Diethylstilbestrol (DES) is one of the synthetic estrogen available today for therapeutic use. It is also referred to as a carcinogenic agent, with a great number of side effects reported between maternal ingestion of DES during pregnancy, as a postovulatory agent to prevent implantation and possible occurrence of carcinoma in the progeny of women known to be aborterse. In the present study, experiments were done to determine the effects of DES on the estrogen titer of the maternal, fetal and neo-natal plasma ovarian homogenates of female Long-Evans rats. Adult and 30-day old rats were treated via stomach intubation with 35 mg/2cc/kg body wt of DES. The estrous cycle of the rats was monitored and vaginal smear cell counts were determined in 0.5 cc saline smear volume. Radioimmunoassay was used to determine the estradiol levels in the plasma and ovarian homogenates. Results showed no changes in the estrous cycle synchrony of the maternal rats, while the estrous cycle of the treated 30-dayold rats has synchronous. The vaginal smear cell count was significantly greater in the two groups of treated rats studied than in the controls. Comparing the mean estradrol value for the plasma and ovarian homogenates in the maternal rats, an obvious increase in the plasma E2 level was obtained as compared to small, decrease in the mean value of ovarian E2 level. There was no difference in the mean value of pooled ovarian homogenate E2 level of the control saline, control and DES-treated 19-1/2-day old rats. A significant decrease in the plasma E2 mean value of 30-day old treated rats was obtained when compared to both control groups. There was no significant increase in ovarian homogenate E2 level of both treated and the control groups. In light of these results, DES has a secondary effect, asynchronous cell proliferation in the vaginal epithelia leading to prolonged specific stages of the estrous cycle of the young adult female rats. Also, DES causes an increase in plasma E2 levels of treated maternal rats and a decrease in plasrna E2 levels of 30-dayold rats. Finally, DES has no effect on the estrogen level of the ovarian homogenates of the maternal, fetal and 30-clay-old young Long-Evans female rats.

Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg / Background and objectives Prelabour rupture of the membranes (PROM) is a major obstetric problem affecting about 20% of pregnancies. Complications include preterm labour, ascending intrauterine and perinatal infections, and neonatal mortality. Standard guidelines are formulated and continually reviewed to improve the clinical management of PROM and to reduce poor perinatal outcomes associated with this condition. The objectives of this study, conducted using women in Johannesburg as a sample population, were: 1) to audit the implementation of the standard protocol on management of PROM, and 2) to determine the maternal and fetal outcomes of this condition. Methods A cross-sectional descriptive study was done on women admitted to the antenatal wards of Chris Hani Baragwanath Academic Hospital with PROM. Inclusion criteria were that PROM was the main reason for admission, gestation ≥24 weeks, and maternal age 18 years or more. Hospital clinical files were studied for obstetric and clinical characteristics, adherence by doctors to the management protocol, and final outcome including latency period, induction rate, mode of delivery, and neonatal outcome. Results Ninety-seven women participated in the study. Their mean age was 27.0 years, and 37 (38%) were nulliparous. Eighty-five (87%) had attended antenatal clinic. Twenty-nine (30%) were HIV-infected, 23 (79%) of them on highly active antiretroviral treatment. 6 The mean gestational age on admission was 32.8 weeks, with 78 (80%) women having preterm PROM at GA<37 weeks and 52 (54%) at GA <34 weeks. The most frequent methods of diagnosis were visual inspection in 77 (79%), speculum examination in 49 (51%) and ultrasound scan in 81 (84%) of the women. Antibiotics were given to 96 women (99%), and antenatal corticosteroids were used in all women <34 weeks pregnant. No cases of clinical chorioamnionitis were detected. The mean latency from PROM to delivery for women <37 weeks pregnant was 15 days, and for those <34 weeks, it was 19 days. Twenty-nine women (30%) required induction of labour, and 25 (25.8%) had caesarean sections. There were 12 perinatal deaths (with the exclusion of three late neonatal deaths), resulting from prematurity (n=4), congenital anomalies (n=2), neonatal jaundice (n=2), respiratory distress syndrome (n=2) and perinatal asphyxia / hypoxic ischaemic encephalopathy (n=2). There were no recorded cases of either neonatal or puerperal sepsis. Conclusion The study may have under-represented term PROM, so the findings are most applicable to preterm PROM. The condition was mostly managed appropriately within the local protocol, especially in terms of corticosteroid and antibiotic use. Overt or clinically evident chorioamnionitis was not detected. However, the perinatal mortality rate was high, and whatever the causes of perinatal death in this group, it is clear that PROM is a high-risk condition deserving of close clinical attention.

