Biofilme subgengival, conteúdo vaginal, âmnio e parênquima placentários foram obtidos de 93 puérperas. Os periodontopatógenos (BPPG) P.g., A.a, F.n e T.f foram identificadas por PCR, corioamnionite e vilosite por histopatologia e analisados estatisticamente. Roturas de membranas (22,2%), cesáreas (65,6%), pretermo (36,6%), baixo peso (34,4%), morte perinatal (5,4%), CAM (34,4%) e vilosite (5,5%) foram observados. Periodontite agressiva (62,4%) e cáries (83,9%). Periodontite ou BPPG em qualquer sitio não se associou com maior freqüência ou com maior risco de corioamnionite ou de desfecho reprodutivo ruim. No biofilme observou-se Aa em 2 (2,1%), Fn em 16 (17,20%), Pg em 30 (32,30%) e Tf em 29 (31.2%); na vagina, Aa em 3 (3,2%), Fn em 2 (2,1%), Pg em 16 (17,2%) e Tf em 3 (3,2%); no âmnio, Fn em 4 (4,2%) e Pg em 9 (9,7%); na placenta, Fn em 1 (1,07%), Pg em 4 (4,3%) e Tf em 1 (1,1%). P.g e F.n foram observados simultaneamente: 6/30 casos de Pg na boca estavam na vagina, 3 no âmnio e 1 na placenta; dos 16 Fn na boca, 1 foi encontrado na placenta. Esta taxa de disseminação sugere que as BPPG na vagina, âmnio ou placenta não se originaram na boca das puérperas. / Subgingival biofilm and buccal samples, vaginal contents, amnion and placental parenchyma were obtained from 93 pregnant. The periodontopathogens (PPG) Pg, Aa, Fn, and Tf were identified by PCR, the diagnosis of chorioamnionitis (CAM) and villitis by histopathology methods and its relationships with adverse perinatal outcome (APO) statically analyzed. Rupture of membranes (22.2%), cesarean (65.6%), preterm (36.6%), low fetal weight (34.4%), perinatal death (5.4%), CAM (34.4%), and villitis (5.5%) were observed. Aggressive periodontitis (62,4%), and 83.9% had caries. Periodontitis or PPG (Aa, Fn, Pg, and Tf) in any site not associated with greater frequency or at greater risk of CAM or APO. In the subgingival biofilm Aa was observed in 2 (2.1%), Fn in 16 (17.20%), Pg in 30 (32.30%) and Tf in 29 (31.2%); in the vagina, 3 in Aa (3.2%), Fn 2 (2.1), Pg 16 (17.2%) and Tf 3 (3.2%); amnion, Fn in 4 (4.2%) and Pg 9 (9.7%); in the placenta, Fn 1 (1.07%), Pg 4 (4.3%) and Tf 1 (1.1%). Only Fn and Pg were observed simultaneously: 30 mothers with Pg in the mouth, 6 were detected in the vagina, 3 in amnion and 1 in the placenta; Fn 16 with the mouth, 1 was found in the placenta. This low rate of spread suggests that most of periodontopathogens present in vagina, amnion or placenta did not belong to the pregnant mouth.

