Thesis (M.S.)--University of Michigan, 1995.

Thesis (M.Sc.)--Memorial University of Newfoundland, Faculty of Medicine, 1999. / Typescript. Bibliography: leaves 82-110.

Call number: LD2668 .T4 1979 S38 / Master of Science

by Shen Tai. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1997. / Includes bibliographical references (leaves 84-92). / Chapter CHAPTER1 --- INTRODUCTION --- p.2 / Chapter CHAPTER2 --- LITERATURE REVIEW / Chapter 2.1 --- Fibronectin --- p.4 / Chapter 2.1a --- Functions and basic molecular structure --- p.4 / Chapter 2.1b --- Polymorphism and alternative splicing --- p.5 / Chapter 2.1c --- Primary classification --- p.6 / Chapter 2.2 --- Oncofetal fibronectin --- p.7 / Chapter 2.2a --- Introduction --- p.7 / Chapter 2.2b --- Recognition by FDC-6 monoclonal antibody --- p.7 / Chapter 2.2c --- Specificity of FDC-6 antibody --- p.8 / Chapter 2.2d --- Glycosylation of fetal fibronectin molecule --- p.9 / Chapter 2.2e --- Fibronectin and human pregnancy --- p.9 / Chapter 2.2f --- Regulation of fetal fibronectin synthesis --- p.11 / Chapter 2.2g. --- Possible mechanism of fetal fibronectin release --- p.12 / Chapter 2.3 --- The uterine cervix in human labour --- p.13 / Chapter 2.3a --- Introduction --- p.14 / Chapter 2.3b --- Physiological cervical ripening --- p.14 / Chapter 2.3c --- Role of prostaglandins --- p.16 / Chapter 2.3d --- Fibronectin and degradation of cervical matrix --- p.16 / Chapter 2.4 --- Evaluation of cervical status --- p.17 / Chapter 2.4a --- Bishop score --- p.17 / Chapter 2.4b --- Intravaginal ultrasound evaluation of cervix --- p.18 / Chapter 2.4c --- Fibronectin as a tool for evaluation of cervical status --- p.19 / Chapter 2.5 --- Pre-induction cervical ripening with PGE2 --- p.20 / Chapter 2.5a --- Introduction --- p.20 / Chapter 2.5b --- Route of delivery --- p.21 / Chapter 2.5c --- Indications for cervical ripening with prostaglandins --- p.21 / Chapter 2.5d --- Possible Mechanism --- p.22 / Chapter 2.5e --- PGE2 effectiveness and potential risks --- p.23 / Chapter 2.5f --- Other cervical ripening techniques and agents --- p.25 / Chapter 2.5g --- Prediction for outcomes of induction and pre- induction cervical ripening with PGE2 --- p.26 / Chapter 2.6 --- Application of fibronectin in Obstetrics --- p.29 / Chapter 2.6a --- Prediction of preterm delivery --- p.29 / Chapter 2.6b --- Evaluation of cervical status --- p.31 / Chapter 2.6c --- Prediction of prolonged pregnancy --- p.32 / Chapter 2.6d --- Prediction for outcomes of induced labor --- p.32 / Chapter CHAPTER3 --- METHODOLOGY / Chapter 3.1 --- Introduction --- p.36 / Chapter 3.2. --- Study population and recruitment --- p.36 / Chapter 3.2a --- Inclusive criterion --- p.36 / Chapter 3.2b --- Exclusive criterion --- p.36 / Chapter 3 3 --- Measurement of Fetal Fibronectin --- p.38 / Chapter 3.3.1 --- Fetal Fibronectin Membrane Immunoassay --- p.39 / Chapter 3.3.1a --- Principle of the test --- p.39 / Chapter 3.3.1b --- Reagent and materials --- p.39 / Chapter 3.3.1c --- Specimen collection --- p.40 / Chapter 3.3.1d --- Assay procedure and interpretation of results --- p.40 / Chapter 3.3.2 --- Fetal Fibronectin Enzyme Immunoassay --- p.40 / Chapter 3.3.2a --- Principle of the test --- p.40 / Chapter 3.3.2b --- Materials --- p.41 / Chapter 3.3.2c --- Specimen collection --- p.42 / Chapter 3.3.2d --- Assay procedure and interpretation of results --- p.43 / Chapter 3.4 --- Cervical status determination --- p.44 / Chapter Chapter4 --- RESULT --- p.47 / Chapter Chapter5 --- DISCUSSION --- p.80 / REFERENCES --- p.83

Licentiatavhandling (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 2 uppsatser.

