Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg / Background and objectives Prelabour rupture of the membranes (PROM) is a major obstetric problem affecting about 20% of pregnancies. Complications include preterm labour, ascending intrauterine and perinatal infections, and neonatal mortality. Standard guidelines are formulated and continually reviewed to improve the clinical management of PROM and to reduce poor perinatal outcomes associated with this condition. The objectives of this study, conducted using women in Johannesburg as a sample population, were: 1) to audit the implementation of the standard protocol on management of PROM, and 2) to determine the maternal and fetal outcomes of this condition. Methods A cross-sectional descriptive study was done on women admitted to the antenatal wards of Chris Hani Baragwanath Academic Hospital with PROM. Inclusion criteria were that PROM was the main reason for admission, gestation ≥24 weeks, and maternal age 18 years or more. Hospital clinical files were studied for obstetric and clinical characteristics, adherence by doctors to the management protocol, and final outcome including latency period, induction rate, mode of delivery, and neonatal outcome. Results Ninety-seven women participated in the study. Their mean age was 27.0 years, and 37 (38%) were nulliparous. Eighty-five (87%) had attended antenatal clinic. Twenty-nine (30%) were HIV-infected, 23 (79%) of them on highly active antiretroviral treatment. 6 The mean gestational age on admission was 32.8 weeks, with 78 (80%) women having preterm PROM at GA<37 weeks and 52 (54%) at GA <34 weeks. The most frequent methods of diagnosis were visual inspection in 77 (79%), speculum examination in 49 (51%) and ultrasound scan in 81 (84%) of the women. Antibiotics were given to 96 women (99%), and antenatal corticosteroids were used in all women <34 weeks pregnant. No cases of clinical chorioamnionitis were detected. The mean latency from PROM to delivery for women <37 weeks pregnant was 15 days, and for those <34 weeks, it was 19 days. Twenty-nine women (30%) required induction of labour, and 25 (25.8%) had caesarean sections. There were 12 perinatal deaths (with the exclusion of three late neonatal deaths), resulting from prematurity (n=4), congenital anomalies (n=2), neonatal jaundice (n=2), respiratory distress syndrome (n=2) and perinatal asphyxia / hypoxic ischaemic encephalopathy (n=2). There were no recorded cases of either neonatal or puerperal sepsis. Conclusion The study may have under-represented term PROM, so the findings are most applicable to preterm PROM. The condition was mostly managed appropriately within the local protocol, especially in terms of corticosteroid and antibiotic use. Overt or clinically evident chorioamnionitis was not detected. However, the perinatal mortality rate was high, and whatever the causes of perinatal death in this group, it is clear that PROM is a high-risk condition deserving of close clinical attention.

Thesis advisor: Rosanna Demarco / For 21 years (1983-2004), the civil war in Sudan concentrated in the South resulting in massive population displacements and human suffering. Following the comprehensive peace agreement in 2005, the government of South Sudan is rebuilding the country's infrastructure. However, the post war South Sudan has some of the worst health indicators, lack of basic services, poor health infrastructure and severe shortage of skilled labor. The maternal mortality ratio for example is 2,054/100,000 live births, currently the highest in the world. Abortion complication leads among causes of admission at the gynecology units. This research contributes nursing knowledge on reproductive health among populations affected by war. The purpose was to explore the experiences of women with abortion complications in the post war South Sudan. Using qualitative descriptive methodology, in-depth interviews were conducted with 26 women following treatment for abortion complications at the gynecology unit of a county hospital. Data was collected from March 2nd to April 26th, 2008. Spontaneous abortion was the most common among study participants. Post abortion care was nonexistent at the community level health facilities, but present at the hospital. The women interviewed were reluctant to reflect in-depth about their experiences with abortion complications. They described the process, signs, symptoms and the events that led to the pregnancy loss, and were more concerned about regaining their reproductive function, a societal expectation of a married woman in South Sudan. A female child in South Sudan is assigned a "special" role in the family and community - that of getting married, attracting a high bride wealth paid as dowry to her parents and delivering children for the husband. Arranged and/or forced early marriage is common. A woman's world view about reproductive health and experiences with abortion complications is therefore influenced by this cultural context. Implications of these findings include the need to develop the nurse midwifery profession in South Sudan. Nurse midwives can lead in providing gender and culturally sensitive reproductive health services including post abortion care. Plans for care must include opportunities to listen to women's perspectives. / Thesis (PhD) — Boston College, 2010. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

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by Li Wen. / "April 2000." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2000. / Includes bibliographical references (p. 200-236). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

Lau, Tze Kin. / "May 1998." / Thesis (M.D.)--Chinese University of Hong Kong, 1998. / Includes bibliographical references (p. 165-178). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web.

