Orientador: Márcia Guimarães da Silva / Banca: Luciane Alarcão Dias-Melicio / Banca: Roseane Mattar / Banca: Leandro Oliveira / Banca: Gisele Alborghetti Nei / Resumo: Introdução: A prematuridade é a principal causa de mortalidade neonatal e os riscos de complicações decorrentes são inversamente proporcionais à idade gestacional na qual o parto ocorre. Diversos estudos na literatura demonstram o papel da resposta imune inata e dos receptores Toll-like (TLRs) durante a gestação normal e na presença de complicações gestacionais. A expressão de TLRs vem sendo avaliada principalmente nos tecidos da interface materno-fetal e os resultados de tais estudos são conflitantes. A investigação da expressão de TLRs em tecidos gestacionais é de grande importância para o entendimento da participação da imunidade inata em gestações normais e com desfechos gestacionais adversos, porém tais tecidos permitem análise somente após a resolução da gestação. Nesse contexto, uma possível fonte de estudo para análise de TLRs no decorrer da gestação em curso são as células do sangue periférico materno, uma vez são facilmente obtidas por punção venosa, além de possuírem papel fundamental na reposta imune inata e expressarem diversos tipos de TLRs. Objetivo: Traçar o perfil de expressão gênica e proteica de receptores Toll-like 1, -2, -4 e -6 em células mononucleares (PBMCs) e em neutrófilos do sangue periférico materno ao longo da gestação normal e na prematuridade. Materias e métodos: Foram incluídas no estudo 119 gestantes normais, as quais foram subdivididas em trimestres de acordo com sua idade gestacional. Além disso, foram avaliadas 20 gestantes em trabalho de parto pré-termo e 18 gestantes de termo. A análise de expressão gênica foi realizada por PCR em tempo real e a avaliação da expressão proteica por citometria de fluxo. Para a análise dos dados foram empregados os testes não paramétricos de Kruskal-Wallis e Mann-Whitney através do software SigmaStat 3.1. Resultados: Em relação às PBMCs, não foram observadas diferenças significativas nas expressões gênica e... / Abstract: Introduction: Prematurity is the leading cause of neonatal mortality and serious neonatal morbidity worldwide and the risk is inversely proportional to gestational age at birth. Several studies demonstrate the role of innate immune response and Toll-like receptors (TLRs) in normal and complicated pregnancies, however most studies have focused on the tissues of the maternal-fetal interface. Research of the expression of TLRs in gestational tissues is of great importance for understanding the involvement of innate immunity in normal pregnancies and adverse pregnancy outcomes, but the analysis of these tissues allows for results only after the complete resolution of gestation. In this scenario, a potential biological sample of interest for analysis of TLRs in the ongoing gestation are maternal peripheral blood cells, since they play a crucial role in the immune system and express high levels of many of the TLRs. Main: Evaluate the profile of gene expression of TLR-1, -2, -4 and -6 in peripheral blood mononuclear cells (PBMCs) and polymorphonuclear cells (PMNs) and compare these expressions between preterm and term pregnancies. Materials and methods: 119 normal pregnant women were included in the study, subdivided into three groups according to the gestational trimester. In addition, 20 pregnant women in preterm labor and 18 pregnant women at term were evaluated. Gene expression analysis was performed by real-time PCR and protein expression evaluation by flow cytometry. Statistical analyses were performed using the nonparametric Kruskal-Wallis and Mann-Whitney tests by SigmaStat 3.1 software. Results: Regarding PBMCs, there were no significant differences in gene and protein expressions of TLR-1, TLR-2, TLR-4 and TLR-6 among the trimesters. The same was observed when comparing PBMCs of preterm and term pregnancies. In relation to neutrophils, gene and protein expressions of TLR-1, TLR-2, TLR-4 and TLR-6 remained unchanged throughout normal ... / Doutor

