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Background: Polycystic ovary syndrome (PCOS) is associated with increased metabolic risk and hypertension, which may relate to enhanced sympathetic nervous system (SNS) activation. The cerebral pathways involved in this process are not known. Aims: (1) To compare blood pressure and SNS activation in response to isometric forearm contraction (IFC) between PCOS and control groups. (2) To identify and compare the neuronal signatures of this response. (3) To investigate metabolic and anthropometric correlates of SNS activation. Methods: 20 PCOS (age 29.8 yrs, BMI 26.1 kg/ m²) and 20 matched controls (age 29.7 yrs, BMI 26.1 kg/ m²; p=NS) were studied. Out-of-scanner tests: measurement of mean blood pressure (MAP) and heart rate (HR) responses to 30% IFC for 180 seconds; baseline and post-task catecholamines, and microneurography (MSNA) in a subgroup of 8 PCOS and 8 controls. In-scanner: Blood oxygen level dependent (BOLD) fMRI using an identical block paradigm design for IFC, BOLD signalcorrelating to MAP responses (threshold Z > 2.3, corrected cluster threshold p=0.05). Results: IFC elicited an increase in HR and MAP in PCOS and controls but these did not differ between groups (p=0.16[HR] and p=0.06[MAP]). Adrenaline increased significantly post-IFC in PCOS (0.68 to 1.23ng/mL p < 0.001) but not in controls (0.77 to 0.99ng/mL p=0.14). MSNA burst frequency increased by 68% in the PCOS group compared to 11.9% in controls (p=0.002). Brain activation indexed by the BOLD signal in response to IFC was significantly greater in the PCOS group compared to the control group in the right orbitofrontal cortex (p < 0.0001), left angular gyrus and lateral occipital cortex (p=0.04). When the BOLD signal was separately corrected for insulin sensitivity, BOLD signal in the right orbitofrontal cortex was no longer significant. Conclusions: PCOS is associated with enhanced SNS activation and increased regional brain activation in response to IFC. The right orbitofrontal cortex BOLD signal change in the PCOS group is associated with insulin sensitivity.

There have been phenomenal advances in the field of reproductive medicine and success rates following in vitro fertilisation have improved dramatically in recent years. The aim of this project was to improve our understanding of human preimplantation embryo development by identifying potential markers of viability that may aid us in selecting the best embryo for uterine transfer in the clinical embryology laboratory. Investigations into the distribution of cytoskeletal F-actin in human embryos demonstrated that a highly organised actin cortex is important for embryo cleavage and continued development to the blastocyst stage. Whilst they are polarised in the mouse from the oocyte to the blastocyst, the regulatory proteins leptin and STAT3 are co-localised only at the oocyte stage in humans, and are distributed within different cytoplasmic domains in human cleavage stage embryos and blastocysts. Whether polarity in humans is predetermined in the oocyte remains elusive, but none of the evidence generated in this thesis supports this idea. Leptin transiently activates STAT3 via the long form of the leptin receptor, and most significantly in the ICM of human day 6 blastocysts. Morphological features of blastocysts that can be visualised microscopically, such as a double ICM and cytoplasmic projections connecting the ICM to the TE, provide clues to their viability and may help us to choose the most suitable embryo from a cohort when deciding which to transfer. Nuclear volumes may in future contribute to this selection. Using time lapse technology to study cleavage patterns is now a routine occurrence in the clinical embryology laboratory. The results in this thesis show that distinctive patterns of divisions and the site at which blastocysts hatch can provide us with more information than a snap-shot morphological evaluation. Finally, contributing to the development of modelling software and predictive algorithms for the study of human embryos, particularly in time lapse imaging, means that our understanding of this fascinating area of medicine will continue to progress.

<p> Obstetric hemorrhage is one of the most common causes of maternal morbidity and mortality. The measurement of quantitative blood loss (QBL) at delivery prevents clinicians from failing to recognize hemorrhage in healthy obstetric patients who initially compensate for excessive blood loss. The purpose of this project was to improve the compliance of labor and delivery nurses in a community hospital with consistent QBL measurement. Key theories that formed the basis for the project were Lewin&rsquo;s theory of planned change and homeostasis. The project question addressed was: Is the use of weekly scorecards to provide feedback to nurses with both blinded individual data and aggregate unit data associated with an increase in the percent of patients with blood loss at delivery documented as a QBL measurement over a 12-week period of time? A blinded scorecard of the percent of deliveries attended by each nurse that had QBL documented and an aggregate run chart of the percent of all deliveries with QBL documented were posted in the unit weekly. The postings included discussions of means to enhance facilitators of and decrease barriers to QBL measurement. Over 12 weeks, the percent of deliveries with QBL documented increased from 22.7% to 80.0%. This result is consistent with previous reports that clear and objective feedback from scorecards is associated with improvement in performance. Scorecard feedback may be explored to determine if it is associated with improvement of other nursing practices. This project has implications for positive social change as it may contribute to a reduction in preventable maternal deaths. Decreasing maternal morbidity and mortality supports the health of women in a population and influences the health of the next generation.</p><p>

