Our ultimate goal as obstetric and neonatal care providers is to improve care for mothers and their babies. Continuous quality improvement (CQI) involves iterative cycles of practice change and audit of ongoing clinical care identifying practices that are associated with good outcomes. A vital prerequisite to this evidence based medicine is data collection. In Canada, much of the country is covered by separate fragmented silos known as regional reproductive care databases or perinatal health programs. A more centralized system which includes collaborative efforts is required. Moving in this direction would serve many purposes: efficiency, economy in the setting of limited resources and shrinking budgets and lastly, interaction among data collection agencies. This interaction may facilitate translation and transfer of knowledge to care-givers and patients. There are however many barriers towards such collaborative efforts including privacy, ownership and the standardization of both digital technologies and semantics. After thoroughly examining the current existing perinatal data collection among Perinatal Health Programs (PHPs), and the Canadian Perinatal Network (CPN) database, it was evident that there is little standardization of definitions. This serves as one of the most important barriers towards data sharing. To communicate effectively and share data, researchers and clinicians alike must construct a common perinatal language. Communicative tools and programs such as SNOMED CT® offer a potential solution, but still require much work due to their infancy. A standardized perinatal language would not only lay the definitional foundation in women’s health and obstetrics but also serve as a major contribution towards a universal electronic health record.

While the concept of regional organization (regionalization) of perinatal care aimed at reducing perinatal mortality has remained at the agenda of developed countries since 1970&rsquo / s, Turkey is one of the countries that does not have such a system yet. In this study, a three-level hierarchical location-allocation model is developed for the regionalization of perinatal care in an attempt to have a better distribution of maternal and perinatal health care services in Turkey. Since the mathematical model developed is difficult to solve in a reasonable time, we propose three heuristic approaches: top-down, modified top-down and Lagrangean relaxation based heuristics. These heuristics are computationally tested on a set of problem instances for networks ranging from 10 to 737 vertices. A significant result is that Lagrangean relaxation based heuristic outperforms the other two heuristics in terms of solution quality. In most of the test problems, the modified top-down heuristic outperforms the top-down heuristic in terms of solution quality. Using the proposed approaches, we solve a real life problem corresponding to the Eastern and South Eastern Anatolian Regions (the East Region) of Turkey.

El bajo peso del recién nacido, es considerado como un indicador general de salud en los países en vías de desarrollo, de allí la importancia de obtener los factores que más influyen en el bajo peso al nacer. Utilizamos el análisis de Regresión Logística para clasificar a los recién nacidos en dos grupos: bajo peso al nacer y peso normal al nacer. El estudio se basa en todos los pacientes que se atendieron en el Instituto Materno Perinatal durante los meses de Enero a Junio del presente año. El presente trabajo no se limita a la estimación de parámetros del modelo; se realiza la validación de supuestos, evaluación de la bondad de ajuste del modelo, análisis de los residuos, detectar observaciones influyentes y finalmente la evaluación de la capacidad predictiva del modelo propuesto. / The low weight of the recent born, is considered like a general indicator of health in developing countries, of there the importance of obtaining the factors with more influence in the low weight when being born. We used the analysis of Logistic Regression to classify to the recent born in two groups: low weight when being born and normal weight when being born. The study is based on all the patients who were taken care of in Perinatal Maternal Institute during the months from January to June of the present year. The present work is not limited to the estimation of parameters of the model; it is made the validation of assumptions, evaluation of the kindness of adjustment of the model, analysis of the residues, to detect influential observations and finally the evaluation of the predictive capacity of the proposed model.

Thesis (M.N.)--Memorial University of Newfoundland, School of Nursing, 2001. / Typescript. Bibliography: leaves 138-148.

Resume af ph.d afhandling, Uppsala Universitet.

During the latest decade Somali-born women with experiences of long-lasting war followed by migration have increasingly encountered Swedish maternity care, where antenatal care midwives are assigned to ask questions about exposure to violence. The overall aim in this thesis was to gain deeper understanding of Somali-born women’s wellbeing and needs during the parallel transitions of migration to Sweden and childbearing, focusing on maternity healthcare encounters and violence. Data were obtained from medical records (paper I), qualitative interviews with Somali-born women (II, III) and Swedish antenatal care midwives (IV). Descriptive statistics and thematic analysis were used. Compared to pregnancies of Swedish-born women, Somali-born women’s pregnancies demonstrated later booking and less visits to antenatal care, more maternal morbidity but less psychiatric treatment, less medical pain relief during delivery and more emergency caesarean sections and small-for-gestational-age infants (I). Political violence with broken societal structures before migration contributed to up-rootedness, limited healthcare and absent state-based support to women subjected to violence, which reinforced reliance on social networks, own endurance and faith in Somalia (II). After migration, sources of wellbeing were a pragmatic “moving-on” approach including faith and motherhood, combined with social coherence. Lawful rights for women were appreciated but could concurrently risk creating power tensions in partner relationships. Generally, the Somali-born women associated the midwife more with providing medical care than with overall wellbeing or concerns about violence, but new societal resources were parallel incorporated with known resources (III). Midwives strived for woman-centered approaches beyond ethnicity and culture in care encounters, with language, social gaps and divergent views on violence as potential barriers in violence inquiry. Somali-born women’s strength and contentment were highlighted, and ongoing violence seldom encountered according to the midwives experiences (IV). Pragmatism including “moving on” combined with support from family and social networks, indicate capability to cope with violence and migration-related stress. However, this must be balanced against potential unspoken needs at individual level in care encounters.With trustful relationships, optimized interaction and networking with local Somali communities and across professions, the antenatal midwife can have a “bridging-function” in balancing between dual societies and contribute to healthy transitions in the new society.

