The primary purpose of CTG is to detect early signs of intrapartum hypoxia and improve foetal outcomes. Intrapartum hypoxia remains the major cause of perinatal deaths mainly in monitored labours. This is attributed to the midwives’ lack of skills in the foetal implementation and interpretation of CTG. Midwives interpret foetal heart rate patterns erroneously hence they fail to detect early signs of severe foetal compromise. Accurate interpretation of CTG is the cornerstone for clinical decision during intra-partum foetal surveillance. Therefore, it is mandatory that midwives are competent in CTG. The purpose of the study was to explore and describe the perceptions of midwives in KwaZulu-Natal public hospitals regarding their level of competence related to the CTG. The purpose of the study was to explore and describe the perceptions of midwives in KwaZulu-Natal public hospitals regarding their level of competence related to the CTG. The objectives of this study were: -to explore and describe the perceptions of the midwives regarding their level of competence relating to cardiotocography. -to establish the levels of competence of midwives in relation to CTG. -to develop clinical guidelines that could be utilised by midwives in the implementation and interpretation of the cardiotocograph. The study utilised a quantitative non-experimental comparative descriptive research design. A self-developed and self-administered questionnaire was developed under the supervision of a statistician and was to collect data from a purposively selected sample of midwives who work in labour wards in Kwa-Zulu Natal public hospitals. A sample of 226 practicing midwives working in labour wards of the nine KZN public hospitals was selected using a non-probability convenience sampling method; only 125 responded. Data were collected on an excel spread sheet and analysed under the supervision of the statistician and research supervisor. The researcher assured of validity and reliability of the data collection method and data as well as of the data collection instrument. The findings revealed that the midwives in KZN public hospitals perceived themselves as being competent regarding CTG tasks; however they lack knowledge and skills in the implementation and interpretation of CTG. It was also evident that the midwives’ years of midwifery clinical experience, labour ward experience, possession of additional post basic midwifery qualification and the perceived level of competence related to CTG tasks number of years of the midwives did not influence their level of competence in the implementation and interpretation of CTG. Literature control supported these findings and there was consistency with that literature. Recommendations were made and clinical guidelines were developed to assist midwives with the assessment of foetal heart rate and the interpretation of the cardiotocograph results.

This study examined effectiveness of heart rate variability (HRV) biofeedback-assisted stress management training in reducing anxiety and stress in pregnant women and the effect of maternal stress management skills practice on fetal heart rate measures in real time. Participants were seven working pregnant women who volunteered in response to recruitment announcements and invitations from cooperating midwives. Reported state and trait anxiety and pregnancy specific stress were measured during five 45- to 50-minute training sessions. Training included bibliotherapy, instruction in the use of emotion-focused stress management techniques, and HRV biofeedback. Subjects used portable biofeedback units for home practice and were encouraged to practice the skills for 20 minutes a day and for short periods of time during stressful life events. At the end of training, fetal heart rate was monitored and concurrent maternal HRV measures were recorded. Repeated measures ANOVA and paired samples t-test analysis of study data revealed no statistically significant reductions in state or trait anxiety measures or in pregnancy specific stress measures. Partial eta squared (n²) and Cohen's d calculations found small to medium effect sizes on the various test scales. Friedman's analysis of variance of biofeedback measures showed a statistically significant decrease in low HRV coherence scores (X2 = 10.53, p = .03) and medium HRV coherence scores (X2 = 11.58, p = .02) and a statistically significant increase in high HRV coherence scores (X2 = 18.16, p = .001). This change is an indication of improved autonomic function. Results of concurrent maternal and fetal HRV recordings were generally inconclusive. A qualitative discussion of individual subject results is included. During follow-up interviews five subjects reported that they felt they were better able to cope with stress at the end of the study than at the beginning, that they used the stress management skills during labor, and that they continue to practice the skills in their daily lives.

