<p>Transcatheter Arterial Embolization (TAE) is a method in which a catheter is inserted into an artery under fluoroscopy guidance. By using material that creates a thrombus, inserted through the catheter, the artery can be occluded and the bleeding stopped.</p><p>Endoscopy is the treatment of choice in upper gastrointestinal (GI) bleeding, but 10% to 30% of patients rebleed and needs other treatment options. Post Partum Hemorrhage (PPH) may evolve rapidly and can become life threatening. Obstetrical treatment will manage most cases, but in some cases emergency surgery is needed and in the worst case hysterectomy.</p><p>The primary aim of this thesis was to evaluate the clinical usefulness, improve the TAE technique and compare the outcome of TAE with surgery used as “salvage therapy” in patients with upper GI bleeding. Evaluate TAE technique and the long-term effect on the menstrual cycle and fertility in severe PPH.</p><p>To evaluate the clinical usefulness 13 patients were treated with TAE after endoscopic treatment failure and 5 were treated for recurrent hemorrhage after emergency surgery. </p><p>The clinical outcome and mortality rate of 40 patients treated with TAE was compared with 51 patients treated with surgery of upper GI bleedings. </p><p>In 13 patients the ulcer was marked with placement of a metallic clip at endoscopy to be able to locate the exact site of the bleeding ulcer during the TAE procedure.</p><p>A retrospective study of 20 patients with severe PPH treated with bilateral TAE of the uterine artery was performed. </p><p>TAE was found to be effective and an alternative to emergency surgery for control of massive upper GI bleeding. The 30-day mortality was lower in the TAE group (3%) compared to the surgical group (14%). </p><p>By marking the bleeding ulcer at endoscopy using a metallic clip the site of bleeding could be identified on angiography without extravasation of contrast media.</p><p>No major impact on fertility or menstruation cycle was found in patients treated with TAE in PPH. TAE in PPH is safe and have no major long-term side effect. By using TAE in PPH hysterectomy can be avoided.</p>

Transcatheter Arterial Embolization (TAE) is a method in which a catheter is inserted into an artery under fluoroscopy guidance. By using material that creates a thrombus, inserted through the catheter, the artery can be occluded and the bleeding stopped. Endoscopy is the treatment of choice in upper gastrointestinal (GI) bleeding, but 10% to 30% of patients rebleed and needs other treatment options. Post Partum Hemorrhage (PPH) may evolve rapidly and can become life threatening. Obstetrical treatment will manage most cases, but in some cases emergency surgery is needed and in the worst case hysterectomy. The primary aim of this thesis was to evaluate the clinical usefulness, improve the TAE technique and compare the outcome of TAE with surgery used as “salvage therapy” in patients with upper GI bleeding. Evaluate TAE technique and the long-term effect on the menstrual cycle and fertility in severe PPH. To evaluate the clinical usefulness 13 patients were treated with TAE after endoscopic treatment failure and 5 were treated for recurrent hemorrhage after emergency surgery. The clinical outcome and mortality rate of 40 patients treated with TAE was compared with 51 patients treated with surgery of upper GI bleedings. In 13 patients the ulcer was marked with placement of a metallic clip at endoscopy to be able to locate the exact site of the bleeding ulcer during the TAE procedure. A retrospective study of 20 patients with severe PPH treated with bilateral TAE of the uterine artery was performed. TAE was found to be effective and an alternative to emergency surgery for control of massive upper GI bleeding. The 30-day mortality was lower in the TAE group (3%) compared to the surgical group (14%). By marking the bleeding ulcer at endoscopy using a metallic clip the site of bleeding could be identified on angiography without extravasation of contrast media. No major impact on fertility or menstruation cycle was found in patients treated with TAE in PPH. TAE in PPH is safe and have no major long-term side effect. By using TAE in PPH hysterectomy can be avoided.

