Made available in DSpace on 2014-06-11T19:29:51Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-08-25Bitstream added on 2014-06-13T20:20:19Z : No. of bitstreams: 1 cidade_dg_me_botfm.pdf: 368558 bytes, checksum: 1d1fed8b52f56286485cb9248fcf21d2 (MD5) / Fundação de Ensino e Pesquisa em Ciências da Saúde (FEPECS) / O objetivo desta revisão foi apresentar informações atuais sobre a prevalência do sobrepeso e da obesidade e discutir as evidências acerca do impacto desses estados nutricionais na saúde da mãe e do concepto. A busca pelos artigos foi realizada através de pesquisa nos bancos de dados MEDLINE/PUBMED e SCIELO abrangendo os últimos 5 anos e através da revisão das referências bibliográficas dos artigos selecionados. Diante de assuntos com resultados discordantes ou sem informações satisfatórias, procedemos a uma terceira etapa de busca, usando ampla variedade de termos. Os artigos encontrados foram selecionados por avaliação subjetiva, considerando metodologia, tamanho da amostra, coerência nas conclusões e o ano de publicação. Informações atuais sustentam uma prevalência elevada e crescente do sobrepeso e da obesidade. Fortes evidências associam esses estados nutricionais no período pré-gestacional ao desenvolvimento de hipertensão específica da gestação, diabete gestacional, gestação com 41 semanas ou mais, tromboembolismo, realização de cesariana, infecção puerperal, macrossomia, malformações fetais e mortes fetal e neonatal. O excesso de peso no período pré-gestacional é um dos mais importantes fatores de risco à saúde da mãe e do concepto, cuja importância aumenta por se tratar de fator de risco modificável. A gestante obesa deve ser considerada de alto risco e é recomendável que as mulheres estejam com o peso o mais próximo possível do normal antes da concepção / The goal of this review was to present up-to-date information on the prevalence of overweight and obesity and to discuss the evidence regarding the impact of these nutrition-related conditions on the health of mother and fetus. We conducted a search for articles in the MEDLINE, PUBMED and SCIELO databases covering the past 5 years, and reviewed the bibliographical references contained in the articles selected. After reviewing cases with discordant results or lacking satisfactory data, we proceeded to a third step using a wide variety of TORs. Articles were selected by subjective evaluation in terms of methodology, sample size and year of publication. We found strong evidence linking excess weight before pregnancy with the development of pregnancy-induced hypertension, gestational diabetes, pregnancy at 41 weeks or over, thromboembolism, cesarean section, puerperal infection, macrosomia, birth defects and fetal and neonatal deaths. Excess weight during pre-pregnancy is one of the major risk factors affecting the health of mother and fetus. It is especially important to realize that this is a modifiable risk factor. Since obese pregnant women must be considered at high risk it is recommended that they should focus on attaining a normal weight before conceiving

MSc (Nursing), Faculty of Health Sciences, University of the Witwatersrand, 2009 / Pregnancy induced hypertension (PIH) occurring during pregnancy, labour and puerperium is a major contributor to the high percentage of maternal morbidity and mortality in the Eastern Cape Province, and worldwide. In South Africa (SA), PIH is the second most common of all primary causes of maternal mortality reported in the triennium from 1999 to 2001. From 1999 to 2001, PIH was the cause of 20,7 % (n = 507) of all maternal mortalities in SA (Department of Health (DOH), 2001:38). In the light of these statistics and other statistics related to other causes of MMR, the National Confidential Committee on Enquiries into Maternal Deaths (NCCEMD) developed the National Guidelines for Maternity Care in South Africa, a Manual for Clinics, Community Health Centres and District Hospitals. The guidelines related to PIH were of particular interest in this study. A quantitative, descriptive and contextual survey was conducted to determine the implementation of the National Guidelines for Maternity Care for the management of PIH by the midwife at level-1 clinics in the Eastern Cape, and to make recommendations for the management of PIH by midwives at level-1 clinics with the intention of reducing maternal mortality and morbidity due to PIH. The research method comprised a retrospective record review of the records of all patients admitted with PIH at a level-3 hospital who were referred by a midwife from a level-1 clinic. Data were collected by means of a researcher-administered data collection tool based on the iii National Guidelines for Maternity Care in SA for the management of PIH. The researcher wished to determine whether the National Guidelines for Maternity Care in SA was being implemented for the management of PIH by midwives at level-1 clinics in East London. A purposive sample of 290 maternal records of mothers who had been admitted for PIH at level 3 after being referred from level-1 clinics from May 1999 to June 2003 were used. Data were analysed using descriptive statistics. Ethical issues were taken into consideration. Validity and reliability were ensured. In conclusion, given the study findings, the researcher has made recommendations with the intention of reducing mortality due to PHI in the Eastern Cape.

