Orientador: Wilter Ricardo Russiano Vicente / Coorientador: Maria Emilia Franco Oliveira / Coorientador: Marcus Antônio Rossi Feliciano / Banca: Luciana Cristina Padilha Nakaghi / Banca: Felipe Farias Pereira da Câmara Barros / Banca: Erika da Silva Carvalho Morani / Banca: Eliandra Antonia Pires Buttler / Resumo: O entendimento acerca da fisiologia do processo gestacional e desenvolvimento embrionário/fetal oferece conhecimento para que se tome decisões acertadas em relação ao manejo da fêmea gestante, além destes animais serem utilizados como modelo experimental para a medicina humana, o que reforça a importância do estudo da gestação em ovinos. Nesse contexto, a ultrassonografia se apresenta como melhor opção para avaliar o desenvolvimento da gestação. É uma tecnologia segura que permite que se façam avaliações repetidas durante todo o processo gestacional. Objetivou-se estudar o desenvolvimento fisiológico embrionário/fetal durante a gestação de ovelhas por meio da ultrassonografia a fim de se obter parâmetros de normalidade que possam ser utilizados como referência para o diagnóstico de possíveis alterações do desenvolvimento embrionário/fetal e desenvolver fórmulas para predição de idade gestacional. Foram utilizadas 30 ovelhas Santa Inês pesando 45,4±4,3 kg, entre 2 e 5 anos e realizados exames ultrassonográficos semanais desde a 3ª, até a 21ª semana gestacional. Para a análise estatística, realizou-se teste de "Shapiro" para normalidade, com medidas reais ou transformadas correlacionadas com as semanas gestacionais pelo teste de "Spearman". Quando significativo, foram testados os ajustes dos parâmetros e semanas gestacionais à modelos de regressão. Foi utilizado nível de significância de 5% e os resultados apresentados como média±DP (desvio padrão). Foram avaliados os diâmetros... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The understanding about the physiology of the gestational process and embryonic/fetal development offers tools to make wise decisions regarding the management of the pregnant female, besides, these animals are used as experimental models, which reinforces the importance of the study of gestation in sheep. In this context, ultrasonography is the best option for the evaluation of gestation. It is safe and allows repeated evaluations to be made throughout the gestational process. The objective of this study was to assess the embryonic/fetal physiological development during pregnancy of sheep by means of ultrasonography in order to obtain normality parameters that can be used as a reference for the diagnosis of embryonic/fetal development alterations and to develop formulas for estimate gestational age. Thirty Santa Ines sheep weighing 45.4±4.3kg, between 2 and 5 years old were used. Ultrasound examinations were performed weekly from the 3rd to the 21st gestational week. For the statistical analysis Shapiro test was performed for normality with real or transformed measurements correlated with the gestational weeks by the Spearman test. When significant, parameter adjustments and gestational weeks were tested for regression models. A significance level of 5% was used and the results presented as mean ± SD (standard deviation). The gestational vesicle (GV), abdominal (AD), thoracic (TD), biparietal (BPD), ocular orbit (OO) and placentonium (PL) diameters were evaluated, as well as ... (Complete abstract click electronic access below) / Doutor

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Thesis (MMed)-- Stellenbosch University, 2013. / ENGLISH ABSTRACT: Background: Studies about management of prolonged pregnancy dealt with pregnancy with certain gestational age, confirmed with early ultrasound scans. Objective: The primary aim for the study is to review the current management of uncertain gestational age (GA) post term pregnancy in Tygerberg Academic Hospital (TBH). Women at 42 weeks with an uncertain GA and an amniotic fluid index (AFI) of ≥ 10 cm as well as reassuring cardiotocographs (CTG) would be assessed to determine whether follow up over one week or two weeks are required. Method: A retrospective descriptive study included all patients with an uncertain gestation of 42 weeks referred to TBH. Results: A total of 135 pregnant women were studied. Booking fundal height (BFH) was used to determine GA in 99% and last menstrual period (LMP) in 1% of patients. The time interval between first evaluation at 42 weeks and delivery varies between 0 to 46 days (median 10 days); 104 women delivered vaginally (71% spontaneously, 6% after induction of labour (IOL)); 31 women (23%) by caesarean section; 1 elective, 4 due to cephalopelvic proportion (CPD), 5 had failed IOL, 3 poor progress and 18 fetal distress. Out of the total 11 (8%) women with AFI ≥ 10 had caesarean sections for fetal distress within 2 weeks of the visit at 42 weeks. No neonatal morbidity or mortality was noted in this study. Conclusion: Weekly monitoring with AFI and CTG for women at 42 weeks with unsure gestation is safe. A follow-up following 2 weeks cannot be recommended as 8% of women required caesarean sections within less than 2 weeks due to fetal distress. / AFRIKAANSE OPSOMMING: Agtergrond: Studies oor verlengde swangerskap handel oor swangerskappe met seker swangerskapsduurte, bevestig met vroeë ultraklank skandering. Doelwit: Die primêre doelwit van die studie is om die huidige hantering van verlengde swangerskap met onseker swangerskapsduurte by Tygerberg Hospitaal (TBH) te beoordeel. Vroue wat volgens onseker swangerskapsduurte 42 weke swanger is met ‘n amnionvogindeks (AVI) van >10 en gerusstellende kardiotokogramme (KTG) sal nagegaan word om te bepaal of opvolg oor een of twee weke nodig is. Metode: ‘n Retrospektiewe studie wat alle pasiënte insluit wat na Tygerberg Akademiese Hospitaal verwys word wat ‘n onseker swangerskapsduurte van 42 weke het. Resultate: ‘n Totaal van 135 vroue is bestudeer. Die fundale hoogte is gebruik om swangerskapsduurte te bepaal in 99% van gevalle en die laaste menstruasie in 1%. Die tydsinterval tussen die eerste evaluasie op 42 weke en verlossing wissel tussen 0 en 46 dae (mediaan 10 dae); 104 vroue het ‘n vaginale verlossing gehad (71% met spontane aanvang van kraam, 6% na induksie van kraam); 31 (23%) is met keisersnitte verlos; 1 elektief, 4 as gevolg van skedelbekken disproporsie, 5 gefaalde induksies, 3 swak vordering en 18 met fetal nood. Uit die totaal was daar 11 (8%) vroue met ‘n AVI ≥ 10 wat keisersnitte vir fetale nood binne 2 weke van die besoek op 42 weke gehad het. Geen neonatale morbititeit of mortaliteit het in die studie voorgekom nie. Gevolgtrekking: Weeklikse monitering met AVI en KTG vir vroue wat 42 weke swanger is met onseker swangerskapsduurte, is veilig. Opvolg na 2 weke kan nie aanbeveel word nie want 8% het keisersnitte vir fetale nood gehad na minder as 2 weke.

published_or_final_version / Paediatrics and Adolescent Medicine / Master / Master of Philosophy

Includes list of papers arising from this thesis. "July 2004" Includes bibliographical references (leaves 253-297)

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The study objectives were to: (1) assess fetal exposure to oxidative stress by measuring amniotic fluid concentrations of nitric oxide (NO), thiobarbituric acid--reactive substances (TBARS), and ferric reducing antioxidant power (FRAP) and (2) establish whether these concentrations were associated with infant birth weight, gestational age, or oxidative stress-related conditions arising during pregnancy. Frozen amniotic fluid samples were obtained from 654 mothers undergoing amniocentesis for genetic testing during second trimester in Montreal, QC, Canada. Maternal and neonatal characteristics were collected from medical charts and questionnaires and exclusion criteria were applied. ANOVAs and multivariate regression analyses showed that NO, which differed among pre-term, term, and post-term groups, was a positive predictor of gestational age. TBARS were highly correlated with sample storage and were not associated with pregnancy outcome parameters. FRAP positively predicted gender-corrected birth-weight-for-gestational-age. Our study shows that markers of oxidative and nitrative stress in-utero are associated with pregnancy outcomes.

The study objective was to determine whether early 2 nd trimester amniotic fluid (AF) erythropoietin (EPO) was associated with and predictive of (a) development of maternal gestational diabetes (GDM) and (b) the infant outcome parameters of (i) gestational age at birth (GAAB) assessed exclusively among spontaneous vaginal deliveries or (ii) birth weight (measured in grams and percentiles). Enzyme-linked-immunosorbent assay was used to determine the EPO concentration of 170 biobanked AF samples. Student's t-test revealed no difference between GDM and non-GDM subjects. AF EPO was not predictive of GAAB despite being significantly greater among preterm infants compared to post-term infants. In contrast, AF EPO was significantly higher among the smallest infants using both birth weight classification schemes. However, following inclusion of known covariates AF EPO was predictive of gram birth weight only. Early 2nd trimester AF EPO may emerge as a useful biomarker of fetal nutritional status and/or growth.