Peripartum cardiomyopathy: diagnosis and management

No abstract available

'This Is Real Misery': Experiences of Women Denied Legal Abortion in Tunisia.

Barriers to accessing legal abortion services in Tunisia are increasing, despite a liberal abortion law, and women are often denied wanted legal abortion services. In this paper, we seek to explore the reasons for abortion denial and whether these reasons had a legal or medical basis. We also identify barriers women faced in accessing abortion and make recommendations for improved access to quality abortion care. We recruited women immediately after they had been turned away from legal abortion services at two facilities in Tunis, Tunisia. Thirteen women consented to participate in qualitative interviews two months after they were turned away from the facility. Women were denied abortion care on the day they were recruited due to three main reasons: gestational age, health conditions, and logistical barriers. Nine women ultimately terminated their pregnancies at another facility, and four women carried to term. None of the women attempted illegal abortion services or self-induction. Further research is needed in order to assess abortion denial from the perspective of providers and medical staff

Improved modeling of clinical data with kernel methods

Objective: Despite the rise of high-throughput technologies, clinical data such as age, gender and medical history guide clinical management for most diseases and examinations. To improve clinical management, available patient information should be fully exploited. This requires appropriate modeling of relevant parameters. Methods: When kernel methods are used, traditional kernel functions such as the linear kernel are often applied to the set of clinical parameters. These kernel functions, however, have their disadvantages due to the specific characteristics of clinical data, being a mix of variable types with each variable its own range. We propose a new kernel function specifically adapted to the characteristics of clinical data. Results: The clinical kernel function provides a better representation of patients' similarity by equalizing the influence of all variables and taking into account the range r of the variables. Moreover, it is robust with respect to changes in r. Incorporated in a least squares support vector machine, the new kernel function results in significantly improved diagnosis, prognosis and prediction of therapy response. This is illustrated on four clinical data sets within gynecology, with an average increase in test area under the ROC curve (AUC) of 0.023, 0.021, 0.122 and 0.019, respectively. Moreover, when combining clinical parameters and expression data in three case studies on breast cancer, results improved overall with use of the new kernel function and when considering both data types in a weighted fashion, with a larger weight assigned to the clinical parameters. The increase in AUC with respect to a standard kernel function and/or unweighted data combination was maximum 0.127, 0.042 and 0.118 for the three case studies. Conclusion: For clinical data consisting of variables of different types, the proposed kernel function which takes into account the type and range of each variable - has shown to be a better alternative for linear and non-linear classification problems. (C) 2011 Elsevier B.V. All rights reserved

Effect of interpregnancy interval on outcomes of pregnancy after miscarriage : retrospective analysis of hospital episode statistics in Scotland

Peer reviewedPublisher PD

Decision-making regarding place of birth in high-risk pregnancy: a qualitative study

Introduction: Women consider factors including safety and the psychological impact of their chosen location when deciding whether to give birth in hospital or at home. The same is true for women with high-risk pregnancies who may plan homebirths against medical advice. This study investigated women’s decision-making during high-risk pregnancies. Half the participants were planning hospital births and half were planning homebirths. Methods: A qualitative study using semi-structured interviews set in a hospital maternity department in the UK. Twenty-six participants with high-risk pregnancies, at least 32 weeks pregnant. Results were analysed using systematic thematic analysis. Results: Three themes emerged: perceptions of birth at home and hospital; beliefs about how birth should be; and the decision process. Both groups were concerned about safety but they expressed different concerns. Women drew psychological comfort from their chosen birth location. Women planning homebirths displayed faith in the natural birth process and stressed the quality of the birth experience. Women planning hospital births believed the access to medical care outweighed their misgivings about the physical environment. Discussion: Although women from both groups expressed similar concerns about safety they reached different decisions about how these should be addressed regarding birth location. These differences may be related to beliefs about the birth process. Commitment to their decisions may have helped reduce cognitive stress

