Homoeopathy is a system of medicine used in obstetric prescribing to reduce the minor common complications of pregnancy (Cure, 1999). One such complication is haemorrhoids. Haemorrhoids are varicosities of the haemorrhoidal plexus in the rectum, and are often complicated by inflammation, thrombosis and haemorrhage (Beers & Berkow, 1999). The aim of the study was to determine the effect of homoeopathic similimum treatment on haemorrhoids in pregnant women. This was a quantitative, interventive and descriptive study spanning one month. The research method used homoeopathic similimum treatment and a participant administered questionnaire in a panel longitudinal, in-depth case study. Non-probability purposive sampling was used to select 12 primigravida or multigravida pregnant females, aged 18-35, from the 12th to 35th week of gestation, presenting with haemorrhoids, who met the inclusion criteria. The sample was obtained by advertisements placed in antenatal classes, private clinics and pharmacies; and by pamphlets handed out at Baby City shops and baby expositions to pregnant women; and referrals from health care providers. The similimum medicine was selected after an initial consultation and physical examination. The symptoms of the initial consultation were noted on a case taking form. The similimum medicine was prescribed in potency between 5CH and 200CH. Dosage was determined by the laws of similimum prescribing. Questionnaires relating to the patients symptoms were completed by the patient daily during the duration of the study. A follow up consultation and physical examination was conducted at the end of the 2nd week of treatment. As indicated by the symptoms at the follow up consultation, a new similimum was prescribed; the original similimum was continued; or it was decided to wait and watch the action of the medicine in the participant if there were signs of improvement. A final consultation and physical examination was conducted at the end of the 4th week of treatment to document the effectiveness of the treatment. The questionnaire was collected. The symptoms of both follow up consultations were noted on a follow up form. Data obtained from the questionnaires were analysed. An ordinal regression, time 1 vs. time t - 1 analysis, regression using sums and a reliability analysis were performed. The data from the individual consultations were used to write up an in depth case study. Eighty three percent (10/12) of the cases of haemorrhoids in pregnancy improved on homoeopathic similimum treatment. Homoeopathic similimum medicine had a significant effect on decreasing the severity of the pain (p < 0.00) and protrusion (p < 0.00). Besides the improvement to the haemorrhoids, there were also signs of improvement to some of the concomitant symptoms experienced by the participants. In conclusion, homoeopathic similimum treatment within a clinical setting is effective in relieving the symptoms of haemorrhoids in pregnant women. Further research needs to be conducted in order to verify these findings. / Dr. Candice Bodkin Dr. Elizabeth Solomon

Pregnancy loss, the demise of a pregnancy at any time between implantation and delivery, is a common event in women’s lives, affecting approximately one in three pregnancies. Pregnancy loss often causes profound psychological distress to women, their partners, and their families. However, despite its frequency and troubling nature, relatively little is known about the natural history of pregnancy loss, especially the multitude of signs and symptoms that precede a loss and distinguish it from an ongoing healthy pregnancy. One of the challenges in describing the natural history of pregnancy loss is that most losses occur very early, before entry to clinical care, necessitating the use of preconception cohort studies. Few such studies have ever been conducted worldwide. This dissertation aimed to describe the natural history of early pregnancy loss at <20 weeks gestation for the first time using a unique preconception cohort with daily prospective follow-up from the start of the pregnancy attempt through seven weeks post-conception. To accomplish this goal, three specific aims were undertaken. First, a systematic literature review was conducted to synthesize the existing literature on the relationships between the signs and symptoms and pregnancy loss. Two analytic aims were then undertaken to delineate thoroughly the relationships between prospectively ascertained signs and symptoms—namely, vaginal bleeding, lower abdominal cramping, nausea and vomiting (hereafter referred to as “signs and symptoms”)—and subsequent early pregnancy loss. The first analytic aim used a fixed covariate and fixed effect survival analytic approach to