Bakgrund: Missfall räknas som den vanligaste graviditetskomplikationen. Kvinnors omvårdnadsbehov efter missfall består av både fysiska och psykiska aspekter. Känslor av skuld, förlust, tomhet och sorg uppkom och ofta kvarstod känslorna under en längre tid. Kvinnorna som fått missfall upplevde ofta att deras omvårdnadsbehov inte tillgodosetts adekvat. Sjuksköterskans kompetensområde innefattar tillgodoseende av både fysiska och psykiska omvårdnadsbehov. Syfte: Att beskriva kvinnors erfarenheter och omvårdnadsbehov vid missfall. Metod: En litteraturöversikt baserad på elva vetenskapliga artiklar som granskats med hjälp av innehållsanalys. Resultat: Resultatet av denna litteraturöversikt visar att erfarenheten av att genomgå ett missfall påverkar kvinnan psykiskt, fysiskt och socialt. Resultatet indelades i två huvudteman; Känslomässiga erfarenheter vid missfall och Vårderfarenheter vid missfall, med tre underkategorier; Behov av bekräftande bemötande, Behov av stöd och Behov av information. Diskussion: Diskussionen behandlade bland annat hur en god vård skall kunna uppnås genom exempelvis empatiskt bemötande, förståelse för sorg och skuld samt information. Vidare fördes diskussion kring hur den teoretiska modellen för bekräftande omvårdnad, SAUK, kan användas för att skapa en optimal omvårdnad efter missfall. Målet med att använda SAUK-modellen är att kvinnan ska kunna bearbeta missfallet och låta den händelsen bli en del av hennes liv. / Background: Miscarriage is counted as the most common pregnancy complication. Women's nursing needs after miscarriage consists of both physical and mental aspects. Feelings of guilt, loss, emptiness and grief arose and the feelings often persisted for a long time. The women who miscarried often experienced that their nursing needs were not met adequately. The nurse's competence includes satisfying of both physical and psychological nursing needs. Aim: To describe women's experiences and needs of care after miscarriage. Methods: A literature study based on eleven scientific papers, which have been examined using a content analysis. Results: The result of this study shows that the experience of undergoing an abortion affects women psychologically, physically and socially. The results were divided into two main themes; Emotional experiences of miscarriage and Care experiences of miscarriage, with three sub-categories; Need of confirming nursing, Need of support and Need of information. Discussions: The discussion dealt with matters such as how good care is to be achieved through for example empathetic attitude, understanding of grief and guilt, and information. Further discussion of how the theoretical model for confirming nursing, SAUK, can be used to create optimal nursing after miscarriage. The goal of using the SAUK-model is to enable the woman to process the miscarriage and allow the incident to become part of her life.

Introdução: O aumento do nível sérico de prolactina tem sido associado com desfechos ginecológicos e obstétricos desfavoráveis, entre eles a endometriose e aborto recorrente. Sabendo que o polimorfismo do receptor da dopamina D2 (DRD2) está associado com hiperprolactinemia, realizamos este estudo para verificar sua associação com endometriose e com abortamento de repetição. Objetivos: Verificar a prevalência dos polimorfismos de receptores de dopamina D2 em pacientes com endometriose peritoneal e em pacientes com abortamento de repetição comparando com mulheres saudáveis. Métodos: Dois estudos de caso-controle foram realizados: um estudo com 107 mulheres com idade entre 18 e 35 anos que foram atendidas no Hospital de Clínicas de Porto Alegre devido à infertilidade causada pela endometriose peritoneal comparada com mulheres saudáveis. O outro estudo foi realizado com um total de 54 mulheres