Intrauterine Growth Restriction (IUGR) is evident in infants born with a reduced weight or length, and/or increased thinness for gestational age. IUGR is associated with altered postnatal growth and regulation, due to unknown mechanisms. Much clinical IUGR results from the reduced delivery of essential substrates (oxygen and nutrients) to the fetus, due to either maternal or placental limitations. Catch-up growth (accelerated rate of growth in absolute or fractional terms) occurs in the majority of IUGR infants, and returns an infant to their predetermined growth curve. IUGR is associated with increased risks of morbidity and mortality in the perinatal period, and with a reduced final adult stature and increased risk of adult onset diseases, particularly diabetes and cardiovascular disease. Catch-up growth after IUGR predicts improved health in terms of reduced hospital visits in infants and children, and an increased final adult stature but also predicts an increased risk of developing obesity, as well as diabetes and cardiovascular disease. The underlying mechanisms for catch-up growth may contribute to this range of outcomes in later life, but are poorly understood. Studies in IUGR infants have demonstrated increased absolute and/or fractional growth rates following birth, termed catch-up growth, in the presence of reduced or normal plasma concentrations of the thyroid hormones and major anabolic hormones (insulin and/or IGF-I). This suggests that increased sensitivity to, rather than increased production of insulin, IGF-I and thyroid hormone, causes catch-up growth following IUGR. We therefore hypothesised that placental restriction of fetal growth would reduce size at birth and increase postnatal growth and adiposity in association with increased metabolic sensitivity to insulin, IGFs and thyroid hormones. This study has shown that the placentally restricted (PR) lamb has a reduced size at birth in terms of soft and skeletal tissues, has increased rates of growth postnatally, and has increased adiposity by six weeks of age. We have also shown that PR of fetal growth in the sheep did not alter gestational age at delivery, but reduced survival rate. PR lambs demonstrated catch-up growth in most parameters by 30 days of age and increased adiposity at six weeks of age compared to the control lambs. Placental restriction increased insulin and IGF sensitivity of circulating free fatty acids, which in turn, predicts increased adiposity. Neonatal catch-up growth after fetal growth restriction was substantially predicted by both abundance of, and metabolic sensitivity to insulin, suggesting increased insulin action as an underlying cause. Catch-up growth occurs in the neonate despite reduced concentrations of fasting plasma IGFs, along with increased IGF sensitivity of free fatty acid metabolism and adiposity. Plasma TH concentrations predicted growth of soft and skeletal tissue in lambs during early postnatal life, particularly in those undergoing catch-up growth following PR. Therefore neonatal catch-up growth after IUGR is associated with increased sensitivity to both insulin and IGFs, particularly of circulating free fatty acids, and appears to occur to the extent allowed by the prevailing abundance of these hormones and of thyroid hormones. If this altered endocrine state persists, increased adiposity and its subsequent amplification may contribute to the development of obesity, and related adverse metabolic and cardiovascular outcomes in adult life. / Thesis (Ph.D.)--School of Molecular and Biomedical Science, 2004.

The purpose of this study was to determine the effect of posttraumatic stress disorder (PTSD), diagnosed prospectively during pregnancy, on the occurrence of low birthweight (<2500 grams) and preterm delivery (<37 weeks gestational age). A cohort of 1362 women was recruited from prenatal care visits and screened for depression, panic disorder, posttraumatic stress disorder, and substance use. Current episodes of PTSD were assessed using the MINI International Neuropsychiatric Interview. Pregnancy outcomes were abstracted from hospital records after delivery, and the data were analyzed using logistic regression. Two hundred sixty two women (33%) were lost to follow-up due to unavailable medical records, leaving 1100 women in the final analyses. Among these 1100 women, 31 (3%) were found to have PTSD during pregnancy. Substance use in pregnancy, panic disorder, major and minor depressive disorders, and prior preterm delivery were significantly associated with PTSD in the sample, while age, language spoken, and race were not. Low birthweight (LBW) was present in 6.5% of sampled women and was not significantly associated with a diagnosis of PTSD in pregnancy when adjusting for potential confounders. However, LBW was significantly associated with minor depressive disorder OR= 1.82 (CI=1.01, 3.29). Preterm delivery occurred in 7.0% of those without and 16.1% of those with PTSD (p=0.055). Because prior preterm delivery data were not available for 33% of women with PTSD, this variable was included only in secondary analyses. However, the association between PTSD and preterm delivery depended on this variable, with OR= 2.82 (0.95, 8.38) before controlling for prior preterm delivery and OR=3.35 (1.04, 10.85) after controlling for prior preterm delivery. These data suggest that a possible association of PTSD and preterm delivery was limited by the low rates of PTSD in this cohort and the inability to control for all confounders. Taken together, these findings provide limited support for the hypothesized association between PTSD and preterm delivery and no support for an association of PTSD with LBW.

