Bakgrund: Inom förlossningsvården används en typ av bedövning kallad pudendusblockad (PDB). Denna bedövning kan administreras på två olika sätt; antingen genom så kallad inre eller yttre teknik. Den yttre tekniken introducerades 2015, dess praktiska för- och nackdelar är ännu inte utförligt dokumenterade i litteraturen.  Syfte: Att utforska barnmorskors erfarenheter av yttre pudendusblockad vid inspektion och suturering postpartum.  Metod: Studien genomfördes med en kvalitativ design. Insamlad data består av intervjuer från totalt tio barnmorskor från två sjukhus i södra Sverige. Dataanalysen genomfördes med kvalitativ innehållsanalys.  Resultat: Resultaten av studien indikerar bland annat att yttre PDB är en uppskattad bedövningsteknik i regionerna, de intervjuade barnmorskorna angav att de använde yttre PDB i majoriteten av alla förlossningar. Över lag var också samtliga deltagare positiva till bedövningen; den upplevs framför allt som en säker smärtlindring, lätt att administrera och kvinnorna ansågs väl bedövade inför suturering. Några väsentliga negativa aspekter kunde enligt deltagarna ej påvisas.  Slutsats: Yttre PDB är en uppskattad bedövningsform som används i stor utsträckning på båda sjukhusen. / Background: Pudendal nerve block (PNB) is a common anesthetic used in maternity care. This anesthesia can be administered in two different ways; either through the so-called inner or outer technique. The outer technique introduces 2015, its practical pros and cons have not yet been thoroughly described in literature.  Purpose: To explore midwives experiences of outer pudendal nerve block during inspection and suturing after delivery.  Method: The study is conducted with a qualitative design. Collected data consists of interviews from a total of ten midwives from two hospitals in southern Sweden. Data has been analyzed with qualitative content analysis. Result: The results of the study indicate for instance that outer PNB is an appreciated technique for anesthesia in the examined geographical region, the interviewees stated that they use outer PNB in the majority of all cases. Furthermore, every interviewee was positive towards the treatment; most importantly, it is viewed as a safe method, easy to administer and patients are well anaesthetized for suturing. No primary negative aspect could be concluded from the interviews.  Conclusion: Outer PNB is an appreciated technique that is used to a large extent at the hospitals surveyed in this study.

Bakgrund: Många nyblivna mödrar drabbas av olika former av depressioner direkt efter förlossningen. I de flesta fall är detta en kort övergående period av depression kopplad till förväntningar med den nya mödrarollen. I vissa fall kan depression för mödrarna bli bestående och sträcka sig över en längre tid, denna form av depression benämns postpartumdepression PPD. Beroende på hur länge denna form av depression pågår får den olika påverkan på den direkta anknytningen till barnen, därför är det viktigt att uppmärksamma detta på ett tidigt stadium för att det inte ska komma att påverka barnens kommande utveckling. Syftet: Syftet med studien var att sammanställa aktuell kunskap kring sambandet mellan mödrar med PPD och barnens utveckling. Metoden: Litteraturstudie med narrativ ansats. Resultatet: Resultatet påvisade att det fanns ett samband mellan postpartumdepression hos modern och barnens utveckling inom fyra olika områden: 1) Språkliga utvecklingen, 2) Motoriska utvecklingen, 3) Kognitiva utvecklingen och 4) Socioemotionella och Neuropsykologiska utveckling. Slutsats: Det finns samband mellan PPD hos mödrarna och barnens utveckling, det är därför viktigt att identifiera och behandla mödrarna för att främja god hälsa hos barnen / Background: Many new mothers suffer from various forms of depression immediately after childbirth. In most cases, this is a short transitory period of depression linked to expectations with the new maternal role. But in some cases, this depression can become extend over a longer period of time or become permanent. This form of depression is called postpartum depression PPD. Depending on how long this form of depression lasts, it has different effects on the direct attachment to the children, therefore it is important to pay attention to this at an early stage so that it does not affect the children's future development. Purpose: The purpose of the study was to compile current knowledge about the connection between mothers with PPD and the children's development. The method: Literature study with a narrative approach. The result: The result showed that there was a connection between postpartum depression in the mother and the children's development in four different areas: 1) Language development, 2) Motor development, 3) Cognitive development and 4) Socio- emotional and Neuropsychological development. Conclusion: There is a connection between PPD in the mothers and the children's development, it is therefore important to identify and treat the mothers to promote good health in the children

