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Repercussões da violência sob a gestação percebidas pelas gestantes com síndromes hipertensivas / Impact of violence in the gestation perceived by pregnant with syndromes hypertensivesMárcia Fontes Peixoto Azeredo 11 March 2009 (has links)
Este estudo tem como objeto a perspectiva de gestantes com síndromes hipertensivas sobre as repercussões da violência vivida na gestação. A violência é um problema muito complexo em virtude de sua multicausalidade, assim como, pelo seu impacto na saúde das populações. Representa ameaça de vida, produz enfermidades e pode provocar até a morte. Várias são as conseqüências da violência para a saúde da mulher, particularmente no processo gestacional e no desenvolvimento do concepto. O estudo fundamenta-se em conhecer o fenômeno a partir da perspectiva da gestante. Possui como objetivos: descrever a definição da violência contra a mulher na perspectiva da gestante com Síndrome Hipertensiva; discutir os tipos de violência vivenciados por gestantes com diagnóstico de Síndrome Hipertensiva; e analisar as repercussões da violência vivida sobre a gestação na perspectiva da gestante com Síndrome Hipertensiva que a vivenciou. Em decorrência do grau de complexidade e subjetividade do objeto optou-se por uma pesquisa descritiva na abordagem qualitativa, pois esta busca entender um fenômeno específico em profundidade, tendo como fonte primária os discursos dos sujeitos, ou seja, gestantes de risco internadas em maternidades de referência com diagnóstico de Síndromes Hipertensivas e que vivenciaram a violência. Os cenários da pesquisa foram duas maternidades referência para gestação de alto risco, inseridas em dois hospitais universitários da cidade do Rio de Janeiro, sendo investigadas 18 gestantes. A investigação ocorreu no período de abril e maio de 2008. Como técnica de coleta foi realizada entrevista semi-estruturada associada a um questionário de caracterização social dos sujeitos da pesquisa. No aprofundamento dos dados utilizamos a técnica de análise de conteúdo de Bardin, onde emergiram dos depoimentos duas categorias: A violência na perspectiva da gestante com Síndrome Hipertensiva - um olhar de quem a vivenciou; e Violências vivenciadas por gestantes com síndromes hipertensivas e suas repercussões. Na primeira, verificamos que 14 gestantes definem a violência contra a mulher como violação dos direitos humanos e como algo inerente ao contexto familiar; e 04 apresentaram dificuldades em explicar. Na segunda, constatamos que todas as gestantes relatam vivenciar a violência intrafamiliar e algumas, também, a violência comunitária. Das 18 gestantes entrevistadas, 16 fizeram relação da violência vivida com a internação em decorrência da hipertensão arterial. As relações foram expressas através das repercussões da violência vivida na gestação sobre o seu organismo, destacadas como repercussões: emocionais, físicas e sociais. O estudo permitiu conhecer a realidade e aspectos valiosos do contexto dessas gestantes, principalmente, demonstrando a partir das próprias vítimas, a importância de refletir sobre as possíveis causas não fisiológica, tais como a violência, que podem agravar ou mesmo desencadear uma hipertensão arterial. Permitiu também, compreender e visualizar a violência vivenciada pela gestante nos seus diversos contextos: família, trabalho, comunidade onde reside e na instituição hospitalar a que recorre. Consideramos ser relevante despertar para todo o contexto histórico-social que cerca uma gestante, particularmente a que possui uma morbidade associada. E também, oferecer um cuidar integral, que valorize a perspectiva do gênero, focado mais na contextualização do processo saúde doença e na humanização, logo, minimizando a medicalização. / This study has as object the pregnant perspective with hypertensive syndromes about the violence repercussions experiences in the pregnancy. It represents life threatening, produces illnesses and can provoke including the death. Several are the violence consequences for the womans health, particularly in the gestational process and in the being development. The study bases on knowing the phenomenon from the pregnant perspective. It has as objectives: describe the violence definition against the woman in the pregnant s point of view with Hypertensive Syndrome; discuss the types of violence experiences by pregnant women with diagnosis of Hypertensive Syndrome; and analyze the violence repercussions experienced about the pregnancy in the pregnant women s point of view with Hypertensive Syndrome that experienced it. Object complexity and subjectivity grade it decided for a descriptive research in the qualitative approach, once this aims at understanding an specific phenomenon in depth, having