Thesis (MMed)-- Stellenbosch University, 2013. / ENGLISH ABSTRACT: Misoprostol is often used for the purpose of induction of labour. However, its effect on fetal heart rate has not been systematically studied. Objective To assess the effect of misoprostol on fetal heart rate parameters during induction of labour from 38 completed weeks in women with previous intrauterine death or postterm pregnancy. Study design A retrospective descriptive study of 127 women for a period of 18 months. Method Women who underwent induction of labour with misoprostol for either previous intrauterine death or postterm pregnancy at Tygerberg hospital were eligible. The selected process of induction of labour happened according to the departmental protocol. The primary outcomes were changes in fetal heart rate (variability, accelerations and decelerations) pre-and post-administration of misoprostol. Secondary outcomes were neonatal highcare or intensive care unit (ICU) admissions. Results There was no statistical difference in the mean fetal heart rate and baseline variability in relation to time recordings after administration of misoprostol. There were no statistically significant differences in the distribution of accelerations and decelerations in different time intervals before and after administration. There were more reactive patterns at all time intervals after the administration of misoprostol, but these differences did not quite reach statistical significance. In both study groups no neonatal complications or intensive care admissions were reported. Conclusion In the absence of contra indications, 50mcg of oral misoprostol can be given to mothers for induction of labour as no harmful fetal heart tracing abnormalities were found for 45 minutes; however large prospective randomized controlled trials are still needed to confirm effectiveness and evaluate further maternal and neonatal safety issues. Optimal dose and frequency also still need robust interrogation. Based on this thesis it does appear that misoprostol is probably not harmful to the fetus under these circumstances. / AFRIKAANSE OPSOMMING: Misoprostol word dikwels gebruik vir induksie van kraam. Die effek daarvan op fetale hartspoed is egter nie sistematies ondersoek nie. Doel Om die effek van misoprostol op fetale hartspoedparameters gedurende die induksie van kraam van 38 voltooide weke in vroue met vorige intra-uteriene dood or oortyd swangerskap te evalueer. Studei-ontwerp „n Retrospektiewe beskrywende studie van 127 vroue oor „n periode van 18 maande. Metode Vroue wat induksie van kraam met misoprostol ondergaan het vir of vorige intra-uteriene dood of oortyd swangerskap by Tygerberg Hospitaal is ingesluit. Die proses van induksie van kraam is volgens departementele protokol uitgevoer. Die primêre uitkomste was veranderinge in fetale hartspoed (variasie, versnellings en verstadigings) pre- en post-toediening van misoprostol. Neonatale hoësorg of intensiewe sorg toelatings was sekondêre uitkomste. Resultate Ons het geen statistiese verskille in gemiddelde fetale hartspoed en basislynvariasie in verhouding tot die tyd na toediening van misoprostol gevind nie. Daar was geen statisties betekenisvolle verskille in die verspreiding van versnellings en verstadigings in verskillende tydsintervalle nie. Daar was meer reaktiewe patrone gedurende alle tydsintervalle na die toediening van misoprostol, maar hierdie verskille was nie statisties betekenisvol nie. In beide studiegroepe was daar geen neonatale komplikasies of intensiewe sorg toelatings nie. Gevolgtrekking In die afwesigheid van kontra-indikasies kan 50 mcg misoprostol aan moeders toegedien word vir induksie van kraam aangesien geen skadelike fetale hartsped abnormaliteite gevind is nie. Groot prospektiewe gerandomiseerde gekontroleerde studies word steeds benodig om effektiwiteit te bevestig en om moederlike en fetale veiligheidskwessies verder te evalueer. Optimale dosis en frekwensie benodig ook robuuste ondersoek. Gebaseer op hierdie tesis kom dit voor of misoprostol waarskynlik nie skadelik vir die fetus onder hierdie omstandighede nie.