Background The Millennium Development Goals call for two-third and three-quarter reductions in Perinatal Mortality Rates and Maternal Mortality Ratios. The main strategy towards achieving these reductions is to increase access to skilled attendance. However, it cannot be confirmed that all health professionals are skilled in managing women in labour, nor that they are functioning in enabling environments. To measure the provision of skilled attendance, this study was undertaken in five Level 1 Hospitals in the uThungulu Health District of KwaZulu-Natal. The objectives of the study were: 1. To establish perinatal outcomes for each Level 1 Hospital in uThungulu Health District. 2. To evaluate the quality of intrapartum care provided in Level 1 Hospitals in uThungulu Health District. 3. To evaluate the obstetric knowledge of health workers attending births in Level 1 Hospitals in uThungulu Health District. 4. To evaluate the obstetric skills of health workers attending births in Level 1 Hospitals in uThungulu Health District. 5. To evaluate the environment in which births are attended in Level 1 Hospitals in uThungulu Health District. 6. Compare the quality of care, the knowledge, skills and environment with perinatal outcomes. Methods Perinatal outcomes (PNMR, FSBR, ENNDR and PCI) were calculated for each hospital; maternity case records of women who have delivered in these Level 1 Hospitals were audited to assess the quality of intrapartum care; obstetric knowledge and skills of midwives were assessed; as was the enabling environment within which midwives worked, which included a measurement of their workload. A correlation between perinatal outcomes and the quality of intrapartum care, knowledge and skills and the enabling environment was performed to determine whether variables were associated. Results The overall PNMR for five hospitals in uThungulu Health District was 31 per 1000 births. Three hospitals demonstrated PNMRs below 30 per 1000, while the other two showed rates above 45 per 1000. The combined FSBR for the five hospitals was 6 per 1000 births, the combined ENNDR was 12 per 1000 live births. The PCI in all hospitals ranged between 3 and 4. An audit of maternity case records revealed that all hospitals have a high overall mean percentage score per record. However, analysis of subsets showed good performance in recordings on the labour graph, but poor performance in the admission assessment and in the management of labour. The Kruskal-Wallis Non-Parametric Test showed a statistically significant difference in overall scores amongst hospitals (p=0.01), suggesting differences in performance in all five hospitals in terms of the quality of care provided. Overall, all hospitals scored poorly on tests of obstetric knowledge and skills. There were no statistically significant differences in the overall knowledge median scores and subsets median scores amongst hospitals (p=0.07), indicating that all five hospitals performed on a similar level in terms of obstetric knowledge. However, all hospitals performed differently in relation to obstetric skills, as there was a statistically significant difference in the overall skill median scores amongst hospitals (p=0.002). Three hospitals met the enabling environment standard. All hospitals but one scored poorly on referral, and the availability of supervision on both shifts. One hospital scored poorly on drugs and supplies. Overall no hospitals reported the presence of all the elements of the enabling environment. Three hospitals had acceptable workloads. No association could be detected between variables. However, there were trends that can be traced in different hospitals. Conclusions In South Africa, from the Demographic and Health Survey, 84% of deliveries are assisted by skilled attendant. While an attendant may be present, one cannot say that skilled attendance has been provided, as it has been shown for uThungulu Health District. / Thesis (MMed.)-University of KwaZulu-Natal, Durban, 2010.

Our ultimate goal as obstetric and neonatal care providers is to improve care for mothers and their babies. Continuous quality improvement (CQI) involves iterative cycles of practice change and audit of ongoing clinical care identifying practices that are associated with good outcomes. A vital prerequisite to this evidence based medicine is data collection. In Canada, much of the country is covered by separate fragmented silos known as regional reproductive care databases or perinatal health programs. A more centralized system which includes collaborative efforts is required. Moving in this direction would serve many purposes: efficiency, economy in the setting of limited resources and shrinking budgets and lastly, interaction among data collection agencies. This interaction may facilitate translation and transfer of knowledge to care-givers and patients. There are however many barriers towards such collaborative efforts including privacy, ownership and the standardization of both digital technologies and semantics. After thoroughly examining the current existing perinatal data collection among Perinatal Health Programs (PHPs), and the Canadian Perinatal Network (CPN) database, it was evident that there is little standardization of definitions. This serves as one of the most important barriers towards data sharing. To communicate effectively and share data, researchers and clinicians alike must construct a common perinatal language. Communicative tools and programs such as SNOMED CT® offer a potential solution, but still require much work due to their infancy. A standardized perinatal language would not only lay the definitional foundation in women’s health and obstetrics but also serve as a major contribution towards a universal electronic health record.