The teratogenic effects of prenatal alcohol exposure can significantly influence the development of a child, which may result in a range of structural, cognitive and behavioural abnormalities. The severity of these effects can vary and fall under the fetal alcohol spectrum disorder (FASD). South Africa hosts the highest prevalence rate (12%) of this disorder in the world. All conditions included in the FASD spectrum are completely preventable through maternal abstinence of alcohol during pregnancy. At present, very limited information is available regarding how much pregnant women in South Africa know about adverse effects caused by prenatal alcohol exposure. This study aimed to determine pregnant women’s awareness of alcohol’s potential teratogenic effects on pregnancy and their knowledge of the features and characteristics associated with fetal alcohol syndrome (FAS), the most severe of the FASD conditions. Additionally, the study compared the awareness and knowledge of pregnant women attending private antenatal centres, to those attending an antenatal clinic at Charlotte Maxeke Johannesburg Academic Hospital, a state hospital in the Johannesburg area. Participants (n=211) completed a self-administered questionnaire at their private antenatal class or state clinic. A total of 211 questionnaires were analysed; 107 questionnaires from the state antenatal clinic and 104 from the private antenatal centres. The awareness levels regarding alcohol use in pregnancy were found to be very similar amongst the private (52%) and state (55%) participants. However, results indicated that significantly more private participants (19%), compared to state participants (3%) could be classified as having knowledge of the condition FAS. Overall, this study found that pregnant women from various backgrounds have limited knowledge of the harms caused by alcohol use during pregnancy. Misconceptions about the acceptable levels of maternal alcohol consumption and the effects thereof were also evident. The results of this research highlights that prevention strategies and awareness campaigns regarding alcohol use during pregnancy should incorporate information on the severity and permanent nature of FAS, as well as highlighting the fact that all types of alcoholic beverages can result in this condition. Also, these campaigns should focus on informing women that no level of alcohol is acceptable during pregnancy, as any amount may have potentially teratogenic effects on the developing fetus.

Introdução: o timo é importante órgão linfoide do sistema imunológico. Estudos mostraram que, durante o período fetal, a atrofia desse órgão faz parte da resposta adaptativa do feto ao ambiente intrauterino adverso, como a desnutrição crônica causada pela insuficiência placentária. Essa situação pode explicar a associação entre restrição de crescimento intrauterino e as alterações no sistema imunológico após o nascimento, na infância e na adolescência. Objetivos: analisar as dimensões do timo fetal pela ultrassonografia em gestações com insuficiência placentária, comparando com gestações de alto risco sem insuficiência placentária e gestações de baixo risco. Métodos: estudo prospectivo com 30 gestações com insuficiência placentária (Doppler de artéria umbilical com índice de pulsatilidade > p95) comparadas com 30 de alto risco e 30 de baixo risco (grupo controle). Os critérios de inclusão foram: idade gestacional entre 26 e 37 semanas, feto único e vivo, ausência de malformações fetais, membranas íntegras, ausência de sinais de trabalho de parto, ausência de infecção materna ou fetal e não realização de corticoterapia antes da avaliação ultrassonográfica fetal. O timo fetal foi identificado na interface com os pulmões, na altura dos três vasos da base do coração, no corte do tórax fetal. Foram realizadas três medidas do diâmetro transverso (DT) e do perímetro (P) do timo, e as médias foram utilizadas para análise, transformadas em escores zeta, de acordo com a idade gestacional em que se efetuou a medida. Foram realizadas as medidas ultrassonográficas da circunferência cefálica (CC) e do comprimento do fêmur (CF) fetal, com as quais se calculou as relações DT/CF, DT/CC, P/CF e P/CC. Resultados: o grupo com insuficiência placentária apresentou mediana significativamente maior do escore zeta do IP da artéria umbilical quando comparado ao grupo de alto risco e controle (4,6 vs. -0,5 vs. -0,2, p < 0,001). As medidas do timo fetal no grupo com insuficiência placentária [escore zeta do DT (média=-0,69; DP=0,83) e escore zeta do P (média=-0,73; DP=0,68)] foram significativamente (p < 0,001) menores quando comparadas aos grupos de alto risco [escore zeta do DT (média=0,49; DP=1,13) e escore zeta do P (média=0,45; DP=0,96)] e