Bakgrund: En normal graviditet räknas från det att befruktningen skett tills barnet föds, upp till graviditetsvecka 40. Risker för fetala komplikationer ökar när graviditeten fortskrider efter 40 fullgångna graviditetsveckor. Förekomsten av inducerade förlossningar har ökat under de senaste decennierna både i Sverige och resten av världen. Enligt de nya nationella riktlinjerna i Sverige bör kvinnan vara i värkarbete, eller ha fött sitt barn innan graviditetsvecka 42+0. Målet med induktion är att minimera riskerna och sträva efter barnets och moderns hälsofrämjande. Syfte: Syftet var att undersöka hur induktion av förlossning i graviditetsvecka 41 påverkar maternella medicinska förlossningsutfall. Metod: En litteraturöversikt med ett systematiskt tillvägagångssätt genomfördes. Databassökning skedde i databaserna PubMed och CINAHL, vilket genererade 15 kvantitativa artiklar till studiens resultat. Resultat: Studiens huvudfynd sammanfattades med tre huvudkategorier. Den första kategorin var: Induktionens påverkan på akut kejsarsnitt. Den andra kategorin: Induktions påverkan på operativa förlossningar. Den tredje kategorin var: Induktionens påverkan på övriga maternella medicinska komplikationer. Slutsats: Studien fann motstridiga fynd gällande hur induktion under prolongerad graviditet påverkade maternella medicinska förlossningsutfall. Resultaten gällande hur induktion påverkade andelen av akuta kejsarsnitt samt operativa förlossningar var inte entydiga. Påverkan på övriga maternella medicinska komplikationer visade inte någon statistisk signifikant skillnad. / Background: A normal pregnancy is counted from the time fertilization took place until the child is born, up to week 40 of pregnancy. Risks for fetal complications increase as the pregnancy progresses after 40 weeks. The labor inductions have increased in recent decades both in Sweden and the rest of the world. According to the new national guidelines in Sweden, the woman should be in labor, or have given birth to her child before pregnancy week 42+0. The goal of induction is to minimize the risks and strive to promote the health of the child and the mother. Aim: to evaluate how induction of labor at 41 weeks affects maternal medical delivery outcomes. Method: A general literature review with a systematic approach was performed. The data was collected via the databases PubMed and CINAHL. 15 articles with quantitative method were included in the study. Result: The main findings of the study were summarized in three main categories: 1. The impact of induction on emergency caesarean section; 2. The impact of induction on operative deliveries; 3. The impact of the induction on other maternal medical complications. Conclusion: The study found inconsistent findings regarding how induction during prolonged pregnancy affected maternal medical delivery outcomes. The results regarding how induction affected the proportion of emergency cesarean sections and operative deliveries were not clear-cut. The impact on other maternal medical complications did not show any statistically significant difference.

