Orientador : Fernando Ferreira Costa / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-07-18T21:46:08Z (GMT). No. of bitstreams: 1 Goncalves_MarildadeSouza_D.pdf: 5264143 bytes, checksum: 05109fefc545410d2c5381d11617ab9f (MD5) Previous issue date: 1994 / Doutorado / Genetica Medica / Doutor em Ciências Biológicas

Includes bibliographical references. / ith the advances made in the management of cardiac conditions, much importance has been placed on the maternal outcome in pregnancies complicated by heart disease. However, to enable attending clinicians to provide suitable counseling and manage the pregnancy appropriately, the potential complications arising in the fetus and neonate also require attention. Adverse neonatal and perinatal outcome is more common in pregnant women with cardiac disease. Analysis of the available data pertaining to the South African population is important, as this population’s profile, like that of Africa, differs from that of industrialized countries. The relevance of maternal heart disease is highlighted by the National Committee for the Confidential Enquiries into Maternal Deaths (NCCEMD) in South Africa ( http://www.doh.gov.za/docs/reports/2012/Report_on_Confidential_Enquiries_into_ Maternal_Deaths_in_South_Africa ). Objectives To describe the perinatal outcome in women with heart disease and to determine whether there is an associated adverse outcome related to babies born to mothers with heart disease. Methods 82 patients were collected serially over 18 months. Neonatal outcome was recorded. Adverse neonatal outcome was defined as perinatal mortality, admission to NICU and the need for delivery room resuscitation. Results Perinatal mortality rate in this cohort was good, and better than the rate in the general population from whence this cohort came, but was linked to a high rate of obstetric intervention. The rate of adverse neonatal outcome is better than the rate in industrialized countries. Conclusion Perinatal outcome is good when mothers with heart disease are managed in a multidisciplinary clinic.

Includes bibliography. / The aim of this thesis was to investigate the feasibility of using the shape of the umbilical flow waveform, obtained clinically with Doppler ultrasound, to monitor the condition growth impaired foetuses. This aim was addressed via the following . 1. Survey the literature to obtain information regarding : a) the foetal blood flow distribution for normal foetuses. b) the effect of placental pathology and maternal hyperoxygenation in compromised foetuses. 2. Model the foetal circulation to investigate the effect, on the umbilical flow waveform, of physiological changes resulting from placental insufficiency. 3. Perform a theoretical and practical assessment of Doppler ultrasound by considering its suitability in monitoring foetal condition, through alterations in the umbilical blood flow waveform shape. 4. Clinically gather and analyse umbilical blood flow waveforms from foetuses currently on a trial to investigate appropriate protocols for the assessment of maternal hyperoxygenation.

Includes abstract. / Includes bibliographical references. / Postpartum haemorrhage (PPH) accounts for more than 75% of maternal deaths from obstetric haemorrhage. In South Africa, maternal mortality resulting from postpartum haemorrhage has persistently been shown to be higher in HIV positive compared to HIV negative women. It is unknown whether the incidence of PPH is higher in HIV positive women; and/or whether HIV positive women have more severe bleeding and suffer greater morbidity as a result of PPH. The aim of the study was to investigate the effect of HIV infection on the incidence and severity of PPH. All women delivering at Mowbray Maternity and Groote Schuur Hospital in 2009 who had PPH were identified through a manual search of labour ward and operating theatre records. The women were categorized according to their HIV status as HIV positive, negative and untested. Data was also obtained on HIV status of the whole delivery population at these two hospitals. For women with PPH, data regarding background characteristics:- blood loss; cause of PPH and management provided; severity of and morbidity from PPH was analysed by comparing the HIV positive with the HIV negative group. Severity was assessed in terms of blood loss alone. Morbidity on the other hand was a composite assessment of blood loss, need for blood products, interventions required and complications of the PPH. Data was also collected on CD4 counts and treatment provided although the study was not powered to investigate these factors as associations.

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No description available.

