Thesis (MCS) -- AUT University, 2009. / Includes bibliographical references. Also held in print (vi, 43 leaves : col. ill. ; 30 cm + 1 DVD (4 3/4 in.)) in the City Campus Theses Collection (T 155.937 MCK)

Thesis (Ph. D.)--University of Florida, 1981. / Description based on print version record. Typescript. Vita. Includes bibliographical references (leaves 107-115).

The greatest less of infant life occurs around the time of birth (Eliet, 1958) and the mortality rate for first day deaths has shown less improvement than for any other time during the first year (Arey and Dent, 1953). "Once the human feetus has attained a gestational age permitting extra-uterine survival, neonatal death may be more commonly associated with failure of respiratory adaptation than with any other adaptational failure" (Smith, 1964). About two-thirds of all deaths in the newborn are associated with respiratory failure (Briggs and Nogg, 1958; Drissell and Smith, 1962). Hutchisen et al (1962) stated that the pulmonary syndrome of the newborn is probably the major problem of present day neonatal paediatries.

Background Unexplained stillbirth is the largest contributor to perinatal death, accounting for one third of stillbirths. Although prognostic information is limited, there is no increase in perinatal death rates in subsequent pregnancies after an unexplained stillbirth. However, those pregnancies have increased rates of preterm birth, low birthweight, induced labour, instrumental and caesarean delivery, 'fetal distress,' and postpartum haemorrhage. These outcomes might be iatrogenic, caused by obstetric intervention. Aims 1. To examine obstetricians' and womens' wishes for management in pregnancies subsequent to an unexplained stillbirth, and whether these might contribute to an increase in rates of intervention. 2. To examine whether socio-demographic factors, or how women perceive that an unexplained stillbirth was managed, influence how women want their next pregnancy managed. 3. To assess whether management of unexplained stillbirth differs according to model of care, or country where the event occurred. Methods 1. An anonymous postal survey of all Australian obstetricians to determine recommended management of the next pregnancy after an unexplained stillbirth. 2. An Internet-based survey of women after an unexplained stillbirth, seeking details about their wishes for subsequent pregnancy management. Results 1. Obstetricians' survey Early pregnancy managements were little different from standard care of low-risk pregnancy. Increased 'fetal surveillance' (by ultrasound, cardiotocography, and formal fetal movement charting) in late pregnancy was recommended by most respondents. Induction of labour would be offered by 93% of respondents, as early as 37 weeks by one third. More than one third of obstetricians would offer elective caesarean delivery, with 13% offering this before 38 weeks. 2. Womens'survey 93% of respondents wanted 'testing' over and above normal pregnancy care in their next pregnancy. 81% of respondents wanted early delivery, and 26% wanted a caesarean delivery, irrespective of obstetric indications. These wishes were not influenced by socio-demographic factors, management of the index stillbirth (with the exception of having had a caesarean delivery), or advice received about management of the next pregnancy (with the exception of being advised to have an early or caesarean delivery). Conclusions Both obstetricians and the women they care for wanted increased fetal surveillance and early delivery, but not necessarily elective caesarean section. These practices have the potential to increase the rate of intervention, with consequent adverse maternal and neonatal outcomes.

Thesis (Ph.D.)--York University, 2007. Graduate Programme in Sociology. / Typescript. Includes bibliographical references (leaves 217-233). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pqdiss&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:NR39000

Midwives working in labour wards usually have the pleasure of delivering a live baby and rejoicing with the mother. However, the delivery could become tragic for the mothers and midwives when the baby dies at birth due to pregnancy related complications. The result is that midwives have to render care and support to mothers who have lost their babies at birth. The objectives of this study were to explore and describe the experiences of midwives caring for mothers who have lost their babies at birth. A qualitative explorative, descriptive and contextual design was used to conduct this research study to gain an understanding of how the midwives experienced caring for mothers who have lost their babies at birth. A purposive criterion based non-probability sampling method was used. Ten semi-structured face-to-face interviews were conducted to collect data. Ethical considerations were observed throughout the research study. Measures of trustworthiness were ensured by using credibility, transferability, dependability and conformability. Data analysis was done using Tesch’s method to make sense out of text and data. Four themes were identified, namely, Midwives shared their diverse experiences relating to caring for mothers who have lost their babies at birth; Midwives expressed how their personal values and beliefs influenced the ways they dealt with babies dying at birth; Midwives described the organizational values and beliefs related to death and dying and how this influences their own experiences and lastly Midwives provided suggestions regarding how they can be assisted in caring for mothers who have lost their babies at birth. Two main guidelines were developed based on the research findings and literature. The study concludes with recommendations made with regard to areas of nursing practice, education and research.