controle [escore zeta do DT (média=0,83; DP=0,85) e escore zeta do P (média=0,26; DP=0,89)]. Nas relações estudadas, houve diferença significativa (p < 0,05) na média dos grupos: insuficiência placentária (DT/CC=0,10, P/CF=1,32 e P/CC=0,26); alto risco (DT/CC=0,11, P/CF=1,40 e P/CC=0,30) e controle (DT/CC=0,11, P/CF=1,45 e P/CC=0,31). Conclusão: em gestações complicadas pela insuficiência placentária, ocorre redução das dimensões do timo fetal sugerindo que pode ser decorrente da adaptação fetal ao ambiente intrauterino adverso / Introduction: thymus gland is an important lymphoid organ involved in immune response. Studies have shown that during fetal life, thymus atrophy is part of an adaptive response to a compromised intrauterine environment, like chronic malnutrition due to placental insufficiency. This may explain the association between intrauterine growth restriction and later altered immune function. Objective: to evaluate fetal thymus by ultrasonography in pregnancies with placental insufficiency and compare to high risk pregnancies without placental insufficiency and low risk pregnancies. Methods: a prospective study with 30 pregnancies with placental insufficiency (umbilical artery Doppler with pulsatility index > p95), compared to 30 high risk pregnancies and 30 low risk pregnancies (control group). The inclusion criteria were: gestational age ranging from 26 to 37 weeks, singleton pregnancies, absence of fetal malformations, intact membranes, not in labor, no signs of maternal or fetal infection, and no corticotherapy before the ultrasound evaluation. Fetal thymus was identified in its interface with the lungs, at the level of the tree-vessel view of the fetal thorax. Three measures of thymus transverse diameter (TD) and perimeter (P) were made, and the media were converted into zeta score according to the gestational age. Head circumference (HC) and femur length (F) were also measured and used in the calculation of the relations TD/F, TD/HC, P/F, P/HC. Results: the group with placental insufficiency presented median of umbilical artery PI elevated, when compared to high risk pregnancies and low risk pregnancies (4.6 vs. -0.5 vs. -0.2, p < 0.001). Fetal thymus measurements were significantly (p < 0.001) lower in pregnancies with placental insufficiency [TD zeta score (media=-0.69; SD=0.83) and P zeta score (media=-0.73; SD=0.68)] when compared to high risk pregnancies [TD zeta score (media=0.49; SD=1.13) and P zeta score (media=0.45; DP=0.96)] and control group [TD zeta score (media=0.83; SD=0.85) and P zeta score (media=0.26; SD=0.89)]. There was significant difference (p < 0,05) in the relations studied among the groups: pregnancies with placental insufficiency (TD/HC=0.10, P/F=1.32 e P/HC=0.26), high risk pregnancies (TD/HC=0.11, P/F=1.40, P/HC=0.30) and control group (DT/HC=0.11, P/F=1.45, P/HC=0.31). Conclusion: fetal thymus measurements are reduced in pregnancies with placental insufficiency, suggesting that it is a fetal adaptive response for adverse environment

Sickle cell anemia is caused by a single mutation in the β-hemoglobin gene, HBB. The disease originated in Africa and affects millions of people worldwide. Sickle hemoglobin tetramers polymerize upon deoxygenation and lead to hemolysis and vaso-occlusion. Patients with high fetal hemoglobin (HbF) can have milder disease. The only FDA-approved drug is hydroxyurea that increases HbF. HbF modulates the disease by preventing the polymerization of sickle hemoglobin and reduces the pain episodes, anemia, and organ damage associated with the disease. There are five common haplotypes associated with the HbS gene and that are very loosely associated with disease severity and HbF. Understanding the genetic bases of HbF regulation is a key factor to identify potential drug targets to induce HbF for therapeutic purposes. To fully understand the mechanism behind HbF regulation, developing a fast and accurate computational method for sickle cell haplotype classification is useful for examining the variability of HbF among sickle cell patients. Moreover, investigating the cis and trans-acting regulators of HbF gene expression to pinpoint the mechanism through which they regulate HbF is essential to develop a successful treatment. The availability of high-throughput genetic data provides an excellent opportunity to study HbF regulation in sickle cell patients and normal people comprehensively. The work reported in this thesis describes a fast and accurate method for sickle cell HBB haplotype classification. I also examine the differential effect of cis and trans-acting HbF hemoglobin regulators on -globin gene expression using the GTEx database and identify BCL2L1 as a new potential trans-regulator of HbF.

