Midwives’ experiences of Shoulder Dystocia and investigation of its incidence rate: An exploratory sequential mixed methods study

University of Technology Sydney. Faculty of Health.Shoulder dystocia (SD) is known as one of the most traumatic birth experiences for midwives. Experience of a traumatic birth such as SD may cause emotional disturbances or in severe cases, mental health disorders for clinicians. Evidence is limited on the professional behavioural consequences for midwives who experience births complicated by SD. This thesis explored the experiences of midwives regarding SD as well as the incidence and trends of SD, its risk factors and outcomes. A two-phase sequential exploratory mixed methods study was conducted. The first phase included a qualitative descriptive study, and the second phase was a retrospective medical record review using de-identified data from one tertiary referral hospital in New South Wales (NSW), Australia over the period 2013-2018. For the first phase, a total of 25 midwives participated in the study. Midwives viewed SD as a traumatic birth associated with panic and anxiety. Following the event, the pathways of thinking and practising were not similar among all midwives. Fear of repetition of the incident and negative thoughts after the experience shifted some midwives towards catastrophic thinking and hypervigilant behaviours. However, for some other midwives, SD was viewed as an opportunity to grow and to actualise their potential midwifery skills. Results from the second phase of the study showed that the overall incidence of SD was 6% among live births. Diagnosis of mild SD showed an increasing trend from 2013 to 2018. Shoulder dystocia was significantly associated with some antenatal and intrapartum risk factors, including post-term pregnancy, maternal pre-existing diabetes/ Gestational Diabetes Mellitus, labour induction/ augmentation and duration of second stage of labour (more than two hours). The main maternal and neonatal adverse outcomes associated with SD were higher rate of postpartum haemorrhage, APGAR score< 7 at the 1st and 5th minute, and higher rates of neonatal resuscitation and admission to Neonatal Intensive Care Unit. This study demonstrated that midwives’ emotions (from previous experiences) can affect how they perceive normal birth, how they practise at birth and how they diagnose SD. The findings highlighted the need for further workplace and collegial support. In addition, the increasing trend of SD is an alarm signal that suggests provision of further supports for midwives who may frequently be exposed to SD-complicated births are necessary

Audit of Intrapartum Care Based on the National Guideline for Midwifery and Birth Services

© The Author(s) 2018. Providing high-quality maternity care is a worldwide health concern that necessitates regular assessment of intrapartum practice. In an observational study, we aimed to audit intrapartum care based on the National Guideline for Midwifery and Birth Services. Using quota sampling, a total of 200 pregnant women, admitted for normal vaginal delivery, were recruited from four educational hospitals in Tehran, Iran. An observational checklist was developed based on the national guideline to assess the quality of provided care. Content and face validity of the tool were checked and confirmed. Reliability of the observational checklist and questionnaire was confirmed using concurrent observation (intrarater reliability; r =.93) and test–retest (r =.9) methods, respectively. We found that the compatibility of intrapartum care and the national guideline in different domains were as follows: history taking 88.3%, vital sign measurement 64.6%, performing Leopold’s maneuver 38.5%, initial assessment 83.4%, labor care 22.5%, using pain relief methods 63.5%, labor progress assessment 71.5%, process of delivery 89.5%, and postpartum management 89.5%. The findings indicate that additional attention and monitoring are required to align current intrapartum care practices with the national guidelines

Propagation and scattering of electromagnetic waves in low THz band in automotive radar applications

This thesis, firstly, due to the lack of knowledge in influence of harsh outdoor environment on the performance of the low-THz automotive sensors, the investigation has been done to demonstrate the performance of low-THz sensors in the presence of different radome contaminants (mud, oil, grit, etc.) and various weather conditions (rain, snow, fog, etc.) to prove the feasibility of using low-THz frequencies (100 GHz -1 THz) in automotive radar in uncontrolled environmental conditions. Secondarily, this thesis reports and discuss the important and yet unsolved task on automotive surface recognition and shows the possibility of using Low THz radar for road surface classification by exploring the radar signal backscattering from surfaces with different roughness, and finally this thesis demonstrate the novel approach to surface classification based on the analysis of radar images obtained using the low THz imaging radar and demonstrate the advantage of low THz radar for surface discrimination for automotive sensing. The proposed experimental technique in combination with a convolutional neural network provides high surface classification accuracy

A Bayesian model to estimate the cutoff value of TSH for management of preterm birth

Background Determining a thyroid hormone cutoff value in pregnancy is challenging issue and several approaches have been introduced to optimize a utility function. We aimed to estimate the cutoff value of TSH using Bayesian method for prediction of preterm-birth. Methods This study was a secondary-analysis of the population-based data collected prospectively within the framework of the Tehran Thyroid and Pregnancy Study. A total of 1,538 pregnant women attending prenatal clinics. Results Using Bayesian method resulted a TSH-cutoff of (3.97mIU/L,95%CI:3.95–4.00) for distinguishing pregnant women at risk of preterm-birth. The cutoff was associated with acceptable positive predictive and negative predictive values (0.84,95% CI:0.80–0.88) and 0.92 (95%CI: 0.91–0.94), respectively). In women who were negative for thyroid peroxides antibody (TPOAb) with sufficient urinary iodine concentration (UIC), the TSH cutoff of 3.92 mIU/L(95%CI:3.70–4) had the highest predictive value; whereas in TPOAb positive women with insufficient UIC, the cutoff of 4.0 mIU/L(95%:CI 3.94–4) could better predict preterm birth. Cutoffs estimated in this study are close to the revised TSH value of 4.0mIU/L which is currently recommended by the American Thyroid Association. Conclusion Regardless of TPOAb status or iodine insufficiency, risk of preterm labor is increased in pregnant women with TSH value of > 3.92 mIU/L; these women may benefit from Levothyroxine (LT4) therapy for preventing preterm birth

