For this project I describe the socio-historical development of a particular application of genetic prenatal diagnosis, in terms of changing social relations that govern an ethics of reproductive choice. I examine ways that medicine and government articulate prenatal diagnosis to problematise the maternal body and govern women's reproductive choices about chromosomal abnormality in the fetus. Since its introduction in the early 1970s, the major use of prenatal diagnosis has been to detect chromosomal abnormalities-in particular, Down syndrome-in the fetus. Medico-scientific knowledge claims negotiated in everyday practices in the genetic counselling clinic between health professionals and their clients are situated within broader social relations. Negotiations between medicine and government have produced technoscientific possibilities, realised with greater or lesser success in the co-construction of a workable prenatal diagnosis standardised package. I describe how these socio-technical relations have produced similarities and differences across time, and national and professional boundaries. My analysis draws on observations in three genetic counselling clinics, and of the health professionals' other work activities. I also draw on interviews with them and other actors in that arena, as well as claims made about prenatal diagnosis technologies in the medico-scientific literature. I analyse my data using concepts developed in social worlds/arenas theory within a Foucauldian framework of social relations that govern the body. Since the early formation of a standardised package of genetic counselling about amniocentesis, ethical decisions about prenatal diagnosis have identified multiple parts of the self to be governed. This ethics has relied on a duty to make genetically responsible decisions as a particular way to relate to oneself, although it has been expressed in different ways. Newer technologies have articulated greater ethical possibilities for governing the self by co-constructing new ways of assembling the constituent components. Throughout, there have been tensions between two major aims for governing the self: that of giving birth to a healthy baby, and that of managing maternal rationality in order to act as an autonomous rational individual. I have thus described how a woman's use of prenatal diagnosis is not simply one of individual choice. Her decision is a complex ethical one that is historically and socially contingent on relations between medicine and government that present the maternal body in certain ways for her to act upon herself.

Includes list of papers arising from this thesis. "July 2004" Includes bibliographical references (leaves 253-297)

No description available.

Thesis (Ph. D.)--University of California, San Diego, 2001. / Vita. Includes bibliographical references (leaves 276-291).

There has been an increase in rates of chromosomal abnormalities in newborns as a result of reproductive aging. For the past decades, a lot of effort has been placed on identifying pregnancies at risk of genetic defects. Conventional prenatal genetic diagnosis is achieved by invasive procedures that have been associated with an increased risk of pregnancy loss. This has led the researchers to explore the use of non-/minimally invasive techniques for prenatal diagnosis. Trophoblasts are known to be shed from regressing chorionic villi into the lower uterine pole of pregnant women during the first trimester. These cells are trapped within cervical mucus, which can be retrieved with a cytobrush. By using human leukocyte antigen G (HLA-G) and cytokeratin-7 (CK7) as trophoblast markers, this study aims to investigate the possibility of isolating individual fetal trophoblast from transcervical samples for genetic diagnosis. 195 healthy pregnant women requesting for legal termination of pregnancy (TOP) were recruited in this study. Transcervical cells were collected from them with the use of a cytobrush before TOP. HLA-G+ or CK7+ cells were then isolated by a combination of mucolytic action, fluorescent immunohistochemistry, and micromanipulation. The origin of these cells was subsequently investigated by either fluorescent in situ hybridization (FISH) or allelic profiling by quantitative fluorescent polymerase chain reaction (QF-PCR) based on chromosome 16, chromosome X, amelogenin gene and sex determining region Y (SRY) gene. This study first demonstrated the presence of fetal cells in transcervical samples based on the detection of chromosome Y signal by ordinary PCR. Cells expressing HLA-G and CK7 were also identified among transcervical cells. Immunopositive cells were isolated by micromanipulation under fluorescent microscopy. One isolated cell expressing CK7 was shown to inherit paternal allele at a locus on chromosome 16, suggesting the possible fetal origin of this cell. However, this study was still hampered by a number of technical factors. Further optimization of the protocol is required before transcervical trophoblasts can be retrieved in a reliable manner. / published_or_final_version / Obstetrics and Gynaecology / Master / Master of Philosophy

In view of the lifelong impact of Obstetrical Brachial Plexus Palsies (OBPP), prevention of OBPP would be of great significance. Despite contemporary advances in antenatal planning and assessment, OBPP remains an unfortunate consequence after difficult childbirth. Permanent brachial plexus palsy is a leading cause of litigation related to birth trauma. Objectives: To determine the incidence of Obstetrical Brachial Plexus Palsy (OBPP), Cephalopelvic Disproportion (CPD) and macrosomia in KwaZulu-Natal. As well as to investigate the relationship between OBPP and CPD, and the relationship between OBPP and macrosomia. The study also aimed to determine whether antenatal risk factors could identify those prone to OBPP. Study design: This was a case control study that included all deliveries from 1997 to 2000 from four provincial hospitals (Addington, King Edward VIII, Prince Mshiyeni Memorial and RK Khan hospital). The outcome variable was OBPP. Results were analyzed using Statistical Program for Social Sciences (SPSS). Results: A total of 60 infants of 76 352 deliveries sustained OBPP. The incidence of OBPP was found to be 0.72 per 1000 deliveries. The incidence of CPD was found to be 33.5 per 1000 deliveries and the incidence of macrosomia was found to be 16.7 per 1000 deliveries. Race, Maternal height> 150 cm, gravida >3, parity >4, history of a previous big baby, normal vaginal delivery, delivery by a midwife, difficult labour, inadequate or doubtful pelvic capacity, birth weight of >3700 g and gestation period> 34 weeks were significant risk factors. Logistic regression analysis showed that race, parity> 4, normal vaginal delivery and gestation period> 35 weeks were the variables most associated with OBPP. Using linear regression model was obtained for the calculation of predictive risk scores. Conclusion: Using standard statistical formulae the probability of OBPP can be calculated in women with significant risk factors from the logistic regression formula. This would need to be validated and could provide a useful tool for screening for OBPP thus contributing to preventing this devastating complication of birth trauma. The risk assessment profile would contribute greatly to the prediction of OBPP and the subsequent prevention of this debilitating birth injury. / Thesis (M.Sc.)-University of Durban-Westville, 2002.

Thesis (M.S.)--Brandeis University, 2009. / Title from PDF title page (viewed on May 29, 2009). Includes bibliographical references.

Thesis (Ph. D.)--University of Washington, 1996. / Vita. Includes bibliographical references (leaves [145]-157).

Thesis (M.Med.Sc.)--University of Hong Kong, 2002. / Includes bibliographical references (leaves 25-30). Also available in print.

Thesis (M.S.)--University of Wisconsin-Madison, 1993. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 65-74).