Thesis (Ph.D. (Psychology)) -- University of Limpopo, 2022 / The psychological impact of perinatal death in the form of bereavement has been widely researched especially from the western perspective. The aim of this study was to establish the help-seeking pathways by mothers bereaved through perinatal death from the African perspective. The qualitative research paradigm in particular the phenomenological approach was adopted for the study. Phenomenology is described as an approach that focuses on the study of the lived experiences of individuals within their world. The application of this approach included personal interviews of 20 mothers who have experienced perinatal death at Doctor George Mukhari hospital in Gauteng province. The aim was to establish the help-seeking pathways they adopted to relief their distress, in terms of how they managed their bereavement and the help that they sought to relief their emotional distress. The findings of the study indicated that mothers lacked knowledge about what precipitated the onset of sudden symptoms such as early rupture of membrane, bleeding, lack of foetal movement which finally led to perinatal death. This lack of knowledge led mothers to attribute the cause of perinatal death to various reasons and conclusions such as distance decay, bad roads that delayed their arrival timeously at the hospital for their babies to be saved. Some cited lack of sense of urgency from the medical personnel and shortage of staff, especially doctors. However, they perceived positive social support from their families, spouses and medical professionals as one of the factors that contributed to their level of calmness and ability to bear the pain of loss. However, participants sought alternative help to facilitate clear understanding about what could have caused their babies to die, also how to manage their grief and how to deal with their subsequent pregnancies. Most of the participants benefited from the various healing pathways they chose. There is a need for healthcare system and community support to be more responsive to the plight of bereaved mothers, in reducing the stigma and the self-blame by bereaved mothers by offering support through counseling center. The findings reaffirm that despite the great studies taken in reducing perinatal deaths, there is a need for collaboration between the modern healthcare system and the traditional healthcare practitioners. Furthermore, emphasis v is needed on the preventative measures and training of healthcare practitioners within the maternal and child healthcare system to further reduce the alarming increase of prenatal deaths

