No description available.

No description available.

The purpose of this study was to explore the differences in physiologic and financial outcomes among women of single gestation whose labor was induced, augmented or natural. The decision analysis model was chosen as the theory for this study based on its value as a prescriptive aid. Prior to this study, no outcomes of this type had been published. Therefore, health care providers and women have only assumed there were no differences in outcomes for women whose labor was induced, augmented or natural. A comparative descriptive design was used to determine physiologic and financial outcomes among the three groups of women. A systematic stratified random sample was used to select a sample of 218 from term women with a single gestation who delivered between August 1, 1996, and August 1, 1997. The data were collected from the medical records of a large tertiary medical center in central Florida. The analysis of the data indicated there was a statistically significant difference in the physiologic and financial outcomes among women whose labor was induced, augmented, or natural.

Call number: LD2668 .T4 1979 S38 / Master of Science

Thesis (MMed)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Objective: The aim of the study was to determine whether Beta-hCG levels at various time intervals during the follow-up period after primary treatment of molar pregnancies could be used to predict progression of the disease later, in an attempt to shorten the period of surveillance. Furthermore an assessment of the demographic details and risk factors for the development of persistent trophoblastic disease was examined. Levels of compliance to the current surveillance protocol were evaluated. Method: A retrospective analysis of all patients diagnosed with molar pregnancies at Tygerberg Hospital, Cape Town from January 2000 to December 2010. Results: Among the 120 patients, 13 (19.7%) of complete moles and 10 (20%) of partial moles developed persistent trophoblastic disease. There was no statistical significance of the demographic data when comparing the two types of moles. 66% of complete and 50% of partial moles were lost to follow-up within the first six months of surveillance. A potential Beta-hCG cut-off value of 148mIU/ml at week 6 offered a sensitivity of 0.89 and specificity of 0.88 that surveillance could be terminated. Conclusions: Patient compliance is a limiting factor in the evaluation of molar pregnancy surveillance. However, based on our results, the suggestion that termination of surveillance after primary evacuation could occur at 6 weeks if the Beta-hCG level was 148 mIU/ml or lower remains undecided, and it is our opinion that higher sensitivities and specificities are required. Further research is needed to solidify this claim. The acquisition of demographic information of our population remains a priority, in order for more informed decisions to be made. / AFRIKAANSE OPSOMMING: Doel: Die doel van die studie was om te bepaal of Beta-mCG vlakke of verskillende intervalle, gedurende die opvolg periode na primêre behandeling van mola swangerskappe gebruik kan word om siekte progressie te voorspel, en sodoende die tydperk van opvolg te verminder. Verder was die demografiese besonderhede en risiko faktore vir die ontwikkeling van persisterende trofoblastiese siekte ondersoek. Die nakoming tot die huidige toesighouding protokol was geevalueer. Metode: ‘n Retrospektiewe analise van al die pasiënte wat gediagnoseer is met ‘n mola swangerskap by Tygerberg Hospitaal, Kaapstad vanaf Januarie 2000 tot Desember 2010. Resultate: Van die 120 pasiënte het 13 (19.7%) van die volledige molas en 10 (20%) van die gedeeltelike molas persisterende trofoblastiese siekte ontwikkel. Daar was geen statistiese belang in die demografiese data, wanneer die twee tipe molas met mekaar vergelyk is nie. 66% van die volledige en 50% van die gedeeltelike molas was verlore met opvolg binne die eerste ses maande van opvolg. ‘n Potensiële Beta-mCG afsnywaarde van 148mIU/ml op ses weke het ‘n sensitiwiteit van 0.89 en spesifisiteit van 0.88 gewys dat toesighouding getermineer kan word. Opsomming: Pasiënt nakoming is ‘n beperkende faktor in die opvolg van mola swangerskappe. Alhoewel, gebaseer op ons resultate, ons kan voorstel dat terminasie van “surveillance/toesighouding” na primêre lediging, kan plaasvind op 6 weke indien die Beta-mCG vlak 148mIU/ml of minder is, bly dit onbeslis. Dit is ons opinie dat hoër vlakke van sensitiwiteit en spesifisiteit nodig is. Verdere navorsing is nodig om hierdie voorstelling te staaf. Die invordering van demografiese inligting van ons populasie bly ‘n prioriteit, om sodoende meer ingeligte besluite te neem.