as primary source the subjects discourses, in other words, risk pregnant women interned in qualified maternity hospital with diagnosis of Hypertensive Syndromes and who experienced the violence. The research scenarios were two qualified maternity hospitals for high risk pregnancy, inserted in two university hospitals of the Rio de Janeiro city, being investigated 18 pregnant women. Investigation occurred in the period of April and May of 2008. As collection technique it was realized semi-structured interview linked to a questionnaire of social characterization of the research subjects. For the data deepening we utilized the content analysis of Bardin, where emerged from the depositions two categories: The violence in the pregnant women perspective with Hypertensive Syndrome a look from who experienced it; and Violence experienced by pregnant women with hypertensive syndromes and theirs repercussions. In the first we verified that 14 pregnant women define the violence against the woman as violation of the human rights and as something inherent to the familiar context and four presented difficulties in explaining such question .In the second, we verified that all the pregnant women relate that experience the intra familiar violence and any women, the community violence. Of the 18 pregnant women interviewed, 16 linked the violence experienced to the internment as result of the arterial hypertension. Relations were expressed through the violence repercussions experienced in the pregnancy about her organism, detached as emotional repercussions:: emotional, physical and social. The study allowed to know the reality and value context aspects of these pregnant women, mainly showing from the own victims, the importance of reflecting about the possible no physiological causes, such the violence, that can aggravate or even give rise to an arterial hypertension. It also allowed, understand and visualize the violence experienced by the pregnant in its several contexts: family, work, community where lives and in the hospital institution to one that recurs. We considerer be relevant arise to all historical-social context that envelop a pregnant, particularly the one that has a morbidity associated. And also, offer an integral care, that value the gender perspective, focused more in the health-disease process and in the humanization, therefore, minimizing the medical aid.
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Repercussões da violência sob a gestação percebidas pelas gestantes com síndromes hipertensivas / Impact of violence in the gestation perceived by pregnant with syndromes hypertensivesMárcia Fontes Peixoto Azeredo 11 March 2009 (has links)
Este estudo tem como objeto a perspectiva de gestantes com síndromes hipertensivas sobre as repercussões da violência vivida na gestação. A violência é um problema muito complexo em virtude de sua multicausalidade, assim como, pelo seu impacto na saúde das populações. Representa ameaça de vida, produz enfermidades e pode provocar até a morte. Várias são as conseqüências da violência para a saúde da mulher, particularmente no processo gestacional e no desenvolvimento do concepto. O estudo fundamenta-se em conhecer o fenômeno a partir da perspectiva da gestante. Possui como objetivos: descrever a definição da violência contra a mulher na perspectiva da gestante com Síndrome Hipertensiva; discutir os tipos de violência vivenciados por gestantes com diagnóstico de Síndrome Hipertensiva; e analisar as repercussões da violência vivida sobre a gestação na perspectiva da gestante com Síndrome Hipertensiva que a vivenciou. Em decorrência do grau de complexidade e subjetividade do objeto optou-se por uma pesquisa descritiva na abordagem qualitativa, pois esta busca entender um fenômeno específico em profundidade, tendo como fonte primária os discursos dos sujeitos, ou seja, gestantes de risco internadas em maternidades de referência com diagnóstico de Síndromes Hipertensivas e que vivenciaram a violência. Os cenários da pesquisa foram duas maternidades referência para gestação de alto risco, inseridas em dois hospitais universitários da cidade do Rio de Janeiro, sendo investigadas 18 gestantes. A investigação ocorreu no período de abril e maio de 2008. Como técnica de coleta foi realizada entrevista semi-estruturada associada a um questionário de caracterização social dos sujeitos da pesquisa. No aprofundamento dos dados utilizamos a técnica de análise de conteúdo de Bardin, onde emergiram dos depoimentos duas categorias: A violência na perspectiva da gestante com Síndrome Hipertensiva - um olhar de quem a vivenciou; e Violências vivenciadas por gestantes com síndromes hipertensivas e suas repercussões. Na primeira, verificamos que 14 gestantes definem a violência contra a mulher