Ceratite ulcerativa é uma das enfermidades oculares mais comuns em cães e requer tratamento clínico-cirúrgico urgente. Neste contexto, o tratamento cirúrgico com implante de membrana biológica é opção benéfica. Estudou-se o implante de membrana amniótica (MA) e membrana alantoamniótica (MAAM) alógenas preservadas em glicerina a 98% em vinte córneas de cães submetidas previamente à ceratectomia lamelar superficial. Dividiram-se os cães em dois grupos para o estudo aos 2, 7, 15, 30 e 60 dias de pós-operatório. Avaliaram-se, segundo parâmetros clínico-oftalmológicos e histopatológicos. Clinicamente detectou-se fotofobia e blefarospasmo, tipos e graus de secreção, edema e neovascularização corneana e transparência da córnea no local do implante. Nos períodos pré-determinados as córneas foram submetidas à avaliação histológica. Foram constatados, com base no exame ocular, graus leves a moderado de fotofobia e blefarospasmo; predominou o tipo de secreção mucoso com grau moderado e o edema corneano permaneceu leve no grupo que recebeu MA, e moderada a leve no grupo que recebeu MAAM. A neovascularização intensificou-se no 15º dia de pós-operatório em ambos os grupos. Com base nos achados histopatológicos os grupos evoluíram de forma semelhante; constatou-se o desenvolvimento do processo de cicatrização dentro dos parâmetros normais para a córnea. Concluiu-se que a utilização da MA comparada com a MAAM de cães preservadas em glicerina a 98% em ceratoplastias não diferem quanto sua evolução segundo os parâmetros adotados para análise. Ambas as membranas são igualmente efetivas como membrana biológica alógena na reparação de defeito corneano. / Ulcerative ceratitis is one of the most frequent ocular diseases in dogs and it requires prompt surgical and clinical therapy. In this context, surgical treatment using biological membrane implants is a benefic option. In this study alogenous 98% glycerin-preserved amniotic (MA) and alantoamniotic (MAAM) membranes were implanted on twenty corneas from dogs previously submitted to superficial lamellar keratectomy. Clinical, ophthalmologic and histological parameters were investigated. The animals were divided in two groups and pos-operative corneal histological evaluation was taken on days 2, 7, 15, 30 and 60. Photophobia, blefarospasm, different types and severity of ocular secretion, corneal edema and neovascularization and corneal transparency at the implant site. Ocular examination revealed mild to severe photophobia and blefarospasm, moderate mucous secretion was the most frequent. Corneal edema was mild in the MA group and mild to moderate in the MAAM group. From the 15th pos-operative day neovascularization was more pronounced for both groups. Based on the histological findings the groups showed similar evolution and the healing process was found to be within normal parameters for the corneal tissue. We concluded that in dogs 98% glycerin-preserved MA and MAAM applied to keratoplasty do not differ among the parameters evaluated. Both membranes are equally effective as allogenous biological membrane for the repair of corneal defects.

In 1926, the German biologist Johanna (Hanni) Hrabowski published a study of the morphology and development of the fetal placenta in lizards that has proven to be of historical importance. Her anatomical descriptions and interpretations identified developmental patterns that differ from other amniotes – features now recognized as unique attributes of squamate (lizards and snakes) development. Her 1926 monograph presented the first histological comparison of fetal membranes in closely-related oviparous and viviparous reptiles, thereby establishing a comparative framework for understanding placental specializations for viviparity. Hrabowski reported that yolk sac development did not differ between oviparous and viviparous species. The novel, shared components of yolk sac development she identified are now recognized as the foundation for the unique yolk sac placenta of reptiles, the omphaloplacenta. In addition, Hrabowski's extensive ontogenetic sampling and the detail and accuracy of her anatomical descriptions set high standards for subsequent studies of comparative evolutionary embryology.

O saco vitelino é uma estrutura única dos vertebrados que evoluiu uma grande diversidade de características de desenvolvimento, estrutural e funcional. É considerado de fundamental importância para a sobrevivência inicial do embrião. Apesar dos intensos estudos sobre a placentação no guinea pig, ainda existem lacunas importantes para a sua compreensão, no que se refere ao saco vitelino. Esta pesquisa visa detalhar a caracterização morfológica e do desenvolvimento do saco vitelino no Cavia porcellus. Dezessete amostras foram coletadas em idades gestacionais de 12 a 55 dias e investigadas mediante histologia convencional, histoquímica, imunohistoquímica incluindo o marcador de proliferação e microscopia eletrônica de transmissão. O material histórico da implantação embrionária foi utilizado da Embryological Collection of the Museum of Natural History Berlim, Germany. Foi observada a presença temporária do saco vitelino parietal e da cavidade do saco vitelino, durante a implantação do blastocisto. O saco vitelino, que recobre a placenta corioalantoica, mostrou uma grande diferença estrutural entre o 12º e 18º dia, como a transição do epitélio pseudoestratificado para projeções, que se assemelham a uma árvore. A membrana de Reichert não está desenvolvida no 12º dia, entretanto verifica-se um espaço preenchido de material extracelular e vacúolos. A membrana de Reichert foi encontrada a partir do 16º dia de gestação e com o