A Research Report submitted to the Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, South Africa, in partial fulfilment of the requirements for the Degree of Master of Public Health - Maternal and Child Health Submitted: August 2014 / Introduction: A partograph is a tool that is used to monitor progress of labour, and its correct use and appropriate interpretation can assist in early identification of complications of labour. The aim of this study was to assess if and how the partograph was used at Mulanje District Hospital in Malawi. Methods: This was a retrospective review of records of women who delivered at the Mulanje District hospital from the 1st to the 30th of September, 2010. A total of 360 women’s files were reviewed. Data was collected from the delivery register, theatre register, case files and partograph charts. A Chi-square was used for statistical analysis and a p value of < 0.05 was considered significant. Results: The partographs were available in 93.3% (336/360) of women’s files. Forty eight percent (162/336) of women’s files had partographs with all three sections of labour monitoring documented, but only 10% (16/162) of the partographs had information correctly and completely filled in on each parameter of the three components of the partograph. Forty percent (64/162) of women delivered after crossing the action line, and 67.2% (43/64) who delivered after crossing the action line were referrals, while 32.8% (21/64) were women who came to the hospital in labour. Almost 40.6% (26/64) of women who crossed the action line suffered immediate adverse outcomes. There was no significant difference in maternal outcomes (post partum haemorrhage, ruptured uterus and maternal deaths) and foetal outcomes (low Apgar score of 5/10 or less at 1 minute and 5 minutes, fresh still births and deaths within 24 hours) between women that were from the primary care health centres and those that reported to the hospital in labour. The study found that 57.8% (37/64) of women who crossed the action line had spontaneous vertex delivery, almost 38% (24/64) delivered by caesarean section and 4.7% (3/64) delivered by assisted vacuum extraction. There was a significant difference in mode of delivery after v crossing the action line. More caesarean sections were performed on women from the primary care health centres as compared to those that came to the hospital in labour: 44.2% (19/43) vs 23.8% (5/21), p=0.049. Conclusion and Recommendation: Although partographs were available in women’s files, the partograph data were not completed adequately. While progress of labour was frequently documented, maternal and foetal condition were incompletely documented. Effective interventions such as in-service training, regular supportive supervision, regular audits of records of women in labour and intensification of use of guidelines for labour management are required to strengthen the use of the partograph for women in labour. Further research is recommended to highlight barriers for correct use of the partograph

Habilitationsschrift. / Bibliographical foot-notes.

by Ip Wan Yim. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1995. / Includes bibliographical references (leaves 65-85). / ACKNOWLEDGEMENTS / ABSTRACT --- p.ii / TABLE OF CONTENTS --- p.iv / LIST OF TABLES --- p.vi / LIST OF FIGURES --- p.vii / Chapter CHAPTER 1. --- INTRODUCTION --- p.1 / Anxiety and labour --- p.3 / Reducing anxiety in labour --- p.8 / Social support and labour --- p.11 / Husband support --- p.16 / Chapter CHAPTER 2. --- METHODOLOGY / Null hypotheses --- p.25 / Research design --- p.26 / Setting --- p.26 / Sample --- p.27 / Instruments --- p.28 / Procedure --- p.32 / Chapter CHAPTER 3. --- RESULTS / Sample characteristics --- p.35 / Comparison of treatment and control groups --- p.39 / Intercorrelations between obstetrical outcome measures --- p.46 / Husbands support --- p.47 / Chapter CHAPTER 4. --- DISCUSSION / Preference and importance rating for husband's presence --- p.52 / "Effect on anxiety, pain, length of labour and dosage of analgesic" --- p.53 / Intercorrelations between the obstetrical outcome measures --- p.56 / Mothers' perception of husbands support and obstetric outcome measures --- p.57 / Mothers' ratings of husbands support and duration of husband's presence --- p.59 / Chapter CHAPTER 5. --- CONCLUSION AND RECOMMENDATIONS / Childbirth education --- p.62 / Clinical management of labour --- p.63 / Research --- p.63 / REFERENCES --- p.65 / APPENDICES / Chapter A. --- Pre-Test Questionnaire --- p.86 / Chapter B. --- The Chinese Version Of STAI FormX-1 In Pre-Test Questionnaire --- p.88 / Chapter C. --- The Chinese Version of STAI FormX-2 In Pre-Test Questionnaire --- p.89 / Chapter D. --- Post-Test Questionnaire --- p.90 / Chapter E. --- The Cinese Version of STAI Form X-1 In Post-Test Questionnaire --- p.93 / Chapter F. --- The Cinese Version of STAI Form X-l In Post-Test Questionnaire --- p.94 / Chapter G. --- Consent Form --- p.95 / Chapter H. --- Letter Of Request For Approval --- p.96 / Chapter I. --- The Original Version Of The STAI Form X-l --- p.97 / Chapter J. --- The Original Version Of The STAI Form X-2 --- p.98

