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 Medicine in Obstetrics and Gynaecology MMed (O&G) Johannesburg, October 2014 / Background Grand multiparous women, defined as women who have had five or more deliveries, have historically been considered to be at risk for maternal and fetal complications. Over the years, these complications have been attributed to physiological changes as a result of high parity, maternal age, age-related medical conditions and socioeconomic status. Recent research has indicated a strong relationship between access to health care, especially in the antenatal phase, and outcomes. This work aimed to describe maternal, obstetric and fetal complications occurring in GM women, to determine their attendance at antenatal clinic, to review their modes of delivery and to identify any demographic characteristics related to GMP. Methods This was a prospective, descriptive study undertaken at Chris Hani Baragwanath Academic Hospital, a tertiary and regional hospital situated in Soweto that serves approximately two million people within its jurisdiction. In excess of 23 000 deliveries take place there each year. The labour ward attends mostly to high-risk women and approximately 20 % low-risk walk-ins. Another 10 000 births are conducted at midwife obstetric units in Soweto. This study surveyed a sample of pregnant women presenting at Chris Hani Baragwanath and the referring midwife obstetric units who had had five or more viable deliveries, including the current birth, and was conducted over four months in 2011. Results A total of 122 women were included with 124 deliveries as there were two twin pregnancies. Detailed data were available for 98 of these women. The study group were largely of advanced maternal age and were generally healthy. The attendance rate at antenatal care was high (91.35%). Antepartum and postpartum complications were infrequent and there were no intensive care unit admissions or maternal deaths. The CS rate was high (32.79 %), with more emergency CSs performed than elective CSs. The majority of the emergency CSs performed was as a result of fetal distress. There were four stillbirths (3.23%), and 25 (20.16%) of infants weighed <2500g at birth. Conclusion This study showed good maternal and fetal outcomes in a group of GM women who have access to and who largely attended antenatal care facilities. The results, albeit from a small sample, do not support traditional views that GM women are at risk of poor outcomes due to advanced maternal age, physiological changes as a result of high parity or low socioeconomic status. GM women who are generally healthy and are afforded access to adequate health care facilities should have good pregnancy outcomes.

Lau, Tze Kin. / "May 1998." / Thesis (M.D.)--Chinese University of Hong Kong, 1998. / Includes bibliographical references (p. 165-178). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web.

Tesis--México (que para optar la plaza de profesor).

Dissertation--Halle.