Consonni, E. B. (2013). Vínculo e perda: vivências de mulheres que interromperam a gestação por malformação fetal incompatível com a vida após o nascimento. Tese de Doutorado, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto. O desenvolvimento das técnicas de diagnóstico pré natal possibilita detecção acurada de anomalias letais no feto, colocando o casal frente à difícil decisão de interromper ou não a gestação. O presente estudo teve por objetivo compreender o significado das vivências de mulheres que interromperam a gestação sob autorização judicial, devido à malformação fetal incompatível com a vida. Participaram do estudo dez mulheres atendidas no Setor de Medicina Fetal do Hospital das Clínicas de Botucatu. Para coleta dos dados foram realizadas duas entrevistas semi-estruturadas, uma durante a gestação e outra quarenta dias após a interrupção. As entrevistas foram audiogravadas, transcritas na íntegra e tiveram os dados analisados na perspectiva da análise de conteúdo. Os resultados revelaram que o contato com o diagnóstico desencadeou reações de choque, incredulidade e esperança. As imagens do feto na ultrassonografia, especialmente nos casos de anomalias externas, causaram espanto e sofrimento, ao mesmo tempo em que, junto a outras imagens e informações obtidas pelas mães na internet, colaboraram para que melhor compreendessem o diagnóstico fetal. Os relatos apontaram dificuldades das gestantes na esfera social, como ao responder perguntas e comentários sobre a gravidez e o bebê e ao ouvir opiniões a respeito da malformação e da interrupção. Desde o diagnóstico pré-natal até o puerpério, as mães buscaram explicações e significados para a condição fetal e a perda do filho, sendo muito frequentes respostas religiosas e auto culpabilizantes. Os relatos mostram a existência de forte vinculação materno-fetal, tanto antes como após o diagnóstico, e as mulheres optaram pela interrupção da gestação na intenção de não se vincular ainda mais ao bebê e evitar sofrimento maior, sem que isso no entanto significasse o rompimento do vínculo. As mães que optaram por conhecer e se despedir do bebê após o nascimento, enfatizaram a importância deste momento, lembrado como positivo pela possibilidade de ver, despedir-se e guardar para sempre uma lembrança. Os relatos no puerpério marcaram sentimentos de tristeza, saudade e sensação de vazio pela perda do filho, revelando também a necessidade das mães manterem-se ligadas a ele. Na opinião destas mulheres, mediante a confirmação médica da impossibilidade de sobrevida após o nascimento, a mãe e/ou casal deveria ter autonomia para decidir sobre a interrupção da gestação, sendo a autorização judicial percebida como desnecessária e um fator de mais angústia para a situação vivida. Conclui-se que o diagnóstico fetal de malformação incompatível com a vida causou sofrimento para essas mulheres, pois precedeu inúmeras perdas e desencadeou complexo processo de luto. As mães estavam e continuaram vinculadas aos seus filhos; a interrupção da gestação, embora tenha sido uma escolha que evitasse a intensificação do vínculo e minimizasse a dor de uma perda inevitável, não as poupou de vivências de grande sofrimento. O estudo traz subsídios para a discussão e planejamento de abordagens e cuidados com a saúde de gestantes que recebem diagnóstico de malformação fetal letal. / Consonni, E. B. (2013). Attachment and loss: the experiences of women who terminate a pregnancy due to fetal malformations incompatible with postnatal life. Tese de Doutorado, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto. The development of prenatal diagnostic techniques has enabled lethal fetal anomalies to be detected with accuracy, thus leaving couples with the difficult decision of whether or not to terminate the pregnancy. The objective of the present study was to gain understanding on what these experiences meant to those women who were granted legal authorization to terminate their pregnancy due to a fetal malformation incompatible with life. Ten women receiving care at the