como violação dos direitos humanos e como algo inerente ao contexto familiar; e 04 apresentaram dificuldades em explicar. Na segunda, constatamos que todas as gestantes relatam vivenciar a violência intrafamiliar e algumas, também, a violência comunitária. Das 18 gestantes entrevistadas, 16 fizeram relação da violência vivida com a internação em decorrência da hipertensão arterial. As relações foram expressas através das repercussões da violência vivida na gestação sobre o seu organismo, destacadas como repercussões: emocionais, físicas e sociais. O estudo permitiu conhecer a realidade e aspectos valiosos do contexto dessas gestantes, principalmente, demonstrando a partir das próprias vítimas, a importância de refletir sobre as possíveis causas não fisiológica, tais como a violência, que podem agravar ou mesmo desencadear uma hipertensão arterial. Permitiu também, compreender e visualizar a violência vivenciada pela gestante nos seus diversos contextos: família, trabalho, comunidade onde reside e na instituição hospitalar a que recorre. Consideramos ser relevante despertar para todo o contexto histórico-social que cerca uma gestante, particularmente a que possui uma morbidade associada. E também, oferecer um cuidar integral, que valorize a perspectiva do gênero, focado mais na contextualização do processo saúde doença e na humanização, logo, minimizando a medicalização. / This study has as object the pregnant perspective with hypertensive syndromes about the violence repercussions experiences in the pregnancy. It represents life threatening, produces illnesses and can provoke including the death. Several are the violence consequences for the womans health, particularly in the gestational process and in the being development. The study bases on knowing the phenomenon from the pregnant perspective. It has as objectives: describe the violence definition against the woman in the pregnant s point of view with Hypertensive Syndrome; discuss the types of violence experiences by pregnant women with diagnosis of Hypertensive Syndrome; and analyze the violence repercussions experienced about the pregnancy in the pregnant women s point of view with Hypertensive Syndrome that experienced it. Object complexity and subjectivity grade it decided for a descriptive research in the qualitative approach, once this aims at understanding an specific phenomenon in depth, having as primary source the subjects discourses, in other words, risk pregnant women interned in qualified maternity hospital with diagnosis of Hypertensive Syndromes and who experienced the violence. The research scenarios were two qualified maternity hospitals for high risk pregnancy, inserted in two university hospitals of the Rio de Janeiro city, being investigated 18 pregnant women. Investigation occurred in the period of April and May of 2008. As collection technique it was realized semi-structured interview linked to a questionnaire of social characterization of the research subjects. For the data deepening we utilized the content analysis of Bardin, where emerged from the depositions two categories: The violence in the pregnant women perspective with Hypertensive Syndrome a look from who experienced it; and Violence experienced by pregnant women with hypertensive syndromes and theirs repercussions. In the first we verified that 14 pregnant women define the violence against the woman as violation of the human rights and as something inherent to the familiar context and four presented difficulties in explaining such question .In the second, we verified that all the pregnant women relate that experience the intra familiar violence and any women, the community violence. Of the 18 pregnant women interviewed, 16 linked the violence experienced to the internment as result of the arterial hypertension. Relations were expressed through the violence repercussions experienced in the pregnancy about her organism, detached as emotional repercussions:: emotional, physical and social. The study allowed to know the reality and value context aspects of these pregnant women, mainly showing from the own victims, the importance of reflecting about the possible no physiological causes, such the violence, that can aggravate or even give rise to an arterial hypertension. It also allowed, understand and visualize the violence experienced by the pregnant in its several contexts: family, work, community where lives and in the hospital institution to one that recurs. We considerer be relevant arise to all historical-social context that envelop a pregnant, particularly the one that has a morbidity associated. And also, offer an integral care, that value the gender perspective, focused more in the health-disease process and in the humanization, therefore, minimizing the medical aid.
