Feminist and social historians have long been interested in that particularly female ability to become pregnant and bear children. A significant body of historiography has challenged the notion that pregnancy and childbirth considered to be the acceptable and 'appropriate' roles for women for most of the twentieth century in Australia - have always been welcomed, rewarding and always fulfilling events in women's lives. Several historians have also begun the process of enlarging our knowledge of the changing cultural attitudes towards bereavement in Australia and the eschewing of the public expression of sorrow following the two World Wars; a significant contribution to scholarship which underscores the changing attitudes towards perinatal loss. It is estimated that one in four women lose a pregnancy to miscarriage, and two in one hundred late pregnancies result in stillbirth in contemporary Australia. Miscarriage, stillbirth and neonatal death are today considered by psychologists and social workers, amongst others, as potentially significant events in many women's lives, yet have received little or passing attention in historical scholarship concerned with pregnancy and motherhood. As such, this study focuses on pregnancy loss: the meaning it has been given by various groups at different times in Australia's past, and how some Australian women have made sense of their own experience of miscarriage, stillbirth or neonatal death within particular social and historical contexts. Pregnancy loss has been understood in a range of ways by different groups over the past 100 years. At the beginning of the twentieth century, when alarm was mounting over the declining birth rate, pregnancy loss was termed 'foetal wastage' by eugenicists and medical practitioners, and was seen in abstract terms as the loss of necessary future Australian citizens. By the 1970s, however, with the advent of support groups such as SANDS (Stillbirth and Neonatal Death Support) miscarriage and stillbirth were increasingly seen as the devastating loss of an individual baby, while the mother was seen as someone in need of emotional and other support. With the advent of new prenatal screening technologies in the late twentieth century, there has been a return of the idea of maternal responsibility for producing a 'successful' outcome. This project seeks to critically examines the wide range of socially constructed meanings of pregnancy loss and interrogate the arguments of those groups, such as the medical profession, religious and support groups, participating in these constructions. It will build on existing histories of motherhood, childbirth and pregnancy in Australia and, therefore, also the history of Australian women.

Hypothyroidism is a common endocrine disorder affecting women of reproductive age. On a global level, iodine deficiency is still the most common cause of hypothyroidism. Also genetic variations, in particular SNP rs4704397 in the PDE8B gene, are responsible for a significant proportion of TSH variations.  Untreated hypothyroidism has significant adverse effects on pregnancy and fetal outcome. Most international guidelines suggest targeted thyroid testing in pregnant women with risk factors for thyroid disturbances. In a case-control study, an association between homozygous A/A as well as homozygous G/G carriers of SNP rs 4704397 in PDE8B and recurrent miscarriage was found. The explanation for this association is unknown. In a nationwide survey, all guidelines for thyroid testing and management of hypothyroidism during pregnancy in Sweden were collected and compared with international guidelines. The local guidelines were variable and poorly compliant with the international guidelines. In a follow-up in one district, 5,254 pregnant women were included for subsequent review of their medical reports. We found a targeted thyroid testing rate of 20.1% in clinical practice, with an overall frequency of women with trimester-specific elevated TSH of 18.5%. More disturbingly, half of the women who were on levothyroxine treatment at the time of conception had an elevated TSH level at thyroid testing. In a subsequent cohort study of the 5,254 women, we found the prevalence of trimester-specific elevated TSH and overt hypothyroidism to be equal in targeted thyroid tested and untested women. In a cross-sectional study, a median urinary iodine concentration (UIC) of 98 μg/l was found in the study population. According to WHO/UNICEF/IGN criteria, the population-based median UIC during pregnancy should be 150-249 μg/l. In conclusion, genetic variations may contribute to adverse pregnancy outcomes. In clinical practice, thyroid testing and the management of hypothyroidism during pregnancy is unsatisfactory, regarding the whole chain from development of local guidelines to their implementation and to targeted thyroid testing. Moreover, our results indicate insufficient iodine status in the pregnant population of Sweden.

