Using the rat as a model we tested the hypothesis that pregnancy might lead to an attenuation of the diuretic/natriuretic effects of atrial natriuretic factor (ANF) to allow physiologically required fluid expansion. Our studies revealed that this was indeed the case. Effects of ANF on fluid and sodium excretion as well as on glomerular filtration rate were significantly reduced during pregnancy This decrease in the renal effects of ANF during pregnancy was not associated with any changes in the pharmacokinetics or renal metabolism of ANF. However, binding studies demonstrated a significant decrease in guanylyl cyclase (GC)-linked ANF receptors and a decrease in ANF stimulated cGMP production in glomeruli and papillae of pregnant rats. The ribonuclease protection assay and Western blot analysis revealed that pregnancy caused a significant decrease in GC-A-linked ANF receptors in renal papillae. It is concluded that pregnancy is associated with attenuation of the renal effects of ANF and this is due to a downregulation of GC-A-linked ANF receptors which might reflect physiological adjustment to facilitate fluid/electrolyte expansion.

The purpose of this study was to describe maternal fatigue during the first six weeks postpartum. Forty-eight healthy, primiparous mothers who experienced uncomplicated vaginal births in a large urban hospital were asked to complete the Maternal Piper Fatigue Scale during their hospital stay, and at two and six weeks postpartum. Fatigue intensity was relatively high at two days and two weeks, but had significantly declined to a relatively "normal" level by six weeks postpartum. However, 25% of the mothers were still reporting "severe" fatigue at six weeks. The contributing factors most frequently identified by the mothers were labour and delivery issues (2 days), sleep pattern disturbances, and infant care issues (2 & 6 weeks). Rest, sleep, and instrumental support were consistently identified by mothers as helping alleviate their fatigue during the first six weeks postpartum.

Prenatal care provides numerous maternal and infant health benefits, and it is more likely to be effective if women begin receiving care early and continue their care throughout pregnancy. Patient satisfaction is recognized as a predictor of adherence to medical recommendations and utilization of care. The purpose of this study was to identify the factors associated with pregnant women’s satisfaction with prenatal care in Winnipeg. A cross-sectional, descriptive, correlational design was used to examine the relationships between expectations, interpersonal processes of care, the quality of prenatal care, personal characteristics, and the type of provider with overall satisfaction, as well as with satisfaction with each of the following dimensions: information, provider care, staff interest, and system characteristics. Donabedian’s (2003) structure, process, and outcome framework guided the study. A convenience sample of 216 pregnant women from diverse socioeconomic backgrounds was surveyed using self-administered questionnaires in late third trimester; providers were obstetricians (58.2%), midwives (15.9%), family physicians (13.9%), nurse practitioners (4.8%), or mixed (7.2%). Multiple linear regression analyses were used to identify predictors of satisfaction. Perceived quality of care was a significant predictor of overall satisfaction and all the satisfaction subscales. The provider’s interpersonal style was a significant predictor in all but one of the satisfaction measures, satisfaction with information, where patient-centered decision-making was significant. The type of prenatal care provider (midwife) was a predictor of satisfaction with system characteristics. Expectations for prenatal care were unrelated to satisfaction. Although most of the participants in this study were satisfied with prenatal care, 5-20% reported dissatisfaction with various dimensions. The findings of this study have implications for future research, practice, education and policy. Important information on structure and process was generated, with the potential to improve the experience and satisfaction of women receiving prenatal care.

<p> The National Database of Nurse Quality Indicators (NDNQI) contains many nurse sensitive indicators for benchmarking adult medical/surgical patient outcomes but no perinatal nurse sensitive indicators. Project objectives were to form a collaborative, identify a perinatal nurse sensitive indicator, metrics that would contribute to its success and methods to measure and report them. The researcher developed a theoretical framework and three phase process to support the formation of the collaborative based on empowerment theory, collective impact and the Plan, Do, Study, Act cycle. Seven Midwest magnet organizations participated and identified breastfeeding as the indicator, along with three metrics that promote it: baby to breast in the first 60 minutes, non-separation of mom and baby, and skin-to-skin contact during the recovery period. Methods to document, measure and report metrics were developed and a database was selected for data comparison. While all objectives were met, only three organizations remained at project completion.</p>

No abstract available.

From an historical perspective, the maternity hospital has borne criticism in two major respects. Firstly it has been argued that the voluntary maternity hospital played a negligible, even harmful role in delivering women in childbirth and therefore cannot be regarded as having a positive influence on maternal mortality. Secondly, but not unrelated, is the widely held assumption that the maternity hospital was little more than an instrument of male medicalisation responsible for subordinating midwives and their patients to medical authority. Drawing evidence from hospital records (Board minutes, registers and annual reports) relating to Manchester, Liverpool, Sheffield, Birmingham and Newcastle, the thesis challenges both points of view. Using Manchester as a principal case study, it has been found that the city's two maternity hospitals, conducting both ward and home confinements, played a far more demographically significant role than previous estimates have allowed. By adopting those factors considered crucial determinants of low maternal mortality, 'free', 'accessible' care of 'a high standard', administered by a 'careful midwife' and a 'skilled doctor', the hospital's potential to influence local maternal mortality rates was formidable. The Manchester material is again used in the medicalisation debates, but much more relevant to this discussion are the findings at the Liverpool Maternity Hospital. Managed by the Ladies Committee, practices at the hospital refute the opinion that, women managing women's affairs, was to the greater good of their gender simply because they shared 'the same biological experience of femaleness ...'. Class interest also accounted for the women's involvement and the way they exercised their influence. The Liverpool material also provides, along with material from other provincial maternity hospitals, a detailed explanation of the medicalisation process so far as it effected maternity hospitals. It is only from the 1920s that the medicalisation of the institutions begin to have a detrimental effect on the confinement of women, but as the conclusions indicate, there was more to the maternity hospital by this date than forceps and sutures.