Michael Scott Rogers. / Thesis (Ph.D.)--Chinese University of Hong Kong, 1997. / Includes bibliographical references (p. 265-314). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web.

by Chiu Pui Yu. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (leaves 86-118). / Abstracts in English and Chinese. / Title Page --- p.i / Abstract --- p.ii-iv / Acknowledgement --- p.v / Table of Contents --- p.vi-viii / List of Tables --- p.ix / List of Figures --- p.x-xii / List of Abbreviations --- p.xiii / Chapter Section I: --- Introduction / Chapter Chapter 1: --- Overview --- p.1-2 / Chapter Chapter 2: --- Teratogenic Effects of Hyperglycemia / Chapter 2.1 --- What is Hyperglycemia --- p.3 / Chapter 2.2 --- Teratogenic Effects of Hyperglycemia --- p.4-6 / Chapter 2.2.1 --- Human Studies / Chapter 2.2.2 --- Animal Studies / Chapter 2.3 --- Timetables for Embryogenesis: Rats versus Humans --- p.7 / Chapter 2.4 --- Mechanisms of Hyperglycemia Induced Teratogenesis --- p.8-12 / Chapter 2.4.1 --- What are Free Radicals? / Chapter 2.4.2 --- Major Free Radical Species Involvedin Hyperglycemic Teratogenesis / Chapter 2.4.3 --- Molecular Damage Induced by Reactive Oxygen Species / Chapter 2.4.4 --- Supporting Evidence of Reactive Oxygen Species Causing Anomalies / Chapter 2.4.5. --- Hyperglycemia and Formation of Free Radicals / Chapter Chapter 3: --- Caffeine as Teratogen and Antioxidant / Chapter 3.1 --- Popularity of Caffeine --- p.13 / Chapter 3.2 --- Basic Metabolism of Caffeine --- p.14 / Chapter 3.3 --- Biological Actions of Caffeine --- p.15 / Chapter 3.4 --- Teratogenicity of Caffeine --- p.16-20 / Chapter 3.4.1 --- Animal Studies / Chapter 3.4.1.1 --- Teratogenic Effects of Caffeine in Animals / Chapter 3.4.1.2 --- Teratogenic Dose of Caffeine / Chapter 3.4.1.3 --- Interspecies Sensitivity / Chapter 3.4.2 --- Human Studies / Chapter 3.5 --- Possible Mechanisms for the Teratogenic Actions of Caffeine --- p.21 / Chapter 3.6 --- Caffeine as an Antioxidant --- p.22 / Chapter 3.7 --- Combined Effects of Caffeine with Other Substances --- p.23 / Chapter Chapter 4: --- Combined Effects of Hyperglycemia and Caffeine on Early Embryogenesis- A Question to be Answered / Chapter 4.1 --- Possible Links between Hyperglycemia and Caffeine --- p.24 / Chapter 4.2 --- Objectives of the Present Study --- p.25 / Chapter 4.3 --- Hypothesis --- p.26 / Chapter Section II: --- Research Designs and Methods / Chapter Chapter 5: --- Materials and Methods / Chapter 5.1 --- Licenses --- p.27 / Chapter 5.2 --- Overall Study Design --- p.28-40 / Chapter 5.2.1 --- Whole Embryo Culture Model / Chapter 5.2.1.1 --- Animals / Chapter 5.2.1.2 --- Explantation of Embryos and Serum Collection / Chapter 5.2.1.3 --- Preparation of Serum / Chapter 5.2.1.4 --- Culture Media / Chapter 5.2.1.5 --- Embryo Culture / Chapter 5.2.2 --- Experimental Groups / Chapter 5.2.3 --- Morphological Assessment / Chapter 5.2.4 --- Quantitation of Oxidative Stress / Chapter 5.2.5 --- Protein Assay / Chapter 5.3 --- Statistical Evaluation --- p.41 / Chapter Chapter 6: --- Laboratory Considerations / Chapter 6.1 --- Whole Embryo Culture Model --- p.42-43 / Chapter 6.1.1 --- Subjects / Chapter 6.1.2 --- Time Mating / Chapter 6.1.3 --- Culture Medium / Chapter 6.1.4 --- Gas Phase and Rotating Bottle Culture Method / Chapter 6.2 --- Quantification of Oxidative Stress --- p.47-49 / Chapter 6.2.1 --- 8-Isoprostaglandins F2a as a Marker / Chapter 6.2.2 --- Assay for 8-Isoprostaglandins F2a / Chapter 6.2.2.1 --- Enzyme Immunoassay versus Gas Chromatography/ Mass Spectrometry / Chapter Section III: --- Results / Chapter Chapter 7: --- Results / Chapter 7.1 --- Justifications of Methods of Statistical Analysis --- p.50 / Chapter 7.2 --- Effects of Hyperglycemia on Early Embryogenesis --- p.51-56 / Chapter 7.2.1 --- Effects of Hyperglycemia on Morphological Development / Chapter 7.2.2 --- Effects of Hyperglycemia on Production of 8-isoprostaglandins F2a / Chapter 7.2.3 --- Effects of Hyperglycemia on Total Protein Content / Chapter 7.3 --- Effects of Caffeine on Early Embryogenesis --- p.57-61 / Chapter 7.3.1 --- Effects of Caffeine on Morphological Development / Chapter 7.3.2 --- Effects of Caffeine on Total Protein Content / Chapter 7.4 --- Combined Effects of Hyperglycemia and Caffeine on Early Embryogenesis --- p.62-66 / Chapter 7.4.1 --- Combined Effects of Hyperglycemia and Caffeine on Morphological Development / Chapter 7.4.2 --- Combined Effects of Hyperglycemia and Caffeine on Production of 8-isoprostaglandins F2a / Chapter 7.4.3 --- Combined Effects of Hyperglycemia and Caffeine on Total Protein Content / Chapter Section IV: --- Discussion and Conclusions / Chapter Chapter 8: --- Discussion --- p.67-83 / Chapter Chapter 9: --- Conclusions and Future Directions --- p.84 / Appendices --- p.85 / References --- p.86-118

