<p>This thesis is about HELLP Syndrome (hemolysis, elevated liver enzymes, low platelet count in pregnancy): a devastating maternal hypertensive complication that results in multi-system changes that can rapidly deteriorate into organ failure and death. Despite rapid advancesin medical technology and medical science this disease continues to take&nbsp / the lives of women and their infants. The only effective intervention for this disorder is immediate termination irrespective of the gestational stage of the pregnancy. The primary objective of this thesis was to explore the subjective experiences and meaningmaking processes of women in and through their high-risk pregnancies. This objective crystallised into the following aims: to facilitate and listen to the voices of women who were HELLP Syndrome survivors / to explore the reported bodily, psychological and&nbsp / emotional experiences of HELLP Syndrome survivors / to understand the role medical intervention and biomedical discourses play in these women&rsquo / s experiences and finally to explore the subjective experiences of HELLP Syndrome in the context of traditionallyheld notions of motherhood. The study was couched in a feminist poststructuralist&nbsp / epistemology. A material-discursive framework which comprised phenomenological and poststructuralist theorising was usedin an attempt to understand both the lived experiences as well as the discursively constructed nature of those subjective experiences. Thus the analysis encompassed both a broadly phenomenological framework to understand the lived experiences of HELLP Syndrome, and a discourse analysis to explore the meaning-making processes of participants in relation to larger social&nbsp / discourses, in particular the dominant biomedical and motherhood discourses. A qualitative approach using in depth semi-structured interviews was utilisedto gather data. Eleven participants from very diverse backgrounds consented to be part of thisstudy. The findings of the study highlighted the immense trauma, difficulties and challenges participants faced in these high-risk situations. What was evident from the analysis was that their experiences were so diverse and werecompletely shaped by the severity of the disorder and the gestational stage of the pregnancy. Some women ended up in the Intensive Care Units (ICU) and had near-death experiences, some had very premature babies, while some of the participants lost their babies during the process. With regards to the emotional, psychological and corporeal aspects of the disorder,participants described their situations as a disaster, painful and difficult. Due to the rapid deterioration of symptoms, they described the tempo of these events as a whirlwind in which they felt they had no control. Emotions ranged from shock, total disbelief and surprise to anger, helplessness and powerlessness. Lacking knowledge and access to appropriate&nbsp / information further compounded the situation for participants. Theparticipants who had premature babies found the Neonatal Intensive Care Unit experience (NICU) extremely challenging and stressful. A discourse analysis revealed that women&rsquo / s talk was shaped by the disciplinary frameworks oftechnocratic medicine and patriarchal notions of&nbsp / gender. Participants&rsquo / discourses about their encounters inthe medical context werelocated in, and shaped by, the structure of health care in our country. In this regard binaries&nbsp / (like private versus public health care, women versus men and nurses versus doctors) were evident. Furthermore their hospital stay reflected their experiences in the Intensive&nbsp / Care (ICU) and the Neonatal Intensive Care Units (NICU) both of which are highly technologically orientated and managed. Biomedical discourses that filtered through the&nbsp / participants&rsquo / talk were: medicine as indisputable truth / mechanistic model of the body as machine / medical doctors as gods and the foetus as &lsquo / super subject&rsquo / . Discourses of risk&nbsp / were inevitably taken up as participants tried to make sense of both their current pregnancies and the potential ones to follow. The passage into motherhood for these&nbsp / participants was dependent on whether they had live babies or not. For those who had live babies it was a difficult time as they had to contend with their own recovery as well as the prematurity of their infants. The NICU experience was described as tiring, trying and cumbersome. For mothers who lost their babies it was a time of profound sadness and&nbsp / loss coupled to the notion that motherhood itself was lost. This loss of their children symbolised broken dreams, severed connections and a powerful taboo. In addition, discourses in which motherhood was naturalised and normalised saturated their talk and framed their experience in a narrative of deficit and failure. The ideologies of mother&nbsp / blame and the &lsquo / all responsible&rsquo / mother were pervasive in their discussions. In conclusion, this high-risk situation represented a time of tremendous uncertainty and unpredictability for all participants and was powerfully shaped by dominant discourses about motherhood and the biomedical discursive and institutional framework in which&nbsp / participants were subjugated. The study thus highlights how the HELLP syndrome experience illuminates the erasure of women&rsquo / s subjectivities while the foetus/infants&rsquo / life&nbsp / takes precedence. This has significant implications for scholarship in general and feminist scholarship in particular and highlights the need for this type of engagement in an area that has remained on the periphery of feminist research.</p>

