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Evaluation et prise en charge des anomalies foetales du rein et du tractus urinaireIsmaili, Khalid January 2006 (has links)
Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished
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Etude de la perfusion placentaire par imagerie fonctionnelle sur un modèle murin de retard de croissance intra-utérin / Functional imaging of the placenta in an inrauterine growth restriction rat model by uterine ligationArthuis, Chloé 05 December 2016 (has links)
La distinction entre les fœtus constitutionnellement petits de ceux qui présentent une réelle restriction de croissance liée à une insuffisance placentaire n’est pas aisée avec les mesures échographiques utilisées en pratique courante. Le retard de croissance intra-utérin (RCIU) est responsable d’une part importante de la prématurité induite, et d’une augmentation du risque de mortalité et de morbidité néonatales. C’est pourquoi, l’amélioration de la connaissance de la vascularisation placentaire est indispensable pour mieux identifier et prendre en charge les situations d’hypoxie chroniques foetales associées à l’insuffisance placentaire.Pour quantifier la vascularisation les modalités d’imagerie de perfusion disponibles sont l’échographie et l’IRM. Les études évaluant la quantification de la perfusion placentaire par échographie de contraste sont peu nombreuses. Les avantages et les limites de cet examen ont été évalués sur un modèle murin de RCIU par ligature vasculaire. Ainsi, l’échographie de contraste permettait de quantifier une baisse de la perfusion placentaire sur un modèle de RCIU sans que l’on puisse observer de passage d’agents de contraste ultrasonores au travers la barrière placentaire. Les résultats obtenus ont été comparés aux données obtenues par l’IRM de perfusion. Les paramètres quantitatifs obtenus à partir des courbes de cinétiques du contraste pour chacune des deux modalités d’imagerie étaient comparables sur un modèle identique de RCIU murin. Enfin, une méthode d’étude de l’oxygénation placentaire par imagerie photoacoustique a été évaluée. Cette modalité d’imagerie non invasive permettait d’obtenir en temps réel l’oxygénation placentaire, avec cependant une profondeur limitée d’exploration. Le placenta semblait se comporter comme une réserve en oxygène au cours de l’étude d’une séquence hypoxie – hyperoxygénation maternelle avec une désaturation moins importante que celle observée dans les autres tissus maternels. / To identify fetuses small for their gestational-age who have reached their appropriate growth potential from growth-restricted fetuses due to placental insufficiency is uneasy. Intra Uterine Growth Restriction (IUGR) increases the risk for indicated preterm delivery, neonatal mortality and morbidity. Therefore, improving the knowledge of the placental perfusion is essential to better identify and manage fetal chronic oxygen deprivation associated with placental insufficiency.Contrast Enhanced Ultrasound (CEUS) and MRI are two imaging modalities available to quantify placental perfusion. However, few studies focus on the quantification of placental perfusion with CEUS. First, the advantages and limitations of CEUS were presented in an IUGR rat model by uterine ligation. The placental perfusion observed by CEUS was significantly decreased in the ligated horn. No contrast enhancement was observed in the umbilical vein or the fetus. Then, we compared the CEUS parameters to results obtained by MRI perfusion. Perfusion parameters were obtained from the signal intensity decay curve for the two imaging modalities. Results of such perfusion parameters were comparable in the same IUGR rat model. Finally, we evaluated the response of the placenta to oxygenation by photoacoustic imaging. PA imaging is a real-time, non-invasive method to evaluate placental oxygenation without contrast agents. Our results suggesting that placenta is less affected than maternal tissue by the decline in maternal oxygenation. The placenta may play an important role in protecting the feus against hypoxia.