Bakgrund: En moder som lider av post partum depression har svårare att knyta an till sitt barn. Barnets kognitiva och känslomässiga utveckling kan då hämmas. Det är viktigt att tidigt upptäcka dessa mödrar för att på så vis kunna erbjuda stöd och förkorta moderns sjukdomstid. Syfte: Syftet var att belysa BVC-sjuksköterskors erfarenheter av att ge stöd till mödrar med post partum depression. Metod: Datamaterialet analyserades med kvalitativ innehållsanalys med induktiv ansats. Data insamlades genom intervjuer med åtta BVC-sjuksköterskor med specialistexamen som distriktssköterska verksamma inom barnhälsovård. Resultat: Ur analysen av datamaterialet framträdde sex kategorier så som; följsam till moderns behov, erbjuda råd och vägledning, bygga upp moderns insikt om post partum depression, initiera samarbete runt modern, känsla av egen otillräcklighet, kommunikationsproblem med 14 underkategorier. Konklusion: För att kunna erbjuda modern ett optimalt stöd behöver en relation byggd på förtroende skapas mellan BVC-sjuksköterskan och modern. Kommunikation är ett viktigt verktyg för att skapa tillit vilket är en förutsättning för relationen. / Background: A mother who is suffering from post partum depression has difficulties with the attachment to her child. As a result of this, the child’s cognitive and emotional development can be harmed. It is important to detect these mothers at an early stage, to offer support in order to shorten the time of suffering. Aim: The aim of this study was to illustrate child health care nurses’ experiences of giving support to mothers with postpartum depression. Method: The data were analyzed using qualitative content analysis technique with inductive approach. Eight interviews with child health care nurses’ who work with childrens’ health care were performed. Results: Six categories emerged from the analysis; Responsive to the needs of the mother, offer advice and guidance, build awareness of postpartum depression, initiate collaboration around the mother, sense of their own inadequacy, communication problem and 14 subcategories. Conclusion: In order to offer the mother optimal support needs a relationship between the child health care nurse and the mother be created, which is built on trust. Communication is an important tool to build trust, which is essential for the relationship.

Mémoire de sage-femme : Médecine : Nancy 1 : 2009. / Titre provenant de l'écran-titre. Bibliogr.

O objetivo do trabalho foi verificar o efeito da antecipação de um luteolítico prévio a retirada do dispositivo intravaginal de progesterona (P4) sobre a taxa de prenhez na inseminação artificial em tempo fixo (IATF) de vacas com cria ao pé em comparação com protocolos de IATF tradicionais que utilizam o luteolítico na ocasião da retirada de P4. Também verificar a ação e eficácia dos implantes com um grama de progesterona de primeiro e segundo uso. Utilizou-se 210 vacas de corte amamentando da raça Montana com 48-98 dias pós-parto. Destas, 127 eram vacas multíparas e 83 eram vacas primíparas. Os animais foram divididos em dois lotes de 105 vacas, comparando oito grupos. O lote D6,5 foi tratado no dia zero (data:17/11/2008) com 2mg de benzoato de estradiol i.m. (BE, Estrogin®) juntamente com implante intravaginal de progesterona de 1º uso (G1- Sincrogest®, n=29; G2- Primer®, n=26) e de 2º uso (G3- Sincrogest®, n=26; G4- Primer®, n=24), no dia 6,5 foi aplicado 150mcg i.m. de Cloprostenol Sódico (Sincrocio®), sendo a retirada do implante de P4 no dia 8. Dia 9, ocorreu a aplicação de 1mg de BE i.m. e no dia 10 a tarde a IATF. O lote D8 iniciou o protocolo de IATF no dia 25/11/2008 e foi tratado da mesma forma, à exceção da aplicação do luteolítico que ocorreu no oitavo dia. Os grupos foram formados: implante de 1º uso (G5- Sincrogest®, n=27; G6- Primer®, n=28) e de 2º uso (G7-Sincrogest®, n=26; G8- Primer®, n=24). Foram realizadas duas coletas de sangue (dia 0 e dia 9 do protocolo) para dosagem de progesterona plasmática através do método de radioimunoensaio. As taxas de prenhez dos grupos do lote D6,5 foram de 55,17%(G1), 69,23%(G2), 57,67%(G3), 70,83%(G4) (p=0,263). No lote D8 os grupos G5, G6, G7, G8 deste lote apresentaram 44,44%, 67,86%, 46,15%, e 58,33% de prenhez (p=0,573). As taxas de prenhez para os lotes D6,5 e D8 foram, de 62,86% e 54,29%. Não houve diferença nas taxas de prenhez a IATF entre os lotes (p= 0,262). O teste Qui-quadrado e o T-test foram utiizados para a análise estatística dos dados. O ECC médio dos dois lotes foi de 2,66 (n=210). Não houve influência do ECC sobre as