fetal medicine unit of the Botucatu Teaching Hospital participated in the study. Two semi-structured interviews were held for the purpose of collecting data, the first during pregnancy and the second forty days after termination. The interviews were audio-recorded and transcribed in their entirety. The data were analyzed according to the content analysis methodology. Results showed that becoming aware of their diagnosis triggered reactions of shock, disbelief and hope in these women. The ultrasound images of the fetus, particularly in those cases in which the abnormalities were external, caused shock and distress; however, together with other images and information obtained by the mothers from the internet, they contributed towards providing a better understanding of the fetal diagnosis. The women\'s accounts highlighted their difficulties in the social sphere, for example, when having to answer questions and respond to comments on their pregnancy and on their baby, and when listening to opinions on fetal malformation and pregnancy termination. Between the time of prenatal diagnosis and the puerperium, the mothers sought explanations and meanings for the fetal condition and for the loss of their child, with religious and self-blame attributions being very common. These testimonies reveal the existence of a strong maternalfetal attachment, both prior to and following diagnosis. The women opted to terminate their pregnancy to interrupt this process of increasing attachment and to prevent even greater suffering; however, this did not mean that the bond was broken. Those mothers who took the decision to see their baby after he/she was born and to say goodbye emphasized the importance of this moment, remembering it as positive because they had been able to see the child, say farewell to him/her and keep that memory of the child for ever. The statements made by the women during the puerperium were marked by feelings of sadness, nostalgia and emptiness evoked by the loss of their child, which also emphasized the mothers\' need to preserve this attachment. In these women\'s opinions, when faced with medical confirmation that the fetus will not survive after delivery, the mother or the couple should have the autonomy to decide whether or not to terminate the pregnancy, with legal authorization being perceived as unnecessary and a source of further anguish under these circumstances. In conclusion, fetal diagnosis of a malformation incompatible with life led to suffering in these women, since it preceded innumerous losses and triggered a complex grieving process. The mothers were and continue to be attached to their children. Pregnancy termination, although representing a choice made to avoid intensifying the degree of this attachment and to minimize the pain of an unavoidable loss, did not save them from having to experience great suffering. This study adds to the debate on the subject and provides further data for use in planning the management and care of the health of pregnant women who receive a diagnosis of a lethal fetal malformation.

by Wang, Wei Vivian. / Thesis (Ph.D.)--Chinese University of Hong Kong, 1996. / Includes bibliographical references (leaves 237-266). / ACKNOWLEDGEMENTS --- p.viii / SUMMARY --- p.ix / PUBLICATION --- p.xiv / STATEMENT OF ORIGINALITY --- p.xv / LIST OF ABBREVIATIONS --- p.xvi / Chapter CHAPTER 1 --- INTRODUCTION --- p.3 / Chapter 1.1 --- Preamble --- p.3 / Chapter 1.2 --- Free oxygen radicals --- p.7 / Chapter 1.2.1 --- Free oxygen radicals and mechanism of radical damage / Chapter 1.2.1.1 --- What is a free radical? / Chapter 1.2.1.2 --- Mechanism of free radical damage / Chapter 1.2.2 --- Detection and characterisation of free radical species / Chapter 1.2.2.1 --- Direct methods / Chapter 1.2.2.1.1 --- Electron spin resonance (ESR) spectroscopy / Chapter 1.2.2.1.2 --- Chemiluminescence / Chapter 1.2.2.2 --- Indirect methods / Chapter 1.2.2.2.1 --- Lipid peroxidation / Chapter 1.2.2.2.2 --- Protein and DNA oxidation / Chapter 1.2.2.2.3 --- Purine and pyrimidine