Thesis (MMed)-- Stellenbosch University, 2013. / ENGLISH ABSTRACT: Aims of the study Urodynamic studies (UDS) have been suggested to be performed as part of the pre-operative work-up of patients undergoing prolapse surgery. Some women with POP have occult stress urinary incontinence (OSUI) and even if subjectively continent, have a higher incidence of developing de novo stress urinary incontinence (SUI). The aim of this study was to describe the outcome of a group of patients who had pre-operative UDS and manual prolapse reduction. Methods This was a retrospective descriptive study including all women who had prolapse surgery during the period January 2006 to December 2011. Patients received routine pre-operative UDS and manual reduction of prolapse, performed at maximum bladder capacity determined by UDS. Patients demonstrating urodynamic SUI or OSUI were offered a concomitant anti-incontinence procedure. Post-operative follow-up data included symptoms of SUI and clinical evidence of SUI. Results The final group consisted of 131 women. The mean age of the patients was 57 years (range 33 to 79) and parity 3.6 (range 0 to 7). The mean body mass index was 32 (range 19 to 53). Twenty-four (18.3%) women had demonstrable SUI on clinical examination at initial presentation in the clinic. At the time of urodynamic studies, forty patients (30.5%) had evidence of SUI determined by either UDS and/ or cough test in the standing position at maximum bladder capacity. Ninety-one women (69.5%) had no evidence of UI on UDS, of which 20(15.3%) demonstrated OSUI (SUI on manual reduction of prolapse at maximal bladder capacity determined by UDS). Of the 40 women with UI on UDS, 36 had 1-step surgery (combination of anti-incontinence procedure and prolapse repair) and 4 had prolapse surgery alone. Of the 20 women with OSUI on UDS, 16 had 1-step (combined) surgery and 4 prolapse surgeries only. Of the 4 who had prolapse surgery alone, 3 complained of post-operative SUI. In the group with no SUI on UDS and manual reduction of POP, 69 of the 71 women had follow-up data. Only 1 had demonstrable SUI on examination. The manual reduction test had a sensitivity of 42.9% and a specificity of 98.5% (95% CI, 92.0-99.9%). The positive predictive value was 75.0% (95% CI, 19.4-99.3%), with a high negative predictive value of 94.4% (95% CI, 86.2-98.8%). Conclusion The numbers in our study are too small to determine sensitivity and positive predictive value of UDS and manual prolapse reduction for the detection of OSUI. However, our data shows promise in identifying POP patients without OSUI, which is a complement of the hypothesis. We recommend that UDS can be performed pre-operatively in women undergoing prolapse surgery, to identify patients with urodynamic stress incontinence. Manual reduction of the prolapse at maximum bladder capacity can then be done to identify a subgroup of patients without OSUI. Future research is needed on the true predictive value of reduction stress testing with larger numbers. / AFRIKAANSE OPSOMMING: Doel van die studie Urodinamiese studies (UDS) word voorgestel as deel van die pre-operatiewe ondersoeke voor prolaps chirurgie