taxas de prenhez a IATF (p=0,562) . Também não houve diferença estatística na taxa de prenhez a IATF e de prenhez final dos animais conforme a idade e dias pós parto. Dezenove vacas apresentaram P4 maior que 1ng/ml no dia 0 (D6,5= 7, com 5 vacas prenhez e 2 vazias; D8= 12, com 7 vacas prenhez e 5 vacas vazias) e quatro vacas do lote D8 apresentaram P4 maior que 1ng/ml no dia 9 do protocolo (com 1 vaca prenhe). Os implantes da Primer ® e Sincrogest® de primeiro e segundo uso foram eficientes para a sincronização da ovulação das vacas com cria ao pé. A antecipação do luteolítico não aumentou as taxas de prenhez a IATF e prenhez final. / The objective of this work was to verify the effect of the anticipation of a luteolytic before the removal of the intravaginal device with progesterone (P4) on the range of pregnancy in the artificial insemination in fixed time (TAI) of post partum cows compared to the IATF traditional protocols that use the luteolytic while removing P4 and also verify the action and efficacy of the implants with a gram of progesterone of first and second use. 210 post partum cows beef cows of Montana breed were used with 48-98 days post partum. Out of these, 127 were multiparous cows and 83 were primiparous cows. The animals were divided in two lots of 105 cows, comparing 8 groups. The lot D6,5 was treated on the day zero (27/11/2008) with 2mg of estradiol benzoate i.m. (BE, Estrogin®) together with the intravaginal implant of progesterone of first use (G1- Sincrogest®, n=29; G2- Primer®, n=26) and of second use (G3- Sincrogest®, n=26; G4- Primer®, n=24), on the day 6,5 150mcg i.m of Cloprostenol (Sincrocio®), the removal of the implant of P4 on the day 8. On the day 9, there was an application 1mg of BE i.m and on the day 10 the IATF. The lot D8 (05/12/2008) was treated on the same way, except for the application of luteolitico, that occurred on the eighth day. The groups were formed this way: first use (G5- Sincrogest®, n=27; G6- Primer®, n=28) and second use (G7-Sincrogest®, n=26; G8- Primer®, n=24). Two blood sample collections were performed (Day 0 and Day 9 of protocol) for plasma progesterone dosage through the radioimunoensaio method. The ranges of pregnancy of the groups in the lot D6,5 were 55,17%(G1), 69,23%(G2), 57,67%(G3), 70,83%(G4) (p=0,263). In the lot D8 the groups G1, G2, G3, G4 of this lot presented 44,44%, 67,86%, 46,15%, e 58,33% of pregnancy (p=0,573). The ranges of pregnancy for the lots D6,5 and D8 were 62,86% e 54,29%. There was no difference in the ranges of pregnancy TAI between the lots (p= 0,262). The test Qui- Quadrado and T-test was used for the statistics analysis of the data. The average body condition of the two lots was 2,66 (n=210). There was no influence of the body condition on the ranges od pregnancy TAI (p=0,562). There was no statistic difference in the range TAI and final pregnancy of the animals according to the age and post partum days. Nineteen cows presented P4 maior que 1ng/ml no dia 0 (D6,5= 7, with 5 cows pregancy and 2 empty; D8=12, with 7 cows pregnancy and 5 cows empty) and four cows of the lot D8 presented P4 maior que 1ng/ml on the Day 9 of the protocol (with only one cow pregnant). The implants of PRIMER and SINCROGEST of first and second use were efficient for the synchronization of the ovulation of the post partum cows. The anticipation of luteolytic treatment did not increase pregnancy rates to TAI and also the final pregnancy rate.

O objetivo do trabalho foi verificar o efeito da antecipação de um luteolítico prévio a retirada do dispositivo intravaginal de progesterona (P4) sobre a taxa de prenhez na inseminação artificial em tempo fixo (IATF) de vacas com cria ao pé em comparação com protocolos de IATF tradicionais que utilizam o luteolítico na ocasião da retirada de P4. Também verificar a ação e eficácia dos implantes com um grama de progesterona de primeiro e segundo uso. Utilizou-se 210 vacas de corte amamentando da raça Montana com 48-98 dias pós-parto. Destas, 127 eram vacas multíparas e 83 eram vacas primíparas. Os animais foram divididos em dois lotes de 105 vacas, comparando oito grupos. O lote D6,5 foi tratado no dia zero (data:17/11/2008) com 2mg de benzoato de estradiol i.m. (BE, Estrogin®) juntamente com implante intravaginal de progesterona de 1º uso (G1- Sincrogest®, n=29; G2- Primer®, n=26) e de 2º uso (G3- Sincrogest®, n=26; G4- Primer®, n=24), no dia 6,5 foi aplicado 150mcg i.m. de Cloprostenol Sódico (Sincrocio®), sendo a retirada do implante de P4 no dia 8. Dia 9, ocorreu a aplicação de 1mg de BE i.m. e