com idade entre 18 e 35 anos que tinham história de aborto de repetição comparada a mulheres férteis sem história de aborto. Foi realizada a extração de DNA de sangue periférico, seguido de reação em cadeia da polimerase (PCR) e o sequenciamento dos dois polimorfismos no exon 7 do gene receptor de dopamina D2 (DRD2). O polimorfismo 1 ocorre no nucleotídeo 3420 (Citosina para Timina, 313 Histidina), e o polimorfismo 2 ocorre no nucleotídeo 3438 (Citosina para Timina, 319 Prolina). Resultados: A frequência do polimorfismo DRD2 está aumentada em pacientes com endometriose peritoneal moderada/grave. Análise dos genótipos DRD2 demonstra uma razão de chance de 2,98 (1,47 - 6,04; intervalo de confiança (IC) 95%) para o polimorfismo 2 na endometriose peritoneal moderada/grave. O mesmo polimorfismo DRD2 tem uma frequência alélica aumentada nas pacientes com abortamento de repetição com uma razão de chance de 2,37 (1,05 - 5,36; IC 95%). Conclusão: Nossos resultados revelam um excesso do polimorfismo DRD2 em mulheres com endometriose peritoneal moderada-grave e em pacientes com abortamento de repetição. Podemos especular que a presença de polimorfismo 2 pode causar um defeito no mecanismo de pós-sinalização, resultando num ligeiro aumento dos níveis de prolactina sérica. Assim, devido ao possível potencial angiogênico, a prolactina pode desempenhar um papel importante na implantação dos focos de endometriose bem como dificuldades na implantação embrionária com consequente aborto. / Introduction: The increase of serum prolactin levels has been associated with unfavourable gynaecological and obstetrical outcomes, including endometriosis and recurrent abortion. Knowing that the polymorphism of the dopamine D2 receptor is associated with hyperprolactinaemia, we conducted this study to verify its association with endometriosis and recurrent miscarriage. Objective: To verify the prevalence of the polymorphism of the D2 dopamine receptor in patients with peritoneal endometriosis and recurrent abortion compared to healthy women. Methods: Two case-control studies were conducted of women who were enrolled at the Hospital de Clinicas de Porto Alegre: 1) a study with 107 patients with infertility secondary to peritoneal endometriosis compared with healthy women and 2) a second study with 54 women with recurrent miscarriage compared with fertile women with no history of abortion. All of the women were aged between 18 and 35 years. We performed DNA extraction from peripheral blood followed by a polymerase chain reaction to confirm the single-strand polymorphisms and to sequence two polymorphisms in exon 7 of the dopamine receptor D2 (DRD2) gene. Polymorphism 1 occurred in nucleotide 3420 (cytosine to thymine, 313 histidine), and polymorphism 2 occurred in nucleotide 3438 (cytosine to thymine, 319 proline). Results: The frequency of the DRD2 polymorphism 2 was increased in the subjects with peritoneal moderate/severe endometriosis. An analysis of the DRD2 genotypes demonstrated an odds ratio of 2.98 (1.47 - 6.04, 95% confidence interval (CI)) for polymorphism 2 in peritoneal moderate/severe endometriosis. This same polymorphism was increased in the subjects with recurrent miscarriage with an odds ratio of 2.37 (1.05 – 5.36, 95% CI). Conclusions: Our results revealed an excess of the DRD2 polymorphism 2 in exon 7 in women with peritoneal moderate/severe endometriosis and women with recurrent miscarriage. We could speculate that the presence of the polymorphism 2 causes a defect in a post-receptor signalling mechanism, which results in a mild increase in the serum prolactin levels. Thus, the potential angiogenic action of prolactin may play a role in implanting ectopic endometriosis tissue as well as in embryo implantation difficulties with subsequent abortions.