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Analiza problema višeplodnih trudnoća nastalih vantelesnom oplodnjom / Problem analysis of multiple pregnancies conceived by in vitro fertilizationIlić Đorđe 18 February 2015 (has links)
<p>Uvod: Višeplodne trudnoće se javljaju u 1,5% svih trudnoća nakon spontane koncepcije, dok nakon postupaka vantelesne oplodnje ovaj postotak u Evropi iznosi preko 20% uz velike varijacije među zemljama. U našoj sredini, stopa višeplodnih trudnoća nakon postupaka vantelesne oplodnje iznosi daleko iznad 30%. Pojava hipertenzivnog sindroma u trudnoći, gestacijskog dijabetesa, operativnog završavanja trudnoće, prevremenog porođaja, male porođajne telesne mase, neuroloških sekvela kod rođene dece i gotovo svih drugih komplikacija po majku i plod, kao i celokupno opterećenje zdravstvenog sistema višestruko su veći kod višeplodnih u odnosu na jednoplodne trudnoće i udeo navednih komplikacija raste sa brojem plodova. Sa druge strane deca iz postupaka vantelesne oplodnje čine i do 4,5% sve živorođene dece u pojedinim zemljama, što uz činjenicu da infertilitet pogađa 16-18% parova u našoj sredini daje ovoj pojavi posebnu dimenziju i činije i društvenim problemom. Perinatalni ishodi trudnoća iz postupaka vantelesne oplodnje su u velikoj meri kompromitovani visokom stopom multiplih trudnoća, koje se danas smatraju komplikacijom, a ne uspehom postupaka vantelesne oplodnje. Jednoplodne trudnoće iz postupaka vantelesne oplodnje u većim studijama pokazuju diskretno slabije perinatalne ishode u odnosu na one spontano začete, dok kod višeplodnih trudnoća ova korelacija nije jasno izražena i dokumentovana, uz prisutnu dilemu da li je višeplodnost sama po sebi ili način koncepcije glavni problem u zapaženoj pojavi. Cilj rada: Uporediti perinatalne ishode višeplodnih trudnoća nastalih postupcima vantelesne oplodnje i spontano začetih kao i perinatalne ishode jednoplodnih i višeplodnih trudnoća iz postupaka vantelesne oplodnje. Pored navdenog cilj rada je i ukazati sveobuhvatnost navedenog problema i na moguća rešenja za smanjenje njihove učestalosti. Materijal i metode: Kombinacijom retrospektivne opservacione studije i prospektivne longitudinalne kohortne studije u periodu analizom perinatalnih ishoda pacijentkinja porođenih na Klinici za ginekologiju i akušerstvo Kliničkog centra Vojvodine u periodu od od 01.01.2008. do 31.12.2010. godine, studija je analizirala i poredila perinatalne ishode kod 174 spontano začete višeplodne trudnoće, 163 višeplodne trudnoće nastale postupkom vantelesne oplodnje, kao i 155 jednoplodnih trudnoća začete postupkom vantelesne oplodnje. Analizirani parametric bili su telesna masa novorođenčeta, dostignuta gestacijska starost, vrednosti Apgar skora, učestalost hipertenzivnog sindroma kod majke i brojni drugi parametri perinatalnog ishoda. Uzeti od strane obučenih kliničara i unošeni u posebno dizajniranu bazu podataka, rezultati su statistički analizirani u program JMP ver 9.0 (SAS publisher) uz korišćenje ANOVA analize za testiranje statističke značajnosti između srednjih vrednosti kontinuiranih varijabli, dok je statistička značajnost razlike učestalosti kategorijskih varijabli je određivana Pearsonovim χ2 testom. Rezultati: Jednoplodne ART trudnoće uz prosečnu starost od 33,5 godine, prosečnu gestacijsku starost na porođaju od 38,26 gn, udeo prevremenih porođaja od 12,9%, prosečnu telesnu masu od 3258 g, AS u prvom minutu od 8,35 i u petom minutu od 9,2, stopu carskog reza od 65,81%, udeo GDM-a od 7,1%, anemije od 41,94% i preeklampsije od 4,52%, ima sve relevantne parametre perinatalnog ishoda statistički značajno (p<0.0001) superiornije od kako ART tako i non ART blizanačkih trudnoća. ART blizanačke trudnoće pokazale su prosečnu starost majke od 32,9 godina, prosečnu gestacijsku starost na porođaju od 35,6 gn, udeo prevremenih porođaja od 58,27%, prosečnu telesnu masu od 2374 g, AS u prvom minutu od 7,45 i u petom minutu od 8,65, stopu carskog reza od 83,7%, udeo GDM-a od 15,11%, anemije od 78,42% i preeklampsije od 12,23%, dok su non ART blizanačke trudnoće pokazale prosečnu starost majke od 28,8 godina, prosečnu gestacijsku starost na porođaju od 36,08 gn, udeo prevremenih porođaja od 49,71%, prosečnu telesnu masu od 2433 g, AS u prvom minutu