Yes / Stillbirth is a global public health priority. Within the United Kingdom, perinatal mortality disproportionately impacts Black, Asian and minority ethnic women, and in particular migrant women. Although the explanation for this remains unclear, it is thought to be multidimensional. Improving perinatal mortality is reliant upon raising awareness of stillbirth and its associated risk factors, as well as improving maternity services. The aim of this study was to explore migrant women’s awareness of health messages to reduce stillbirth risk, and how key public health messages can be made more accessible. Method: Two semi-structured focus groups and 13 one to one interviews were completed with a purposive sample of 30 migrant women from 18 countries and across 4 NHS Trusts. Results: Participants provided an account of their general awareness of stillbirth and recollection of the advice they had been given to reduce the risk of stillbirth both before and during pregnancy. They also suggested approaches to how key messages might be more effectively communicated to migrant women. Conclusions: Our study highlights the complexity of discussing stillbirth during pregnancy. The women in this study were found to receive a wide range of advice from family and friends as well as health professionals about how to keep their baby safe in pregnancy, they recommended the development of a range of resources to provide clear and consistent messages. Health professionals, in particular midwives who have developed a trusting relationship with the women will be key to ensuring that public health messages relating to stillbirth reduction are accessible to culturally and linguistically diverse communities. / Funding was received from the University of Huddersfield internal funding scheme.

A quantitative descriptive, retrospective and cross-sectional study was conducted. The purpose of the study was to identify and describe factors that contributed to high sickness and death rate of babies admitted in the Neonatal Unit at a tertiary institution in Limpopo Province. Data were collected from the patient’s records by administering an auditing tool. The tool included initial assessment on antenatal care, intra-partum and neonatal care. Analysis of data was performed by IBM Statistical Package for Social Sciences (SPSS) Statistics 22 computer software version. Frequency tables and pie graphs were used to present the data. The findings revealed that 42% of the mothers whose babies were admitted in the Neonatal Unit were in their childbearing period, 71% of the mothers started antenatal care at the second trimester and 75% babies were admitted within the first six hours of life. Respiratory distress, 77% and prematurity, 43% were the common conditions for admission in the Neonatal Unit. Spontaneous preterm and immaturity were the common causes of death. Recommendations are that education and training on record keeping to be done on continuous basis, to conduct quality improvement programmes and implement maternal and neonatal guidelines in the clinical area throughout. / Health Studies / M.A. (Health Studies)

Despite the unprecedented improvement in child health in last 15 years, burden of stillbirth and neonatal death remain the key challenge in Nepal and the reduction of these deaths will be crucial for reaching the health targets for Sustainable development goal by 2030. The aim of this thesis was to explore the risk factors for stillbirth and neonatal death and change in perinatal outcomes after the introduction of the Helping Babies Breathe Quality Improvement Cycle (HBB QIC) in Nepal. This was a prospective cohort study with a nested case-control design completed in a tertiary hospital in Nepal. Information were collected from the women who had experienced perinatal death and live birth among referent population; a video recording was done in the neonatal resuscitation corner to collect information on the health workers’ performance in neonatal resuscitation.  Lack of antenatal care had the highest association with antepartum stillbirth (aOR 4.2, 95% CI 3.2–5.4), births that had inadequate fetal heart rate monitoring were associated with intrapartum stillbirth (aOR 1.9, CI 95% 1.5–2.4), and babies who were born premature and small-for-gestational-age had the highest risk for neonatal death in the hospital (aOR 16.2, 95% CI 12.3–21.3). Before the introduction of the HBB QIC, health workers displayed poor adherence to the neonatal resuscitation protocol. After the introduction of HBB QIC, the health workers demonstrated improvement in their neonatal resuscitation skills and these were retained until six months after training. Daily bag-and-mask skill checks (RR 5.1 95% CI 1.9–13.5), preparation for birth (RR 2.4, 95% CI 1.0–5.6), self-evaluation checklists (RR 3.8, 95% CI 1.4–9.7) and weekly review and reflection meetings (RR 2.6, 95% 1.0–7.4) helped the health workers to retain their neonatal resuscitation skills. The health workers demonstrated improvement in ventilation of babies within one minute of birth and there was a reduction in intrapartum stillbirth (aOR 0.46, 95% CI 0.32–0.66) and first-day neonatal mortality (aOR 0.51, 95% CI 0.31–0.83).  The study provides information on challenges in reducing stillbirth and neonatal death in low income settings and provides a strategy to improve health workers adherence to neonatal resuscitation to reduce the mortality. The HBB QIC can be implemented in similar clinical settings to improve quality of care and survival in Nepal, but for primary care settings, the QIC need to be evaluated further.