Made available in DSpace on 2016-12-23T13:47:02Z (GMT). No. of bitstreams: 1 DISSERATACAO PRONTA PARA IMPRESSAO.pdf: 418566 bytes, checksum: 5818bd7ce20758d1ffa3c2e8e3edfb2e (MD5) Previous issue date: 2006-06-06 / O abortamento induzido é considerado problema de saúde pública em todo o mundo. Dallari (2005) reflete que toda a sociedade e, em particular, aqueles que trabalham com a saúde do povo devem discutir em busca do consenso possível sobre a prática do abortamento, a fim encontrar a melhor maneira para lidar com o problema. Os objetivos do estudo foram identificar o perfil sociodemográfico e reprodutivo das mulheres internadas em uma maternidade do município da Serra, Espírito Santo, e avaliar a ocorrência de abortamento induzido associado aos aspectos sociodemográficos e reprodutivos da mesma população. É um estudo transversal, com uma abordagem quantitativa. A amostra constituiu-se de três grupos distintos: 21 mulheres que realizaram abortamento induzido, 62 que apresentaram abortamento espontâneo e 83 que tiveram gestação a termo internadas na Maternidade de Carapina, no período de agosto de 2005 a janeiro de 2006. Para a coleta de dados, foi utilizada entrevista com registro em formulário. Os dados foram analisados pelo Statistical Package for the Social Sciences (SPSS), versão 14.0. Os resultados encontrados demonstram que maioria das pacientes apresentou idade entre 20 e 24 anos, cor da pele parda, anos de estudo de oito a onze anos, renda familiar de até três salários mínimos, religião evangélica, estado conjugal casada/em união estável, ocupação dona de casa, idade da menarca entre nove e doze anos, coitarca e primeira gestação na adolescência, média de 1,2 filho vivo e desconhecimento sobre o Programa de Planejamento Familiar do município. Os seguintes fatores influenciaram na ocorrência de abortamento induzido na análise bivariada: não ser casada ou não viver em união estável, exercer alguma ocupação fora do lar, não conhecer o Programa de Planejamento Familiar do município, não planejar e não desejar a gestação e ter sido aconselhada a abortar. Na análise multivariada, a variável identificação (abortamento induzido/gestação a termo) apresentou relação causal apenas com duas variáveis: estado conjugal e desejo da gravidez. Para atenuar o problema do abortamento inseguro, o governo e a sociedade devem investir em melhores condições de vida para a população e na promoção da saúde reprodutiva com incentivo ao acesso à educação sexual e reprodutiva e ao planejamento familiar. / The induced miscarriage is considered a public health problem all over the world. Dallari (2005) reflects about all society and, especially those who work with people s health who must discuss searching for a possible consensus about the miscarriage practice, aiming to find the best way to deal with the problem. The studies goals were to identify the sociodemographic and reproductive profile of women interned in a maternity in the district of Serra, Espírito Santo State, and to evaluate the frequency of induced miscarriages associated to sociodemographic and reproductive aspects of the same population mentioned above. It is a transversal study, with a quantitative approach. The sample is constituted of three different groups: 21 women who had had an induced miscarriage, 62 who had had spontaneous miscarriage and 83 who had gestation of term interned in Carapina maternity, from August 2005 up to January 2006. For data collection an interview with registration in form was made. Data were analyzed by the Statistical Package for the Social Sciences (SPSS), version 14.0. The results found indicated that most of the cases happened with women aged between 20 to 24 years old, brown skinned, from eight to eleven studying years, having up to three minimum wages familiar income, evangelic religion, married/ stable union, housewife, menarche age between nine and twelve years old, coitarca and first gestation during the adolescence period, having the average of 1,2 live child and showing unawareness about the Family Planning Program in the district. The following factors influenced in the occurrence of the induced miscarriage: not being married or living a stable union, having a job out of home, not being aware of the Family Planning Program of the district, not planning and not wanting the gestation and being advised to abort. In the multivariate analyses, the variable identification (induced miscarriage/ gestation of term) presented casual relation only with two variables: marital status and the desire of getting pregnant. To minimize the insecure miscarriage problem, the government and the society should invest in better qualities of life for the population and in the promotion of the reproductive health with an incentive for the access to sexual and reproductive education and to family planning.

