Thesis (Ph.D.)--University of Adelaide, Dept. of Obstetrics and Gynaecology, 2005? / "March 2005" Includes bibliographical references (leaves 148-164). Also available electronically.

Thesis (Ph.D.)--University of Adelaide, Dept. of Obstetrics and Gynaecology, 2005? / Title from screen page; viewed 25 July 2005. "March 2005" Includes bibliographical references. Also available in print format.

The impact of a termination on subsequent pregnancy outcomes has been widely studied. It has been suggested that women who terminate a pregnancy are more likely to have an adverse outcome of a subsequent pregnancy, either miscarriage, or a preterm or low birthweight baby. However, the evidence to date is inconclusive and in some cases contradictory. Hypothesis: It is hypothesised that those who had terminated their first pregnancy are more likely to have an adverse outcome of a subsequent pregnancy, (either miscarriage, preterm delivery (<37 weeks), or low birthweight ((<2500g) as a proxy for gestation). They are also more likely to have shorter gestation at miscarriage, and the gestation at miscarriage is associated with method of termination. Also, women are more likely to show a dose-response in three-pregnancy series, with increasing numbers of consecutive terminations associated with increasingly poorer outcomes. Data and Methodology: Setting and Sample: Aberdeen maternity hospital (AMH) is the level III consultant-led maternity unit for NHS North of Scotland Region. It provides care for pregnant women both with and without complications and for sick neonates. The data were extracted from the Aberdeen Maternity and Neonatal Databank (AMND), with the sample restricted to Aberdeen city women in 1970-1999, and only singleton pregnancy events were included. Outcomes The study group was Termination-Birth (TB) and this group was compared to three comparison pregnancy history groups, Miscarriage-Birth (MB), Birth-Birth (BB) and Birth (B). The outcomes are preterm and low birthweight deliveries and the sub-categories of preterm and low birthweight. In addition, miscarriage on the index event is also considered as an outcome. Methods: The distributions of gestation and birthweight were examined between and within study groups for outcomes of preterm and low birthweight deliveries, and logistic and multinomial regression was used to assess the impact of selected potentially confounding socio-demographic and pregnancy related characteristics on the odds of delivering at different levels of preterm and low birthweight by pregnancy history. The gestation at miscarriage of the index subsequent event is also examined between study groups, as is the method of termination for women whose first pregnancy was terminated. In addition, two and three pregnancy sequences are examined to determine if there was a ‘dose-response’ effect of termination of pregnancy. Results: For women from group TB, the overall difference in average adjusted gestation at delivery is approximately 1 day less for women from group TB compared to women from group MB, and only 2 days from women with only a history of births, these results could be considered clinically insignificant. This thesis has shown that compared with women with a previous birth, and after adjusting for possible confounding factors, births after a previous termination were consistently more likely to result in a preterm delivery. Women who terminated a first pregnancy have an increased likelihood of preterm delivery from a public health perspective, with an overall 40% increase in risk for preterm birth for women from group TB when compared to women from group B (OR 1.35 95%CI 1.15, 1.58). These increased odds of preterm delivery for group TB are very similar to those for women from group MB (OR 1.45, 95%CI 1.18, 1.79). Similarly, after adjustment for potential confounding factors, women from group TB were consistently more likely to deliver a low birthweight baby, when compared to women with from group B, (OR 1.18 95%CI 1.00, 1.38). Women from group MB were also significantly more likely to deliver a low birthweight baby after adjustment for possible confounding factors (OR 1.42 95%CI 1.16, 1.72). Few if any of the explanatory variables are directly modifiable, and the PAF associated with women from group TB is relatively small, when compared to other significant potential risk factors. Women who terminated a first pregnancy were significantly more likely, after adjustment for socio-demographic characteristics to miscarry late (OR 1.74, 95%CI 1.07, 2.84), but there was no difference between medical and surgical terminations. Finally, there was no evidence of a dose response of termination for either preterm or low birthweight deliveries, although there was marked evidence of a dose response of miscarriage. Conclusions The results from a clinical and public health point of view may appear to be contradictory, in that there is an approximate 40% increase in relative risk for preterm delivery, but only an adjusted absolute difference of two days lower gestation at birth for women from group TB. PAF findings indicate only a small overall reduction in the number of preterm deliveries if the exposure to the risk factor of a previous termination was eliminated. Women who undergo a termination should therefore receive full information on factors which might have an influence on the outcome of a subsequent pregnancy, and in addition medical information given to the women should cover details about the termination process, including methods of termination, possible complications, post termination follow up and future contraception.

published_or_final_version / Medicine / Master / Doctor of Medicine

Thesis (M.D.)--University of Hong Kong, 2000. / Includes bibliographical references (leaves 164-189).