Thesis (MMed)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Background The annual burden of stillbirths is estimated to be more than 3 million deaths globally. Depending on the perinatal classification used, up to two thirds of deaths are reported as unknown.Gardosi, et al (2006) developed the ReCoDe system, which identified the relevant condition at the time of death in utero. The system aims to identify what went wrong in utero, without necessarily indentifying why fetal demise occurred. With comparison to the conventional Wigglesworth classification, the authors were able to reduce the number of unexplained stillbirths from 66.2% to 15.2%. The Perinatal Problem Identification Program (PPIP) is the nationally implemented perinatal classification system in South Africa. The PPIP database recorded approximately 660 000 births from the 1st January 2006 until 31st December 2007. This reflects approximately 40% of all births in health institutions in South Africa during this time period. There were 11742 stillbirths recorded in on the PPIP database for this two year period.Unexplained stillbirths formed 24% of the total perinatal deaths. The Saving Babies Report 2006-2007 has suggested that funding andresearch resources be directed to identifying the causes of deaths in this group. Objective: Our primary objective was to compare the outcomes of the PPIP to the ReCoDe classification system developed by Gardosi, with special attention as to reducing the number of unexplained stillbirths. Methods: We conducted a retrospective descriptive study on the perinatal deaths occurring at or presenting to the Department of Obstetrics and Gynaecology at Tygerberg Hospital, Cape Town, South Africa, for the time period extending from 01 January 2008 to 31 December 2008. A weekly Perinatal Mortality Audit meeting (PNM) is held at Tygerberg Hospital. In attendance at these meetings are General obstetricians, Fetal-maternal specialists, Neonatologists, Pathologists, a Geneticist, Obstetric and Paediatric Registrars. Relevant clinical details are summarised from clinical notes and Perinatal Losses data forms. These forms are specific to Tygerberg Hospital and completed by the attending doctor at first consultation. Placental histology and post-mortem examination would have been performed in certain cases as per the departmental protocol. All perinatal deaths, both stillborn and neonatal deaths weighing more than 499g, are discussed at this forum and consensus then reached on a primary and final cause of death. This information is then entered into the PPIP database, along with any identifiable avoidable factors.The investigators separately reviewed the information available from the Perinatal Losses and the PIPP V2.2 data capture forms and then reclassified each stillbirth according to the ReCoDe hierarchal system Results: We studied the data sheets of 406 stillbirths of babies of whom the deaths had been previously classified according to the PPIP classification. The median maternal age was 25.65 years (range 14 – 45) while the median birth weight was 1127 grams (range 500 – 4100).The vast majority of these stillbirths occurred in singleton pregnancies and are also classified as extremely low birth weight. The three major causes of stillbirth over the study period were antepartum haemorrhage (24.4%), hypertensive disorders (22.4%) and spontaneous preterm labour (11.1%). Within the ReCoDe classification, the leading categories were in the placental group (33.2%), fetal group (21.6%) and the maternal group (20%). The unexplained group (PPIP IUD group), from the index study constitutes 8.1% (33 of 406) of cases, while the number of unclassified stillbirths in the primary ReCoDe classification accounted for 15% (60 of 406) of the total. The main reasons for this difference is that ReCoDe does not incorporate preterm labour as a cause, and uses customised growth charts for identifying fetal growth restriction. Conclusion: PPIP remains the gold standard in Perinatal Audit in South Africa.We would recommend that ReCoDe be evaluated prospectively, alongside the established PPIP system, to better compare their performance outcomes. The development of customized fetal growth potential charts relevant to the local population should be explored. The Perinatal Losses data capture form should be revised to be more comprehensive and relevant. / AFRIKAANSE OPSOMMING: Agtergrond Die jaarlikse las van doodgeboortes word