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Bakgrund: Postpartum Depression (PPD) drabbar mellan 10-15 % av alla kvinnor som föder barn och karakteriseras av depressiva symtom. PPD kan orsakas av flera faktorer, såsom tidigare erfarenhet av psykisk ohälsa och psykisk ohälsa under graviditeten. Syfte: Syftet är att beskriva kvinnors upplevelser med postpartum depression. Metod: Studien är en kvalitativ litteraturöversikt baserad på tio vetenskapliga artiklar som belyser kvinnors perspektiv. Resultat: Kvinnor upplevde bristande anknytning till sina barn och bar på en överväldigande känsla av ansvar gentemot dem. Dessutom kände de sig otillräckliga inför de förväntningar som samhället hade på dem. Det framkom även att många kvinnor fann det svårt att prata om sina känslor på grund av rädsla att bli dömda som "dåliga mammor". Stigmatiseringen kring PPD försvårade ytterligare att prata öppet om sina upplevelser. Konklusion: Studien visade att majoriteten av kvinnorna hade svårt att prata om sina upplevelser. De betonade vikten av hälso- och sjukvårdspersonal, var medvetna om detta och visade empati, förståelse för att underlätta för dem i deras svåra situation. Det framgick även att kvinnor kände sig mindre isolerade om de kunde dela sina erfarenheter med sina närstående eller andra kvinnor i liknande situationer. / Background: Postpartum Depression (PPD) affects between 10-15% of all women who give birth and is characterized by depressive symptoms. PPD can be caused by several factors, such as previous experiences with mental health issues and mental health issues during pregnancy. Aim: The aim of this study is to describe women's experiences with postpartum depression. Method: The study is a qualitative literature review based on ten scientific articles that describe women's perspectives. Findings: Women experienced a lack of attachment to their children and carried an overwhelming sense of responsibility towards them. In addition, they felt inadequate to society's expectations of them. Many women found it difficult to talk about their feelings due to fear of being judged as 'bad mothers'. The stigma surrounding PPD made it evenmore difficult to open up about their experiences. Conclusion: The study showed that the majority of women had difficulty talking about their experiences. It's important that healthcare professionals were aware of this and showed empathy, understanding to faciliate in their difficult situation. It also appeared that women felt less isolated if they could share their experiences with their relatives or other women in similar situations.

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The purpose of this research was to develop, validate, and test an instrument to evaluate motivations to eat in low-income women during the early postpartum period. The instrument was also used in a sample of young college women to further validate the measure and explore determinants of eating in this population. In study 1, the Eating Stimulus Index was validated in 179 low-income women in early postpartum. Validity and reliability were determined via principal components analysis, internal consistency reliability, and test-retest reliability using a subgroup of 31 low-income new mothers. The factor analysis produced an eight factor structure with reliability coefficients ranging from 0.54-0.89. Convenience eating (r=-0.25, P<0.01), emotional eating (r=-0.17, P<0.05), and dietary restraint (r=-0.21, P<0.01) were significantly related to weight status. In study 2, the relationship between eating motivations and diet quality, determined via the Dietary Guidelines Adherence Index, was established in 115 low-income women in early postpartum. High diet quality was related to fruit and vegetable availability (r=0.25, P<0.01), convenience eating resistance (r=-0.36, P<0.001), and vegetable taste preference (r=0.23, P<0.05). Motivations to eat differed between overweight and obese women with the primary motivation being convenience eating and taste, respectively. In study 3, determinants of weight loss were examined in 58 low-income women in early postpartum participating in an 8-week weight loss intervention. Participants were evaluated at pre- and post-study for all measures. Factors related to weight loss included