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Summary Background: Pregnancy-related health education conveys basic information regarding healthy lifestyle choices and preventive healthcare in order to promote the health of the mother and foetus. Verbal education is supplemented frequently by means of healthpromotion leaflets. A pregnancy-related leaflet used in primary care clinics in Tshwane, South Africa titled: ‘Are you pregnant or planning to have a baby?’ was the focus of this research. Objectives: The study had two objectives, the first of which was to explore whether the English pregnancy leaflet improved the knowledge of young female adults with regard to maintaining their health and preventing complications during pregnancy. The second objective was to explore whether the literacy level of the young adult female had an effect on the efficacy of the English pregnancy leaflet. Method: The research design used was a pre-test post-test design. Two samples of 30 participants each, namely, a post-secondary and a tertiary sample, participated in the study. Self-report data were gathered with a questionnaire based on the leaflet. The quantitative data were analysed using descriptive statistics and a Pearson’s chi-square test. Findings: The findings indicated both samples’ prior knowledge regarding health maintenance, showing that prevention of complications during pregnancy was almost nonexistent and that the pregnancy leaflet did not improve their knowledge to an extent where they would be informed and knowledgeable about their health during pregnancy. Conclusion: An evidence base must be developed in order to support the development of behaviour changing material.

Maternal smoking during pregnancy is known to result in an increased incidence of intra-uterine growth retardation. This in part may be due to deleterious effects on the placenta, which is the conduit between the mother and fetus. This study was designed to investigate the effect of maternal smoking on placental function: morphometry, oxygen diffusive capacity, trace element content (zinc and cadmium), microvillous border membrane (MVBM) vesicle zinc and alanine uptake, and placental enzyme activity. The magnitude of maternal smoking and confounding factors were determined twice by questionnaire during pregnancy and confirmed by plasma cotinine; a total of 105 placentae were collected. Morphological changes in membrane thickness, and chrionic villi composition were observed with maternal smoking, however these changes were not great enough to affect the placental oxygen diffusive conductance. Placental cadmium content increased with maternal smoking and also correlated with placental zinc content. There was no correlation for cadmium or zinc with placental metallothionein. MVBM vesicle uptake of zinc exhibited no differences between smoking and non-smoking groups. Similarly, MVBM vesicle sodium-independent alanine uptake exhibited no difference, however sodium-dependent alanine uptake was greater in the smoking group. Placental cytochrome P450 ethoxyresorufin-O-deethylase activity was greater in the smoking group placentae compared to the non-smoking group, however quinone reductase activity was unaffected by maternal smoking. The overall findings of this study extend knowledge regarding the impact of maternal smoking on placental function and support current clinical advice for pregnant mothers to stop smoking during pregnancy.

M.Tech.

MMed, Community Health, Faculty of Health Sciences, University of the Witwatersrand, 2009 / Introduction Adverse outcomes of pregnancy are global health problems that are much more pronounced in developing countries. The risk factors associated with adverse outcomes of pregnancy are multifactorial. In South Africa, the population prevalence and associated risk factors of maternal and perinatal mortality are routinely documented, but there are gaps in the data on other pregnancy adverse outcomes. This study was aimed at determining the prevalence rates and related risk factors of preterm births and pregnancy loss in an urban population in South Africa. Methods The study was a cross-sectional analytical community study of women 18 to 49 years of age, living in the Potchefstroom municipality. It was conducted from August 2007 to April 2008. Participants were selected using a systematic random sampling strategy; 1 210 women participated. An adapted reproductive health questionnaire was used to collect sociodemographic, environmental, occupational and reproductive health data. Results Prevalence of pregnancy loss and preterm births were estimated to be 5.6% [95% CI: 5.57% - 5.63%] and 13.4% [95% CI: 13.36% - 13.44%], respectively. Pregnancy loss was associated with psychological stress and working during pregnancy; preterm birth was associated with White, Coloured and Indian race, primary and high school education, psychological stress and chronic disease; and antenatal care use was protective against both pregnancy loss and preterm birth. Conclusion The prevalence of pregnancy loss found in this study was lower than would be expected in the general South African population; while the preterm birth prevalence, although lower than that of other developing and middle income countries, could be improved. Generally, there are common risk factors for pregnancy loss and for preterm births. Some of the existing evidence on risk factors was supported by the findings of this study. Improvement of surveillance and health information systems for pregnancy loss and preterm births would provide essential information on the burden of these outcomes in South Africa and would subsequently guide policy, research and prioritisation of effective control programmes.

Background and objectives In low resource settings, ultrasound scans may not be available for amniotic fluid volume (AFV) assessment as part of fetal evaluation for suspected prolonged pregnancies (≥41 weeks’ gestation). The objectives of this study were: 1) to describe AFV measurements using ultrasound in women with suspected prolonged pregnancies, and to relate these measurements to maternal and fetal factors; 2) to evaluate different clinical palpation methods for estimating AFV; and 3) to determine the ability of clinical palpation to estimate AFV and predict oligohydramnios, using ultrasound-based amniotic fluid index (AFI) as a gold standard, accounting for the influence of maternal and fetal factors. Methods The study included women referred to Chris Hani Baragwanath Academic Hospital from midwife-run antenatal clinics because of concern about prolonged pregnancy (gestational age ≥41 weeks). On arrival at hospital, the women had real-time ultrasound assessment of AFI by an experienced ultrasonographer. The researcher, blinded to the AFI result, estimated AFV by abdominal palpation using ballottability of fetal parts, uterine fluctuance, uterine irritability, easily felt fetal parts, and a general impression of AFV. After recording the palpation findings, the researcher made a best estimate of gestational age for each woman based on the last menstrual period, early pregnancy ultrasound scans if available, or other relevant clinical information. Oligohydramnios was defined as an AFI <5 cm. Results One hundred women participated, of whom 45 had a best estimate gestational age ≥41 weeks. The mean AFI was 8.1±4.3 cm; 23 women had an AFI <5 cm. Twenty women were HIV infected. In univariable and multivariable linear regression analysis, HIV infection and gestational age were inversely associated with AFI at a P value <0.05. On abdominal palpation, the symphysis-fundal height, uterine fundal fetal parts ballottement, and presenting part ballottement were significantly positively associated with AFI on univariable and multivariable linear regression analysis. For the binary outcome of oligohydramnios, only presenting part ballottement was associated with an AFI <5 cm (negatively), both crudely, and adjusted for gestational age and HIV infection using logistic regression analysis. For women with a fetal head fully palpable (‘five fifths’) above the pubic symphysis (n=55), an inability to ballot the presenting part had a sensitivity of 73%, specificity of 64%, and a negative predictive value of 90% for an AFI <5 cm. Conclusion While fetal part ballottement and symphysis-fundal height measurement showed significant associations with AFI, the predictive value of clinical palpation for oligohydramnios was poor. However, in settings where real-time ultrasound technology is unavailable, the assessment of presenting part ballottement may be of value in women with suspected prolonged pregnancy. In clinical settings similar to those in this study, a ballottable fetal head gives 90% assurance of normal AFV.

Digitized by Kansas Correctional Industries

Thesis (Ed.M.)—Boston University

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