metabolites / Chapter 1.2.3 --- Free oxygen radicals and major disease / Chapter 1.2.4 --- Oxygen-derived free radicals and fetal hypoxia / Chapter 1.3 --- Acid-base status in cord blood --- p.41 / Chapter 1.3.1 --- Correlation between obstetric clinical events and cord blood acid-base / Chapter 1.3.2 --- Practical implications of cord blood acid-base studies / Chapter 1.4 --- Intrapartum cardiotocography (CTG) analysis --- p.58 / Chapter 1.4.1 --- Base line / Chapter 1.4.1.1 --- Baseline rate / Chapter 1.4.1.2 --- Baseline variability / Chapter 1.4.2 --- Accelerations and decelerations / Chapter 1.4.3 --- Fetal outcome of labour / Chapter 1.4.3.1 --- Fetal heart rate (FHR) changes during labour / Chapter 1.4.3.2 --- Acidaemia during labour / Chapter 1.4.4 --- Computerised analysis of cardiotocogram / Chapter 1.5 --- Intrapartum complications --- p.83 / Chapter 1.5.1 --- Meconium stained amniotic fluid / Chapter 1.5.2 --- Nuchal cord entanglement / Chapter 1.5.3 --- Prolonged 1st and 2nd stage of labour / Chapter 1.6 --- Objectives of project --- p.93 / Chapter CHAPTER 2 --- MATERIALS AND METHODS --- p.98 / Chapter 2.1 --- Materials --- p.98 / Chapter 2.1.1 --- Clinical materials / Chapter 2.1.2 --- Chemicals and reagents / Chapter 2.1.2.1 --- The measurement of malondialdehyde (MDA) / Chapter 2.1.2.2 --- The measurement of organic hydroperoxides (OHP) / Chapter 2.1.2.3 --- The measurement of purine and pyrimidine metabolites / Chapter 2.1.3 --- Equipment / Chapter 2.1.3.1 --- Fetal monitor / Chapter 2.1.3.2 --- Fetal heart rate analysis system / Chapter 2.1.3.3 --- Blood gas analyser / Chapter 2.1.3.4 --- UV-VIS Spectrophotometer / Chapter 2.1.3.5 --- Fluorescence Spectrophotometer / Chapter 2.1.3.6 --- High Performance Liquid Chromatography (HPLC) / Chapter 2.2 --- Investigation Methods --- p.105 / Chapter 2.2.1 --- Blood gas / Chapter 2.2.2 --- Lipid peroxidation in umbilical cord blood / Chapter 2.2.2.1 --- The measurement of MDA / Chapter 2.2.2.2 --- The measurement of OHP / Chapter 2.2.3 --- Purine and pyrimidine metabolites in umbilical cord blood / Chapter 2.2.4 --- Computer analysis of CTG / Chapter 2.2.4.1 --- Data and signal processing / Chapter 2.2.4.2 --- The algorithm / Chapter 2.3 --- Statistical analysis --- p.112 / Chapter CHAPTER 3 --- RESULTS --- p.116 / Chapter 3.1 --- Umbilical blood pH and gas measurements --- p.118 / Chapter 3.2 --- Lipid peroxidation in cord blood plasma --- p.121 / Chapter 3.2.1 --- Validation of assay / Chapter 3.2.1.1 --- Performance characteristics of the MDA assay / Chapter 3.2.1.2 --- Performance characteristics of the OHP assay / Chapter 3.2.2 --- "Inter-relationship among MDA, OHP and acid-base status" / Chapter 3.3 --- Nucleotide metabolites in cord blood plasma --- p.142 / Chapter 3.3.1 --- Calibration of assay / Chapter 3.3.2 --- Inter-relationship among nucleotides and acid-base status / Chapter 3.4 --- Analysis of FHR patterns --- p.150 / Chapter 3.4.1 --- Umbilical blood gas and CTG analysis / Chapter 3.4.2 --- Biochemical parameters and CTG analysis / Chapter 3.5 --- "Relations of umbilical arterial blood pH and gas, lipid peroxidation, purine or pyrimidine metabolites and FHR patterns with intrapartum complications" --- p.166 / Chapter 3.5.1 --- Meconium stained amniotic fluid / Chapter 3.5.1.1 --- Clinical features / Chapter 3.5.1.2 --- Relationship between meconium stained amniotic fluid and biochemical parameters / Chapter 3.5.1.3 --- Relationship between meconium stained amniotic fluid and FHR patterns / Chapter 3.5.2 --- Nuchal cord / Chapter 3.5.2.1 --- Clinical features / Chapter 3.5.2.2 --- Relationship between nuchal cord and biochemical parameters / Chapter 3.5.2.3 --- Relationship between nuchal cord and FHR patterns / Chapter 3.5.3 --- The length of second stage of labour / Chapter 3.5.3.1 --- Clinical features / Chapter 3.5.3.2 --- Relationship between the length of second stage and acidaemia or FHR patterns / Chapter 3.5.4 --- Apgar scores / Chapter 3.5.4.1 --- Clinical features / Chapter 3.5.4.2 --- Relationship between Apgar