Squamous intraepithelial lesions (SIL) are believed to be precursors of in situ cervical neoplasia and of invasive cervical cancer. Though the burden of this disease has been greatly reduced thanks to the availability of an effective screening test, the worldwide morbidity and mortality remain high. / On the basis of a classic approach to analysis of data from a prospective cohort study, I correlated HPV status at enrollment with subsequent risk of incident SIL during up to three years of follow-up among women of Brazil enrolled to the Ludwig-McGill cohort. / The risk of occurrence of a first instance of SIL among women was strongly associated with HPV infection. After adjustment for a number of socio-demographic factors that have previously been established as risk factors for cervical cancer, the magnitude of association with high-risk HPVs remained unchanged while the association with low risk types was dampened, furthering the evidence for the role of oncogenic HPV types in the development of cervical cancer. / Parity was found to have an independent positive association with cervical precursor lesions, after adjustment for HPV status, age, previous history of Pap screening, number of sexual partners, age at first intercourse, and income. Income was also positively associated with the development of lesions.

Human papillomavirus (HPV) is the sexually-transmitted etiologic agent of cervical cancer. Despite screening programs, cervical cancer remains too common, particularly in developing countries. Various correlates of prevalent infections have been identified. However, the determinants of incident infections have never been studied. / Data were collected during a prospective cohort study conducted in Brazil. Incidence density rates of infection were calculated and determinants of incident infection were identified using Cox regression models. Analyses were done for HPV types classified into low-risk and high-risk depending on their association with cervical neoplasia. / The incidence density rates were 9.3 and 7.6 per 1000 women-months respectively for low-risk and high-risk HPV infection. Independent positive associations were found between the time of first occurrence of low-risk infection and age, number of sexual partners in the past 5 years, education level and use of non-commercial hygienic absorbents. The first occurrence of high-risk infection was independently predicted by age, age at first sexual intercourse, condom use (negative associations) and by the number of sexual partners in the past year (positive association). Elucidation of the dynamics of infection is a first step towards implementation of public health programs for reducing the risk of cervical cancer.

The purpose of this study was to assess the impact of a Maternity Cooperative Care Program (MCCP) on the prevalence of maternal and infant complications, maternal competence, social support, stress, and first-time-mothers' descriptions of their postpartum experience. Forty-one healthy, primiparous mothers who participated in a MCCP and forty-three healthy, primiparous mothers who received traditional maternity care were asked to complete the Perceived Competence Questionnaire, the Personal Resource Questionnaire, "The Help I Get" Questionnaire (spousal support), and three numerical rating scales relating to stress in general, as well as self- and infant-care stress 24-48 hours postpartum while in hospital and over the telephone at two weeks postpartum. Ten randomly selected mothers from each group also answered twelve open-ended questions during a home visit at 2-3 weeks postpartum. There were no statistically significant differences between the two groups for any of the outcome variables assessed. For both groups, competence with self- and infant-care increased over the two weeks postpartum, while support and stress remained stable. Interviews with the mothers revealed that the number of stressors increased once at home, while support continued to be of value in relieving stress and helping maternal adjustment and confidence. Results of a qualitative comparison between the groups suggests that the MCCP mothers felt more prepared to be discharged home, and identified their partner more often as an active participant during hospitalization.

A significant alteration in the pattern of secretion of gonadotropins is the hallmark of age-related loss of estrous cyclicity and reproductive capacity. Although various components of the reproductive axis contribute to altered gonadotropin secretion, neuroendocrine dysfunction is believed to play an important role in the age-related loss of estrous cyclicity in the rodent. Our studies examining the pituitary responsiveness to GnRH with age revealed that the pituitaries of C57BL/6J mice appear to be capable of sustaining normal endocrine function under appropriate stimulus even in old females. Thus we hypothesized that changes at the level of the hypothalamus may be responsible for the alteration in gonadotropin secretion. Our studies evaluating GnRH neuronal function demonstrated that there is no change in the capacity of GnRH neurons to release GnRH with age although the presence of the ovary appears to modulate the GnRH release. Neuroanatomical and pharmacological studies suggest that an age-related decline in the opiatergic influence is responsible, at least in part, for the altered GnRH release. Posttranslational processing of the opiate peptide, $ beta$-endorphin ($ beta$-endo) from its precursor proopiomelanocortin (POMC) and its further posttranslational modification determine the amount of opiate active and antagonist forms ultimately released at the synapse. We hypothesized that age-related alterations in the content of opiate active and antagonist forms of $ beta$-endo occur which contribute to the decline in opiatergic influences on reproductive function. Our data demonstrated that there is a significant increase in the opiate receptor inactive and antagonist forms of $ beta$-endo in middle aged but not in young or old mice. An important mechanism for the differential processing of $ beta$-endo in the anterior and intermediate lobes of pituitary in adult rodents and in the anterior lobe in neonates appears to lie in the relative levels of expression