Maternal smoking causes serious health danger for a mother but especially for a baby. Cigarette smoking produces complex steroidogenesis changes during the whole life of a woman. To study the influence of smoking on fetoplacental unit focusing on steroid hormons it was important first to concentrate on changes of the chosen steroids around the delivery. The first part of the thesis is dedicated to observe some chosen steroid hormons in peripartal period (37th week of the pregnancy, first stage of labor of mothers and mixed umbilical blood of their neonates) and to look for relations to the age of mother, the increase of the weight during the pregnancy, the type of the delivery and the sex of the baby. It was interesting to compare steroids in the relation to the type of the delivery: vaginal delivery versus planned caesarean section. Non-smoking women who delivered a boy spontaneously had significantly higher level of 17-OH-pregnenolone, progesterone, cortisol, corticosterone and significantly lower level of estradiol in comparison with non-smoking women who delivered a boy by a planned Caesarean section. In the maternal blood in the 37th week of the pregnancy there were found differences between steroids in accordance to the sex of the fetus but they were not found in the neonates' case. The age...

Mothers around the world experience preventable medical complications during labor and delivery that can lead to maternal and newborn mortality. In addition, some expectant mothers can experience abuse, neglect, and discrimination from attending midwives. This lack of quality care has more connection to maternal mortality than lack of access to health services itself, and it is shown that the most effective way to improve care is through training and continuous education of the midwife, the primary obstetric care-giver. Laerdal Global Health [LGH], was collaborated with in this thesis, a not-for-profit company whose work is dedicated to saving the lives of mothers and newborns in low income regions, through high-impact, low-cost solutions involving educational materials and training programs for midwives. The aim of the partnership with LGH was to support competency development for labor management, with a focus on continuous training and education for midwives in Tanzania, sub Saharan Africa. Continuous training is on-going education of midwives through various methods of training and learning, with the goal of keeping skill sets current and evolving with best practice knowledge. Around the world, as well as in in sub Saharan Africa, medical systems can be stressed by a range of factors, including lack of resources and lack experienced midwives, which leads to challenges to follow standardized obstetric guidelines and an over-burdening workload for the midwife. (LGH, 2019). There is also a high frequency of midwife turnover within clinics and hospitals, making it difficult to train a fluctuating staff of varying competencies and knowledge sets. (LGH, 2019). The net effect of these challenges and beyond, made it imperative to address how midwives could be supported in their efforts to engage in continuous education and training. To facilitate and support continuous education, a hybrid chat and professional education platform, Rio, was created, powered by social interaction, knowledge exchange, and democratization of information. This platform’s aim was to give form and body to existing digital and social behaviors, and midwives’ continuous education efforts, something that comes in many shapes and sizes, and levels of tangibility. A proposal in the digital space was determined to be optimal due to its ability to increase access to information, and its adaptability to user needs and environments. Rio also challenges the ubiquitous nature of WhatsApp in the medical context by addressing and rethinking the generation, use, and storage of patient data. In tandem, Rio maintains the successful social platform use patterns, while utilizing these traits to propel and facilitate professional education and knowledge exchange.