Orientador: José Carlos Peraçoli / Coorientador: Paulo Roberto Margotto / Banca: Paulo Sérgio França / Banca: Roseli Mieko Yamamoto Nomura / Resumo: O objetivo desta revisão foi apresentar informações atuais sobre a prevalência do sobrepeso e da obesidade e discutir as evidências acerca do impacto desses estados nutricionais na saúde da mãe e do concepto. A busca pelos artigos foi realizada através de pesquisa nos bancos de dados MEDLINE/PUBMED e SCIELO abrangendo os últimos 5 anos e através da revisão das referências bibliográficas dos artigos selecionados. Diante de assuntos com resultados discordantes ou sem informações satisfatórias, procedemos a uma terceira etapa de busca, usando ampla variedade de termos. Os artigos encontrados foram selecionados por avaliação subjetiva, considerando metodologia, tamanho da amostra, coerência nas conclusões e o ano de publicação. Informações atuais sustentam uma prevalência elevada e crescente do sobrepeso e da obesidade. Fortes evidências associam esses estados nutricionais no período pré-gestacional ao desenvolvimento de hipertensão específica da gestação, diabete gestacional, gestação com 41 semanas ou mais, tromboembolismo, realização de cesariana, infecção puerperal, macrossomia, malformações fetais e mortes fetal e neonatal. O excesso de peso no período pré-gestacional é um dos mais importantes fatores de risco à saúde da mãe e do concepto, cuja importância aumenta por se tratar de fator de risco modificável. A gestante obesa deve ser considerada de alto risco e é recomendável que as mulheres estejam com o peso o mais próximo possível do normal antes da concepção / Abstract: The goal of this review was to present up-to-date information on the prevalence of overweight and obesity and to discuss the evidence regarding the impact of these nutrition-related conditions on the health of mother and fetus. We conducted a search for articles in the MEDLINE, PUBMED and SCIELO databases covering the past 5 years, and reviewed the bibliographical references contained in the articles selected. After reviewing cases with discordant results or lacking satisfactory data, we proceeded to a third step using a wide variety of TORs. Articles were selected by subjective evaluation in terms of methodology, sample size and year of publication. We found strong evidence linking excess weight before pregnancy with the development of pregnancy-induced hypertension, gestational diabetes, pregnancy at 41 weeks or over, thromboembolism, cesarean section, puerperal infection, macrosomia, birth defects and fetal and neonatal deaths. Excess weight during pre-pregnancy is one of the major risk factors affecting the health of mother and fetus. It is especially important to realize that this is a modifiable risk factor. Since obese pregnant women must be considered at high risk it is recommended that they should focus on attaining a normal weight before conceiving / Mestre

Objectif : Établir le profil psychosocial des femmes enceintes de l'Estrie et évaluer de façon préliminaire si ce profil diffère parmi les grossesses avec issues défavorables. Méthode. Cohorte prospective de 120 femmes enceintes, rencontrées à deux reprises (10-20 et 25-30 semaines), entre août 2004 et mars 2006. Il s'agit d'un questionnaire auto-administré des données démographiques, anthropométriques, des facteurs de risques biomédicaux, ainsi qu'un profil psychosocial comportant 6 dimensions: stress psychologique perçu, ennuis quotidiens, détresse psychologique, locus de contrôle, soutien social, traumatismes dans l'enfance. Les paramètres psychosociaux sont présentés en moyennes ou pourcentages. Le profil psychosocial est comparé entre les grossesses normales et anormales avec les tests t de Student ou le test de Mann Whitney, lorsque approprié. Résultats. Trente trois grossesses (27,5%) ont présenté des issues défavorables (prématurité, restriction de croissance intra-utérine, hypertension gestationnelle, diabète gestationnel). L'analyse du profil psychosocial révèle un score de stress psychologique perçu plus élevé entre 10-20 semaines chez les femmes avec issues défavorables de grossesse (score : 34,2 « 12,3 ; P < 0,01) et chez les femmes avec prématurité (score : 36,1 « 11,2 ; P < 0,02) comparativement à celui des femmes avec grossesses normales (score : 28,6 « 9,6). Par ailleurs, les 5 autres dimensions ne semblaient pas différentes selon les issues de grossesse. Conclusion. Ces résultats préliminaires suggèrent une piste possible reliant la perception de stress maternel durant la grossesse et certaines issues défavorables de grossesse, dont l'accouchement prématuré.