Introdução: A importância dos níveis pré-concepcionais de hormônio estimulante da tireoide (TSH) em pacientes inférteis submetidas à estimulação ovariana controlada (EOC) para técnicas de reprodução assistida (TRA) permanece controversa. O hipotireoidismo subclínico pode aumentar a morbidade obstétrica e neonatal. Ainda não existe consenso entre endocrinologistas e ginecologistas em relação ao rastreio de doença tireoidiana por meio da medida do TSH em pacientes inférteis, nem em relação aos valores de corte para o TSH no hipotireoidismo subclínico (se devem ser <2,5mIU/L ou <4,0/4,5mIU/L). Avaliar o potencial impacto das diferentes concentrações de TSH nos resultados reprodutivos de pacientes submetidas à EOC para tratamentos com TRA é um importante passo para se estabelecerem políticas de rastreio e abordagens terapêuticas adequadas. Objetivo: Comparar resultados reprodutivos de pacientes submetidas à EOC para fertilização in vitro (FIV)/injeção intracitoplasmática de espermatozoide (ICSI), de acordo com as diferentes concentrações de TSH (<2,5 mIU/L; 2,5 a 4,0 mIU/L; >4,0 e <10,0 mIU/L; pacientes em uso de levotiroxina, independente dos níveis de TSH). Pacientes e Métodos: Foi realizado um estudo de coorte retrospectiva avaliando mulheres submetidas à FIV/ICSI no Laboratório de Ginecologia e Obstetrícia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, no período de janeiro de 2011 a dezembro de 2012, que apresentavam concentração sérica de TSH descrita em prontuário médico. Foi considerado hipotireoidismo subclínico quando as concentrações de TSH eram de 4,0 mIU/L e <10,0 mIU/L em pacientes assintomáticas, que foram separadas em quatro grupos (TSH <2,5mIU/L; TSH 2.5 e <4,0mIU/L; 4mIU/L e <10mIU/L; em uso levotiroxina). Os desfechos primários avaliados foram: taxa de gestação clínica, de nascidos vivos, de gravidez múltipla e de abortamento. Os desfechos secundários analisados foram: dose total de FSH utilizada e duração da EOC, número de oócitos captados e número de oócitos maduros. Resultados: Das 787 pacientes que realizaram ciclos de FIV/ICSI no período do estudo, 727 foram incluídas na análise. A prevalência de hipotireoidismo subclínico encontrada foi de 15,13%. Sessenta pacientes foram excluídas, pois não havia registro de concentrações de TSH em seus prontuários. Não houve diferença estatisticamente significativa em relação às taxas de gravidez de clínica, nascidos vivos, gestação múltipla e abortamento, entre os grupos estudados. Também não foi detectada diferença significativa na resposta à EOC nos grupos avaliados. Conclusão: A taxa de nascido vivo e de abortamento e a resposta à EOC das mulheres com hipotireoidismo subclínico após FIV/ICSI não foram prejudicadas. Estes achados reforçam as incertezas relacionadas ao impacto das concentrações de TSH nos resultados reprodutivos de mulheres submetidas à EOC para TRA, principalmente em pacientes com concentrações de TSH entre 2,5 e 4,0 mIU/L, e tabém a ausência de dados confiáveis que justifiquem diminuir o limite do TSH para 2,5 mIU/L para a definição de hipotireoidismo subclínico. / Background: The relevance of preconception TSH (thyroid-stimulating hormone) serum concentration in infertile patients undergoing controlled ovarian stimulation (COS) for assisted reproductive techniques (ART) treatments remains controversial. Subclinical hypothyroidism may increase pregnancy e neonatal morbidity. There is no consensus among endocrinologists and gynecologists regarding screening of thyroid disease neither by measurement of TSH in infertile patients nor about the cut-off values for TSH in subclinical hypothyroidism (whether <2.5mIU/L or <4.0/4.5mIU/L). Evaluating the potential impact of different TSH concentrations in reproductive outcomes of patients undergoing COS for assisted reproductive techniques is an important step to establish screening policies and adequate therapeutic approaches. The aim of this study is to compare reproductive outcomes of patients undergoing COS for in vitro fertilization (IVF)/ICSI according to TSH serum concentrations (<2.5 mIU/L, 2.5 to 4.0 mIU/L, and >4.0 e <10mIU/L and those patients using levothyroxine irrespective TSH concentrations. Patients and Methods: Retrospective cohort study evaluating all women who underwent in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) between January 2011 and December 2012 and who had TSH sérum concentration described at medical records. Subclinical hypothyroidism was considered when TSH concentrations 4,0mIU/L and <10.0 mIU/L in asymptomatic patients, but the patients were separated between 4 groups (TSH <2.5mIU/L; TSH 2.5 and <4.0mIU/L; 4m e <10IU/L; patients using levothyroxine irrespective TSH concentrations. The primary endpoints assessed were clinical pregnancy, miscarriage, live birth and multiple pregnancy. Secondary endpoints evaluated were total dose of FSH (follicle-stimulating hormone) and duration of COS, number of retrieved oocytes and number of mature oocytes. Results: 787 women underwent IVF/ICSI in within the period of the study. Sixty of these women were excluded because they didn´t had TSH concentrations available in medical records. The prevalence of hypothyroidism, in the present study was 15.13%. No significant difference was observed between the four groups according to clinical pregnancy, miscarriage, live birth and multiple pregnancy rates. There were no differences between the four groups in regard to the response to COS. Conclusion: The live birth rate, miscarriage rate, and response to COS of women with subclinical hypothyroidism following IVF/ICSI were not impaired. These findings reinforce the uncertainties related to the impact of TSH concentrations on reproductive outcomes of women undergoing COS for ART, mainly in patients with TSH ranging from 2.5-4.0 mIU/L, and the absence of reliable data that justify changing the threshold for the definition of subclinical hypothyroidism for 2,5 mIU/L in this population.

Le véritable enseignement de la présente étude réside en ce que, comme déjà évoqué, le poids de l’appareil judiciaire finit par acquérir plus de consistance que le crime lui-même. A « l’aventure criminelle », c’est-à-dire celle, tragique, des faits à réprimer, se substitue « l’aventure judiciaire », celle de la marche de la justice en vue de parvenir au jugement des faits. Qu’il s’agisse du procès pénal français ou anglo-saxon, l’étude démontre que les règles applicables sont d’une telle complexité qu’elles génèrent une logique judiciaire spécifique et presque détachée des faits à traiter. Les praticiens sont souvent surpris du contraste entre les faits à juger, dont les mobiles et les circonstances sont toujours simples, et la solution judiciaire plus et/ou trop élaborée.L’étude démontre encore le caractère immuable et presque immobile de la justice pénale. Qu’il s’agisse de la France ou des pays anglo-saxons, les fondamentaux des deux systèmes judiciaires en concurrence –procédure inquisitoire ou procédure accusatoire- sont les mêmes depuis le Moyen Âge. Certes, des réformes interviennent, le poids du contradictoire s’accroit, les procédures de recours sont organisées, etc. Mais il s’agit toujours en France de faire faire une enquête approfondie avant procès par un organe d’état et, dans les pays anglo-saxons, de voir s’affronter deux thèses avec un avantage pratique à l’accusation.C’est que, comme le démontre aussi l’étude, la philosophie sociale de chacun des deux mondes français et anglo-saxon est différente sur le statut du suspect : objet d’une recherche de la vérité en France et presque coupable chez les Anglo-Saxons.Cette philosophie sociale en recoupe une autre : la philosophie politique. En France, l’individu est assisté car l’Etat est plus grand que lui ; dans les pays anglo-saxons, l’individu est un homme libre et seul responsable de son destin. Dès lors, en France, l’Etat veut forger sa propre opinion sur des faits délictueux ; dans les pays anglo-saxons, l’affrontement des individus (parquetiers et défenseurs) prime le reste. De plus, dans ces pays, la liberté et l’indépendance reconnues à l’individu le rendent davantage responsable de ses faits et gestes, d’où l’importance démesurée accordée à l’aveu. Pour autant, cette philosophie politique d’un citoyen libre et fort est un extraordinaire levier pour l’Histoire de la Liberté et celle aussi de l’Expansion économique. Sans elle, les pays européens du continent n’auraient sans doute pas pu se soustraire à la botte de conquérants. Sans elle, les Etats-Unis ne seraient pas une locomotive du développement.Il ne faudrait pas croire non plus que le monde anglo-saxon n’a fait que peu d’apports positifs au procès pénal. C’est à la loi britannique sur l’Habeas corpus de 1679 que l’on doit l’idée d’un délai raisonnable pour être jugé et, à défaut, le droit à être remis en liberté. C’est encore aux Britanniques que l’on doit l’idée de droits de la défense recensés en tant que tels, d’abord dans certains articles de la Magna Carta de 1212 puis dans le Bill of Rights de 1689. C’est aux Américains que l’on doit l’idée de sacraliser les droits de la défense en leur donnant un contenu constitutionnel par les amendements à la Constitution de 