scores and biochemical parameters / Chapter 3.5.4.3 --- Relationship between Apgar scores and FHR patterns / Chapter 3.5.4.4 --- "Relationship between Apgar scores and nuchal cord, meconium or second stage of labour" / Chapter CHAPTER 4 --- DISCUSSION --- p.189 / Chapter 4.1 --- Blood pH and gas in fetal asphyxia --- p.189 / Chapter 4.2 --- Lipid peroxidation in cord blood at birth --- p.194 / Chapter 4.2.1 --- Method for measurement of the cord plasma MDA / Chapter 4.2.2 --- Method for measurement of the cord plasma OHP / Chapter 4.2.3 --- Relationship between the fetal asphyxia and lipid peroxidation in cord plasma / Chapter 4.3 --- Purine and pyrimidine metabolites in cord blood at birth --- p.203 / Chapter 4.3.1 --- Limitations imposed by the tcchniqucs used / Chapter 4.3.2 --- Relationship between the fetal asphyxia and purine and pyrimidine metabolites in cord plasma / Chapter 4.4 --- Computerised analysis of CTG --- p.210 / Chapter 4.4.1 --- CTG patterns and cord blood acid base balance / Chapter 4.4.2 --- CTG patterns and cord blood biochemical parameters / Chapter 4.5 --- "Intrapartum complications 2,9" / Chapter 4.5.1 --- Meconium stained amniotic fluid / Chapter 4.5.2 --- Nuchal cord / Chapter 4.5.3 --- The length of second stage / Chapter 4.5.4 --- Apgar scores / Chapter CHAPTER 5 --- CONCLUSION --- p.233 / REFERENCES --- p.237

Yiu Kwan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1998. / Includes bibliographical references (leaves 106-117). / Abstract also in Chinese. / Abstract --- p.1 / Chinese abstract --- p.4 / Acknowledgment --- p.5 / Abbreviations --- p.7 / Content --- p.9 / Chapter I. --- Introduction --- p.11 / Chapter II. --- Literature Review --- p.14 / Chapter II. 1. --- Basic concepts --- p.14 / Chapter II.2. --- Clinical aspects of enzymology --- p.17 / Chapter II.3. --- Changes fetal enzymes in neonate --- p.34 / Chapter III. --- Materials and Methods --- p.48 / Chapter III. 1. --- Study population --- p.48 / Chapter III.2. --- Sample collection and storage --- p.49 / Chapter III.3. --- Determination of cardiac and hepatic enzymes in plasma --- p.51 / Chapter III.4. --- Data handling and statistical analysis --- p.67 / Chapter IV. --- Results --- p.68 / Chapter IV.1. --- Study population --- p.68 / Chapter IV.2. --- Enzyme reference values in cord blood --- p.72 / Chapter IV.3. --- Changes in fetal enzymes in relation to acid-base status at birth --- p.78 / Chapter IV. 4. --- Changes fetal enzymes in relation with other obstetric events --- p.80 / Chapter IV.5. --- Variables related to fetal enzymes levels --- p.85 / Chapter V. --- Discussion --- p.93 / Chapter V. 1. --- Reference value for cardiac and liver enzymes in cord blood for current study population --- p.93 / Chapter V.2. --- Changes fetal enzymes in relation to fetal acid-base status --- p.95 / Chapter V.3. --- Changes in fetal enzymes in relation with other obstetric variables --- p.99 / Chapter V.4. --- Analysis of inter-relationships between obstetric variables and fetal enzymes --- p.102 / Reference --- p.106

Aim To assess current methods of prediction of adverse pregnancy outcomes, develop a prediction model and assess diet and life style in preventing preeclampsia. Methods Meta-analyses performed to assess the role of abnormal 1st trimester biomarker levels in predicting PE and the predictive accuracy of 2nd trimester UAD indices for stillbirth. A prospective observational study was performed to assess the efficacy of maternal characteristics, biomarkers, arteriography and UADs for predicting adverse pregnancy outcomes. Previously published 1st trimester PE prediction models were validated using data collected from the observational study. A systematic review on the effect of diet and life style based metabolic risk modifying interventions on PE was performed. Results The review of biomarkers found that abnormal levels were particularIy associated with early onset PE. The stillbirth review demonstrated a three-four fold increased risk of still birth with abnormal UAD. 1045 women were included