Background: Pre-eclampsia (PET) is one of the major causes of maternal and neonatal morbidity and mortality1. Misclassification of PET can lead to biased or erroneous results in epidemiologic studies resulting in false conclusions. Objectives: The objectives of this thesis are to determine the validity of PET diagnosis in pregnant women in administrative database using the ICD-10-CA codes, to explore the nature of misclassification, and to estimate whether misclassification of PET diagnosis in administrative database may result in biased conclusions. Methods: Pregnant women who participated in the Ottawa and Kingston (OaK) Birth Cohort study and delivered in the Ottawa Hospital were included in the study. All cases with hypertensive disorder of pregnancy in the study population were adjudicated to confirm diagnosis of PET. This adjudicated dataset was used as a reference standard. The PET incidence in hospital discharge database was compared with PET incidence calculated from the reference standard database. Results: 2887 of the requested charts were available for review. The PET incidence was much lower in administrative database (1.47%) than in the OaK Birth Cohort Study (3.6%). The results of the study demonstrated that hospital discharge database via ICD-10-CA was not very sensitive to determine incidence of PET since sensitivity of ICD-10-CA diagnostic codes for PET was low (35.92% with 95% Confidence Intervals (CI): 26.7; 45.9) but specificity, PPV, and NPV were high. The majority of misclassified cases belonged to the category (according to the proposed classification) “PET pregnancies coded with incorrect ICD-10-CA code” (78.88%) followed by the category “Pregnancies affected by PET coded as normal” (14.08%). Conclusion: Using hospital discharge database and ICD-10-CA coding to determine incidence of PET in certain settings may yield low sensitivity. Researchers should validate the results when using the hospital discharge database for PET research to ensure that the findings based on analyses of such data demonstrate what they claimed to demonstrate.

The aim of this thesis was to determine any association between plasma oxytocin and vasopressin concentrations and renal water and sodium excretion during normal pregnancy. In addition to investigate changes in concentrations of estradiol, progesterone, oxytocin, cortisol, and glucose in the blood before and in the nearest hours after delivery and if treatment with oxytocin affected these concentrations and the fluid balance during the different stages of labour. Oxytocin, vasopressin, estradiol, progesterone, and cortisol were analysed in blood plasma or serum by radioimmunoassay or ELISA: serum glucose, and osmolality, and sodium in plasma and urine were  analysed by standard laboratory techniques. Fifty-seven women were studied during pregnancy and fifty-one during parturition and post partum. The low plasma vasopressin and increasing plasma oxytocin concentrations with unchanged water and sodium excretion indicate that oxytocin assists vasopressin in concentrating urine during pregnancy. Plasma vasopressin concentration continued to be low during parturition and post partum. Urine flow and concentration was unrelated to changes in plasma sodium concentration, indicating regulation of fluid balance during parturition was different to the non-gravid state. Women with weak myometrial contractions during parturition (slow progress of labour) reacted differently than women with normal parturition and a group of women with fast progress of labour. The group with slow labour had lower serum estradiol concentration in the latency phase and became hyponatremic. Pulsatile and continuous oxytocin infusions were both effective in the treatment of slow progress of labour. A lower amount of oxytocin was needed to affect delivery when given as pulsatile infusion. Serum cortisol and glucose concentrations were high during labour and cortisol level remained elevated after delivery and glucose concentration reached the highest levels (12 mmol/L) at the same time. Insulin resistance together with the long time of elevated cortisol concentration partly explained the high glucose concentration. In conclusion, fluid balance is not regulated according to the usual sensitive osmotic and volumetric influence on vasopressin release from the neurohypophysis during pregnancy and parturition. Parturition involves a change from one demanding condition, pregnancy, to another, lactation. Parturition and the hours directly after delivery are a turbulent period involving considerable stress.

