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Breech malpresentation is associated with maternal-infant morbidity and mortality. Maternal knee-chest posture is a clinical practice intended to reduce the incidence of breech presentation and its concomitant risks in pregnancy. However, research on postural management has been inconclusive. This randomized clinical trial investigated whether knee-chest posture is associated with a higher proportion of breech infants converting to cephalic presentation during pregnancy. The study was conducted with 25 pregnant women whose infants were in breech presentation at 34–38 weeks gestation. Gestational age, parity, race, and treatment were evaluated for effect on version using Fisher exact tests. Gestational age, parity and treatment met screening criteria (p ≤ .25) for significance in the univariate analyses. Logistic regression was not employed due to zero cells in some of the univariate contingency tables. Effects of the intervention on infant presentation in labor, mode of delivery, birthweight, and 5-minute Apgar were examined by Fisher exact tests. There was no significant effect of intervention on birth outcomes at the p ≤ .05 level. Data from this study of 25 women were combined with data from two previous randomized trials for the same intervention. There was no effect of knee-chest posture on breech presentation in pregnancies over 36 weeks gestation. Implications for nurses and obstetric care providers include knowing that postural management of breech pregnancy is not yet adequately tested, advising clients accordingly and participating in the research to establish whether knee-chest posture promotes cephalic version of breech presentation.

Thesis (M.S.)—Boston University

Racial disparities in maternal mortality in the United States are urgently in need of greater attention and research. The prevalence of preeclampsia is higher among African American women than White women by 1.7-fold, and African American women are three times more likely to die from preeclampsia complications. Among African American patients, Apolipoprotein L1 protein (APOL1) gene variants are known to be linked to increased risk for non-diabetic chronic kidney disease (CKD). The Sub-Saharan African population is particularly affected by these risk variants, and they also have one of the highest rates of preeclampsia in the world. Variants in the APOL1 gene are common, with about 40-50% of African American individuals carrying one variant, suggesting that APOL1 may underlie other health conditions that disproportionately affect patients of recent African origin, including preeclampsia. Previous epidemiologic studies support an association between APOL1 variants in the fetus and preeclampsia risk. There are also indications that in the kidney podocytes, these variants increase the endoplasmic reticulum (ER) specific stress protein GRP78, also known to regulate trophoblast syncytialization in the placenta. Although previous studies are suggestive, the mechanisms by which APOL1 variants alter placental function to increase preeclampsia risk are not understood. We utilized immunofluorescence (IF) studies to probe APOL1 expression in first trimester placenta (6-7 weeks gestation), as well as reverse-transcription polymerase chain reaction (RT-PCR) and Western blot studies to probe basal expression of messenger ribonucleic acid (mRNA) and protein of both APOL1 and GRP78 in BeWo cells. Our results have laid the foundation for studies of the role APOL1 plays in the genesis of preeclampsia. / 2026-03-06T00:00:00Z

Background: Communication failures during handover has long been noted as a threat to patient safety.1 Breakdown in communication among health professionals is reported to account for up to 85% of hospital sentinel events.1 Lack of formal structure and training in handover methods 53 as well as modes of communication including nonverbal behaviors 59 have been reported to affect the quality of information exchange in handovers. 59 The objective of this mixed methods study is to conduct a detailed analysis of handover content among physicians and among nurses on a Birthing Unit and to examine communication processes within these groups in order to identify gaps in the process. This may provide a basis for future development of standardized approaches and training efforts. Methods: A convergent, parallel mixed methodology was used. The sample in this study comprises the nurses and medical obstetrical team in a hospital Birthing Unit in Hamilton Ontario. Phase one of the study involved initial observations of handover, performing a Delphi to gain consensus on handover content and creating a handover assessment tool. Phase two involved reliability testing of the tool and in phase three, twenty five paired nurse to nurse compared to medical handovers were video recorded, scored and correlated to participant questionnaires. Results: Gaps in handover content were identified; the nurses achieved a mean score of 10.24 items compared to physicians mean score of 9.02 (correlation 0.582, p <0.01). This showed statistically significant differences in the items mentioned among the two groups iii (t = 13.2, p < 0.001). Nonverbal behaviors noted during handover observations revealed inconsistencies in conveying information, within and between the two groups. The findings of this study contribute to a better understanding of handover gaps, has implications to other health team practices and highlights the need for standardized processes, training and policy development. / Thesis / Master of Science (MSc)