estimate the cumulative incidence of early pregnancy loss by the presence of individual, combinations, and patterns of signs and symptoms and the associations between signs and symptoms and the cumulative incidence of pregnancy loss. The second analytic aim used a time-varying covariate and time-varying effect survival analytic approach to estimate the weekly associations between signs and symptoms and pregnancy loss to determine if these relationships were consistent or divergent across gestational ages. The results of the first and second analytic aims were then compared to gain a more complete understanding of the natural history of early pregnancy loss. The literature review revealed a dearth of studies on the signs and symptoms of pregnancy loss. Two preconception and 16 pregnancy cohort studies were identified. The literature suggested that vaginal bleeding, particularly heavy vaginal bleeding, was associated with an increased risk of pregnancy loss while vomiting, and in some studies nausea, was associated with a decreased risk of pregnancy loss. However, reliance on care-seeking cohorts, maternal retrospective reports of signs and symptoms after pregnancy loss, and retrospective recall of signs and symptoms over long periods (e.g., entire trimesters) may have biased the observed associations between signs and symptoms and pregnancy loss leading to incorrect inferences regarding the relationships between signs and symptoms and pregnancy loss. The two analytic aims addressed the data gaps identified in the literature review. The preconception cohort design with prospective daily follow-up from the beginning of the pregnancy attempt facilitated the ascertainment of pregnancies at the earliest stages of gestation and losses prior to clinical care entry through the use of urine-based home pregnancy testing. The daily reporting of multiple signs and symptoms in the first five weeks after a positive home pregnancy test, or approximately two to seven weeks post-conception, allowed for a full description of the relationships between signs and symptoms of pregnancy loss without recall bias. Data for the two analytic aims come from the Longitudinal Investigation of Fertility and the Environment (LIFE) Study, a population-based cohort with preconception recruitment of couples in 16 counties in Michigan and Texas followed for 12 months of trying for pregnancy and then through pregnancy loss or delivery for couples achieving an hCG pregnancy. 501 couples entered the study, and 347 achieved a pregnancy during the study period. Three hundred forty-one singleton pregnancies comprise the study population for the two analytic aims in this dissertation. Overall, 95 (28%) pregnancies in the study population ended in a pregnancy loss. Lower abdominal cramping, nausea, and vomiting were often reported during the early pregnancy period; vaginal bleeding was less common. The results of the fixed covariate fixed effect survival analysis from the first analytic aim demonstrated that vaginal bleeding, particularly heavy bleeding and bleeding accompanied by lower abdominal cramping, was associated with an increased risk of pregnancy loss. In contrast, the presence of vomiting, but not nausea alone, during the early pregnancy period was associated with a lower risk of loss. Analyses in the second analytic aim using weekly time-varying covariates and time-varying effects of signs and symptoms on pregnancy loss revealed some new findings. The first week after a positive pregnancy test appeared to be a vulnerable period. Vaginal bleeding and lower abdominal cramping were associated with an increased risk of loss in the first week but not in later weeks; conversely, nausea and/or vomiting were associated with lower risk of pregnancy loss but only after the first week. The observed weekly variations in the signs and symptoms of pregnancy loss may reflect changes in maternal adaptation to pregnancy across gestation. Overall, relatively little is known about the biological processes underlying healthy and unhealthy adaption to pregnancy as well as how embryo quality may affect these adaptive processes. More work is required from basic scientists, clinicians and epidemiologists to better understand the causes of signs and symptoms and their relationships to pregnancy loss, including genetic and environmental factors and their interactions. In the meantime, prognostic models developed from data in this dissertation using time-varying signs and symptoms may be useful to women and their health care providers for identifying pregnancies at increased risk for pregnancy loss. These models could prompt women to seek medical care when concerning patterns of signs and symptoms arise.

No description available.