A quantitative descriptive, retrospective and cross-sectional study was conducted. The purpose of the study was to identify and describe factors that contributed to high sickness and death rate of babies admitted in the Neonatal Unit at a tertiary institution in Limpopo Province. Data were collected from the patient’s records by administering an auditing tool. The tool included initial assessment on antenatal care, intra-partum and neonatal care. Analysis of data was performed by IBM Statistical Package for Social Sciences (SPSS) Statistics 22 computer software version. Frequency tables and pie graphs were used to present the data. The findings revealed that 42% of the mothers whose babies were admitted in the Neonatal Unit were in their childbearing period, 71% of the mothers started antenatal care at the second trimester and 75% babies were admitted within the first six hours of life. Respiratory distress, 77% and prematurity, 43% were the common conditions for admission in the Neonatal Unit. Spontaneous preterm and immaturity were the common causes of death. Recommendations are that education and training on record keeping to be done on continuous basis, to conduct quality improvement programmes and implement maternal and neonatal guidelines in the clinical area throughout. / Health Studies / M. A. (Health Studies)

Thesis (M Social Work)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: According to South African annual statistics, stillbirth is a relevant issue and National health policies, social welfare services and health care providers should place special focus on pregnant women to avoid the possible occurrence of a negative pregnancy outcome such as a stillbirth. An event that should have been a joyous birth, ended in a tragic death, forcing the mother to deal with the emotions of birth and death simultaneously. The bereaved mother needs to receive special care and support as soon as possible and the crisis intervention approach is seen as being helpful to regain a sense of equilibrium in her and the family’s life before starting to adapt to the new situation. This study explores and describes the lived experience of 25 mothers who experienced a stillbirth. Focus was given to the psychosocial implications of stillbirth on mothers and their families. This study examined the mothers’ feelings about the stillbirth six months or longer after the event, as well as its impact on relationships with partners and other children. By adopting a crisis intervention approach, the effectiveness of crisis intervention shortly after the stillbirth could be investigated. This study used a combination of quantitative and qualitative research approaches and assumed an exploratory and descriptive research design to provide a detailed description of the phenomenon being studied, i.e. the psychosocial implications of stillbirth. A questionnaire was used to obtain demographic (quantitative) data and a semi-structured questionnaire – the design based on information from literature - was administered during individual interviews. Obtained data was both measurable and rich in description and revealed that mothers still longed for their stillborn babies after a period of six or more months had passed. It also indicated that the father or partner of the baby and other children were affected by a stillbirth. Gender differences in how stillbirth is experienced by each partner, consequently adds extra tension on the relationship. Most of the mothers experienced the stillbirth as a crisis and found support in their mothers, family and a counsellor. Significantly, mothers felt crisis-intervention was beneficial, but preferred that crisis intervention be followed by on-going therapy. The stillbirth also resulted in feelings of alienation from community, friends and family - who did not know how to approach them. Generally, mothers were satisfied with medical care received but several issues regarding autopsy consent and guilt feelings surrounding this are highlighted. Important recommendations resulting from the study indicate that the