Thesis (M.N.)--Memorial University of Newfoundland, School of Nursing, 2000. / Bibliography: leaves 109-116.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009.

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The SA National Department of Health made maternal deaths notifiable in 1997. It also commissioned a National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD) to confidentially investigate all maternal deaths, to write the "Saving Mothers Report" and to make recommendations based on the findings of the study. The Department of Health in 2003 commissioned an evaluation of the extent to which the 10 recommendations contained in the first "Saving Mother's Report" had been implemented. This rapid appraisal was carried out by Centre for Health and Social Studies (CHESS), University of Natal. A report 'The Progress with the Implementation of the Key Recommendations of the 1998 "Saving Mothers Report" on the Confidential Enquiry into Maternal Deaths in South Africa - A Rapid Appraisal," was published in 2003. The data collected on Recommendation 5 on the use of the obstetric partogram in 46 selected provincial hospitals in all the 9 provinces was only partially analysed in this report. This study reports on a secondary analysis of the 942 questionnaires that were completed on the use and application of the partogram in hospitals in South Africa. In the rapid appraisal experienced field workers evaluated the use of the partogram using a 36-point checklist. Provincial and national averages for each of these variables were calculated and hospitals were evaluated into how they performed according to these averages using Lot Quality Assurance Sampling methodologies. Using national and provincial averages, the hospitals in each province are compared with one another provincially and nationally. In addition, the application and use of partograms in areas and levels of hospitals are described. An attempt is made to show if there is relation between the number of deliveries and the recording of the partogram. The main findings were that, of all the provinces KwaZulu-Natal had the lowest number variables below the national average from the 36 variables used as a checklist. Eastern Cape and Limpopo had the highest number of variables below the national average. The hospital with the highest number below the national average is in the Eastern Cape. In the recording of the chart rural and level one hospitals are low in comparison with urban and level three hospitals. There was no relation in the recording of the chart and the number of deliveries. / Thesis (M.PH.)-University of KwaZulu-Natal, 2004.

OBJECTIVES: To determine if women with Human Immunodeficiency Virus infection with severe degrees of immunosuppression are more predisposed to mortality from Gestational Trophoblastic Disease compared with HIV-infected women with less severe degrees of immunosuppression and Human Immunodefiency Virus (HIV) non-infected women. DESIGN: Retrospective review of case records. METHOD: A retrospective review was performed on all patients with Gestational Trophoblastic from 2003 to July 2007. A chart review was conducted and information captured on a data sheet. This retrospective audit was performed at the combined gynaecology oncology clinic of Inkosi Albert Luthuli Central Hospital. All information was kept confidential and was strictly for the purposes of the audit. STATISTICS: Factors associated with mortality were tested using Fisher's exact test. Odds ratios were reported as a measure of the strength of association. Breslow-Day's test for homogeneity in odds ratios was used to compare mortality in HIV-infected and HIV non-infected women. The analysis was done using Stata 9. i RESULTS: A total of 78 patients with Gestational Trophoblastic Disease were reviewed. There were 53 patients with invasive molar pregnancy and 25 patients with choriocarcinoma. The HIV sero-prevalence was 31%. There were 15 deaths (19%). There were 8 HIV-infected (33%o) and 7 HIV non-infected (13%) women who demised. Of the 8 patients with CD4 counts less than 200 cells/ uL, 7 patients demised. There were no mortalities amongst patients with CD4 counts more than 200 cells/uL. Of the 15 deaths, 5 HIV-infected patients and 5 HIV non-infected patients received chemotherapy. There were 5 patients admitted in very poor general condition precluding the administration of chemotherapy. Amongst the 10 patients who received chemotherapy and demised, the causes of death included widespread disease, multiorgan failure and toxicity due to chemotherapy. CONCLUSION: The overall survival of all patients managed with Gestational Trophoblastic Disease was 82% in keeping with the expected high survival reported elsewhere. The majority of patients who demised were admitted in poor general condition and had abnormal blood profiles. Despite resuscitation, these patients failed to improve precluding the administration of chemotherapy which is the mainstay of treatment. Although the numbers are small, there is clear evidence that if patients are HIV-infected with CD4 counts 200 cells/uL despite transient grade 2 myelotoxicity. / Thesis (MMed)-University of KwaZulu-Natal, Durban, 2008.