Objetivo: Correlacionar as variáveis ultrassonográficas do colo uterino ao sucesso da indução do parto e ao Índice de Bishop. Métodos: Estudo observacional prospectivo envolvendo 190 gestantes candidatas à indução do parto, que foram submetidas à ultrassonografia transvaginal para avaliação do comprimento do colo uterino, da distância da apresentação fetal ao OCE, dilatação cervical e identificação da imagem em funil no OCI, no período de fevereiro de 2008 a fevereiro de 2010. As pacientes foram categorizadas segundo o escore de Bishop em favoráveis e desfavoráveis à IP. Os seguintes desfechos foram analisados: probabilidade de sucesso da IP, parto vaginal em 24 horas e presença de fase ativa do parto. A análise estatística foi realizada usando testes qui-quadrado, teste t-Student e Mann- Whitney para as variáveis numèricas, além do cálculo das curvas ROCs para cada variável e cada desfecho. Através de regressão logística foram avaliados os preditores dos desfechos assim como determinadas equações de probabilidade dos eventos. Resultados: O sucesso da IP, o parto vaginal em 24 horas e a presença de fase ativa do parto foram observados em 133 (70%) 119 (62%) e 155 (82%) das gestantes, respectivamente. O comprimento do colo uterino, a distância da apresentação fetal ao OCE, a dilatação cervical e a presença da imagem em funil no OCI influenciaram o sucesso da IP, a presença de parto vaginal em 24 horas e a presença de fase ativa do parto, principalmente em gestantes com escore de Bishop desfavorável à IP. As variáveis ultrassonográficas apresentaram sensibilidade entre 63 e 71% e especificidade entre 63 e 82% e acurácia média de 70%. O escore de Bishop se correlacionou diretamente à dilatação cervical e inversamente ao comprimento do colo uterino e à distância da apresentação fetal ao OCE e foi preditor independente de todos os desfechos da indução do parto (p<0,001). Conclusão: O comprimento do colo uterino, a distância da apresentação fetal ao OCE, a dilatação cervical e presença da imagem em funil no OCI se relacionaram ao sucesso da IP, porém com baixo poder de predição / Objective: To correlate the ultrasonographic variables of cervix to the success on labor induction (LI) and Bishops Index. Methods: A prospective, observational study involving 190 pregnant women that were applicant for labor induction, submitted to transvaginal ultrasound to evaluate the cervixs length, fetal head-external os distance, cervical dilatation and identification of funnel image on internal os, during the period between February 2008 and February 2010. Patients were classified according to Bishops score as favorable and unfavorable to labor induction. The following conclusions were studied: success probability to LI, vaginal delivery in 24 hours and presence of labors active phase. Statistical analysis was performed using chi-square tests, t-Student and Mann-Whitney test for numerical variables, in addition to ROCs curves calculation for each variable and each conclusion. By logistic regression, the conclusion predictors were evaluated, as well as some determined equations from events probability. Results: The labor induction success, vaginal delivery in 24 hours, and presence of labors active phase were noticed on 133 (70%), 119 (62%) and 155 (82%) pregnant women, respectively. Cervixs length, fetal head-external os distance, cervical dilatation and identification of funnel image on internal os influenced the LI success, vaginal delivery at 24 hours and presence of labors active phase, especially on pregnant with Bishops score unfavorable to labor induction. Ultrasonographic variables had sensitivity between 63 and 71%, specificity between 63 and 82%, and 70% of average accuracy. Bishops score was directly correlated to cervical dilatation and inversely correlated to cervixs length and fetal head-external os distance and was a independent predictor to all conclusions of labor induction (p<0.001). Conclusion: The cervixs length, fetal head-external os distance, cervical dilatation and identification of funnel image were related to LI success but with low prediction potency

Objetivo: Correlacionar as variáveis ultrassonográficas do colo uterino ao sucesso da indução do parto e ao Índice de Bishop. Métodos: Estudo observacional prospectivo envolvendo 190 gestantes candidatas à indução do parto, que foram submetidas à ultrassonografia transvaginal para avaliação do comprimento do colo uterino, da distância da apresentação fetal ao OCE, dilatação cervical e identificação da imagem em funil no OCI, no período de fevereiro de 2008 a fevereiro de 2010. As pacientes foram categorizadas segundo o escore de Bishop em favoráveis e desfavoráveis à IP. Os seguintes desfechos foram analisados: probabilidade de sucesso da IP, parto vaginal em 24 horas e presença de fase ativa do parto. A análise estatística foi realizada usando testes qui-quadrado, teste t-Student e Mann- Whitney para as variáveis numèricas, além do cálculo das curvas ROCs para cada variável e cada desfecho. Através de regressão logística foram avaliados os preditores dos desfechos assim como determinadas equações de probabilidade dos eventos. Resultados: O sucesso da IP, o parto vaginal em 24 horas e a presença de fase ativa do parto foram observados em 133 (70%) 119 (62%) e 155 (82%) das gestantes, respectivamente. O comprimento do colo uterino, a distância da apresentação fetal ao OCE, a dilatação cervical e a presença da imagem em funil no OCI influenciaram o sucesso da IP, a presença de parto vaginal em 24 horas e a presença de fase ativa do parto, principalmente em gestantes com escore de Bishop desfavorável à IP. As variáveis ultrassonográficas apresentaram sensibilidade entre 63 e 71% e especificidade entre 63 e 82% e acurácia média de 70%. O escore de Bishop se correlacionou diretamente à dilatação cervical e inversamente ao comprimento do colo uterino e à distância da apresentação fetal ao OCE e foi preditor independente de todos os desfechos da indução do parto (p<0,001). Conclusão: O comprimento do colo uterino, a distância da apresentação fetal ao OCE, a dilatação cervical e presença da imagem em funil no OCI se relacionaram ao sucesso da IP, porém com baixo poder de predição / Objective: To correlate the ultrasonographic variables of cervix to the success on labor induction (LI) and Bishops Index. Methods: A prospective, observational study involving 190 pregnant women that were applicant for labor induction, submitted to transvaginal ultrasound to evaluate the cervixs length, fetal head-external os distance, cervical dilatation and identification of funnel image on internal os, during the period between February 2008 and February 2010. Patients were classified according to Bishops score as favorable and unfavorable to labor induction. The following conclusions were studied: success probability to LI, vaginal delivery in 24 hours and presence of labors active phase. Statistical analysis was performed using chi-square tests, t-Student and Mann-Whitney test for numerical variables, in addition to ROCs curves calculation for each variable and each conclusion. By logistic regression, the conclusion predictors were evaluated, as well as some determined equations from events probability. Results: The labor induction success, vaginal delivery in 24 hours, and presence of labors active phase were noticed on 133 (70%), 119 (62%) and 155 (82%) pregnant women, respectively. Cervixs length, fetal head-external os distance, cervical dilatation and identification of funnel image on internal os influenced the LI success, vaginal delivery at 24 hours and presence of labors active phase, especially on pregnant with Bishops score unfavorable to labor induction. Ultrasonographic variables had sensitivity between 63 and 71%, specificity between 63 and 82%, and 70% of average accuracy. Bishops score was directly correlated to cervical dilatation and inversely correlated to cervixs length and fetal head-external os distance and was a independent predictor to all conclusions of labor induction (p<0.001). Conclusion: The cervixs length, fetal head-external os distance, cervical dilatation and identification of funnel image were related to LI success but with low prediction potency