The early postnatal period is marked by the rapid acquisition of sensorimotor processing capabilities. Initially responding to a limited set of environmental stimuli with a restricted repertoire of behaviors, mammals exhibit a remarkable proliferation of sensorimotor abilities in the early postnatal period. Central to action selection, reinforcement, and contingency learning are a subcortical set of evolutionarily conserved nuclei called the basal ganglia. The striatum, which is the primary input nucleus of the basal ganglia, receives afferent innervation from throughout the CNS. Its projection neurons (SPNs) integrate these diverse inputs, regulating movement and encoding salient cue-outcome contingencies. Here, using electrophysiological, electrochemical, imaging, and behavioral approaches in mice, I will explore the postnatal maturation of the striatal cholinergic interneuron (ChI), a critical modulator of dopamine signaling, afferent excitation, and SPN excitability. In Chapter 1, I will set the stage for this exploration by reviewing the current literature on striatal postnatal development, including cellular physiology, axonal elaboration and synapse formation, and plasticity expression. I will survey striatal deficits observed in clinical neurodevelopmental conditions such as autism, ADHD, tic disorders, and substance use disorders. I will additionally summarize evidence that the striatum is uniquely vulnerable to physiological and immunological insult, as well as early life adversity. In Chapter 2, I turn my focus specifically to the striatal ChI, uncovering fundamental cell-intrinsic changes that occur postnatally in this population. I will also elaborate on the postnatal maturation of dopamine release properties and regulation thereof by cholinergic signaling from the ChI. In Chapter 3, I investigate the circuit connectivity and circuit-driven firing dynamics of ChIs as they mature postnatally. I utilize a brain slice preparation retaining thalmostriatal afferents in order to assay the ChI pause, a synchronized transient quiescence in ChIs thought to facilitate cue learning and behavioral flexibility. I find that the ChI pause is refined postnatally, dependent on developmental changes in thalamic input strength and the cell- intrinsic expression of specific ionic conductances. Finally, in Chapter 4, I present preliminary evidence that ChI circuit maturation as defined in preceding chapters is delayed by chronic stress exposure postnatally. Following the maternal separation model of early life stress, ChI intrinsic characteristics mature normally, but they retain heightened thalamic innervation and thalamus-driven pause expression.

The major physiological function of the carotid body is to respond to a low partial pressure of oxygen in the systemic arterial blood. The structure and functions of the adult carotid body have been extensively investigated over the past fifteen years. However, the carotid body in children has been relatively neglected with only a handful of studies being performed. To date, no study has been undertaken to investigate the effects of intrauterine hypoxia on the carotid body of foetuses. Clinically, intrauterine growth retardation has been ascribed, amongst other causes, to placental insufficiency that results in chronic hypoxia in the fetus. Intrauterine growth retardation can be divided into two types: - Type I (symmetrical) and type II (asymmetrical). In Type II intrauterine growth retardation, growth retardation does not become clinically evident until the third trimester. There is relative brain sparing with a greater deprivation in the size of abdominal organs, such as the liver and the kidneys. Previous studies have shown that there is no correlation between volume of the carotid body and hypoxia in children. However, Heath et al. made the observation that there are three variants of chief cells (progenitor, light and dark) within the carotid body and that an increase in the relative percentage of the dark subtype is an indicator of hypoxia. Using this observation, the present study set out to test two hypotheses: Firstly, whether the carotid body is functional in utero; and secondly whether there are any objective morphological changes in the carotid bodies of fetuses that have been subjected to intrauterine growth retardation. The carotid bodies from 72 fetuses with a gestational age between thirty and forty weeks were removed from the archived autopsy material, and differential cell counts were performed of the various cells present within the carotid bodies, using haematoxylin and eosin stained sections of the carotid bodies. The cases were assigned to three groups: - I) cases that had clinical and pathological evidence of intrauterine growth retardation, 2) negative controls and 3) positive controls. The three main groups were categorised as follows: -: (1) Intrauterine growth retardation (all cases with a weight for gestational age that is below the tenth centile and a brain to liver ratio of greater than four.) (2) Negative controls (all cases in whom there is a normal weight for age, a brain to liver ratio of less than three and no histological evidence of an episode of significant hypoxia before death). (3) Positive controls (all cases in whom there was clinically significant hypoxia present before death). The groups comprised of: 20 hypoxic positive controls, 15 negative controls, and 16 test cases which had suffered from intrauterine growth retardation. The remaining 21 cases were 7 dysmorphic infants, 3 congenital infection cases (congenital syphilis) and 11 cases that fitted the negative control criteria but had suffered significant hypoxia, thus excluding them from that category. The results showed that no significant difference was present in the percentage of sustentacular cells between any of the three groups. The results of the percentage of dark chief cells were as follows: l) mean percentage of dark chief cells in the intrauterine growth retardation group was 21.1 ±10.9%. 2) mean percentage of dark chief cells in the negative controls was 12.3 ±7.3%. 3) mean percentage of dark chief cells in the positive controls was 21.2 ±9.8%. A significant difference was present between the intrauterine growth retardation cases and the negative controls p=0.013, and between the positive and negative controls p=0.006. The dark chief cell count in the intrauterine growth retardation group showed no significant difference from the positive controls. No age-related difference appeared to be present in any of the groups. The conclusions reached are: a) Clinical hypoxia correlates with morphological changes in the carotid body, manifesting as an increase in the percentage of dark chief cells. b) intrauterine growth retardation cases show similar morphological changes in the carotid body to cases that have suffered from clinical hypoxia. c) therefore, by deduction intrauterine growth retardation fetuses have probably also been exposed to significant hypoxia while in utero. d) the fact that morphological changes in response to hypoxia are occurring in the carotid bodies of fetuses is an indication that the carotid body may be functional in utero. The results of the study indicate that a dark chief cell percentage of greater than 20% indicates that the fetus has been subjected to significant hypoxia, while a percentage of less than 10% indicates that it has not. A percentage of between 10 and 20% is unhelpful in determining whether hypoxia has taken place. The results of this study indicate that histological examination of the carotid bodies in neonates suspected of intrauterine growth retardation could be a useful additional means of assessment.