This work has as its object the speeches about childbirth studied from the analysis of discourse. Using speeches about childbirth as relays for public policies and between technicians and users of the health system in Aracaju, social movements and the humanization of childbirth step to formulate the question: were the modes of naturalization in childbirth practices reflecting modeling conduct, production of stereotypies and determinism in the effects of this experience? The goal is to study how the disciplining and control bodies traverse the speeches on labor and the extent to which discourses about childbirth presented as progressive or liberating subdues can produce. To this end, the article shows a brief genealogy of the birth, the trajectory of their practices, biopolitical crossings and State policies, and discuss and give visibility to the affective, economic, aesthetic, ecological implications. The trajectory analysis ends up unfolding the relationship between the proposed humanized labor and the emergence of a pedagogy of childbirth and pregnancy anchored in the role of Doula. The research method is based on the concepts of institutional analysis implication and superimplication, regarded to research on the implications of the research are considered the essence of scientific work. / O presente trabalho tem como objeto os discursos sobre o parto estudado a partir da análise do discurso. Utilizando os discursos sobre o parto tal como se veicula pelas políticas públicas e entre técnicos e usuários do sistema de saúde em Aracaju, e pelos movimentos sociais de humanização do parto passo a formular a questão: estariam os modos de naturalização nas práticas de parto refletindo modelação de condutas, produção de estereotipias e determinismos nos efeitos dessa experiência? O objetivo é estudar de que forma a disciplinarização e/ou o controle dos corpos atravessam os discursos sobre o parto e em que medida os discursos sobre o parto apresentados como progressistas ou libertadores podem produzir assujeitamentos. Para tanto, o texto percorre uma breve genealogia do parto, a trajetória de suas práticas, atravessamentos biopolíticos e das políticas de Estado, além de discutir e dar visibilidade às implicações afetivas, econômicas, estéticas, ecológicas. A trajetória da análise acaba desdobrando as relações entre a proposta de parto humanizado e a emergência de uma pedagogia do parto e da gestação ancorada na função da Doula. O método da pesquisa se baseia nos conceitos da análise institucional de implicação e sobreimplicação que se refere à pesquisa em que as implicações do pesquisador são consideradas como o essencial do trabalho científico.

The purpose of this study was to propose women-centered guidelines to enhance the utilization of health facility-based delivery among attendees of FANC in Addis Ababa, Ethiopia. A qualitative exploratory and descriptive research design was used to achieve the aims and objectives of the study. The design was contextual in nature.The study was conducted in three phases, using purposively selected attendees of FANC who participated in individual and focus group interviews in phases I and II respectively. Data were analyzed by means of thematic analysis. In phase III of the study, the findings of the first two phases and literature were used as the basis for the development of guidelines to enhance the utilization of health facility-based delivery services among attendees of FANC in Addis Ababa, Ethiopia. From the analysis of individual interview data, four (4) themes emerged, namely, perceived benefits of home delivery, knowledge deficit about health facility-based delivery, poor access to health care facilities and inadequate resources. These themes were identified as rich and detailed account of the perspectives of facility-based and home delivery among attendees of FANC in Addis Ababa, Ethiopia. Two (2) themes emerged from the analysis of focus group interviews data, namely provision of quality, respectful and dignified midwifery care and increased awareness of FANC. These themes were identified as the rich and detailed account of the views of, and recommendations made by attendees of FANC on measures needed to enhance the development of women-centred guidelines to enhance the utilization of health facility-based delivery services. The recommended measures addressed the negative perceptions of health facility-based delivery among attendees of FANC, with the aim of decreasing home deliveries and increasing the number of institutional deliveries. The study recommends that the Ministry of Health, Addis Ababa Health Bureau and the health facilities use the proposed guidelines to enhance the utilization of health facility-based delivery. / Health Studies / D. Litt. et Phil. (Health Studies)

The study explored cultural perspectives of the Zimbabwean Ndebele on alternative modes of childbirth. A qualitative generic, exploratory and descriptive design guided the study. The problem is that alternative modes of birthing are not acceptable to the Zimbabwean Ndebele. Women who give birth through alternative modes of birthing, which include caesarean section (CS) instrumental deliveries (ID) and any other unnatural modes are stigmatised. Data were collected from purposively selected samples of women who had given birth through alternative modes of birthing, spouses, mothers-in-law, community elders, sangomas (traditional healers) and traditional birth attendants (TBAs) using individual unstructured in-depth interviews, structured interviews and focus group interviews (FGIs). Data were analysed through use of qualitative content analysis which involved verbatim transcripts. Interpretations of narrations of data and script reviewing were done while simultaneously listening to audio-tapes which were transcribed in the IsiNdebele the language that was used to collect data. Data were then translated into English to accommodate all readers. Accounts of all the informants that were interviewed point to effects of supernatural ancestral powers, infidelity and use of traditional and herbal medicines as cause for “tiedness” (labour complications), a concept that showed a strong thread throughout the study. Study findings illuminated that traditional practices are culture-bound and the desire is to perpetuate the valued culture. Recommendations made from the study are; cultural orientation of local and foreign health workers, cultural consultation and collaboration with sangomas (traditional healers) and particular recognition of the significance of the study as a cultural heritage of the Zimbabwean Ndebele society. Further research on how women and their spouses cope with the grieving process after experiencing the crisis and grief following CS is recommended. With all the recommended areas addressed, Zimbabwean Ndebele would find alternative modes of birthing acceptable. / Health Studies / D. Lit. et Phil. (Health Studies)

The study explored cultural perspectives of the Zimbabwean Ndebele on alternative modes of childbirth. A qualitative generic, exploratory and descriptive design guided the study. The problem is that alternative modes of birthing are not acceptable to the Zimbabwean Ndebele. Women who give birth through alternative modes of birthing, which include caesarean section (CS) instrumental deliveries (ID) and any other unnatural modes are stigmatised. Data were collected from purposively selected samples of women who had given birth through alternative modes of birthing, spouses, mothers-in-law, community elders, sangomas (traditional healers) and traditional birth attendants (TBAs) using individual unstructured in-depth interviews, structured interviews and focus group interviews (FGIs). Data were analysed through use of qualitative content analysis which involved verbatim transcripts. Interpretations of narrations of data and script reviewing were done while simultaneously listening to audio-tapes which were transcribed in the IsiNdebele the language that was used to collect data. Data were then translated into English to accommodate all readers. Accounts of all the informants that were interviewed point to effects of supernatural ancestral powers, infidelity and use of traditional and herbal medicines as cause for “tiedness” (labour complications), a concept that showed a strong thread throughout the study. Study findings illuminated that traditional practices are culture-bound and the desire is to perpetuate the valued culture. Recommendations made from the study are; cultural orientation of local and foreign health workers, cultural consultation and collaboration with sangomas (traditional healers) and particular recognition of the significance of the study as a cultural heritage of the Zimbabwean Ndebele society. Further research on how women and their spouses cope with the grieving process after experiencing the crisis and grief following CS is recommended. With all the recommended areas addressed, Zimbabwean Ndebele would find alternative modes of birthing acceptable. / Health Studies / D. Lit. et Phil. (Health Studies)

The aim of this study was to identify factors affecting facility-based delivery with the purpose of developing a framework for the promotion of facility-based delivery among women living in rural Ethiopia. Explanatory mixed methods design, comprising of four phases-the descriptive (quantitative), explorative (qualitative), meta-inference and development phases was employed. The quantitative phase was conducted first using a structured questionnaire to identify the variables influencing facility-based delivery care seeking behaviour. A sample of 389 responses were used for data analysis using Structural Equation Modeling. The quantitative phase conducted next to explain the determinants that contributed to influencing facility-based delivery care seeking behaviour. Sixteen participants who were involved the first phase were involved in the follow-up second phase. As illustrated by the results of the study, the majority of women in the study areas continued to deliver at home, putting themselves at risk of dying from pregnancy related causes. As highlighted by the key findings from the quantitative and qualitative data of this study, the most influential factors in predicting and explaining delivery care seeking behaviour are response efficacy, attitude, subjective norm, and perceived behavioural control which are shaped by mothers’ confidence in the outcome, quality of care, interpersonal relations with family members, willingness to conform, access to services, and their decision making power. The way these findings emphasized the factors attitude, subjective norm and perceived behavioural control were consistent with the Theory of Planned Behaviour, while the significance of response efficacy was in line with Protection Motivation Theory. The study developed a framework to help promote facility-based delivery among mothers living in rural Ethiopia. / Health Studies / D. Litt. et Phil. (Health Studies)

Background Pregnancy and childbirth are normal physiological processes but the internal and external circumstances in which the child is conceived and born affect the life of the mother and child. Every pregnancy is associated with unpredictable risks and complications. Therefore, having a birth preparedness and complication prevention plan including safe motherhood are paramount to reduce maternal and infant mortality rates. Purpose of the study This study aimed to establish the pregnant women’s knowledge, perceptions and practices regarding birth preparedness planning, complication readiness and safe motherhood at Raleigh Fitkin Memorial Hospital to help reduce some of the avoidable causes of maternal and infant mortality rates. Research design and methods An exploratory, descriptive and qualitative research design was used for the study. Women who had delivered within a period of one week were purposively selected from the research site and interviewed using a structured interview guide until saturation of data. Ethical considerations were adhered to and measures of trustworthiness were applied. Giorgi’s analytic method was used for data analysis. Findings The findings revealed that most participants were not well informed about birth preparedness although some had managed to save for baby requirements and hospital fees. Transportation to the hospital for ANC and delivery was a problem to those who ended up delivering their babies at home or on the way to hospital. Knowledge about complications of birth was poor and only a few participants could name bleeding and prolonged labour. Most participants were not sure about safe motherhood, whilst some mentioned contraception and post-natal care. Conclusion Evidence from the study reveal that as much as pregnant women prepare baby’s clothes and money for labour and delivery, psychological preparation and transport preparation seemed poor. Complication readiness was not known by most participants. / Health Studies / M.A. (Health Sciences)

The purpose of this study was to analyse and describe the factors that influence the choice of site of delivery by pregnant women in Mukono district. By employing quantitative, non experimental research methods, 431 women were interviewed by using structured questionnaires. These women had either delivered at; home, TBA, private or public clinic and 72% had been delivered by skilled attendants. Choice of delivery site was influenced by the attitudes of health workers which were rather poor in public sites, proximity of site, attendance of antenatal clinic at a site, availability of supplies and drugs, plus level of care including emergency obstetric care. / Health Studies / M. A. (Public Health)

The purpose of this study was to analyse and describe the factors that influence the choice of site of delivery by pregnant women in Mukono district. By employing quantitative, non experimental research methods, 431 women were interviewed by using structured questionnaires. These women had either delivered at; home, TBA, private or public clinic and 72% had been delivered by skilled attendants. Choice of delivery site was influenced by the attitudes of health workers which were rather poor in public sites, proximity of site, attendance of antenatal clinic at a site, availability of supplies and drugs, plus level of care including emergency obstetric care. / Health Studies / M. A. (Public Health)

Indiana University-Purdue University Indianapolis (IUPUI) / This thesis project aims to address the following question: How do women who were planning a vaginal birth with limited medical intervention experience an unplanned c-section? Specifically, this research project involved: completing in-depth interviews with 15 women who planned a vaginal birth with limited medical intervention but instead experienced an unplanned c-section between six months and two years ago; discovering and describing the nature of the birth the mothers originally envisioned for their child; exploring the women’s experiences with, and feelings about, the birth itself and how it might differ from what they envisioned; developing a better understanding of how these experiences and feelings affected the women during the first two years following the birth; describing any challenges they faced and how, if at all, they managed such challenges; and identifying strategies that could be used to improve the experience of women recovering from an unplanned c-section who envisioned a vaginal birth with limited medical intervention.