No description available.

Background: Preliminary observations suggest that aberrations in maternal central hemodynamics and uterine artery Doppler velocimetry reflect the severity of hypertensive disorders of pregnancy. In addition, the precise changes of cardiac output in normal pregnancy, particularly in the third trimester, have remained controversial. Aims and Objective: To measure concomitantly Doppler echocardiographic maternal central hemodynamics and uterine artery Doppler velocimetry and evaluate their association with adverse feto-neonatal outcome in hypertensive pregnant women. To evaluate cardiac output longitudinally in the latter half of pregnancy in normal healthy women. Design and Setting: Prospective study conducted at the Obstetric Unit, King Edward VIII Hospital, Durban, South Africa. Study sample: forty (40) pregnant hypertensives without any prior therapy and a further group of pre-eclamptic women (n=22) treated with stat dose sodium gardinal and alpha-methyldopa were studied. Results: i) A trend to a higher cardiac output was seen in the hypertensives compared to the normotensives. Hypertensive women were of larger stature; there was no difference in cardiac index. Fetal birthweight correlated poorly with cardiac index in pre-eclamptic women (r =0.21). A better correlation was seen with uterine artery resistance index (r = - 0.65) and systemic vascular resistance index (r = -0.49). Critical values for cardiac index and systemic vascular resistance index to predict poor adverse feto-neonatal outcome with good predictive values were not identified. ii) Pre-eclamptics treated with stat dose of sodium gardinal and/or methyldopa prior to echocardiography had a significantly lower systemic vascular resistance index and uterine artery resistance index compared to the untreated group. The lower systemic vascular resistance index in this treated cohort occurred from a combination of non-significant lower blood pressure and higher cardiac index. iii) Compared to normotensive women, untreated pre-eclamptics had a significantly lower heart rate (p< 0.001), a higher stroke index (p=0.018) and no difference in resultant cardiac index (p=0.452). iv) In gestational apoteinuric hypertensives presenting after 34 weeks gestation, maternal hemodynamics and uterine artery resistance index did not help define a higher risk group. v) In chronic hypertensives pregnancies, left ventricular hypertrophy correlated with severity of blood pressure. Higher risk chronic hypertensives were better selected by proteinuria than maternal central hemodynamics or uterine artery resistance index. vi) In normal pregnancy, maternal cardiac output peaked in early to mid third trimester and was maintained till term. Significant correlations were observed among maternal cardiac output, maternal body surface area and fetal birth weight. Discussion: i) This study shows that cardiac index and systemic vascular resistance index measured in the latter part of the second and third trimesters in hypertensive pregnant women were not associated with adverse fetal outcome. Large variations in cardiac index values were observed that restricted detection of satisfactory critical values for cardiac index and systemic vascular resistance index to predict adverse outcome. ii) An improved correlation of uterine artery resistance index with maternal hemodynamics and fetal birthweight in pre-eclampsia supports the hypothesis that poor placentation does not allow for a normal increase in uterine blood flow. iii) The poor correlation between uterine artery resistance index and maternal central hemodynamics, does not support the hypothesis that elevated cardiac output in hypertensive pregnancies (hyperdynamic disease model) occurs as a compensatory response to maintain adequate perfusion in a utero-placental bed with high resistance that did not decrease. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2004.

Thesis (M.S.)--University of Wisconsin. School of Nursing, 1976. / eContent provider-neutral record in process. Description based on print version record.