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The experiences of women who had intra-uterine fetal death in Vhembe District of Limpopo Province of South AfricaKharivhe, Martha Lufuno 18 September 2017 (has links)
MCur / Department of Advanced Nursing Science / See the attached abstract below
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Faktorer som påverkar kvinnors beslut om intrauterina preventivmedel : En systematisk litteraturöversikt / Factors influencing women's decisions about intrauterine contraception : A systematic literature reviewGimnes, Marie, Wagner, Julia January 2021 (has links)
Kvinnor har länge använt olika metoder för att skydda sig mot graviditet. Omkring 1,1 miljarder kvinnor världen över är i behov av preventivmedelsrådgivning och familjeplanering. Ett av de vanligaste reversibla preventivmedlen är intrauterina preventivmedel. Det är ett säkert preventivmedel och ett allt mer populärt sådant. Samtidigt florerar negativa uppfattningar och erfarenheter kring preventivmedlet vilket gör att kvinnor inte vill använda det. Trots att det finns kunskap om ämnet finns det begränsat med kunskap om vilka faktorer som påverkar kvinnans val av preventivmetod. Genom att identifiera olika faktorer kan detta bidra till en förbättrad sexuell och reproduktiv hälsa för kvinnor. Syftet är att beskriva och sammanfatta faktorer som påverkar kvinnors beslut om att använda och inte använda intrauterina preventivmedel. Systematisk litteraturöversikt valdes som metod, där tretton artiklar med kvalitativ och kvantitativ design granskades. Två huvudteman med tillhörande subteman identifierades; Faktorer som relaterar till beslut om att använda intrauterina preventivmedel och Faktorer som relaterar till beslut om att inte använda intrauterina preventivmedel. Faktorerna kategoriserades vidare in i subteman och benämns som ett säkert preventivmedel, en trygg relation till vårdpersonal, rädsla för preventivmetodens egenskaper, negativ påverkan från samhället och kunskapsbrist hos patient och professionell vårdare. Resultaten visar att flera olika faktorer spelar in i kvinnans val gällande att använda eller inte använda intrauterina preventivmedel som preventivmetod. Ojämlikhet rörande ansvarstagande inom preventivmedel kan ses. Delaktighet och informerat val behövs för att skapa en god vårdrelation. / Women have used various methods to protect themselves against pregnancy. Around 1.1 billion women worldwide are in need of contraceptive counseling and family planning. One of the most common reversible contraceptives is intrauterine contraception. This contraceptive is a safe method and an increasingly popular one. At the same time, negative perceptions and experiences about the contraceptive abound, which means that some women do not want to use it. Although there is in-depth knowledge of the subject, there is limited knowledge about the factors that influence a woman's choice of contraceptive method. By identifying various factors, it can contribute to improved sexual and reproductive health for women. The aim of this study is to describe and summarize factors that influence women's decisions to use and non-use intrauterine contraceptives. A systematic literature review was selected where thirteen articles with qualitative and quantitative design have been reviewed. Two main themes and associated sub-themes were identified; Factors related to decisions to use intrauterine contraceptives and Factors related to decisions to not use intrauterine contraceptives. The factors were further categorized into sub-themes and are referred to as a safe contraceptive, a trusting relationship with healthcare staff, fear of the qualities of the contraceptive method, negative impact from society and lack of knowledge among patients and professional careers. The results show that several different factors play a role in a woman’s choice to use or non-use intrauterine contraceptives as a method of contraception. Inequality regarding responsibility in contraception can be seen. Participation and informed choice are needed to create a good care relationship.