<p> The rigors of labor and childbirth are incredibly demanding on the mother's body physically, emotionally, and psychology. Most new mothers deliver in a hospital setting where they are discharged after approximately two days. However, the mother's health and well-being does not improve that drastically within those two days of post-delivery recovery. Common struggles that new mothers face include postpartum depression, intimate partner violence, mood and body changes, as well as nutrition and sleep deprivation. Therefore, it is not only important to be attentive to the newborn but to the mother's recuperation as she adjusts to postnatal life. While there are many options for new mothers to deliver their baby through hospitals or birth centers, there is a lack of postnatal care facilities in comparison. </p><p> Pamper Partum, LLC is a private company with an organizational mission to offer quality service and care that eases the transition to motherhood, to empower a new mother through education and community support, and to reduce any preventable risks associated with the postnatal period. Pamper Partum, LLC is an all-inclusive healthcare facility that provides services such as breastfeeding assistance, peer-support groups, private counseling, nutrition, general health care, and 24/7 infant monitoring in a state-of-the-art nursery. Pamper Partum, LLC will seek to be the first postnatal care facility that serves Orange County.</p><p>

The dimensions of the pelvis are important when performing pelvic procedures and during obstetrics. The aim was to assess the clinically relevant dimensions of the pelvis, in South Africans. Eighty intact cadaver pelves and 303 os coxae, from the Northern Gauteng area were sampled. Five points on the os coxae and 12 on the intact pelves were marked, digitized for shape analysis and distances measured. Statistical comparisons were made between sex-population groups and according to stature. Smaller peri-obturator dimensions in blacks and shorter individuals exposed the obturator nerve during procedures, whilst in taller males and whites, the greater dimensions endangered the pudendal nerve branches. The deeper, narrower pelvic canal and broader ischiopubic rami in males may complicate pelvic procedures. The smaller pelvic inlet and midpelvis, whilst similar outlet diameters in black females contributed to pelvic canal shape differences. Shorter black women, poses a risk for CPD according to established recommendations. / Dissertation (MSc)--University of Pretoria, 2013. / gm2014 / Anatomy / Unrestricted

Background: The literature review reveals information about what makes a good midwife from several perspectives. However, there is a dearth of knowledge around women’s perceptions of a good midwife in different birthplaces. Aim. The aim of the study was to explore and explain first-time mothers’ expectations and experiences of a good midwife during childbirth in the context of different places of birth. Methods: A qualitative grounded theory methodology was undertaken. Fourteen first-time mothers planning to birth in different settings in England (Home, Freestanding Midwifery Unit, Obstetric Unit) were recruited. Data were collected through two semi-structured interviews for each participant (before and after birth). Data analysis included the processes of coding and conceptualising data, with constant comparison between data, literature and memos. Ethical approval was gained. Informed consent was obtained from participants and women were free to decline participation or to withdraw at any time. Confidentiality was guaranteed. Findings: The model named ‘The kaleidoscopic midwife: a conceptual metaphor illustrating first-time mothers’ perspectives of a good midwife’ was developed. The model is dynamic and woman-centred, operationalised as the midwife’s characteristics that should adapt to each woman’s individual needs in the context of each specific labour, irrespective of the birth setting. Four pillars of care are encompassed in the care provided by a good midwife in the labour continuum: promoting individuality; supporting embodied limbo; helping to go with the flow; providing information and guidance. As a kaleidoscopic figure, a good midwife should be multi-coloured and ever changing in the light of the woman’s individual needs, expectations and labour journey (e.g. stage of labour and events occurring during childbirth), in order to create an environment that enables her to move forward despite the uncertainty and the expectations-experiences gap. The following elements are harmonised by the kaleidoscopic midwife: relationship-mediated being; knowledgeable doing; physical presence; immediately available presence. Conclusion: The model presented has relevance to contemporary debates about quality of care and place of birth and can be used by midwives to pursue excellence in caring for labouring mothers. Independently from the place of birth, when the woman is cared for by a midwife demonstrating the above characteristics, she is more likely to have an optimum experience of birth.

