No description available.

Background: The aims of this randomised, double blind, placebo controlled trial were to compare vaginal PGE2 gel with oral misoprostol in the induction of labour at term. Methods: Women randomised to the oral misoprostol group received 20mcg oral misoprostol solution at two hourly intervals and placebo vaginal gel, and those in the vaginal prostaglandin group received vaginal PGE2 gel at six hourly intervals and oral placebo solution. The primary outcome measures were vaginal birth not achieved in 24 hours, uterine hyperstimulation with associated fetal heart rate changes, and caesarean section. Women were asked about their preferences for care, and a cost comparison was performed for the two methods of induction of labour. A nested randomised trial compared health outcomes for the woman and her infant related to morning or evening admission for commencing induction of labour. Results: A total of 741 women were randomised, 365 to the misoprostol group and 376 to the vaginal PGE2 group. There were no differences between women in the oral misoprostol group and women in the vaginal PGE2 group, for the outcomes vaginal birth not achieved in 24 hours (Misoprostol 168/365 (46.0%) versus PGE2 155/376 (41.2%); RR 1.12 95% CI 0.95-1.32; p=0.134), caesarean section (Misoprostol 83/365 (22.7%) versus PGE2 100/376 (26.6%); RR 0.82 95% CI 0.64- 1.06; p=0.127), or uterine hyperstimulation with fetal heart rate changes (Misoprostol 3/365 (0.8%) versus PGE2 6/376 1.6%); RR 0.55 95% CI 0.14-2.21; p=0.401). Women in the misoprostol group were more likely to indicate that they 'liked everything' associated with their labour and birth experience compared with women in the vaginal PGE2 group (Misoprostol 126/362 (34.8%) versus PGE2 103/373 (27.6%); RR 1.26; 95% CI 1.02-1.57; p=0.036). There were no differences in the primary outcomes when considering morning or evening admission to commence induction. The use of misoprostol was associated with a saving of $110.83 per woman induced. Conclusions: The use of oral misoprostol in induction of labour does not lead to poorer health outcomes for women or their infants, women express greater satisfaction with their labour and birth experience, and with misoprostol induction there is a cost saving to the institution. / Thesis (Ph.D.)--Department of Obstetrics and Gynaecology, 2005.

Thesis (M. P. A.)--University of Hong Kong, 2007. / Title proper from title frame. Also available in printed format.

Obstetric malpractice claims, concerning delivery during a period of eight years, were analysed for motives behind disciplinary actions, and for the frequency of inappropriate oxytocin use.Failure to respond to signs of foetal distress, injudicious use of oxytocin and a failure to effect a timely delivery were the recurrent problems that accounted for the majority of disciplinary actions. Inappropriate use of oxytocin was more frequent than reported in earlier studies. (Paper I) In a case-control study, differences in the obstetric management in neonates born with and without acidaemia (umbilical artery pH < 7.05), was evaluated. Out of 28,486 deliveries during 1994–2004, 305 neonates were born with acidaemia. Uterine hyperactivity and oxytocin use were independently associated to acidaemia at birth. The increased uterine activity was related to oxytocin treatment in 75 % of cases. Pathological cardiotocographic patterns occurred significantly more often in the case group. The results indicate that guidelines on oxytocin use and foetal surveillance are not followed. The duration of bearing down is less important when uterine contraction frequency has been considered. (Paper II) In a subset of study II, cases with metabolic acidosis (umbilical artery pH < 7.05 and base deficit ≥12 mmol/L) and controls were audited for the occurrence of suboptimal intrapartum care, and the nature of such care. It was found that suboptimal care occurred in half (49%) of the cases, while it was less frequent but not uncommon among controls (13%). Suboptimal care consisted of injudicious use of oxytocin and a failure of appropriate action upon signs of foetal distress. A high rate of NICU admissions and diagnosis of encephalopathy in the case group confirms that metabolic acidosis should be avoided. We estimate that metabolic acidosis could probably have been prevented in 40-50% of the cases.(PaperIII) Women (n=103) scheduled for elective caesarean section in regional anaesthesia were randomised to 5 or 10 units oxytocin, given as an intravenous bolus (double blinded), and electrocardiograms were analysed for ST depressions as a sign of myocardial ischaemia. ST depressions were associated with oxytocin administration significantly more often in subjects receiving 10 compared with 5 units. A dose of 10 units resulted in a more marked decrease of the mean arterial blood pressure, but no difference in increase of the heartrate. There was no difference in estimated blood loss. (paper IV)