A Bayesian model to estimate the cutoff value of TSH for management of preterm birth

publishedVersio

Third generation cephalosporin use in a tertiary hospital in Port of Spain, Trinidad: need for an antibiotic policy

BACKGROUND: Tertiary care hospitals are a potential source for development and spread of bacterial resistance being in the loop to receive outpatients and referrals from community nursing homes and hospitals. The liberal use of third-generation cephalosporins (3GCs) in these hospitals has been associated with the emergence of extended-spectrum beta- lactamases (ESBLs) presenting concerns for bacterial resistance in therapeutics. We studied the 3GC utilization in a tertiary care teaching hospital, in warded patients (medical, surgical, gynaecology, orthopedic) prescribed these drugs. METHODS: Clinical data of patients (≥ 13 years) admitted to the General Hospital, Port of Spain (POSGH) from January to June 2000, and who had received 3GCs based on the Pharmacy records were studied. The Sanford Antibiotic Guide 2000, was used to determine appropriateness of therapy. The agency which procures drugs for the Ministry of Health supplied the cost of drugs. RESULTS: The prevalence rate of use of 3GCs was 9.5 per 1000 admissions and was higher in surgical and gynecological admissions (21/1000) compared with medical and orthopedic (8 /1000) services (p < 0.05). Ceftriaxone was the most frequently used 3GC. Sixty-nine (36%) patients without clinical evidence of infection received 3Gcs and prescribing was based on therapeutic recommendations in 4% of patients. At least 62% of all prescriptions were inappropriate with significant associations for patients from gynaecology (p < 0.003), empirical prescribing (p < 0.48), patients with undetermined infection sites (p < 0.007), and for single drug use compared with multiple antibiotics (p < 0.001). Treatment was twice as costly when prescribing was inappropriate CONCLUSIONS: There is extensive inappropriate 3GC utilization in tertiary care in Trinidad. We recommend hospital laboratories undertake continuous surveillance of antibiotic resistance patterns so that appropriate changes in prescribing guidelines can be developed and implemented. Though guidelines for rational antibiotic use were developed they have not been re-visited or encouraged, suggesting urgent antibiotic review of the hospital formulary and instituting an infection control team. Monitoring antibiotic use with microbiology laboratory support can promote rational drug utilization, cut costs, halt inappropriate 3GC prescribing, and delay the emergence of resistant organisms. An ongoing antibiotic peer audit is suggested

Discrimination during childbirth among black birthing people predicts postpartum care utilisation

[Extract] Racial disparity in the USA has been a leading cause of poorer perinatal care and higher rates of pregnancy and birth mortality among black people

Assessment of the Scientific Validity, Reliability and Normalization of APS, AAS and MAC-R Tests for Spotting Vulnerable Individuals Exposed to Drug Abuse Among the Male High School Students in the City of Tehran

Bearing in mind the growing trend of drug abuse in societies, the application of appropriate tools for identifying drug abusers and those who are exposed to the high risk of drug abuse is one of the basic requirements of the current Iranian society. At the moment, the only way for identifying drug addicts is the use of morphine- detecting kits that examine the person’s urine and is based on a medical model. It only indicates the existence of morphine in urine and cannot be relied upon as a certain method for detecting the person’s addiction. Within this framework, it seems necessary to use psychological tests for identifying individuals that are exposed to the risk of drug abuse. Based on this necessity and with the aim of normalization and preparation of three sub-scales of addiction acknowledgement scale (AAS), addiction potential (APS) and Mac Andrew Alcoholism Scale Revised (MAC.R) from the Minnesota Multi-Phasic Personality Inventory a questionnaire is prepared comprising 90 questions. The plan was conducted among 1000 male high school students of Tehran using the random sample-taking from 4 districts (7,5,3,18) as well as 200 volunteers who seek to give up addiction. The following questions were raised: 1. Does the addiction test for identifying students exposed to addiction risk enjoy reliability? 2. Does the AAS scale aimed at identifying students that suffer from drug abuse enjoy reliability? and indirect observations. The statistical grouping of the research includes the admitted students and eventually 483 female and 53 male students in seven provinces constituted the statistical samples of the study. It was concluded that the separation plan is facing numerous problems at the current juncture. The relevant procedures and the manner of inter-organizational cooperation are not sufficient and the admission process has to undergo changes. Welfare facilities at the centers are not sufficient and keeping the students at the dorms for a long time will bring about many problems for them. Hence, the existence of a strong observation system as well as social workers are among the requisites for keeping up the implementation of the plan. Moreover, attention must be paid to other substitute methods so that the student would be able to study in his normal living environment and in this way reduce possible risks

Low-risk caesarean among black women may be independent of hospital structural characteristics

[Extract] Racial disparities have been shown to increase the likelihood of low-risk caesarean (LRC) among non-Hispanic black or Hispanic people compared to white people.1 In a cross-sectional study, Clark et al2 compared the caesarean birth rates of black and white women at low risk for caesarean birth across hospitals that were categorised into low, medium and high proportions of black women. LRC was defined as a term, singleton, vertex and live birth in women without prior caesareans and without high-risk diagnoses. Hospital categories were created based on the proportion of black women giving birth at a hospital