Introdução: O aumento do nível sérico de prolactina tem sido associado com desfechos ginecológicos e obstétricos desfavoráveis, entre eles a endometriose e aborto recorrente. Sabendo que o polimorfismo do receptor da dopamina D2 (DRD2) está associado com hiperprolactinemia, realizamos este estudo para verificar sua associação com endometriose e com abortamento de repetição. Objetivos: Verificar a prevalência dos polimorfismos de receptores de dopamina D2 em pacientes com endometriose peritoneal e em pacientes com abortamento de repetição comparando com mulheres saudáveis. Métodos: Dois estudos de caso-controle foram realizados: um estudo com 107 mulheres com idade entre 18 e 35 anos que foram atendidas no Hospital de Clínicas de Porto Alegre devido à infertilidade causada pela endometriose peritoneal comparada com mulheres saudáveis. O outro estudo foi realizado com um total de 54 mulheres com idade entre 18 e 35 anos que tinham história de aborto de repetição comparada a mulheres férteis sem história de aborto. Foi realizada a extração de DNA de sangue periférico, seguido de reação em cadeia da polimerase (PCR) e o sequenciamento dos dois polimorfismos no exon 7 do gene receptor de dopamina D2 (DRD2). O polimorfismo 1 ocorre no nucleotídeo 3420 (Citosina para Timina, 313 Histidina), e o polimorfismo 2 ocorre no nucleotídeo 3438 (Citosina para Timina, 319 Prolina). Resultados: A frequência do polimorfismo DRD2 está aumentada em pacientes com endometriose peritoneal moderada/grave. Análise dos genótipos DRD2 demonstra uma razão de chance de 2,98 (1,47 - 6,04; intervalo de confiança (IC) 95%) para o polimorfismo 2 na endometriose peritoneal moderada/grave. O mesmo polimorfismo DRD2 tem uma frequência alélica aumentada nas pacientes com abortamento de repetição com uma razão de chance de 2,37 (1,05 - 5,36; IC 95%). Conclusão: Nossos resultados revelam um excesso do polimorfismo DRD2 em mulheres com endometriose peritoneal moderada-grave e em pacientes com abortamento de repetição. Podemos especular que a presença de polimorfismo 2 pode causar um defeito no mecanismo de pós-sinalização, resultando num ligeiro aumento dos níveis de prolactina sérica. Assim, devido ao possível potencial angiogênico, a prolactina pode desempenhar um papel importante na implantação dos focos de endometriose bem como dificuldades na implantação embrionária com consequente aborto. / Introduction: The increase of serum prolactin levels has been associated with unfavourable gynaecological and obstetrical outcomes, including endometriosis and recurrent abortion. Knowing that the polymorphism of the dopamine D2 receptor is associated with hyperprolactinaemia, we conducted this study to verify its association with endometriosis and recurrent miscarriage. Objective: To verify the prevalence of the polymorphism of the D2 dopamine receptor in patients with peritoneal endometriosis and recurrent abortion compared to healthy women. Methods: Two case-control studies were conducted of women who were enrolled at the Hospital de Clinicas de Porto Alegre: 1) a study with 107 patients with infertility secondary to peritoneal endometriosis compared with healthy women and 2) a second study with 54 women with recurrent miscarriage compared with fertile women with no history of abortion. All of the women were aged between 18 and 35 years. We performed DNA extraction from peripheral blood followed by a polymerase chain reaction to confirm the single-strand polymorphisms and to sequence two polymorphisms in exon 7 of the dopamine receptor D2 (DRD2) gene. Polymorphism 1 occurred in nucleotide 3420 (cytosine to thymine, 313 histidine), and polymorphism 2 occurred in nucleotide 3438 (cytosine to thymine, 319 proline). Results: The frequency of the DRD2 polymorphism 2 was increased in the subjects with peritoneal moderate/severe endometriosis. An analysis of the DRD2 genotypes demonstrated an odds ratio of 2.98 (1.47 - 6.04, 95% confidence interval (CI)) for polymorphism 2 in peritoneal moderate/severe endometriosis. This same polymorphism was increased in the subjects with recurrent miscarriage with an odds ratio of 2.37 (1.05 – 5.36, 95% CI). Conclusions: Our results revealed an excess of the DRD2 polymorphism 2 in exon 7 in women with peritoneal moderate/severe endometriosis and women with recurrent miscarriage. We could speculate that the presence of the polymorphism 2 causes a defect in a post-receptor signalling mechanism, which results in a mild increase in the serum prolactin levels. Thus, the potential angiogenic action of prolactin may play a role in implanting ectopic endometriosis tissue as well as in embryo implantation difficulties with subsequent abortions.

