No description available.

No description available.

No description available.

The objective of this work is to look at the feasibility of using heart rate variability analysis as a method of improving discrimination between those fetuses suffering distress and those not.;Heart rate variability analysis was applied to data acquired from rats who had undergone asphyxia for set durations of up to 7 minutes. From analysis in both the time and frequency domain, it was possible to clearly identify the occurrence of the injury. Further correlations were made between these results, pH levels and neurological assessments for the different durations of asphyxia. It was found that during and following the injury, the pH and the heart rate decrease as expected, but the overall change in heart rate variability was much more pronounced. Some interesting results were also found for the shorter durations of asphyxia which will be looked at.;Fetal heart rate data was collected before and during labour in normal patients and variability analysis of the heart rate was performed. The acquisition of heart rate data using Doppler ultrasound is discussed and comparisons made between heart rate data acquired non-invasively using Doppler ultrasound and that acquired invasively using the scalp electrode during labour. It was found that providing the ultrasound signals did not suffer greater from noise, a reasonable comparison of beat-to-heat intervals and the time domain measure of heart rate variability was possible. The application of these results is discussed.;In conclusion, it has been found that it is feasible to detect asphyxial distress in rats using the standard deviation of 30 second intervals of heart beats. It has also been possible to collect fetal heart rate data and perform a similar heart rate variability analysis however further work needs to be undertaken to find out if this is predictive of distress in the fetus during labour.

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No description available.

Society is gripped by an ever-increasing preoccupation with risk and it is generally believed that women aged over thirty-five years are 'labelled' as 'old' in terms of pregnancy and childbirth and both they and their babies are perceived as being 'at risk'. This study investigated the impact of these perceptions on the experiences of women themselves and the professionals providing their care. The srudy, based on an interpretive approach, was conducted in three stages. During stage one women and professionals were interviewed to explore perceptions and experiences of risk in pregnancy and childbirth for women over 35 years old, who were pregnant with their first baby. Stage two focused only on the women participants and postnatal interviews were undertaken on a sub-sample, from six weeks following childbirth, to investigate whether perceptions changed following birth and what influenced that change. The final stage brought together a focus group of women who had taken part in the study and a further group of professional participants, to feedback the initial fmdings. Ethical approval was granted and access to women was negotiated at Trust level, using a delegated 'link' midwife at each location. Professionals were approached directly by the researcher . . Following infonned consent, interviews with 20 nulliparous women aged 35-42 years old and 20 healthcare professionals, comprising midwives, obstetricians and general practitioners, were conducted on the basis of purposive sampling. The sample was drawn from four urban, NHS acute hospital Trusts in London and one corresponding GP surgery. The aim was to explore the everyday lived experiences of those involved in order to generate an understanding of risk and risk perception in women and their professional carers that could be used to develop more effective care and means of support for this population of women in the future. Thematic analysis identified six main themes within each group, which although many were common to both groups, were interpreted differently. These included: balancing risks with uncertainty, differing perceptions, learning from experience, the importance of others in highlighting risk and risk perception, it is not what is said but what is heard that is important, influence of the media on culture and society, a changed society, challenging the biological clock, professional beliefs and the 'wise older woman', choice as a mediator for risk, risk perception and the culture of care, a life transition and how the media influenced risk perceptions and practice. These are discussed during the course of this thesis. The implications are that understanding how risk is perceived and reducing uncertainty are fundamental to providing effective care for older childbearing women .

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No description available.

Postpartum haemorrhage (PPH) is the most common cause of maternal mortality leading to an estimated 86, 000 deaths/year. The most common cause of PPH is failure of the uterus to contract properly (uterine atony). Several measures have been introduced to prevent and treat atonic PPH, but in spite of active management of the third stage of labour (AMTSL), maternal deaths from PPH still occur. PPH can kill rapidly within two hours or less. PPH has long been recognised as a dangerous complication for mothers. In order to optimise the prevention and treatment of PPH, different approaches have been introduced and modified over the last century. We reviewed the regimes used in the management of the third stage of labour between 1917 and 2011 as described in the successive editions of the ‘Ten Teachers’ books. Throughout the Ten Teachers series, uterotonic drugs have always been taught as being the best initial measure to manage PPH. However, the importance of bimanual uterine compression (BMC) has increased gradually, moving from third to first treatment option over the editions (Aflaifel and Weeks, 2012a). The components of the AMTSL package for PPH prophylaxis have recently been extensively examined in clinical trials. Its effectiveness in reducing blood loss is now known to be almost all due to the uterotonics (Aflaifel and Weeks, 2012b). However, clinical trials evaluating the efficacy of uterotonics in treating PPH are comparatively rare. Where present they usually compare two uterotonics with an absence of control group, as it is unethical to leave a bleeding woman untreated. A recent innovation is to model the likely outcomes in the absence of uterotonic therapy through histograms. This also allows an assessment of the efficiency of treatment by measuring the number of women who stop bleeding shortly after administering treatments. This model has never previously been applied to databases in which uterotonics were used for prophylaxis. In a secondary analysis of 4 large randomised trials, small secondary histogram peaks (primarily attributed to a treatment effect) were still present even if uterotonic therapy had not been used. Furthermore, the study revealed that women were commonly treated at low levels of blood loss (< 500 mls). It was also seen that, of those diagnosed with PPH (≥ 500 mls), most stopped bleeding at blood losses of around 700 mls even if they did not receive any uterotonic therapy. This should warn against ascribing all the effect to uterotonic therapy. As well as stopping spontaneously, other physical therapies may also have been used concurrently and may have had an effect. The evidence from the histogram study suggested that use of additional uterotonic is not a good surrogate for PPH in the research context. Chapter 4 reports on evaluations of the outcomes that are used by researchers in PPH trials. In the 121 studies evaluated, there was a huge diversity in choosing the outcomes (PPH prevention). The most common was ‘Incidence of PPH ≥ 500 mls’, which was mentioned in 21% (25/121) of trials. The study interestingly showed that use of additional uterotonic was used for sample size calculation in 6% (7/121) of studies as a surrogate for PPH. The above findings emphasise the importance of physical measures in the early treatment of PPH. BMC is thought to help in treating PPH, although there are no clinical trials on its effectiveness. A survey was therefore conducted amongst obstetric care providers in the UK to look at the frequency of BMC use in clinical practice and the attitudes towards its use. The survey found that, although clinicians find BMC effective, it is rarely used as the procedure is considered to be too tiring and too invasive. If, however, BMC could be performed in a less invasive manner, then it could act as an effective low-cost treatment for those PPHs arising from atony. The thesis concludes with an investigation into a new low cost intervention that might contribute to the early physical management of PPH. The ‘PPH Butterfly’ is a new device that is designed to make uterine compression simpler, less tiring and less invasive. It was compared to the standard BMC in a mannequin model. The main objective was to compare the efficacy of the PPH Butterfly to standard BMC in producing sustained uterine compression. The study revealed that the PPH Butterfly is simple to use on a mannequin model, even among obstetric care providers with little experience. It produces an equivalent amount of pressure to BMC, but neither method produced sustained compression over the 5 minutes of use. It also demonstrates the feasibility of using a mannequin model for teaching and performing BMC.