GB virus C (GBV-C) is a common, apathogenic virus that can inhibit human immunodeficiency virus (HIV) replication in vitro. Persistent coinfection with GBV-C has been associated with improved survival among HIV-infected adults while loss of GBV-C viremia has been associated with poor survival. If GBV-C does inhibit HIV replication, it is possible that GBV-C infection may reduce mother-to-child-transmission (MTCT) of HIV. This study investigated whether maternal or infant GBV-C infection was associated with reduced MTCT of HIV infection. The study population consisted of 1,783 pregnant women from three Bangkok perinatal HIV transmission studies (1992-94, 1996-7, 1999-2004). We tested plasma collected at delivery for GBV-C RNA, GBV-C antibody, and GBV-C viral genotype. If maternal GBV-C RNA was detected, the four- or six-month infant specimen was tested for GBV-C RNA. Rates of MTCT of HIV in GBV-C-infected and GBV-C-uninfected women and infants were compared using multiple logistic regression as were associations with MTCT of GBV-C and prevalence of GBV-C infection. The prevalence of GBV-C infection (i.e. presence of RNA or antibody) was 33% among HIV-infected women and 15% among HIV-uninfected women. Forty-one percent of GBV-C-RNA-positive women transmitted GBV-C to their infants. Only two of 101 (2.0%) GBV-C-RNA-positive infants acquired HIV infection compared to 162 (13.2%) of 1,232 of GBV-C-RNA-negative infants (RR 0.15, p<0.0001). This association remained after adjustment for maternal HIV viral load, antiretroviral prophylaxis, CD4+ count and other covariates. MTCT of HIV was not associated with presence of maternal GBV-C RNA or maternal GBV-C antibody. Maternal receipt of antiretroviral therapy was associated with increased MTCT of GBV-C, as was high GBV-C viral load, vaginal delivery and absence of infant HIV infection. GBV-C infection among women was independently associated with more than one lifetime sexual partner, intravenous drug use and HIV-infection. We observed a higher prevalence of GBV-C infection among HIV-infected compared to HIV-uninfected pregnant women in Thailand, likely due to common risk factors. Antiretroviral therapy appears to increase MTCT of GBV-C. Infant GBV-C acquisition, but not maternal GBV-C infection, was significantly associated with reduced MTCT of HIV. Mechanisms for these later two associations are unknown. / Bhanich Supapol W, Remis RS, Raboud J, Millson M, Tappero J, Kaul R, Kulkarni P, McConnell MS, Mock PA, Culnane M, McNicholl J, Roongpisuthipong A, Chotpitayasunondh T, Shaffer N, Butera S. 2008. Reduced mother-to-child transmission of HIV associated with infant but not maternal GB virus C infection. J Infect Dis 197(10):1369-1377. Bhanich Supapol W, Remis RS, Raboud J, Millson M, Tappero JW, Kaul R, Kulkarni P, McConnell MS, Mock PA, McNicholl JM, Vanprarar N, Asavapiriayanont S, Shaffer N, Butera ST. 2009. Mother-to-child transmission of GB virus C in a cohort of women coinfected with GB virus C and HIV in Bangkok, Thailand. J Infect Dis 200:227-235.

El bajo peso del recién nacido, es considerado como un indicador general de salud en los países en vías de desarrollo, de allí la importancia de obtener los factores que más influyen en el bajo peso al nacer. Utilizamos el análisis de Regresión Logística para clasificar a los recién nacidos en dos grupos: bajo peso al nacer y peso normal al nacer. El estudio se basa en todos los pacientes que se atendieron en el Instituto Materno Perinatal durante los meses de Enero a Junio del presente año. El presente trabajo no se limita a la estimación de parámetros del modelo; se realiza la validación de supuestos, evaluación de la bondad de ajuste del modelo, análisis de los residuos, detectar observaciones influyentes y finalmente la evaluación de la capacidad predictiva del modelo propuesto. / --- The low weight of the recent born, is considered like a general indicator of health in developing countries, of there the importance of obtaining the factors with more influence in the low weight when being born. We used the analysis of Logistic Regression to classify to the recent born in two groups: low weight when being born and normal weight when being born. The study is based on all the patients who were taken care of in Perinatal Maternal Institute during the months from January to June of the present year. The present work is not limited to the estimation of parameters of the model; it is made the validation of assumptions, evaluation of the kindness of adjustment of the model, analysis of the residues, to detect influential observations and finally the evaluation of the predictive capacity of the proposed model.