Background: In 2011, 45% of the 6.1 million pregnancies in the United States were unintended. Of the unintended pregnancies, 50% were attributed to contraceptive failure or method non-adherence. Long-acting reversible contraceptives (LARCs) are birth control methods consisting of intrauterine devices (IUDs) and the birth control implants that are the most effective forms of reversible contraceptives. LARCs are 20 times more effective than other birth control methods; yet only 5.6% of women are choosing LARCs. Despite multiple pharmacological and non-pharmacological interventions prior to the procedure, 35% of women reported having moderate pain and 42% of women had severe pain associated during the IUD placement Purpose: The purpose of this quality improvement project was to identify health care providers’ knowledge and practice of pain management methods for IUD insertion in iparous women at a military medical treatment facility (MTF). Methods: This DNP quality improvement (QI) project used a quantitative descriptive methodology with a pretest-posttest design and educational intervention to identify the current practice and knowledge primary care providers have regarding appropriate pain management for iparous women when placing an IUD. Results: The providers’ responses reflect a self-efficacy represented by a knowledge increase in the areas of the limited benefit of premedication with either oral analgesics or cervical softening agents, placing an IUD based on the patient’s menstrual cycle, incorporating the use of a local analgesic, and the connection between counseling and patient satisfaction. Limited provider knowledge can be suggested by the varied responses regarding the topic of a CPG. Self-efficacy stayed stable for the areas of post-procedural NSAID use and having the time for counseling regarding expected pain during the procedure. Conclusion: Improving provider knowledge, skill, and counseling techniques can help decrease the expected and perceived pain for iparous women having an IUD placed leading to an increase of women having IUDs placed. An ultimate goal is to increase IUD use and retention, leading to decreased unintended pregnancy rates, lower maternal and newborn mortality, and improving patient satisfaction when having an IUD placed.

The only practical method for artificially breeding ewes with frozen semen is laparoscopic insemination into the lumen of the uterine horn. Like all surgical procedures, however, laparoscopic artificial inseminatiom has limitations. The procedure requires surgical skill and costly equipment. Repeated passage of the laparoscope through the abdominal wall causes adhesions. Depositing frozen/thawed semen at the os cervix results in low conception rates. The inability to pass an insemination pipette through the cervix has prevented artificial insemination in sheep from becoming a standard breeding method as in the cattle industry. This study compared laparoscopic and transcervical methods of insemination in nulliparous ewes and transcervical insemination in multiparous ewes after estradiol cypionate treatment. Forty nulliparous commercial-cross Rambouillet ewes were treated with pessaries containing fluorogesterone acetate to synchronize estrus. After 14 days, pessaries were removed and ewes were injected IM with 400 IU of pregnant mare serum gonadotropin (PMSG). Ewes were randomly divided into laparoscopic and transcervical treatment groups, 14 and 26 respectively. Ewes were inseminated with thawed semen (75x106 motile spermatozoa). Pregnancy rate with laparoscopic insemination was 85% (confirmed at 55 days with real-time ultrasound) .. With the transcervical method, the speculum could only be inserted into the vagina of five ewes and the insemination pipette could only be passed through the cervix in two ewes. The combined pregnancy rate for deep cervical and transcervical insemination was 40% at 55 days. Forty multiparous commercial-cross Rambouillet ewes were synchronized as previously described. Ewes were randomly separated into a control and estradiol cypionate treatment group of 20 animals each. Within each group 10 ewes were inseminated with frozen/thawed Suffolk semen and 1 Owith Rambouillet semen. Ten ewes within each sire genotype were treated with 1 mg IM of estradiol cypionate 16 hours prior to insemination. Treated ewes were inseminated into the uterine body 90% of the time and non-treated ewes 95%. There was no significant difference in cervical passage between these groups. Pregnancy rates for transcervical artificial insemination in the Suffolk genotype were 0.05% and 40% in the Rambouillet (pregnancy confirmed at 55 days by real-time ultrasound). Lambing rates for the Suffolk and Rambouillet groups were zero and 0.05%, respectively.