Introdução: O aumento do nível sérico de prolactina tem sido associado com desfechos ginecológicos e obstétricos desfavoráveis, entre eles a endometriose e aborto recorrente. Sabendo que o polimorfismo do receptor da dopamina D2 (DRD2) está associado com hiperprolactinemia, realizamos este estudo para verificar sua associação com endometriose e com abortamento de repetição. Objetivos: Verificar a prevalência dos polimorfismos de receptores de dopamina D2 em pacientes com endometriose peritoneal e em pacientes com abortamento de repetição comparando com mulheres saudáveis. Métodos: Dois estudos de caso-controle foram realizados: um estudo com 107 mulheres com idade entre 18 e 35 anos que foram atendidas no Hospital de Clínicas de Porto Alegre devido à infertilidade causada pela endometriose peritoneal comparada com mulheres saudáveis. O outro estudo foi realizado com um total de 54 mulheres com idade entre 18 e 35 anos que tinham história de aborto de repetição comparada a mulheres férteis sem história de aborto. Foi realizada a extração de DNA de sangue periférico, seguido de reação em cadeia da polimerase (PCR) e o sequenciamento dos dois polimorfismos no exon 7 do gene receptor de dopamina D2 (DRD2). O polimorfismo 1 ocorre no nucleotídeo 3420 (Citosina para Timina, 313 Histidina), e o polimorfismo 2 ocorre no nucleotídeo 3438 (Citosina para Timina, 319 Prolina). Resultados: A frequência do polimorfismo DRD2 está aumentada em pacientes com endometriose peritoneal moderada/grave. Análise dos genótipos DRD2 demonstra uma razão de chance de 2,98 (1,47 - 6,04; intervalo de confiança (IC) 95%) para o polimorfismo 2 na endometriose peritoneal moderada/grave. O mesmo polimorfismo DRD2 tem uma frequência alélica aumentada nas pacientes com abortamento de repetição com uma razão de chance de 2,37 (1,05 - 5,36; IC 95%). Conclusão: Nossos resultados revelam um excesso do polimorfismo DRD2 em mulheres com endometriose peritoneal moderada-grave e em pacientes com abortamento de repetição. Podemos especular que a presença de polimorfismo 2 pode causar um defeito no mecanismo de pós-sinalização, resultando num ligeiro aumento dos níveis de prolactina sérica. Assim, devido ao possível potencial angiogênico, a prolactina pode desempenhar um papel importante na implantação dos focos de endometriose bem como dificuldades na implantação embrionária com consequente aborto. / Introduction: The increase of serum prolactin levels has been associated with unfavourable gynaecological and obstetrical outcomes, including endometriosis and recurrent abortion. Knowing that the polymorphism of the dopamine D2 receptor is associated with hyperprolactinaemia, we conducted this study to verify its association with endometriosis and recurrent miscarriage. Objective: To verify the prevalence of the polymorphism of the D2 dopamine receptor in patients with peritoneal endometriosis and recurrent abortion compared to healthy women. Methods: Two case-control studies were conducted of women who were enrolled at the Hospital de Clinicas de Porto Alegre: 1) a study with 107 patients with infertility secondary to peritoneal endometriosis compared with healthy women and 2) a second study with 54 women with recurrent miscarriage compared with fertile women with no history of abortion. All of the women were aged between 18 and 35 years. We performed DNA extraction from peripheral blood followed by a polymerase chain reaction to confirm the single-strand polymorphisms and to sequence two polymorphisms in exon 7 of the dopamine receptor D2 (DRD2) gene. Polymorphism 1 occurred in nucleotide 3420 (cytosine to thymine, 313 histidine), and polymorphism 2 occurred in nucleotide 3438 (cytosine to thymine, 319 proline). Results: The frequency of the DRD2 polymorphism 2 was increased in the subjects with peritoneal moderate/severe endometriosis. An analysis of the DRD2 genotypes demonstrated an odds ratio of 2.98 (1.47 - 6.04, 95% confidence interval (CI)) for polymorphism 2 in peritoneal moderate/severe endometriosis. This same polymorphism was increased in the subjects with recurrent miscarriage with an odds ratio of 2.37 (1.05 – 5.36, 95% CI). Conclusions: Our results revealed an excess of the DRD2 polymorphism 2 in exon 7 in women with peritoneal moderate/severe endometriosis and women with recurrent miscarriage. We could speculate that the presence of the polymorphism 2 causes a defect in a post-receptor signalling mechanism, which results in a mild increase in the serum prolactin levels. Thus, the potential angiogenic action of prolactin may play a role in implanting ectopic endometriosis tissue as well as in embryo implantation difficulties with subsequent abortions.