1787, ajoutés à partir de 1789, une idée qui sera reprise bien plus tard dans la Convention Européenne des Droits de l’Homme et des libertés fondamentales.L’étude montre donc que les pays anglo-saxons réputés pragmatiques ont plutôt fait des contributions de principe, sans mesurer que les applications pratiques qu’ils en tirent dénaturent le procès pénal. L’étude montre aussi que la France, réputée pour ses approches dogmatiques et rationnelles mais d’une raison déconnectée des réalités, a une vision bien plus juste du procès pénal.L’étude a enfin montré que, dans le domaine de la justice pénale, les mondes français et anglo-saxons s’ignorent. / This study shows that the criminal process finally acquires more consistency than the crime itself. The “criminal adventure”, namely the tragical story of the crime itself, turns into “the judicial adventure”, namely the path of justice towards the final decision (conviction or dismissal). Whether it deals with the French or with the Anglo-Saxon models, the legal rules are so complicated that they create a judicial logic which is specific and clipped from the facts of the case. In comparison, the motives and the circumstances of a crime are always simple. Accordingly, the judicial issue appears to be more (and often too much) elaborated than the crime itself.The study also shows the unchanging character of the criminal justice. Whether it is in France or in the Anglo-Saxon countries, the fundamentals of the two justices which are concurrent – inquisitorial model and adversary one- are the same that in the Middle Age. Of course, some reforms happened. The importance of the rule of the contradictory increases, etc. However, the main concern of the French justice still deals with a pretrial investigation which is very thoroughly conducted by a state agency. The Anglo-Saxon model always lies in the confrontation of two thesis with a practical advantage given to the prosecution. These different approaches by the two justices are attributable to a different social philosophy. The status of the suspected person greatly differs whether he is prosecuted in France or in the Anglo-Saxon countries: in France, this status is a matter of the search for the truth; in the Anglo-Saxon countries, this status is in practice that of an almost guilty one, even if his guilt must be proved beyond a reasonable doubt.This social and/or ethic philosophy recuts another one: the political philosophy. In France, the individual is assisted since the State is deemed to be “stronger” than him; in the Anglo-Saxon countries, the individual is a free man; accordingly, he is solely responsible for his acts. Therefore, in France, the State wants to fix up its own opinion about the crime; in the Anglo-Saxon countries, the confrontation of the prosecution and the lawyer outdoes all the rest, in particular the truth. Moreover, in these countries, according to the freedom and the independence of the individual, an undue importance is given to confessions.However, the Anglo-Saxon political philosophy is an extraordinary lever for the history and the liberty and also for the economic expansion. Without it, the continental countries would not have been able to be freed from the conquerors of the two world wars and the cold war. Without it, the US would not be a forefront of the progress.We do not consider that the Anglo-Saxon world made few positive contributions to the criminal proceedings. Indeed, this is the famous English Habeas Corpus Act of 1679 which created the idea of a reasonable time to be tried in court and, if not, to be released from prison. From the English comes the idea of an explicit list of rights of the defence, in particular in some articles in the Magna Carta of 1212 and then officially included in the Bill of Rights of 1689. From the Americans comes the idea of making the rights of defence sacred through the amendments of the constitution. We remember that this idea arrived late in Europe with the ECHR.Therefore, the study shows that the Anglo-Saxons countries which benefit from a reputation of pragmatism have rather acted as theoreticians of criminal law. They have provided the world of criminal justice mainly with contributions close to symbols. They have underestimated the consequences of these symbols in the practice of the criminal proceedings. The study shows also that the French, who are often known for their dogmatic approach of problems, have a better understanding of the criminal proceedings.The study shows especially that the Anglo-Saxon world of criminal justice and the French one totally ignore each other.