<p>This thesis is about HELLP Syndrome (hemolysis, elevated liver enzymes, low platelet count in pregnancy): a devastating maternal hypertensive complication that results in multi-system changes that can rapidly deteriorate into organ failure and death. Despite rapid advancesin medical technology and medical science this disease continues to take&nbsp / the lives of women and their infants. The only effective intervention for this disorder is immediate termination irrespective of the gestational stage of the pregnancy. The primary objective of this thesis was to explore the subjective experiences and meaningmaking processes of women in and through their high-risk pregnancies. This objective crystallised into the following aims: to facilitate and listen to the voices of women who were HELLP Syndrome survivors / to explore the reported bodily, psychological and&nbsp / emotional experiences of HELLP Syndrome survivors / to understand the role medical intervention and biomedical discourses play in these women&rsquo / s experiences and finally to explore the subjective experiences of HELLP Syndrome in the context of traditionallyheld notions of motherhood. The study was couched in a feminist poststructuralist&nbsp / epistemology. A material-discursive framework which comprised phenomenological and poststructuralist theorising was usedin an attempt to understand both the lived experiences as well as the discursively constructed nature of those subjective experiences. Thus the analysis encompassed both a broadly phenomenological framework to understand the lived experiences of HELLP Syndrome, and a discourse analysis to explore the meaning-making processes of participants in relation to larger social&nbsp / discourses, in particular the dominant biomedical and motherhood discourses. A qualitative approach using in depth semi-structured interviews was utilisedto gather data. Eleven participants from very diverse backgrounds consented to be part of thisstudy. The findings of the study highlighted the immense trauma, difficulties and challenges participants faced in these high-risk situations. What was evident from the analysis was that their experiences were so diverse and werecompletely shaped by the severity of the disorder and the gestational stage of the pregnancy. Some women ended up in the Intensive Care Units (ICU) and had near-death experiences, some had very premature babies, while some of the participants lost their babies during the process. With regards to the emotional, psychological and corporeal aspects of the disorder,participants described their situations as a disaster, painful and difficult. Due to the rapid deterioration of symptoms, they described the tempo of these events as a whirlwind in which they felt they had no control. Emotions ranged from shock, total disbelief and surprise to anger, helplessness and powerlessness. Lacking knowledge and access to appropriate&nbsp / information further compounded the situation for participants. Theparticipants who had premature babies found the Neonatal Intensive Care Unit experience (NICU) extremely challenging and stressful. A discourse analysis revealed that women&rsquo / s talk was shaped by the disciplinary frameworks oftechnocratic medicine and patriarchal notions of&nbsp / gender. Participants&rsquo / discourses about their encounters inthe medical context werelocated in, and shaped by, the structure of health care in our country. In this regard binaries&nbsp / (like private versus public health care, women versus men and nurses versus doctors) were evident. Furthermore their hospital stay reflected their experiences in the Intensive&nbsp / Care (ICU) and the Neonatal Intensive Care Units (NICU) both of which are highly technologically orientated and managed. Biomedical discourses that filtered through the&nbsp / participants&rsquo / talk were: medicine as indisputable truth / mechanistic model of the body as machine / medical doctors as gods and the foetus as &lsquo / super subject&rsquo / . Discourses of risk&nbsp / were inevitably taken up as participants tried to make sense of both their current pregnancies and the potential ones to follow. The passage into motherhood for these&nbsp / participants was dependent on whether they had live babies or not. For those who had live babies it was a difficult time as they had to contend with their own recovery as well as the prematurity of their infants. The NICU experience was described as tiring, trying and cumbersome. For mothers who lost their babies it was a time of profound sadness and&nbsp / loss coupled to the notion that motherhood itself was lost. This loss of their children symbolised broken dreams, severed connections and a powerful taboo. In addition, discourses in which motherhood was naturalised and normalised saturated their talk and framed their experience in a narrative of deficit and failure. The ideologies of mother&nbsp / blame and the &lsquo / all responsible&rsquo / mother were pervasive in their discussions. In conclusion, this high-risk situation represented a time of tremendous uncertainty and unpredictability for all participants and was powerfully shaped by dominant discourses about motherhood and the biomedical discursive and institutional framework in which&nbsp / participants were subjugated. The study thus highlights how the HELLP syndrome experience illuminates the erasure of women&rsquo / s subjectivities while the foetus/infants&rsquo / life&nbsp / takes precedence. This has significant implications for scholarship in general and feminist scholarship in particular and highlights the need for this type of engagement in an area that has remained on the periphery of feminist research.</p>

