Thesis (MMedVet (Gyn))--University of Pretoria, 2006. / Includes bibliographical references.

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Objective: Mastitis is a common and painful condition experienced in up to 33% of breast-feeding women (Cusack & Brennan, 2011; Jahanfar, Ng & Teng, 2009; Scott, Robertson, Fitzpaterick, Knight, & Mulholland, 2008; Spencer, 2008). The period following having a baby may be emotionally and physically demanding due to the physical, hormonal and lifestyle changes a woman undergoes (Cusack & Brennan, 2011). Developing mastitis during this time may therefore be debilitating and has been found to be a common reason for discontinuing breastfeeding. This study aimed to explore women’s experiences of breast-feeding and mastitis, the formal and informal support that was available to them when they had mastitis, and the impact it had on whether they continued or discontinued breastfeeding (Amir, Forster, Lumley & McLachlan, 2007; Cleminson, Oddie, Renfrew & McGuire, 2015). Method: Grounded theory was used to analyse the data. Sixteen women who had experienced mastitis were included in the study. Results: All of the women intended to breast-feed. However, they often experienced problems early on (i.e. engorgement and nipple damage) that were unexpected and left them feeling exhausted and emotional. These problems precipitated mastitis. Mastitis was for most, a very difficult experience sometimes leading to discontinuation of breast-feeding. Delaying help-seeking negatively affected health outcomes. Determination and receiving good advice and support were fundamental factors in breast-feeding continuation. Conclusion: Improved support, communication, and advice with breast-feeding from the outset would reduce the risk of problems occurring and persisting, and potentially reduce the risk of mastitis developing. Early diagnosis and treatment of mastitis once it has developed is very important. Understanding that breast-feeding is a skill that often encompasses both ups and downs may reduce the pressure women put on themselves when they feel like they are failing because it is not going as well as they expected it to. Once mastered, women found breast-feeding to be a lovely bonding experience that exceeded their expectations.

Phosphoinositide-3-kinase (PI3K)/Akt dependent signaling has been shown to improve outcome in sepsis/septic shock. There is also ample evidence that PI3K/Akt dependent signaling plays a crucial role in maintaining normal cardiac function. We hypothesized that PI3K/Akt signaling may ameliorate septic shock by attenuating sepsis-induced cardiac dysfunction. Cardiac function and survival were evaluated in transgenic mice with cardiac myocyte specific expression of constitutively active PI3K isoform, p110α (caPI3K Tg). caPI3K Tg and wild type (WT) mice were subjected to cecal ligation/puncture (CLP) induced sepsis. Wild type CLP mice showed dramatic cardiac dysfunction at 6 hrs. Septic cardiomyopathy was significantly attenuated in caPI3K CLP mice. The time to 100% mortality was 46 hrs in WT CLP mice. In contrast, 80% of the caPI3K mice survived at 46 hrs after CLP (p30 days (p

A consistent trend in global migration has resulted in a rapidly growing multicultural population here in the United States. This trend highlights the importance of increasing nurses' cultural awareness since they will increasingly interact with the diverse populations migrating here from around the globe. This is particularly relevant for providers of obstetrical care since childbirth, being an experience fundamental to human existence and thus a most significant life event, is largely influenced by the culture in which the birthing woman is most familiar. The American Academy of Nurses and the American College of Nurse Midwives, recognize that there is yet no theoretical framework regarding migration and its implications for nursing care during pregnancy and childbirth. Therefore, this investigation seeks a greater understanding of the out-of-culture birth experience from the perspective of Cambodian mothers in the United States. It is hoped this research will contribute to nursing knowledge by extending one's understanding of childbirth as it occurs as an out-of-culture experience for women who have emigrated here from Cambodia.

No description available.

Background and Objectives: To date, no research has examined the prevalence and management of suspected fetal macrosomia in midwifery care, which may provide an alternative approach to cesarean section and induction with improvements in maternal and infant outcomes. The objectives of this study were to 1) determine the prevalence of fetal macrosomia and adverse outcomes that may result from a macrosomic birth in the MANAstats database; 2) identify the maternal characteristics which predict macrosomia; 3) determine the adverse maternal and infant outcome differences among macrosomic and normal weight infants in the MANAstats database. Methods: We analyzed 10,011 midwifery reported pregnancy and birth records from midwives across North America from January 2007- December 2009. After excluding for certain high-risk criteria, we compared the prevalence and adverse outcomes associated with macrosomic infants (4000-4499 grams, 4500-4999 grams, and >5000 grams) to non-macrosomic infants who weighed 3000-3000 grams. Results: The prevalence of macrosomia according to >4000 grams criteria was 24.7% and >4500 grams 5.53%. Maternal risk factors for macrosomia included: Caucasian race, married, maternal age between 15-34 years, and a gestational length greater than 40 weeks. The proportion of obstetric and infant complications showed a progressive and significant increase among the macrosomic birth weight categories with the highest risk at >5000 grams. The risk of shoulder dystocia (4000-4449-g infants: odds ratio, 4.08 [95% CI, 3.27-5.09]; 4500-4999-g infants: odds ratio, 8.31 [95% CI, 6.20-11.14]; and >5000-g infants: odds ratio, 29.92 [95% CI, 17.42-51.39]) and 5-minute Apgar scores 5000-g infants: odds ratio, 10.23 [95% CI, 2.32-45.13]) posed the highest risk in comparison to previous research on this topic. The prevalence of cesarean section among all groups was less than 9% and not found to be statistically significant by birthweight group. Conclusion: It is unclear if the risks shoulder dystocia and 5-minute Apgar scores < 3 outweigh the risks of prophylactic cesarean section on perceived macrosomic infants without jeopardizing maternal and infant health. Until further research regarding the risk versus benefit of alternatives to macrosomic vaginal birth, we recommend that strategies to prevent Grades II and III macrosomia need to be incorporated into the midwifery model of care. / Epidemiology