Syfte: Att kartlägga barnmorskors erfarenheter vid akut omhändertagande av barn i samband med förlossning. Metod: Kvantitativ tvärsnittsstudie. Datainsamling genom webbenkäter som analyserades med deskriptiv statistik. Resultat: Totalt besvarades 100 enkäter av barnmorskor verksamma på förlossningsavdelning. Av barnmorskorna uppgav 64 % att de med säkerhet kunde identifiera barn med asfyxi, 49 % kunde utföra neonatal HLR med säkerhet. Både barnmorskor med kortare och längre erfarenhet behövde mer teoretisk och praktisk kunskap i akut omhändertagande av barn vid födelsen, mest kunskap behövde de med kortast erfarenhet. Barnmorskor med kortare erfarenhet var även mindre säkra i att stödja och informera föräldrar när barnet behövde akut omhändertagande. Slutsats: Det är barnmorskors ansvar att handlägga barn som är i behov av akut omhändertagande vid förlossning. Det är möjligt att det behövs mer förberedelser och längre introduktion i ämnet för nyutexaminerade barnmorskor. / Aim: To examine midwives experiences in emergency care of children immediately after birth. Method: Quantitative cross-sectional study. Data were collected through a web based survey and analyzed with descriptive statistics. Result: A total of 100 questionnaires were answered by midwives working at maternity wards. Among the midwives 64 % could with certainty identify children with asphyxia, 49 % could perform neonatal CPR with certainty. Midwives experienced a need for more theoretical and practical knowledge in emergency care of children at birth, those with the least experience felt a higher need for additional knowledge. Midwives with the least experience were less certain in the support of parents when their newborn needed emergency care. Conclusion: It is the midwives’ responsibility to care for children who are in need of emergency care during childbirth. It is possible that more preparation and longer introduction to the subject for new graduate midwives is needed.

