Made available in DSpace on 2015-03-05T17:17:58Z (GMT). No. of bitstreams: 0 Previous issue date: 28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A partir do advento de novas tecnologias de diagnóstico pré-natal, passou a ser possível a identificação intra-uterina de graves anomalias fetais. Contudo, o avanço da Medicina ainda não permite, na grande maioria das vezes, a disponibilização de tratamento para essas enfermidades. Por isso, o aborto adquire um sentido diferenciado, na medida em que se coloca como a única opção disponível para amenizar o sofrimento daqueles, gestantes ou casais, que, diante da impossibilidade de sobrevivência do feto após o nascimento, afirmam não poder suportar levar a termo a gravidez. Isso se reflete também no âmbito jurídico, principalmente por meio das ações judiciais que demandam autorização para a realização do aborto. Diante da ausência de regulamentação legal da questão, a resposta tem sido dada pelo Poder Judiciário. O objetivo principal deste trabalho é o de verificar quais são os discursos jurídicos proferidos sobre o tema, bem como o de compreender os significados que engendram esses mesmos discursos, dando-se es / From the advent of new technologies of prenatal diagnosis, it started to be possible the intrauterine identification of serious foetus anomalies. However, the improvement of Medicine still does not allow, most of the times, the availability of treatment for these diseases. Consequently, the abortion acquires another sense, because it leads to the only available option to reduce the suffering of the pregnants or couples, who has to face the impossibility of the foetus survival after the birth and do not consider themselves able to bear and take pregnancy to the term. This fact also reflects in the legal area, mainly considering the legal actions that demand authorization for abortion accomplishment. Because there is no legal regulation for this question, the answer has been given by the Court. The main objective of the present work is to verify what are the pronounced legal speeches regarding the subject, as well as to comprehend the meanings that are behind these speeches, giving special enfasis to the pregna

abstract: This thesis reviews the initial cases of fetal surgery to correct myelomeningocele, a severe form of spina bifida, and discusses the human and social dimensions of the procedure. Myelomeningocele is a fetal anomaly that forms from improper closure of the spinal cord and the tissues that surround it. Physicians perform fetal surgery on a developing fetus, while it is in the womb, to mitigate its impacts. Fetal surgery to correct this condition was first performed experimentally in the mid-1990and as of 2020, it is commonly performed. The initial cases illuminated important human and social dimensions of the technique, including physical risks, psychological dimensions, physician bias, and religious convictions, which affect decision-making concerning this fetal surgery. Enduring questions remain in 2020. The driving question for this thesis is: given those human and social dimensions that surround fetal surgery to correct myelomeningocele, whether and when is the surgery justified? This thesis shows that more research is needed to answer or clarify this question. / Dissertation/Thesis / Masters Thesis Biology 2020

A partir de données en population, nous avons: 1) évalué le risque de cardiopathies congénitales (CC) chez les fœtus conçus par assistance médicale à la procréation (AMP); et 2) déterminé les effets de l’AMP sur la prise en charge prénatale et le devenir périnatal des fœtus porteurs de CC. Nous avons observé que l'AMP était associée à une augmentation de 40% du risque de CC sans anomalies chromosomiques associées (OR ajusté = 1,4 IC95% 1,1-1,7). Nous avons également retrouvé qu'il existait des associations variables selon la catégorie de CC et la méthode d'AMP considérées. Nous avons observé que l'AMP était associée à une multiplication par 2,4 du risque de tétralogie de Fallot (OR ajusté = 2,4 IC95% 1,5-3,7), alors que nous n’avons pas retrouvé d’association statistiquement significative pour les trois autres CC spécifiques étudiées. Dans notre population, l'exposition à l'AMP ne semblait pas modifier le recours au diagnostic prénatal et à l'interruption médicale de grossesse chez les fœtus porteurs de CC comparés aux fœtus porteurs de CC conçus spontanément. Nous avons par ailleurs observé que le risque de prématurité des fœtus porteurs de CC conçus par AMP était environ 5 fois plus élevé que celui des fœtus porteurs de CC conçus spontanément (OR ajusté = 5,0 IC95% 2,9-8,6). En nous basant sur une méthodologie d'analyses de cheminement, nous avons retrouvé que les grossesses multiples contribuaient pour environ 20% au risque plus élevé de tétralogie de Fallot associé à l'AMP que nous avons observé. Enfin, les grossesses multiples contribuaient pour environ 2/3 du risque de prématurité associé à l'AMP chez les fœtus porteurs de CC. / Using population-Based data, we: 1) assessed the risk of congenital heart defects (CHD) in assisted reproductive techniques (ART) conceived fetuses; and 2) evaluated the effects of ART on prenatal management and perinatal outcomes of fetuses with CHD. We observed that ART were associated with a 40% increased risk of CHD without associated chromosomal anomalies (adjusted OR = 1.4 95%CI 1.1-1.7). We also found varying associations between the different methods of ART and categories of CHD. We observed that ART were associated with 2.4-Higher odds of tetralogy of Fallot (adjusted OR = 2.4 95%CI 1.5-3.7), whereas no statistically significant association was found for the three other specific CHD included. In our population, ART exposure did not seem to modify prenatal diagnosis and termination of pregnancy for fetal anomaly in fetuses with CHD compared to fetuses with CHD conceived spontaneously. The risk for premature birth in fetuses with CHD conceived following ART was 5-Fold higher as compared to fetuses with CHD conceived spontaneously (adjusted OR = 5.0 95%CI 2.9-8.6). Using a path-Analysis method, we found that multiple pregnancies contributed for about 20% to the higher risk of tetralogy of Fallot associated with ART that we had found. Finally, multiple pregnancies contributed for the 2/3 of the risk of premature birth associated with ART in fetuses with CHD.

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