Despite the unprecedented improvement in child health in last 15 years, burden of stillbirth and neonatal death remain the key challenge in Nepal and the reduction of these deaths will be crucial for reaching the health targets for Sustainable development goal by 2030. The aim of this thesis was to explore the risk factors for stillbirth and neonatal death and change in perinatal outcomes after the introduction of the Helping Babies Breathe Quality Improvement Cycle (HBB QIC) in Nepal. This was a prospective cohort study with a nested case-control design completed in a tertiary hospital in Nepal. Information were collected from the women who had experienced perinatal death and live birth among referent population; a video recording was done in the neonatal resuscitation corner to collect information on the health workers’ performance in neonatal resuscitation.  Lack of antenatal care had the highest association with antepartum stillbirth (aOR 4.2, 95% CI 3.2–5.4), births that had inadequate fetal heart rate monitoring were associated with intrapartum stillbirth (aOR 1.9, CI 95% 1.5–2.4), and babies who were born premature and small-for-gestational-age had the highest risk for neonatal death in the hospital (aOR 16.2, 95% CI 12.3–21.3). Before the introduction of the HBB QIC, health workers displayed poor adherence to the neonatal resuscitation protocol. After the introduction of HBB QIC, the health workers demonstrated improvement in their neonatal resuscitation skills and these were retained until six months after training. Daily bag-and-mask skill checks (RR 5.1 95% CI 1.9–13.5), preparation for birth (RR 2.4, 95% CI 1.0–5.6), self-evaluation checklists (RR 3.8, 95% CI 1.4–9.7) and weekly review and reflection meetings (RR 2.6, 95% 1.0–7.4) helped the health workers to retain their neonatal resuscitation skills. The health workers demonstrated improvement in ventilation of babies within one minute of birth and there was a reduction in intrapartum stillbirth (aOR 0.46, 95% CI 0.32–0.66) and first-day neonatal mortality (aOR 0.51, 95% CI 0.31–0.83).  The study provides information on challenges in reducing stillbirth and neonatal death in low income settings and provides a strategy to improve health workers adherence to neonatal resuscitation to reduce the mortality. The HBB QIC can be implemented in similar clinical settings to improve quality of care and survival in Nepal, but for primary care settings, the QIC need to be evaluated further.

L’analyse visuelle du rythme cardiaque fœtal (RCF) est une excellente méthode de dépistage de l’hypoxie fœtale. Cette analyse visuelle est d’autre part sujette à une variabilité inter- et intra-individuelle importante. L’hypoxie fœtale au cours du travail s’exprime par des anomalies du RCF. La sous-évaluation de la gravité d’un RCF entraine une prise de risque indue pour le fœtus avec une augmentation de sa morbi-mortalité et sa surévaluation entraine un interventionnisme obstétrical inutile avec une augmentation du taux de césariennes. Ce dernier point pose par ailleurs en France un problème de santé publique.L’analyse automatisée du signal RCF permet de diminuer la variabilité inter- et intra-individuelle et d’accéder à d’autres paramètres calculés visant à augmenter la valeur diagnostique. Les critères d’analyse morphologiques du RCF (ligne de base, nombre d’accélérations, nombre et typage des ralentissements, variabilité à long terme (VLT)) ont été décrits ainsi que d’autres tels que les surfaces des ralentissements, les indices de variabilité à court terme (VCT) et les analyses fréquentielles. Il n’en demeure pas moins que la définition de la ligne de base, à partir de laquelle sont repérés les accélérations et les ralentissements reste, dans certains cas, difficile à établir.L’objectif principal de la thèse est d’établir un modèle prédictif de l’acidose fœtale à partir d’une analyse automatisée du RCF. L’objectif secondaire est de déterminer la pertinence des différents paramètres élémentaires classiques (CNGOF 2007) (fréquence de base, variabilité, accélérations, ralentissements) et