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Prädiktive Wertigkeit von Parametern des oxidativen Status bei Präeklampsie und intrauteriner Wachstumsretardierung: Prädiktive Wertigkeit von Parametern des oxidativen Status beiPräeklampsie und intrauteriner WachstumsretardierungHeihoff-Klose, Anne 17 January 2012 (has links)
Eine Dysbalance zwischen Sauerstoffradikalen und der plasmatischen antioxidativen Kapazität sowie eine gesteigerte Aktivität der neutrophilen Granulozyten werden als mögliche pathophysiologische Faktoren der Schwangerschaftserkrankungen Präeklampsie (PE) und intrauterine Wachstumsretardierung (IUGR) diskutiert. Das Ziel der Studie war, zu prüfen, ob der plasmatische antioxidative Status und die Plasmaspiegel der neutrophilen Granulozyten Myeloperoxidase und PMN Elastase bei Schwangerschaften mit uteriner Perfusionsstörung, die ein Hochrisikokollektiv für die oben genannten Schwangerschaftskomplikationen darstellen, verändert sind. Die Messungen mit dem immundiagnostischen ELISA zur Bestimmung der antioxidativen Kapazität (ImAnOx) ergaben, dass eine signifikante Erniedrigung der Totalen Antioxidativen Kapazität im Hochrisikokollektiv vorlag. Eine Verbesserung der Risikobeurteilung war durch den ImAnOx-Test nicht möglich. Die Berechnung des Antioxidativen Quotienten durch die zusätzliche Bestimmung des Harnsäurespiegels konnte die Voraussage nicht verbessern. Zur inflammatorischen Komponente mit Hilfe der Enzymspiegelmessungen zeigten die Ergebnisse weder einen Zusammenhang mit der uterinen Perfusionsstörung noch verbesserten sie die Einschätzung des Risikos. Anhand der Ergebnisse wird deutlich, dass mit der uterinen Dopplersonographie insbesondere für das fetale Geburtsgewicht eine Kalkulation möglich ist.
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Adaptations métaboliques cardiaques chez le fœtus de rat dans un modèle de restriction de croissance intra-utérineMaréchal, Loïze 12 1900 (has links)
La restriction de croissance intra-utérine (RCIU) est une conséquence immédiate d’un environnement utérin défavorable qui prédispose les individus atteints à de plus grands risques de développer des maladies cardiométaboliques une fois adulte. L’environnement fœtal s’ajoute ainsi à l’hérédité, au sexe et au mode de vie comme facteur déterminant de la santé cardiométabolique. Afin de mieux comprendre les différents aspects de cette prédisposition, notre laboratoire a développé un modèle animal de RCIU asymétrique recréant une diminution de la perfusion placentaire. La caractérisation des animaux a mis en évidence des différences dans la physiologie cardiovasculaire des individus adultes avec des dissemblances selon le sexe, ainsi qu’une différence dans l’expression de plusieurs gènes impliqués dans le métabolisme lipidique chez le fœtus. A partir de ces données, nous émettons l’hypothèse que le cœur fœtal RCIU subit une reprogrammation métabolique, conséquence du stress causé par l’environnement fœtal défavorable. Nous nous attendons aussi à une régulation différente du métabolisme entre les mâles et les femelles. Pour répondre à cette hypothèse, nous avons tout d’abord déterminé la contribution du métabolisme lipidique dans les cœurs fœtaux RCIU ainsi que sa régulation. Ensuite, nous avons approfondi les conséquences d’un métabolisme lipidique élevé dans les cœurs fœtaux RCIU. Le sexe des animaux a été pris en compte dans nos travaux.
L’ensemble de ces travaux démontrent une plus grande utilisation du métabolisme lipidique chez les fœtus RCIU, impliquant une activation du récepteur nucléaire PPARα et du coactivateur PGC1a par une abondance d’acides gras (AG) à longue chaîne dans les cœurs fœtaux RCIU. L’activation de PPARα entraine une augmentation de l’expression de nombreux gènes impliqués dans l’oxydation des AG et de la biogenèse mitochondriale. Les mitochondries des cœurs fœtaux RCIU femelles montrent de plus grandes capacités de production d’ATP, comparées aux femelles témoins, mais aucune différence n’a été montrée chez les mâles. Un tel dysmorphisme a également été observé dans l’augmentation des capacités d’oxydation des AG à très longues chaînes chez les femelles RCIU, mais pas chez les mâles. L’augmentation de l’expression de Pdk4 dans les cœurs fœtaux RCIU confirme le fort métabolisme lipidique et suggère une abondance d’acétyl-CoA, molécule intermédiaire à plusieurs voies métaboliques, dont la production de corps cétoniques. Nous avons montré une synthèse intracardiaque de corps cétoniques chez les fœtus RCIU, sans élévation de la cétolyse, causant une accumulation d’acétoacétate et de β-hydroxybutyrate (bHB). Enfin, l’exploration des rôles signalétiques du bHB nous a permis d’observer une régulation positive de ce corps cétonique sur le métabolisme lipidique, par une activation de PPARα.