geskat op meer as 3 miljoen sterftes wêreldwyd. Afhangende van die perinataleklassifikasiesisteem wat gebruik word, tot twee derdes van sterftes is aangemeld as onbekend. Gardosi, et al (2006) het die ReCoDesisteemontwikkel, wat die betrokke toestand in die tyd van die dood in utero geïdentifiseer. Die sisteem het ten doel om te identifiseer wat verkeerd geloop het in utero, sonder om noodwendig te indentifiseer waarom fetaledood plaasgevind het. Invergelyking met die konvensionele Wigglesworth klassifikasie, was die skrywers in staat om die getal van die onverklaarbare dood geboortes van 66,2% tot 15,2% te verminder. Die Perinataleprobleemidentifikasie Program (PPIP) is die nasionaalgeïmplementeerperinataleklassifikasiesisteemin Suid-Afrika. Die PPIP databasis aangeteken ongeveer 660 000 geboortes van die 1ste Januarie 2006 tot 31 Desember 2007. Dit weerspieël ongeveer 40% van alle geboortes in die gesondheids-instellings in Suid-Afrika gedurende hierdie tydperk. Daar was 11.742 doodgeboortes aangeteken in op die PPIP databasis vir hierdie twee jaartydperk. Onverklaarbaredoodgeboortesvorm 24% van die totaleperinatalesterftes. Die Saving Babies Verslag 2006-2007 het voorgestel dat befondsing en navorsing gerig word aan die identifisering van die oorsake van sterftes in hierdie groep. Doelstelling: Ons primêre doel was om die uitkomste van die PPIP te vergelyk met die ReCoDeklassifikasiesisteem wat deur Gardosiontwikkelis , met spesiale aandag aan die vermindering van die aantal van onverklaarbaredoodgeboortes. Metodes: Ons het'n retrospektiewebeskrywendestudie uitgevoer op die perinatalesterftes wat aangemeld het by die noodeenheid van die Departement Obstetrie en Ginekologie aanTygerberg Hospitaal, Kaapstad, Suid-Afrika, vir die tydperk wat strek vanaf 01 Januarie 2008 tot 31 Desember 2008. 'n Weeklikse Perinatale Mortaliteit Ouditvergadering (PNM) word gehou by Tygerberg Hospitaal. In die bywoning van hierdie vergaderings is Algemene Verloskundiges, Fetale-moederskant Spesialiste, Neonatoloë, Patoloë, 'n Genetikus, Obstetriese en Pediatriese Klienieseassistente. Relevante kliniese inligting is uit die kliniese notas en perinataleverliesedatavorms opgesom. Hierdie vorms is spesifiek na die Tygerberg-hospitaal en deur die dokter by die eerstekonsultasie voltooi. Plasentale histologie en post-mortem ondersoek sou voltooi gewees het in sekere gevalle soos per die departementeleprotokol. Alle perinatalesterftes, beide doodgebore en neonatalesterftes wat meer as 499g, word bespreek op hierdie forum en konsensus bereik oor 'n primêre en finale oorsaak van die dood. Hierdie inligting word dan in die PPIP databasis, saam met 'n identifiseerbare voorkombare faktore. Die navorsers afsonderlik die inligting beskikbaar van die perinataleverliese en die PIPP v2.2 datavasleggingsvorms en dan herklassifiseer elke stilgeboorte volgens die ReCoDehiërargiesestelsel. Results: Ons bestudeer die data velle van 406 doodgeboortes van babas van wie die sterftes voorheen volgens die PPIP klassifikasie geklassifiseer is. Die mediaanmoeder se ouderdom was 25,65jaar (range 14? 45?) Terwyl die mediaangeboortegewig was 1127 gram (reeks 500? 4100). Die oorgrote meerderheid van hierdie doodgeboortes plaasgevind in Singleton swangerskappe en word ookgeklassifiseer as &'n baie lae geboortegewig. Die drie grootste oorsake van doodgeboorte oor die studietydperk was antepartum bloeding (24,4%), die hipertensiewesiektes (22,4%) en &'n voortydsekraam (11,1%). Binne die ReCoDeSistematiek, die voorstekategorieë in die plasentalegroep (33,2%), die fetalegroep (21,6%) en die moedergroep (20%). Die onverklaarbaregroep (PPIP IUD groep), van die indeksstudie behels 8,1% (33 van 406) van gevalle, terwyl die aantal van ongeklassifiseerde doodgeboortes in die primêre ReCoDeSistematiek verantwoordelik vir 15% (60 406) van die totaal. Die belangrikste redes vir die verskil is dat ReCoDenieneemvoortydsekraam as &'n oorsaak, en gebruike aangepasgroeikaarte vir die identifisering van fetalegroeibeperking. Gevolgtrekking: PPIP bly die gouestandaard in Perinataleoudit in Suid-Afrika. Ons sal aanbeveel dat ReCoDe vooruitwerkend geëvalueer word, saam met die gevestigde PPIP stelsel, om beter te vergelyk hulprestasieuitkomste. Die ontwikkeling van persoonlikefetalegroeipotensiaalkaarte met betrekking tot die plaaslike bevolking moet ondersoek word. Die perinataleverliese data capture vorm moet hersien word om meer omvattende en relevant te wees.