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Public Health in the field of Hospital Management July, 2014 / BACKGROUND: The World Health Organization (WHO) has acknowledged the importance of maternal care and listed it as part of its Millennium Development Goals (MDGs). The 5th goal is focused on improving maternal health by reducing the maternal mortality rate by 75% by 2015. South Africa has aligned itself with the MDGs. The Gauteng Department of Health and Social Development has also embraced the MDGs and decided to improve its maternal health services. It has decided to target Intra-partum period for interventions to improve maternal health because intra-partum period is associated with a high rate of perinatal death from intra-partum hypoxia (4.8 per 1000 births) (National Department of Health, 2000), as well as a significant number of maternal death (8.7%) (NCCEMD, 2007). This study was planned to systematically study the clinical procedure performed during the intra-partum period at the Heidelberg Hospital (a semi - rural district hospital in the Lesedi Sub – district of Sedibeng District in Gauteng Province). AIM: To describe the clinical procedures and factors related to these procedures and maternal and neonatal health outcomes for the mothers admitted and delivered in the Maternity unit at Heidelberg hospital during one year period (1st April 2010 to 31st March 2011) METHODOLOGY: The setting of this study was the Maternity unit of the Heidelberg Hospital. A cross sectional study design was used based on retrospective review of routinely collected data for 12 months (2010 April 1st to 2011 March 31st). No intervention was done as a part of this study. The study variables included different clinical procedures (such as normal vaginal delivery, assisted vaginal delivery, caesarean section, evacuation of uterus, caesarean hysterectomy), socio-demographic profile of patients (such as age, gender, ethnicity, medical aid), clinical profile (such antenatal diseases, booking status, intra-partum complications, postpartum complications) and maternal and perinatal outcomes. RESULTS: The study found highest number of deliveries (78.6%) were normal vertex deliveries and a very few (1%) assisted and breech deliveries. The caesarean section rate was high (20.4%) as compared to the normal national target (12, 5%). Fetal distress and CPD was the main indications for caesarean section. The majority of women who delivered at Heidelberg Hospital maternity came from poor socio-economic class, mostly single, teenagers, and unemployed. They were the most vulnerable group in the Society. The majority of women were booked and referred from PHC clinic where they were booked for antenatal check-up. Pregnancy induced hypertension was the commonest obstetric problem encountered during antenatal period. Most women who delivered at Heidelberg hospital during the period were discharged without complications, no maternal deaths were reported. There were 8.1% preterm deliveries but a relatively high still birth rate which is of concern. CONCLUSION: The study was the first of its kind to be done at Heidelberg Hospital and the Sedibeng Health District. The study systematically analysed routinely collected data and identified high risk patients, who would require special attention. This study would hopefully assist the Hospital Management to realise the high rate of CS and to develop appropriate measures to reduce unnecessary C/S being done, and to strengthen referral systems. In addition, further study is necessary at clinic level in the sub-district to identify work-loads in the feeder clinics.

Diss. (sammanfattning) Umeå : Umeå universitet, 2006. / Härtill 4 uppsatser.

Thesis (M.S.)--University of Wisconsin--Madison, 1981. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 63-65).