crisis-intervention approach as method in social work is effective when rendering service for bereaved mothers and families after a stillbirth. It helps to regain a sense of equilibrium, but further intervention is recommended to facilitate the grief process. In addition, the study emphasizes the importance of social workers being aware that the stillbirth causes tension in partner- and family relationships. Receiving social work intervention is not only highly effective, but allows bereaved mothers to feel empowered and encouraged to openly grieve for their stillborn babies - much needed in an environment where a stillbirth is seen as a silent birth. / AFRIKAANSE OPSOMMING: Volgens jaarlikse Suid-Afrikaanse statistieke, is stilgeboorte ‘n relevante onderwerp en die Nasionale gesondheidsbeleid, maatskaplike welsynsdienste en gesondheidssorgverskaffers moet fokus op swanger vroue ten einde moontlike negatiewe swangerskapuitkomstes, soos stilgeboorte, te voorkom. Tydens ‘n stilgeboorte, eindig die heuglike vooruitsig van ‘n geboorte in die tragiese afsterwe van die baba en word die moeder geforseer om emosies van geboorte en sterfte gelyktydig te hanteer. Sulke moeders benodig spesiale versorging asook ondersteuning so spoedig moontlik. Krisis intervensie is ‘n effektiewe metode om die moeder te help om ‘n mate van balans in haar en haar gesin se lewe te herwin voordat hulle kan begin aanpas by die nuwe situasie. Hierdie studie ondersoek en beskryf ervarings van 25 moeders wat ‘n stilgeboorte ervaar het. Fokus word geplaas op die psigososiale effek van stilgeboorte op moeders en hul gesinne. Moeders se gevoelens rakende die stilgeboorte ses maande of langer na die geboorte, is ondersoek, asook die effek daarvan op hul verhoudings met lewensmaats en ander kinders. Deur die krisis intervensie benadering te gebruik, kon die effektiwiteit daarvan kort na die stilgeboorte ondersoek word. Kwantitatiewe en kwalitatiewe navorsingsmetodes is in hierdie studie gebruik. Die studie veronderstel ʼn verkennende en beskrywende navorsingsontwerp om sodoende ʼn uitvoerige beskrywing van die psigososiale implikasie van stilgeboorte te verskaf. Data word verkry deur ʼn vraelyste - demografiese (kwantitatiewe) data, asook semigestruktureerde vraelyste (kwalitatief) wat tydens individuele onderhoude toegedien is. Die ontwerp van die semi-gestruktureerde vraelys is gebaseer op inligting vanuit die literatuurstudie. Die bevindinge van die empiriese ondersoek dui aan dat moeders na ses maande of langer steeds hunker na hul stilgebore babas. Geslagsverskille rakende die wyse waarop moeders en vaders die stilgeboorte ervaar dra gevolglik by tot ekstra spanning in die verhouding. Die meeste moeders het die stilgeboorte as ‘n krisis ervaar en het ondersteuning gevind by hulle moeders, gesinne en ‘n berader/maatskaplike werker. ‘n Beduidende bevinding was dat moeders krisis intervensie as voordelig beskou het, maar verkies dat dit opgevolg moet word deur deurlopende terapie. Die stilgeboorte veroorsaak ook dat die moeders ‘n gevoel van vereensaming van die gemeenskap, vriende en familie ervaar het. Volgens hulle was mense te bang en onseker in hoe om hulle te benader. In die algemeen was moeders tevrede met die mediese sorg wat hulle ontvang het, maar kwessies rakende toestemming en skuldgevoelens rondom nadoodse ondersoeke word uitgelig. Belangrike aanbevelings dui aan dat krisis intervensie as metode in maatskaplike werk effektief is ten opsigte van dienslewering vir ‘n moeder en haar gesin na ‘n stilgeboorte. Dit help om ‘n mate van balans te herstel, maar verdere intervensie word aanbeveel om die rouproses te fasiliteer. Die studie beklemtoon ook dat dit belangrik is dat maatskaplike werkers bewus moet wees dat ‘n stilgeboorte spanning veroorsaak in huweliks- en gesinsverhoudings. Die ontvangs van maatskaplike werk intervensie is nie net hoogs effektief nie, maar bemagtig en motiveer moeders om openlik te rou vir hulle stilgebore babas, iets wat nodig is in ‘n samelewing waar stilgeboorte as ‘n geboorte beskou word waaroor daar nie gepraat word nie.

