The introduction of free mother and child services in South Africa in 1994, changed the way in which the services were delivered. There was an increase in the number of women seeking services, therefore a need arose to look at what constituted essential, basic services. The introduction of the maternal held card in State hospitals enabled the women to seek ante-natal care at the venue most accessible to her. This document also involved her in the responsibility of her own care and that of her unborn child. This study explored the information which mothers had been given ante-natally to assist them with the task of bearing the responsibility of their unborn child's health, which they had unilaterally been given by the Healthcare providers. A descriptive study was undertaken and 221 primigravid patients were interviewed at a large academic hospital post-delivery using a structured interview schedule. Their records were also reviewed retrospectively for type of delivery and foetal outcome. Results of the studies found that the mothers were given insufficient information to equip them with responsibility of assessing foetal health. Healthcare providers, it was found, did not give specific information and it appeared that at times, the mothers report of decreased foetal movement was disregarded. Implications of the study are that healthcare providers need to pay attention to how they provide information. The women interviewed clearly made the distinction between what was seen as 'teaching' and what was perceived as information given. It is also important to note that although the health workers understand the implications of foetal well-being, patients do not necessarily share the same insight or sense of responsibility. This has implications for the delivery of antenatal services in South Africa.

Decreased fetal movement can indicate uncommon complication of labor; in response, we have developed a non-invasive, wearable monitoring tool to objectively assess fetal movement called the Babykick device. The novelty of this device is that it moves away from a traditional subjective assessment of fetal movement to an objective, quantitative measurement that remains low-cost. The designed tool refrains from utilizing expensive and less available monitoring modalities such as ultrasound imaging, Doppler velocimetry or cardiotocography. Instead, the wearable consists of a piezo-sensitive belt that is wirelessly connected to a phone or tablet. It can be used to record the frequency and amplitude of fetal movements perceived passively and non-invasively on the surface of the abdomen of the pregnant woman for a period of up to one hour while she is supine or seated in a reclined position. The ndings from the Babykick device will be correlated with those from subjective maternal assessment and the observation of the Research Coordinator during the test. This low-cost, non-invasive wearable belt could potentially reduce negative outcomes such as stillbirth, perinatal mortality and neonatal morbidity in low- to middle-income settings and is anticipated to be useful for long-term home monitoring. / Graduate

<p>Bird incubation is a natural phenomenon that balances the needs of the parents for nourishment with the needs of the fetus for heat provision and protection. In this context, any means of communication between the fetus and the parents would have an adaptive value. The aim of the study was to investigate whether putative means of fetomaternal communication would correlate to physiological changes caused by environmental alterations. Oxygen consumption was used to measure fetal well being and six independent variables associated with fetal vocalizations and fetal movements were used to evaluate their potential for communicating the fetus statu quo. Broiler fetuses (<em>Gallus gallus domesticus</em>) of three developmental stages (day 18, internally pipped and externally pipped) were challenged by a stepwise reduction in ambient temperature down to 30ºC. A linear drop in oxygen consumption in response to lowered temperatures was found in all three developmental stages indicating that the fetus was affected by the temperature changes. No differences correlating with temperature variations were found in any of the variables associated with fetal vocalization. Fetal vocalizations are consequently not used to communicate the thermal status of the fetus. Movement occurrence, movement intensity and ventilation frequency, however, followed a “maximum peak” trend, with a highest response at the third temperature interval (35.0-35.5ºC). Considering that the lower limit of optimal development is between 35-36ºC, the results suggest that fetal movements can be of potential use to the incubating parent to assess the well-being of the fetus.</p>

Bird incubation is a natural phenomenon that balances the needs of the parents for nourishment with the needs of the fetus for heat provision and protection. In this context, any means of communication between the fetus and the parents would have an adaptive value. The aim of the study was to investigate whether putative means of fetomaternal communication would correlate to physiological changes caused by environmental alterations. Oxygen consumption was used to measure fetal well being and six independent variables associated with fetal vocalizations and fetal movements were used to evaluate their potential for communicating the fetus statu quo. Broiler fetuses (Gallus gallus domesticus) of three developmental stages (day 18, internally pipped and externally pipped) were challenged by a stepwise reduction in ambient temperature down to 30ºC. A linear drop in oxygen consumption in response to lowered temperatures was found in all three developmental stages indicating that the fetus was affected by the temperature changes. No differences correlating with temperature variations were found in any of the variables associated with fetal vocalization. Fetal vocalizations are consequently not used to communicate the thermal status of the fetus. Movement occurrence, movement intensity and ventilation frequency, however, followed a “maximum peak” trend, with a highest response at the third temperature interval (35.0-35.5ºC). Considering that the lower limit of optimal development is between 35-36ºC, the results suggest that fetal movements can be of potential use to the incubating parent to assess the well-being of the fetus.