Bakgrund Urininkontinens är ett av de vanligaste kroniska hälsoproblemen i samhället, där få söker vård för sina besvär, vilket innebär en försämrad livskvalitet. Resultatet huruvida träning påverkar urinläckage varierar i tidigare forskningsstudier.  Syfte Att undersöka punktprevalensen av ansträngningsinkontinens hos fysiskt aktiva nulliparous totalt och uppdelat på olika träningsformer, samt analysera korrelationen mellan upplevd besvärsgrad av urininkontinens och volymen av måttlig till hög aktivitetsnivå bland fysiskt aktiva nulliparous med ansträngningsinkontinens.  Metod Kvantitativ observationsstudie som utfördes via en webbaserad enkät baserad på IPAQ-SF och PFIQ-7. Fysiskt aktiva kvinnor mellan 16–55 år, som var födda med kvinnligt kön, ej fått barn eller varit gravida efter vecka 13 samt ej var elitidrottare inkluderades. Resultat 215 personer besvarade enkäten, 61 exkluderades. Av 154 deltagare upplevde 37 kvinnor besvär av ansträngningsinkontinens (prevalens 24%). De vanligaste aktiviteterna var löpning (prevalens 26%) och gym/styrketräning (prevalens 18%). Högintensiv träning hade en prevalens av ansträngningsinkontinens på 31–38%. Lågintensiv träning hade en prevalens på 19%. Ingen korrelation kunde påvisas mellan upplevda besvär av urininkontinens och volym av måttlig till hög aktivitetsnivå bland kvinnor med ansträngningsinkontinens (r = -0,0489) (p = 0,8). Konklusion Ansträngningsinkontinens är vanligt hos tränande nulliparous. Det är vanligare med ansträngningsinkontinens vid högintensiva aktiviteter jämfört med lågintensiva. Ingen korrelation kunde påvisas mellan upplevd besvärsgrad av urininkontinens hos kvinnor med ansträngningsinkontinens och aktivitetsnivå. Mer forskning kring träning som eventuell riskfaktor och som eventuell behandlingsmetod krävs. / Background Urinary incontinence is one of the most common chronic health issues in society where few seek care meaning a decreased quality of life. Research regarding how exercise affects urinary incontinence varies.  Purpose On one occasion examine the prevalence of stress urinary incontinence (SUI) in physically active (PA) nulliparous in total and divided by activity, and the correlation between perceived level of discomfort of urinary incontinence (UI) and volume of moderate to high activity level amongst PA nulliparous with SUI. Method Quantitative observational study conducted via a web-based survey based on IPAQ-SF and PFIQ-7. PA women, age 16-55, who were born with a female gender, hadn’t given birth or been pregnant after week 13 and weren’t elite athletes were included.  Result 215 women responded to the survey, 61 were excluded. Of 154 participants 37 women experienced SUI (prevalence 24%). Strength training (prevalence 18%) and running (prevalence 26%) were the most common activities. High-intensity training had a prevalence of 31–38%. Low intensity training had a prevalence of 19%. No correlation between experienced level of discomfort of UI and volume of moderate to high level of physical activity amongst women with SUI could be revealed. (r = -0,0489, p = 0,8).   Conclusion  SUI is common amongst exercising women without known risk factors. It is more common with SUI during high-intensity activities compared with low-intensity. No correlation was demonstrated between UI amongst women with SUI and activity level. Research regarding exercise as risk factors and treatment for UI is required.

Sammanfattning Bakgrund Urininkontinens är ett av de vanligaste kroniska hälsoproblemen i samhället, där få söker vård för sina besvär, vilket innebär en försämrad livskvalitet. Resultatet huruvida träning påverkar urinläckage varierar i tidigare forskningsstudier.  Syfte Att undersöka punktprevalensen av ansträngningsinkontinens hos fysiskt aktiva nulliparous totalt och uppdelat på olika träningsformer, samt analysera korrelationen mellan upplevd besvärsgrad av urininkontinens och volymen av måttlig till hög aktivitetsnivå bland fysiskt aktiva nulliparous med ansträngningsinkontinens.  Metod Kvantitativ observationsstudie som utfördes via en webbaserad enkät baserad på IPAQ-SF och PFIQ-7. Fysiskt aktiva kvinnor mellan 16–55 år, som var födda med kvinnligt kön, ej fått barn eller varit gravida efter vecka 13 samt ej var elitidrottare inkluderades. Resultat 215 personer besvarade enkäten, 61 exkluderades. Av 154 deltagare upplevde 37 kvinnor besvär av ansträngningsinkontinens (prevalens 24%). De vanligaste aktiviteterna var löpning (prevalens 26%) och gym/styrketräning (prevalens 18%). Högintensiv träning hade en prevalens av ansträngningsinkontinens på 31–38%. Lågintensiv träning hade en prevalens på 19%. Ingen korrelation kunde påvisas mellan upplevda besvär av urininkontinens och volym av måttlig till hög aktivitetsnivå bland kvinnor med ansträngningsinkontinens (r = -0,0489) (p = 0,8). Konklusion Ansträngningsinkontinens är vanligt hos tränande nulliparous. Det är vanligare med ansträngningsinkontinens vid högintensiva aktiviteter jämfört med lågintensiva. Ingen korrelation kunde påvisas mellan upplevd besvärsgrad av urininkontinens hos kvinnor med ansträngningsinkontinens och aktivitetsnivå. Mer forskning kring träning som eventuell riskfaktor och som eventuell behandlingsmetod krävs. / Abstract Background Urinary incontinence is one of the most common chronic health issues in society where few seek care meaning a decreased quality of life. Research regarding how exercise affects urinary incontinence varies.  