Made available in DSpace on 2014-06-11T19:29:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-08-18Bitstream added on 2014-06-13T20:39:44Z : No. of bitstreams: 1 moura_mdr_me_botfm.pdf: 476585 bytes, checksum: 619c85e4fc295e56f3b00ad14f5ccdbe (MD5) / Fundação de Ensino e Pesquisa em Ciências da Saúde (FEPECS) / Os dados do Ministério da Saúde mostram a hipertensão na gestação como a maior causa de morte materna no Brasil sendo assinalada também como a maior causa de óbito fetal ou do recém-nascido. Esses alarmantes dados nacionais mostram a importância do conhecimento desta patologia gestacional tanto para obstetras como neonatologistas. Dentre as síndromes hipertensivas gestacionais, especial atenção deve ser dada à pré-eclâmpsia ou doença hipertensiva específica da gravidez que ocorre como forma isolada ou associada à hipertensão arterial crônica, pois esta está ligada aos piores resultados maternos e perinatais. O adequado controle pré-natal com seguimento rigoroso da gestante é a única forma de reduzir a mortalidade materna e perinatal. O uso de recurso de imagem como a dopplervelocimetria permite ao examinador diagnosticar insuficiência placentária e avaliar as condições circulatórias materno-fetal de forma segura e não invasiva. A decisão pela antecipação do nascimento nestas circunstâncias nem sempre é uma proposta segura. A equipe médica e familiares devem estar ciente dos riscos que um recém nascido além de prematuro, apresenta na maioria das vezes grave restrição do crescimento intrauterino. A UTI Neonatal deve estar preparada para oferecer cuidado intensivo e multiprofissional que permita diagnóstico e tratamento das mais variadas complicações, bem como a disponibilidade de recursos tecnológicos avançados são fundamentais para a melhoria dos resultados neonatais, tanto na sobrevivência, como na qualidade de vida / Data from the Ministry of Health showed that hypertension in pregnancy as a major cause of maternal death in Brazil is also noted as a major cause of stillbirth or newborns death.These alarming national data show the importance of knowledge of this gestation pathology to obstetricians and neonatologists. Among the hypertensive disorders of pregnancy special attention should be given to pre-eclampsia this hypertensive disorders of pregnancy can occurs as isolated or associated with chronic hypertension, can cause the worse maternal and perinatal outcomes. Only with a adequate prenatal and a close maternal follow up it is the only way to reduce maternal and perinatal mortality. The use of image resource as the dopplervelocimetria allows the examiner to diagnose and assess the placental maternal-fetal circulatory conditions safely and noninvasively. The decision to anticipation of the birth in these circumstances is not always a safe proposal. Medical staff and family members should be aware of the risks of a premature newborn that often presents severe intrauterine growth restriction. The NICU should be prepared to offer intensive care and multidisciplinary staff prepare to diagnosis and treatment of various complications, as well as the availability of advanced technological resources are critical to the improvement of neonatal outcomes no only in survival but in quality of life too

No description available.

Orientador: Lígia Maria Suppo de Souza Rugolo / Coorientador: Paulo Roberto Margotto / Banca: Maria Cristina Ferreira Sena / Banca: Francisco Diogo Rios Mendes / Resumo: Os dados do Ministério da Saúde mostram a hipertensão na gestação como a maior causa de morte materna no Brasil sendo assinalada também como a maior causa de óbito fetal ou do recém-nascido. Esses alarmantes dados nacionais mostram a importância do conhecimento desta patologia gestacional tanto para obstetras como neonatologistas. Dentre as síndromes hipertensivas gestacionais, especial atenção deve ser dada à pré-eclâmpsia ou doença hipertensiva específica da gravidez que ocorre como forma isolada ou associada à hipertensão arterial crônica, pois esta está ligada aos piores resultados maternos e perinatais. O adequado controle pré-natal com seguimento rigoroso da gestante é a única forma de reduzir a mortalidade materna e perinatal. O uso de recurso de imagem como a dopplervelocimetria permite ao examinador diagnosticar insuficiência placentária e avaliar as condições circulatórias materno-fetal de forma segura e não invasiva. A decisão pela antecipação do nascimento nestas circunstâncias nem sempre é uma proposta segura. A equipe médica e familiares devem estar ciente dos riscos que um recém nascido além de prematuro, apresenta na maioria das vezes grave restrição do crescimento intrauterino. A UTI Neonatal deve estar preparada para oferecer cuidado intensivo e multiprofissional que permita diagnóstico e tratamento das mais variadas complicações, bem como a disponibilidade de recursos tecnológicos avançados são fundamentais para a melhoria dos resultados neonatais, tanto na sobrevivência, como na qualidade de vida / Abstract: Data from the Ministry of Health showed that hypertension in pregnancy as a major cause of maternal death in Brazil is also noted as a major cause of stillbirth or newborns death.These alarming national data show the importance of knowledge of this gestation pathology to obstetricians and neonatologists. Among the hypertensive disorders of pregnancy special attention should be given to pre-eclampsia this hypertensive disorders of pregnancy can occurs as isolated or associated with chronic hypertension, can cause the worse maternal and perinatal outcomes. Only with a adequate prenatal and a close maternal follow up it is the only way to reduce maternal and perinatal mortality. The use of image resource as the dopplervelocimetria allows the examiner to diagnose and assess the placental maternal-fetal circulatory conditions safely and noninvasively. The decision to anticipation of the birth in these circumstances is not always a safe proposal. Medical staff and family members should be aware of the risks of a premature newborn that often presents severe intrauterine growth restriction. The NICU should be prepared to offer intensive care and multidisciplinary staff prepare to diagnosis and treatment of various complications, as well as the availability of advanced technological resources are critical to the improvement of neonatal outcomes no only in survival but in quality of life too / Mestre

No description available.

