Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 5 uppsatser.

Thesis (Ph. D.)--University of Sydney, 2003. / Title from title screen (viewed 8 May 2008). Roman numbering forms part of the numbering sequence, the arabic numbering starts from leaf 12. Includes tables, information sheet, letters, consent form and questionnaires. Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Centre for Behavioural Sciences, Faculty of Medicine. Includes bibliographical references. Also available in print form.

Bakgrund: En intrauterin fosterdöd (IUFD) innebär att förlora ett barn i en graviditet efter gestationsvecka 22. Att förlora ett barn ingår sällan i framtidsbilden och påverkar individer på olika sätt. Oftast finns ingen förklaring till varför en IUFD inträffar men riskfaktorer som övervikt hos modern, rökning, missbildning hos barnet och fel på placentan kan leda till att barn plötsligt dör. Förekomsten av IUFD är oftast högre i låg- och medelinkomstländer. Sjuksköterskor finner det ofta svårt att möta föräldrar som har förlorat ett barn.     Syfte: Syftet var att belysa föräldrars upplevelser av en intrauterin fosterdöd. Metod: Metoden utgick från en litteraturöversikt enligt Friberg (2017). Databaser som användes var CINAHL Complete, psycINFO och Academic Search Complete. Tio vetenskapliga artiklar analyserades där endast kvalitativa data inkluderades i resultatet. Resultat: Analysen resulterade i två huvudteman: Föräldrars känslomässiga reaktioner med underteman Känslor och tankar, Relationen till varandra efter förlusten och Minnet av det döda barnet. Betydelsen av stöd och hjälp med underteman Existentiella aspekter och trosuppfattningens betydelse och Föräldrars upplevelser av sjukvården.  Diskussion: I metoddiskussionen diskuteras litteraturöversiktens svagheter och styrkor. I resultatdiskussionen diskuteras olika ämnen utifrån sjuksköterskans perspektiv med fokus på kunskap angående omvårdnad för sörjande föräldrar och utbildning i vård vid sorg. / Background: An intrauterine fetal death (IUFD) means losing a child in pregnancy after gestation week 22. Losing a child is rarely included in the image of the future and will affect individuals in different ways. There is usually no explanation to why an IUFD occurs but risk factors such as overweight with the mother, smoking, malformation of the child and placenta failure can cause a sudden death of a child. The prevalence of IUFD is usually higher in low- and middle- income countries. Nurses often find it hard to meet parents who have lost a child.  Aim: The aim was to highlight parents experiences of an intrauterine fetal death. Method: The method was based on a literature review in accordance to Friberg (2017). The databases that were used was CINAHL Complete, psycINFO and Academic Search Complete. Ten scientific articles were analysed where only qualitative data were included in the result.  Results: Two main themes were discovered: Parents emotional responses with subthemes Feelings and thoughts, The relationship with each other after the loss and The memory of the dead child. The importance of support and assistance with subthemes Existential aspects and the beliefs significance and Parents perspectives of healthcare.  Discussion: The method discussion brought up weaknesses and strengths. The outcome discussion discussed different subjects out of the nurse perspective with focus on the knowledge of care for bereaved parents and education of nursing care in grief.

The Use of Thromboelastography in Evaluation of Coagulation in Females with Physiological or Pathological Pregnancy MUDr. Ferdinand Polák Abstract Introduction: The target of this study was to compare thromboelastography coagulation parameters in the following three groups: a) healthy pregnant women, b) healthy non-pregnant women and c) pregnant women with pathological pregnancy and also to compare it to reference limits for the common population. If appropriate, we would propose recommendations for new reference ranges for pregnant women in their third trimester. Materials and methods: Prospective observational study, comparing, by using thromboelastography, the blood samples of 60 healthy women in their third trimester of pregnancy (group GRAV) to the samples of the control group of 43 healthy non-pregnant fertile women (group NON-GRAV) and to the samples of 50 women with pathological pregnancy (preeclampsia, fetal death) in their third trimester (group PATOL). Selective percentiles were used to determine new reference limits. Results and conclusions: We found statistically significant differences between groups GRAV and NON-GRAV. Therefore, we established, based on our results, new thromboelastography reference limits for pregnant women. Coagulation changes during pathological pregnancy are less...