Bereavement of a miscarriage is complex because of factors that are unique to this loss. There is no visible child to mourn for, no memories or shared life experiences. The death is sudden and there usually a lack of recognition of the significance of such a loss by society. In addition, women who miscarry are often in need of the absent social and emotional support that is provided with other types of bereavement. The suppression of appropriate mourning due to society’s inhibitions may cause further stress and long-term emotional consequences. Prenatal loss is unique in the sense that the parents do not know the object of loss as it would be with the death of a loved one who has been part of their lives and social structure. The anticipated child is both a fantasy child and an internal entity within a woman’s body. The loss of a baby is also the loss of part of a women’s self. The researcher is of the opinion that a miscarriage is a traumatic experience which, if not thoroughly dealt with, can cause great damage to a sufferer’s life. According to her, projective techniques in the form of play therapy can encourage women to talk about their miscarriage in order to deal with suppressed emotions. The purpose of this research was to determine to what extent projective techniques could be used in respect of a mother’s emotional experience of a miscarriage. For this study the qualitative research approach was used. The participants were selected by making use of purposive sampling as a form of non-probability sampling. During the empiric research two respondents attended eight in-depth interviewes with a therapeutic component. The first interview comprised a semi-structured interview schedule. Six interviews followed where projective play therapeutic techniques were used. The empirical data was obtained from the interview schedule and the researcher was the primer instrument of gathering information. The value of meaning that the participants attached to the subject was of great importance. The empirical data showed that the two participants were better enabled to deal with their miscarriages after the interviews. Thus, regarding the experience of the two paricipants, it was possible to answer the research question positively. It seems as if projective techniques can indeed be used in respect of a mother’s emotional experience of a miscarriage. / Dissertation (MA (Play Therapy))--University of Pretoria, 2005. / Social Work / unrestricted

Rift Valley fever virus (RVFV) is a mosquito-borne virus which has the ability to infect a large variety of animals including humans in Africa and Arabian Peninsula. The abortion rate among these animals are close to 100%, and young animals develop severe disease which often are lethal. In humans, Rift Valley fever (RVF) presents in most cases as a mild illness with influenza-like symptoms. However, in about 8% of the cases it progresses into a more severe disease with a high case fatality rate. Since there is such a high abortion rate among infected animals, a link between human miscarriage and RVFV has been suggested, but never proven. We could in paper I for the first time show an association between acute RVFV infection and miscarriage in humans. We observed an increase in pregnant women arriving at the Port Sudan Hospital with fever of unknown origin, and several of the patients experienced miscarriage. When we analysed their blood samples for several viral diseases we found that many had an acute RVFV infection and of these, 54% experienced a miscarriage. The odds of having a miscarriage was 7 times higher for RVFV patients compared to the RVFV negative women of which only 12% miscarried. These results indicated that RVFV infection could be a contributing factor to miscarriage. RVFV is an enveloped virus containing the viral glycoproteins n and c (Gn and Gc respectively), where Gn most likely is responsible for the initial cellular contact. The protein DC-SIGN on dendritic cells and the glycosaminoglycan heparan sulfate has been suggested as cellular receptors for RVFV, however other mechanisms are probably also involved in binding and entry. Charge is a driving force for molecular interaction and has been shown to be important for cellular attachment of several viruses, and in paper II we could show that when the charge around the cells was altered, the infection was affected. We also showed that Gn most likely has a positive charge at a physiological pH. When we added negatively charged molecules to the viral particles before infection, we observed a decreased infection efficiency, which we also observed after removal of carbohydrate structures from the cell surface. Our results suggested that the cellular interaction partner for initial attachment is a negatively charged carbohydrate. Further investigations into the mechanisms of RVFV cellular interactions has to be undertaken in order to understand, and ultimately prevent, infection and disease. There is currently no vaccine approved for human use and no specific treatments for RVF, so there is a great need for developing safe effective drugs targeting this virus. We designed a whole-cell based high-throughput screen (HTS) assay which we used to screen libraries of small molecular compounds for anti-RVFV properties. After dose-response and toxicity analysis of the initial hits, we identified six safe and effective inhibitors of RVFV infection that with further testing could become drug candidates for treatment of RVF. This study demonstrated the application of HTS using a whole-cell virus replication reporter gene assay as an effective method to identify novel compounds with potential antiviral activity against RVFV.