The success of any civilisation rests on a number of factors, to include their ability to procreate and produce heirs. This given, the health of women in any society is of most importance given their primary role in both birth and raising children. The study of medicine dedicated to the care of women in ancient Egypt is of vital importance and to this end, various archaeological finds have been consulted and analysed. Information in the field gynaecology shows a relatively advanced discipline with many overlaps with modern medicine and modern pharmacopoeia. Information on obstetrics is more limited with reliance on mythological texts, inscriptions, artifacts, conjecture and deductive reasoning required. A lot of areas still require exploration in the field and the study raises issues for future research / Biblical and Ancient Studies / M.A. (Ancient Near Eastern Studies)

The effects of undertaking a regular exercise programme during and following pregnancy were investigated with healthy primigravid women within Ayrshire Central Hospital, Irvine. A randomised control trial was used with subjects being randomly assigned to either a control group who continued with the existing antenatal education programme or an exercise group who had the addition of participating in an aerobic exercise programme. In early pregnancy, no significant differences were found between the groups in relation to activity levels or mean scores of psychological variables with the exception of the control group having significantly more positive scores for perceptions of body image. During and following pregnancy, the exercise group maintained their scores on all psychological variables i.e. perceptions of coping assets (positive psychological well-being), coping deficits (negative psychological well-being), physical well-being, body image, somatic symptoms experienced, attitudes to marital relationships, sex and pregnancy. In contrast, the control group tended to have significant reductions in perceptions of the ability to cope (positive psychological well-being), physical well-being, body image, somatic symptoms experienced, attitudes to marital relationships, pregnancy and sex during pregnancy in addition to an increase in perceived coping deficits (negative psychological well-being).The exercise group participated in a significantly higher number of episodes of physical activity sessions than the control group. No significant relationship was noted between frequency of physical activity and responses to psychological indictors in post pregnancy. In conclusion, women who participated in regular physical activity tended to have a protection against a reduction of psychological well-being as measured by a variety of psychological constructs. The maintenance in psychological well-being was experienced both during and following pregnancy and there was no indication of any risk to the pregnancy or the baby. This was in contrast to the significant reduction in psychological well-being experienced by the women in the control group during the same period.

Obesity is a global health problem and the current available evidence from the literature suggests that obese women may suffer from a wide spectrum of reproductive complications. The current understanding of obesogenic effects on the peri-implantation endometrium is limited and has become an important research topic as the emerging clinical evidence from the published studies indicate the possible role of the endometrium. The first part of this thesis addresses the clinical question of whether an early pregnancy outcome is affected by the body mass index and whether there is any difference in time taken to achieve pregnancy in obese women with recurrent miscarriage when compared to normal weight women. The results are in chapters 3 and 4, where we demonstrated that obese women were more likely to have miscarriage of empty gestational sac or anembryonic pregnancies. In recurrent miscarriage context, the obese women were more ‘super-fertile’ suggesting the possible loss of an endometrial ability to select normal from abnormal pregnancies. The second part of this thesis provides an analysis of the peri-implantation endometrial stromal compartment in normal weight and obese women. In chapter 5, using immunohistochemical methods it was shown that there was no difference in the uterine natural killer cell and macrophage density in the peri-implantation endometrium of different weight groups. This suggests that the endometrial dysfunction in obese women with reproductive failure does not appear to be immune cell mediated. In chapter 6 it was shown that the clonogenecity of endometrial mesenchymal stem cells (W5C5+) was significantly negatively correlated with the BMI. The obese women had significantly reduced cloning efficiency of W5C5+ cells when compared to normal weight women, suggesting of a possible sub-optimal regenerative capacity of the endometrium in obese women. Finally, chapter 7 showed a potential association between obesogenic environment and impaired stromal cell decidualisation. Using an in-vitro model, it was shown that there was no significant difference in the expression of decidualisation markers (PRL and IGFBP1) in the decidualising endometrial stromal cells from normal weight women when compared to high BMI women. However, when the stromal cells were decidualised in an artificial obesogenic environment, the PRL expression was significantly inhibited in the presence of supernatant from adipose tissue explants of obese women when compared to normal weight women. In summary, the findings from my work have provided an understanding of the peri-implantation endometrium in obese women and evidence to suggest that the endometrial stromal function is possibly facilitated by metabolic influences.