Adverse maternal events around the time of conception influence embryonic development. Thus, aberrations in the uterine environment during early pregnancy, such as those resulting from maternal metabolic or nutritional disruption, can alter gene expression in the developing embryo, leading to variations in its developmental trajectory. Dietary supplementation of long-chain omega-3 polyunsaturated fatty acids (LCPUFA), especially Docosahexaenoic acid (DHA) improves metabolic and reproductive health across species. The objective of this study was to evaluate the effects of peri-conceptual LCPUFA supplementation on endometrial gene expression, uterine health and embryonic gene expression in overweight horses. Thirteen non-lactating light horse mares (mean ± SEM age=13.56±0.11 yr; mean ± SEM BCS=7.07±0.21) were supplemented with concentrate (n=6) or an isocaloric diet containing 0.06 g/kg BW algae-derived omega-3 LCPUFA (n=7) beginning 60 d prior to sample collection. Four consecutive ovulatory cycles were monitored, and uterine endometrial samples were obtained 12 d post-ovulation in cycles 1, 3 and 4. Mares were bred and embryos were flushed 12 d post ovulation 2,3 and 4. Endometrial biopsies obtained from supplemented mares contained increased DHA and omega-3 fatty acids as a percent of total fat (P< 0.05). Endometrial biopsy scores were assigned to endometrial tissues and mares receiving the LCPUFA supplementation had improved scores during the first ovulatory period as compared to control animals (P=0.009). Candidate genes essential to inflammation, prostaglandin synthesis and embryonic development were evaluated by quantitative reverse transcriptase polymerase chain reaction. Data were log transformed and analyzed using the GLM procedure in SAS (v9.3). When examining the data independent of breeding and pregnancy status, endometrial obtained samples from LCPUFA supplemented mares contained reduced IL6 (P= 0.04) and TNFa (P=0.03) mRNA abundance and tended to have increased transcript abundance for Uterocalin (P= 0.09), SAA (P= 0.06) and IL10 (P= 0.06). Endometrial samples from mares fed LCPUFA pregnant in cycle 3 contained greater IL10 (P< 0.001), PTGFS (P=0.05), OXTR (P=0.05) and PLA2G3 mRNA (P= 0.009) and had a tendency for increased SAA (P= 0.08), PTGES (P=0.10) and SLCO2A1 (P=0.10) mRNA abundance. Supplemented mares bred but not pregnant at day 12 in cycle 3 had reduced expression of PTGER2 (P=0.001) and PTGS1 (P= <0.001) in endometrial samples. In embryos obtained post ovulatory cycle 3 and 4, relative transcript abundance of GATA4 and GATA6, markers of endoderm differentiation, along with GATA3 and ELF3, markers of trophectoderm differentiation were greater (P< 0.05) in embryos from LCPUFA supplemented mares (n=5), than controls (n=5). These results indicate that algae-derived LCPUFA supplementation during the peri-conceptual period alters the post-ovulatory uterine environment in the horse by modifying expression of genes related to inflammation and regulating prostaglandin synthesis. Additionally, embryos obtained from supplemented mares displayed differential gene expression related to embryonic lineage specification. / Ph. D.

Attachment is a unique attribute between a mother and fetus that develops throughout the pregnancy. Maternal-fetal attachment's (MFA) significance to health and well being of the current pregnancy and future child growth is of great importance, because it not only affects the mother but can also affect the fetus as well. The purpose of the thesis was to determine the best nursing interventions to promote the outcome of positive maternal-fetal attachment. An integrative review of research was performed using CINAHL, Pre-CINAHL, MEDLINE, PsychINFO and Psycharticles. Search teams include 'prenatal', 'maternal-fetal' and 'attachment'. This review included literature available in English with a nursing subset between a 1999-2008 publication dates. Fourteen studies were examined with three categories of interventions emerging. These categories included the use of ultrasounds, education, and social support to promote MF A .. Nursing interventions that enhance MF A all appear to correspond to psychological well-being. Multiple approaches to accomplish this outcome are recommended.