El objetivo del estudio fue determinar los principales factores de riesgo para desarrollar síndrome HELLP en gestantes preeclámpticas severas en el Hospital Regional Hermilio Valdizán Medrano de Huánuco – Perú, durante los años 2010-2014. Se realizó un estudio retrospectivo transversal, observacional analítico de tipo casos y controles. Se compararon 76 gestantes con preeclampsia severa que desarrollaron síndrome HELLP (casos) con 76 mujeres con preeclampsia severa que no desarrollaron síndrome HELLP (controles). El análisis estadístico se realizó con el programa IBM Statistics SPSS 19. La edad de la población estudiada varió entre los 14 y 44 años, con una media de 26,1 +/- 7,7 años. El análisis de regresión logística no demostró asociación entre las variables desarrollo de síndrome HELLP y antecedente de hipertensión crónica, nivel plaquetario, antecedente de preeclampsia, eclampsia, trombofilia, gestante adolescente, gestante añosa, tabaquismo, sobrepeso/obesidad, desnutrición paridad y riesgo social. Se concluyó que el antecedente de síndrome HELLP y el antecedente familiar de preeclampsia/HELLP incrementaron significativamente el riesgo para desarrollar síndrome HELLP.

Proefschrift Universiteit van Amsterdam. / Met samenvatting in het Nederlands.

Objetivo General: Determinar la correlación clínica y de exámenes de laboratorio del Síndrome Hellp con los resultados materno - neonatales. Material y Métodos: Se realizó un estudio observacional longitudinal, retrospectivo correlacional, en pacientes como diagnostico Síndrome de Hellp, encontrándose en un lapso de tres años, un total de 153 casos; se correlacionó los resultados maternos y resultados neonatales con los parámetros de laboratorio que hacen el diagnóstico de Sd de Hellp. Para el análisis se usaron las pruebas t de student, para las variables paramétricas; y para las variables no paramétricas, se utilizó la prueba de Kruskal – Wallis, considerándose la significación estadística con un valor de p <0.05. Resultados: La incidencia del S. de Hellp fue de 0.76%, siendo la clase III la mas frecuente (60%), el 48% no tuvo CPN, la mayor parte de las gestaciones culminaron por cesárea (62.7%), siendo la clase I la que tuvo mas cesáreas; se observó que el edema pulmonar se encontró en la clase I, los vómitos están relacionados significativamente con malos resultados materno y neonatales, La epigastralgia se relaciona mejor con la clase I en el 50%, la eclampsia no guarda relación de causalidad con los niveles plaquetarios, los parámetros de laboratorio no guardan relación con resultados neonatales, la diferencia de resultados neonatales con el tipo de Hellp no fue observada, los preterminos se presentaron en el 44.3%, la ictericia se asocio mas a clases I y II con 50 y 41%, la mortalidad neonatal se observo mas con la clase 1 con 16.7%; en los RN se observo la relación directa de nauseas con muerte neonatal 25%, también de nauseas con sepsis neonatal (66.6%), finalmente se aprecia un mayor uso de hemoderivados en la Clase I, >66%. Conclusiones: La Clase de Hellp de mayor severidad se correlaciona con malos resultados maternos, mayor tasa de cesáreas, uso de hemoderivados, complicaciones oculares, pulmonares, uso de UCI, mayor tiempo de hospitalización, así como de malos resultados neonatales, sepsis y muerte neonatal; siendo el parámetro clínico de mayor importancia las nauseas y los vómitos, que se relacionan con malos resultados maternos; en cuanto a los niveles de plaquetas, los valores bajos se asocian a muerte y sepsis neonatal. / Tesis de segunda especialidad

Hurricane Katrina hit the Gulf Coast on August 29th, 2005. It is considered to be one of the costliest and devastating disasters in the history of the United States. The storm flooded 70% of New Orleans resulting in more than 1,500 people losing their lives and the displacement of an entire urban population. Reconstruction over the past ten years has revitalized much of New Orleans, demonstrating a great resilience and determination of its people. Nonetheless, New Orleans is also experiencing the long-term effects of Hurricane Katrina where victims of domestic violence and the institutions that serve them have been forever changed. This dissertation examines perceptions of domestic violence and help-seeking behaviors among women in post-Hurricane Katrina New Orleans from 2005 to 2015. Findings show that many women face striking inequalities demonstrated in higher rates of poverty, lack of affordable housing, and one of the highest wage gaps in the United States. Patriarchal attitudes seen in legal institutions, the police force, and political systems contribute to the perception of a gender bias against women. This qualitative research uses a case study methodology and employs ethnographic methods of observation, including 31 in-depth interviews that capture the complexity of domestic violence and identify the social and economic dynamics that create barriers to help-seeking in New Orleans. The data contends that women who have increased access to informal and formal networks are able to enact behaviors that will allow them to seek help and extricate themselves from abusive relationships. These findings demonstrate that inequalities in post-disaster reconstruction have created barriers to help-seeking among victims of domestic violence. These barriers include the destruction of social capital, institutional failures, and limited economic resources. Likewise, findings reveal that attitudes and behaviors regarding domestic violence help-seeking are dependent on social and economic well-being. This highlights the need for more research and hard data on the incidence of domestic violence in New Orleans to learn the exact scope of the problem and how to overcome the social and economic barriers that perpetuate the cycle of domestic violence. / 1 / Kelley Virginia Ponder

