Objetivo Analizar la percepción de la gestante hacia el tacto vaginal durante el trabajo de parto y su relación con la explicación del profesional de salud. Materiales y métodos Estudio descriptivo comparativo, retrospectivo, transversal. Se realizó un cuestionario a puérperas de parto eutócico a quienes se les practicó un tacto vaginal durante su trabajo de parto en centro obstétrico del Instituto Nacional Materno Perinatal durante los meses de noviembre y diciembre del 2010. Resultados Se estudió 100 puérperas de parto eutócico. El 37% tiene una edad entre 20 a 24 años, el 58% son convivientes, el 65% tienen grado de instrucción secundaria, el 69% no tiene empleo y el 38% eran primigestas. El 78% refirieron una inadecuada explicación del procedimiento del tacto vaginal y el 22% una adecuada explicación del mismo. El 92% refirió una inadecuada percepción hacia el procedimiento del tacto vaginal y sólo el 8% tuvo una adecuada percepción del mismo. Para las participantes que presentaron percepción adecuada hacia el tacto vaginal, un 50% tuvo una explicación adecuada al procedimiento y el otro 50% restante una explicación inadecuada. Para las participantes que presentaron percepción inadecuada hacia el tacto vaginal, un 19.6% tuvo una explicación adecuada al procedimiento y un 80.4% una explicación inadecuada. Conclusiones Se encontró evidencia para la relación de la explicación del procedimiento del tacto vaginal y la percepción hacia el mismo, donde existe 4 veces mayor probabilidad de que haya percepción inadecuada cuando hay explicación inadecuada (OR= 4,1 IC95% 0,9 – 18,0). PALABRAS CLAVES: Percepción, explicación, tacto vaginal.

Thesis (M.S.)--Boston University

This thesis presents the results of a qualitative study of self-care in pregnancy, birth and lactation within a non-random sample of 27 women in British Columbia, Canada. The women were interviewed in the third trimester of pregnancy, and 23 of the participants were re-interviewed post-partum. Interviews were tape recorded, transcribed, and subjected to thematic analysis. Results were discussed in the context of the social science literature on the medicalization of pregnancy and childbirth. All but one woman used herbal medicine while pregnant. In the post-partum interviews, nearly half reported using galactagogue herbs. The safety and efficacy of each herbal remedy are discussed here. Most of the herbs are considered safe and effective according to the herbal literature, but clinical reports are largely lacking. While many of the women were cautious about using herbs during pregnancy, as a general rule, they considered them to be safer than pharmaceutical drugs. In choosing to self-medicate with herbs, the women said they were guided by prior knowledge (32%), trusted sources of advice (56%), and intuition (12%). Trusted sources of advice included books, friends, family members, maternity care providers, herbalists, herbal shops, and internet. The majority of herbal advice (69%) was received by word-of-mouth. Prolonged pregnancy also proved to be an interesting situation. Many women said they were opposed to labour induction at the time of the first interview, yet all but one woman who went beyond 40 weeks gestation used self-help measures to stimulate labour. This appeared to be a response to pressure from maternity care providers, friends, and family members. Though the medical definition of prolonged pregnancy is 42+ weeks gestation, in the social context, 40+ weeks was cause for concern. Health care professionals, partners, family members, friends, and co-workers all affected self-care behaviour, and their influence could be positive or negative. After an overwhelmingly negative experience with a maternity care provider, over half of the women went to another care provider, or forewent formal maternity care entirely. These findings did not support the hypothesis that childbearing is almost completely medicalized, at least for the sample population. Rather, women negotiated their maternity care within several frameworks, including the medical, midwifery, and self-care models. Medical language was used to describe birth stories, but only by women in physician care. There was an almost universal effort among the women to normalize the childbearing experience. The findings of this study point to a need for: (1) clinical investigation of herbal medicines used in pregnancy, birth and lactation; (2) public and care-provider education regarding social and psychological aspects of prolonged pregnancy; (3) broad-scale inquiry into the phenomena of medicalization/normalization of the childbearing experience, and (4) further investigation into women’s preferences for empowering styles of maternity care. / Graduate