gedoen word. Sommige vroue met genitale prolaps het verborge druklek, en selfs as hulle subjektief kontinent is, het hulle ‘n groter insidensie van de novo druklek. Die doel van die studie was om die uitkoms van ‘n groep pasiënte wat pre-operatiewe UDS en manuele prolaps reduksie gehad het, te beskryf. Metodes Die studie was ‘n retrospektiewe beskrywende studie. Al die pasiënte wat prolapse chirurgie in die tydperk Januarie 2006 tot Desember 2011 gehad het, is ingesluit. UDS en manuele prolaps reduksie tydens maksimale blaaskapasiteit, bepaal deur UDS, was deel van die roetine pre-operatiewe ondersoeke. In die gevalle waar urodinamiese druklek of verborge druklek demonstreer is, is die opsie van ‘n meegaande prosedure vir kontinensie tydens prolaps chirurgie aangebied. Post-operatiewe opvolg inligting het simptome van druklek en kliniese bewys van druklek ingesluit. Resultate Die finale groep was 131 vroue reikwydte. Die gemiddelde ouderdom van die pasiënte was 57 jaar (reikwydte 33 - 79) en pariteit 3.6 (reikwydte 0 - 7). Die gemiddelde liggaamsmassa indeks was 32 (reikwydte 19 - 53). Vier-en-twintig (18.3%) vroue het aantoonbare druklek gehad met kliniese ondersoek tydens die eerste kliniek afspraak. Tydens UDS het 40(30.5%) pasiënte druklek getoon tydens UDS en/ of hoestoets in die staande posisie teen maksimale blaaskapasiteit. Een-en-negentig (69.5%) het geen tekens van urinêre inkontinensie tydens UDS demonstreer nie, waarvan 20(15.3%) verborge druklek demonstreer het (druklek met reduksie van prolapse tydens maksimale blaaskapasiteit, bepaal deur UDS). Veertig pasiënte het urodinamiese druklek gehad, waarvan 36 een-stap chirurgie (‘n kombinasie van prolaps herstel en meegaande kontinensie prosedure) en 4 prolaps chirurgie alleenlik gehad het. Uit die 20 vroue met verborge druklek tydens UDS, het 16 een-stap (kombinasie) chirurgie en 4 prolaps chirurgie alleen gehad. Uit die 4 wat prolaps chirurgie alleen gehad het, het 3 post-operatiewe klagtes van druklek gehad. In die groep wat geen inkontinensie tydens UDS en manuele prolaps reduksie gehad het nie, het 69 van die 71 vroue opvolg data gehad. Druklek kon net by een pasiënt met ondersoek demonstreer word. Die manuele reduksie toets het ‘n sensitiwiteit van 42.9% en ‘n spesifisiteit van 98.5% (95% CI, 92.0-99.9%) gehad. Die positiewe voorspellingswaarde was 75.0% (95% CI, 19.4-99.3%), en die negatiewe voorspellingswaarde was 94.4% (95% CI, 86.2-98.8%). Gevolgtrekking Die getalle in ons studie was te min om te bepaal wat die sensitiwiteit en positiewe voorspellingswaarde van UDS and manuele prolaps reduksie is om verborge druklek te demonstreer. Die belowende data om pasiënte te identifiseer met genitale prolaps sonder verborge druklek (‘n kompliment van die hipotese). UDS kan pre-operatief gedoen word in pasiënte wat prolapse herstel chirurgie benodig, om pasiënte met urodinamiese druklek te identifiseer. Manuele reduksie van die prolaps tydens maksimum blaas kapasiteit kan dan volg, om ‘n subgroep van pasiente sonder verborge druklek, uit te ken. Verdere navorsing, met groter getalle word benodig om die werklike voorspellende waarde van die reduksie toets te ondersoek.

Thesis (MMed)-- Stellenbosch University, 2013. / ENGLISH ABSTRACT: Background: Studies about management of prolonged pregnancy dealt with pregnancy with certain gestational age, confirmed with early ultrasound scans. Objective: The primary aim for the study is to review the current management of uncertain gestational age (GA) post term pregnancy in Tygerberg Academic Hospital (TBH). Women at 42 weeks with an uncertain GA and an amniotic fluid index (AFI) of ≥ 10 cm as well as reassuring cardiotocographs (CTG) would be assessed to determine whether follow up over one week or two weeks are required. Method: A retrospective descriptive study included all patients with an uncertain gestation of 42 weeks referred to TBH. Results: A total of 135 pregnant women were studied. Booking fundal height (BFH) was used to determine GA in 99% and last menstrual period (LMP) in 1% of patients. The time interval between first evaluation at 42 weeks and delivery varies between 0 to 46 days (median 10 days); 104 women delivered vaginally (71% spontaneously, 6% after induction of labour (IOL)); 31 women (23%) by caesarean section; 1 elective, 4 due to cephalopelvic proportion (CPD), 5 had failed IOL, 3 poor progress and 18 fetal distress. Out of the total 11 (8%) women with AFI ≥ 10 had caesarean sections for fetal distress within 2 weeks of the visit at 42 weeks. No neonatal morbidity or mortality was noted in this study. Conclusion: Weekly monitoring with AFI and CTG for women at 42 weeks with unsure gestation is safe. A follow-up following 2 weeks cannot be recommended as 8% of women required caesarean sections within less than 2 weeks due to fetal distress. / AFRIKAANSE OPSOMMING: Agtergrond: Studies oor verlengde swangerskap handel oor swangerskappe met seker swangerskapsduurte, bevestig met vroeë ultraklank skandering. Doelwit: Die primêre doelwit van die studie is om die huidige hantering van verlengde swangerskap met onseker swangerskapsduurte by Tygerberg Hospitaal (TBH) te beoordeel. Vroue wat volgens onseker swangerskapsduurte 42 weke swanger is met ‘n amnionvogindeks (AVI) van >10 en gerusstellende kardiotokogramme (KTG) sal nagegaan word om te bepaal of opvolg oor een of twee weke nodig is. Metode: ‘n Retrospektiewe studie wat alle pasiënte insluit wat na Tygerberg Akademiese Hospitaal verwys word wat ‘n onseker swangerskapsduurte van 42 weke het. Resultate: ‘n Totaal van 135 vroue is bestudeer. Die fundale hoogte is gebruik om swangerskapsduurte te bepaal in 99% van gevalle en die laaste menstruasie in 1%. Die tydsinterval tussen die eerste evaluasie op 42 weke en verlossing wissel tussen 0 en 46 dae (mediaan 10 dae); 104 vroue het ‘n vaginale verlossing gehad (71% met spontane aanvang van kraam, 6% na induksie van kraam); 31 (23%) is met keisersnitte verlos; 1 elektief, 4 as gevolg van skedelbekken disproporsie, 5 gefaalde induksies, 3 swak vordering en 18 met fetal nood. Uit die totaal was daar 11 (8%) vroue met ‘n AVI ≥ 10 wat keisersnitte vir fetale nood binne 2 weke van die besoek op 42 weke gehad het. Geen neonatale morbititeit of mortaliteit het in die studie voorgekom nie. Gevolgtrekking: Weeklikse monitering met AVI en KTG vir vroue wat 42 weke swanger is met onseker swangerskapsduurte, is veilig. Opvolg na 2 weke kan nie aanbeveel word nie want 8% het keisersnitte vir fetale nood gehad na minder as 2 weke.

Thesis (DMed (Obstetrics and Gynaecology))--Stellenbosch University, 2008. / Chapter 1 presents a literature study on the diagnostic debate of PCOS. The literature study includes a discussion of the recent Rotterdam consensus statement regarding the diagnosis of PCOS. This is followed by a discussion on the essential work-up of the patient presenting with PCOS. Finally, chapter 1 presents a discussion on the complexity of the different variations in women presenting with PCOS. Chapter 2 is a literature review on ovulation induction methods in patients who present with PCOS. This literature study puts special emphasis on the different available methods used for ovulation induction in women with PCOS and the profounding effect weight loss will have in managing these patients. This chapter also addresses the use of newer agents, like aromatase inhibitors (Letrozole), and the current role of each of these agents in ovulation induction protocols. Chapter 3 is a literature overview on the effect of Metformin in Clomiphene-resistant PCOS women. The inclusion criteria of this review was all prospective randomized trials where Metformin was added for ovulation in the Clomiphene-resistant PCOS patient. The data is presented as a metaanalysis. Chapter 4 is a prospective randomise control trial to evaluate the benefit of metformin if added to Clomiphene in a primary ovulation induction protocol in comparison to Clomiphene alone. This chapter also evaluates all factors influencing ovulation outcome. Finally in the discussion section all the recent studies published addressing this topic were reviewed. Chapter 5 is a literature review to evaluate the classification systems for semen parameters and the in vivo fertility potential. This data is also used to establish fertility/subfertility thresholds for semen parameters. This chapter also presents the results of a prospective and retrospective study of the semen analysis of the partners of women with PCOS. We believe that this population presents the best reference group to study the semen profile of the general male population. Chapter 6 is a summary of the results of these studies and serves as an evidence based approach for ovulation induction in women with PCOS.