od 7,75 i u petom minutu od 8,75, stopu carskog reza od 58,33%, udeo GDM-a od 7,02%, anemije od 67,84% i preeklampsije od 11,11%. Pored godina majke i udela carskog reza koji su bili viši u ART blizanačkim trudnoćama (<0.0001), kao i blago veće pojavi poremećaja količine plodove vode (p=0,033), gotovo svi ostali pokazatelji toka i ishoda trudnoće bili su komparabilni u navedenim grupama. Diskusija i zaključak: Studija je pokazala da su tok i ishod višeplodnih trudnoća nastalih spontano i postupcima vantelesne oplodnje ekvivalentni u gotovo svim pokazateljima uz sličnu prosečnu telesnu masu i gestacijsku starost novorođenčadi, kao i da su svi navedeni parametri ovih višeplodnih trudnoća bez obzira na način koncepcije upadljivo i podjednako lošiji u poređenju sa jednoplodnim trudnoćama iz postupka vantelesne oplodnje. Izuzimajući višeplodnost kao factor rizika deca iz postupaka vantelesne oplodnje su generalno zdrava. Sama višeplodnost, a ne način koncepcije predstavljaju problem, koje se sa pravom smatra najvećom komplikacijom vantelesne oplodnje. Dodatna analiza iskustava drugih zdravstvenih sistema ukazuje da jedino široka i sveobuhvatna implementacija strategije vraćanja samo jednog embriona (Single embryo transfer – SET) može da dovede do smanjivanje stope multiplih trudnoća nakon postupaka vantelesne oplodnje, i sledstvenih komplikacija, a bez ugrožavanja samog uspeha vantelesne oplodnje. Iskustva drugih zdravstvenih sistema ukazuju da je uspešna implementacija SET-a jedino moguća uz angažovanje celog društva, zajedno sa brojnim legislativnim merama iz domena nadzora, kontrole i finansiranja postupaka vantelesne oplodnje. Obim i način finansiranja postupaka vantelesne oplodnje od strane države (uz više besplatnih pokušaja za infertilne parove) uz obaveznu upotrebu SET-a, i sistema krioprezervacije na osnovu primera iz prakse predstavlja ključ u borbi za smanjenje problema višeplodnih trudnoća nakon postupaka vantelesne oplodnje.</p> / <p>Introduction: Multiple pregnancies occur in 1.5% of all pregnancies after spontaneous conception and in more than 20 % of all pregnancies concieved after assisted reproductive technologies in Europe, with large variations between countries. In our setting, the rate of multiple pregnancies after the ART is well above 30%. The occurrence of hypertensive syndrome in pregnancy, gestational diabetes, operative delivery, premature birth, low birth weight, neurological and developmental impairment in children, and almost all the other complications for the mother and fetus, as well as the entire burden of the health system are several times higher in multiple pregnancies compared with singleton pregnancies. Incidence of forementioned complications rises with number of fetuses. On the other hand, children from in vitro fertilization procedures make up 4.5% of all live births in some countries, which together with the fact that infertility affects aproximately 16-18% of couples in our country gives an extra dimension to this phenomenon and makes it not just medical but wider social problem. Perinatal outcomes of pregnancies after assisted reproductive technologies (ART) are greatly compromised by the high rate of multiple pregnancies, which are now considered to be a complication rather than success of ART procedures. ART Singleton pregnancies have, in larger studies, show discretely lower perinatal outcomes compared with those conceived spontaneously, while for the multiple pregnancies, this correlation is not clearly expressed and documented. There remains dilemma whether multiplicity itself or the way of conception (ART vs. non ART) constitutes a major problem in the observed differences regarding perinatal outcome of ART pregnancies. Objective: To compare the perinatal outcomes of multiple pregnancies conceived by In vitro fertilization (IVF) and spontaneously and perinatal outcomes of IVF conceived singleton and multiple pregnancies. Additional aim of this thesis is to point out the complexity of this problem and offer possible solutions. Materials and Methods: Design of a study was a combination of retrospective and prospective observational longitudinal cohort study. Analysis included pregnancies which had delivery at the Department of Gynecology and Obstetrics, Clinical