Introdução: O istmo aórtico (IAo) fetal é um pequeno segmento vascular localizado entre a origem da artéria subclávia esquerda e a extremidade aórtica do canal arterial, que reflete o equilíbrio entre a impedância ao fluxo no território cerebral e na circulação fetal periférica. Considerado o único shunt arterial verdadeiro entre os sistemas vasculares direito e esquerdo, seu fluxo alterado se associa a resultados perinatais adversos, incluindo aumento da mortalidade fetal e morbidade neurológica, especialmente em fetos com insuficiência placentária e restrição de crescimento. Justificativa: Não há protocolo mundial estabelecido definindo conduta clínica baseada na avaliação Doppler do istmo aórtico fetal, havendo espaço para que sua análise seja incorporada como justificativa para indicação do parto e proteção contra injúrias perinatais. Entretanto, implementar novas medidas à prática clínica requer a demonstração de quão confiáveis e reprodutíveis são os resultados obtidos, o que contribui para a garantia de qualidade em sua utilização. Objetivos: Estimar a reprodutibilidade intra e interobservador do índice de pulsatilidade do istmo da aorta fetal (IAo-IP) no terceiro trimestre de gestação (32 a 36+6 semanas), e determinar qual das aquisições, longitudinal ou transversal, produz medidas com melhores confiabilidade e concordância. Métodos: Estudo observacional (transversal) para o qual foram convidadas a participar gestantes no terceiro trimestre de gestação (32 a 36+6 semanas) que preenchiam os critérios de elegibilidade. O IAo-IP foi obtido por dois observadores, que utilizaram os planos longitudinal e transversal para as aquisições, realizadas de forma completamente independente, sem que tivessem conhecimento dos valores das próprias medidas, tampouco das medidas do outro observador. Os dados foram apresentados como média ± DP (desvio-padrão), mediana, mínimo e máximo; A reprodutibilidade foi avaliada pelo coeficiente de correlação intraclasse (ICC). Resultados: As principais características das 49 gestantes foram: média de idade de 26.3 ± 4.7 anos, variando entre 18 e 40 anos, com média da idade gestacional de 33.6 ± 1.5 semanas e índice de massa corporal de 27.9 ± 4.5 Kg/m2. Os resultados dos IP obtidos do estudo Doppler espectral do istmo aórtico fetal pela via longitudinal, demonstraram uma média de 2.75 ± 0.46 para o observador A, 2.53 ± 0.38 para o observador B, e 2.74 ± 0.58 para a segunda medida do observador A. Para a via transversal, as médias foram de 2.75 ± 0.46 para o observador A, 2.53 ± 0.38 para o observador B, e 2.74 ± 0.58 para a segunda medida do observador A. A avaliação Doppler do istmo aórtico fetal no plano longitudinal apresentou ICC de 0.25 na comparação entre os observadores (interobservador), e de 0.42 para a análise intraobservador. No plano transversal, os coeficientes obtidos foram de 0.18 e 0.43 respectivamente para as análises inter-observador e intraobservador. Conclusões: Embora o papel do istmo aórtico na hemodinâmica fetal esteja bem estabelecido, o presente estudo demonstrou que sua reprodutibilidade no terceirotrimestre (32 a 36+6 semanas) é fraca, logo, a medida do IAo-IP deve ser interpretada com cautela, desencorajando seu emprego na prática clínica. Os estudos que examinam aperfeiçoamentos técnicos para melhorar a sua reprodutibilidade devem ser incentivados / Introduction: The fetal aortic isthmus (AoI) is a small vessel located between the origin of the left subclavian artery and the aortic extremity of the arterial ductus, which reflects the balance between the impedance of the brain and systemic circulation of the fetus. Known as the only arterial shunt regarding both right and left vascular systems, its abnormal flow is associated to adverse perinatal outcomes, including high fetal mortality and neurological morbidity, especially among placental insufficiency and growth-restricted fetuses. Rationale: There is no established global protocol defining clinical management based on the Doppler evaluation of the fetal aortic isthmus, allowing its analysis to be incorporated as a reason to indicate delivery and protection against perinatal injury. However, implementation of new methods to clinical practice requires demonstration of how reliable and reproducible the results are, which contributes to quality assurance in their use. Objectives: To estimate the intra and interobserver reproducibility of the fetal aortic isthmus pulsatility index (IAo-PI) in the third trimester of gestation (32 to 36+6 weeks), and to determine which of both longitudinal and transversal acquisitions show better reliability and agreement. Methods: Observational (cross-sectional) study in which were invited to participate pregnant women in the third trimester of gestation (32 to 36+6 weeks) who met the eligibility criteria. The AoI-PI was obtained by two observers, who used the longitudinal and transverse plans for the acquisitions, performing independent acquisitions and blinded analysis. Data were presented as mean ± SD (standard deviation), median, minimum and maximum. The reproducibility was evaluated by the intraclass correlation coefficient (ICC). Results: The main characteristics of the 49 pregnant women were: mean age of 26.3 ± 4.7 years, ranging from 18 to 40 years, with mean gestational age of 33.6 ± 1.5 weeks and body mass index of 27.9 ± 4.5 kg/m2. The results of the PI obtained from the spectral Doppler evaluation of the fetal aortic isthmus, regarding the longitudinal plane, have demonstrated an average of 2.75 ± 0.46 for observer A, 2.53 ± 0.38 for observer B, and 2.74 ± 0.58 for the second measurement of observer A. For the transversal plane the mean values were 2.75 ± 0.46 for the observer A, 2.53 ± 0.38 for the observer B, and 2.74 ± 0.58 for the second measurement of the observer A. The Doppler evaluation of the fetal aortic isthmus in the longitudinal plane has shown a ICC of 0.25 in the comparison between the observers (interobserver), and 0.42 for the intraobserver analysis. In the transversal plane, the coefficients obtained were 0.18 and 0.43 respectively for the interobserver and intraobserver analysis. Conclusions: Although the role of the aortic isthmus in fetal hemodynamics is well established, the present study have reported that its reproducibility in the third trimester (32 to 36+6 weeks) is very poor, so the measurement of the AoI-PI should be interpreted with caution, discouraging its use in clinical practice. Studiesexamining technical amendments to improve its reproducibility should be encouraged