This research situated antenatal education within a health promotion framework to determine a consumer-based approach to improving antenatal and postnatal education purported to prepare for parenthood. Research, both published and unpublished, criticises current structured educational programs and first time parents are reported to experience high levels of stress and unhappiness. Stage One of this study was a multiple source, multiple methods needs assessment conducted at two large, metropolitan hospitals in Sydney. The aim of the needs assessment was to explore the needs, interests and concerns of first time expectant and new parents, their changing nature during the childbearing year, ascertain learning processes that best suited their needs, and plan effective antenatal education around the results. Repeated in-depth interviews, focus groups, participant observation and surveys were used to collect data from expectant and new parents. Focus groups, surveys and participant observation were used to collect complementary data from educators, midwives and Child and Family Health Nurses who work with expectant and new parents. The third source of data analysed was documentary, that is program outlines and session plans of three comparable hospitals. The needs assessment demonstrated that to effectively prepare women and men for their childbearing experience, a range of strategies, programs and learning activities were required. This resulted in the design of a ‘menu’1 approach to antenatal and postnatal education with an emphasis placed on ‘life as a mum and a dad’, and the ‘world’ of their baby. The results also demonstrated a significant difference existed between the actual learning needs and priorities of expectant and new parents and those perceived to be their needs by the professionals. Expectant and new parents questioned the group facilitation skills of educators and identified methods to improve practice. Three strategies identified by these expectant and new parents as priorities were designed, implemented and an evaluation of each was undertaken in Stage Two of this study. The strategies were: 1. Seven session Having a Baby program for first time parents. 2. Group skills training program for antenatal and postnatal educators. 3. Breastfeeding resource package for antenatal educators. Stage Three of this research was an empirical study. A repeated measures randomised control trial was undertaken to test the effectiveness of the new Having a Baby program. In particular whether women and men who attended this program had improved perceived parenting self-efficacy, knowledge, and decreased worry about the baby eight weeks after birth compared with those who attended the conventional antenatal education program. The new program placed the labour and birth experience as a microcosm of the childbearing experience, and incorporated learning activities designed to enhance the confidence of pregnant women and their partners during their adjustment to parenthood. Perceived parenting self-efficacy2 was the measure by which parenting confidence, and therefore adjustment to parenthood, was measured The randomised control trial demonstrated that the perceived parenting self-efficacy of women and men in the experimental group was higher than those of control group participants at approximately eight weeks after the birth, with the difference being statically significant. The labour and birth outcomes of both groups, and their demographic details, were similar. Evaluation of the group skills training program for antenatal and postnatal educators and the breastfeeding resource package for antenatal educators were undertaken. Data collected from focus groups, interviews and surveys demonstrated the effectiveness of these strategies. The findings of this research question the validity of conventional antenatal classes and confirm the need for training and mentoring of antenatal educators. Effective, high quality antenatal education operating within budget allocation, facilitated by group skills trained educators, can produce superior postnatal outcomes.

Thesis.

Thesis (M.S.)--Case Western Reserve University, 2009. / [School of Medicine] Department of Genetic Counseling. Includes bibliographical references.

Thesis (Ph. D.)--University of Texas at Austin, 2002. / Vita. Includes bibliographical references. Available also from UMI Company.

The purpose of the current study is to contribute to the understanding of prenatal cerebellar pathology in autism. Reduction of Purkinje neurons is well reported in the cerebella of individual’s with autism. While there is evidence to suggest that this abnormality may be evident as early as prenatal development, no study to date has examined in the anataomical prenatal development of the cerebella in children later diagnosed with autism. The primary prediction being made is that a reduction of Purkinje neurons during prenatal development will present as reduced cerebellar size in the reports from mother’s prenatal ultrasound records. It is hypothesized that this reduction will be greater in children with an autism diagnosis compared to the records of children without an autism diagnosis. The secondary prediction will attempt to further support the link between aberrant cerebellar development and increased stereotyped behavior and repetitive interests. A retrospective analysis of prenatal ultrasound records and autism diagnostic information will test these hypotheses, predicting that records from children who have been diagnosed with an autism spectrum disorder will show reductions in transverse cerebellar diameter measurements when compared to TD peers, and that greater reductions will correlate with increased stereotypical and repetitive behaviors as measured by a standard diagnostic tool. / text