Orientador: Denise Pontes Cavalcanti / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T12:05:12Z (GMT). No. of bitstreams: 1 Aleixo_CintiaNogueira_M.pdf: 3345062 bytes, checksum: 312a7b2cb7ac2054263960b084875b6e (MD5) Previous issue date: 2008 / Resumo: O presente estudo relata uma investigação de óbitos pré-natais na Maternidade do Centro de Atenção Integral a Saúde da Mulher (CAISM ¿ UNICAMP), durante o período de setembro de 1999 a setembro de 2007, com o objetivo geral de conhecer as causas de mortalidade pré-natal, com ênfase ao fator fetal. Os objetivos específicos foram: identificar a prevalência de óbitos pré-natais na maternidade do CAISM; identificar as causas de óbito maternas e fetais mais freqüentes, com suas proporções; identificar as malformações mais freqüentes, com suas proporções e diferentes tipos de apresentação clínica; avaliar a contribuição de exames de necropsia, radiografia e cariótipo para o diagnóstico e a proporção de óbitos fetais potencialmente evitáveis. Realizou-se um estudo retrospectivo dos óbitos pré-natais durante o intervalo proposto, com a investigação de 1.011 casos, segundo protocolo específico que incluiu avaliação dismorfológica, anamnese, estudo radiológico, citogenético, necropsias e documentação fotográfica. Na casuística avaliada, 52,4% dos casos de mortalidade pré-natal foram de origem fetal, 40,4% de origem materna, 2,5% de origem mista (materna e fetal) e 4,7% de origem indeterminada. Entre os óbitos de causa fetal predominaram as malformações (80,8%), representadas predominantemente por malformações isoladas (38,8%). Entre as demais malformações observou-se 34,8% de síndromes diversas e 20,6% de malformações múltiplas não caracterizadas como síndromes específicas. Entre os óbitos de origem materna, predominaram a hipertensão (25,5%) e o descolamento prematuro da placenta (18,1%). A avaliação dos exames complementares entre os óbitos de causa fetal mostrou que 3,4% dos exames radiológicos realizados foram essenciais para a conclusão, assim como 10,2% dos exames citogenéticos e 22,5% dos exames anátomo-patológicos. Finalmente, os resultados do presente estudo permitiram estimar que 42,4% de óbitos seriam potencialmente evitáveis na gestação em questão (relacionados predominantemente a condições maternas) e 20,7% de óbitos poderiam ser potencialmente evitáveis em uma gestação futura (correspondendo em sua maioria a defeitos de fechamento do tubo neural e anomalias cromossômicas) / Abstract: Contribution of congenital anomalies to prenatal mortality during an 8 years period (1999-2007) in a tertiary hospital in Brazil. An investigation was performed concerning all the stillbirths born at CAISM ¿ UNICAMP, during an 8 years period (1999-2007). The purpose was to evaluate causes of prenatal mortality, with a clinical-genetical approach, emphasizing fetal causes of death. Specific objectives were to identify prevalence of fetal mortality; identify and classify causes of death (fetal and non-fetal) and its proportions, frequencies of congenital anomalies and its clinical presentations within each group; evaluate the contribution of a postmortem protocol exams and the proportion of avoidable deaths. A retrospective study was performed, with 1,011 cases submitted to a investigation protocol that includes dysmorphological exam, clinical history, X-ray, cytogenetic study and autopsy. The entire study stablished that 52.4% of deaths were of fetal origin, 40.4% were of maternal origin, 2.5% were of both origin (fetal and maternal) and 4.7% remain undeterminated. Among deaths of fetal origin predominated malformations (80.8%), the majority of them isolated (38.8%). Among others malformations was noticed that 34.8% were varied syndromes and 20.6% were multiple malformations. Among deaths of maternal origin predominated hypertension (25.5%) and placental abruption (18.1%). Analysis of complementary exams on fetal causes of death showed that 3.4% of X-rays was essential to diagnosis, as well as 10.2% of cytogenetic exams, and 22.5% of autopsies. Finally, results of entire study allowed to estimate that 42.4% of deaths would be potencially avoidable in the present pregnancy, as well as 20.7% of deaths would be potencially avoidable in a future pregnancy / Mestrado / Genetica Medica / Mestre em Ciências Médicas