Hui Sau Lei Raydi. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1999. / Includes bibliographical references (leaves 71-82). / Abstracts in English and Chinese. / ABSTRACT (English and Chinese) --- p.i / ACKNOWLEDGMENT --- p.1 / LIST OF FIGURES --- p.2 / LIST OF TABLES --- p.3 / LIST OF ABBREVIATIONS --- p.4 / Chapter I. --- Introduction and Objectives --- p.5-8 / Chapter II. --- Literature review --- p.9 / Chapter II.A --- Corticotrophin-releasing hormone --- p.9 / Chapter II.A.1. --- Structure of Corticotrophin-releasing hormone --- p.9-10 / Chapter II.A.2. --- Corticotrophin releasing hormone and normal Physiology --- p.11 / Chapter II.A.2.a. --- Pituitary-adrenal axis --- p.11-12 / Chapter II.A.2.b. --- Role of Pituitary-adrenal axis --- p.12 / Chapter II.A.3. --- Placental Corticotrophin releasing hormone --- p.13 / Chapter II.A.3.a. --- Origin --- p.13 / Chapter II.A.3.b. --- Physiology --- p.14 / Chapter II.A.3.C. --- Normal pregnancy --- p.15 / Chapter II.A.3.d. --- Association with human parturition --- p.16 / Chapter II.A.3.e. --- Association with preterm delivery and other abnormal pregnancy outcomes --- p.17-18 / Chapter II.B. --- Alpha-fetoprotein --- p.19 / Chapter II.B.1. --- Physiology --- p.19-20 / Chapter II.B.2. --- Maternal alpha-fetoprotein levels in the second trimester --- p.21-22 / Chapter III : --- Materials & Method --- p.23 / Chapter III.A. --- Study population --- p.23-24 / Chapter III.B. --- Sample collection and Analysis --- p.25 / Chapter III.C. --- Corticotrophin releasing hormone radioimmunoassay --- p.26 / Chapter III.C.l.a. --- Theoretical basis for radioimmunoassay --- p.26-27 / Chapter III.C.l.b. --- Vycor extraction of maternal plasma samples --- p.28-30 / Chapter III.C.l.c. --- Standard curve --- p.31-32 / Chapter III.C.l.d. --- Antisera --- p.33 / Chapter III.C.1.e. --- Tracer --- p.34-35 / Chapter III.C.l.f. --- HPLC Tracer Purification --- p.36-37 / Chapter III.C.l.g. --- Separation of bound from unbound Cortico- trophin-releasing hormone: second antibody --- p.38 / Chapter III.C.1.h. --- Corticotrophin-releasing hormone radio- immunoassay procedure --- p.39 / Chapter III.C.2. --- Corticotrophin-releasing hormone reagents --- p.40-41 / Chapter III.C.3. --- Estimation of Corticotrophin-releasing hormone extraction recovery --- p.42 / Chapter III.C.4. --- Sample dilution --- p.43 / Chapter III.D. --- Alpha-fetoprotein: microparticle enzyme immunoassay --- p.44 / Chapter III.D.1. --- Principles --- p.44 / Chapter III.D.2. --- Reaction Process --- p.45-46 / Chapter III.D.3. --- MEIA Optical Assembly --- p.47 / Chapter III.D.4. --- Operation --- p.47 / Chapter III.D.5. --- Alpha-fetoprotein reagents --- p.48 / Chapter III.D.6. --- Sample Dilution --- p.49 / Chapter III.D.7. --- Inter-assay and Intra-assay Variation --- p.50-52 / Chapter III.E. --- Data handling --- p.53 / Chapter III.F. --- Statistical Analysis --- p.53 / Chapter IV: --- Results --- p.54 / Chapter IV.A. --- Demographic Data --- p.55-57 / Chapter IV.B. --- Corticotrophin-releasing hormone levels --- p.58 / Chapter IV.B.1. --- Corticotrophin-releasing hormone levels increases as gestation advances --- p.58 / Chapter IV.B.2 --- The association between the plasma Corticotrophin releasing hormone levels and the time to delivery --- p.59 / Chapter IV.B.3 --- Elevated Corticotrophin-releasing hormone levels among the preterm group --- p.60 / Chapter IV.B.4. --- Corticotrophin releasing hormone levels and history of threatened abortion --- p.61 / Chapter IV.C. --- Alpha-fetoprotein levels --- p.62 / Chapter IV.C.1. --- Alpha-fetoprotein levels and gestational age --- p.62 / Chapter IV.C.2. --- Alpha-fetoprotein levels and preterm labour --- p.63 / Chapter V: --- Discussion --- p.64-65 / Chapter V.A. --- Importance of dating --- p.64 / Chapter V.B. --- Diagnosis of preterm labour --- p.64-65 / Chapter V.C.1. --- Corticotrophin-releasing hormone and labour --- p.65-66 / Chapter V.C.2. --- Corticotrophin-releasing hormone and infection --- p.66-67 / Chapter V.C.3. --- Diurnal rhythm of Corticotrophin-releasing hormone --- p.67 / Chapter V.C.4. --- Laboratory assays of Corticotrophin-releasing hormone --- p.68 / Chapter V.D. --- Alpha-fetoprotein and labour --- p.69-70 / Chapter VI. --- Reference --- p.71-82

Thesis (M.D.) -- University of Pennsylvania, 1806. / Film 633 reel 38 is part of Research Publications Early American Medical Imprints collection (RP reel 38, no. 663). DNLM Includes bibliographical references.

Thesis (Ph. D.)--University of Washington, 1999. / Vita. Includes bibliographical references (leaves 56-62).

Thesis (doctoral)--Katholieke Universiteit te Nijmegen. / Bibliography: p. 156-174.

Objective: Unknown ethiology Background: Capnocytophaga ochracea is a gram-negative anaerobic organism commonly found in human oral flora. It is characteristically sensitive to beta-lactams and resistant to aminoglycosides. Case Report: A 23-year-old woman presented with lower abdominal pain and was admitted for premature labor at 24-weeks of gestation. At presentation, the cervix was closed and the membrane was intact; however, contractions continued, the membrane subsequently ruptured before receiving any steroids or magnesium, and the mother gave birth to a 540-gram female baby. At birth, Apgar scores were 1 at 5 minutes, 1 at 10 minutes, and 2 at 15 minutes. On the fifth day of life, the blood culture grew Capnocytophaga species. Consequently, Cefotaxime was started and ampicillin continued for a total of 14 days; however, on the 6th day, the head ultrasound showed grade 4 intraventricular hemorrhage and a Do Not Resuscitate (DNR) order was placed in the chart. The patient's health continued to deteriorate, having multiple episodes of bradycardia and desaturation until cardiac arrest on the 17th day. Conclusions: Capnocytophaga ochracea was isolated from the blood culture of a preterm neonate. It was thought to be the cause of the premature labor and subsequent neonatal septicemia. This case report suggests that the prevalence of Capnocytophaga infections is most likely underestimated and that additional premature labors and abortions could have been caused by Capnocytophaga infections that were never detected. Hence, more studies are needed to investigate the route of transmission.

Leung Tse Ngong. / Thesis (M.D.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (p. 169-197). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web.