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.

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.

External cephalic version (ECV) involves turning a fetus in utero by manipulation through the maternal abdomen and the uterine wall. / Many clinicians and patients, however, still decline ECV in favour of Caesarean section. This could be due to the lack of experience of ECV, and fear of complications or pain during the version. / Summary. The force applied during ECV can be measured and analysed using a customized pair of gloves incorporating piezo-resistive pressure sensors and suitable analytical software. The degree of force required for a successful version is highly variable. Failure of version is not usually due to insufficient force. Uterine tone is the most important factor affecting the degree of force applied during a version attempt. The degree of force applied is associated with the changes in fetal cerebral blood flow after ECV, and the amount of pain perceived by the patients. (Abstract shortened by UMI.) / The lack of information in this area is primarily due to the lack of a suitable device that would allow measurements of the force applied without interfering with the ECV. A suitable device would therefore have to be sufficiently robust so that it could be worn on the hands, durable so that it could be used repeatedly, incorporate multiple individual sensors, each of which is capable of making dynamic and mutually independent measurements during the version procedure. / There is no report in the literature on quantification of the force applied during ECV. It is also unknown whether the degree of force applied is related to the version outcome. In particular, it is unclear whether a failed attempt is related to insufficient force, or whether an increase in force may help to achieve version after a failure. Furthermore, it is also not known if any patients' factors may influence how much force is applied through the operator's hands. Although the chance of successful version could be predicted by some clinical factors, whether these factors may also affect the degree of applied force is not known. / This thesis reports on the design and development of a suitable measuring device fulfilling the requirements described above. In addition, it will test a number of hypotheses relating to the degree of force applied during ECV and clinical feto-maternal parameters and outcomes, in a study cohort of 92 patients. / Leung Tak Yeung. / "April 2005." / Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 3717. / Thesis (M.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 155-174). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / School code: 1307.

Diss. (sammanfattning) Umeå : Univ., 2005. / Härtill 4 uppsatser. S. 57-69: Bibliography.

OBJETIVO: Analisar a associação entre o estado nutricional materno em gestações de alto risco e complicações do parto, do puerpério e análise do consumo dietético dessas gestantes. MÉTODOS: Estudo prospectivo e observacional realizado no período de agosto de 2009 a agosto de 2010, com os seguintes critérios de inclusão: puérperas até o quinto dia; idade acima de 18 anos; gestação de alto risco; feto único e vivo no início do trabalho de parto; parto na Instituição; peso materno aferido no dia do parto. O estado nutricional no final da gestação foi avaliado pelo índice de massa corporal (IMC), aplicando-se a curva de Atalah. As pacientes foram classificadas em: baixo peso, adequado, sobrepeso e obesidade. O consumo dietético foi avaliado por aplicação do questionário de frequência do consumo alimentar. As complicações do parto e do puerpério, investigadas durante o período de internação e 30 dias após a alta, foram: tipo de parto, infecção e/ou secreção em ferida cirúrgica, infecção urinária, infecção puerperal, febre, hospitalização, uso de antibióticos e morbidade composta (pelo menos uma das complicações puerperais citadas). RESULTADOS: Foram incluídas 374 puérperas classificadas pelo IMC final em: baixo peso (n=54, 14,4%); adequado (n=126, 33,7%); sobrepeso (n=105, 28,1%) e obesidade (n=89, 23,8%). Não houve diferença significativa na proporção de cesáreas quando comparados os seguintes grupos: baixo peso e adequado (68,3%), sobrepeso (76,2%) e obesidade (78,6%, P=0,201). A obesidade materna apresentou associação significativa com as seguintes complicações do puerpério: infecção de ferida cirúrgica (16,7%, P=0,042), infecção urinária (9,0%, P=0,004), uso de antibiótico (12,3%, P<0,001) e morbidade composta (25,6%, P=0,016). Aplicando-se o modelo de regressão logística, verificou-se que a obesidade no final da gestação é variável independente na predição da morbidade composta (OR: 2,09; IC95%: 1,15 - 3,80, P=0,015). A análise do consumo dietético demonstrou média de consumo energético semelhante nos grupos: baixo peso e adequado (2344 cal/dia), sobrepeso (2433 cal/dia) e obesidade (2450 cal/dia, P=0,640). Não se constatou diferença significativa no consumo médio diário de macro e micronutrientes entre os grupos estudados. CONCLUSÃO: A obesidade materna no final da gravidez, em pacientes de alto risco, está associada, de forma independente, com a ocorrência de complicações infecciosas no puerpério, demonstrando a necessidade de acompanhamento mais eficiente em relação ao ganho de peso materno nessas gestações / OBJECTIVE: To assess the association between maternal obesity and the occurrence of delivery and postpartum complications in high risk pregnancies, and to analyze the dietary intake of these pregnant women. METHODS: Prospective and observational study conducted from August 2009 to August 2010, with the following inclusion criteria: admission to the 5th day, maternal age 18-year-old, high-risk pregnancy, single pregnancy, fetus alive at the beginning of labor, birth at the institution, maternal weight measured at birth. Nutritional status in late pregnancy was assessed by body mass index (BMI), and applying the curve Atalah. The patients were classified as: underweight, appropriate, overweight and obesity. The dietary intake was evaluated applying a food frequency questionnaire. The complications of delivery and postpartum, investigated during the hospitalization and 30 days after discharge, were: infection and / or secretion in the surgical wound, urinary tract infection, puerperal infection, fever, hospitalization, antibiotics, and composite morbidity (at least one puerperal complication). RESULTS: We included 374 postpartum women classified by the final BMI: underweight (n=54, 14.4%), appropriate (n=126, 33.7%), overweight (n=105, 28.1%) and obesity (n=89, 23.8%). There was no significant difference in the proportion of cesarean when compared the following groups: underweight and appropriate (68.3%), overweight (76.2%) and obesity (78.6%, P=0.201). Maternal obesity was significantly associated with the following puerperal complications: surgical wound infection (16.8%, P=0.042), urinary tract infection (9.0%, P= 0.004), antibiotic use (12.3%, P<0.001) and composite morbidity (25.6%, P=0.016). The logistic regression model showed that obesity in late pregnancy is an independent variable in predicting the composite morbidity (OR: 2.09, 95% CI: 1.15 to 3.80, P=0.015). The analysis of dietary intake showed average energy consumption similar in the groups: underweight and appropriate (2344 cal/day), overweight (2433 cal/day) and obesity (2450 cal/day, P=0.640). There was no significant difference in the average daily consumption of macro-and micronutrients among the groups studied. CONCLUSION: Maternal obesity at the end of high-risk pregnancy is independently associated with the occurrence of postpartum infectious complications, showing the need for more efficient monitoring of maternal weight gain in these pregnancies