Submitted by (edna.saturno@ufrpe.br) on 2016-10-13T14:32:54Z No. of bitstreams: 1 Jose Wilton Pinheiro Junior.pdf: 1486430 bytes, checksum: 24b38026485ee7cc269f6334912b551c (MD5) / Made available in DSpace on 2016-10-13T14:32:54Z (GMT). No. of bitstreams: 1 Jose Wilton Pinheiro Junior.pdf: 1486430 bytes, checksum: 24b38026485ee7cc269f6334912b551c (MD5) Previous issue date: 2008-03-07 / The objective of this study was to study the production, hygienicalsanitary and reproduction aspects, and the epidemiology bacterial infectious (brucellosis and clamidofilosis) and parasitic (toxoplasmosis) diseases involved in reproduction disturbs in sheep in the state of Alagoas. Twenty seven properties distributed in twenty three municipalities in the state of Alagoas were studied. To the study of the the production, hygienical-sanitary and reproduction aspects, investigative questionnaires involving questions related to the properties were applied and analyzed. To the anti-Brucella abortus antibodies search the Tamponated Acidified Antigen, Modified Tamponated Acidified Antigen and Complement Fixation Reaction techniques were used. The agreement among the tests used in the Brucella abortus infection diagnosis was verified using the Kappa coefficient. For the study of Brucella ovis infection, the immunodiffusion technique in gelatinous agar was employed. To the anti-Chlamydophila abortus antibodies search the Complement Fixation Reaction technique with a 1:32 cutoff point was used. TheToxoplasma gondii infection diagnosis was done based on the indirect immunoflorescency technique considering the cutoff point of 1:64. To the study of risk factors associated with the Clamydophila abortus and Toxosplama gondii infection were selected variables related to properties characteristics, hygienical-sanitary management and reproduction disturbs. The analysis of the sanitary and socio-economic profile allowed to observe that the sheep creator from Alagoas is an individual with reasonable degree of education, that need information about the nutritional, reproductive and sanitary management and they still suffer the effects of the infectious and parasitic diseases occurrence, highlighting the miscarriage and reproduction disturbs. The utilization of biological techniques of reproduction is still ignorant, mainly assembles a natural in most herds studied. It was not observed positive animals to B. abortus and the agreement among the RB, RBm tests comparing to the FCR test was weak (K = 0.00; 0.00). From an amount of two hundred and seventy nine analyzed samples to B. ovis, it was observed that nine (3.2%) were positive and two hundred and seventy (96.8%) negative, distributed in six herds (37.5%) and in sixmunicipalities (46.2%). It was not possible to observe any significant statistics differences among sex, age, region, property size, creation management, significant association was observed for a historical of the reproduction disturbs (p<0,001). The results referents to the C. abortus shown that 59/274 (21.5%) were positive and 187 (68.3%) negative, noting77.7% of focus infection. The only variable that presented a significant association within the multivariate analysis statistics was the region (p<0.001; OR=3.48; I.C. 1.79 – 6.76). To the T. gondii infection, it was possible to see a significant association among the variables: age (OR=4.01; I.C. 2.03 – 7.94), property size (OR=0.48; I.C. 0.26 – 0.90), semi-intensive creation system (OR=3.17; I.C. 1.24 – 8.13), current water fount (OR=3.13; I.C. – 1.66 – 5.87), and the presence of cats (OR=1.72; I.C. 1.08 – 2.75). Based on the obtained results of the sero-epidemiologic inquiry, the conclusion is that the animals are exposed to the B. ovis, C. abortus e T. gondii infection with different epidemiological meanings in the studied population. Sanitary measures and works in health