Ziel: Einzellfallanalyse der Totgeburten hinsichtlich ihrer Vermeidbarkeit und Vermeidungsfaktoren als ein wesentlicher Anteil der internen Qualitätssicherung. Methode: Im Zeitraum von 1996 bis 2000 wurden nach dem Ausschluss der Abbrüche bei Fehlbildungen 100 Totgeburten bei 99 Entbindungen mit einem Geburtsgewicht von mindestens 500 g in die Analyse miteinbezogen. Ergebnisse: Die korrigierte Totgeburtenrate lag bei 5,23 Totgeburten/1000 Geburten. Der Anteil von totgeborenen Mehrlingen (11%) war 4fach so hoch dem Normalkollektiv (2,8%) gegenüber. Die relativ große Zahl der zwischen 20-23 vollendeten SSW (22%) und vor 28 vollendeten SSW (36%) auftretenden intrauterinen Fruchttode in unserer Untersuchung weist auf eine Population mit einem großen Anteil an früher Frühgeburtlichkeit hin. Die meisten Totgeburten (38%) befanden sich in der Gewichtsgruppe 500-999 g. Zwei Drittel (14/21) der Kinder mit SGA wurden ab 32 SSW und knapp die Hälfte (10/21) am Entbindungstermin mit 37 bis 41 SSW geboren. Die Todesursachen waren Plazentainsuffizienz (31%), AIS (21%), vorzeitige Plazentalösung (20%), Nabelschnurkomplikationen (7%), FFTS (2%) und Hydrops fetalis (2%). Das Amnioninfektionssyndrom (AIS) als Todesursache trat häufiger in frühen Schwangerschaftswochen (20-24 SSW: n= 17 von 21 Fällen mit AIS als Todesursache) auf. Nabelschnurkomplikationen fanden sich dagegen in späteren Schwangerschaftswochen (34-40 SSW: n=7). Unabhängig von den Todesursachen waren 51% der Totgeburten nach unserer Analyse nicht vermeidbar, 12% waren intern vermeidbar und 37% möglicherweise vermeidbar durch die Frauenärzte/Innen bzw. die Patientinnen selber. Eine gute Schwangerschaftsvorsorge, eine ausreichende fetale Überwachung und ein gutes Geburtsmanagement hätten viele Totgeburten vermeiden können. Die Beteiligung der Schwangeren ist dabei die Grundvoraussetzung. Schlussfolgerung: Die Betrachtung der Todesursache allein ist zur Beurteilung der Vermeidbarkeit nicht ausreichend. Das Verständnis der Ereignisse, die zu den Totgeburten führten, ist der Ausgangspunkt für eine kritische Auswertung. / Objective: The avoidability and the preventive factors relating to stillbirths were evaluated as an important part of internal quality control. Methods: After exclusion of interruptions because of fetal malformations, the case records of 100 stillbirths with a minimal birth weight of 500 g from 99 deliveries in our clinic in the years 1996 till 2000 were retrospectively as single cases analysed. Results: The corrected rate of stillbirth was 5,23 per 1000 births. The proportion of the stillborn multiplets (11%) was 4 times higher then the proportion in the normal population (2,8%). That the stillbirths occurred preferentially between 20-23 menstrual weeks of pregnancy (22%) and before 28 menstrual weeks in our collection points out a population with a large proportion of earlier prematurity. Most of the stillbirths (38%) were born with a birth weight between 500-999 g. Two third (14/21) of the stillbirths from 32 menstrual weeks and almost the half of the stillbirths (10/21) between 37 till 41 menstrual weeks were born with small for gestational age (SGA). The principal causes of the stillbirths were placental insufficiency (31%), chorioamnionitis (21%), placental abruption (20%), cord complications (7%), twin-to-twin transfusion syndrom (2%) and hydrops (2%). The chorioamnionitis appeared more frequently in the early menstrual weeks (20-24 menstrual weeks: n=17 of 21 cases with chorioamnionitis). The cord complications on the contrary occurred in the late menstrual weeks (34-40 menstrual weeks: n=7). Independent of the causes of deaths, 51% of the stillbirths according to our analysis were not avoidable, 12% were internally preventable and 37% could be prevented by the external gynecologists or the patients themselves. A qualified and compliance to prenatal care, a sufficient fetal surveillance and a good management of delivery could avoid many stillbirths. The corporation of the pregnant patients is nevertheless prerequisite. Conclusion: The only consideration of the cause of death is not sufficient to evaluate the preventability of stilllbirths. The insight of the events that lead to stillbirths is the starting point for a critical interpretation.