Increased levels of oestrogen and progesterone during pregnancy may lead to periodontal disease. The anaerobic Gram-negative bacteria called red complex (Porphyromonas gingivalis, Tannerella forsythensis and Treponema denticola) are frequently associated with periodontal disease. Periodontopathogens produce toxins and enzymes which can enter the bloodstream and cross the placenta to harm the foetus. The response of the mother&rsquo / s immune system to infection by these periodontopathogens, brings about the release of inflammatory mediators which may trigger preterm labour or result in low birth-weight infants. The purpose of this study was to examine the prevalence of red complex, using BANA and PCR in subginginval plaque samples from pregnant women. Subgingival plaque samples were obtained from pregnant women between the ages of 17 to 45 years attending a Mitchells Plain ante-natal clinic. Plaque samples were analyzed by the enzymatic BANA-test for detection of the presence of red complex and DNA was extracted and analyzed using 16 rDNA-Polymerase Chain Reaction (PCR).<br /> <br /> Seventy-nine percent of pregnant women showed gingival index scores of &ge / 1 of which 74.24% harboured by at least one of the members of the red complex. P.gingivalis was the most prevalent of the three members of the red complex. Findings of this study confirmed a need for dental preventive measures in pregnant women and microbial monitoring of suspected periodontopathogenes. This could be achieved by joint cooperation between Maternity Obstetric Units (MOU), Dentistry and oral microbiology departments. The results of this study revealed that although PCR is more sensitive than BANA in detecting members of the red complex, BANA showed a better association with the indices used to diagnose periodontal disease.

Depression occurs in approximately 20% of pregnant women, and up to 25% of them experience anxiety. Several pregnancy complications and labour and delivery outcomes have been associated with antenatal depression and anxiety, such as higher rates of nausea and vomiting, bleeding, psychosomatic complaints, preterm labour and delivery complications. Neonatal outcomes include lower Apgar scores, shorter gestation, smaller head circumference, and increased admissions to the neonatal intensive care unit. Research Questions: 1. To examine the prevalence of pregnancy complications and neonatal outcomes in this study sample. 2. To examine whether there is a difference in the association between observed pregnancy complications and neonatal outcomes and major depression, when depression is episodic compared to when the depression is continuous. 3. To examine whether there is a difference in the association between observed pregnancy complications and neonatal outcomes and mild depression, when the mild depression is episodic compared to when it is continuous. 4. To examine whether there is a difference in the association between observed pregnancy complications and neonatal outcomes and anxiety, when anxiety is episodic compared to when it is continuous. Methods: The data for this study was collected for the Feelings in Pregnancy and Motherhood Study (FIP). This population-based study interviewed 649 participants three times: in the second trimester, the third trimester, and in the early postpartum. Participants were screened for depression and anxiety with the Edinburgh Postnatal Depression Scale (EPDS), using the validated cut-off scores of >12 and >4 respectively. Sociodemographic data as well as detailed risk behaviours, and sources of stress and coping, were explored. Finally, pregnancy, labour and delivery and neonatal complications were collected. Descriptive and multivariate logistic regression analyses were completed. Results: Major depression in the second trimester was significantly associated with gestational diabetes (OR: 3.518; 95% CI 1.56, 7.93) and swelling/edema (OR: 2.099; 95% CI 1.13, 3.89). Major depression that occurred continuously throughout pregnancy was significantly associated with induced labour (2.417; 95% CI 0.99, 5.92) and antenatal bleeding/abruption (OR: 2.099; 95% CI 1.13, 3.89). Anxiety in the second trimester was significantly associated with caesarean birth (OR: 0.522; 95% CI 0.29, 0.95). Anxiety occurring continuously throughout pregnancy was significantly associated with swelling/edema (OR: 1.816; 95% CI 1.19, 2.77) and there was a significant interaction between age and anxiety that predicted epidural use during pregnancy: while age decreased in the participants who had anxiety in both trimesters, the likelihood of using an epidural increased. Finally, mild depression in the second trimester was significantly associated with antenatal bleeding/abruption (OR: 2.124; 95% CI 1.09, 4.14) and PROM (OR: 2.504; 95% CI 1.04, 6.05). Mild depression in the third trimester was associated with caesarean birth (OR: 0.298; 95% CI 0.10, 0.86). Mild depression that occurred continuously throughout pregnancy was significantly associated with the use of vacuum/forceps in delivery or an operative delivery (OR: 4.820; 95% CI 1.10, 21.16). Conclusions: These results show that episodic depression and anxiety can have a more profound impact on pregnancy complications and labour and delivery outcomes than continuous depression and anxiety. Furthermore, the results demonstrate that even mild depression can have a significant negative impact on pregnancy complications and labour and delivery outcomes. These results further highlight the imperative need for women to be screened and treated for depression and anxiety during pregnancy.