desenvolvimento gestacional e se tornou cada vez mais espessa e constituída de material amorfo e acelular. Os dados morfológicos sugerem que a transferência de nutrientes do saco vitelino para o feto foi mais intensa entre o 22º e 40º dia, especialmente no 40º dia. No último terço da gestação, houve uma diminuição dos tecidos de ambos os sacos vitelinos placentário e visceral. Em conclusão, o desenvolvimento do saco vitelino do guinea pig revela grande semelhança com os outros caviomorfos. Os dados sugerem que o saco vitelino nos caviomorfos é fundamental na gestação média, mas, não tanto, para os períodos iniciais da gestação, como é o caso dos outros vertebrados. / The yolk sac is a unique structure of vertebrates that evolved a great diversity of developmental, structural and functional features. It is regarded to have a fundamental role for early embryo survival. Although placentation has been intensely studied in the guinea pig, there are important gaps as in regard to the yolk sac. This research will undergo a detailed morphological and developmental characterization of the yolk sac in Cavia porcellus. Seventeen specimens have been collected at gestational ages from day 12 to 55 and investigated by conventional histology, histochemistry, immunohistochemistry including proliferation marker and transmission electron microscopy. Historical material on earlier stages was used from the Embryological Collection of the Museum of Natural History Berlin, Germany. A temporary parietal yolk sac and yolk sac cavity occurred during the blastocyst implantation. The yolk sac covering the chorioallantoic placenta showed great structural differentiation between day 12 and 18 such as a transition from a pseudostratified epithelium to projections that resemble a tree. A Reicherts membrane was not developed on day 12, but a space filled with extracellular material and vacuoles was present. The membrane was found from day 16 onward and became thick and composed of amorphous and acellular material. The morphological data suggest that a transfer of nutrients from the yolk sac to the fetus was most advanced between 22th and 40th day, especially on the 40th day. In the last third of gestation a decrease in both, placenta and visceral, yolk sacs tissues was observed. In conclusion, the development of the yolk sac in the guinea pig showed similarities to other caviomorphs. Data suggest that the yolk sac in caviomorphs is most important for mid gestation, but not so much for early pregnancy as it is for other vertebrates.

[Truncated abstract] This thesis explores the risk factors and perinatal outcomes associated with prelabour rupture of membranes, with a particular focus on the environmental context. Prelabour rupture of membranes is defined as the rupture of fetal membranes before the onset of labour. It is a relatively common obstetric endpoint, occurring in approximately 8-10% of pregnant women at term (PROM) and in up to 40% of all preterm deliveries (pPROM). Despite the high prevalence of the condition, the biological mechanisms and risk factors, and in particular the role of environmental predictors, behind the development of PROM and pPROM remain largely unclear. A record-based prevalence design was used to analyse a population of 16,229 nulliparous, Caucasian women residing in Perth, Western Australia who gave birth to a single newborn during 2002-2004. Maternal age, socioeconomic status and threatened preterm labour during pregnancy were identified as risk factors for prelabour rupture of membranes. Term PROM was significantly associated with fetal distress (OR 1.19; 95%CI 1.00-1.43) and post-partum haemorrhage (OR 1.99; 95%CI 1.60-2.48). A number of perinatal complications were observed to be associated with the presentation of preterm PROM, including prolapsed cord (OR 13.95; 95%CI 4.57-42.61), ante-partum haemorrhage (OR 3.29; 95%CI 2.20-4.91), post-partum haemorrhage (OR 2.12; 95%CI 1.54-2.91), low birth weight (OR 17.79; 95%CI 13.87-22.82), very low birth weight (OR 20.01; 95%CI 14.12-28.35) and stillbirth (OR 5.42; 95%CI 2.87-10.21). However, the outcomes were similar between pPROM patients and other preterm deliveries, indicating that the complications arose due to the timing of the delivery. In contrast though, the risk factors between the two outcomes varied which may suggest that a different aetiological pathway exists between preterm PROM and other preterm deliveries. The frequency of complications decreased with increasing gestational age at delivery until the pregnancy reached full-term, whereupon an increase in gestational age at delivery resulted in an increased risk of fetal distress and post-partum haemorrhage. This finding is novel and may have important implications for the management of prelabour rupture of membranes, specifically with regard to the relative risks and benefits of expectant management (that is, the patient is admitted to an obstetric facility or hospital and closely monitored) versus planned delivery. ... This study represents the first attempt to investigate the potential associations between environmental risk factors and prelabour rupture of membranes. The results of the thesis provide a substantial contribution to our knowledge on prelabour rupture of membranes, including findings of direct relevance to clinical practice as well as a potentially contributing environmental exposure pathway. These original findings suggest a possible preventative approach to reducing the occurrence and associated morbidity of prelabour rupture of membranes may be feasible, and should be pursued if future research confirms the preliminary findings of this thesis.