celle d’autres paramètres inaccessible à l’œil (indices de variabilité à court terme, surfaces des ralentissements, analyse fréquentielle…). Par la suite, nous voulons identifier des critères de décision qui aideront à la prise en charge obstétricale.Nous proposons d’aborder l’analyse automatisée du RCF pendant le travail par l’intermédiaire d’une étude cas-témoins ; les cas étant des tracés RCF de nouveau-nés en acidose néonatale (pH artériel au cordon inférieur ou égal à 7,15) et les témoins, des tracés RCF de nouveau-nés sans acidose (pH artériel au cordon supérieur ou égal à 7,25). Il s’agit d’une étude monocentrique à la maternité de l’hôpital Saint Vincent de Paul, GHICL – Lille, sur notre base de données « Bien Naitre » (archivage numérique des tracés RCF depuis 2011), comptant un un nombre suffisant de cas sur ce seul centre. La maternité Saint Vincent de Paul (GHICL) présente depuis 2011 environ 70 cas par an d’acidose néonatale (pHa ≤ 7,10) (3,41%). Le logiciel R sera utilisé pour l’analyse statistique / Visual analysis of the fetal heart rate FHR is a good method for screening for fetal hypoxia but is not sufficiently specific. The visual morphological analysis of the FHR during labor is subject to inter- and intra-observer variability – particularly when the FHR is abnormal. Underestimating the severity of an FHR leads to undue risk-taking for the fetus with an increase in morbidity and mortality and overvaluation leads to unnecessary obstetric intervention with an increased rate of caesarean section. This last point also induces a French public health problem.FHR automated analysis reduces inter and intra-individual variability and accesses other calculated parameters aimed at increasing the diagnostic value. The FHR morphological analysis parameters (baseline, number of accelerations, number and typing of decelerations, long-term variability (LTV)) were described as well as others such as the decelerations surfaces, short-term variability (STV) and frequency analyzes. Nevertheless, when attempting to analyze the FHR automatically, the main problem is computation of the baseline against which all the other parameters are determined.Automatic analysis provides information on parameters that cannot be derived in a visual analysis and that are likely to improve screening for fetal acidosis during labor.The main objective of the thesis is to establish a predictive model of fetal acidosis from a FHR automated analysis. The secondary objective is to determine the relevance of the classical basic parameters (CNGOF 2007) (baseline, variability, accelerations, decelerations) and that of other parameters inaccessible to the eye (indices of short-term variability, surfaces of decelerations, frequency analysis ...). Later, we want to identify decision criteria that will help in the obstetric care management.We propose to validate FHR automated analysis during labor through a case-control study; cases were FHR recordings of neonatal acidosis (arterial cord pH less than or equal to 7.15) and controls, FHR recordings of neonatal without acidosis (arterial cord pH upper than or equal to 7.25). This is a monocentric study at the maternity hospital of Saint Vincent de Paul Hospital, GHICL - Lille, on our « Well Born » database (digital archiving of RCF plots since 2011), with a sufficient number of cases on this only center. Since 2011, the Saint Vincent de Paul hospital (GHICL) has had about 70 cases per year of neonatal acidosis (pHa less than or equal to 7.10) (3.41%). The R software will be used for statistical analysis.