Thesis (MMed)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Introduction Pregnancies in women with a previous unexplained stillbirth may be jeopardized by increased antenatal surveillance and higher rates of induction of labour and caesarean delivery without clear evidence of benefit. Despite the fact that there have been no studies that adequately tested fetal benefit in routine induction of labour for a previous stillbirth, a policy of routine induction of labour at 38 weeks, with all the associated maternal, fetal and health-care associated costs, was in practice at Tygerberg Hospital for the past 30 years. This study aimed to investigate the safety of continuation of these pregnancies until term (≥39 weeks). Aims and Objectives To assess the clinical outcome and impact on the health service in a pregnancy with a previous unexplained intra-uterine demise (IUD) by routine induction of labour at term instead of at 38 weeks. Methodology This was a prospective observational study on the safety of a new hospital protocol which was introduced in 2012. The protocol extended the gestation for induction after a previous IUD from 38 weeks to term. The study population included all pregnant patients with a current singleton pregnancy, and a previous unexplained or unexplored (no data available) singleton fetal demise ≥24 weeks/500grams. All patients with a previous stillbirth in the metropolitan drainage area of Tygerberg Hospital are referred to Tygerberg for further care; and all referrals during 2012 were recruited for the study. Patients with known or recurrent risks for intra-uterine death were managed according to the relevant clinical condition and were excluded from the study. Results During the audit period, 306 patients with a previous intra-uterine fetal death were referred for further management. Of these, 161 had a clear indication for either earlier intervention or no intervention and were excluded from the protocol. Of the remaining 145 patients, 9 met exclusion criteria and there were 2 patients who defaulted. Forty-two of the study patients (with no known previous medical problems) developed complications during their antenatal course that necessitated a change in clinical management and earlier (<39 weeks) delivery. Of the remaining 92 patients in the audit, 47 (51%) went into spontaneous labour before their induction date. There were no intra-uterine deaths prior to delivery. Conclusions Careful follow up at a high risk clinic identifies new or concealed maternal or fetal complications in 29% of patients with a previous IUD and no obvious maternal or fetal disease in the index pregnancy. When all risks are excluded and the pregnancy allowed to progress to 39 weeks before an induction is offered, 51% will go into spontaneous labour. / AFRIKAANSE OPSOMMING: Inleiding Swangerskappe in vroue met vorige onverklaarbare stilgeboorte mag in gevaar gestel word deur meer intense voorgeboorte sorg en ‘n groter hoeveelheid induksies van kraam en keisersnitte sonder duidelike bewyse dat dit tot voordeel strek. Ten spyte van die feit dat daar geen studies is wat bewys het dat roetine induksie van kraam vir ‘n vorige stilgeboorte op 38 weke tot voordeel van die baba was nie, was ‘n beleid van roetine induksie van kraam op 38 weke, met al die geassosieërde moederlike en fetale risikos daaraan verbonde; asook die hoë gesondheidskostes, roetine praktyk in Tygerberg Hospitaal vir die afgelope 30 jaar. Hierdie studie het ten doel gehad om die veiligheid van voortsetting van hierdie swangerskappe tot voltyd (≥39 weke) te ondersoek. Doelwitte Om die kliniese uitkoms; asook die impak op gesondheidsdienste te evalueer in ‘n swanger vrou met n vorige onverklaarbare intra-uteriene sterfte; deur roetine induksie van kraam aan te bied op voltyd in plaas van 38 weke. Metodologie Hierdie was n prospektiewe kohort studie om die veiligheid van ‘n nuwe hospitaal protokol wat in 2012 geïmplimenteer is, te bepaal. Hierdie protokol het die gestasie tydperk van induksie van kraam van alle swanger pasiënte na ‘n vorige onverklaarbare stilgeboorte van 38 weke na voltyd verleng. Die studiepopulasie het alle swanger pasiënte met ‘n huidige enkelswangerskap en ‘n vorige onverklaarbare of onbekende (geen data beskikbaar) enkelvoudige fetale sterfte ≥24 weke/500gram, ingesluit. Alle pasiënte in die metropolitaanse dreineringsarea van Tygerberg Hospitaal met ‘n vorige stilgeboorte word na Tygerberg verwys vir verdere hantering, en alle verwysings gedurende 2012 was gewerf vir die studie. Pasiënte met bekende of herhalende risikofaktore vir ‘n intra-uteriene sterfte was hanteer volgens die relevante kliniese inligting en was uitgesluit by die studie. Resultate Drie-honderd-en-ses pasiënte met ‘n vorige intra-uteriene fetale sterfte was gedurende die oudit periode verwys vir verdere hantering. In 161 pasiënte was daar ‘n duidelike indikasie vir of vroeër intervensie of geen intervensie nie; en hulle was uitgesluit van die protokol. Van die oorblywende 145 pasiënte is 9 pasiënte uitgesluit as gevolg van die uitsluitingskriteria en daar was 2 pasiënte wat versuim het om op te volg. Twee-en-veertig pasiënte (met geen bekende vorige mediese probleme nie) het komplikasies gedurende hulle voorgeboorte verloop ontwikkel wat gelei het tot verandering in kliniese hantering en vroeëre verlossing (≤39 weke) genoodsaak het. Van die oorblywende 92 pasiënte in die oudit, het 47 (51%) in spontane kraam gegaan voor hulle induksiedatum. Daar was geen intra-uteriene sterftes voor verlossing nie. Gevolgtrekkings Noukeurige opvolg by ‘n hoërisiko kliniek identifiseer nuwe of versteekte moederlike en fetale komplikasies in 29% van pasiënte met ‘n vorige intra-uteriene sterfte sonder enige duidelike moederlike of fetale siekte in die indeks swangerskap. Wanneer alle risikos uitgesluit word en die swangerskap toegelaat word om voort te gaan tot 39 weke voor ‘n induksie aangebied word, sal 51% van pasiënte spontaan in kraam gaan.

Thesis (M.N.)--Memorial University of Newfoundland, School of Nursing, 2001. / Typescript. Bibliography: leaves 138-148.