This study focuses on women with both pre-eclampsia and Human Immunodeficiency Virus (HIV). Pre-eclampsia is a pregnancy-specific syndrome that occurs after 20 weeks gestation. Thrombocytopenia is the most common haematological abnormality in pre-eclampsia. Further, studies suggest that the immunological mechanism plays some role in the aetiology of pre-eclampsia. The immunological hallmark of HIV infection is a progressive decline in the number of CD4 T lymphocytes and significant haematological abnormalities are also common in HIV-infected individuals i.e. anaemia, thrombocytopenia and leukopenia. The study population comprised of two groups i.e., pre-eclamptic HIV-positive African women and preeclamptic HIV-negative African women as the control group. Samples were analysed for haematological parameters (full blood count) and immunological markers (flow cytometry). There was no statistical significance in the following parameters: RBC, Hb, haematocrit, MCV, MCH, MCHC, platelets, MPV, WBC, lymphocytes, neutrophils, eosinophils, monocytes, basophils and CD8. There was a statistical difference in the CD3 and CD4 counts between both the groups. However, the CD3 and CD4 counts were within the normal range in the HIV-negative pre-eclamptic group and even though CD3 decreased, it was still within the normal range in the HIV-positive pre-eclamptic group, with CD4 decreasing below the normal range in the HIV-positive pre-eclamptic group. This suggests that immune mechanisms involving CD estimations do not play a role in pre-eclampsia since the decrease in the counts can be solely attributed to HIV infection. Results obtained in this study do not show any severe haematological or immunological abnormalities when women have both pre-eclampsia and HIV infection. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, 2007.

A prospective study was conducted on a group of 160 students from 9 to 14 years of age with learning disabilities to predict neuropsychological outcome using perinatal information as predictors. Perinatal information was obtained from the Maternal Perinatal Scale (MPS) (Dean & Gray, 1985). Subjects' neuropsychological functioning was assessed by the Short Neuropsychological Screening Device (SNSD) (Reitan & Herring, 1985). Information concerning subjects' intelligence was obtained from the Wechsler Intelligence Scale for Children-III (WISC-III) administered within the past two years. Hollingshead's Four Factor Index of Social Status was employed to determine subjects' socioeconomic status. A stepwise multiple regression analysis yielded a regression model that contained a subset of 7 perinatal risk factors, involving: (1) Obstetric History; (2) Gestational Age; (3) Psychosocial Events; (4) Delivery; (5) Intrauterine Stress; (6) Teratogenic Stress; and (7) Fetal Oxygenation. A hierarchical regression analysis was further performed to examine if adding socioeconomic and intellectual information to the regression model could increase the prediction of neuropsychological outcome. Results showed that up to 82% of the variability in the neuropsychological outcome was explained by the linear composite of the 7 risk factors. When socioeconomic and intellectual information were added to the regression model, the prediction of neuropsychological outcome was significantly improved. About 201 of the students with learning disabilities in the present study were found to display symptoms similar to minimal brain damage (MBD) relating to poor visual-motor integration, underdeveloped language skills, and aphasic conditions. The results support the theory of a "continuum of reproductive casualty" proposed by Pasamanick et al. (1956). The importance of detecting early indicators of neuropsychological deficits in at risk children was further suggested by the present study. / Department of Educational Psychology

With increases in medical technology, infant mortality has decreased, while infant morbidity has increased over the past half century. Moreover, the definition of high-risk pregnancy continues to lack true universal acceptance. Thus, continued research in the area of perinatal complications is warranted. There have been studies that have suggested short-term and long-term deficits considered to be secondary to perinatal complications. Psychologists often gather information about a given child’s perinatal history, but do not always have means to interpret how those complications may impact the child later in life. The Maternal Perinatal Scale (MPS) has been shown to have good reliability and validity in past studies, but a scoring system has yet to be established. This project consisted of two studies. The first study created a preliminary scoring system for the developmental questionnaire, the Maternal Perinatal Scale. This questionnaire has proven to have potential for good clinical utility, but prior to this study, had nothing beyond item-by-item analysis for interpreting the results. To test the validity of the proposed scoring system, a second study was conducted to determine cutoff scores and classification rates for the scoring system on data previously collected with children in elementary school. Results revealed proposed scores for each item on the MPS and classification rates associated with certain developmental disorders later in life. / Department of Educational Psychology