The purpose of this study was to describe the obstetric hospitalization rates of northern and registered Indian women from April 1, 1992 to March 30, 1993 and to compare them with those of southern rural women in Saskatchewan.<p> Saskatchewan Health provided hospital separation data for 100% of northern and registered Indian women and for a 10% sample of southern rural and southern urban women hospitalized with obstetric diagnoses and procedures in 1992/93.<p> The crude, age-specific, and age-standardized hospitalization rates were based on the number of women of reproductive age or the number of deliveries or pregnancies. The average length of stay and hospital location were examined. Crude and age-adjusted odds ratios with 95% confidence intervals and chi-square tests were used to compare rates with southern rural women as the reference group. Oneway analysis of variance was used to compare the average length of stay for obstetric episodes among study groups.<p> The rate of obstetric episodes per 100 pregnancies were only 5 to 18% higher for northern women and southern registered Indian women. Northern and registered Indian women had higher rates for deliveries per 1,000 women, for ectopic pregnancies per 1,000 pregnancies, and for antenatal episodes with diabetes or abnormal glucose or with urinary tract infections per 100 pregnancies and lower rates of deliveries with cesarean sections, instrument use and episiotomy. Northern women had higher rates for deliveries with fetal and placental problems and for vaginal birth after cesarean section per 100 deliveries, and lower rates of antenatal episodes with hyperemesis per 100 pregnancies. All registered Indian women had lower rates of labour and delivery complications per 100 pregnancies. The average length of stay for obstetric episodes was similar for all study groups. Over 35% of northern women delivered in northern hospitals.<p> The results support continued northern obstetric practice and provide a baseline for evaluation of health transfer and renewal for northern tribal councils and health districts. The high fertility rates among northern and registered Indian women warrant a high priority on obstetric services, hospital facilities, prenatal care and postnatal care that are age and culture sensitive.<p>

The purpose of this study was to describe the obstetric hospitalization rates of northern and registered Indian women from April 1, 1992 to March 30, 1993 and to compare them with those of southern rural women in Saskatchewan.<p> Saskatchewan Health provided hospital separation data for 100% of northern and registered Indian women and for a 10% sample of southern rural and southern urban women hospitalized with obstetric diagnoses and procedures in 1992/93.<p> The crude, age-specific, and age-standardized hospitalization rates were based on the number of women of reproductive age or the number of deliveries or pregnancies. The average length of stay and hospital location were examined. Crude and age-adjusted odds ratios with 95% confidence intervals and chi-square tests were used to compare rates with southern rural women as the reference group. Oneway analysis of variance was used to compare the average length of stay for obstetric episodes among study groups.<p> The rate of obstetric episodes per 100 pregnancies were only 5 to 18% higher for northern women and southern registered Indian women. Northern and registered Indian women had higher rates for deliveries per 1,000 women, for ectopic pregnancies per 1,000 pregnancies, and for antenatal episodes with diabetes or abnormal glucose or with urinary tract infections per 100 pregnancies and lower rates of deliveries with cesarean sections, instrument use and episiotomy. Northern women had higher rates for deliveries with fetal and placental problems and for vaginal birth after cesarean section per 100 deliveries, and lower rates of antenatal episodes with hyperemesis per 100 pregnancies. All registered Indian women had lower rates of labour and delivery complications per 100 pregnancies. The average length of stay for obstetric episodes was similar for all study groups. Over 35% of northern women delivered in northern hospitals.<p> The results support continued northern obstetric practice and provide a baseline for evaluation of health transfer and renewal for northern tribal councils and health districts. The high fertility rates among northern and registered Indian women warrant a high priority on obstetric services, hospital facilities, prenatal care and postnatal care that are age and culture sensitive.<p>

Thesis (D.N. Sc.)--Catholic University of America. / Typescript. eContent provider-neutral record in process. Description based on print version record. Bibliography: leaves 279-290.

<p> Proper implementation of pregnancy prevention programs is essential to sexual health program success and intended health outcomes for participants (Demby et. al, 2014). Large scale implementation of state-wide and local programs can vary. Multiple studies have shown that proper implementation of such programs is an essential requirement to their success (LaChausse, Clark, &amp; Chapple, 2014; Demby et. al, 2014; Fixsen et. al, 2009). Generally, there are three types of organizations that receive funds for pregnancy prevention program implementation: schools, large city community organizations, and smaller community-based organizations (Demby et. al, 2014; Fixsen et. al, 2009). Be Proud! Be Responsible! is an evidence-based comprehensive sexual health curriculum that is implemented in all three settings.</p><p> The current study is an evaluability assessment of Be Proud! Be Responsible!, one of the evidence-based programs implemented as part of the New York State Department of Health&rsquo;s Comprehensive Adolescent Pregnancy Prevention initiative. Evaluability assessments, also known as &lsquo;exploratory evaluations&rsquo;, are administered with the intention of providing enough useful information to maximize the program&rsquo;s subsequent evaluations, policies, or practices (Leviton et. al, 2010). This evaluability assessment utilized a mixed-methods approach in the form of interviews, fieldnotes from observation, document review, and secondary data analysis during Fall 2014 and Spring 2015, using Be Proud! Be Responsible! data from 2012-2013. </p><p> This study drew upon multiple sources to seek convergence and corroboration through the use of different data sources and methods (Bowen, 2009). By using this mixed-method approach to analysis it was determined that process evaluation is feasible and assessable while outcome evaluation can be carried out in the future with slight modification to the current measurement tools &ndash; the pre- and post- test, attendance records, and the fidelity checklist. It was also determined that there was a significant change in pre- and post- test responses for Be Proud! Be Responsible! participants in 2013, showing that evidence-based sexual health programs can be successful when properly implemented in specific settings.</p>