Made available in DSpace on 2016-07-01T13:10:24Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-04-24. Added 1 bitstream(s) on 2016-07-01T13:14:07Z : No. of bitstreams: 1 000866191.pdf: 1592677 bytes, checksum: cbfcdb8a7242a22f947e68ab4cde944d (MD5) / Introdução: O Trabalho de Parto Pré-Termo (TPP) e a Rotura Prematura de Membranas Pré-Termo (RPM-PT) acarretam severas complicações para o binômio materno-fetal. Entre os fatores de risco associados ao TPP e à RPM-PT, a predisposição genética vem ganhando importância. Contudo, a associação entre genes polimórficos, ancestralidade e a patogênese do TPP e da RPM-PT permanece alusiva. Objetivo: Determinar a associação entre marcadores informativos de ancestralidade (AIMs) e polimorfismos de nucleotídeo único (SNPs) dos genes da Interleucina-1 beta (IL1B), IL6, Receptor de IL6 (IL6R), Fator de Necrose Tumoral Alfa (TNFA), Receptor de TNF alpha (TNFR), IL10, Receptor Toll-like 2 (TLR2), TLR4, Metaloproteinase 9 (MMP9), Inibidor de Metaloproteinase 1 (TIMP1) e TIMP2 maternos e fetais e o TPP e a RPM-PT. Pacientes e Métodos: Foram coletados swabs bucais de gestantes com TPP e/ou RPM-PT e DE seus filhos (TPP: 137 mulheres e 88 filhos; RPM-PT: 64 mulheres e 44 filhos) atendidas no Hospital das Clínicas da Faculdade de Medicina de Botucatu, UNESP, entre os anos de 2003 e 2014. O grupo controle foi constituído por 201 mulheres que tiveram gestações resolvidas a termo e seus 201 filhos, pareadas ao grupo caso por idade materna e sexo do recém-nascido. O DNA total foi extraído dos swabs bucais e submetido à identificação de AIMs por análise de fragmentos e genotipagem de SNPs utilizando Taqman® SNP Genotyping Assays (Applied Biosystems) e Reação em Cadeia da Polimerase (PCR). O software Structure v2.3.4 foi utilizado para estimar mistura étnica materna. Teste de desequilíbrio de ligação e proporção da Hardy-Weinberg foram testados com Genepop 3.4 e haplótipos inferidos com Phase. Os dados sociodemográficos e biológicos foram comparados utilizando os testes de χ2, teste exato de Fisher, Regressão Logística, Manova, Mann-Whitney e Odds Ratio. Resultados: Nas amostras maternas, o TPP foi associado a maior... / Introduction: A genetic predisposition to Preterm Labor (PTL) and Preterm Premature Rupture of Membranes (PPROM) has been suggested; however the relevance of polymorphisms and ancestry to susceptibility to PTL and PPROM in different populations remains unclear. Objective: To evaluate the association between Ancestry Informative Markers (AIM) and Single Nucleotide Polymorphisms (SNPs) in Interleukin-1 beta (IL1B), IL6, IL6 Receptor (IL6R), Tumor Necrosis Factor Alpha (TNFA), TNF Receptor (TNFR), IL10, Toll Like Receptor 2 (TLR2), TLR4, Metalloproteinase 9 (MMP9), Tissue Inhibitors of Metalloproteinase 1 (TIMP1) and TIMP2 genes and the susceptibility to PTL and PPROM in Brazilian women. Patients and Methods: Oral swabs were collected from women with PTL and/or PPROM and their babies (PTL: 137 women and 88 babies; PPROM: 64 women and 44 babies) seen at the Botucatu Medical School's Hospital, between 2003 and 2014. Control group included 402 mother-babies pairs of term deliveries, matched to case group by age and newborn gender. After DNA extraction, AIMs were identified by fragment analysis and SNPs by Taqman® SNP Genotyping Assays (Applied Biosystems) and Polymerase Chain Reaction (PCR). The software Structure v2.3.4 was used to estimate ethnic admixture of mothers. Linkage Disequilibrium and Hardy-Weinberg proportions were tested with Genepop 3.4 and haplotypes inferred using Phase. Mann-Whitney, χ2, Fisher's exact test, Logistic Regression models, Odds Ratio and Manova were used in data analysis. Results: Regarding maternal samples, PTL was associated to European ancestry and smoking and African ancestry was protective. Regarding ancestry analysis, self-reported ethnicity only explained 20% and 15% of the global variation in African and European contributions, respectively. Fetal IL10-592 C and IL10-819 C were also associated to PTL. Maternal alleles IL10-1082 G and TLR2 A increased the risk ...