Made available in DSpace on 2014-08-20T13:57:57Z (GMT). No. of bitstreams: 1 Tese_Alicia_Matijasevich_Manitto.pdf: 2913108 bytes, checksum: 78680a724fa7ab0a5d31a434a6e8cf3f (MD5) Previous issue date: 2005-04-19 / The aim of this study was to evaluate the available epidemiological evidence of the effect of caffeine consumption during pregnancy on fetal mortality. A systematic qualitative review of observational studies that referred to any source of exposure to caffeine from food in pregnancy and to fetal mortality as the outcome was conducted at the electronic databases Medline and Lilacs. Studies published between January 1966 and September 2004 were searched. The following descriptors were used: caffeine , coffee , tea , cola and cacao to define the exposure and fetal death , stillbirth , fetal demise and fetal loss to define the outcome. A total of four publications were found. The small number of publications addressing this subject, methodological limitations, inaccurate exposure assessment in all the studies, overall risks only marginally significant in most cases and the possibility of publication bias prevent to state with certainty that caffeine consumption is actually associated with fetal death. Well-designed future research with further assessment of caffeine intake is needed to define the role of caffeine in fetal mortality. / O objetivo deste estudo foi avaliar a evidência epidemiológica do efeito do consumo de cafeína durante a gravidez sobre a mortalidade fetal. Uma revisão sistemática qualitativa de estudos observacionais que se refere a qualquer fonte de exposição a cafeína de alimentos na gravidez e para a mortalidade fetal como o resultado foi conduzido na eletrônica bases de dados Medline e Lilacs. Estudos publicados entre janeiro de 1966 e setembro de 2004. Os descritores utilizados foram: "cafeína", "café", "chá", "cola" e "cacau" para definir a exposição e "morte fetal", "natimorto", "morte fetal" e "perda fetal" para definir o resultado. Um total de quatro publicações foram encontradas. O pequeno número de publicações que tratam desse assunto, as limitações metodológicas, a avaliação da exposição imprecisa em todos os estudos, os riscos marginalmente significativas na maioria dos casos e a possibilidade de viés de publicação evitar afirmar com certeza que o consumo de cafeína é associado a morte fetal. Bem concebido futuras pesquisas com uma nova avaliação de ingestão de cafeína é necessário para definir o papel da cafeína na mortalidade fetal.

Abstract Type XIII collagen is a type II oriented transmembrane protein with a short intracellular domain, a single transmembrane domain and a large, mostly collagenous extracellular domain. Tissue localization and cell culture studies have implicated that it is involved in cell adhesion. The spatio-temporal expression of type XIII collagen mRNA and protein during murine development is studied here. Type XIII collagen mRNAs were expressed at a constant rate during development, with an increase of expression towards birth. The strongest expression was detected in the central and peripheral nervous systems of the developing mouse fetus. Cultured primary neurons expressed this collagen, and recombinant type XIII collagen was found to enhance neurite outgrowth. Strong expression was also detected in the heart, with localization to cell-cell contacts and perinatal accentuation in the intercalated discs. Other sites of type XIII collagen expression included cartilage, bone, skeletal muscle, lung, intestine and skin. Clear developmental shifts in expression suggest a role in endochondral ossification of bone and the branching morphogenesis in the lung. To elucidate the function of type XIII collagen transgenic mice were generated by microinjection of a cDNA construct that directs the synthesis of truncated α1(XIII) chains with an in-frame deletion of the central collagenous COL2 domain. This construct was thought to disrupt the assembly of normal type XIII collagen trimers. Expression of shortened α1(XIII) chains by fibroblasts derived from mutant mice was demonstrated, and the lack of intracellular accumulation in immunohistochemical analysis of tissues suggested that the mutant molecules were expressed on the cell surface. Transgene expression led to developmental arrest and fetal mortality in offspring from heterozygous mating with two distinct phenotypes. The early phenotype fetuses were aborted by day 10.5 of development due to a failure in the fusion of the chorion and allantois membranes and subsequent disruption in placentation, while the late phenotype fetuses were aborted by day 13.5 of development due to cardiovascular and placental defects. Furthermore, it was shown that the heterozygous mice that were initially of normal appearance and bred normally had an increased susceptibility to develop T-cell lymphomas and angiosarcomas later in life. The results presented here increase the evidence that type XIII collagen is involved in cell adhesion, with several important tasks during development. A role of type XIII collagen in malignant transformation of certain mesenchymal cell populations is also implicated.