Three-dimensional (3D) sonography is regarded as a further development of ultrasound imaging technology and its application has greatly increased in recent years. This thesis summarizes the original research findings of the application of 3D ultrasonography for biometry measurement, morphology screening, prenatal diagnosis of abnormalities, ultrasound training and the application of 3D volumetry in the early diagnosis of homozygous α-thalassemia and birth weight prediction in term pregnancy. In a study involving 50 singleton pregnancies at 17-34 weeks' gestation, fetal biometric measurements obtained by an inexperienced operator using both two-dimensional (2D) and 3D ultrasound were reproducible and showed good agreement with those obtained by an experienced operator (all intraclass correlation coefficients were ≥ 0.991). The use of 3D ultrasound by an inexperienced operator allowed faster measurement of fetal biometric parameters than the use of 2D ultrasound, and also seemed to facilitate the acquisition of higher-quality images for the measurement of abdominal circumference. In basic central nervous system and cardiac screening examination, for the inexperienced operator, 3D/four-dimensional(4D) volume acquisition yielded a quicker but less optimal anatomic examination of the fetal central nervous system and heart structures compared to 2D. The diagnostic accuracy of 3D ultrasonography in central nervous system abnormalities was also investigated. The results illustrated that 3D agreed with 2D ultrasonography in the prenatal diagnosis of intracranial malformations. Homozygous α0-thalassemia is very common in South-east Asia and its prenatal diagnosis is essential due to increased fetal and maternal mortality and morbidity. Placental volume/CRL quotient measured by 3D volumetry was significantly higher in pregnancies with α0-thalassemia major cases, and 1.49 may be regarded as a cut-off for early prediction of α0-thalassemia major. In a cross-sectional study of 290 Hong Kong Chinese women with a singleton pregnancy at 37-42 weeks of gestation, the birth weight prediction models based on 3D thigh volume and conventional 2D biometric measurements were developed. It was found that with 3D thigh model, the precision of birth weight prediction to within 5 and 10% of actual birth weight in a Chinese population at term gestation could be achieved. Previous studies have shown that there is a difference in the learning curve of fetal biometry measurement by 2D ultrasound among trainees. Whether there is any difference in the learning curve between 2D and 3D ultrasound is unknown. The study included three trainees and each of them performed 90 scans in biometry measurements. By using cumulative sum analysis graphs, it could be shown that there was no difference in the learning curve between 2D and 3D ultrasound. In conclusion, the above studies have demonstrated that the use of 3D ultrasound has diversified and provided much additional information in selected indications. / published_or_final_version / Obstetrics and Gynaecology / Doctoral / Doctor of Philosophy

T2DM is a growing health problem worldwide. It is now increasingly being diagnosed earlier in life. The factors involved in such an epidemic are complex. The intrauterine environment has long been known as an important contributor to many diseases including metabolic disorders such as T2DM. Recently, there is emerging evidence for maternal micronutrients affecting vital developmental processes in utero which can adversely “programme” the offspring to develop metabolic disorders in later life. Thus, “gene-diet” interaction during foetal development is likely to be a significant contributor to the epidemic of T2DM. In particular, the intrauterine imbalance between the two related vitamins, vitamin B12 and folate, affect DNA methylation and in turn programme the foetus for the whole life. Evidence from mandatory folic acid fortification studies suggests that in the presence of adequate folate, neural tube defects due to vitamin B12 insufficiency have tripled. In India, children born to mothers with “high folate and low vitamin B12” had higher adiposity and insulin resistance. Therefore, micronutrient status during pregnancy is likely to have a significant impact on the metabolic risk of the offspring. This thesis examines whether vitamin B12 insufficiency is prevalent in pregnancy, especially in a non-vegetarian population across the world as well as the Saudi pregnant population. As estimated intake is an accepted measure for micronutrient levels, we also examined the relationship between estimated vitamin B12 and folate intake with actual levels in the blood. We have found that vitamin B12 insufficiency was not uncommon during pregnancy across the world even in the non-vegetarian population and is also common in the Saudi population. Surprisingly, vitamin B12 insufficiency was observed in 50% of the tested population even in the presence of adequate vitamin B12 intake. In addition, we have also shown for the first time in the Saudi population that maternal BMI is inversely related to vitamin B12 levels, particularly in pregnancy. Even though we have shown a similar (or worse) picture in mothers with gestational diabetes, this study needs to be replicated, as our numbers are too small. Prospective studies linking the role of vitamin B12 insufficiency especially in the presence of high folate on birth outcomes in the Saudi population as well as intervention studies investigating the role of vitamin B12 supplementation in women of childbearing age and in pregnancy are urgently needed.