Center of Vojvodina in the period from 1.01.2008. to 31.12.2010. The study analyzed and compared the perinatal outcomes in 174 spontaneous conceived multiple pregnancies, 163 multiple pregnancies resulting from IVF procedures, and 155 singleton pregnancies conceived by IVF procedure. Analyzed parameters were newborns birth weight, gestational age at delivery, the value of the Apgar score, occurrence of hypertensive syndrome in pregnancy, gestational diabetes, as well as numerous parameters of perinatal outcome. Taken by trained clinicians and were entered into a specially designed database, the results were statistically analyzed in JMP ver 9.0 software (SAS publisher) using ANOVA analysis to test the statistical significance between the mean values of continuous variables, while the statistical significance of the difference in frequency of categorical variables was assessed by Pearsons χ2 test. Results: ART singleton pregnancies had an average mothers age of 33.5 years, the average gestational age at birth of 38.26 gestational weeks (gw), preterm delivery rate of 12.9%, average birth weight 3258 g, Apgar score (AS) in the first minute 8.35, and in the fifth minute 9.2, cesarean section rate 65.81%, Gestational diabetes (GDM) in 7.1% pregnancies, anemia occurred in 41.94% of pregnancies, while preeclampsia was observed in 4.52% of all pregnancies. All relevant parameters of perinatal outcome were significantly (p<0.0001) superior to both ART and non-ART twin pregnancies. ART twin pregnancy showed the average mothers age of 32.9 years, the average gestational age at birth of 35.6 gw, the preterm delivery rate 58.27%, the average body weight newborns 2374 g, AS in the first minute of 7.45, and in the fifth minute of 8.65, the cesarean section rate of 83.7%, GDM in 15.11% of all pregnancies, anemia occurred in 78.42% and preeclampsia in 12.23% of pregnancies, while the non-ART twin pregnancy showed an average mothers age of 28.8 years, the average gestational age at birth of 36.08 gw, the preterm delivery rate of 49.71%, the average body weight of 2433 g, AS in the first minute of 7.75 in the fifth minute 8.75, the caesarian section rate of 58.33%, GDM-a occurred in 7.02%, anemia in 67.84% and preeclampsia in 11.11% of pregnancies. Except for maternal age and the caesarean section rate, which were significantly higher in ART twin pregnancies (p<0.0001), as well as small increase in proportion of amniotic fluid volume disorders (p = 0.033), almost all other parameters of perinatal outcome of were comparable in these groups. Discussion and Conclusion: The study showed that the course and outcome of multiple pregnancies conceived spontaneous and after IVF procedures are equivalent in almost all parameters with similar average body weight and gestational age at birth, and that all these parameters of multiple pregnancies regardless of the conception mode are equally worse compared with singleton pregnancies from IVF procedures. With the exception of multiplicity as a risk factor children from in vitro fertilization procedures are generally healthy. Multiplicity itself and not the mode of conception presented a problem, which is rightly considered the major complication of IVF today. Additional analysis of the experiences of other health system indicates that only a broad and comprehensive implementation of strategy to return only one embryo (SET–single embryo transfer) can lead to a reduction of the rate of multiple pregnancies after IVF procedures, and the accompanying complications, without compromising IVF success. The experience of other health systems indicate that a successful implementation of SET is only possible with the involvement of the whole society, along with a number of legislative measures in the field of monitoring, control and reimbursement of assisted reproduction procedures. The scope and funding of an IVF procedures (with more free attempts for infertile couples, reimbursed by public health) with mandatory use of SET, and good cryopreservation programs are, based on examples in other countries who had successfully dealt with his problem, is the key in reducing the problem of multiple pregnancies after IVF procedures.</p>
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