Bakgrund: Fosterrörelserna ses som ett friskhetstecken. Fostrets rörelser ändrar karaktär under graviditeten, men det är en myt att de ofta blir svagare i slutet av graviditeten. Minskade fosterrörelser är ett viktigt kliniskt tecken som kan föregå intrauterin fosterdöd (IUFD). Kvinnan tar telefonkontakt när hon är orolig då hon upplever ett ändrat rörelsemönster. Socialstyrelsens nya riktlinjer finns till för korrekt handläggning, undersökning utan fördröjning kan förebygga livshotande tillstånd hos fostret. Syftet var att beskriva barnmorskors erfarenheter av telefonrådgivning till gravida som kontaktar förlossningsavdelningen gällande minskade fosterrörelser.Design: Studien har utgått ifrån en kvalitativ design med deskriptiv ansats. Datainsamlingen utfördes med semistrukturerade intervjuer och analyserades med kvalitativ innehållsanalys.Deltagare och omgivning: Tio barnmorskor som arbetade vid en förlossningsavdelning i norra Sverige.Resultat: I studien framkom två huvudkategorier, försöka bemöta oron samt komma till ett beslut och sju kategorier. Barnmorskorna är medvetna om vilka riskfaktorer som föreligger för minskade fosterrörelser och IUFD samt kring andra faktorer som kan ha betydelse för fosterrörelserna. Barnmorskorna ger “handgripliga” råd till kvinnan innan hon återkommer och i vissa fall erbjuds undersökning direkt. Telefonrådgivning förekommer dagligen och barnmorskorna belyser vikten av att vara lyhörd och ta kvinnans oro på allvar. Det ses som svårt att bedöma fostrets välmående över telefonen. Kommunikationen och erfarenhetsutbyte mellan kollegor anses värdefullt, men det upplevs även som en svårighet att ta del av nya riktlinjer på kliniken. Slutsats: Telefonrådgivningen är en komplex uppgift där en korrekt handläggning som grundar sig på evidens är avgörande för fostrets överlevnad. Riktlinjer och PM måste utformas för att barnmorskorna ska kunna handlägga minskade fosterrörelser på likartat sätt. Kliniska implikationer: Gravida kvinnor bör få information om fosterrörelser på mödravården för att öka medvetenheten. Ett nationellt utformat PM för rådgivning vid minskade fosterrörelser bör upprättas för kvinnors lika vård på lika villkor. Ökad medvetenhet hos vårdgivare om att undvika avvaktande råd då dessa saknar evidens. Nyckelord: Barnmorska, minskade fosterrörelser, IUFD, telefonrådgivning, rådgivning

The Use of Thromboelastography in Evaluation of Coagulation in Females with Physiological or Pathological Pregnancy MUDr. Ferdinand Polák Abstract Introduction: The target of this study was to compare thromboelastography coagulation parameters in the following three groups: a) healthy pregnant women, b) healthy non-pregnant women and c) pregnant women with pathological pregnancy and also to compare it to reference limits for the common population. If appropriate, we would propose recommendations for new reference ranges for pregnant women in their third trimester. Materials and methods: Prospective observational study, comparing, by using thromboelastography, the blood samples of 60 healthy women in their third trimester of pregnancy (group GRAV) to the samples of the control group of 43 healthy non-pregnant fertile women (group NON-GRAV) and to the samples of 50 women with pathological pregnancy (preeclampsia, fetal death) in their third trimester (group PATOL). Selective percentiles were used to determine new reference limits. Results and conclusions: We found statistically significant differences between groups GRAV and NON-GRAV. Therefore, we established, based on our results, new thromboelastography reference limits for pregnant women. Coagulation changes during pathological pregnancy are less...