Orientador: Márcia Guimarães da Silva / Coorientador: Steven Witkin / Banca: Leandro Gustavo de Oliveira / Banca: Erick da Cruz Castelli / Banca: Rodrigo Paupério Soares de Camargo / Banca: Gisele Alboreghetti Nair / Resumo: Introdução: O Trabalho de Parto Pré-Termo (TPP) e a Rotura Prematura de Membranas Pré-Termo (RPM-PT) acarretam severas complicações para o binômio materno-fetal. Entre os fatores de risco associados ao TPP e à RPM-PT, a predisposição genética vem ganhando importância. Contudo, a associação entre genes polimórficos, ancestralidade e a patogênese do TPP e da RPM-PT permanece alusiva. Objetivo: Determinar a associação entre marcadores informativos de ancestralidade (AIMs) e polimorfismos de nucleotídeo único (SNPs) dos genes da Interleucina-1 beta (IL1B), IL6, Receptor de IL6 (IL6R), Fator de Necrose Tumoral Alfa (TNFA), Receptor de TNF alpha (TNFR), IL10, Receptor Toll-like 2 (TLR2), TLR4, Metaloproteinase 9 (MMP9), Inibidor de Metaloproteinase 1 (TIMP1) e TIMP2 maternos e fetais e o TPP e a RPM-PT. Pacientes e Métodos: Foram coletados swabs bucais de gestantes com TPP e/ou RPM-PT e DE seus filhos (TPP: 137 mulheres e 88 filhos; RPM-PT: 64 mulheres e 44 filhos) atendidas no Hospital das Clínicas da Faculdade de Medicina de Botucatu, UNESP, entre os anos de 2003 e 2014. O grupo controle foi constituído por 201 mulheres que tiveram gestações resolvidas a termo e seus 201 filhos, pareadas ao grupo caso por idade materna e sexo do recém-nascido. O DNA total foi extraído dos swabs bucais e submetido à identificação de AIMs por análise de fragmentos e genotipagem de SNPs utilizando Taqman® SNP Genotyping Assays (Applied Biosystems) e Reação em Cadeia da Polimerase (PCR). O software Structure v2.3.4 foi utilizado para estimar mistura étnica materna. Teste de desequilíbrio de ligação e proporção da Hardy-Weinberg foram testados com Genepop 3.4 e haplótipos inferidos com Phase. Os dados sociodemográficos e biológicos foram comparados utilizando os testes de χ2, teste exato de Fisher, Regressão Logística, Manova, Mann-Whitney e Odds Ratio. Resultados: Nas amostras maternas, o TPP foi associado a maior... / Abstract: Introduction: A genetic predisposition to Preterm Labor (PTL) and Preterm Premature Rupture of Membranes (PPROM) has been suggested; however the relevance of polymorphisms and ancestry to susceptibility to PTL and PPROM in different populations remains unclear. Objective: To evaluate the association between Ancestry Informative Markers (AIM) and Single Nucleotide Polymorphisms (SNPs) in Interleukin-1 beta (IL1B), IL6, IL6 Receptor (IL6R), Tumor Necrosis Factor Alpha (TNFA), TNF Receptor (TNFR), IL10, Toll Like Receptor 2 (TLR2), TLR4, Metalloproteinase 9 (MMP9), Tissue Inhibitors of Metalloproteinase 1 (TIMP1) and TIMP2 genes and the susceptibility to PTL and PPROM in Brazilian women. Patients and Methods: Oral swabs were collected from women with PTL and/or PPROM and their babies (PTL: 137 women and 88 babies; PPROM: 64 women and 44 babies) seen at the Botucatu Medical School's Hospital, between 2003 and 2014. Control group included 402 mother-babies pairs of term deliveries, matched to case group by age and newborn gender. After DNA extraction, AIMs were identified by fragment analysis and SNPs by Taqman® SNP Genotyping Assays (Applied Biosystems) and Polymerase Chain Reaction (PCR). The software Structure v2.3.4 was used to estimate ethnic admixture of mothers. Linkage Disequilibrium and Hardy-Weinberg proportions were tested with Genepop 3.4 and haplotypes inferred using Phase. Mann-Whitney, χ2, Fisher's exact test, Logistic Regression models, Odds Ratio and Manova were used in data analysis. Results: Regarding maternal samples, PTL was associated to European ancestry and smoking and African ancestry was protective. Regarding ancestry analysis, self-reported ethnicity only explained 20% and 15% of the global variation in African and European contributions, respectively. Fetal IL10-592 C and IL10-819 C were also associated to PTL. Maternal alleles IL10-1082 G and TLR2 A increased the risk ... / Doutor