Purpose On one occasion examine the prevalence of stress urinary incontinence (SUI) in physically active (PA) nulliparous in total and divided by activity, and the correlation between perceived level of discomfort of urinary incontinence (UI) and volume of moderate to high activity level amongst PA nulliparous with SUI. Method Quantitative observational study conducted via a web-based survey based on IPAQ-SF and PFIQ-7. PA women, age 16-55, who were born with a female gender, hadn’t given birth or been pregnant after week 13 and weren’t elite athletes were included.  Result 215 women responded to the survey, 61 were excluded. Of 154 participants 37 women experienced SUI (prevalence 24%). Strength training (prevalence 18%) and running (prevalence 26%) were the most common activities. High-intensity training had a prevalence of 31–38%. Low intensity training had a prevalence of 19%. No correlation between experienced level of discomfort of UI and volume of moderate to high level of physical activity amongst women with SUI could be revealed. (r = -0,0489, p = 0,8).   Conclusion SUI is common amongst exercising women without known risk factors. It is more common with SUI during high-intensity activities compared with low-intensity. No correlation was demonstrated between UI amongst women with SUI and activity level. Research regarding exercise as risk factors and treatment for UI is required.

Bakgrund: Gravida i Sverige är generellt sett nöjda med mödrahälsovården men önskar individanpassad vård, mer stöd från barnmorskan, ökad delaktighet och tillgänglighet. Behovet av insatser från mödrahälsovården skiljer sig mellan förstföderskor och omföderskor. Syfte: Undersöka om gravidas upplevelser av de tidiga besöken hos mödrahälsovården skiljer sig mellan förstföderskor och omföderskor i en region i Mellansverige. Metod: Retrospektiv tvärsnittsstudie av Sveriges Kommuner och Regioners graviditetsenkät. Resultat: Förstföderskor skattade generellt något lägre än omföderskor avseende upplevelserna av erhållen information, tillgänglighet, delaktighet, trygghet och stöd. Upplevelsen av mödrahälsovård påverkades av födelseland, utbildningsnivå samt tidigare behandling för psykisk ohälsa. Slutsats och klinisk tillämpbarhet: Insatser behövs för att möta förstföderskors behov inom mödrahälsovården då de generellt skattar sin upplevelse av mödrahälsovården lägre jämfört med omföderskor. Uppdaterad information om gravidas upplevelser av mödrahälsovården är viktig för att kunna utveckla verksamheter och vårdrutiner. Vården som erbjuds idag varierar mellan olika regioner och utvärderingar behövs för att bedöma behovet av verksamhetsutveckling på lokal nivå. / Background: Pregnant women in Sweden are generally satisfied with the maternal health care but wants more individualized care and more support from the midwife, an increased participation in care as well as better access to care. The needs for interventions from maternal health care differs between nulliparous and multiparous. Aim: To investigate whether pregnant women's experiences of the early visits to maternal health care differ between nulliparous and multiparous in a region in midcentral Sweden. Method: A retrospective cross-sectional study of Sveriges Kommuner och Regioners survey, Graviditetsenkäten. Results: Nulliparous generally rated lower than multiparous regarding their experience of obtained information, accessibility, participation, security, and support. The experience of maternal health care was affected by the country of birth, level of education and whether the pregnant woman was treated för mental illness or not. Conclusion and clinical implications: Efforts are needed to meet the needs of nulliparous women in maternity care, as they generally rate their experience of maternal health care lower compared with multiparous. Updated information about pregnant women's experiences of maternal health care is important to be able to develop care routines. The care offered today varies between different regions and evaluations are needed to assess the need for development at a local level.