Varje år sker 2,6 miljoner dödfödslar världen över. Av 1000 födda barn föds tre till fyra barn döda (en stilla födsel), i Sverige varje år. Att ett barn dör intrauterint eller under förlossningen kan ha många orsaker, ungefär 90 procent av alla dödfödda barn dör intrauterint i Sverige. Inom mödrahälsovården arbetar barnmorskor med att identifiera riskfaktorer som kan leda till negativt graviditetsutfall både för barnet och kvinnan. Frånvaro av fosterrörelser kan ge misstankar om att barnet har dött i livmodern, om hjärtljud hos fostret inte kan registreras konfirmeras misstanken. Ett barn som föds stilla är förenat med långvarig och djup sorg. Barnmorskors medverkan, attityder och förhållningssätt är viktiga och värdefulla vid en stilla födsel och det krävs stor kunskap och engagemang från barnmorskorna. Barnmorskorna ska se till alla människors lika värde och arbetar för att ge kvalitativ och respektfull vård. Syftet med denna litteraturöversikt var att belysa barnmorskors upplevelser av att bistå en stilla födsel. Med ökad kunskap och förståelse kunna ge barnmorskor vägledning att hantera dessa händelser i sin profession. En allmän litteraturöversikt där 16 vetenskapliga artiklar kvalitetsgranskades och inkluderades i resultatet. En analys genomfördes av utvalda kvalitativa artiklar i sex steg. Tre kategorier identifierades: En svår situation, Känsla av otrygghet och I mötet med föräldrarna, med totalt åtta underkategorier. Underkategorierna som framkom var: Svårigheter med att bistå, Strategier, Emotionellt och mentalt påverkad, Bristande kunskap och kompetens, Kollegialt stöd, Ge stöd i sorg - attityder och förhållningssätt, Ärofullt och givande samt Behandla barnet med respekt. Barnmorskors upplevelser av att bistå en stilla födsel var individuellt och berodde till stor del av tidigare erfarenheter. En stilla födsel medförde många starka känslor vilket bidrog till att barnmorskor upplevde det svårt att stödja familjer i sorg. Tillgängligheten av stöd från kollegor var av stor betydelse för hur barnmorskor hanterade sina känslor och situationen. Behovet att tydliga riktlinjer i vården vid en stilla födsel upplevdes vara stort. / Every year 2,6 million stillbirths occur worldwide. Out of 1000 born children three to four children are stillborn (a still birth), in Sweden every year. The reason why a child dies intrauterine or during childbirth can depend on many different factors, about 90 percent of all stillborn children die intrauterine in Sweden. In maternal health care midwives work to identify risk factors that can lead to negative pregnancy outcomes in both the child and the pregnant woman. Absence of fetal movements may give rise to suspicions that the child has died in the womb, if the fetal heartbeat can not be registered, the suspicion is confirmed. A child who is born still iss associated with prolonged and deep grief. Midwives' involvement, attitudes and approach is important and valuable, and great knowledge and commitment is required from the midwife in a stillbirth. The midwives’ must ensure the equal value of all people and work to provide qualitative and respectful care. The aim of this literature review was to illuminate midwives' experience of assisting a stillbirth. With increased knowledge and understanding, be able to give midwives guidance to deal with these events in their profession. A general literature review where 16 scientific articles were quality reviewed and included in the result. An analysis was performed of selected qualitative articles in six steps. Three categories were identified: A difficult situation, A feeling of insecurity and In the meeting with the parents, with a total of eight subcategories. The subcategories that emerged were: Difficulties with assisting, Strategies, Emotionally and mentally affected, Lack of knowledge and competence, Collegial support, Giving support in grief - attitudes and approach, Honorable and rewarding and Treat the child with respect. Midwives' experiences of assisting a stillbirth were individual and were largely due to previous experiences. A stillbirth brought many strong emotions, which contributed to midwives finding it difficult to support families in grief. The availability of support from colleagues was of great importance for how midwives handled their emotions and situations. The need for clear guidelines in care during a stillbirth was perceived to be great.