Currently there is no test to accurately predict stillbirth. It is proposed that better identification of placental disease in utero may aid stillbirth prediction and prevention. Pregnancies complicated by reduced fetal movement (RFM) have increased risk of stillbirth. We hypothesised that RFM is a symptom of placental dysfunction associated with adverse pregnancy outcome (APO) and that this placental abnormality can be detected antenatally and used to identify fetuses at highest-risk of APO. We tested this hypothesis by: 1) comparison of ex vivo placental structure and function between APO RFM pregnancies and their normal outcome RFM counterparts, 2) comparison of in utero estimates of placental size, vascularity, vascular and endocrine functions obtained from placental ultrasound, Doppler waveform analysis and maternal circulating placentally-derived hormone concentrations, to their ex vivo correlates and 3) examination of the predictive potential of placental biomarkers at the time of RFM.Ex vivo placentas from APO RFM pregnancies, compared to normal outcome RFM counterparts, were smaller (diameter, area, weight and volume, p<0.0001), less vascular (vessel number and density, p≤0.002), with arteries that were less responsive to sodium nitroprusside (p<0.05), and with aberrant endocrine function (reduced tissue content and/or release of human chorionic gonadotrophin (hCG), human placental lactogen (hPL) and soluble fms-like Tyrosine Kinase-1 (sFlt-1), p<0.03). Placental volume (PV) ex vivo correlated with sonographic estimated PV (p<0.004), hPL, hCG and placental growth factor (PlGF) concentrations in the maternal circulation (p<0.03). Ex vivo villous vessel number and density correlated with Doppler impedance at the umbilical artery free-loop (UAD-F, p=0.02) and intraplacental arteries (p<0.0001) respectively, whilst UAD-F impedance correlated with arterial thromboxane sensitivity (p<0.04). Examination of placental structure and function at the time of presentation with RFM identified 15 independently-predictive biomarkers. Three potential predictive models, incorporating measures of placental size (PlGF), endocrine function (sFlt-1), arterial thromboxane sensitivity and villous vascularity (UAD-F), were proposed. Using these models, sensitivity for APO was improved from 8.9% with baseline care (assessment of fetal size and gestation) to up to 37.5% at a fixed specificity of 99% (p<0.05). This series of studies shows that antenatal placental examination is possible and improves identification of pregnancies at highest risk of stillbirth in a high-risk population by up to 29%. Therefore such tests merit further development to prospectively assess their ability to predict and prevent stillbirth itself.

INTRODUÇÃO: Gastrosquise é um defeito no fechamento da parede abdominal do feto que está relacionado a elevadas taxas de óbito intrauterino por mecanismos ainda desconhecidos. Em fetos normais, basicamente, todos os parâmetros da frequência cardíaca fetal (FCF) analisados na cardiotocografia computadorizada (CTGc) apresentam uma mudança significativa no decorrer da gestação. OBJETIVO: Descrever as características da FCF e o comportamento dos parâmetros avaliados pela CTGc anteparto, no período de 28 a 36 semanas de gestação. MÉTODOS: Estudo retrospectivo realizado na Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no período de janeiro de 2012 a junho de 2015, envolvendo pacientes com gestação única, feto vivo e portador de gastrosquise isolada que foram submetidas à avaliação antenatal pela CTGc (Sistema FetalCare). Os parâmetros avaliados foram: número de movimentos fetais por hora, frequência cardíaca fetal basal (FCF), desacelerações, acelerações, episódios de alta e baixa variação e variação de curto prazo. A análise não paramétrica para medidas repetidas (ANOVA não paramétrica) foi utilizada para análise comparativa dos parâmetros da CTGc em cada idade gestacional avaliada. RESULTADOS: O estudo envolveu 87 gestantes com média de 3,5 (1-9) avaliações cardiotocográficas por paciente. O número de avaliações cardiotocográficas em cada idade gestacional foi >= 20, exceto para a idade de 29 semanas (n = 16). Os principais parâmetros da FCF avaliados pela CTGc como a FCF basal e o STV não apresentaram mudança significativa. Apenas dois parâmetros da CTGc apresentaram mudança significativa no período avaliado: o número de exames com presença de episódios de baixa variação da FCF aumentou no decorrer da gestação (p = 0,019); e o número de acelerações acima de 15 batimentos por minuto aumentou no evoluir das idades gestacionais estudadas (p = 0,001). Nenhum dos outros parâmetros avaliados pela CTGc apresentou mudança significativa no decorrer do período avaliado: o número de movimentos fetais por hora (p = 0,244), a FCF basal (p = 0,606) e o STV (p = 0,145). CONCLUSÃO: O comportamento da FCF dos fetos com gastrosquise difere do padrão apresentado por fetos normais, já que a maioria dos parâmetros da FCF avaliados pela CTGc de fetos com gastrosquise não apresentou mudança significativa no período gestacional avaliado / INTRODUCTION: Fetal gastroschisis is an abdominal wall defect associated with high rates of intrauterine death of unknown mechanisms. In normal fetuses, basically all computerized cardiotocography (cCTG) parameters present a significant change across gestation. OBJECTIVE: To describe the antepartum cCTG parameters between 28 to 36 weeks gestation. METHODS: Retrospective study, accomplished in the Obstetrics Department of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - Brazil between January 2012 and June 2015, involving singleton pregnancies, with alive fetus and isolated gastroschisis that underwent to cCTG (System 8002-Sonicaid) during the antenatal care. The cCTG parameters evaluated were: number of fetal movements per hour, baseline fetal heart rate (FHR) decelerations, accelerations, episodes of high and low variation and short-term variation. A non-parametric analysis for repeated measures (nonparametric ANOVA) was used for comparative analysis of the mean distribution of each cCTG parameters throughout the study period. RESULTS: The study involved 84 pregnant women with a mean of 3.5 (1 - 9) cCTG records per patient. The number of records in each gestational age was >= 20 except for the weeks 29 (n = 16). The cCTG parameters that presented significant change during the study period were: increase in the number of records with episodes of low variation (p = 0.019); and increase in the number of accelerations higher than 15 beats per minute (p = 0.001). None of the others analyzed parameters showed significant changes during the study period, the number of movements/hr (p = 0,244), basal FHR (p = 0,606) and the STV (p = 0,145). CONCLUSION: Only two of the cCTG parameters changed significantly during the study period. Therefore, it seems that the behavior patterns of cCTG parameters, in gastroschisis fetuses, are not similar to the normal fetuses