promotion should be encouraged aiming the prevention and control of the dissemination of these important agents in animal and public health. / Objetivou-se com este trabalho estudar aspectos de produção, higiênicosanitário e reprodutivo, além da epidemiologia de algumas doenças infecciosas bacterianas (brucelose e clamidofilose) e parasitária (toxoplasmose) envolvidas em distúrbios reprodutivos em ovinos no Estado de Alagoas. Foram estudadas 27 propriedades distribuídas em 23 municípios nas três mesorregiões do Estado de Alagoas. Para o estudo dos aspectos produtivos, higiênico-sanitário e reprodutivo, foram aplicados e analisados questionários investigativos, abordando perguntas objetivas relacionadas às propriedades. Para a pesquisa de anticorpos anti-Brucella abortus foram utilizadas as técnicas Antígeno Acidificado Tamponado, Antígeno Acidificado Tamponado Modificado e Reação da Fixação do Complemento. A concordância entre os testes utilizados no diagnóstico da infecção por Brucella abortus foi verificada utilizando-se o coeficiente Kappa. Para o estudo da infecção por Brucella ovis empregou-se a técnica de Imunodifusão em Gel de Agar. Para pesquisa de anticorpos anti-Chlamydophila abortus utilizou-se a técnica deReação da Fixação do Complemento com ponto de corte 1:32. O diagnóstico da infecção por Toxoplasma gondii foi realizado com base na técnica de Imunofluorescência Indireta considerado ponto de corte 1:64. Para o estudo dos fatores de risco associados às infecções por Clamydophila abortus e Toxoplasma gondii foram selecionadas variáveis relacionadas às características das propriedades, manejo higiênico-sanitário e distúrbios reprodutivos. A análise do perfil sócio-econômico e sanitário permitiu observar que o ovinocultor alagoano é um indivíduo com razoável grau de escolaridade, necessita de informações sobre práticas de manejo nutricional, reprodutivo e sanitário e ainda sofrem os efeitos da ocorrência de enfermidades infecto-contagiosas e parasitárias, destacando-se o aborto e outros distúrbios reprodutivos. A utilização das biotécnicas da reprodução ainda é insipiente, predominando a monta natural na maioria dos rebanhos estudados. Não foram observados animais positivos para B. abortus e a concordância entre os testes AAT, AATm frente a RFC foifraca (K = 0,00; 0,00). Das 279 amostras analisadas para B. ovis, observou-se que nove (3,2%) foram positivas e 270 (96,8%) negativas, distribuídas em seis rebanhos (37,5%) e em seis municípios (46,2%). Não foram observadas diferenças estatísticas significativas entre sexo, idade, região, tamanho da propriedade, sistema de criação, observou-se associação significativa para histórico de distúrbios reprodutivo(p<0,001). Os resultados referentes à infecção por C. abortus demonstraram que 59/274 (21,5%) animais forampositivos e 187 (68,3%) negativos, constatando-se 77,7% de focos da infecção. A única variável que apresentou associação significativa na análise multivariada foi a região (p<0,001; OR=3,48; I.C. 1,79 – 6,76). Para a infecção por T. gondii, observou-se prevalência geral de 32,9% e o número de focos de 100%. Na análise estatística multivariada, observou-se associação significativa para as variáveis: idade (OR=4,01; I.C. 2,03 – 7,94), tamanho da propriedade (OR=0,48; I.C. 0,26 – 0,90), sistema de criação semiintensivo (OR=3,17; I.C. 1,24 – 8,13), fonte de água corrente (OR=3,13; I.C. – 1,66 – 5,87) e presença de gatos (OR=1,72; I.C. 1,08 – 2,75). Com base nos resultados obtidos nos inquéritos soro-epidemiológicos, conclui-se que os animais estão expostos a infecção por B. ovis, C. abortus e T. gondii com significados epidemiológicos distintos na população estudada. Medidas sanitárias e trabalhos de promoção em saúde devem ser incentivados com objetivo de prevenir e controlar a disseminação destes agentes importantes na saúde animal e coletiva.