O saco vitelino é uma estrutura única dos vertebrados que evoluiu uma grande diversidade de características de desenvolvimento, estrutural e funcional. É considerado de fundamental importância para a sobrevivência inicial do embrião. Apesar dos intensos estudos sobre a placentação no guinea pig, ainda existem lacunas importantes para a sua compreensão, no que se refere ao saco vitelino. Esta pesquisa visa detalhar a caracterização morfológica e do desenvolvimento do saco vitelino no Cavia porcellus. Dezessete amostras foram coletadas em idades gestacionais de 12 a 55 dias e investigadas mediante histologia convencional, histoquímica, imunohistoquímica incluindo o marcador de proliferação e microscopia eletrônica de transmissão. O material histórico da implantação embrionária foi utilizado da Embryological Collection of the Museum of Natural History Berlim, Germany. Foi observada a presença temporária do saco vitelino parietal e da cavidade do saco vitelino, durante a implantação do blastocisto. O saco vitelino, que recobre a placenta corioalantoica, mostrou uma grande diferença estrutural entre o 12º e 18º dia, como a transição do epitélio pseudoestratificado para projeções, que se assemelham a uma árvore. A membrana de Reichert não está desenvolvida no 12º dia, entretanto verifica-se um espaço preenchido de material extracelular e vacúolos. A membrana de Reichert foi encontrada a partir do 16º dia de gestação e com o desenvolvimento gestacional e se tornou cada vez mais espessa e constituída de material amorfo e acelular. Os dados morfológicos sugerem que a transferência de nutrientes do saco vitelino para o feto foi mais intensa entre o 22º e 40º dia, especialmente no 40º dia. No último terço da gestação, houve uma diminuição dos tecidos de ambos os sacos vitelinos placentário e visceral. Em conclusão, o desenvolvimento do saco vitelino do guinea pig revela grande semelhança com os outros caviomorfos. Os dados sugerem que o saco vitelino nos caviomorfos é fundamental na gestação média, mas, não tanto, para os períodos iniciais da gestação, como é o caso dos outros vertebrados. / The yolk sac is a unique structure of vertebrates that evolved a great diversity of developmental, structural and functional features. It is regarded to have a fundamental role for early embryo survival. Although placentation has been intensely studied in the guinea pig, there are important gaps as in regard to the yolk sac. This research will undergo a detailed morphological and developmental characterization of the yolk sac in Cavia porcellus. Seventeen specimens have been collected at gestational ages from day 12 to 55 and investigated by conventional histology, histochemistry, immunohistochemistry including proliferation marker and transmission electron microscopy. Historical material on earlier stages was used from the Embryological Collection of the Museum of Natural History Berlin, Germany. A temporary parietal yolk sac and yolk sac cavity occurred during the blastocyst implantation. The yolk sac covering the chorioallantoic placenta showed great structural differentiation between day 12 and 18 such as a transition from a pseudostratified epithelium to projections that resemble a tree. A Reicherts membrane was not developed on day 12, but a space filled with extracellular material and vacuoles was present. The membrane was found from day 16 onward and became thick and composed of amorphous and acellular material. The morphological data suggest that a transfer of nutrients from the yolk sac to the fetus was most advanced between 22th and 40th day, especially on the 40th day. In the last third of gestation a decrease in both, placenta and visceral, yolk sacs tissues was observed. In conclusion, the development of the yolk sac in the guinea pig showed similarities to other caviomorphs. Data suggest that the yolk sac in caviomorphs is most important for mid gestation, but not so much for early pregnancy as it is for other vertebrates.