<p>These studies were undertaken to investigate risks of maternal and perinatal complications in pregnant women with chronic hypertensive disease, and to investigate future risk of preeclampsia in women born small for gestational age (SGA). Population based cohort studies using the Swedish Medical Birth Register from different years were performed.</p><p>The maternal complications mild and severe preeclampsia, gestational diabetes and abruptio placenta were studied in a population of 681 515 women, with a prevalence of 0,5% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics as age, parity, BMI, ethnicity and smoking habits. Chronic hypertensive women wore found to have significantly increased risks of all complications. </p><p>The perinatal complication SGA was studied in a population of 560 188, with a prevalence of 0,5% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics and for the secondary complications mild and severe preeclampsia. Chronic hypertensive women were found to suffer a significantly increased risk of giving birth to an offspring that is SGA. </p><p>The perinatal complication fetal/infant mortality was studied in a population of 1 222 952 with a prevalence of 0,6% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics and for the complications mild and severe preeclampsia, gestational diabetes, abruptio placenta and offspring being SGA In the analysis an effect modification by gender was included. Chronic hypertensive women were found to have a significantly increased risk for stillbirth and neonatal death in male, but not in female, offspring. Thus a clear gender difference in mortality was revealed. The risk of mortality of offspring was mediated by severe preeclampsia, abruptio placenta and offspring being SGA. Mild preeclampsia and gestational diabetes did not affect the risk. No increased risk of post neonatal mortality was found.</p><p>A generation study was performed in 118 634 girls of which 5.8% were born SGA. Their future risk for mild and severe preeclampsia in first pregnancy was analysed. Risk estimates were adjusted for age, smoking, BMI and for preeclampsia in the mothers while pregnant with the study population. Women who were born SGA were shown to have a significantly increased risk for severe preeclampsia, but not for mild preeclampsia. </p>

These studies were undertaken to investigate risks of maternal and perinatal complications in pregnant women with chronic hypertensive disease, and to investigate future risk of preeclampsia in women born small for gestational age (SGA). Population based cohort studies using the Swedish Medical Birth Register from different years were performed. The maternal complications mild and severe preeclampsia, gestational diabetes and abruptio placenta were studied in a population of 681 515 women, with a prevalence of 0,5% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics as age, parity, BMI, ethnicity and smoking habits. Chronic hypertensive women wore found to have significantly increased risks of all complications. The perinatal complication SGA was studied in a population of 560 188, with a prevalence of 0,5% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics and for the secondary complications mild and severe preeclampsia. Chronic hypertensive women were found to suffer a significantly increased risk of giving birth to an offspring that is SGA. The perinatal complication fetal/infant mortality was studied in a population of 1 222 952 with a prevalence of 0,6% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics and for the complications mild and severe preeclampsia, gestational diabetes, abruptio placenta and offspring being SGA In the analysis an effect modification by gender was included. Chronic hypertensive women were found to have a significantly increased risk for stillbirth and neonatal death in male, but not in female, offspring. Thus a clear gender difference in mortality was revealed. The risk of mortality of offspring was mediated by severe preeclampsia, abruptio placenta and offspring being SGA. Mild preeclampsia and gestational diabetes did not affect the risk. No increased risk of post neonatal mortality was found. A generation study was performed in 118 634 girls of which 5.8% were born SGA. Their future risk for mild and severe preeclampsia in first pregnancy was analysed. Risk estimates were adjusted for age, smoking, BMI and for preeclampsia in the mothers while pregnant with the study population. Women who were born SGA were shown to have a significantly increased risk for severe preeclampsia, but not for mild preeclampsia.

