This thesis approaches the Gesta Roberti Wiscardi as a means of gaining an insight into the cultural values of its author and intended audience. A detailed study is made of the various role models within the poem: the ideal soldier, the good lord, the role of women in society, and the perception of priests and the papacy. In addition to this the text is used to establish racial stereotypes for the following groups of peoples: the Germans, Sicilians, Seljuqs, Greeks, Italians, Venetians and Normans. The significance of the characterisation of individuals who are portrayed in a manner inconsistent with their racial stereotype is also examined. The thesis re-examines the evidence in the text and in other document sources concerning the author of the poem and establishes a viable identification. A new interpretation of the role of the two patrons. Urban II and Roger Borsa, is also discussed. The question of the consistency of style in William of Apulia's poem is also addressed and set in the context of the subject matter and intent of the work. Finally a discussion is made of the evidence for the use of William as a source by three subsequent historians: Robert of Torigni, Suger of St Denis and Anna Comnena. This thesis draws attention to further use of the Gesta by Robert than previously realised and for the first time forwards a concrete case for its use by the latter two authors.

Despite its apparent popularity in fifteenth-century Ireland—as attested by its presence in eight manuscripts—Stair Fortibrais, the Irish adaptation of the twelfth-century chanson de geste Fierabras has received very little scholarly attention. This fact proves especially unfortunate since the text possesses particular relevance for two important trends in recent scholarship, one concerning Celtic Studies and the other more broadly Continental in scope. In the case of the former, researchers have begun to consider how translations can inform the interpretation of the greater corpus of medieval Irish literature. The latter relates to an interest in the person of Charlemagne himself as a pan-European figure. As an Irish translation of a poem from the geste du roi, Stair Fortibrais has much to contribute to both these academic discussions. Because the text remains relatively unknown, this thesis is by design intended largely as a scholarly introduction to the material. It seeks to present data about the text and serve as a guide to some of its most important themes. The Introduction will provide basic information about Stair Fortibrais and its Hiberno-Latin source Gesta Karoli Magni and their unique place amongst Irish translation literature. The body of the thesis is composed of four chapters. The first examines all manuscripts containing the Irish adaptation as well as the single codex featuring its Latin source. More specifically, it considers how its placement within the manuscripts provides guidance for interpreting the text. All three remaining chapters compare the Irish adaptation—and, where appropriate, its fragmentary Latin source—with Fierabras. The second chapter discusses additions, reordering, reduction/omission and substitution in Stair Fortibrais in an attempt to determine the adaptor’s translation technique, with a particular emphasis on patterns in his approach. The penultimate chapter analyses the adaptation’s treatment of some of the chanson de geste’s important themes. It is divided into three sections: Character Studies, Religion and the Supernatural and Religion and Historiography. The final chapter studies topics both political—rank and feudal duties— and cultural—family, unity, and moderate behaviour— which appear to have particularly interested the adaptor but which do not feature prominently in the French poem. The conclusion of the thesis will postulate that, through a series of subtle but carefully-considered alterations, the adaptors not only translated but also re-appropriated their source material for its Irish audience. It will also briefly consider some of the numerous avenues for additional exploration of the tradition of Charlemagne in Ireland.

The origins and development of a sense of Scottish national identity have long been a matter of critical importance for historians of medieval Scotland. Indeed, this was also the case for historians in medieval Scotland itself: this period saw the composition of a number of chronicles that sought to describe the history of Scotland and the Scottish people from their earliest origins until the chroniclers' own time. The dissertation explores ideas of national identity within two medieval Scottish chronicles, known today as Gesta Annalia I and Gesta Annalia II. Taken together, these two chronicles, one written before the Wars of Independence, the other after, can offer valuable insights into the development of the identity of the Scottish kingdom and its people, and the way in which this was affected by the Wars of Independence, providing evidence both of continuity and of contrast. This is of particular interest with respect to their portrayals of the role of the Scottish king and his relationship with the kingdom, given the way in which Robert I and his supporters later apparently attempted to shape the narrative of Scotland's past and the position of its king to their own ends. The dissertation therefore seeks to investigate how such issues of Scotland's identity are presented in Gesta Annalia I and Gesta Annalia II. The first section of the study discusses the construction of these texts. The second then looks at how terms such as 'Scotland' and 'Scot' are understood in the two chronicles, and the relationship between these ideas of the Scottish kingdom and the Scottish people. The third section examines the presentation of the crown, church and language in the chronicles, and the role of these elements in uniting the kingdom and fostering this sense of identity, arguing that the continuity of these ideas between the two texts suggests that many elements of Scotland's national identity were well-established by the later thirteenth century.