Objective: to evaluate the risk of obstetric and perinatal outcomes in teenage pregnancy in comparison with adult pregnancy. Methods: retrospective cohort study of 67.693 pregnant women attended in a public hospital in Lima between 2000 and 2010. Obstetric and perinatal outcomes were evaluated. The adolescent group was divided in late adolescents (15-20 years), and early adolescents (<15 years) and was compared among the adult group (20-35 years). Adjusted odds ratios were calculated by education, civil status, prenatal care, previous pregnancies, parity, and pre-gesta-tional BMI. Results: higher risk of cesarean (OR=1,28; CI95%=1,07-1,53) and puerperal infection (OR=1,72; CI95%=1,17-2,53) was found in teenager under 15 years old; as well as higher risk of episiotomy (OR=1,34; CI95%=1,29-1,40) in late teenagers. In addition, this study identified a lower risk of teenage pregnancy for preeclampsia (OR=0,90; CI95%=0,85-0,97), 2nd half-pregnancy bleeding (OR=0,80; CI95%=0,71-0,92), premature rupture of membranes(OR=0,83; CI95%=0,79-0,87), preterm labor (OR=0,87; CI95%=0,80-0,94) and vaginal tearing (OR=0,86; CI95%=0,79-0,93). Conclusion: pregnancy behaves as a risk factor for some obstetric outcomes in the adolescent group, especially in the youngest ones. In addition to maternal age, there are other factors that constitute the need to form multidisciplinary teams to reduce obstetric outcomes in this population. / diego.maticorena@gmail.com / Objetivos: analizar el riesgo de complicaciones obstétricas y perinatales en adolescentes embarazadas en un hospital de Lima, Perú. Métodos: estudio de cohorte retrospectiva de 67.693 gestantes atendidas en el período 2000-2010. Se evaluó complicaciones obstétricas y perinatales. Las adolescentes se clasificaron en tardías (15-19 años) y tempranas (< 15 años) y se compararon con las adultas (20-35 años). Se calculó OR ajustados por educación, estado civil, control prenatal, gestaciones previas, paridad e IMC pregestacional. Resultados: se encontró mayor riesgo de cesárea (OR=1,28; IC95%=1,07-1,53) e infección puerperal (OR=1,72; IC95%=1,17-2,53) en las adolescentes menores de 15 años, así como mayor riesgo (OR=1,34; IC95%=1,29-1,40)de episiotomía en las adolescentes tardías. Asimismo, se identificó un menor riesgo del embarazo adolescente para preeclampsia (OR=0,90; IC95%=0,85-0,97), hemorragia de la 2da mitad del embarazo (OR=0,80; IC95%=0,71-0,92), ruptura prematura de membranas (OR=0,83; IC95%=0,79-0,87), amenaza de parto pretérmino (OR=0,87; IC95%=0,80-0,94) y desgarro vaginal (OR= 0,86; IC95%=0,79-0,93). Conclusión: el embarazo se comporta como factor de riesgo para ciertas complicaciones obstétricas en la población adolescente, especialmente en las adolescentes tempranas. Existen además otros factores, que sumados a la edad materna, constituyen la necesidad de formar equipos multidis-ciplinarios para reducir complicaciones obstétricas en esta población. / Revisión por pares

Made available in DSpace on 2016-12-23T13:55:59Z (GMT). No. of bitstreams: 1 Laura Fregonassi Ribeiro Fraga.pdf: 4567995 bytes, checksum: 80f83feca246031271e511fadd682376 (MD5) Previous issue date: 2013-08-30 / A infecção amniótica e a corioamnionite (CAM) são determinantes de infecções materna e perinatal, parturição e nascimento pretermo e morbi-mortalidade pós-natal. Embora métodos clínicos, histopatológicos, microbiológicos, bioquímicos e moleculares possam diagnosticar CAM, nenhum logrou amplo emprego, permanecendo muitos casos clínica e epidemiologicamente ocultos. O presente estudo analisa o exame do cório placentário (EECP) proposto por Blanc (1953) para o diagnóstico de CAM a tempo de orientar o manejo da puérpera e do neonato sob risco. Objetivo. Determinar o valor e a reprodutibilidade do EECP em comparação com a histopatologia