increases in dietary restraint, weight management skills, and weight loss self-efficacy and decreases in fruit juice servings, total energy, and discretionary energy intakes. After hierarchical regression analysis, improvement in weight loss self-efficacy was the most significant determinant (β=0.263, P<0.05) followed by decreases in discretionary energy intake (β=-0.241, P<0.05). In study 4, determinants of diet quality were assessed in a sample of 88 young college women using the Eating Stimulus Index. Low diet quality was associated with poor fruit and vegetable availability, convenience eating resistance, vegetable taste preference, and weight management self-efficacy, while high diet quality was related to increased frequency of meals prepared at home and decreased frequency of meals consumed at fast food restaurants. / text

Les objectifs de cette étude ont été de : (1) déterminer s’il existe une association entre la présence intra-utérine d'Escherichia coli dans la 1 ère semaine postpartum et le développement de la métrite postpartum, (2) déterminer s’il y a une association entre les gènes de virulence d'E. coli et la métrite postpartum, et (3) d'évaluer si les analyses bactériologiques (bactéries et gènes de virulence d'E. coli) pourraient prédire la métrite postpartum chez la vache laitière. Des écouvillons utérins ont été prélevés dans la première semaine postpartum sur 486 vaches de race Holstein et soumis au laboratoire pour détection de E. coli. Les gènes de virulence d'E. coli ont été identifiés par la technique d'hybridation des sondes radioactives. Un total de 252 vaches (52%) ont été positives à E. coli et 67 vaches positives à la métrite postpartum (13,7%). Les vaches positives à E. coli intra-utérin dès la première semaine postpartum avaient un risque 2,6 fois plus élevé de développer la métrite postpartum que les vaches sans E. coli. La plupart des E. coli possédaient un ou plusieurs gènes des E. coli d'origine extra-intestinale (ExPEC) dont fimH (89%), HlyE (87%) et iss (70%). Parmi les autres gènes ExPEC, on a retrouvé sitA (23%), fepC (20%) hra1 (20%) malX (14%) tsh (11%) et bien d'autres. Les gènes de virulence kpsMTII et hra1 ont été associés à la métrite postpartum avec un rapport de cote de 4,3 chacun. La présence d'E. coli dans l'utérus avait une valeur prédictive positive de 18% tandis que la présence des gènes kpsMTII et hra1 avait une valeur prédictive positive de 36% et 31% respectivement. La détection de certains gènes de virulence d'E. coli dans les prélèvements utérins pourrait renseigner sur le risque de développement de la métrite postpartum chez la vache laitière. Les études ultérieures pourraient tester encore plus de gènes et viser à développer des tests de dépistage simple, facilement et rapidement applicable à la ferme. / The objectives of this study were to (1) determine whether there is an association between the presence of intra-uterine Escherichia coli in the first week postpartum and the occurrence of postpartum metritis in the subsequent weeks, (2) determine whether there is an association between E. coli virulence genes and postpartum metritis, and (3) to assess whether the presence of these E. coli virulence genes could predict the occurrence of postpartum metritis in dairy cows. Uterine swabs were collected in the first week postpartum from 486 Holstein cows and submitted to the laboratory for detection of E. coli. Virulence genes of E. coli were identified using the radioactive probe hybridization method. A total of 252 cows (52%) were positive for intra-uterine E. coli and 67 cows (13.7%) were positive for postpartum metritis. Cows positive for intra-uterine E. coli in the first week postpartum had 2.6 times the odds of developing postpartum metritis compared to negative cows. Most intra-uterine E. coli possessed one or more ExPEC genes, among which FimH (89%), hlyE (87%), and iss (70%). Other ExPEC genes such as sitA (23%), fePC (20%) hra1 (20%) malX (14%) tsh (11%) and others were found with low prevalence. The presence of the virulence genes kpsMTII and hra1 was associated with 4.3 times each the odds of developing postpartum metritis compared to negative cows. The presence of E. coli in the uterus had a positive predictive value of 18%, while the presence of the genes kpsMTII and hra1 had a positive predictive value of 36% and 31% respectively. The detection of certain virulence genes of E. coli in uterine swabs could inform about the risk of developing postpartum metritis in dairy cattle. Further studies could test more virulence genes and aim at developing molecular tests that would be simple, quickly and easily applicable on farm.