Les Gesta Berengarii imperatoris sont un panégyrique anonyme de 1090 vers composé vers 915-916 en l'honneur de Bérenger Ier d'Italie. Le texte est conservé entièrement dans un seul manuscrit (Venezia, Biblioteca Nazionale Marciana, Lat. XII 45), où il est accompagné de nombreuses gloses dont une partie remonte à l'auteur lui-même. Cette thèse propose une édition et un commentaire de ce panégyrique et de ses gloses, accompagnés de la première traduction en français du poème. Une attention toute particulière a été portée aux sources du texte et de ses gloses. Cette enquête révèle que le poète-glossateur des Gesta est profondément influencé par les productions des écoles de Francie occidentale, et notamment par celles de l'école d’« Auxerre ». Ces découvertes permettent de mieux connaître la culture de cet intellectuel carolingien tout en dessinant les contours du réseau intellectuel européen fréquenté par ce personnage. Une étude de trois autres manuscrits liés à ce réseau d'échanges (Paris, BNF, lat. 7900A, München, BSB, Clm 14420, Venezia, Bibloteca Nazionale Marciana, Lat. XIII 66) vient mettre en perspective ces résultats et permet de retracer l'histoire des échanges intellectuels entre Vérone, la Lombardie et le nord-est de la Francie à la fin du IXe et au début du Xe siècle. / The Gesta Berengarii imperatoris are an anonymous panegyric consisting of 1.090 verses and written around 915-916 in honour of Berengar I of Italy. The text is entirely retained in one manuscript (Venezia, Biblioteca Nazionale Marciana, Lat. XII 45), that is accompanied by numerous glosses which can be partly attributed to the author himself. The following thesis offers an edition and a commentary of the panegyric and its glosses, along with the first translation in French of the poem. Particular attention has been given to the sources of the text and its glosses. This study reveals that the poet-glossator of the Gesta has been greatly influenced by the productions of the schools of West Francia, and more particularly the ones from the school of “Auxerre”. These findings contribute to a better understanding of the knowledge of this Carolingian scholar while outlining the author’s European intellectual network. A study of three other manuscripts linked to this intellectual exchanges network (Paris, BNF, lat. 7900A, München, BSB, Clm 14420, Venezia, Bibloteca Nazionale Marciana, Lat. XIII 66) helps bring these results into perspective and traces the history of the intellectual exchanges between Verona, the Lombardy and the north-east of France from the end of the 9th century to the beginning of the 10th century.

A Chanson de Roland, obra construída no século XIX como fundadora da literatura francesa, foi bastante explorada ao longo dos últimos 150 anos, muitas vezes com usos políticos, nem sempre expressos. Apesar de exaustivamente trabalhada pelos estudos literários, são quase inexistentes as investigações históricas sobre o seu conteúdo cristão e suas possíveis relações com a legitimação do combate contra os pagãos. Este trabalho investiga de que forma os pagãos são representados na gestas do final do século XI, e como estas constroem uma alteridade através da religião, da moralidade, da territorialidade, e da etnicidade. Investiga também como os cristãos são representados dentro uma unidade pan-européia, numa sobreposição das noções de império e cristandade, e como sua luta contra os pagãos é legitimada, e mesmo santificada, pelas obras, através do martírio dos seus cavaleiros. / The Song of Roland, explored in the nineteenth century as the main text of French literature, was heavily exploited over the past 150 years, often with political uses, not always expressed. Despite extensive work by literary studies, there hardly any historical research on its Christian content and its possible association with the legitimacy of the combat against the pagans. This work investigates how the pagans are represented in the gestas of the late eleventh century, and how they build an otherness through religion, morality, territoriality, and ethnicity.It also investigates how Christians are represented in a pan-European unity, in a superposition of the notions of empire and Christianity, and how their fight against the heathen is legitimated and even sanctified through the martyrdom of their knights.