En conclusion, ce projet de thèse a contribué à mieux comprendre les mécanismes d’adaptation métabolique des cœurs fœtaux à une RCIU causée par une diminution de la perfusion placentaire en fonction du sexe. Notre travail ouvre également la voie à de nouvelles avenues de recherche sur le rôle signalétique des corps cétoniques et des AG à longue chaîne dans la programmation des maladies cardiométaboliques. / An unfavorable womb environment often leads to intrauterine growth restriction (IUGR), which is known to increase the likelihood of developing cardiometabolic diseases later in life. The fetal environment is thus added to other factors such as heredity, sex and lifestyle that have an impact on cardiometabolic health. To investigate IUGR predisposed condition, our laboratory has developed an animal model of asymmetric IUGR by decreasing placental perfusion. Our findings using this animal model have highlighted sex-dependent differences in the cardiovascular physiology of IUGR adults, and specific changes in the expression of key genes involved in lipid metabolism in IUGR fetuses. Therefore, we hypothesize that the IUGR fetal heart undergoes a metabolic remodeling in response to the stress caused by the unfavorable uterine environment. We also expect selective metabolic changes in males and females. To verify this hypothesis, we addressed the contribution and regulation of lipid metabolism in IUGR fetal hearts. We also thoroughly investigated the consequences of a high lipid metabolism in IUGR fetal hearts. Changes between males and females were also considered.
This study shows an increased use of lipid metabolism in IUGR fetuses, which involves the transcriptional activation of the nuclear receptor PPARα and the coactivator PGC1 in response to accumulated levels of specific long-chain fatty acids (FA) in IUGR fetal hearts. Activation of PPARα lead to an increase in the expression of critical genes involved in the oxidation of FAs and mitochondrial biogenesis. Mitochondrial respiration analysis demonstrated a greater ATP production capability in female IUGR fetal hearts compared to control females, a finding not observed in males. The increased expression of Pdk4 in IUGR fetal hearts attests such a strong lipid metabolism and suggests an abundance of acetyl-CoA, an intermediate molecule to several metabolic pathways, including the production of ketone bodies. Indeed, our results indicate an increased intracardiac synthesis of ketone bodies in IUGR fetuses without inducing ketolytic genes, resulting in significant accumulation of acetoacetate and β-hydroxybutyrate (bHB). Moreover, we provide evidence of a signaling role of bHB with a positive regulation of lipid metabolism through the transcriptional activation of PPARα.
In conclusion, this thesis contributes to a better understanding of the mechanisms involved in the metabolic adaptation of fetal hearts to IUGR and highlights selective changes according to sex. Our study also paves the way for new research avenues on the signaling role of ketone bodies and long-chain FAs on the programming of cardiometabolic diseases.