Thesis (M.D.)--University of Hong Kong, 2000. / Includes bibliographical references (leaves 164-189) Also available in print.

Call number: LD2668 .T4 1979 S38 / Master of Science

Thesis (MMed)-- Stellenbosch University, 2013. / ENGLISH ABSTRACT: Misoprostol is often used for the purpose of induction of labour. However, its effect on fetal heart rate has not been systematically studied. Objective To assess the effect of misoprostol on fetal heart rate parameters during induction of labour from 38 completed weeks in women with previous intrauterine death or postterm pregnancy. Study design A retrospective descriptive study of 127 women for a period of 18 months. Method Women who underwent induction of labour with misoprostol for either previous intrauterine death or postterm pregnancy at Tygerberg hospital were eligible. The selected process of induction of labour happened according to the departmental protocol. The primary outcomes were changes in fetal heart rate (variability, accelerations and decelerations) pre-and post-administration of misoprostol. Secondary outcomes were neonatal highcare or intensive care unit (ICU) admissions. Results There was no statistical difference in the mean fetal heart rate and baseline variability in relation to time recordings after administration of misoprostol. There were no statistically significant differences in the distribution of accelerations and decelerations in different time intervals before and after administration. There were more reactive patterns at all time intervals after the administration of misoprostol, but these differences did not quite reach statistical significance. In both study groups no neonatal complications or intensive care admissions were reported. Conclusion In the absence of contra indications, 50mcg of oral misoprostol can be given to mothers for induction of labour as no harmful fetal heart tracing abnormalities were found for 45 minutes; however large prospective randomized controlled trials are still needed to confirm effectiveness and evaluate further maternal and neonatal safety issues. Optimal dose and frequency also still need robust interrogation. Based on this thesis it does appear that misoprostol is probably not harmful to the fetus under these circumstances. / AFRIKAANSE OPSOMMING: Misoprostol word dikwels gebruik vir induksie van kraam. Die effek daarvan op fetale hartspoed is egter nie sistematies ondersoek nie. Doel Om die effek van misoprostol op fetale hartspoedparameters gedurende die induksie van kraam van 38 voltooide weke in vroue met vorige intra-uteriene dood or oortyd swangerskap te evalueer. Studei-ontwerp „n Retrospektiewe beskrywende studie van 127 vroue oor „n periode van 18 maande. Metode Vroue wat induksie van kraam met misoprostol ondergaan het vir of vorige intra-uteriene dood of oortyd swangerskap by Tygerberg Hospitaal is ingesluit. Die proses van induksie van kraam is volgens departementele protokol uitgevoer. Die primêre uitkomste was veranderinge in fetale hartspoed (variasie, versnellings en verstadigings) pre- en post-toediening van misoprostol. Neonatale hoësorg of intensiewe sorg toelatings was sekondêre uitkomste. Resultate Ons het geen statistiese verskille in gemiddelde fetale hartspoed en basislynvariasie in verhouding tot die tyd na toediening van misoprostol gevind nie. Daar was geen statisties betekenisvolle verskille in die verspreiding van versnellings en verstadigings in verskillende tydsintervalle nie. Daar was meer reaktiewe patrone gedurende alle tydsintervalle na die toediening van misoprostol, maar hierdie verskille was nie statisties betekenisvol nie. In beide studiegroepe was daar geen neonatale komplikasies of intensiewe sorg toelatings nie. Gevolgtrekking In die afwesigheid van kontra-indikasies kan 50 mcg misoprostol aan moeders toegedien word vir induksie van kraam aangesien geen skadelike fetale hartsped abnormaliteite gevind is nie. Groot prospektiewe gerandomiseerde gekontroleerde studies word steeds benodig om effektiwiteit te bevestig en om moederlike en fetale veiligheidskwessies verder te evalueer. Optimale dosis en frekwensie benodig ook robuuste ondersoek. Gebaseer op hierdie tesis kom dit voor of misoprostol waarskynlik nie skadelik vir die fetus onder hierdie omstandighede nie.

Thesis (M.S.)--University of Michigan, 1995.

Thesis (M.Sc.)--Memorial University of Newfoundland, Faculty of Medicine, 2001. / Typescript. Bibliography: leaves 82-94. Also available online.