Made available in DSpace on 2015-04-14T14:23:26Z (GMT). No. of bitstreams: 1 438863.pdf: 759727 bytes, checksum: 017c46706b3654bdaa2713fc000f90e2 (MD5) Previous issue date: 2001-01-11 / The surpose of this study is to search the understanding of the meaning of maternity during the adolescence. The research has been done in Porto Alegre city. It has been used the phenomenological qualitative methodology. The interviews with six adolescents aged between 15 and 17, which were in the post-birth period, have been taken place. The semi-structured interviews turned possible the collection of information and the knowledge of young mothers life experience origin. The phenomenological method was epplied in the analysis of the information accordingly to what Giorgi (1985) and Comiotto (1992) proposed. The adolescent mothers narratives, their world point-of-view jull of wisches, fantasies, conflicts and contradictions permitted to find out about essences and their dimenssions. The essences which stand out are: The meaning of maternity which makes a link between adolescents julings and mother's role; family and emotional relationship, which evidences that parents , partner's and other relatives support is very important; life projects which relates interrupted plans because of pregnancy and readequacy of adolescents body image after the pregnancy; and finally, educational factors and responsible maternity, which relate the young women's Knowledge about contraceptive methods, care with the child and relapsing into pregnancy in adolescence. This research presents suggestions of intervention that can modify the situation of the pregnancy during adolescence and favor stimulus to responsible maternity through a work with multidisciplinaries groups which involve the adolescents in a holistic way, integrating them with their family. / O objetivo deste estudo ? a busca da compreens?o do significado da maternidade na adolesc?ncia. A investiga??o ocorreu na cidade de Porto Alegre e utilizou-se a metodologia qualitativa fenomenol?gica. Foram realizadas entrevistas com seis adolescentes entre 15 e 17 anos de idade e que se encontravam no per?odo do puerp?rio. As entrevistas, semi-estruturadas, possibilitaram a coleta de dados, e o conhecimento das viv?ncias das jovens. Na an?lise das informa??es foi aplicado o m?todo fenomenol?gico conforme proposta de Giorgi (1985) e Comiotto (1992). Os relatos da vida das m?es adolescentes, sua vis?o de mundo permeada de desejos, fantasias, conflitos e de contradi??es permitiram o desvelamento das ess?ncias e suas dimens?es. Entre as ess?ncias destacam-se: o assumir a maternidade, ligando os sentimentos das adolescentes ao papel de m?e; relacionamento familiar e afetivo, evidenciando a import?ncia do apoio dos pais, do companheiro e de outros membros da fam?lia; os projetos de vida, relatando os planos interrompidos com a gravidez e a readequa??o da sua imagem corporal ap?s a gesta??o e, por fim, os fatores educacionais e a maternidade respons?vel, abordando os conhecimentos da jovem, relacionados com os m?todos contraceptivos, o cuidado com o filho e a possibilidade de reincid?ncia da gravidez ainda na adolesc?ncia. A investiga??o apresenta sugest?es de interven??es que poder?o modificara situa??o da gravidez na adolesc?ncia e favorecer o est?mulo ? maternidade respons?vel, principalmente atraves de grupos de orienta??o multidisciplinares, a nivel de atendimento ambulatorial ou hospitalar, e que se proponham a uma abordagem holpistica, integrando esta adolescente e sua fam?lia ao contexto vivido neste momento.

A traição é um tema que temos estudado já faz algum tempo, utilizando como fontes as Canções de Gesta, um gênero literário poético corrente nas regiões que compunham o reino da França, entre o século XI e o século XV. O período áureo dessa poesia coincidiu com o governo da dinastia conhecida como dos Capetos diretos, cujo reinado e sucessão de pai para filho persistiu sem interrupção de 987 até 1328. Criadas e difundidas nos diversos senhorios territoriais da França, em especial no norte do reino, as Canções de Gesta tratavam em seus enredos de vários problemas de ordem moral e política vigentes na época. Em uma sociedade cuja coesão, ao menos na sua camada governante, era baseada na fidelidade e na criação de laços vassálicos, a traição constituía uma grave ameaça à estabilidade e à paz. Tanto a moral cristã quanto a moral cavaleiresca condenavam quem a praticasse, mas isso não evitou a sua constante ocorrência. Estudamos cinco poemas épicos: a Chanson de Roland (c. 1100), o Girart de Vienne (1180-1185), o Renaut de Montauban (início do século XIII), o Gaydon (1230- 1240) e o Jehan de Lançon (metade do século XIII). O Roland, sendo o mais antigo desses poemas, apresenta um monarca respeitado e difere dos poemas posteriores, cujos enredos valorizam os personagens conhecidos desde o século XIX como Vassalos Rebeldes. Da análise da traição nessa poesia e da relação entre vassalos e o rei pudemos extrair alguns pontos importantes. De início o ligado à questão vocabular, pois traïson / traïtre / traïr designam um dos mais graves crimes ali descritos, graças a sua ligação com a tradição neotestamentária da entrega de Jesus por Judas Iscariotis, suplantando outros termos de origem latina ou não (proditio, felonie). Nas Canções, a traição é dirigida primeiramente contra os barões e cavaleiros sendo os seus executores da mesma condição social de suas vítimas. Só tardiamente ela denomina um atentado contra o monarca. Outro ponto é a defesa, nos poemas, do direito à guerra ao senhor caso este não cumprisse suas obrigações de justiça para com seu vassalo. Assim, os heróis em luta contra Carlos Magno não eram mostrados pelo poeta como traidores e sim como vítimas de uma perseguição. Esses cavaleiros conservavam o respeito pelo seu senhor e aspiravam ser perdoados e reintegrados à corte régia. A responsabilidade pelas traições era direcionada para uma linhagem específica, a de Ganelon, responsável pelo desastre de Roncesvales na Chanson de Roland. Mas se aqui a traição fora um crime individual, desde fim do século XII há um trabalho de readaptação no qual o fato de se pertencer a essa família já tornava o personagem passível de ser um traidor. As suas traições podiam ir da falsa acusação até ao envenenamento de outros personagens. A prova da traição se dava frequentemente através do duelo judicial e os culpados, além de condenados à morte, podiam ter os corpos destruídos para evitar a ressurreição no final dos tempos. / Treason is a theme that we have been studying for some time, using as sources the Songs of Geste, a poetic genre current in the regions that made up the Frances kingdom, between the eleventh and the fifteenth centuries. That poetrys golden period coincided as the dynasty of government known as the \"direct Capetian\" which reign and father to son succession persisted without interruption from 987 to 1328. Created and disseminated in the various Frances territorial manorials, especially in the northern kingdom, the Songs of Geste treated in their plots of various problems of moral and political force at that time. In a society whose cohesion, at least in its ruling layer, was based on loyalty and creating vassalian ties, treason constituted a serious threat to stability and peace. Both Christian morality as the moral chivalry condemned those who practiced it, but that did not stop their constant occurrence. We studied five epic poems: the Chanson de Roland (C1100), the Girart de Vienne (1180-1185), the Renaut de Montauban (early thirteenth century), the Gaydon (1230-1240) and Jehan de Lançon (half of the century XIII). Roland, is the oldest of those poems, has a respected monarch, and differs from the later poems whose plots value the characters known since the nineteenth century as \"Vassals Rebels\". From the analysis of treason in this poetry and the relationship between vassals and the king, we could draw some important points. Initially the connected to the vocabulary question because traïson / traître / traïr designate one of the most serious crimes described there, thanks to its connection with the neo testamentary tradition of Jesus delivery by Judas Iscariot, supplanting other terms Latin or not (proditio, felonie). In Chansons, the treason is primarily directed against the barons and knights and the executors are of the same social condition of their victims. Only belatedly it calls an attack against the monarch. Another point is the defense, in the poems, from the right to the war to the lord if he does not achieve his justices obligations to his vassal. Thus, the heroes in the fight against Charlemagne were not shown by the poet as traitors but as victims of persecution. Those knights keep respect for their master and aspire to be forgiven and reintegrated to the royal court. Responsibility for treason is directed to a specific lineage, that of Ganelon, responsible for Roncesvales disaster in the Chanson de Roland. But if here the treason was an individual crime, since the end of the twelfth century there is a readjustment work in which the fact of belonging to that family already makes the character capable of being a traitor. Their treasons can go from false accusation to the poisoning of other characters. The proof of treason is often done through the judicial duel and the guilty, beyond sentenced to death, they might have their bodies destroyed to prevent the resurrection at the end of time.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2015-04-22T12:11:40Z No. of bitstreams: 1 467314.pdf: 1610100 bytes, checksum: aa3bb34f2885150a63290c0e7a0dc4b5 (MD5) / Made available in DSpace on 2015-04-22T12:11:41Z (GMT). No. of bitstreams: 1 467314.pdf: 1610100 bytes, checksum: aa3bb34f2885150a63290c0e7a0dc4b5 (MD5) Previous issue date: 2015-01-15 / Cigarette smoking during pregnancy has several impacts on fetal development, including teratogenic effects. The objective of this study was to assess whether the toxic substances (cotinine and polycyclic aromatic hydrocarbons) found in pregnant smokers are transmitted to their fetuses. The outcomes were analyzed measuring cotinine and 1-hydroxypyrene in the amniotic fluid and maternal urine, benzopyrene and cotinine in the umbilical cord blood.Through a controlled cross-sectional design, 125 pregnant women were selected and classified according to their smoking status: 37 current smokers, 25 passive smokers and 63 non-smokers (controls). We performed highperformance liquid chromatography to measure substances? concentrations. A post-hoc Tukey?s test was used to analyze the differences between the groups. All variables were significantly different between controls and smokers. The mean ratios between the concentration of cotinine in smokers compared to controls were as follows: 5.9 [2.5 - 13.5], p < 0.001 in the urine; 25 [11.9 - 52.9], p < 0.001 in the amniotic fluid; and 2.6 [1.0- 6.8], p = 0.044 in the umbilical cord blood.The mean ratios of 1-hydroxypyrene concentration between smokers and controls were 7.3 [1.6 - 29.6], p = 0.003 in the urine and 1.3 [1.0 - 1.7], p = 0.012 in the amniotic fluid, and of benzopyrene in umbilical cord blood was 2.9 [1.7 - 4.7], p < 0.001. There were no significant differences between controls and passive smokers. When comparing the three groups together, there were statistical differences between all variables.Thus, the fetuses of pregnant smokers are exposed to toxic and carcinogens substances. To our knowledge, this is the first study to measure 1- hydroxypyrene in the amniotic fluid and benzopyrene in umbilical cord blood by high-performance liquid chromatography when considering pregnant women in relation to smoking exposure only. / O tabagismo na gesta??o tem sido associado a in?meras altera??es, impactando em v?rias fases do desenvolvimento fetal, incluindo efeito teratog?nico. O objetivo deste estudo foi avaliar se a exposi??o materna a algumas subst?ncias t?xicas existentes na fuma?a do cigarro (cotinina, 1-hidroxipireno e benzopireno) s?o transmitidas ao feto.Atrav?s de delineamento transversal controlado, foram selecionadas 125 gestantes internadas no Centro Obst?trico do Hospital S?o Lucas da PUCRS, em Porto Alegre. As volunt?rias foram classificadas conforme seu status tab?gico: 37 tabagistas ativas, 25 tabagistas passivas e 63 n?o fumantes (controles). Foram realizadas as dosagens de cotinina e 1-hidroxipireno na urina materna e l?quido amni?tico; cotinina e benzopireno no sangue do cord?o umbilical atrav?s de cromatografia l?quida de alta efici?ncia. Para estimar a diferen?a proporcional das vari?veis assim?tricas entre os grupos utilizou-se a raz?o das m?dias (RM) e intervalo de confian?a de 95%. Para o c?lculo das diferen?as entre os grupos foi utilizado o teste post-hoc de Tukey.Todas as vari?veis estudadas apresentaram diferen?a estatisticamente significativa entre os grupos controle e tabagista. N?o foi observada diferen?a significativa entre os grupos controle e tabagista passivo. A concentra??o de cotinina foi cerca de 6 vezes maior na urina das gestantes tabagistas, RM: 5,92 [2,59 - 13,55], p<0,001 em rela??o aos controles; no l?quido amni?tico a concentra??o foi 25 vezes maior que a do grupo controle, RM: 25,09 [11,9 - 52,91], p<0,001; e no sangue do cord?o umbilical foi 2,6 vezes maior nos fetos das gestantes tabagistas, RM: 2,64 [1,02-6,84], p=0,044.A concentra??o de 1-hidroxipireno foi sete vezes maior na urina das gestantes tabagistas, quando comparadas ao grupo controle, RM: 7,3 [1,64 - 29,69], p=0,003. No l?quido amni?tico, o grupo tabagista apresentou concentra??o 30% maior que o grupo controle, RM: 1,3 [1,05 - 1,7], p=0,012. A concentra??o de benzopireno foi cerca de 3 vezes maior no sangue do cord?o umbilical dos fetos de m?es tabagistas, RM: 2,9 [1,76 - 4,79], p<0,001 quando comparadas ao grupo controle. Desse modo, conclui-se que fetos de gestantes tabagistas est?o mais expostos a subst?ncias reconhecidamente t?xicas e carcinog?nicas. Pelo nosso conhecimento, este estudo ? o primeiro que dosou o 1-hidroxipireno no l?quido amni?tico e benzopireno isolado no sangue do cord?o umbilical por cromatografia l?quida de alta efici?ncia, comparando gestantes somente em rela??o ? exposi??o ao tabagismo.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2016-03-30T17:02:31Z No. of bitstreams: 1 TES_MARISA_REGINATTO_VIEIRA_COMPLETO.pdf: 3906952 bytes, checksum: 0346741513899775dc5b6837169dfdfd (MD5) / Made available in DSpace on 2016-03-30T17:02:31Z (GMT). No. of bitstreams: 1 TES_MARISA_REGINATTO_VIEIRA_COMPLETO.pdf: 3906952 bytes, checksum: 0346741513899775dc5b6837169dfdfd (MD5) Previous issue date: 2015-09-29 / Objective: To analyze the behaviour of blood pressure at the first 8 hours of emergency care in pregnant women who arrive with hypertension in an obstetric unit. Methods: Blood pressure was measured at an Obstetric Unit in a cohort of 415 pregnant women with high blood pressure at the initial evaluation. Data of the first 8 hours of blood pressure readings were analyzed by Generalized Estimated Equations test. Results: At baseline the means(+SD) were 154.3?16.5 mmHg and 98.0?12.1 mmHg for systolic and diastolic blood pressure, respectively. There was a significant reduction in blood pressure during follow-up (p<0.001). Blood pressure means (SD) were: 1st hour: 146.6+19.1 and 89.7+15.6, 2nd: 139.0+17.8 and 83.2+14.2, 3rd: 137.2+15.6 and 78.7+12.2, 4th: 136.9+14.7 and 78.8+14.5, 5th: 135.9+16.6 and 78.2+14.1, 6th: 135.6+16.3 and 77.9+13.5, 7th: 133.3+14.2 and 75.7+11.9, and 8th hour 133,8+15.6 and 76.9+12.9 mmHg for systolic and diastolic blood pressure, respectively. Blood pressure stabilized after the third hour. Conclusion: The study provides evidence that an interval of at least three hours between measurements is adequate to establish the diagnosis of gestational hypertension in pregnant women presenting with high blood pressure at an obstetric unit. / Objetivo: Analisar o comportamento da press?o arterial nas primeiras 8 horas de cuidados de emerg?ncia em mulheres gr?vidas com mais de 20 semanas de idade gestacional que chegam com hipertens?o em uma unidade obst?trica. M?todos: A press?o arterial foi medida numa Unidade Obst?trica em uma coorte de 415 mulheres gr?vidas com press?o arterial elevada na avalia??o inicial. Dados das primeiras 8 horas de leituras de press?o arterial foram analisadas por teste de Equa??es de Estimativas Generalizadas. Resultados: No momento da chegada ? Unidade Obst?trica, a m?dia foi 154,3 ? 16,5 mmHg e 98,0 ? 12,1 mmHg para a press?o arterial sist?lica e diast?lica, respectivamente. At? 8 horas todas as m?dias das aferi??es diminu?ram a cada hora (p <0,001). As medidas da primeira hora foram 146,6+19,1 e 89,7+15,6, na segunda hora: 139,0+17,8 e 83,2+14,2, 3?: 137,2+15,6 e 78,7+12,2, 4?: 136,9+14,7 e 78,8+14,5, 5?: 135.9+16,6 e 78,2+14,1, 6?: 135,6+16,3 e 77,9+13,5, 7?: 133,3+14,2 e 75,7+11,9 e na 8? hora 133,8+15,6 e 76,9+12.9 mmHg para a press?o arterial sist?lica e diast?lica respectivamente. No tempo de tr?s horas 55,3% das pacientes tiveram a press?o arterial estabilizada e abaixo de 140/90mmHg. A idade gestacional foi maior em gestantes que atingiram a estabiliza??o em tr?s horas (36,4+4,4 versus 34,3+4,9 semanas; p = 0,007). Conclus?o: O estudo fornece evid?ncias de que um intervalo de pelo menos tr?s horas entre as medidas seja suficiente para estabelecer o diagn?stico de hipertens?o gestacional em mulheres gr?vidas que apresentam press?o alta em uma unidade de obstetr?cia.

Made available in DSpace on 2015-04-14T13:34:51Z (GMT). No. of bitstreams: 1 422341.pdf: 583577 bytes, checksum: 4e87e5f7b70c7e7c04ae9c1673b68e2a (MD5) Previous issue date: 2010-01-21 / Introdu??o: Evid?ncias de toxicidade da nicotina sobre o desenvolvimento fetal s?o amplamente documentadas na literatura. Um dos mecanismos envolvidos na toxicidade resulta do comprometimento da vasculariza??o placent?ria. Os trabalhos, geralmente, quantificam o tabagismo em rela??o ao n?mero de cigarros fumados referidos pelas pacientes, informa??es nem sempre verdadeiras. As medidas bioqu?micas mais utilizadas para validar a auto-declara??o s?o as concentra??es de mon?xido de carbono no ar exalado (COex) e a da cotinina salivar, plasm?tica ou urin?ria. A dopplervelocimetria ? um m?todo que propicia o estudo hemodin?mico materno e fetal atrav?s da estimativa de fluxo nas art?rias uterinas, umbilicais e cerebrais m?dias fetais, utilizando as rela??es entre as velocidades de fluxo sist?lico e diast?lico. O objetivo deste trabalho ? estudar os efeitos do tabagismo sobre a circula??o materno-fetal atrav?s da medida dos fluxos nas art?rias uterinas, cerebral m?dia e umbilical e peso fetal ao nascer, relacionando os valores encontrados com as medidas de COex e cotinina urin?ria. M?todo: Estudo coorte prospectiva. Foram recrutadas pelo pesquisador, ap?s assinatura de termo de consentimento livre e esclarecido, 30 gestantes tabagistas e 34 n?o tabagistas, no terceiro trimestre da gesta??o, do Ambulat?rio de Assist?ncia Pr?-natal de baixo risco do Servi?o de Obstetr?cia do HSL-PUCRS. Foi realizada ecografia para avaliar o ?ndice de resist?ncia das art?rias uterinas, umbilical e cerebral m?dia; medida de CO exalado e cotinina urin?ria. Essas pacientes foram acompanhadas at? o parto, para avaliar o peso fetal ao nascer. As pacientes tabagistas foram divididas em grupos com valores crescentes de COex e cotinina urin?ria para avaliar os efeitos sobre os ?ndices de resist?ncia vascular. Resultados: Ao comparar os grupos, sem estratificar a carga tab?gica, observou-se aumento significativo dos ?ndices de resist?ncia nas art?rias uterinas direita, esquerda e na umbilical. O ?ndice de resist?ncia da art?ria cerebral m?dia mostrou tend?ncia ? diminui??o. Ao classificar conforme os valores do COex, foi observado aumento significativo nos ?ndices de resist?ncia nas art?rias uterinas direita, esquerda e na umbilical associado ? diminui??o na art?ria cerebral m?dia. Detectou-se diminui??o significativa no percentil do peso fetal ao nascimento, associado ao aumento do COex. Quando o grupo tabagista foi separado quanto aos valores crescentes de cotinina urin?ria, os resultados foram similares, exceto na art?ria uterina direita. A art?ria cerebral m?dia evidenciou tend?ncia ? diminui??o significativa dos ?ndices de resist?ncia associado ao aumento da cotinina na regress?o linear, por?m n?o manteve a signific?ncia quando foi corrigido para os poss?veis fatores de confus?o. Verificouse tamb?m uma diminui??o proporcional do percentil do peso fetal ao nascimento com o aumento dos valores da cotinina urin?ria, estatisticamente significativo. Conclus?o: Neste estudo, detectou-se, por dopplervelocimetria das art?rias uterinas, umbilical e cerebral m?dia, altera??es compat?veis com hip?xia cr?nica associada a poss?veis mecanismos de compensa??o fetal para manter sua homeostase e consequente diminui??o do peso fetal ao nascer, crescentes em rela??o ?s medidas de COex e cotinina urin?ria.