Made available in DSpace on 2016-03-15T19:41:17Z (GMT). No. of bitstreams: 1 Horacio Bernardo Rosario.pdf: 2513065 bytes, checksum: 21d7ec7d83235895e090241d837335a5 (MD5) Previous issue date: 2012-08-20 / The prevalence rate of live born and stillborn infant twins has been the target of many studies, including in Brazil. However, modifications in people s reproductive style and improvements in labor procedures and better healthcare for newborns show that the knowledge on twinning must be updated over time. To be able to evaluate these modifications better, historical records in hospitals that have regular medical service represent an important frame of reference. In this thesis the records of births of the Centro Obstétrico do Serviço de Ginecologia e de Obstetrícia of the Hospital do Servidor Público Estadual, São Paulo, Brazil, in the period of 1978 to 2009 has been researched, a total of 32 years. In this period, 65,258 labors of stillborn and live born children have been registered. Of this sample, 64,560 were labors of newborn only and 1,396 of double births. Between these, 257 belonged to the genre MM; 270 to FF and 171 to MF. The estimative of the zygosity using the Weinberg method defined that 339 were dizygotic (DZ) and 359 were monozygotic (MZ). The information gathered was stored in a data bank in a computer for future analysis. The SPSS statistical program V 11, 5 using statistical modules, such as correlation analysis, regression analysis, adjusting curves, and comparisons between two groups, analyzed the data. The program Curve Expert V 11,4 was also used for curve fitting. The study of prevalence, maternal age, weight and the Apgar Bulletin allowed the following conclusions: 1. the prevalence varied 0.71 to 1.47% in the 32 years considered. The tendency of prevalence rates for the total of twin births showed a decrease from 1979 to 1993 and an increase around 2005. This distribution is consistent with other Brazilian samples and it can be explained by the variation of maternal age and the use of treatments against infertility. In the last four years there was a decrease in the birth of twins, but this trend did not hold in the years of 2010 and 2011; 2. the prevalence was not evenly distributed between DZ and MZ. Among the first, the distribution was similar to the total twin births. Among the second, there was an increase from 1986 to 2002 in a way that it was higher than that of DZ. In the total sample there was a greater number of MZ. Although not statistically significant this result, 3. the average maternal age of twins was higher than that of the singletons (29,71 years and 28,44 years respectively). This difference is statistically significant according to the literature. The tendency of the distribution of maternal age between twins and singletons is not uniform: there is among the first consistent decrease ranging around 29 years in the first periods to 28 in the last. The variation of maternal age of the twins has a heterogeneous pattern; 4. the average weight of newborns twins was 2,335 g with a tendency to decrease throughout the period. The same trend was observed for singletons. There was also a decrease in gestational age among twins and singletons, it could explain the decline in weight. The trend descending gestational age does not seem to be related to the type of birth since the proportion of these is not changed; 5. the means of the Apgar scores for single births and twins were high in both the first and fifth minutes. The single births had a greater rate and were more stable. The twin births showed consistent increase. 6. the stillbirth among singletons was only less than 1% with a tendency to decrease in recent years and much lower than the national average. Among twins the prevalence is above 3% with increasing tendency. Further studies are needed to lead us to a better enlightenment of the results. / As taxas de prevalência em gêmeos nativivos e natimortos têm merecido muitos estudos, inclusive no Brasil. No entanto, mudanças no estilo reprodutivo das populações e melhorias na assistência ao parto e ao recém-nascido mostram que o conhecimento sobre as concepções gemelares devem ser atualizadas ao longo do tempo. Para melhor avaliar estas mudanças, séries históricas registradas em hospitais com atendimentos regulares \ representam importante referência. Neste trabalho foram levantados os registros dos nascimentos no Centro Obstétrico do Serviço de Ginecologia e de Obstetrícia do Hospital Servidor Público Estadual, São Paulo, Brasil, no período de 1978 a 2009, isto é, 32 anos. Num total de 65.258 partos, entre nativivos e natimortos, 64.560 referem-se a partos de recém-nascidos únicos e 1.396 a nascimentos duplos. Entre estes, 257 eram do gênero MM; 270 FF e 171 MF. A estimativa da zigosidade pelo método de Weinberg definiu que 342 eram Dizigóticos (DZ) e 356 Monozigóticos (MZ). As informações coletadas neste trabalho foram armazenadas em um banco de dados de um microcomputador para posterior análise. Os dados foram analisados