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Bakgrund: Förlossningsrädsla hos gravida kvinnor som väntar sitt första barn påverkar både den blivande modern och det ofödda barnet. Det är därför viktigt att barnmorskan i mödravården kan uppmärksamma rädsla inför förlossningen i tid för att kunna hjälpa kvinnan på bästa sätt. Förlossningsrädsla är ett ökande problem som kan leda till fler komplicerade förlossningar och kejsarsnitt, vilket även kostar samhället mer pengar.   Syfte: Syftet med denna studie var att belysa barnmorskors erfarenheter av att stödja och bemöta förstföderskor med förlossningsrädsla under graviditet samt studera vad som gett upphov till rädslan.   Metod: Arbetet innehåller en kvalitativ design som baseras på individuella semi-strukturerade intervjuer med 11 barnmorskor inom mödravården i mellansverige. Datan har analyserats genom kvalitativ innehållsanalys och manifest metod.   Resultat: Resultatet visade på fyra kategorier: Olika sätt att kommunicera rädsla, rädslans innehåll, inverkande faktorer samt att hjälpa och stötta kvinnor med förlossningsrädsla. Tretton subkategorier skapades och utgjorde kategorierna: Uttrycker rädslan med ord, sluter sig, katastroftankar, kontrollförlust, smärta, komplikationer, tidigare erfarenheter, övergrepp, psykisk ohälsa, yttre påverkan, svårt att nå kvinnan, en utmaning och stärka kvinnans självförtroende.   Slutsats: De flesta förstföderskor uttrycker sin förlossningsrädsla tidigt i graviditeten men det är inte alla som vågar prata om den. Att tappa kontrollen beskrivs vara det främsta motivet till rädslan. Den vanligaste bidragande faktorn till förlossningsrädsla idag beror på yttre faktorer så som media och influenser från vänner och familj. Även dagens pressade förlossningssituation påverkar kvinnornas rädsla inför förlossningen. Det kan upplevas vara en utmaning att kunna stödja och bemöta kvinnan på bästa sätt. / Background: Fear of childbirth in pregnant women waiting for their first child is affecting both mother and child. That is why it is important for the midwife’s in the antenatal care to pay attention to fear of childbirth in time and also to help the women in the best possible way. Fear of childbirth is a problem that increases which can result in complicated deliveries and sections which costs a lot of money for the community.   Aim: The aim of this study was to investigate midwife’s experience of supporting and responding to fear of childbirth in nulliparous women and to study what has caused the fear.   Method: We conducted a qualitative interview study with 11 midwives working at antenatal clinics in mid Sweden. The interviews were analyzed with manifest content analysis.   Result: Four categories were found: Different ways to communicate fear, the content of the fear, influence factor and to help and support women with fear of childbirth.  Thirteen subcategories were created and formed the categories: Expresses the fear with words, no words, thoughts about disaster, control loss, pain, complications, past experiences, abuse, mental illness, external impact, difficult to reach the woman, a challenge and strengthening the woman's self-esteem.   Conclusion: Most nulliparous women express their fear of childbirth early in pregnancy, but not everyone dares to talk about it. Controll loss is described as the main motive for fear. The most common cause of fear of childbirth today is due to external factors such as media and influences from friends and family. Also today's situation of maternity ward affects women's fear of childbirth. It could be a challenge to be able to support and respond to the woman in the best way.

Bakgrund: Förstföderskors ålder ökar i höginkomstländer och med stigande ålder ökar risken för graviditetsrelaterade komplikationer. Även andelen interventioner som avser att sätta igång, förstärka progressen och övervaka den fysiologiska förlossningsprocessen ökar. Syfte: Syftet med examensarbetet var att undersöka om antalet interventioner och förlossningsutfall vid ett medelstort sjukhus i västra Sverige skiljer sig mellan äldre förstföderskor (≥35 år) och yngre förstföderskor (20–24 år) med spontan värkstart. Metod: Examensarbetet var en kvantitativ retrospektiv tvärsnittsstudie där data samlats in under ett år. Materialet som bestod av 232 förstföderskor bearbetades med deskriptiv och jämförande statistiska analyser. Resultat: Det var vanligare att äldre förstföderskor fick utökad fosterövervakning och att de födde barn som vägde 4500 gram eller mer jämfört med yngre förstföderskor. Oavsett ålder födde förstföderskorna vanligtvis vaginalt och interventioner som värkstimulerande dropp och skalpelektrod användes vid runt hälften av förlossningarna. Slutsats och klinisk tillämpbarhet: Få signifikanta skillnader fanns mellan de jämförda åldersgrupperna. Examensarbete visade att det behövs en individuell bedömning av varje kvinna eftersom åldersförändringar sker gradvis. Som barnmorska måste man beakta att ålder bara är en faktor i bedömningen av den födande kvinnan och vara medveten om att man påverkas av den kulturella kontexten och organisationen. / Background: The age of first-time mothers increases in high-income countries and with increasing age, the risk of pregnancy related complications gets more common. The proportion of interventions that are needed to initiate, strengthen and monitor the psychological birth process is also increasing. Aim: The aim of this study was to investigate if interventions and delivery outcomes differ between older nulliparous women (≥35 years) and younger nulliparous women (20–24 years) with spontaneous onset of labor. Method: We conducted a quantitative retrospective cross-sectional study where data were collected from a hospital in Sweden. The material, which consisted of 232 nulliparous women, was processed with descriptive and comparative statistical analyzes. Results: In our study, we found that older nulliparous women more often received extended fetal monitoring and gave birth to babies weighing 4,500 grams or more compared to younger nulliparous women. Regardless of age, nulliparous gave birth vaginally and interventions such as administration of oxytocin and fetal scalp electrodes were used in around half of the births. Conclusion and clinical implications: There were few significant differences between the compared age groups. Our study didn’t show large differences between the age groups, however, research shows that age is a risk factor. As a midwife, you must consider that age is only one factor in assessing the woman giving birth.