OBJETIVO: Analisar a associação entre o estado nutricional materno em gestações de alto risco e complicações do parto, do puerpério e análise do consumo dietético dessas gestantes. MÉTODOS: Estudo prospectivo e observacional realizado no período de agosto de 2009 a agosto de 2010, com os seguintes critérios de inclusão: puérperas até o quinto dia; idade acima de 18 anos; gestação de alto risco; feto único e vivo no início do trabalho de parto; parto na Instituição; peso materno aferido no dia do parto. O estado nutricional no final da gestação foi avaliado pelo índice de massa corporal (IMC), aplicando-se a curva de Atalah. As pacientes foram classificadas em: baixo peso, adequado, sobrepeso e obesidade. O consumo dietético foi avaliado por aplicação do questionário de frequência do consumo alimentar. As complicações do parto e do puerpério, investigadas durante o período de internação e 30 dias após a alta, foram: tipo de parto, infecção e/ou secreção em ferida cirúrgica, infecção urinária, infecção puerperal, febre, hospitalização, uso de antibióticos e morbidade composta (pelo menos uma das complicações puerperais citadas). RESULTADOS: Foram incluídas 374 puérperas classificadas pelo IMC final em: baixo peso (n=54, 14,4%); adequado (n=126, 33,7%); sobrepeso (n=105, 28,1%) e obesidade (n=89, 23,8%). Não houve diferença significativa na proporção de cesáreas quando comparados os seguintes grupos: baixo peso e adequado (68,3%), sobrepeso (76,2%) e obesidade (78,6%, P=0,201). A obesidade materna apresentou associação significativa com as seguintes complicações do puerpério: infecção de ferida cirúrgica (16,7%, P=0,042), infecção urinária (9,0%, P=0,004), uso de antibiótico (12,3%, P<0,001) e morbidade composta (25,6%, P=0,016). Aplicando-se o modelo de regressão logística, verificou-se que a obesidade no final da gestação é variável independente na predição da morbidade composta (OR: 2,09; IC95%: 1,15 - 3,80, P=0,015). A análise do consumo dietético demonstrou média de consumo energético semelhante nos grupos: baixo peso e adequado (2344 cal/dia), sobrepeso (2433 cal/dia) e obesidade (2450 cal/dia, P=0,640). Não se constatou diferença significativa no consumo médio diário de macro e micronutrientes entre os grupos estudados. CONCLUSÃO: A obesidade materna no final da gravidez, em pacientes de alto risco, está associada, de forma independente, com a ocorrência de complicações infecciosas no puerpério, demonstrando a necessidade de acompanhamento mais eficiente em relação ao ganho de peso materno nessas gestações / OBJECTIVE: To assess the association between maternal obesity and the occurrence of delivery and postpartum complications in high risk pregnancies, and to analyze the dietary intake of these pregnant women. METHODS: Prospective and observational study conducted from August 2009 to August 2010, with the following inclusion criteria: admission to the 5th day, maternal age 18-year-old, high-risk pregnancy, single pregnancy, fetus alive at the beginning of labor, birth at the institution, maternal weight measured at birth. Nutritional status in late pregnancy was assessed by body mass index (BMI), and applying the curve Atalah. The patients were classified as: underweight, appropriate, overweight and obesity. The dietary intake was evaluated applying a food frequency questionnaire. The complications of delivery and postpartum, investigated during the hospitalization and 30 days after discharge, were: infection and / or secretion in the surgical wound, urinary tract infection, puerperal infection, fever, hospitalization, antibiotics, and composite morbidity (at least one puerperal complication). RESULTS: We included 374 postpartum women classified by the final BMI: underweight (n=54, 14.4%), appropriate (n=126, 33.7%), overweight (n=105, 28.1%) and obesity (n=89, 23.8%). There was no significant difference in the proportion of cesarean when compared the following groups: underweight and appropriate (68.3%), overweight (76.2%) and obesity (78.6%, P=0.201). Maternal obesity was significantly associated with the following puerperal complications: surgical wound infection (16.8%, P=0.042), urinary tract infection (9.0%, P= 0.004), antibiotic use (12.3%, P<0.001) and composite morbidity (25.6%, P=0.016). The logistic regression model showed that obesity in late pregnancy is an independent variable in predicting the composite morbidity (OR: 2.09, 95% CI: 1.15 to 3.80, P=0.015). The analysis of dietary intake showed average energy consumption similar in the groups: underweight and appropriate (2344 cal/day), overweight (2433 cal/day) and obesity (2450 cal/day, P=0.640). There was no significant difference in the average daily consumption of macro-and micronutrients among the groups studied. CONCLUSION: Maternal obesity at the end of high-risk pregnancy is independently associated with the occurrence of postpartum infectious complications, showing the need for more efficient monitoring of maternal weight gain in these pregnancies