Objetivo General: Determinar la correlación clínica y de exámenes de laboratorio del Síndrome Hellp con los resultados materno - neonatales. Material y Métodos: Se realizó un estudio observacional longitudinal, retrospectivo correlacional, en pacientes como diagnostico Síndrome de Hellp, encontrándose en un lapso de tres años, un total de 153 casos; se correlacionó los resultados maternos y resultados neonatales con los parámetros de laboratorio que hacen el diagnóstico de Sd de Hellp. Para el análisis se usaron las pruebas t de student, para las variables paramétricas; y para las variables no paramétricas, se utilizó la prueba de Kruskal – Wallis, considerándose la significación estadística con un valor de p <0.05. Resultados: La incidencia del S. de Hellp fue de 0.76%, siendo la clase III la mas frecuente (60%), el 48% no tuvo CPN, la mayor parte de las gestaciones culminaron por cesárea (62.7%), siendo la clase I la que tuvo mas cesáreas; se observó que el edema pulmonar se encontró en la clase I, los vómitos están relacionados significativamente con malos resultados materno y neonatales, La epigastralgia se relaciona mejor con la clase I en el 50%, la eclampsia no guarda relación de causalidad con los niveles plaquetarios, los parámetros de laboratorio no guardan relación con resultados neonatales, la diferencia de resultados neonatales con el tipo de Hellp no fue observada, los preterminos se presentaron en el 44.3%, la ictericia se asocio mas a clases I y II con 50 y 41%, la mortalidad neonatal se observo mas con la clase 1 con 16.7%; en los RN se observo la relación directa de nauseas con muerte neonatal 25%, también de nauseas con sepsis neonatal (66.6%), finalmente se aprecia un mayor uso de hemoderivados en la Clase I, >66%. Conclusiones: La Clase de Hellp de mayor severidad se correlaciona con malos resultados maternos, mayor tasa de cesáreas, uso de hemoderivados, complicaciones oculares, pulmonares, uso de UCI, mayor tiempo de hospitalización, así como de malos resultados neonatales, sepsis y muerte neonatal; siendo el parámetro clínico de mayor importancia las nauseas y los vómitos, que se relacionan con malos resultados maternos; en cuanto a los niveles de plaquetas, los valores bajos se asocian a muerte y sepsis neonatal.

Die Präeklampsie als schwangerschaftsspezifische Erkrankung zählt unverändert weltweit zu den Hauptursachen fetaler und maternaler Morbidität und Mortalität. Ungeachtet vieler Forschungsbestrebungen fehlt bisher vor allem eine effiziente Früherkennung sowie daraus ableitbare kausale Therapieoptionen. Obgleich Ätiologie und Pathogenese nach wie vor als ungeklärt gelten, existieren zunehmend überzeugende Hinweise, welche einer Dysbalance von angiogenen Faktoren, wie VEGF und PlGF, und antiangiogenen Faktoren, wie sFlt1 und sEng, eine zentrale Rolle in der Entstehung der Erkrankung zuschreiben. Mehrere Studiengruppen konnten in diesem Zusammenhang veränderte Plasmakonzentrationen antiangiogener Proteine noch vor der eigentlichen Manifestation der Erkrankung nachweisen. Ziel dieser Studie war es zu klären, ob eine pathologisch uterine Perfusion im 2. Trimenon mit erhöhten sFlt1-Werten assoziiert ist und in einem prospektiven Ansatz die prädiktive Wertigkeit der antiangiogenen Faktoren sFlt1 und sEng, in einem durch Dopplersonografie vorselektierten Risikokollektiv zu bestimmen. Dazu wurden im retrospektiven Teil von 39 und im prospektiven Teil von 77 Einlingsschwangerschaften im 2. Trimester in venös entnommenen Blutproben mit Hilfe des ELISA - Tests die maternalen sFlt1- und sEng- Konzentrationen gemessen. Es konnte gezeigt werden, dass in einem durch Dopplersonografie vorselektierten Patientenkollektiv die maternale sFlt1-Konzentration bei Patientinnen mit späteren Schwangerschaftskomplikationen signifikant erhöht ist. Zusätzlich konnte belegt werden, dass die sEng - Konzentration in einem dopplersonografisch vorselektierten Risikokollektiv ebenfalls als unabhängiger prädiktiver Marker zur Vorhersage einer späteren Präeklampsie genutzt werden kann. Vielmehr ist es sogar möglich, Hochrisikopatientinnen mit Manifestation der Erkrankung vor der 34. SSW durch ausgesprochen hohe Sensitivität und Spezifität zu identifizieren.