INTRODUÇÃO: Gastrosquise é um defeito no fechamento da parede abdominal do feto que está relacionado a elevadas taxas de óbito intrauterino por mecanismos ainda desconhecidos. Em fetos normais, basicamente, todos os parâmetros da frequência cardíaca fetal (FCF) analisados na cardiotocografia computadorizada (CTGc) apresentam uma mudança significativa no decorrer da gestação. OBJETIVO: Descrever as características da FCF e o comportamento dos parâmetros avaliados pela CTGc anteparto, no período de 28 a 36 semanas de gestação. MÉTODOS: Estudo retrospectivo realizado na Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no período de janeiro de 2012 a junho de 2015, envolvendo pacientes com gestação única, feto vivo e portador de gastrosquise isolada que foram submetidas à avaliação antenatal pela CTGc (Sistema FetalCare). Os parâmetros avaliados foram: número de movimentos fetais por hora, frequência cardíaca fetal basal (FCF), desacelerações, acelerações, episódios de alta e baixa variação e variação de curto prazo. A análise não paramétrica para medidas repetidas (ANOVA não paramétrica) foi utilizada para análise comparativa dos parâmetros da CTGc em cada idade gestacional avaliada. RESULTADOS: O estudo envolveu 87 gestantes com média de 3,5 (1-9) avaliações cardiotocográficas por paciente. O número de avaliações cardiotocográficas em cada idade gestacional foi >= 20, exceto para a idade de 29 semanas (n = 16). Os principais parâmetros da FCF avaliados pela CTGc como a FCF basal e o STV não apresentaram mudança significativa. Apenas dois parâmetros da CTGc apresentaram mudança significativa no período avaliado: o número de exames com presença de episódios de baixa variação da FCF aumentou no decorrer da gestação (p = 0,019); e o número de acelerações acima de 15 batimentos por minuto aumentou no evoluir das idades gestacionais estudadas (p = 0,001). Nenhum dos outros parâmetros avaliados pela CTGc apresentou mudança significativa no decorrer do período avaliado: o número de movimentos fetais por hora (p = 0,244), a FCF basal (p = 0,606) e o STV (p = 0,145). CONCLUSÃO: O comportamento da FCF dos fetos com gastrosquise difere do padrão apresentado por fetos normais, já que a maioria dos parâmetros da FCF avaliados pela CTGc de fetos com gastrosquise não apresentou mudança significativa no período gestacional avaliado / INTRODUCTION: Fetal gastroschisis is an abdominal wall defect associated with high rates of intrauterine death of unknown mechanisms. In normal fetuses, basically all computerized cardiotocography (cCTG) parameters present a significant change across gestation. OBJECTIVE: To describe the antepartum cCTG parameters between 28 to 36 weeks gestation. METHODS: Retrospective study, accomplished in the Obstetrics Department of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - Brazil between January 2012 and June 2015, involving singleton pregnancies, with alive fetus and isolated gastroschisis that underwent to cCTG (System 8002-Sonicaid) during the antenatal care. The cCTG parameters evaluated were: number of fetal movements per hour, baseline fetal heart rate (FHR) decelerations, accelerations, episodes of high and low variation and short-term variation. A non-parametric analysis for repeated measures (nonparametric ANOVA) was used for comparative analysis of the mean distribution of each cCTG parameters throughout the study period. RESULTS: The study involved 84 pregnant women with a mean of 3.5 (1 - 9) cCTG records per patient. The number of records in each gestational age was >= 20 except for the weeks 29 (n = 16). The cCTG parameters that presented significant change during the study period were: increase in the number of records with episodes of low variation (p = 0.019); and increase in the number of accelerations higher than 15 beats per minute (p = 0.001). None of the others analyzed parameters showed significant changes during the study period, the number of movements/hr (p = 0,244), basal FHR (p = 0,606) and the STV (p = 0,145). CONCLUSION: Only two of the cCTG parameters changed significantly during the study period. Therefore, it seems that the behavior patterns of cCTG parameters, in gastroschisis fetuses, are not similar to the normal fetuses