for analysis in the prospective observational study. Our models' detection rate (false positive rate of 15%) was 72% for PE; 48% PIH; 30 % SGA < 10th centile; 57% SGA < 5th centile and 67% stillbirth. In the validation study the observed discrimination ability in the derivation studies ranged from 0.70 to 0.954. When validated against the study cohort, the AUC varied importantly, ranging from 0.504 to 0.833. Dietary interventions were shown to reduce the risk of PE by 33%, with no reduction in risk with mixed interventions or fatty acid supplementation. Conclusion The high heterogeneity of studies in the systematic reviews makes it difficult to draw firm conclusions regarding the use of biomarkers or UADs in screening for pregnancy complications. Our prospective study showed a role for haemodynamics as part of routine 1st trimester screening for assessing the risk of hypertensive disease in pregnancy.

Orientador: Ney Lemke / Resumo: Os efeitos biológicos da radiação ionizante são causados pela deposição de energia no tecido. Efeitos de baixas doses de radiação ionizante induzem consequências de longo alcance, especialmente durante desenvolvimento intrauterino. Os riscos de exposição in utero permanecem controversos na literatura e nenhum efeito biológico é relatado em doses abaixo de 50 mGy. Modelos animais são frequentemente utilizados para investigação dos efeitos biológicos das radiações ionizantes pois permitem a manipulação de diversas configurações experimentais. Esse trabalho investigou o impacto da exposição intrauterina a baixa dose de radiação ionizante no desenvolvimento pós-natal de ratos. Ratas Wistar foram expostas a 15 mGy de raios X nos dias gestacionais 8 e 15, respectivamente o início e o fim da fase organogênese. Quatro animais machos foram selecionados de cada ninhada para o estudo. Nos recém-nascidos foram realizados o teste de abertura dos olhos e o teste de geotaxia negativa. Nas idades pós-natais de 30 e 70 dias, jovens e adultos, os animais foram testados no teste de campo aberto, no labirinto em cruz elevado e hole board. Avaliou-se o ganho de peso de todos os animais ao longo de todo experimento. Através dos resultados das avaliações identificou-se menor ganho de peso dos ratos expostos durante o desenvolvimento fetal quando adultos. Foram encontradas fortes evidências de alterações comportamentais e prejuízos no sistema nervoso central, também, observou-se comprometimento da c... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Low-dose ionizing radiation may induce far-reaching consequences in human, especially regarding intrauterine development. Many studies have documented that the risks of in utero irradiation remain controversial and no effect is reported at doses below 50 mGy. Animal models are often used to clarify the non-fully understood impact of intrauterine irradiation and allow the manipulation of several experimental setups, making possible the analysis of a wide range of end points. We investigated the impact of in utero low-dose X-ray irradiation on postnatal development in rat offspring through a set of well-established behavioral parameters and weight gain. We exposed pregnant Wistar to 15 mGy of X-rays, which is a low-dose value into diagnostic range that can be achieved in a single radiological exam, on gestational days 8 and 15 and control. Four male animals were select from each litter. At infant age, eye-opening test and negative geotaxis tests were performed. Animals were tested at postnatal ages 30 and 70 days in open field, elevated plus-maze, and hole board tests. We evaluated the weight gain of all animals throughout the experiment. Our results present difference between irradiated and non-irradiated: lower weight gain when adults, impairments in the central nervous system since infant phase, behavioral changes persisting later into life and impairment of motor coordination in irradiated animals. The present study found that even low-doses exposure, considered safe, durin... (Complete abstract click electronic access below) / Doutor