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Objetivos: comparar a mensuraÃÃo ultra-sonogrÃfica transvaginal do colo uterino e o Ãndice de Bishop, na prediÃÃo do parto vaginal apÃs induÃÃo do trabalho de parto com misoprostol 25mcg, assim como, determinar os principais fatores relacionados à evoluÃÃo para parto vaginal. Sujeitos e MÃtodos: realizou-se estudo de validaÃÃo de tÃcnica diagnÃstica na Maternidade-Escola Assis Chateaubriand da Universidade Federal do CearÃ, com 126 gestantes com indicaÃÃo para induÃÃo do trabalho de parto que foram avaliadas pelo Ãndice de Bishop e ultra-sonografia transvaginal para mensuraÃÃo cervical. As pacientes foram submetidas à ultra-sonografia obstÃtrica transabdominal, para avaliaÃÃo da estÃtica e peso fetais e Ãndice de lÃquido amniÃtico, e à cardiotocografia basal para avaliaÃÃo da vitalidade fetal. Procedeu-se à induÃÃo do trabalho de parto com misoprostol vaginal e sublingual, um dos comprimidos contendo 25mcg da droga e o outro apenas placebo. Os comprimidos foram administrados a cada seis horas, em um numero mÃximo de oito. A anÃlise estatÃstica foi realizada com o programa SPSS 10.0 (SPSS Co, Chicago, IL, USA), utilizando-se distribuiÃÃo de frequÃncias, mÃdias, desvios-padrÃo e medianas; assim como, anÃlise univariada e construÃÃo de curvas ROC, correlacionando Ãndice de Bishop e parto vaginal, e medida ultra-sonogrÃfica do colo uterino e parto vaginal. Em anÃlise multivariada foram pesquisadas outras variÃveis relacionadas ao parto vaginal. Resultados: atravÃs de curva ROC correlacionando a mensuraÃÃo do colo uterino por ultra-sonografia transvaginal e a evoluÃÃo para o parto vaginal, evidenciou-se uma Ãrea sob a curva de 0,513 com p=0,801. Outra curva ROC, analisando a relaÃÃo da avaliaÃÃo cervical pelo Ãndice de Bishop com o parto vaginal, demonstrou Ãrea sob a curva de 0,617 com p=0,025. AtravÃs de anÃlise de regressÃo logÃstica mÃltipla, evidenciou-se paridade &#8805; 1, escore de Bishop &#8805; 4 e presenÃa de lÃquido amniÃtico claro como associados à evoluÃÃo para o parto vaginal. ConclusÃes: a medida ultra-sonogrÃfica transvaginal do colo uterino nÃo foi boa preditora da evoluÃÃo para parto vaginal em pacientes com trabalho de parto induzido com misoprostol. O Ãndice de Bishop foi melhor preditor para parto vaginal nestas circunstÃncias. Os fatores preditivos mais importantes para parto vaginal, apÃs induÃÃo com misoprostol, foram paridade &#8805; 1, Ãndice de Bishop &#8805; 4 e presenÃa de lÃquido amniÃtico claro