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”ATT BEFINNA SIG I DET TYSTA RUMMET...” : Barnmorskors erfarenhet av att stödja föräldrar vid intrauterin fosterdöd – kvalitativ webbaserad enkätstudieMirza, Asrin, Silao Nguyen, Mei-Linh Asia January 2024 (has links)
Bakgrund: Intrauterin fosterdöd är en sällsynt händelse, av 1000 förlossningar är det cirka tre till fyra förlossningar där det inträffar i Sverige. Som förälder kan det vara svårt att hantera sorgen vid intrauterin fosterdöd och därmed finns det behov av stöd. Föräldrarna uppger att de inte får den rätta vård och stöd som de är i behov av. Det finns bristfällig kommunikation mellan barnmorskor och föräldrar. Stöd till barnmorskor är lika viktigt, vilket är en förutsättning för att kunna hantera svåra situationer. Syftet: Att beskriva barnmorskors erfarenhet av att stödja föräldrar efter förlossning vid intrauterin fosterdöd. Metod: Kvalitativ metod med induktiv ansats. En webbenkät som besvarades av 25 barnmorskor. Resultat: Fyra kategorier och nio subkategorier utformades. Barnmorskorna ansåg att grunden till god vård för föräldrarna vid intrauterin fosterdöd var att vara närvarande och stödja föräldrarna genom hela vårdtiden. Det kan vara en utmaning att hantera egna känslor samtidigt som det är en hög arbetsbelastning på arbetsplatsen. Behovet av fördjupad kunskap kring stödjandet av föräldrarna föreligger. Slutsats: Barnmorskorna ansåg behovet av vidareutbildning inom ämnet för att kunna hantera svåra situationer. Stödet till barnmorskorna var en viktig faktor för att klara av att bemöta föräldrarna vid intrauterin fosterdöd. / Background: Intrauterine fetal death is a rare event, occurring in approximately three to four out of 1000 births in Sweden. As parents, coping with the grief of intrauterine fetal death can be challenging, and the need for support is crucial. Parents report not receiving the proper care and support they require. There is inadequate communication between midwives and parents. Support for midwives is equally crucial, to be able to manage difficult situations. Aim: To describe midwives' experiences in supporting parents after childbirth in cases of intrauterine fetal death. Method: Qualitative method with an inductive approach. A web- based survey was completed by 25 midwives. Results: Four categories and nine subcategories were formed. Midwives believed that the foundation for providing good care to parents in cases of intrauterine fetal death was to be present and support the parents throughout the entire care period. Managing their own emotions while facing a heavy workload at the workplace can be challenging. There is a need for further education regarding supporting parents going through an intrauterine fetal death. Conclusion: Midwives identified the need for further education on the subject to manage difficult situations. Support for midwives was a crucial factor in being able to support parents in cases of intrauterine fetal death.
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Det emotionella arbetet vid intrauterin fosterdöd : Barnmorskors erfarenhet av att bistå föräldrar under hela förlossningsprocessen.Romin, Emelie, Forslund, Emma January 2024 (has links)
Det emotionella arbetet vid intrauterin fosterdöd - barnmorskors erfarenheter av att bistå föräldrar under hela förlossningsprocessen Abstrakt Bakgrund: Intrauterin fosterdöd (IUFD) förekommer runt om i hela världen och närmare två miljoner barn föds fram döda varje år. Rökning, högt BMI samt tillväxthämning hos barnet är några av de kända riskfaktorerna kopplat till IUFD och prevalensen av dödfödda barn är högre i låginkomstländer jämfört med höginkomstländer. Barnmorskor bär en viktig roll i mötet med IUFD där deras uppgift dels är att stötta och tillgodose föräldrarnas behov, vilket ställer stora krav på deras emotionella arbete. Motiv: Att möta föräldrar vars barn har dött intrauterint kan vara ett av de tuffaste möten en barnmorska ställs inför. Det finns få studier i Sverige om barnmorskors erfarenheter i mötet med IUFD, därför är det relevant att fördjupa kunskapen inom ämnet. Syfte: Syftet var att belysa barnmorskors känslor och erfarenheter av att bistå föräldrar innan, under samt efter förlossningen vid intrauterin fosterdöd. Metod: En kvalitativ metod med semistrukturerade intervjuer tillämpades för att besvara syftet med studien. Sju barnmorskor intervjuades och intervjuerna transkriberades ordagrant och analyserades med inspiration av klassisk grundad teori. Resultat: Det teoretiska perspektivet emotionellt arbete bidrog till framväxten av kärnkategorin: Barnmorskors emotionella arbete i interaktionen med föräldrar vid intrauterin fosterdöd, tre kategorier: Att vara fyren i stormen; En känslomässig berg-och-dalbana; Kunskap och stöd – intrauterin fosterdöd, en del av professionen, samt åtta underkategorier. Konklusion: Barnmorskors emotionella arbete i interaktionen med föräldrar vid IUFD belyser det känslomässiga engagemanget som