Background: There are many problems of parenting during infancy for Chinese primiparous women. As an important determinant of good parenting, maternal self-efficacy (MSE) should be paid more attention by researchers. At present, the limitations of previous research examining MSE during infancy are that most studies were related to a homogeneous sample (approximately 90% white) and lacked the consideration of cultural effect; the influencing factors remained poorly explored; and there were few studies related to Chinese women. Therefore, it is necessary to assess MSE and to thoroughly explore the factors influencing MSE among Chinese primiparous women in consideration of the Chinese postnatal culture of “Doing the month” to fill the research gap. Aim: The aim of this study was to describe MSE and to explore factors which may influence MSE in primiparous women in China in the first three months postnatally. Methods: A quantitative longitudinal study using questionnaires was conducted. In total, 420 primiparous women were recruited in obstetric wards at three hospitals in Xiamen City, China. Initial baseline questionnaires to measure socio-demographic and clinical characteristics at three days postnatally were distributed to participants face-to-face by the researcher on the postnatal ward. Participants’ contact details were also collected. Follow-up questionnaires at six and 12 weeks were sent via email by the researcher to participants, including the Self-efficacy in Infant Care Scale (SICS), the Edinburgh Postnatal Depression Scale (EPDS) and the Postpartum Social Support Scale (PSSS) to measure MSE, postnatal depression symptoms and social support, respectively. These were returned by participants via email. Quantitative data were analysed using SPSS. Results: The mean MSE score at six weeks postnatally was 74.92 (SD=11.05), and increased to 77.78 (SD=11.13) at 12 weeks postnatally. The mean social support scores at six and 12 weeks postnatally were 40.99 (SD=9.31) and 43.00 (SD=9.55). The mean EPDS scores decreased from 9.09 (SD=4.33) at six weeks postnatally to 8.63 (SD=4.40) at 12 weeks postnatally; the proportion of women with an EPDS score of ten or more at the two time points declined from 47.4% to 38.3%. The mean score of how satisfied women were with “Doing the month” was 68.73 (SD=17.65) at six weeks postnatally, with most women (91.4%) thinking that “Doing the month” after childbirth was necessary. In the multivariate analysis, the variables: social support scores, women’s satisfaction with “Doing the month” scores, EPDS scores, maternal education, maternal occupation, baby health scores, and baby fussiness scores affected MSE scores during the initial postnatal period. Conclusions: In this study, Chinese primiparous women had a moderate level of MSE and received a moderate level of social support at six and 12 weeks postnatally, and a higher proportion of Chinese women had postnatal depression symptoms than did women in Western countries. From six to 12 weeks postnatally, the mean MSE scores and social support scores had a statistically significant increase; the mean EPDS scores had a statistically significant decrease. “Doing the month” was still popular in Chinese modern society and almost half of the women felt satisfied about their experience of “Doing the month”. Obstetric nurses and women’s family members need to be aware of the significant contribution of social support, women’s satisfaction level with “Doing the month” in positively influencing primiparous women’s MSE, and the significant effect of postnatal depression symptoms in negatively impacting on first-time mothers’ MSE; they should pay more attention to primiparous women with less education, unemployed mothers, women with unskilled occupations, women with an unhealthy baby, and women with a baby with a difficult temperament to improve their comparatively lower MSE levels during the initial postnatal period.

The clinical success of assisted reproductive technology (ART) is measured by the clinical pregnancies (implantation success) and the live births rates. Following ART live birth rates vary from 20-40% and are dependent upon a variety of factors. Various adjunct therapies are being used with ART to improve implantation and pregnancy outcomes. The effectiveness of these adjuvant therapies remains unclear and requires further evaluation. One group of medical adjuvant therapies widely used in clinical practice are thromboprophylactic agents, including heparin. Heparin can potentially modulate many of the mechanisms of implantation including successful apposition, adhesion and penetration of the developing embryo into the endometrium. This is independent of its anticoagulant function for which it is used routinely in clinical practice. Following completion of a literature review, it became evident that heparin could potentially improve decidualisation and implantation. It improves function of various growth factors and cytokines in the endometrium promoting and facilitating implantation in laboratory models. From this initial research, we postulated that heparin used as adjunct to ART should improve the clinical pregnancy and the live birth rates via these mechanisms described. Bleeding is a known side effect of systemic heparin due to its effect on the coagulation cascade. A systematic review and meta-analysis protocol was devised and peer-reviewed to assess the published data. The aim of this was to establish whether using the currently available evidence, peri-implantation heparin improves pregnancy outcomes in women undergoing ART. A secondary aim was to determine if there were any significant side effects. The meta-analysis was performed in accordance with the protocol. This demonstrated that peri-implantation systematic heparin does improve clinical pregnancy rates and live birth rates in these women. Nevertheless, there were only three randomised control trials (RCTs) included in the review that met the inclusion criteria and there was significant heterogeneity amongst the participants in the included studies. Systemic side effects of heparin including bleeding and bruising were also identified in this review. As the proposed mechanism of improving implantation by heparin is improvement of endometrial cytokines and growth factors. It was hypothesised that direct endometrial administration of heparin should improve decidualisation thus improving implantation. To confirm or refute this hypothesis, initially a phase 1 study is required to be undertaken for direct endometrial administration of heparin as currently it is only licenced as a systemic injectable formulation. We developed a protocol to assess the feasibility of intrauterine flushing for direct endometrial administration of low molecular weight heparin (LMWH) with a prospective randomised placebo controlled pilot study. This novel study was approved by National Research Ethics Service (NRES), Medicine & Healthcare products Regulatory Authority (MHRA), UK. Sponsorship was obtained from the University of Warwick and local Research & Development (R&D) approval was obtained. The study was undertaken at University Hospitals Coventry and Warwickshire NHS Trust (UHCW). It demonstrated the acceptability of intrauterine flushing of heparin to women. The concept of the trial was popular with patients making recruitment unproblematic. Minimal side effects were reported, no serious adverse events occurred. Most women recruited underwent ART following the study, with many achieving a clinical pregnancy and live birth. Our hypothesis for primary outcome measure, uterine natural killer (uNK) cell density, as a marker of decidualisation was refuted.