Att bli förälder förknippas ofta med en positiv upplevelse. För föräldrar till barn som börjar livet på en neonatalavdelning kan starten på föräldraskapet bli allt annat än förväntad. På en neonatalavdelning vårdas för tidigt födda och sjuka nyfödda barn och föräldrar ses som en självklar del i vårdteamet.   Syftet med denna studie var att beskriva föräldrars upplevelse av att deras barn vårdas på neonatalavdelning.   För att besvara studiens syfte utfördes en litteraturöversikt. Sökningar gjordes i databaserna CINAHL, PubMed och PsycINFO. Till resultatet inkluderades 16 kvalitativa intervjustudier. Samtliga artiklar granskades utifrån Sophiahemmet Högskolas riktlinjer för självständigt arbete.   Resultatet visade att den oväntade utgången av graviditeten resulterade i en upplevelse präglad av känslor såsom oro och stress. Föräldrarna uttryckte att de hade önskat sig vara mer förberedda. Det tog tid att anpassa sig till den nya miljön och att separeras från sitt barn till följd av att barnet behövde vård på neonatalavdelningen upplevdes som frustrerande. Föräldrarna hade behov av att vara nära sitt barn och vara involverade i dess omvårdnad. När detta var möjligt upplevde föräldrarna ökad delaktighet och deras känsla av att vara förälder stärktes. Miljön på neonatalavdelningen och att barnet behövde vård gjorde det svårt att etablera föräldrarollen vilket påverkade anknytningen och föräldraskapet. Föräldrarna som inte kunde bo kvar på neonatalavdelningen uttryckte att det var negativt då det påverkade anknytningen och delaktigheten i barnets vård.   Slutsatsen av föreliggande studie är att föräldrarna hade svårt att etablera sin föräldraroll när barnet behövde vård på neonatalavdelning vilket påverkade anknytningen. Att få vara nära sitt barn och delaktig i vården stärkte deras identitet som förälder. Som vårdpersonal var det viktigt att stödja föräldrarna med åtgärder som gynnade anknytningen. / Becoming a parent is often associated with a positive experience. To become a parent to a child who begins life in a neonatal unit is often unexpected and it can cause a variety of emotions. Premature and sick newborns are cared for in the neonatal care unit. Parents are seen as an integral part of the care team, which has positive effects on the attachment and participation.    The purpose of this study was to describe parents' experience of their child being cared in neonatal unit.    To answer the purpose of the study, a literature review was performed. Searches were made in the databases CINAHL, PubMed and PsycINFO. 16 qualitative interview study articles were included to answer the purpose. All articles were reviewed based on Sophiahemmet University's guidelines.    The results showed that the unexpected outcome of the pregnancy resulted in an experience marked by a variety of emotions such as anxiety and stress. The parents expressed wishes for being more prepared. It took time to adjust to the new environment and becoming separated, as a result of the child needing care in the neonatal unit, was perceived as frustrating. The parents had a need to be near their child and involved in their care. When this was possible, the parents experienced increased participation and their sense of being a parent strengthened. The environment in the neonatal unit and the fact that the child needed care, made it difficult to establish a parental role, which affected the attachment and parenthood. Parents who could not remain in the neonatal unit, expressed negativity because it affected attachment and participation.    The conclusion of this study is that parents found it difficult to establish a parental role when the child needed care in the neonatal unit, which affected the attachment. To be close to their child and participate in the care, strengthened their role as a parent. As health professionals, it is important to support actions that strengthen the attachment.

Background: Improvement in neonatal care has changed the features of severe hyperbilirubinemia and reduced the number of babies who need exchange transfusion (ET) to avoid bilirubin-induced neurological dysfunction. We conducted this study to determine the demographic and clinical characteristics of the exchanged babies, in order to identify their risk factors, and to determine the adverse effects and outcomes associated with ET. Methodology: This was a retrospective descriptive study, reviewing folders of infants who required ET at CMJAH from June 2006 to December 2011. Results: There were 63 patients who underwent 66 exchange transfusions. Patients exchanged in the neonatal unit accounted for 60.3%, with the rest of the patients (39.7%) being exchanged in the general ward. Preterm babies accounted for 45.7%, and the majority were inborn (44%). The majority were male (58.7%), term (54.3%), and the mean birth weight was 2.29 Kg (±0.89). The median age at exchange was 5 days (mean 4.5 days ±2.1 SD). The cause of jaundice was undetermined in most patients (84.1%), while ABO incompatibility and Rhesus disease accounted for 7.9% and 6.3%, respectively. Seven babies (11.1%) had an abnormal neurological examination before exchange and five (7.9%) were labelled as kernicterus. The mean bilirubin before exchange was 325 mmol/l ±118. The complications of ET were seen in 22.2% of patients. These were Necrotising Enterocolitis (NEC) (1.58%); seizure (1.58%); apnoea (4.76%); bleeding (3.1%); renal failure (3.1%); hypoglycaemia (4.76%); thrombocytopenia (67.6%); and hypercalcemia (85%). We had three deaths, of which two were due to neonatal sepsis acquired prior to exchange, with one case of perforated NEC in an infant with other comorbidities. Hence, the mortality associated with ET in our study was 1.5 percent. At discharge, three infants remained with signs of kernicterus (4.7%). Conclusion: Kernicterus remains a cause of concern in our settings, and mechanisms ought to be put in place to detect severe jaundice in discharged term babies who may benefit from early phototherapy (PTT) and ET; as this is shown to be a relatively safe procedure in our settings, especially in infants without other severe comorbidities. ACKNOWLEDGEMENTS I would like to take this opportunity to thank Prof Daynia Ballot, my research supervisor, who has been an inspiration for research and accepted the task of guiding me through the challenging journey of conducting and writing this review.

No description available.

Thesis (MPH.) -- University of Limpopo, 2021 / Pregnancy and childbearing are most of the crucial milestones in women’s lives as they look forward to becoming mothers. During this time, they have positive expectations while pregnant, however, the physical, hormonal, neurotransmitters and psychosocial changes that occur can make pregnancy to be stressful and overwhelming. The disability associated with depression and its impact on maternal and child health has important implications for public health policy. While the prevalence of postnatal depression is high, there are no prevalence data and associated risk factors on antenatal depression in Helen Franz Hospital of Limpopo Province, South Africa. The purpose of this study was to determine the prevalence and factors associated with depression amongst pregnant women at Helene Franz Hospital. Methodology: A quantitative retrospective design was used in the study and a sample size of 336 was required which was calculated based on the 95% confidence interval, 5% sampling error and 38.5% prevalence of depression amongst pregnant women in KZN. A self-administered questionnaire with close-ended questions which was adopted from the Edinburgh postnatal depression scale was given to the participants to complete. The scoring of the questionnaire was that the maximum score was 30 and the persons who scored 10 or greater were considered depressed according to the Edinburg scale for assessing depression. Data were analysed using SPSS V.21.0 and a p-value of less than 0.05 was considered statistically significant. Results: The participants ranged from 18 to 47 years with the mean age of 27.8±6.9 years. The majority of the pregnant women were in the age groups 20-24 years and 25-29 years. The mean depression score for pregnant women was 7.87±5.2 and ranged from 0 to 23. The prevalence rate of depression symptoms was 31%. Maternal age was not significantly associated with depression and a significantly higher proportion of married pregnant women were depressed as compared to unmarried women at p=0.017. Pregnant women who smoke were significantly more likely to be depressed than those who do not smoke at p=0.002. Pregnant women without financial support from partnerwere significantly likely to be depressed than those who receive financial support at p-=0.002. A significantly greater proportion of pregnant women with partner violent were likely to be depressed than those with non-violent partner at p <0.001. Pregnant women in relationships with unemployed spouses were significantly likely to experience depression than the employed spouse at p=0.035. lastly, pregnant women in relationship with a spouse with lower educational level were significantly likely to be depressed than the other groups at p-.006. Conclusion: The prevalence of depression among pregnant women was high and the main risk factors involved in the onset of antenatal depression have highlighted a complex multifactorial aetiology. These are related to different sources of chronic diseases, psychosocial, environmental, obstetric and pregnancy- related risk factors have been highlighted. Correctly identifying women at risk of suffering from depression would provide an opportunity to target those women who would benefit from preventive and supportive interventions. Therefore, a psychosocial assessment, in the sense of a comprehensive and multidimensional evaluation of a woman's psychosocial circumstances should be common practice for all women during the antenatal period. Key concepts Antenatal care; Pregnancy; Childbearing; Depression; Psychosocial

No description available.