A síndrome HELLP ocorre em gestantes ou puérperas e é caracterizada pelo surgimento de hemólise, elevação de enzimas hepáticas e plaquetopenia. Desenvolve-se em aproximadamente 10% das gestantes com pré-eclampsia, sendo mais freqüente entre a 22a e 36a semanas de gestação. Insuficiência renal aguda é uma complicação freqüente e grave nessas pacientes. O objetivo deste estudo foi avaliar, em pacientes com síndrome HELLP, a prevalência de insuficiência renal aguda e estudar fatores a ela associados. Foram estudadas 49 gestantes com síndrome HELLP, internadas no Hospital de Clínicas de Porto Alegre no período de janeiro de 1990 a fevereiro de 2000. A elevação da creatinina sérica acima de de 1,5 mg/dl foi o critério utilizado para definir insuficiência renal aguda. As pacientes foram divididas em dois grupos: Grupo 1-pacientes que apresentaram insuficiência renal aguda e Grupo 2-pacientes que não apresentaram alteração da função renal. O Grupo 1 foi constituído de 23 pacientes (46,9%), dos quais 13 pacientes (26,6%) recuperaram gradualmente a função renal e 10 pacientes (20,4%) necessitaram de tratamento dialítico. Dos pacientes submetidos à diálise, três pacientes recuperaram função renal e 3 permanecem em hemodiálise crônica (6,1%) por danos renais irreversíveis. Ocorreram 6 óbitos (12,2%): 5 (10,2%) deles nas pacientes do grupo que desenvolveu insuficiência renal. Concluímos que a insuficiência renal aguda e crônica foi uma complicação freqüente e grave da síndrome HELLP nas gestantes estudadas. As pacientes submetidas à diálise apresentaram maior morbimortalidade e pior prognóstico. Essa situação pode levar à insuficiência renal terminal com necessidade de diálise crônica indefinidamente, com graves repercussões clínicas, econômicas e sociais.

A síndrome HELLP ocorre em gestantes ou puérperas e é caracterizada pelo surgimento de hemólise, elevação de enzimas hepáticas e plaquetopenia. Desenvolve-se em aproximadamente 10% das gestantes com pré-eclampsia, sendo mais freqüente entre a 22a e 36a semanas de gestação. Insuficiência renal aguda é uma complicação freqüente e grave nessas pacientes. O objetivo deste estudo foi avaliar, em pacientes com síndrome HELLP, a prevalência de insuficiência renal aguda e estudar fatores a ela associados. Foram estudadas 49 gestantes com síndrome HELLP, internadas no Hospital de Clínicas de Porto Alegre no período de janeiro de 1990 a fevereiro de 2000. A elevação da creatinina sérica acima de de 1,5 mg/dl foi o critério utilizado para definir insuficiência renal aguda. As pacientes foram divididas em dois grupos: Grupo 1-pacientes que apresentaram insuficiência renal aguda e Grupo 2-pacientes que não apresentaram alteração da função renal. O Grupo 1 foi constituído de 23 pacientes (46,9%), dos quais 13 pacientes (26,6%) recuperaram gradualmente a função renal e 10 pacientes (20,4%) necessitaram de tratamento dialítico. Dos pacientes submetidos à diálise, três pacientes recuperaram função renal e 3 permanecem em hemodiálise crônica (6,1%) por danos renais irreversíveis. Ocorreram 6 óbitos (12,2%): 5 (10,2%) deles nas pacientes do grupo que desenvolveu insuficiência renal. Concluímos que a insuficiência renal aguda e crônica foi uma complicação freqüente e grave da síndrome HELLP nas gestantes estudadas. As pacientes submetidas à diálise apresentaram maior morbimortalidade e pior prognóstico. Essa situação pode levar à insuficiência renal terminal com necessidade de diálise crônica indefinidamente, com graves repercussões clínicas, econômicas e sociais.