Introduction: Many medications have an unproven safety profile for use during pregnancy, leading to issues when chronic diseases, such as hypertension and depression, present during pregnancy. The focus of this research programme is to determine whether in utero exposure to antihypertensive and antidepressant medication is associated with increased risk of adverse events at birth, and up to 27 months of age in the child. Methods: Two systematic reviews were performed to identify current published literature and knowledge gaps. Following this, using Scottish healthcare data, a cohort of 268,711 children born 2010-2014 were identified. Following cleaning of the data, multiple imputation was used to account for missing values. Poisson, linear and multinomial regressions were performed to identify the relationship between in utero medication exposure and child outcomes. Results: In utero antihypertensive exposure was associated with preterm birth, low birth weight, small for gestational age, but not developmental issues. However, untreated hypertension was associated with low birth weight, preterm birth, and small for gestational age. In utero antidepressant exposure was associated with preterm birth, low birth weight, small for gestational age, preeclampsia, having a special needs indicator at 10 days and 6-8 weeks post-birth, developmental issues at 27 months Conclusions: This research programme identified several adverse outcomes following in utero exposure to antihypertensive and antidepressant medication.

Orientador: Yara Marcondes Machado Castiglia / Banca: Reinaldo Cerqueira Braz / Banca: Marco Aurélio Marangoni / Banca: Giane Nakamura / Banca: Antônio Carlos Aguiar Brandão / Resumo: O objetivo deste estudo foi analisar o efeito da anestesia no desfecho perinatal de mulheres hipertensas obesas submetidas à cesárea. Trata-se de estudo observacional prospectivo de 98 gestantes hipertensas e seus recém-nascidos, submetidas à cesárea sob anestesia subaracnoidea. As gestantes foram divididas em quatro grupos de acordo com seus índices de massa corporal (IMC): normal, sobrepeso, obesidade I e obesidade II. Dados demográficos e cirúrgicos maternos, bem como os valores de amostras de sangue venoso do cordão umbilical e características neonatais foram comparados entre os quatro grupos. Mediana e percentis foram utilizados (tendência de distribuição não-normal) e variáveis categóricas foram expressas em valores absolutos e percentuais. Quase 70% das mulheres eram brancas. A parada da dilatação como indicação para cesárea diferiu entre os grupos (p = 0,002): 33,33% do grupo obesidade II, 8,69% do grupo obesidade I, 6,66% do grupo normal e zero no grupo com sobrepeso. Pressão arterial sistólica máxima foi maior em mulheres com IMC normal (p = 0,002). Valores de peso ao nascimento, estatura, pH do sangue venoso do cordão umbilical, lactato, meta-hemoglobina, reticulócitos e eritroblastos foram semelhantes entre os grupos. Escores de New Ballard, Apgar e Silverman-Andersen não diferiram significativamente entre os grupos analisados. Somente cinco recém-nascidos foram internados na unidade neonatal, 25 foram levados para o berçário, onde permaneceram até alta para o alojamento conjunto e 68 permaneceram com suas mães após o nascimento. Não houve influência da anestesia subaracnoidea no desfecho perinatal de gestação de hipertensas obesas / Abstract: The aim of this study was to analyze the effect of anesthesia on perinatal outcome of hypertensive obese women undergoing cesarean delivery. This is a prospective observational study of 98 cesarean sections in hypertensive pregnant women, and their newborns, under spinal anesthesia. Women were divided into four groups according to their body mass indices: normal, overweight, obese I, and obese II. Demographic and surgical maternal data, values of cord blood samples and neonatal outcomes were compared between the four groups. Median and percentiles were used (tendency of non-normal distribution) and categorical variables were expressed as absolute values and percentage. Almost 70% of the women were white. The arrest of dilation, which was the indication for cesarean delivery, differed between the groups (p = 0.002): 33.33% in the obese II, 8.69% in the obese I, 6.66% in the normal body mass index, and zero in the overweight group. Maximum systolic blood pressure was higher in women with normal body mass index (p = 0.002). Birth weight, height, umbilical venous cord blood pH, lactate, methemoglobin, reticulocyte, and erythroblast counts were similar between groups. New Ballard, Apgar and Silverman-Andersen scores did not differ significantly between the groups analyzed. Only five newborns were admitted to the neonatal unit, 25 were taken to the nursery, where they stayed until discharge when they joined their mothers and 68 remained with their mothers. There was no adverse effect of spinal anesthesia on neonatal outcome of hypertensive obese pregnant women / Doutor

Thesis (doctoral)--Lund University, 1994. / Added t.p. with thesis statement inserted.