Le facteur VIII (FVIII) joue un rôle essentiel dans la coagulation sanguine. Lorsque le FVIII fait génétiquement défaut, une pathologie hémorragique grave survient: l'hémophilie A (HA) congénitale. La complication majeure de la prise en charge de ces patients est l'apparition d'allo-anticorps (alloAcs) dirigés contre le FVIII thérapeutique administré. Dès lors, la seule thérapeutique efficace est l'induction de tolérance immune (ITI) qui vise à les éradiquer. Cependant, ce traitement échoue dans 30% des cas, sans qu'aucun facteur ne permette actuellement de prédire l'échec de ce traitement contraignant et coûteux. des facteurs immunologiques prédictifs de l'efficacité de l'ITI ont été recherchés chez 25 patients par analyse du répertoire épitopique et isotypique des Acs anti-FVIII à l'aide de la technologie x-MAP. Des biomarqueurs individuels (Acs anti-A2 et -A1 du FVIII), et des combinaisons originales ont été identifiés (0,841 < AUC < 0,946). Des manifestations hémorragiques peuvent apparaitre chez des patients non hémophiles, dues à des autoAcs anti-FVIII (HA acquise). Dans certains cas, les autoAcs se développent au moment du postpartum. peu de données sont disponibles sur cette réponse immune. Dans une seconde étude portant sur 73 cas, nous avons découvert un profil immunologique (autoAcs anti-A1) différenciant les HA du postpartum et les autres HA acquises. Les profils d'IgG anti-FVIII que nous avons établis s'avèrent prometteurs pour prédire l'efficacité de l'ITI et engendrer une cartographie précise de la réponse autoimmune chez les patients atteints d'HA acquise. / Factor VIII (FVIII) plays a critical role in blood coagulation. When FVIII s genetically defective, a serious hemorrhagic disease occurs: congenital hemophilia A (HA). The main complication of the management of these patients is the appearance of alloantibodies (alloAbs) directed against administred therapeutic FVIII. therefore, the only effective treatment is the immune tolerance induction (ITI), which aims to eradicate these alloAbs. However, this treatment fails in up to 30% of cases, without any factor currently able to predict the failure of this constraining and expensive treatment. Immunological factors predictive to the efficacy of ITI were investigated in 25 patients by analysis of epitopic and isotypic IgG profile of anti-FVIII Abs using x-MAP technology. Individual biomarkers (anti-FVIII A1 and -A2 Abs), and original combinations were identified (0,841 < AUC < 0,946). Hemorrhagic manifestations can occur in non-hemophiliac patients, due to anti-FVIII autoAbs (acquired HA). In some patients, the autoAbs appear in postpartum period but few data are available on the immune response due to the rarity of the disease. In a second study of 73 cases, we found a different immunological profile between patients with postpartum HA and the other acuired HA patients. IgG profiles of anti-FVIII we have established are promising for predicting the effectiveness of ITI and generate an accurate mapping of autoimmune response in patients with acquired HA.

Exclusive breastfeeding for at least 6 months provides numerous infant and maternal benefits. Yet mothers with risk factors, such as lower education, lower socioeconomic status, younger maternal age, planned cesarean birth, and anxiety and depression, are more likely to stop breastfeeding in the early postpartum period. Few studies have focused on perinatal depression as a risk factor for breastfeeding cessation. To tailor effective interventions, nurses must first understand the lived experience of breastfeeding for mothers at risk for perinatal depression. A descriptive phenomenological study was conducted to elucidate the experience of breastfeeding for mothers with perinatal depression. The study was grounded in Swanson’s middle-range theory of caring. After university Institutional Review Board approval, a purposive sample of 10 women was recruited from various organizations. Participants completed a demographic questionnaire and the Edinburgh Postnatal Depression Scale, and semistructured, audiorecorded face-to-face or telephonic interviews were conducted. The researcher transcribed the data which was transformed into constituents of the mothers’ lived experience by utilizing Giorgi’s descriptive phenomenological method. Five constituents emerged: choosing selflessness, harboring inadequacy, deliberate persevering, discerning meaning, and cherishing intimacy. The constituents embodied the essence of the mothers’ thoughts and feelings connected to breastfeeding. By daily choosing selflessness, mothers consciously decided to breastfeed despite physical or psychological struggles. They often were harboring inadequacy due to ongoing struggles which led to incessant thoughts of maternal incompetence. Yet they successfully breastfed for at least 2 weeks after birth by deliberate persevering. Through breastfeeding, they were discerning meaning to realize their value as mothers. Finally, they reveled in purposeful moments of togetherness with their babies through cherishing intimacy. The study findings inform recommendations for nursing education, practice, research, and policy. Nursing education must include basic breastfeeding and perinatal mental health knowledge in prelicensure curricula and up-to-date lactation management techniques and perinatal mental health awareness training in continuing education. Practicing maternal-child nurses must provide education and support to mothers about advantages and difficulties of breastfeeding throughout the perinatal period. Future research includes determination of support needs for women with perinatal depression with subsequent development and evaluation of therapeutic actions to promote breastfeeding success. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection