Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2012-11-19T18:11:37Z No. of bitstreams: 1 Nadja de Jesus G. dos Santos. Hemoglobina fetal...pdf: 2812470 bytes, checksum: 55476e9f2f10311274d9f1a3382fda56 (MD5) / Made available in DSpace on 2012-11-19T18:11:37Z (GMT). No. of bitstreams: 1 Nadja de Jesus G. dos Santos. Hemoglobina fetal...pdf: 2812470 bytes, checksum: 55476e9f2f10311274d9f1a3382fda56 (MD5) Previous issue date: 2012 / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, Bahia, Brasil / O estudo de marcadores associados à síntese de hemoglobina fetal (HbF) é de grande interesse científico, pois contribui para o entendimento dos mecanismos regulatórios dos genes envolvidos na síntese das cadeias globínicas gama, uma vez que esta Hb é importante na modulação genética da anemia falciforme (HbSS). O objetivo desse estudo foi investigar a influência de alterações em genes envolvidos na síntese de HbF e suas associações com marcadores laboratoriais e clínicos na HbSS e caracterizar o fenótipo e o genótipo de indivíduos com o perfil sugestivo de persistência hereditária de hemoglobina fetal (PHHF). Dessa forma, foi realizado um estudo de corte transversal, seguido de caso-controle com a casuística de 43 indivíduos HbSS com HbF> 3,0% e 3 indivíduos com perfil sugestivo de PHHF. O presente estudo foi aprovado pelo CEP-CpGM-Fiocruz. Os polimorfismos HBG2 -396/-391del, HBG2 SNP -369 C>G, HBG2 -309 A>G, HBG2 -157 T>C, HBG1 -499 T>A, HBG1 -369 C>G, HBG1 -271 C>T e HBG1-225/-222del foram investigados por sequenciamento automático de DNA; os haplótipos ligados ao gene da globina beta foram investigados por PCR-RFLP; os polimorfismos BCL11Ars766432, BCL11Ars6732518, OR51B5/6rs4910756, OR51B5/6rs7483122, HMIPrs11759553, HMIPrs35959442 foram investigados por PCR em tempo real; a talassemia alfa 23.7 Kb e as deleções PHHF-1, PHHF-2 e PHHF-4 por PCR. As análises hematológicas foram realizadas em contador automático de células, o perfil de hemoglobina foi confirmado por cromatografia líquida de alto desempenho e as dosagens bioquímicas foram investigadas por quimiluminescência. As concentrações de HbF foram associadas com HbS (p<0,0001), hematócrito (p=0,035), VCM (p=0,010), HCM (p=0,045), colesterol VLDL (p=0,044), ferro (p=0,001) e ferritina (p=0,042). Os polimorfismos estudados apresentaram associação com marcadores laboratoriais e clínicos no grupo estudado. O polimorfismo HBG1 -271 C>T foi associado com a concentração de HbF (p=0,027; RP=4,45; IC95%= 1,14 – 17,41) e ferro (p=0,0076); o HBG1 -499 T>A com as concentrações de glicose (p=0,007) e de alfa-1 antitripsina (p=0,008); o HBG1 -225/-222del com as concentrações de colesterol LDL (p=0,017); o HBG2 -396/-391del com as concentrações de HbS (p=0,017), creatinina (p=0,042) e bilirrubina p=0,030), sendo associado também ao quadro clínico mais grave da doença, com ocorrência frequente de crises vaso-oclusivas (p=0,046), litíase biliar (p=0,021) e o uso de hemoterápicos (p=0,009); o BCL11A rs766432 com a contagem de reticulócitos (p<0,0001) e a concentração de colesterol total (p=0,033); o BCL11Ars6736518 com concentração de glicose (p=0,049) e a contagem de eosinófilos (p=0,012); o HMIPrs35959442 com as concentrações de ferritina (p=0,035), creatinina (p=0,008) e VCM (p=0,022); o HMIPrs11759553 com as concentrações de ácido úrico (p=0,033) e ferritina (p=0,020); e os polimorfismos OR51B5/6rs7483122 e OR51B5/6 rs4910756 com as concentrações de creatinina (p=0,001). A análise multivariada mostrou associação do genótipo CAR/CAR com a concentração diminuída de HbF e o uso de hemoterápicos. A talassemia alfa 23.7 Kb apresentou efeito protetor, sendo associada com as concentrações de ALT (p=0,044), AST (p=0,039) e com a contagem de linfócitos (p=0,050). Os três casos associados ao fenótipo de PHHF não apresentaram alterações clínicas e laboratoriais significativas, inclusive o caso 3, que apresentou o genótipo HbSF. É importante salientar que esses indivíduos não eram portadores de nenhuma das formas de PHHF investigadas. Estudos adicionais devem ser conduzidos com o objetivo de validar os resultados encontrados nesse estudo e de esclarecer os possíveis mecanismos pelos quais os marcadores moleculares investigados interferem na modulação da síntese de HbF e se esses biomarcadores podem apresentar mecanismos diferenciados daqueles comumente investigado, uma vez que foram descritas associações com marcadores importantes para o acompanhamento clínico de indivíduos HbSS. / The study of markers associated with the fetal hemoglobin (HbF) synthesis is of great scientific interest, since it can contribute to understanding regulatory mechanisms of genes involved in the synthesis of globin chains, once that HbF participate in the genetic modulation of sickle cell anemia (HbSS). The aim of this study was to investigate the influence of changes in genes involved in the synthesis of HbF and their associations with clinical and laboratory markers in HbSS and characterize the phenotype and genotype of individuals with the profile suggestive of hereditary persistence of fetal hemoglobin (HPFH). Thus, we performed a cross-sectional study, followed by a case-control, in a group of 43 HbSS individuals with HbF> 3.0% and 3 individuals with a suggestive profile of HPFH. Polymorphisms HBG2 -396/-391del, the HBG2 SNP -369 C> G, HBG2 -309 A> G, HBG2 -157 T> C, HBG1 -499 T> A, HBG1 -369 C> G HBG1 the -271 C> T and HBG1-225/-222del were investigated by automated DNA sequencing; haplotypes linked to the beta globin gene were investigated by PCR-RFLP; single nucleotide polymorphisms of BCL11Ars766432, BCL11Ars6732518, OR51B5/6rs4910756, OR51B5/6rs7483122 , HMIPrs11759553, HMIPrs35959442 were investigated by real-time PCR, alpha thalassemia 2 with 3.7 Kb deletion and HPFH-1 , HPFH-2 and HPFH-4 deletions by PCR Hematological tests were performed in automatic cell counter, the profile of hemoglobin was confirmed by high performance liquid chromatography and biochemical analysis were investigated by immunochemistry assay method. Levels of HbF were associated with HbS (p <0.0001), hematocrit (p= 0.035), MVC (p= 0.010), MHC (p= 0.045), VLDL cholesterol (p= 0.044), iron (p= 0.001) and ferritin (p= 0.042). Polymorphisms were associated with clinical and laboratory markers in the studied group. The polymorphism HBG1 -271 C>T was associated with the concentration of HbF (p = 0.027, PR = 4.45, 95% CI 1.14 - 17.41) and iron (p= 0.0076); the HBG1 - 499 T> A was associated with the level of glucose (p= 0.007) and alpha-1 antitrypsin (p= 0.008); the HBG1 -225/-222del with LDL cholesterol concentrations (p= 0.017); the HBG2 - 396/-391del with Hb concentrations (p= 0.017), creatinine (p= 0.042) and bilirubin (p= 0.030), and also with a more severe clinical disease, with frequent occurrence of vaso-occlusive crises (p= 0.046), gallstones (p= 0.021) and the use of haemotherapic (p= 0.009); the BCL11A rs766432 with the reticulocyte count (p<0.0001) and the concentration of total cholesterol (p= 0.033) and BCL11Ars6736518 with the level of glucose (p= 0.049) and eosinophil count (p= 0.012); the HMIPrs35959442 with ferritin concentrations (p= 0.035), creatinina (p= 0.008 ) and MCV (p= 0.022), the HMIPrs11759553 with concentrations of uric acid (p= 0.033) and ferritin (p= 0.020); and the polymorphisms OR51B5/6rs7483122 and the OR51B5/6rs4910756 with creatinine concentrations (p= 0.001 ). Multivariate analysis pointed for the association of the genotype CAR / CAR with a decrease in HbF concentration with the use of blood therapy. The alpha thalassemia 2 with 3.7 Kb deletion showed a protective effect, being associated with concentrations of ALT (p= 0.044), AST (p= 0.039) and lymphocyte count (p= 0.050). The three cases associated with HPFH phenotype did not show significant association with clinical and laboratory data, including the case 3, that showed the genotype HbSF. It is noteworthy that these individuals were not classified in any described HPFH type investigated. Further studies should be conducted in order to validate results found in this work and to clarify the possible mechanisms by which those investigated molecular markers can interfere with the modulation of the HbF synthesis and if they have mechanisms differentiate from the ones commonly investigated, once that the present study described association with important biomarkers that have been used for monitoring individuals with HbSS.

No description available.

A gravidez é um evento que envolve adaptações físicas e emocionais na vida de qualquer gestante, sendo um período em que indicadores emocionais, como a ansiedade e a depressão, podem-se alterar. É também neste período que a vinculação da mãe com seu bebê, que vai nascer, começa a ser estabelecida. Esta vinculação, chamada de apego materno-fetal, é importante para a qualidade de todos os laços afetivos futuros de qualquer indivíduo. Assim, o objetivo deste estudo foi verificar as possíveis diferenças nos comportamentos de apego materno-fetal apresentados por gestantes normais e com gravidez de risco. Para tanto, participaram desta pesquisa gestantes que realizaram exames ultrassonográficos na Escola de Ultra-Sonografia e Reciclagem Médica de Ribeirão Preto, sendo 25 com gravidez normal e 23 que apresentaram gravidez de risco. Entre estas, com gravidez de risco, quatro tiveram fetos malformados. Este estudo foi longitudinal e contou com três etapas de coleta de dados: a primeira, antes da realização do exame de ultrassonografia durante o segundo trimestre gestacional; a segunda, até dois meses após o exame e a terceira, até seis meses após o nascimento dos bebês. Utilizaram-se a Escala de Apego Materno-fetal, os Inventários de Ansiedade e Depressão de Beck e três roteiros de entrevista, um para cada fase de coleta, elaborados para atender aos objetivos desta pesquisa. Os dados obtidos foram analisados quantitativamente, de acordo com as normas estabelecidas de cada um deles, e os dados das entrevistas foram transcritos na íntegra e explorados a partir do sistema quantitativointerpretativo. Posteriormente, os dados foram correlacionados entre si, através de testes estatísticos não paramétricos. Assim, obteve-se que não há diferenças entre o apego maternofetal dos dois grupos estudados, sendo que este índice aumentou à medida que a gestação avançava, apresentando-se valores máximos desde antes da ultrassonografia, no segundo trimestre gestacional. O aumento do apego foi confirmado pelo relato das gestantes, ao demonstrarem a intensificação dos comportamentos que apresentavam em relação a seus bebês, conforme a gravidez evoluía e também depois do nascimento deles. Os índices de ansiedade e depressão mostraram-se mais elevados, durante todo o período pré-natal e também depois do nascimento, entre as participantes cujas gestações foram de risco, principalmente para aquelas que tiveram filhos malformados. Estas gestantes, especialmente, sofreram o impacto da notícia de uma malformação em seus filhos ainda intraútero e quando os mesmos nasceram, apresentando reações de choque, negação, tristeza e equilíbrio na busca por adaptação à situação que vivenciavam. Conclui-se que a gravidade da realidade vivida por estas mães implica em níveis mais elevados de ansiedade e depressão, porém, não impede a formação da relação de apego entre elas e seus filhos. Enfatiza-se, portanto, a necessidade de programas de saúde com profissionais especializados que visem a assistência pré-natal emocional a todas as gestantes, de um modo geral, e principalmente àquelas que apresentam condições adversas durante a gestação. / Pregnancy is an event which involves physical and emotional adaptation in any pregnant woman\'s life. It is also a period in which emotional indicators, such as anxiety and depression, can be altered. Besides that, this is the period in which the mother and her unborn child begin to establish an attachment. This attachment, named maternal-fetal attachment, is important for the quality of all future affective bonds of any person. Therefore, the objective of this study is to find possible differences in the maternal-fetal attachment behaviour shown by normal pregnant women and the ones with risk pregnancies. For that, pregnant women who underwent ultrasound exams in the School of Ultrasound and Medical Recycling of Ribeirão Preto (Escola de Ultra-Sonografia e Reciclagem Médica de Ribeirão Preto) participated in this study. Of this group, 25 had normal pregnancies and 23 presented highrisk pregnancies. Among the latter, 4 had malformed fetuses. This is a longitudinal study, with three data collection phases: the first one was done before the ultrasound exam during the second gestational trimester; the second, up to two months after the exam and the third, up to six months after the children\'s birth. The Maternal-Fetal Attachment Scale, the Beck Anxiety and Depression Inventories and three interview scripts, one for each phase of the collection, specially designed to meet the objectives of this research, were used during the study. The information obtained was analysed quantitatively, according to each set of established rules and the data from the interviews were transcribed in full and explored using the quantitative-interpretative system. Posterior to that, the data was correlated through nonparametric static tests. It was, then, established that there are no differences between the maternal-fetal attachment of the two groups. The index, however, increased as the gestation progressed, with higher numbers since before the ultrasound, in the second gestational trimester. The growth of the attachment was confirmed by the pregnant women\'s report, when they showed the intensification of the behaviours which were presented in relation to their babies, as the pregnancies evolved and also after the babies\' birth. The levels of anxiety and depression were higher during all prenatal period and also after birth, among the participants whose gestations were of higher risk, mainly for those who had malformed babies. These pregnant women, particularly, suffered the impact of the news of a malformation in their children still intrauterine and when these children were born, they still presented reactions of shock, denial, sadness and balance when trying to adapt to their new situation. To conclude, the seriousness of the reality lived by these mothers implicate in higher levels of anxiety and depression, although it does not prevent the formation of an attachment relationship between them and their children. It is emphasised, therefore, the need of health programmes with specialised professionals which aim at emotional prenatal assistance to all pregnant women, in general, and mainly to those who go through adverse conditions during pregnancy.

Orientadores : Helena Zerlotti Wolf Grotto, Carmen Silvia Passos Lima / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-01T18:09:11Z (GMT). No. of bitstreams: 1 Borba_Ronaldo_M.pdf: 2686096 bytes, checksum: 9c069274b60d010afb07b8626a0cebf5 (MD5) Previous issue date: 2002 / Resumo: A hemoglobina Fetal (HbF) é um inibidor eficaz da polimerização da HbS. A hidroxiuréia (HU) é usada para aumentar a síntese de HbF e melhorar a evolução clínica de pacientes com síndromes fa1ciformes. Foram estudados uma série de parâmetros laboratoriais relativos à produção de HbF e à resposta dos reticulócitos (RTC), e foram comparados os dados entre 2 grupos: 13 pacientes com síndromes falciformes tratados com HU e 33 pacientes com síndromes fa1ciformes sem tratamento. No grupo tratado com HU, os resultados mostraram uma maior concentração de Hb, no volume corpuscular médio (VCM), na hemoglobina corpuscular média (HCM), no volume corpuscular médio dos RTC (VCMr), na concentração de HbF, na porcentagem de células F e na quantidade de Hb F/célula F. O número de RTC, o índice médio de fluorescência (MFI) e o número de neutrófilos foram significativamente menores em pacientes usando HU. Houve uma correlação significativa entre o VCMr e os níveis de HbF e entre o VCMr e as células F em pacientes tomando HU. A concentração de HbF/célula F foi significativamente maior em pacientes tratados com HU, mas este aumento aparentemente é independente da produção de células F. Esses dados demonstram que os parâmetros reticulocitários fornecidos por analisadores hematológicos de última geração, podem ser úteis para acompanhar as mudanças eritropoiéticas em pacientes usando HU e, permitem uma melhor compreensão de como essa terapia induz o aumento da produção de HbF e celsF nos pacientes com síndromes falciformes / Abstract: Haemoglobin F (HbF) is an effective inhibitor of HbS polymerisation. Hydroxyurea (HU) is used to increase HbF synthesis and to improve the clinical course of the sickle cell disease (SCD) patients. We studied a series of laboratorial parameters concerning to HbF production and reticulocyte response and compared the data between 2 groups: 13 SCD patients treated with HU and 33 SCD patients without treatment. Higher Hb concentration, mean cell volume (MCV), mean cell hemoglobin (MCH), mean reticulocyte volume (MRV), HbF concentration, percentage of Fce11 and proportion of HbF/Fcell were observed in the treated group ofpatients. There was no correlation between Hb and HbF increase. Reticulocyte count, immature reticulocyte count, mean fluorescence index (MFI) and neutrophil count were significantly lower in treated patients. These fmdings taken together suggest that a milder hemolytic process occurred in patients under HU treatment. There was significant correlation between MCV and HbF, MRV and HbF, and between MRV and Fce11 in patients taking HU. These data suggest that macroreticulocytes correspond to Freticulocytes, and that the increased MRV in SCD patients using HU may be an indirect evidence of F cell production. Concentration of HbF/Fcell was higher in patients treated with HU, but it is apparently independent Fcell production. RTC parameters provided by hematological analysers may be use fuI to follow erythropoietic changes in patients using HU and can, indirectly, indicate HbF and Fce11 production induced by HU therapy / Mestrado / Ciencias Biomedicas / Mestre em Ciências Médicas

Orientador: Maria de Fatima Sonati / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-03T19:34:30Z (GMT). No. of bitstreams: 1 Duarte_DeniseFaustino_M.pdf: 7306197 bytes, checksum: 55a6878d5149e5503cb31be7cf7a85ea (MD5) Previous issue date: 2003 / Resumo: O resumo poderá ser visualizado no texto completo da tese digital / Abstract: The abstract is available with the full electronic digital document / Mestrado / Ciencias Biomedicas / Mestre em Ciências Médicas

Orientador : Anibal Faundes / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-07-14T03:17:02Z (GMT). No. of bitstreams: 1 Barini_Ricardo_D.pdf: 2105967 bytes, checksum: daaa8dc08683806c5e85aa2dd664e9ad (MD5) Previous issue date: 1989 / Resumo: Foram analisadas as fichas obstétricas de 12.000 pacientes que deram à luz na Maternidade do Hospital das Clínicas da Universidade Estadual de Campinas, entre maio de 1979 a julho de 1989. Identificou-se uma amostra de 1360 pacientes que dispunham dos dados completos de pré-natal e do recém-nascido (RN) para estudo. Deste grupo, 704 pacientes não apresentavam patologias próprias ou associadas à gestação, ao contrário do observado nas demais 656 pacientes. Com os dados da medida de altura uterina (AU) das 572 pacientes sem patologias e que deram à luz a recém nascido (RN) de peso adequado para a idade gestacional, construiu-se uma curva-padrão de AU. Foi avaliado o poder de detecção da curva-padrão de AU para RNs pequenos para a idade gestacional (PIG) e para RNs grandes para a idade gestacional (GIG), no grupo de 656 gestantes com patologia. A sensibilidade na detecção de RN PIG foi de 63,5% e a especificidade de 82,1% .A sensibilidade na detecção de RN GIG foi de 67,9% e a especificidade de 73,2% . Estudou-se a influência do peso materno nos índices de detecção da curva-padrão de AU. A sensibilidade na detecção de RN PIG teve redução importante no grupo de gestantes consideradas de peso aumentado em relação aos grupos de peso normal e/ou diminuído. A especificidade na detecção de RN GlG teve redução importante no grupo de peso aumentado em relação ao grupo de peso normal. Conclui-se que a curva-padrão de AU se configura em tecnolog1a apropriada ao rastreamento das anomal1as de desenvolv1mento do peso fetal / Abstract: We analyzed 12.000 patlents and their obstetric records that gave birth at the Maternity of the Hospial das Clínicas at the Sate University of Campinas between May 1979 and July 1987. A sample of 1360 patients that presented complete pre-natal and newborn data ava1iable for study were 1dentified, 704 pat1ents did not present any pathology related or associated to gestation while 656 presented known pathology. Based on the uterine helght data of the 572 patients that gave birth to newborns of adequate welght in relation to gestational age, a standard curve of growth was elaborated. In the group of 656 patients with pathology, the power detection of the standard curve of growth was evaluated regarding small and large newborns for gestational age. The sensiltivity 1n the detection of small newborn for gestational age was 63,5% and the specificity 82,1%, for large newborn for gestat10nal age 67,9 and 73,2%. The influence of maternal welght on the rates of detection of the standard curve of growth was studied. The sensitivity in the detection of small newborn for gestational age had an important reduction in the overweight group when compared to normal and low weight group. The specificity in the detection of large newborn for gestational age had an 1mportant reduction 1n the overweight group compared to the normal we1ght group. In conclusion the standard curve growth for uterine he1ght is an adequate technology for normal fetal weight development screening when of abnormal fetal weight development screening / Doutorado / Doutor em Tocoginecologia

As the current growing threat to maternal-fetal health, the most recent and largest outbreak of the Zika virus has introduced the devastating fetal effects of microcephaly and other central nervous system deficits. Therefore, the need for appropriate recognition, treatment, management, and prevention of the Zika virus prompts the necessity for further education and high quality level research to be conducted and utilized. A search of the literature using the databases PubMed, UptoDate, and CINAHL was conducted for articles published between 2009 and 2016. In addition, key informant interviews from various specialties including clinical genetics and public health were conducted. The proposed best practice recommendations for education regarding the Zika virus and appropriate prevention and treatment methods are outlined in an electronic education module that would be delivered to patients and their families prior to visiting their healthcare providers. As the Zika virus continues to spread and further research is conducted regarding its teratogenic effects, the need for concise and effective education is critical in order to raise awareness and conversely decrease the potential for maternal exposure and adverse fetal outcomes.

Orientador: Anibal Faundes / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-07-13T21:39:10Z (GMT). No. of bitstreams: 1 Teles_EugenioPacellideBarreto_M.pdf: 1776462 bytes, checksum: 79e8590656f0c22243435d364c35846b (MD5) Previous issue date: 1990 / Resumo: Estudamos a associação de vinte e uma variáveis materno-fetais com parto prematuro em 5689 partos assistidos na maternidade do Departamento de Tocoginecologia da UNICAMP no período de 1982 a 1988. Selecionamos dez variáveis pré-gestacionais (estado civil, escolaridade, idade, paridade, intervalo interpartal, altura peso pré-gravídico, antecedentes de abortos, de partos prematuros e de natimortos) e onze variáveis gestacionais (infecção, diabetes, hipertensão, cirurgia, hemorragia, ruptura prematura de membranas, tabagismo, número de consultas e comparecimento ao pré-natal, sexo fetal e mal formação fetal) para tal estudo. Numa primeira etapa, fizemos uma análise isolada de cada variável. Em seguida, realizamos uma análise multivariada, envolvendo todo o conjunto das variáveis. Somente oito variáveis tiveram associação estatisticamente significativa com a ocorrência de parto prematuro, na seguinte ordem de importância: Hipertensão, número de consultas pré-natais, hemorragia, ruptura prematura de membranas, antecedentes de partos prematuros, peos pré-gravídico, comparecimento ao pré-natal e malformação fetal. Salienta-se a utilidade da identificação destas variáveis orientar para cuidados pré-natais especiais e/ou para encaminhamento a assistência de nível terciário. / Abstract: The association of twenty-one maternal-fetal variables with premature birth was studied in 5689 deliveries assisted at the maternity of the Department of Gynecology and Obstetrics of UNICAMP during the period 1982 through 1988. Ten pre-gestacional variables (marital status, schooling, age, parity, period between births, height, pre-pregnant weight, previous abortions, premature births and stillbirth) and eleven gestacional variables (infection, diabetes, hypertension, surgery, hemorrhage, premature rupture of the menmbranes, marital status, smoking, prenatal attendance and nember of visits consultations, fetal sex and fetal malformation) were selected for the study. As a first step, the association between each independent variable and premature birth was analysed. Then, a multivariated analysis was done involving all independent variables. Only eight variables were statistically significant associated with the ocurrence of premature birth in the following order of importance: hypertension, number of pre-natal consultations, hemorrhage, premature rupture of membranes, previous preterm birth, pre-pregnant weight, pre-natal attendance and fetal malformation. We emphasize the importance of the identification of these variables for reference to special pre-natal care and/or third level assistance. / Mestrado / Mestre em Ciências Médicas

Decreased fetal movement can indicate uncommon complication of labor; in response, we have developed a non-invasive, wearable monitoring tool to objectively assess fetal movement called the Babykick device. The novelty of this device is that it moves away from a traditional subjective assessment of fetal movement to an objective, quantitative measurement that remains low-cost. The designed tool refrains from utilizing expensive and less available monitoring modalities such as ultrasound imaging, Doppler velocimetry or cardiotocography. Instead, the wearable consists of a piezo-sensitive belt that is wirelessly connected to a phone or tablet. It can be used to record the frequency and amplitude of fetal movements perceived passively and non-invasively on the surface of the abdomen of the pregnant woman for a period of up to one hour while she is supine or seated in a reclined position. The ndings from the Babykick device will be correlated with those from subjective maternal assessment and the observation of the Research Coordinator during the test. This low-cost, non-invasive wearable belt could potentially reduce negative outcomes such as stillbirth, perinatal mortality and neonatal morbidity in low- to middle-income settings and is anticipated to be useful for long-term home monitoring. / Graduate

Memoria para optar al Título Profesional de Médico Veterinario / El presente estudio evaluó la hipótesis de que la gestación mellicera y la subnutrición materna en la preñez ovina generan hipoxia fetal y estrés oxidativo, afectando el normal crecimiento fetal, lo cual podría ser prevenido mediante la administración diaria de vitaminas antioxidantes, C y E. Se ocuparon ovejas de preñez única y doble, a la mitad de cada tipo de gestación se les manejó únicamente bajo pastoreo, supliendo aproximadamente un 70% de sus requerimientos nutricionales, mientras que a la otra mitad se les suplementó con un concentrado comercial para alcanzar el total de sus requerimientos nutricionales. A su vez, dentro de cada nivel nutricional, a la mitad de los animales se les administró diariamente una dosis oral de vitaminas C y E, iniciándose todos los manejos desde el día 30 de gestación. Al día 100 de gestación se midieron características de oxigenación en la sangre arterial materna y venosa umbilical, además de biomarcadores de estrés oxidativo en sangre fetal y características biométricas fetales. La gestación mellicera y la subnutrición materna afectó negativamente la oxigenación fetal y su combinación genera condiciones francamente hipóxicas a nivel fetal. Por su parte, la administración diaria de vitaminas antioxidantes mejoró el aporte de O2 a los fetos. No se evidenció modificación en los biomarcadores de estrés oxidativo (MDA y CAT fetal), por lo cual probablemente el grado de hipoxia fetal fue leve a esta edad gestacional, o bien el estatus antioxidante endógeno fue suficiente para contrarrestar los efectos de la hipoxia como inductor de estrés oxidativo. La subnutrición y la gestación mellicera disminuyeron el tamaño y el peso fetal, con máximo efecto en gestaciones melliceras bajo subnutrición. En conclusión, a los 100 días de preñez la gestación mellicera, la subnutrición y su combinación conducen a una restricción del crecimiento intrauterino, la cual se podría deber a la disminución del traspaso de otros nutrientes por sobre el efecto de la hipoxia y estrés oxidativo, razón por la cual no existiría un claro efecto benéfico de la administración de vitaminas C y E. / The present study evaluated the hypothesis that twin pregnancies and undernutrition in the sheep pregnancy generates fetal hypoxia and oxidative stress, affecting the normal fetal growth, which can be prevented by the daily administration of antioxidant vitamins, C and E. Single and twin sheep pregnancies were used, half of each type of gestation were handled only under grazing, supplying about 70% of their nutritional requirements, while the other half were supplemented with a commercial concentrate to reach the total of their nutritional requirements. Additionally, within each nutritional level, half of the animals were given a daily oral dose of vitamins C and E, starting from day 30 of gestation. At day 100 of gestation, oxygenation characteristics in maternal arterial and venous umbilical blood were measured, as well as biomarkers of oxidative stress in the fetal blood and fetal biometric characteristics. Twin pregnancy and undernutrition negatively affects the conditions of fetal oxygenation, and their combination actually generates fetal hypoxia. On the other hand, the daily administration of antioxidant vitamins improve the O2 supply to the fetuses. There was no increase of oxidative stress biomarkers (MDA and fetal TAC), thus the degree of fetal hypoxia is probably slight at this gestational age, or the endogenous antioxidant status is enough to counteract the effects of hypoxia as inducer of oxidative stress. Undernutrition and twin pregnancy decreased fetal size and weight, with the maximum effect in twin pregnancies with undernutrition. In conclusion, at 100 days of gestation twin pregnancies, undernutrition and their combination lead to intrauterine growth restriction, which would be explained due to the decrease in the transfer of other nutrients over the effect of hypoxia and oxidative stress, therefore a clear beneficial effect of the vitamins C and E administration was not detected at this gestational period / Proyecto Fondecy 1160892