A Institucionalização da assistência ao parto colaborou muito para o avanço da obstetrícia. Foi possível acompanhar o desenvolvimento primeiro do parto e puerpério e depois do período gestacional, o que proporcionou aos profissionais detectar e tratar as complicações do período gravídico-puerperal, fazendo com que o principal objetivo da institucionalização da assistência ao parto fosse alcançado, a diminuição das taxas de mortalidade materna e neonatal. Mas com o avanço das práticas obstétricas, a maioria das gestações e partos, de baixo risco obstétrico, com evolução fisiológica, também foram encarados como de alto potencial para complicações. Isso fez com que procedimentos desnecessários e de rotina fossem introduzidos na assistência a gestação, parto e puerpério. O uso desenfreado desses procedimentos na assistência ao parto, no final do século passado, trouxe como consequência um aumento da morbimortalidade materna e perinatal, e a incorporação de intervenções danosas se tornou problemática. Objetivo: identificar a prevalência de intervenções obstétricas realizadas em mulheres durante o trabalho de parto e parto. Metodologia: trata-se de um estudo transversal descritivo, de caráter quantitativo, com coleta retrospectiva de dados em prontuário, sobre o emprego de intervenções obstétricas em parturientes atendidas no Centro de Referência da Saúde da Mulher - MATER, durante outubro, novembro e dezembro de 2009 e janeiro, fevereiro e março de 2010, totalizando 810 prontuários. Resultados: A maioria (83,6%) das mulheres apresentavam entre 18 e 34 anos de vida, realizaram pré-natal e estavam na primeira gestação. A amniotomia foi praticada em 41,7% das mulheres, sendo a maioria realizada (56,9%) na fase ativa do trabalho de parto; a infusão de ocitocina foi utilizada em 61,7% das parturientes e o início da infusão, em 63,4% das mulheres, aconteceu na fase ativa do trabalho de parto; 56,8% das mulheres receberam analgesia de parto, a maioria (75,4%) realizada na fase ativa do trabalho de parto e 77,6% das mulheres que receberam analgesia receberam apenas uma dose da medicação; a monitorização eletrônica fetal (cardiotocografia) foi realizada em 32,5% das mulheres, na maioria (65,4%) apenas uma vez; e a episiotomia esteve presente em 37,3% dos partos vaginais; a incidência de parto cesárea foi de 28,8% e de parto fórceps de 3,2%. Conclusão: considerando os resultados obtidos e a discussão realizada, podemos constatar que a maternidade em estudo possui índice da maioria das intervenções abaixo dos índices nacionais e, algumas vezes, índices próximos a de países desenvolvidos, porém a maioria das intervenções tem índices acima dos recomendados pela Organização Mundial da Saúde e pelo Ministério da Saúde brasileiro. Sendo assim, é necessária a revisão de alguns protocolos institucionais, assim como uma conscientização da equipe assistencial quanto aos riscos e benefícios reais das intervenções obstétricas empregadas durante o trabalho de parto e parto. / The institutionalization of delivery care contributed greatly to the advancement of obstetrics. It was possible to first follow the development of childbirth and later the period of pregnancy, which allowed professionals to detect and treat complications of the pregnancy and puerperal period, enabling the achievement of the main goal of institutionalization of labor care, to decrease maternal and neonatal mortality rates. The advancement of obstetrical practices, however, made most pregnancies and births with low obstetric risk, with physiological evolution, to be seen as with high potential risk for complications. This caused unnecessary and routine procedures to be introduced into pregnancy, childbirth and postpartum care. The rampant use of these procedures in delivery care, at the end of last century, caused an increase in maternal and perinatal morbidity and mortality, and the practice of damaging interventions has become problematic. Objective: to identify the prevalence of obstetric interventions performed on women during labor and delivery. Methods: this is a cross-sectional, quantitative and descriptive study, with retrospective data collection in patient files, about the use of obstetric interventions in pregnant women who receive care at the Reference Center for Women\'s Health - MATER, from October 2009 to March 2010, totaling 810 patient files. Results: Most (83.6%) women were aged between 18 and 34 years, received prenatal care and were at their first pregnancy. Amniotomy was performed in 41.7% of women, most (56.9%) were held in the active phase of labor, oxytocin infusion was used in 61.7% of pregnant women and start of infusion for 63.4% of women occurred at the active phase of labor. Of the total, 56.8% received labor analgesia, most (75.4%) were performed at the active phase of labor and 77.6% of women who underwent analgesia received only one dose of medication. Electronic fetal monitoring (cardiotocography) was performed in 32.5% of women, in most (65.4%) only once, and episiotomy was present in 37.3% of the vaginal deliveries, the incidence of cesarean section was 28.8% and of forceps deliveries was 3.2%. Conclusion: considering the results obtained and discussions held, it was noted that the studied hospital has rates for most interventions lower than the Brazilian rates, and sometimes levels are close to the ones found in developed countries, however, most interventions have rates above those recommended by the World Health Organization and the Brazilian Ministry of Health. Thus, there is need to review some institutional protocols, as well as raising awareness of the health care team regarding the real risks and benefits of obstetric interventions used during labor and delivery.

