaken. Plasma AEA levels were then measured in these women on the day of oocyte retrieval (OR), embryo transfer (ET) and at pregnancy test (PT) and comparisons made between pregnant and non-pregnant women and between those with viable pregnancies and those who had miscarried at 6 weeks. The relationship between plasma AEA and sex steroids in the stimulated cycles was also examined. AEA was found to be hormonally regulated, mainly by gonadotrophins and estradiol, and its highest levels were at ovulation and low at the implantation window in natural and stimulated cycles. The endocannabinoid system was localised in human ovary, FF AEA was associated with folliculogenesis, ovulation and oocyte maturity. ROC analysis indicated that a FF AEA concentration of 1.09 nM discriminated between mature and immature oocytes. In successful pregnancies a significant decline in plasma AEA levels from ovulation to the day of ET than a significant rise from the day of ET to the day of PT appeared to be important Plasma AEA levels were high at 4 and 5 weeks gestation and then significantly declined at 6 weeks gestation. These data may show the potential for using AEA as a biomarker test for oocyte assessment and to improve pregnancy outcomes in stimulated IVF/ICSI cycles.