BACKGROUND: Rising rates of maternal morbidity and mortality and persistent disparities in care utilization and outcomes signal a need for new approaches to prenatal care delivery. This study uses perspectives of low-socioeconomic status (SES) pregnant women to generate features of a patient-centered intervention aimed at improving outcomes in high cost, high need pregnant individuals. METHODS: We performed a secondary analysis of qualitative interviews with Medicaid-insured pregnant high and low utilizers of unscheduled obstetric care. Using a grounded theory approach, we tightly mapped themes to generate intervention strategies with potential to improve prenatal care delivery. RESULTS: Three key themes translated into intervention features: social support, care delivery, and access. Unlike low utilizers, high utilizers had a desire for more social support, improved communication in care delivery, and access to timely and efficient appointments. For low utilizers, improved insurance access and the ability to opt out of support services that didn’t align with their priorities were essential. CONCLUSION: High and low utilizers of unscheduled obstetric care have unique ideas for improving their care. Targeted interventions to improve prenatal care can be tested to potentially address unmet needs of vulnerable subgroups of low-SES pregnant women at risk for poor outcomes. / 2019-10-31T00:00:00Z

本文回顧了前近代時期中國傳統婦產科一門的醫學沿革與歐美產科醫學的「現代化」過程，追溯了西方婦產醫學自19世紀中期以來傳入廣州的發展軌跡。同時將目光聚焦於傳統醫學與19世紀傳入廣州的西方醫學，並將兩種體系進行比較。發現在不同的情況下二者表現出不同的利弊，無法評價其各自方法之優劣。而由傳教士所帶來的西法接生因為其統一、規範的操作被務實的廣州人所接受，並被善堂採用而作為慈善服務的一種，從而在廣州傳播並得到普及。可見，在廣州的西化過程中，是國人將適合自身的西方事物融入到本地社會生活中，並在不斷的磨合中完成「現代化」，而非國人克服種種困難，不斷地追求科學等現代指標。 / 此外，本文描繪廣州社會在20世紀初期接納「西法接生」，並將其作為一種摩登的接生方法而運用的歷史。受教會訓練的「女醫生」已成為一種正當的職業在社會上存在，「西法接生」這種由西醫外科衍變而來的技術為女醫生所利用，成為她們執業的亮點。通過善堂的贈接生善舉，「西法接生」在廣州的認知度得以提升，直至政府將婦女生產納入其衛生行政體系，並對接生從業者加以規管。可見，廣州婦女分娩的「現代化」並非得力於政府衛生行政的推動，而是在更早時期自發出現的。 / 通過比較香港、北京、廣州、上海四地政府對助產人員的規管條例，不同城市顯示出各自的特色。北京、上海借助西方公共衛生行政管理方法，集中對產婆進行培訓、登記，使其接生操作符合衛生行政要求，從而建立出一套適應中國社情的混合式制度，並以這一模式進行婦女生產的「現代化」。在中國醫療西化的過程中，不同的地方社會有著不同的衛生行政管理軌跡。 / This article examines the introduction, development, and proliferation of western Obstetrics, in particular the Midwifery, in Canton from 1860s to 1930s. By comparing and contrasting treatment of childbirth by traditional Chinese Midwifery in pre-modern period, especially the Ming and Qing Dynasties to the Western Midwifery brought to Canton in this period, it is concluded that, subscribed to each distinctive medical theories, the two applied different views and strategies on the course of childbirth. Nevertheless, from an overall perspective, western Midwifery didn’t display obvious advantages compared with the Chinese traditional one. During the period of 1890s and 1920s, local philanthropic organizations actively promoted the approach and benefits of western midwifery