Thesis (M Med (Family Medicine))--University of Limpopo, 2010. / The number of diabetic patients will continue to rise even in rural settings and the burden of this disease will continue to take its effect on the limited resources of these communities. The effect of such burden will be more pronounced if we are to add the various complications associated with substandard management of diabetes mellitus. The first step in assessing the level of care we give to this category of patients is to measure their level of adherence, in an effort to expose the pitfalls on both the side of the patients and on the side of the health care provider. The aim of the study is to assess the level of adherence to treatment among type2 diabetic patients in Matlala district hospital; Limpopo Province. This cross-sectional study used the convenience method of sampling with the aid of a tested, structured questionnaire, to obtain data from respondents between December 2009 and March 2010, a period of 4 months. The excel computer program was used for data capturing. Percentages and numbers were used for interpretation and cross tabulation was used to determine association. The result of the study indicated that 137 {70%} of the respondents adhere to diabetes treatment. There were two demographical characteristics that are significantly associated with non adherence: age {p=0.028} and employment status {p=0.018}. Of those respondents that keep their appointments, 98% are adherent to treatment. When considering reasons for poor adherence; 29% of respondents stated that the clinic did not have their pills, 16% stated that they forgot to take their medication and 14% stated that they travelled to visit ix and did not take enough pills with them. On the reasons for poor adherence to lifestyle: 29% of the respondents said that they were too old, 22% stated no specific reason, 13% struggled to motivate themselves and 10% simply forgot what to do. Most, 68%, of the respondents that adhere to the recommended use of medication agreed that they take it at meal time, 14% set a reminder, 8% employed the assistance of a treatment supporter and other respondents used other means to remember. The study revealed an above average level of adherence in my setting and it will be logical to assess whether this corresponds to the metabolic control expected of good adherence. More is needed to be done on the reasons why our patients do not adhere to both medication and lifestyle changes and each stake holder needs to address their short comings.

Thesis (M.Cur.) --University of Limpopo, 2011 / Introduction and aim: Globally it is of paramount importance that all pregnant women in labour are monitored by midwives utilizing a partograph so that a live baby is delivered. Midwives seemed not to utilize the partograph correctly when monitoring women in labour. The purpose of this study was to determine the utilization of the partograph by midwives in the labour wards of Lebowakgomo and Zebediela level 1 hospitals in the Capricorn District of the Limpopo Province, South Africa. The research question was, “What skills and knowledge do midwives have on the utilization of the partograph for monitoring pregnant women in labour”. The objectives of this study were to explore and describe the utilization of the partograph by midwives in Lebowakgomo and Zebediela level 1 hospitals in the Capricorn District of the Limpopo Province, and to develop guidelines that would assist midwives to effectively utilize the partograph hence provision of quality midwifery care. Research Design and method: The research design was qualitative, descriptive, explorative and contextual in nature. The population comprised all midwives registered with the South African Nursing Council and practicing as such in Lebowakgomo and Zebediela level 1 hospitals. A purposive sampling technique was used to select 15 participants. Data were collected using semi-structured in–depth interviews with a guide. The semi-structured in-depth interviews were conducted until data were saturated. Trustworthiness was ensured by credibility, dependability, transferability and confirmability. Ethical clearance to conduct the study was obtained from the University of Limpopo and from the Department Health and Social Development. The principles of informed consent, confidentiality and anonymity were observed during the study. Data were analyzed using the Tesch’s approach as described by Creswell (1994) cited in de Vos (2005:333). Conclusions: The following themes emerged during data analysis: monitoring of foetal status during intrapartum, monitoring of the progress of labour during intrapartum, monitoring of the maternal status during intrapartum, and shortage of staff in the labour wards. Guidelines which aimed at improving midwifery care were formulated.

Typescript. Bibliography: leaves 131-167.