As curvas ponderais, propostas por SIQUEIRA para diagnóstico de desnutrição materna em gestantes normais, foram aplicadas a duas populações de gestantes que frequentaram o Serviço de Obstetrícia (pré-natal e clínica obstétrica) do Hospital das clínicas da Universidade Federal de Goiás (U.F.Go): um grupo foi constituído por gestantes que não apresentaram patologias próprias ou associadas à gestação (Grupo Normais) e o outro foi composto por gestantes que apresentaram processos patológicos (Grupo Patológicas). Foram estudadas variáveis relacionadas à gestação (peso habitual, ganho de peso na gestação, peso ao final da gravidez, estatura da gestante, perímetro cefálico materno, idade da gestante, peso da placenta e idade gestacional pelos métodos de Capurro e Último Período Menstrual Normal (UPMN) e ao recém-nascido (peso, comprimento, perímetro cefálico e perímetro torácico) para ambos os grupos de acordo com o estado nutricional da gestante (desnutridas, nutridas e obesas). Os resultados permitiram concluir que as curvas ponderais propostas por SIQUEIRA são aplicáveis a outros tipos de populações, quer se trate de gestantes normais ou de gestantes patológicas. Foram verificadas as medidas antropométricas (peso, comprimento, perímetro cefálico e perímetro torácico) de 42 crianças que constituíram o grupo Normais e de 23 crianças que formaram o grupo Patológicas, por ocasião do nascimento e ao completarem 1, 3, 6, 9 e 12 meses de idade segundo o estado nutricional materno (desnutridas, nutridas e obesas); foi ainda estudada a idade gestacional dessas 65 crianças pelos métodos de Capurro e do UPMN. Os resultados permitiram concluir que a desnutrição materna contribuiu para o retardo de crescimento da criança no primeiro ano de vida. Verificou-se ainda um retardo no crescimento das crianças cujas mães apresentaram patologias próprias ou associadas à gravidez, mesmo quando classificadas como nutridas ou obesas, mas os filhos de desnutridas patológicas apresentaram ainda um maior déficit no seu crescimento. Concluiu-se que, além da desnutrição materna, também a presença de patologias durante a gestação associou-se com um retardo do crescimento fetal e pós-natal. Além disso, foi possível verificar que a desnutrição e a presença de patologias exerceram um efeito cumulativo sobre o retardo do crescimento fetal e pós-natal. / The weight curves proposed by SIQUEIRA for the diagnosis of maternal malnutrition in normal pregnant women were applied to two pregnant population samples which attended the Obstetric Clinic (Prenatal and Clinical Obstetrics) of the \"Hospital das Clinicas\" of the Federal University of Goiás (U.F.Go) One group (the Normal Group) consisted of expectant women who had no pathological history, either prior to or related to pregnancy, and the other group (the Pathological Group) consisted of expectant mothers who had a history of pathological condition. Several variables related to pregnancy were studied prepregnancy weight, weight-gain during pregnancy weight at and of nregnancy, mother\'s height, maternal cephalic circumference, mother\'s age, weight of placenta and gestational age by Capurro\'s and Last Menstrual Period (LMP) methods as were also some related to thc new-born child (weight, lenght, cephalic and thoracic circumferences) for both of the above groups in accordance with the nutritional status of the mother (undernourished, well-nourished and obese). The results led to the conclusion that the weight curves proposed by SIQUEIRA are applicable to other kinds of populations, whether of nor mal pregnant women or pathological pregnant women. The anthropometric measurements (weight, lenght, cephalic and thoracic circumferences) of the 42 children born to the Normal Group and of the 23 children born to the Pathological Groun were taken at birth and at the end of the 1st·, 6st., gst. and 12th. months, according to the nutritional status of the mother (undernourished, well-nourished and obese). The gestational age of 65 children was also studied, using the Capurro and LMP methods. The results led to the conclusion that maternal malnutrition contributed to the retardation of the child\'s growth in the first year of life. Further, it was discovered that there was a retardation in the growth of children whose mothers presented a pathological history either prior to or associated with pregnancy, even when these were classified as well-nourished or obese. However the children of undernourished mothers wi th a pathological history showed an even greater growth deficiency. The conclusion drawm was that the presence of a pathological condition during pregnancy was associated with retardation of fetal and postnatal growth beyond that caused by maternal malnutrition. It was also possible to establish that malnutrition and the presence of a pathological condition exercised a cumulative effect on the retardation of fetal and postnatal growth.