to the local community to the childbirth modernity. / In addition, the modernization on childbirth in Canton was different to which in Beijing, Shanghai and Hong Kong. In Beijing and Shanghai, the Municipal Governments established a new blended system legislating the centralized training and registration of traditional midwives to archive childbirth modernization with the application of western public health methods. In Canton, on the contrary, a large number of young women who have had more systematic classes and professional western medical training actively in missionary or local medical schools, became so-called “Obstetrics doctors. They participated in the “Free Delivery service offered by local philanthropic organizations with their western midwifery skills as a selling point, and replaced the traditional midwives to obtaining the majority of midwives. This led to another path to childbirth modernization. / It was suggested that different areas of China progressed variously during the journey of medical modernization and Canton played the unique role in the medical modernization of China. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / 蔡笳. / "2012年8月". / "2012 nian 8 yue". / Thesis (M.Phil.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 89-95). / Abstract in Chinese and English. / Cai Jia. / 摘要 --- p.i / 目錄 --- p.iii / 導論 --- p.1 / Chapter 一、 --- 19、 20世紀中國的「現代化」問題 --- p.1 / Chapter 二、 --- 醫療史與中國「現代化」問題的討論 --- p.3 / Chapter 三、 --- 女性生育與醫療 --- p.4 / Chapter 四、 --- 廣州與中國「現代化」的地區差異 --- p.6 / Chapter 五、 --- 章節結構 --- p.8 / Chapter 第一章 --- 明清中國產科與17-19世紀的西方產科 --- p.9 / Chapter 一、 --- 明代以前中國的婦產醫學 --- p.10 / Chapter 二、 --- 明清以來中國婦產醫學與生育習俗 --- p.11 / Chapter （一） --- 明清時期中國婦產醫學 --- p.11 / Chapter （二） --- 明清時期的分娩處理 --- p.12 / Chapter 三、 --- 18、 19世紀歐美產科醫學的發展 --- p.18 / Chapter （一） --- 英國產科醫學的概況 --- p.18 / Chapter （二） --- 現代醫學的產生與婦產科之變化 --- p.20 / Chapter （三） --- 18、 19世紀的美國產科發展 --- p.21 / Chapter 四、 --- 小結 --- p.22 / Chapter 第二章 --- 西醫產科傳入廣州（1834-1890） --- p.25 / Chapter 一、 --- 西醫產科的早期發展 --- p.25 / Chapter （一） --- 伯駕的到來（1834-1850） --- p.25 / Chapter （二） --- 嘉約翰的成就：西醫醫院的雛形和西醫教育（1855-1899） --- p.27 / Chapter 二、 --- 女傳教士醫生的到來和西醫婦產醫療的實踐 --- p.32 / Chapter 三、 --- 女醫學堂的緣起 --- p.35 / Chapter 四、 --- 女醫學堂的醫學教育 --- p.37 / Chapter （一） --- 教育培訓 --- p.37 / Chapter （二） --- 西醫助產方法操作規範 --- p.40 / Chapter （三） --- 備用器材 --- p.44 / Chapter 五、 --- 夏葛醫校與柔濟醫院的婦產醫療實踐 --- p.44 / Chapter 六、 --- 小結 --- p.45 / Chapter 第三章 --- 西醫婦產在當地社會的發展（1895-1930） --- p.47 / Chapter 一、 --- 清末民初廣州善堂的「贈接生」服務 --- p.47 / Chapter （一） --- 順德水藤如春善社與廣州贊育醫社 --- p.49 / Chapter （二） --- 廣州方便醫院 --- p.50 / Chapter 二、 --- 清末民初產科醫院的創立 --- p.53 / Chapter 三、 --- 廣州婦產醫生群體 --- p.55 / Chapter （一） --- 出身背景 --- p.56 / Chapter （二） --- 女性產科師在醫患關係中的角色 --- p.57 / Chapter 四、 --- 政府衛生行政對產科從業者之規管 --- p.59 / Chapter 五、 --- 小結 --- p.68 / 結論 --- p.69 / 附錄 --- p.75 / 參考書目 --- p.89