Background: Pre-eclampsia (PET) is one of the major causes of maternal and neonatal morbidity and mortality1. Misclassification of PET can lead to biased or erroneous results in epidemiologic studies resulting in false conclusions. Objectives: The objectives of this thesis are to determine the validity of PET diagnosis in pregnant women in administrative database using the ICD-10-CA codes, to explore the nature of misclassification, and to estimate whether misclassification of PET diagnosis in administrative database may result in biased conclusions. Methods: Pregnant women who participated in the Ottawa and Kingston (OaK) Birth Cohort study and delivered in the Ottawa Hospital were included in the study. All cases with hypertensive disorder of pregnancy in the study population were adjudicated to confirm diagnosis of PET. This adjudicated dataset was used as a reference standard. The PET incidence in hospital discharge database was compared with PET incidence calculated from the reference standard database. Results: 2887 of the requested charts were available for review. The PET incidence was much lower in administrative database (1.47%) than in the OaK Birth Cohort Study (3.6%). The results of the study demonstrated that hospital discharge database via ICD-10-CA was not very sensitive to determine incidence of PET since sensitivity of ICD-10-CA diagnostic codes for PET was low (35.92% with 95% Confidence Intervals (CI): 26.7; 45.9) but specificity, PPV, and NPV were high. The majority of misclassified cases belonged to the category (according to the proposed classification) “PET pregnancies coded with incorrect ICD-10-CA code” (78.88%) followed by the category “Pregnancies affected by PET coded as normal” (14.08%). Conclusion: Using hospital discharge database and ICD-10-CA coding to determine incidence of PET in certain settings may yield low sensitivity. Researchers should validate the results when using the hospital discharge database for PET research to ensure that the findings based on analyses of such data demonstrate what they claimed to demonstrate.

Background: Pre-eclampsia (PET) is one of the major causes of maternal and neonatal morbidity and mortality1. Misclassification of PET can lead to biased or erroneous results in epidemiologic studies resulting in false conclusions. Objectives: The objectives of this thesis are to determine the validity of PET diagnosis in pregnant women in administrative database using the ICD-10-CA codes, to explore the nature of misclassification, and to estimate whether misclassification of PET diagnosis in administrative database may result in biased conclusions. Methods: Pregnant women who participated in the Ottawa and Kingston (OaK) Birth Cohort study and delivered in the Ottawa Hospital were included in the study. All cases with hypertensive disorder of pregnancy in the study population were adjudicated to confirm diagnosis of PET. This adjudicated dataset was used as a reference standard. The PET incidence in hospital discharge database was compared with PET incidence calculated from the reference standard database. Results: 2887 of the requested charts were available for review. The PET incidence was much lower in administrative database (1.47%) than in the OaK Birth Cohort Study (3.6%). The results of the study demonstrated that hospital discharge database via ICD-10-CA was not very sensitive to determine incidence of PET since sensitivity of ICD-10-CA diagnostic codes for PET was low (35.92% with 95% Confidence Intervals (CI): 26.7; 45.9) but specificity, PPV, and NPV were high. The majority of misclassified cases belonged to the category (according to the proposed classification) “PET pregnancies coded with incorrect ICD-10-CA code” (78.88%) followed by the category “Pregnancies affected by PET coded as normal” (14.08%). Conclusion: Using hospital discharge database and ICD-10-CA coding to determine incidence of PET in certain settings may yield low sensitivity. Researchers should validate the results when using the hospital discharge database for PET research to ensure that the findings based on analyses of such data demonstrate what they claimed to demonstrate.

Background: Pregnancy Induced Hypertension (PIH) and its complications contribute to a significant burden of disease both in developed and developing countries of the world. Unfortunately, PIH has no cure, the delivery of the baby and the placenta is required. Early detection of pregnancy induced hypertension and close monitoring remains the key to achieving a favourable outcome. This study aimed to determine the quality of care given to women diagnosed with Pregnancy Induced Hypertension (PIH) within a care pathway spanning peri-urban primary and urban secondary level facilities. Methods: This was a retrospective clinical audit of medical records of patients diagnosed with PIH. It was conducted in the Wesfleur -New Somerset Hospital drainage area, using a locally validated data extraction tool, based on the South African Maternal Care Guidelines. The data were analyzed using descriptive methods to report on the frequencies and proportions of the variables, and analyzed to report on statistical significance of correlations. Results: The prevalence rate of pregnancy induced hypertension in this study was 12%. The overall pregnancy induced hypertension complication prevalence in the study for mothers was 7.7%, and that of babies was 30.7%. Facilities generally performed well according to the audit indicators detailing structures and processes that should be followed, as outlined by the standard guidelines used. Two process indicators were correlated with adverse outcomes: 66.1% of patients were appropriately referred, resulting in statistically better foetal outcomes (p = 0.059); and those who booked early in the pregnancy had less PIH-induced complications than those who booked late (p = 0.012) Conclusion: This study followed a standardized audit methodology and found that the quality of care in this peri-urban area is of a good standard and identified areas for quality improvement and further enquiry to ensure continual improvement in maternal and fetal outcomes.

No description available.