Submitted by Claudia Rocha (claudia.rocha@udesc.br) on 2018-03-15T12:45:06Z No. of bitstreams: 1 PGCA16MA206.pdf: 750013 bytes, checksum: 70bddcd61c31dd2ee20002e2905f599e (MD5) / Made available in DSpace on 2018-03-15T12:45:06Z (GMT). No. of bitstreams: 1 PGCA16MA206.pdf: 750013 bytes, checksum: 70bddcd61c31dd2ee20002e2905f599e (MD5) Previous issue date: 2016-04-06 / The objective of this study was to evaluate the reproductive performance of gilts subjected to post-cervical artificial insemination (PCAI) compared to traditional artificial insemination (TAI). We also evaluated the degree of difficulty in bypassing the cervix, time required to perform the insemination, presence of bleeding after insemination, semen backflow, as well as the volume and the total reflow cells 30 minutes after insemination. Gilts submitted to PCAI (n = 279) were inseminated with 45 mL doses of 1.5 x 10⁹ sperm cells and the ones submitted to TAI (n = 273) were inseminated with 80 mL doses with 2.5 x 10⁹ cells. The bypassing of the cervix was possible in 91.04% (254/279) of gilts. The difficulty bypassing the cervix in at least one of the gilt’s PCAI procedures happened with 41.58% (116/279) of the females, but it did not affect reproductive performance (P>0.05). The presence of bleeding after insemination did not affect the farrowing rate and total number of piglets born for both treatments (P>0.05). The average time needed to carry out the PCAI was 1.47 minutes and the TAI was 4.04 minutes. The percentage of sperm present in the reflux was higher in TAI than the PCAI, but no correlation was found between litter size and the percentage of sperm in reflux (P>0.05). There was no statistical difference (P>0.05) in farrowing rate (89.38% and 91.76%) and the total number of piglets born (11.63 and 11.81) between TAI and PCAI treatments, respectively. Thus, it is possible to perform the post-cervical artificial insemination in gilts without causing a reduction in reproductive performance, using doses with a concentration of 1.5 x 10⁹ sperm cells / O objetivo deste trabalho foi avaliar o desempenho reprodutivo de nulíparas submetidas à inseminação artificial pós-cervical (IAPC) comparada à inseminação artificial tradicional (IAT). Foram avaliados a ocorrência de sangramento, refluxo durante à inseminação, dificuldade no transpasse da cérvix, volume e o total de células refluídas até 30 minutos após a inseminação. As fêmeas submetidas à IAPC (n=279) foram inseminadas com doses na concentração de 1,5 x 109 diluídos em 45 mL e as fêmeas submetidas à IAT (n=273) foram inseminadas com doses na concentração de 2,5 x 109 diluídos em 80 mL. O transpasse da cérvix foi possível em 91,04% (254/279) das leitoas. A dificuldade no transpasse da cérvix, em pelo menos uma das inseminações, foi de 41,58% (116/279) e não comprometeu o desempenho reprodutivo (P>0,05). A presença de sangramento durante a inseminação não afetou a taxa de parto nem o número de leitões nascidos totais para ambos os tratamentos (P>0,05). O tempo médio necessário para a realização da IAPC foi de 1,47 minutos e a IAT foi de 4,04 minutos. O percentual de espermatozoides presentes no refluxo foi maior na IAT do que na IAPC, não sendo observada diferença no tamanho de leitegada de acordo com o percentual de espermatozoides no refluxo (P>0,05). Não houve diferença estatística (P>0,05) taxa de parto (89,38% e 91,76%) e no número de leitões nascidos totais (11,63 e 11,81) entre os tratamentos IAT e IAPC, respectivamente. Desta forma, podemos concluir que pode - se realizar a inseminação artificial pós-cervical em leitoas sem causar redução no desempenho reprodutivo, utilizando doses com concentração de 1,5 x 109 células espermáticas