Assisted reproduction technology is increasingly used for treatment of couples with subfertility. These women are usually of more advanced maternal age and carry a higher risk of fetal Down syndrome. Results from early publications showed that biochemical markers for screening of fetal Down syndrome in the second trimester were different between pregnancies from in vitro fertilization (IVF) and natural conception. This could potentially increase the false positive rate and result in unnecessary invasive diagnostic procedures. Questions were raised as to whether the alterations were related to ovarian stimulation. This laid the fundamentals of a series of studies presented in this thesis with an aim to address the variations in the concentrations of markers of fetal Down syndrome and the fetal growth profile of pregnancies conceived following different assisted reproduction treatments. Studies were conducted on maternal serum and amniotic fluid alpha fetoprotein (AFP) and human chorionic gonadotrophin (hCG) in the second trimester in pregnancies conceived by assisted reproduction. A reduced level of AFP in maternal serum in pregnancies with fresh embryos together with an elevated level of hCG in both maternal serum and amniotic fluid in pregnancies with frozen thawed embryos were found. This pioneer piece of data showing the raised hCG in frozen thawed embryo pregnancies with unstimulated treatment cycles spoke against the ovarian driven hypothesis, but suggested placental dysfunction be a possible underlying pathophysiology. For markers adopted in the first trimester, the level of pregnancy associated protein A (PAPP-A) was significantly reduced in pregnancies from assisted reproduction. The data on free βhCG was heterogeneous. Apart from biochemical markers, the nuchal translucency was also increased in these singleton pregnancies but not in dichorionic twins. As the direction of deviations of these markers in unaffected pregnancies from assisted reproduction resembled those observed in pregnancies affected by Down syndrome, appropriate adjustment was necessary to reduce the false positive rate for these women. Altered biochemical markers, notably a low PAPP-A level, were also associated with adverse obstetric outcomes. The changes observed in pregnancies from assisted reproduction might be a manifestation of an intrinsic placental insufficiency or fetal developmental delay. A longitudinal study was performed to examine the intrauterine fetal growth profile in these pregnancies. The rate of increment in the mean sac size, which could represent an adaptive compensatory mechanism, was significantly greater in pregnancies from assisted reproduction compared to natural conception. We concluded that pregnancies conceived after assisted reproduction technology were different from pregnancies from natural conception in terms of the concentrations of biochemical and ultrasound markers of Down syndrome. Due to the wide variation in treatment protocols and patients’ background demographics, the exact underlying pathophysiology might be difficult to be explored. Couples undergoing assisted reproduction treatment should be counseled on the increased risk of adverse pregnancy course and perinatal outcome. / published_or_final_version / Medicine / Master / Doctor of Medicine

Epilepsy, a relatively common and chronic neurological condition, affects 1-2% of the population. The underlying pathophysiology of epileptogenesis is not completely understood. To identify potential antecedents to seizure, the effects of maternal stress and environmental enrichment (EE) were investigated. Maternal stress was modeled by exposing pregnant rats to a prenatal stress (PS; an ethologically relevant predatory threat). At birth, PS and naïve control (NC) dams and litters were either maintained in standard cages or transferred to EE until postnatal day (PD) 14. A model of febrile convulsions (FC) was used to determine seizure susceptibility of all offspring. Pup brains were processed for detection of FosB (FosB-ir) from structures in the limbic system and corticotrophin-releasing hormone (CRH-ir) from the paraventricular nucleus of the hypothalamus (PVN). Our results suggest pre- and postnatal dam-dependent effects. PS increased glucocorticoid (GC) levels in dams and decreased pup birth-weights. Seizure scores on PD14 were highly individualized and litter dependent, suggesting a dam-dependent and variable effect of controlled pre- and postnatal factors. EE increased FosBir within the hippocampus but, in other regions, EE decreased FosB-ir. EE also significantly decreased CRH-ir in the PVN. Our results support the concept that both preand postnatal environmental influences affect fetal programming and neurodevelopment.