D.Cur. / Although the general topic of death is receiving increasing attention by the medical community, little is known about the impact that pregnancy loss has on the lives experiencing it. Statistics show that the problem is widespread, but they tell nothing about the tears, the regrets, the feeling of guilt and the long process of rebuilding hope. And the medical community is not consistent in attitude or skill where caring for mothers with pregnancy loss. Mothers expect their physicians to be understanding and compassionate, especially when the worst fear has become a reality and the baby had died. Sadly, these expectations are too often unfulfilled, leaving the mother angry and confused, instead, death becomes the enemy to be avoided and opposed at all costs. The purpose of this study is to develop a conceptual framework of support to mothers with pregnancy loss to assist midwives and doctors in supporting these mothers

Grief and causal attribution are two of the most commonly observed reactions to early miscarriage, yet little is known about these reactions or whether a relationship exists between them. This exploratory and descriptive correlational study examined the maternal grief intensities, the causal attributions, and the relationship between them in a convenience sample of 15 women who spontaneously aborted at 16 weeks' or less gestation. Women responded to both a written questionnaire and a semi-structured Interview at 6 to 10 weeks post-miscarriage. Their responses Indicated both current and retrospective reactions to their miscarriages. Responses were analysed using nonparametric statistics and content analysis. Maternal grief Intensities were found to vary widely at the time of the miscarriage, but all decreased significantly 6 to 10 weeks later. All women reacted to their miscarriage with attribution-seeking behaviors. The explanations most women formed were comprised of more than one causal attribution. Attributions were observed to have four distinct characteristics. Causal attributions were found to be either philosophical or physically oriented; to be organic, non-specific or maternal/self-blaming In origin; to be either dominant or non-dominant, and/or to refer to causalities immediate or prior to the physical event. At the time of the miscarriage a positive correlation between grief Intensity and maternal/self-blaming attributions and between grief Intensity and philosophical attributions was found. These relationships were not observed 6 to 10 weeks later. A positive correlation was found between grief intensity and attributions to maternal emotions at both the time of the miscarriage and 6 to 10 weeks later. / Applied Science, Faculty of / Nursing, School of / Graduate

PRENATAL AND PERINATAL LOSS ENTANGLED IN CZECH INSTITUTIONS Marie Hintnausová ABSTRACT An ethnographic research among women who experienced a loss of child during pregnancy or postpartum aims to expose contexts and backgrounds in which prenatal and perinatal loss emerges in the Czech Republic. This life event is delineated not only by unique biographies of affected mothers, but also by the societal understanding of prenatal life and institutional definitions of human reproduction. This thesis highlights various notions and meanings entangled in the event of prenatal and perinatal death and shows which trajectories women follow in the terrain of societal expectations and governmental and biomedical institutions when they lose a promised assurance of raising a new child.

Bakgrund: Missfall är en vanlig graviditetskomplikation som kan erfordra tillsyn från vården, ofta genom besök på en akutmottagning. Upptäckt av missfall är vanligast mellan graviditetsvecka 9 till 11 och orsakar ofta känslor av sorg och förlust hos kvinnan. Syfte: Syftet var att beskriva kvinnors upplevelser av omvårdnad på akutmottagningen i samband med missfall eller misstänkt missfall. Metod: En allmän litteraturstudie med induktiv ansats genomfördes. Tio vetenskapliga artiklar med kvalitativ ansats bearbetades i en innehållsanalys. Resultat: Innehållsanalysen resulterade i tre huvudkategorier: Behov av information i samband med missfall, Betydelsen av bemötande och emotionellt stöd samt Miljön på akutmottagningen – en utmaning. Flera kvinnor upplevde bristande information, bemötande och emotionellt stöd. Att vänta på akutmottagningen upplevde många som frustrerande. Brist i avskildhet och tidsbrist hos vårdpersonal framkom. Konklusion: Kvinnor upplevde genomgående bristande omvårdnad även om positiva upplevelser förekom i vissa fall. Sjuksköterskor kan åtgärda bristerna genom att ge adekvat information, bra bemötande och emotionellt stöd. / Background: Miscarriage is a common pregnancy complication which might require healthcare supervision, often by a visit to the emergency department (ED). Discovery of miscarriage is most common between the 9th and 11th week of pregnancy and often causes feelings of grief and loss among women. Aim: The aim was to describe women´s experiences of care at the ED while having a miscarriage or suspected miscarriage. Method: A general literature study with an inductive approach was implemented. Ten scientific articles with a qualitative approach were analyzed through content analysis. Results: The content analysis presents three maincategories: The need of information while experiencing a miscarriage, The importance of the encounter of healthcare professionals and emotional support and The environment at the emergency department – a challenge. Several women experienced a shortage of information, lacks in the encounter of healthcare professionals and an absence of emotional support. Many experienced the waitingtime at the ED as frustrating. Lack of privacy and time among healthcare staff was described as a problem. Conclusion: Over all women experienced lack of care even though positive experiences occurred in some cases. Nurses might remedy these shortages by giving accurate information, a proper encounter and emotional support.