CoordenaÃÃo de AperfeÃoamento de Pessoal de NÃvel Superior / IntroduÃÃo: O cuidado prestado à mulher durante o processo de nascimento vem passando por mudanÃas com vistas à humanizaÃÃo da assistÃncia. Neste sentido, salta aos olhos à atual assistÃncia oferecida à mulher, marcada pela medicalizaÃÃo e dominaÃÃo do corpo, em detrimento do respeito ao fenÃmeno natural e fisiolÃgico do parto. O processo de nascimento consiste em momento frÃgil e vulnerÃvel, tornando imprescindÃvel a participaÃÃo do acompanhante no processo parturitivo.Objetivos: Analisar a influÃncia do apoio prestado pelo acompanhante na satisfaÃÃo de primÃparas e nas variÃveis do processo de parto e sobre os resultados maternos e neonatais, comparar os resultados maternos e neonatais acerca dos eventos do trabalho de parto e parto entre os grupos caso (com apoio por acompanhante de sua escolha) e controle (sem acompanhante) e comparar a satisfaÃÃo da parturiente com a experiÃncia do trabalho de parto e parto entre o grupo de caso e o grupo-controle. Metodologia: O estudo foi do tipo caso-controle, realizado com puÃrperas primÃparas internadas no perÃodo de maio a outubro de 2013 no alojamento conjunto da Maternidade Escola Assis Chateaubriand. O grupo caso foram puÃrperas primÃparas internadas que receberam acompanhante durante o parto e que nÃo receberam apoio durante o parto por doulas. O grupo controle foram puÃrperas primÃparas que nÃo receberam acompanhante durante a sala de parto. A coleta de dados foi realizada atravÃs de formulÃrio estruturado e formulÃrios organizados no mÃtodo auto-relato, que foram previamente testados com parturientes, e reformulados apÃs avaliaÃÃo. Foram incluÃdos na amostra 50 controles e 100 casos (total de 150 puÃrperas). Os dados foram analisados no programa estatÃstico SPSS, utilizando os testes adequados. O projeto foi aprovado pelo Comità de Ãtica em pesquisa da Maternidade Escola Assis Chateaubriand, segundo parecer de n 253671. Resultados: A amostra consta de 150 puÃrperas, das quais tinham uma idade mÃdia de 23 anos, a maioria estava entre 20 e 29 anos (64; 42,7%), era proveniente da capital (105; 70,0%), eram casadas/uniÃo estÃvel (100; 66,7%), com renda familiar de 1 a 2 salÃrios mÃnimos (60; 40,0%) e tinham atà 8 anos de estudo (67; 44,7%). Observou-se que a maioria das parturientes respondeu que o apoio do acompanhante foi muito importante (53,0%) tanto no trabalho de parto quanto tanto durante o parto (45,0%), a ajuda do companheiro foi bastante Ãtil tanto no trabalho de parto (65,0%) quanto no parto (66,0%). A presenÃa do acompanhante em sala de parto foi estatisticamente significante nas seguintes variÃveis: a presenÃa de um acompanhante durante a assistÃncia prÃ-natal (p=0,05), a duraÃÃo mÃdia do trabalho de parto das gestantes (p=0,01), a realizaÃÃo de anestesia epidural (p=0,01), a dor sentida durante o trabalho de parto (p=0,001) e parto(p=0,01), a confianÃa durante o trabalho de parto (p= 0,001) e parto(p = 0,001), o medo durante o trabalho de parto (p = 0,001), as expectativas da dor durante o trabalho de parto (p= 0,01) e parto (p= 0,02). ConclusÃo: O apoio por acompanhante escolhido pela parturiente associou-se a maior satisfaÃÃo global das parturientes com a experiÃncia do nascimento. Verifica-se, portanto, a importÃncia de garantir o direito de participaÃÃo do acompanhante durante o trabalho de parto e parto, respeitando assim a escolha de cada mulher durante o processo parturitivo.

Thesis (doctoral)--University of Lund.

Thesis (Ph. D.)--University of Washington, 1989. / Vita. Includes bibliographical references (leaves [179]-190).