Barriers to women's access to alongside midwifery units in England

Background: Alongside midwifery units (AMUs) are managed by midwives and proximate to obstetric units (OUs), offering a home-like birth environment for women with straightforward pregnancies. They support physiological birth, with fast access to medical care if needed. AMUs have good perinatal outcomes and lower rates of interventions than OUs. In England, uptake remains lower than potential use, despite recent changes in policy to support their use. This article reports on experiences of access from a broader study that investigated AMU organisation and care. Methods: Organisational case studies in four National Health Service (NHS) Trusts in England, selected for variation geographically and in features of their midwifery units. Fieldwork (December 2011 to October 2012) included observations (>100 h); semi-structured interviews with staff, managers and stakeholders (n = 89) and with postnatal women and partners (n = 47), on which this paper reports. Data were analysed thematically using NVivo10 software. Results: Women, partners and families felt welcome and valued in the AMU. They were drawn to the AMUs’ environment, philosophy and approach to technology, including pain management. Access for some was hindered by inconsistent information about the existence, environment and safety of AMUs, and barriers to admission in early labour. Conclusions:Key barriers to AMUs arise through inequitable information and challenges with admission in early labour. Most women still give birth in obstetric units and despite increases in the numbers of women birthing on AMUs since 2010, addressing these barriers will be essential to future scale-up

The genetics of prenatal diagnosis, c.1950-1990: the case of Malcolm Ferguson-Smith

In the present day, the fetus is a well-studied entity, with both physical appearance and genetic constitution able to be determined prior to birth. However, this is a relatively new phenomenon, that has been made possible due to developments which have occurred in the field of prenatal testing in the last fifty or so years. Prior to the implementation of antenatal testing technologies, the fetus was surrounded by mystery, accessed through information passed on by the pregnant woman. This thesis examines the developments that have occurred in the prenatal testing field within the time period 1950 to 1990, which have made it possible to characterise the physical and genetic structure of the fetus prior to birth. An analysis is made of the development of relevant prenatal testing technologies, including amniocentesis, chorionic villus sampling, and ultrasound, with a consideration of their role in making the fetus an accessible entity during pregnancy. To examine how these technologies have been implemented into clinical care, this thesis focuses on the development of prenatal testing and screening programmes in the West of Scotland. Within this region, the city of Glasgow presents an interesting case study for analysis. Work in this city was led by Malcolm Ferguson-Smith, who is widely regarded as one of the most eminent British medical geneticists of recent decades. This thesis studies the role which Ferguson-Smith and his colleagues played in the development and implementation of prenatal testing and screening programmes in the West of Scotland, particularly for chromosome disorders and neural tube defects. It will be shown that the group played a central role in bringing prenatal testing to residents of Glasgow, with the majority of screening programmes proving to be popular with pregnant women in the region. Whilst prenatal testing became technically feasible due to advances in technology and science, the field presents a particularly interesting area for analysis, due to the ethical questions which prenatal diagnosis raises. There are no medical treatments available for the majority of conditions which can be detected, and after a positive prenatal diagnosis, many women choose to terminate their pregnancies. The importance of the development of permissive abortion legislation is therefore important to consider within the context of this thesis. With prenatal testing being linked to termination of pregnancy, it can be seen that it has the potential to cause conflict between those who manage and participate in the prenatal testing programmes, and those who oppose abortion, such as certain religious groups. This thesis examines how the two largest religious organisations that were present in Glasgow during the time period of this study, the Church of Scotland and the Roman Catholic Church, responded to permissive abortion legislation in the form of the Abortion Act 1967. The views of both the Church of Scotland and the Roman Catholic Church on abortion following prenatal diagnosis will also be considered, and it will be argued that remarkably few discussions were taking place on this subject. This has created a complex situation whereby the expected conflict between prenatal testing and religion did not seem to be overly prominent during the time period of this study; this is reflected in a lack of direct correlation between prenatal decision making and religious affiliation. Glasgow presents a particularly interesting area for examining the interplay of the technical and social aspects of prenatal diagnosis. In the city there was a focus on prenatal testing amongst the group led by Ferguson-Smith, whilst concurrently the Roman Catholic population in the region were openly voicing their opposition to abortion. This thesis provides a detailed picture of the interaction of the technical and social influences in this geographical region. To achieve this, a wide variety of sources have been examined, including archival material, published scientific papers, and newspapers and magazines. A number of oral history interviews have also been carried out. As a result of the analysis of these sources, what emerges is an in-depth account of the development of prenatal testing in the West of Scotland