MCur / Department of Advanced Nursing Science / See the attached abstract below

The thesis deals with possible ways of coping with the consequences of miscarriage. The theoretical part first defines the topic of pregnancy from a medical and psychological point of view. It also includes the definition of miscarriage types. Furthermore, an overview of the experience of the child's loss in the early stages of pregnancy is elaborated, impacts on the psyche of the woman and manifestations in her behavior are considered. The process of grieving by individual authors is considered in the context of the early loss of the child. The issue of termination of pregnancy is also seen from the perspective of trauma theory. Possible protective and risk factors accompanying the loss-making process are discussed. Last but not least, the following professional psychological, medical and lay care for a woman after the loss of a child is mentioned. The empirical part of the thesis deals with the affection of the whole phenomenon of child loss during the early stages of pregnancy. Emphasis is placed on the mapping of protective and risk factors with which women had their own experience. The empirical part is based mainly on interviews with women with experience of loss of a child and with professionals who work in this field. Data evaluation was based on grounded theory principles. Keywords:...

In addition to fetal alcohol syndrome and fetal alcohol spectrum disorders, prenatal alcohol exposure is associated with many other adverse pregnancy and birth outcomes. Research suggests that alcohol use during pregnancy may increase the risk of miscarriage, stillbirth, preterm delivery, and sudden infant death syndrome. This research has some inherent difficulties, such as the collection of accurate information about alcohol consumption during pregnancy and controlling for comorbid exposures and conditions. Consequently, attributing poor birth outcomes to prenatal alcohol exposure is a complicated and ongoing task, requiring continued attention to validated methodology and to identifying specific biological mechanisms.

Bakgrund: En graviditet ses hos många kvinnor som något positivt och för med sig mycket glädje, men en graviditet innebär också en risk för missfall. Omkring 20–30 procent av alla gravida kvinnor kan komma att drabbas. Ett missfall kan göra kvinnor extra sårbara och utsatta. Det är betydelsefullt att undersöka kvinnors upplevelser vid missfall för att få ökad förståelse och kunskap om hur missfall kan upplevas.  Syfte: Syftet var att beskriva kvinnors upplevelser vid missfall.  Metod: En litteraturöversikt har använts som metod för arbetet. Tio vetenskapliga originalartiklar med kvalitativ metod har analyserats utifrån Fribergs analysmodell. Litteraturöversikten utgick från kvinnor som haft missfall innan graviditetsvecka 22. Resultat: Resultatet innehåller tre huvudteman: Kvinnors emotionella smärta, Stöd från familj och vänner, Omvårdnad vid missfall samt två underteman: Missfall - ett stigma, och Känslig omvårdnad. Slutsats: Slutsatsen i denna litteraturöversikt var att kvinnor upplever en emotionell smärta med känslor av sorg, tomhet och hjälplöshet, och ett stöd från familj, vänner och andra kvinnor som genomgått missfall är viktigt för att de ska kunna bearbeta sitt missfall. Kvinnor beskrev att omvårdnaden var avgörande i hur de upplevde sitt missfall, och en känslig omvårdnad där vårdpersonalen visar empati och förståelse för kvinnan är väsentligt för hennes välmående vid ett missfall. / Background: A pregnancy is seen by many women as something positive and brings a lot of joy, but a pregnancy also entails a risk of miscarriage. Around 20-30 percent of all pregnant women may be affected. A miscarriage can make women extra vulnerable and exposed. It is important to investigate women's experiences of miscarriage in order to gain increased understanding and knowledge of how miscarriage can be experienced.  Aim: The aim was to describe women’s experiences of miscarriage. Method: A literature review has been used as a method for this work. Ten original scientific articles using a qualitative method have been analyzed based on Friberg’s model of analysis. The literature study was based on women who had miscarried before 22 weeks of pregnancy.  Results: The result contains three main themes: Women's emotional pain, Support from family and friends, Nursing care in case of miscarriage, and two sub-themes: Miscarriage - a stigma, and Sensitive care.  Summary: The conclusion of this literature review was that women experience an emotional pain with feelings of sadness, emptiness and helplessness, and support from family, friends and other women who have experienced a miscarriage is important for them to be able to process their miscarriage. Women described that the care was decisive in how they experienced their miscarriage, and sensitive care where the care staff shows empathy and understanding for the woman is essential for her well-being in the event of a miscarriage.