krävs från barnmorskorna, vilket resulterar i att många känner sig emotionellt dränerade. I denna studie tydliggörs förståelsen för den känslomässiga påfrestning och behovet av professionellt stöd som barnmorskor upplever vid IUFD. / The emotional work of intrauterin fetal death - midwives' experiences of assisting parents throughout the birth process Abstract Background: Intrauterin fetal death (IUFD) occurs all around the world and approximately two million babies are stillborn every year. Smoking, high Body Mass Index (BMI) and fetal growth retardation are some of the well-known risk factors associated with stillbirth and the prevalence of stillborn babies are higher in low-income countries compared to high-income countries. Midwives play an important role when meeting IUFD, where their tasks are partly to support and meet the parents’ needs, which places great demands on their emotional work. Motive: Meeting parents whose babies have died in the uterus can be one of the toughest encounters a midwife faces. There are few studies in Sweden about midwives' experiences in meeting with IUFD, therefore it is relevant to deepen the knowledge about the topic. Aim: The aim was to explore midwives' emotions and experiences of assisting parents before, during and after childbirth in case of intrauterine fetal death. Methods: A qualitative method with semi-structured interviews was applied to answer the purpose of the study. Seven midwives were interviewed and the interviews were transcribed verbatim and analyzed with inspiration from classical grounded theory. Result: The theoretical perspective of emotional labor contributed to the emergence of the core category: Midwives' emotional labor in the interaction with parents at intrauterine fetal death, three categories: Being the lighthouse in the storm; An emotional roller coaster; Knowledge and support – intrauterine fetal death, a part of the profession, as well as eight subcategories. Conclusion: Midwives' emotional labor in interacting with parents at IUFD highlights the emotional commitment required from midwives, resulting in many feeling emotionally drained. This study clarifies the understanding of the emotional strain and the need of professional support for midwives who have taken care of parents experiencing an IUFD.
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Analysis of the Impact Hyperglycemia has on Neuronal Functions Using Genetic Approaches in Caenorhabditis elegansRuiz, Manuel Axel 05 1900 (has links)
A chronic hyperglycemic state often results in neuropathological complications such as peripheral diabetic neuropathy (PDN). PDN is a debilitating medical condition that impacts over half of the US population with diabetes. In this study, we used the model organism Caenorhabditis elegans to determine that glucose-supplemented diet leads to an increased rate of intrauterine egg hatching (IUEH) and the reduction of dopamine and serotonin is sufficient to suppress the glucose-induced IUEH. Moreover, in this research demonstrates that a glucose-supplemented diet impacts serotonin and dopamine-associated behaviors. Additionally, we demonstrate that a diet rich in glucose impacts the structure of the serotonergic neurons HSN and NSM. These findings highlight the utility of the model organism C. elegans in elucidating the impact of a glucose-supplemented diet on the nervous system. Finally, these studies show that a glucose-supplemented diet impacts transgenerational and intergenerational phenotypes as well as changes in the transcriptional profile of subsequent generations.
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A study exploring the socio-demographic and service related factors influencing the utilization of intra uterine contraceptive device among family planning users in Addis Ababa, EthiopiaBerhanu Tamir Tirfe 04 July 2014 (has links)
This study aimed at identifying the socio-demographic and service related factors influencing intra uterine contraceptive device (IUD) utilization among family planning clients in Addis Ababa. With a quantitative, cross sectional descriptive design approach, data was collected using structured questionnaires administered by healthcare supervisors. A total of 366 family planning clients and 35 family planning service providers were interviewed. The findings indicated that the level of education, occupation, parity and fertility plan have significant (p<0.05) association with utilization of IUD. Healthcare service provider’s knowledge and skills for provision of intra uterine contraceptive device services were low. Community members lack awareness and knowledge of the benefit and side effects of the device. Therefore, community members need education to promote adherence and effective use of IUD. Similarly, healthcare service providers need skill training and education to ensure quality provision of IUD service / Health Studies / M.A. (Public Health)
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