pelo do programa estatístico SPSS V 11,5 utilizando-se módulos estatísticos, tais como: análise de correlação e de regressão, ajuste de curvas e comparações entre dois grupos. Foi utilizado também, o programa Curve Expert V 1,4 para o ajuste de curvas. O estudo da prevalência, da idade materna, do peso e do Boletim Apgar permitiu as seguintes conclusões: 1. a prevalência variou de 0,71 a 1,47% nos 32 anos considerados. A tendência das taxas de prevalência para o total dos nascimentos gemelares mostrou declínio entre 1979 e 1993 e logo após aumentando até 2005. Esta distribuição está de acordo com a de outras amostras brasileiras e pode ser explicada pela variação da idade materna e utilização de tratamentos contra infertilidade. No último quadriênio houve diminuição no nascimento de gêmeos, mas essa tendência não se manteve nos anos de 2010 e 2011; 2. a prevalência não se distribuiu uniformemente entre DZ e MZ. Entre os primeiros, a distribuição foi similar ao total dos nascimentos gemelares. Entre os MZ houve incremento entre 1986 a 2002 de maneira a ser maior do que a de DZ. Na amostra total o número de Mz foi maior. No entanto, esta diferença não foi estatisticamente significante, neste resultado. 3. a média da idade materna de gemelares foi maior do que dos únicos (29,71 anos e 28,44 anos, respectivamente). Esta diferença é estatisticamente significante e de acordo com os dados da literatura. A tendência da distribuição da idade materna entre gêmeos e únicos não é uniforme, entre os primeiros há queda consistente variando em torno de 29 anos nos primeiros períodos a 28 nos últimos. Entretanto, a variação da idade materna dos gêmeos tem padrão heterogêneo; 4. a média do peso dos recém-nascidos gemelares foi de 2 335 g com tendência a diminuição ao longo do período. A mesma tendência foi observada para os nascimentos únicos. Observou-se também diminuição da idade gestacional entre gêmeos e únicos, o que poderia explicar o declínio do peso. A tendência decrescente da idade gestacional não parece estar relacionada ao tipo de parto, uma vez que a proporção destes não se modificou; 5. as médias do Boletim Apgar para únicos e gêmeos foram elevadas. A média do Apgar 1 entre os recém-nascidos únicos foi de 7,97 e dos gêmeos foi de 7,00. Com relação ao Apgar 5, a média entre os únicos foi de 9,04 e dos gêmeos foi de 8,33. Entre os primeiros foram maiores e estáveis e entre os segundos demonstram. incremento consistente; 6. a natimortalidade entre únicos foi menor do que 1% com tendência a queda nos últimos anos e bem menor do que a média brasileira. Entre os gêmeos a prevalência fica acima de 3% com tendência crescente. Estudos posteriores serão necessários para compreender melhor alguns dos resultados alcançados.

This research study examined mothers’ experiences of gaining access to services following the death of a baby through stillbirth or a neonatal death. An exploratory research design was used to conduct applied research into the said topic through the use of a semi-structured interview schedule. The research sample consisted of fifteen mothers, all having lost a baby within the last five years to stillbirth or neonatal death. These mothers were met in propinquity and the interview schedule was conducted with them. The findings were analysed and presented both quantitatively, by means of percentages and graphs, and qualitatively, by means of themes and sub themes. The research was particularly relevant in that it is estimated that between three and five percent of all pregnant mothers in South Africa will lose their babies to a stillbirth or neonatal death every year. For this reason it is essential that adequate and quality services be offered to these mothers to prevent complications in their grief. The study conducted by the researcher focused on the accessibility of quality hospital, religious, formal and social support services to bereaved mothers following the death of a baby through stillbirth and neonatal death. The researcher then discussed, in detail, the literature informing the study. The discussion of the literature, as outlined by the researcher, was set in a logical progression – beginning with a discussion on grief, the grief process, dysfunctional grief and models of grief, then moving onto a discussion of the grief following the loss of a baby and maternal grief predictors. The theory ended with a discussion on the services, particularly hospital services, religious services and formal services, available to bereaved mothers. The researcher then presented the findings of the study, drawing comparisons between the literature and the empirical findings where relevant. Conclusions and recommendations were then formulated and presented. The researcher firmly believes that the research conducted holds the potential of providing significant practical suggestions to the functioning of the services that are available to bereaved mothers. / Dissertation (MSD (Play Therapy))--University of Pretoria, 2007. / Social Work and Criminology / unrestricted