convencional (HP). Material e métodos. Dentre as placentas examinadas entre 2008 e 2012, em dois laboratórios de Vitória, ES, um público (HUCAM) e um privado (PAT), foram selecionadas 1626, incluindo: uma amostra de corte transversal (HCT, n: 108) e duas séries consecutivas examinadas por suspeita neonatal de CAM (HIB, n: 193) e por variadas indicações obstétricas (PIV, n: 1325). O EECP foi realizado no puerpério imediato (HIB e HCT) ou como primeira etapa da HP (PIV). Os casos foram categorizados por procedência, idade gestacional, desfecho perinatal, método de exame, estágio e grau da CAM e foram calculados índices de valor diagnóstico e concordância entre os dois métodos (EECP e HP). Resultados. CAM por HP foi observada em 12,8% dos casos (HCT: 31,5% e PIV: 11,3%) dos quais 2,4% com resposta inflamatória fetal; CAM pelo EECP foi observada em 14,2% (HCT: 41,7%, HIB: 31,1% e PIV: 9,1%). O EECP revelou-se exequível e rápido, com sensibilidade 50,0%, especificidade 93,7%, valores preditivos positivo 53,8% e negativo 92,7% e razões de verossimilhança positiva 7,9 e negativa 0,53. Concordância entre EECP e HP foi observada em 88,8%, diagnóstico apenas pelo EECP em 5,7% e apenas pela HP em 5,5% (kappa: 0,45). Conclusão. O EECP pode ser empregado para o diagnóstico rápido de CAM. Trata-se de método exequível, que tem bons índices de valor diagnóstico e pode ser útil para orientar a conduta no puerpério e período neonatal imediatos / Amniotic infection and chorioamnionitis (CAM) are determining factors of maternal and perinatal infections, preterm births and postnatal mortality and morbidity. As none of clinical, microbiological, biochemical, molecular and histopathological proposed methods for CAM diagnosis has achieved broad and routine employment, many cases remain clinical and epidemiologically occult. After Blanc s proposal (1959), this study analysis the placental chorionic sampling and microscopical examination (EECP) at early postpartum period to CAM diagnosis in order to help a timely clinical decision to treat the risk mother and newborn infant. Objectives. To establish the diagnostic value and the reproducibility of EECP compared to conventional histopathology (HP) CAM diagnosis. Material e Methods. Out from all placentas examined between 2008 and 2012, in two Pathology laboratories at Vitória City, southwestern Brazil, one public (HUCAM) and one private (PAT), 1626 were selected including: a cross-sectional sampling (HCT, n: 108) and two consecutive cases series examined after neonatal clinical infection suspicion (HIB, n: 193) and varied others obstetrical indications (PIV, n: 1325). The EECP was done at immediate postpartum period (HIB and HCT) or as the first step of HP examination (PIV). The cases were categorized by study groups, gestational age, perinatal outcome, method of examination, CAM stage and grade, and the statistic indexes of agreement and diagnostic value between the two methods (EECP and HP) were calculated. Results. In overall cases, CAM diagnosis by HP were observed in 12.8% (HCT: 31.5% e PIV: 11.3%) from which 2.4% with a fetal inflammatory response; CAM diagnosis by EECP were observed in 14.2% (HCT: 41.7%, HIB: 31.1% e PIV: 9.1%). The EECP revealed itself to be a fast and easy to perform method, with 50.0% sensitivity, 93.7% specificity, 53.8 predictive positive and 92.7% predictive negative values, and 7.9 likelihood positive and 0.53 likelihood negative ratios. Agreement between EECP and HP were observed in 88.8%, CAM diagnosis only by EECP in 5.7% and only by HP in 5.5% (kappa: 0,45). Conclusion. The EECP method could be an important contribution to fast CAM diagnosis. It is easy to perform, with significant statistic indexes of diagnosis value and can be helpful to guide the clinical decision at early postpartum period