Text in English with abstracts in English, Northern Sotho, Tshivenda and Xitsonga / The purpose of this study was to determine the self-reported competence of newly qualified professional nurses on the critical midwifery skills. The study was conducted in the four public hospitals designated for community service in Gauteng Province. A quantitative descriptive design was used with a structured self-report questionnaire as data collection instrument. Non-probability convenience sampling was used for the study. The sample size was eighty-four newly qualified professional nurses. The Stata 15 software was used for statistical analyses. The researcher used descriptive statistics to describe and synthesize the collected data. The findings revealed that most newly qualified professional nurses had no knowledge in identifying different types of decelerations, management of late and variable decelerations, but had knowledge in most of the skills related to management of third stage of labour. / Maikemišetšo a dinyakišišo tše e be e le go hwetša bokgoni bja go ipega ka nnoši bja baoki bao ba ithutetšego profešene ya booki ka go bokgoni bjo bohlokwa bja pelegišo. Dinyakišišo di dirilwe dipetleleng tše nne tša bohle tšeo di kgethetšwego tirelo ya setšhaba ka Profenseng ya Gauteng. Khwanthitheitif diskriptif disaene ‘Quantitative descriptive design’ e dirišitšwe gammogo le lenaneopotšišo leo le beakantšwego la go ipega ka nnoši ‘structured self-report questionnaire’ bjalo ka sedirišwa sa go kgoboketša bohlatsi. “Non-probability convenience sampling” e dirišitšwe mo go kgetheng banyakišišwa. Bogolo bja sešupo e be e le baoki ba masomeseswai-nne ba baswa bao ba ithutetšego profešene ya booki. “Stata 15 software” e dirišitšwe tshekatshekong ya dipalopalo. Monyakišiši o dirišitše dipalopalo tša tlhalošo ‘descriptive statistics’ go hlaloša le go kopanya ‘data’ yeo e kgobokeditšwego. Ditšweletšo di utollotše gore bontši ba baoki ba baswa bao ba ithutetšego profešene ya booki ga ba na le tsebo ya go hlatha mehuta yeo e fapanego ya diphokotšo, taolo ya diphokotšo tša morago le tša go fetoga, efela ba na le tsebo ka go bokgoni bjo bontši bjoo bo amanago le taolo ya kgato ya boraro ya lešoko. / Ndivho ya ngudo iyi yo vha u wanulusa nḓivho ya vhukoni ha iwe muṋe ya vhaongi vhaswa vha kha ḓi bvaho u phasa vhuongi uri vha na zwikili zwa ndeme zwa vhuongi vhubebisi u swika ngafhi. Ngudo iyi yo itwa kha zwibadela zwiṋa zwa muvhuso zwo ṋewaho u isa tshumelo zwitshavhani kha vunḓu ḽa Gauteng. Kha u kuvhanganya mafhungo muṱoḓisi o shumisa ngona ya u ṱalutshedza ya khwanthithethivi ho ṱanganyiswa na mbudziso dzo dzudzanyiwaho dzi bviselaho khagala kha iwe muṋe (structured self-report questionnaire). Vhunanguludzi ho shumiswaho kha ngudo iyi ho vha “Non-probability convenience”. Tshivhalo tsha vhashelamulenzhe vho nanguludzwaho tsho vha vhaongi vhaswa vha kha ḓibvaho u phasa vha fumalo ina. “The Stata 15 software” ndi tshishumiswa tsho shumiswaho kha u sengulusa mafhungo o kuvhanganywaho. Muṱoḓisisi o shumisa zwisiṱatisitika zwa u ṱalutshedza kha u ṱalutshedza na u dzudzanya mafhungo o kuvhanganyiwaho. Ngudo iyi yo bvisela khagala uri vhunzhi ha vhaongi vhaswa vha kha ḓi bvaho u phasa a vha na nḓivho ya u vhona tshaka dzo fhambanaho dza kurwele kwa mbilu ya ṅwana na u langa u lenga ha u rwa ha mbilu ya ṅwana zwo katela na u sa dzudzanyea fhethu huthihi ha kurwele kwa mbilu ya ṅwana, honeha vha na nḓivho ya zwikili zwi yelanaho na vhulanguli ha tshipiḓa tsha vhuraru tsha u beba. / Xikongomelo xa ndzavisiso lowu i ku kuma vuswikoti lebyi munhu a byi twisisaka hi vaongori lava ha ku thwaselaka tidyondzo ta vuongori eka swikili swa nkoka hi vusungukati. Ndzavisiso lowu wu endliwile eka swibedlhele swa mune swa mani na mani leswi yisaka vukorhokeri evanhwini eka Phurovhinsi ya Gauteng, laha ku tirhisiweke maendlelo ya tinhlayo lama hambanaka na swivutiso ku hlengeleta timhaka. Ku tirhisiwile xiphemu xo karhi xa vanhu ku kuma vuxokoxoko hi mayelano na vona hinkwavo. Xiphemu lexi tirhisiweke i xa nhlayo ya vaongori vo ringana makumenhungu-mune wa vaongori lawa ha ku thwaselaka tidyondzo ta vuongori. Ku tirhisiwile “stata software” ku hlela tinhlayo leti tirhisiweke. Mulavisisi u tirhisile tinhlayo, tinhlayonhlamuselo ku hlamusela no katsakanya mahungu lama a ma hlengeleteke. Leswi kumiweke swi paluxa leswaku vunyingi bya vaongori lava ha ku thwaselaka tidyondzo ta vuongori va hava vutivi byo hambanisa mabelo ya mbilu, ku hlawula ku hlwela no hambana ka mabelo ya mbilu, kambe va na vutivi eka swikili mayelana no lawula xiyimo xa vunharhu xo lumiwa. / Health Studies / M.A. (Nursing)