Le déclenchement du travail est une procédure obstétricale qui consiste à provoquer le travail afin que la femme puisse vivre un accouchement vaginal dans les 24 à 48 heures suivant l’initiation de la procédure (Leduc et al., 2013). Cependant, le déclenchement du travail peut ne pas fonctionner entraînant la nécessité de procéder à un accouchement par césarienne après un travail d’une durée de plus de 24 heures. Cette étude qualitative visait à explorer l’expérience de femmes qui ont vécu un échec du déclenchement du travail résultant en une césarienne non planifiée. Cette étude a été menée auprès de 6 femmes durant leur séjour hospitalier post-partum. Les données ont été obtenues à l’aide d’un questionnaire sociodémographique, du dossier médical des participantes et d’un entretien semi-dirigé. Les entretiens semi-dirigés ont été enregistrés, avec l’accord des participantes, puis transcrits et analysés selon l’approche d’analyse thématique de Braun, Clarke, Hayfield et Terry (2019). Cinq thèmes et 12 sous-thèmes ont émergé de l’analyse thématique permettant de mieux saisir l’expérience des femmes vivant un échec du déclenchement du travail résultant en une césarienne. Les thèmes : Les attentes envers l’expérience, Le soutien reçu, La qualité et quantité de l’information reçue ainsi que Le sentiment de contrôle envers l’expérience semblent influencer la satisfaction ou l’insatisfaction de la participante envers son expérience et contribuent au thème global de l’Expérience globale de l’échec du déclenchement du travail résultant en une césarienne. Les infirmières ont un rôle important afin de communiquer l’information aux patientes et de les soutenir quant au déclenchement du travail leur permettant de mieux gérer leurs attentes et exercer le contrôle désiré envers leur expérience. / Induction of labor is an obstetric procedure which consists of inducing labor so that women can experience a vaginal birth within 24 to 48 hours after the initiation of the procedure (Leduc et al., 2013). The induction of labor may not work resulting in the need for a caesarean delivery after lasting more than 24 hours. This qualitative study aimed to explore the experience of women who had experienced labor induction failure resulting in an unplanned caesarean section. This study was conducted with 6 women in the postpartum unit during their hospitalisation. Data were collected from a socio-demographic questionnaire, the participants’ medical chart as well as a semi-structured interview. After participants’ consent, the semi-structured interviews were recorded, transcribed, then analysed using the Braun, Clarke, Hayfield and Terry (2019) thematic analysis approach. Five themes and 12 sub-themes emerged to better capture the experience of women experiencing labor induction failure resulting in a caesarean. Four themes: Expectation of Labor and Delivery: Managing Expectations, Antepartum and Intrapartum Support Received, Comprehensive Information Needed, and Feeling in Control of the Experience emerged as influencing the participant's satisfaction or dissatisfaction towards their Global Experience of a Failed Induction of Labor Resulting in a Ceserean Section. Nurses have a strategic role and are key support professionals in communicating information and supporting women during induction of labor, allowing them to better manage their expectations and have the desired level of control over their experience.