M.Tech. / Homoeopathy is considered to be a safe and effective modality of treatment for various ailments commonly encountered during pregnancy, such as constipation, exhaustion, pyrosis, backache, haemorrhoids, and varicose veins (Castro, 2004; Rothenberg, 2004). Pyrosis is defined as a burning sensation in the epigastric and sub-sternal region, which may radiate to the neck, throat, back and even the face, with rising of acid liquid from the stomach (Beers & Berkow, 1999; O’Toole, 2003). Pyrosis affects up to 85% of pregnant woman, the aetiology being complex and multi-factorial (Broussard & Richter, 1998; Page & Percival, 2000; Richter, 2005). The aim of the study was to determine the effect of homoeopathic similimum treatment on the frequency and severity of pyrosis during pregnancy, and also on the frequency which other antacid medication was taken. A qualitative, interventive, and descriptive study was conducted monitoring twelve participants over a period of five weeks. Non-probability purposive sampling was employed to select twelve pregnant women between 12-34 weeks gestation, suffering from pyrosis, and met the inclusion criteria for the study. Participants were recruited through referrals from midwives and advertisements placed in pharmacies and health stores. The participants evaluated their own symptoms on a daily questionnaire, recording how often they suffered from pyrosis, and also rating the severity of their discomfort. The questionnaire was completed for one week prior to treatment, and then for four weeks during which the participant received homoeopathic similimum treatment. The researcher interviewed each participant during three consultations. A thorough homoeopathic case history was taken during the initial consultation, capturing the totality of the participants’ symptoms on a case study form. After evaluation of the symptoms and repertorisation, a homoeopathic similimum remedy was prescribed. The choice of dosage and potency was individualized to the participant according to homoeopathic principles. A follow-up consultation was conducted after two weeks of treatment. During the follow-up consultation the participants’ symptoms were recorded on a follow-up sheet and their response to the treatment was evaluated. Where indicated the treatment was continued as before, the similimum remedy changed if indicated by a change in symptoms, or treatment stopped when no longer necessary. A final consultation was conducted after another two weeks. The symptoms were again recorded on a follow-up sheet, and the effectiveness of the similimum treatment was then evaluated. The data from the consultations were used to write in-depth case studies representing a qualitative evaluation of the study, based on the subjective experience of symptoms by the participants. Quantitative data was obtained from the daily questionnaires, and represented graphically. The means for all twelve cases, relating to the frequency and severity of pyrosis during the time of the study, were obtained from this data, and represented on bar graphs. From the case studies and questionnaires it was determined that there was an improvement in all twelve of the cases studied. All the participants, except for case five, eight, and nine, experienced improvement in the frequency that pyrosis was experienced. There was improvement of the severity of the symptoms in all twelve case studies. In case five, eight, and nine, the frequency of the symptoms of pyrosis didn’t decrease, but there was amelioration of the severity of the symptoms. In several cases there was also improvement of other concomitant symptoms and participants reported an overall improvement of their health. In case three the symptoms were no longer present after the first two weeks of treatment. No further treatment was required, and the participant remained symptom free for the remainder of her pregnancy. In all of the other cases the participants still continued to experience symptoms, but less frequently and suffered less discomfort. The symptoms were typically ameliorated when the prescribed remedy was taken. Provisional findings suggest that homoeopathic similimum treatment may be effective in managing pyrosis during pregnancy.

Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg / Background and objectives Prelabour rupture of the membranes (PROM) is a major obstetric problem affecting about 20% of pregnancies. Complications include preterm labour, ascending intrauterine and perinatal infections, and neonatal mortality. Standard guidelines are formulated and continually reviewed to improve the clinical management of PROM and to reduce poor perinatal outcomes associated with this condition. The objectives of this study, conducted using women in Johannesburg as a sample population, were: 1) to audit the implementation of the standard protocol on management of PROM, and 2) to determine the maternal and fetal outcomes of this condition. Methods A cross-sectional descriptive study was done on women admitted to the antenatal wards of Chris Hani Baragwanath Academic Hospital with PROM. Inclusion criteria were that PROM was the main reason for admission, gestation ≥24 weeks, and maternal age 18 years or more. Hospital clinical files were studied for obstetric and clinical characteristics, adherence by doctors to the management protocol, and final outcome including latency period, induction rate, mode of delivery, and neonatal outcome. Results Ninety-seven women participated in the study. Their mean age was 27.0 years, and 37 (38%) were nulliparous. Eighty-five (87%) had attended antenatal clinic. Twenty-nine (30%) were HIV-infected, 23 (79%) of them on highly active antiretroviral treatment. 6 The mean gestational age on admission was 32.8 weeks, with 78 (80%) women having preterm PROM at GA<37 weeks and 52 (54%) at GA <34 weeks. The most frequent methods of diagnosis were visual inspection in 77 (79%), speculum examination in 49 (51%) and ultrasound scan in 81 (84%) of the women. Antibiotics were given to 96 women (99%), and antenatal corticosteroids were used in all women <34 weeks pregnant. No cases of clinical chorioamnionitis were detected. The mean latency from PROM to delivery for women <37 weeks pregnant was 15 days, and for those <34 weeks, it was 19 days. Twenty-nine women (30%) required induction of labour, and 25 (25.8%) had caesarean sections. There were 12 perinatal deaths (with the exclusion of three late neonatal deaths), resulting from prematurity (n=4), congenital anomalies (n=2), neonatal jaundice (n=2), respiratory distress syndrome (n=2) and perinatal asphyxia / hypoxic ischaemic encephalopathy (n=2). There were no recorded cases of either neonatal or puerperal sepsis. Conclusion The study may have under-represented term PROM, so the findings are most applicable to preterm PROM. The condition was mostly managed appropriately within the local protocol, especially in terms of corticosteroid and antibiotic use. Overt or clinically evident chorioamnionitis was not detected. However, the perinatal mortality rate was high, and whatever the causes of perinatal death in this group, it is clear that PROM is a high-risk condition deserving of close clinical attention.

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Michael Scott Rogers. / Thesis (Ph.D.)--Chinese University of Hong Kong, 1997. / Includes bibliographical references (p. 265-314). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web.

Background Findings for the association of prenatal maternal infections and schizophrenia are inconsistent. Whether specific maternal infections may contribute to central nervous system dysfunction, like schizophrenia remains unknown. Thus, a systematic review is conducted to clarify the role of infections on the pathogenesis of schizophrenia. Methods A manual and electronic search of the literature for prenatal maternal infection at the individual level and the diagnosis of schizophrenia in offspring was conducted. All the included studies are searched from PubMed and EMBASE databases and generally based on population level datasets with cohort or nested case-control studies designs. We only focus on three kinds of maternal infections in the review (i.e. influenza pandemic, rubella and Toxoplasmosis), other infections such as herpes simples, varicella‐zoster virus and polio were excluded. Positive family history of psychotic illness was excluded as genetic disposition is established as a strong risk factor of developing schizophrenia in offspring. Results Fifteen studies were included in this systemic review. Nine (60%) of these studies reported a positive association between maternal infections and the development of schizophrenia in the later lives of their offspring, while six (40%) of these studies indicated that there is no significant difference among cases of schizophrenia in maternal infections exposure and the control subjects or no association between schizophrenia in offspring and the infections during pregnancy as the exposure. Among all the studies, thirteen cohort studies and two nested‐case studies were examined. Eight (61.5%) showed a positive association, meanwhile five (38.5%) showed a null association. Two nested‐case control studies both suggested that maternal infection exposure is a risk factor for schizophrenia. Conclusion Findings for the association of prenatal maternal infections and schizophrenia are not equal to the evidence for causation. Due to the absence of external validity due to small and non‐representative samples, selection bias was suspected even with a significant result. Additionally, multiple exposures were hard to testify during pregnancy. Even we adjusted for the measured confounders, residual confounding such as genetic disposition and socioeconomic status, as well as unmeasured confounding are concerns. Quasi-experimental methods may help improve causal inference such as the use of instrumental variable analysis in future studies. Preventive strategies such as immunizations need to be deliberated carefully to weight the benefit and the potential impact. / published_or_final_version / Public Health / Master / Master of Public Health