no dia 10 a tarde a IATF. O lote D8 iniciou o protocolo de IATF no dia 25/11/2008 e foi tratado da mesma forma, à exceção da aplicação do luteolítico que ocorreu no oitavo dia. Os grupos foram formados: implante de 1º uso (G5- Sincrogest®, n=27; G6- Primer®, n=28) e de 2º uso (G7-Sincrogest®, n=26; G8- Primer®, n=24). Foram realizadas duas coletas de sangue (dia 0 e dia 9 do protocolo) para dosagem de progesterona plasmática através do método de radioimunoensaio. As taxas de prenhez dos grupos do lote D6,5 foram de 55,17%(G1), 69,23%(G2), 57,67%(G3), 70,83%(G4) (p=0,263). No lote D8 os grupos G5, G6, G7, G8 deste lote apresentaram 44,44%, 67,86%, 46,15%, e 58,33% de prenhez (p=0,573). As taxas de prenhez para os lotes D6,5 e D8 foram, de 62,86% e 54,29%. Não houve diferença nas taxas de prenhez a IATF entre os lotes (p= 0,262). O teste Qui-quadrado e o T-test foram utiizados para a análise estatística dos dados. O ECC médio dos dois lotes foi de 2,66 (n=210). Não houve influência do ECC sobre as taxas de prenhez a IATF (p=0,562) . Também não houve diferença estatística na taxa de prenhez a IATF e de prenhez final dos animais conforme a idade e dias pós parto. Dezenove vacas apresentaram P4 maior que 1ng/ml no dia 0 (D6,5= 7, com 5 vacas prenhez e 2 vazias; D8= 12, com 7 vacas prenhez e 5 vacas vazias) e quatro vacas do lote D8 apresentaram P4 maior que 1ng/ml no dia 9 do protocolo (com 1 vaca prenhe). Os implantes da Primer ® e Sincrogest® de primeiro e segundo uso foram eficientes para a sincronização da ovulação das vacas com cria ao pé. A antecipação do luteolítico não aumentou as taxas de prenhez a IATF e prenhez final. / The objective of this work was to verify the effect of the anticipation of a luteolytic before the removal of the intravaginal device with progesterone (P4) on the range of pregnancy in the artificial insemination in fixed time (TAI) of post partum cows compared to the IATF traditional protocols that use the luteolytic while removing P4 and also verify the action and efficacy of the implants with a gram of progesterone of first and second use. 210 post partum cows beef cows of Montana breed were used with 48-98 days post partum. Out of these, 127 were multiparous cows and 83 were primiparous cows. The animals were divided in two lots of 105 cows, comparing 8 groups. The lot D6,5 was treated on the day zero (27/11/2008) with 2mg of estradiol benzoate i.m. (BE, Estrogin®) together with the intravaginal implant of progesterone of first use (G1- Sincrogest®, n=29; G2- Primer®, n=26) and of second use (G3- Sincrogest®, n=26; G4- Primer®, n=24), on the day 6,5 150mcg i.m of Cloprostenol (Sincrocio®), the removal of the implant of P4 on the day 8. On the day 9, there was an application 1mg of BE i.m and on the day 10 the IATF. The lot D8 (05/12/2008) was treated on the same way, except for the application of luteolitico, that occurred on the eighth day. The groups were formed this way: first use (G5- Sincrogest®, n=27; G6- Primer®, n=28) and second use (G7-Sincrogest®, n=26; G8- Primer®, n=24). Two blood sample collections were performed (Day 0 and Day 9 of protocol) for plasma progesterone dosage through the radioimunoensaio method. The ranges of pregnancy of the groups in the lot D6,5 were 55,17%(G1), 69,23%(G2), 57,67%(G3), 70,83%(G4) (p=0,263). In the lot D8 the groups G1, G2, G3, G4 of this lot presented 44,44%, 67,86%, 46,15%, e 58,33% of pregnancy (p=0,573). The ranges of pregnancy for the lots D6,5 and D8 were 62,86% e 54,29%. There was no difference in the ranges of pregnancy TAI between the lots (p= 0,262). The test Qui- Quadrado and T-test was used for the statistics analysis of the data. The average body condition of the two lots was 2,66 (n=210). There was no influence of the body condition on the ranges od pregnancy TAI (p=0,562). There was no statistic difference in the range TAI and final pregnancy of the animals according to the age and post partum days. Nineteen cows presented P4 maior que 1ng/ml no dia 0 (D6,5= 7, with 5 cows pregancy and 2 empty; D8=12, with 7 cows pregnancy and 5 cows empty) and four cows of the lot D8 presented P4 maior que 1ng/ml on the Day 9 of the protocol (with only one cow pregnant). The implants of PRIMER and SINCROGEST of first and second use were efficient for the synchronization of the ovulation of the post partum cows. The anticipation of luteolytic treatment did not increase pregnancy rates to TAI and also the final pregnancy rate.

Made available in DSpace on 2014-12-17T14:46:33Z (GMT). No. of bitstreams: 1 EtenigerMFO.pdf: 1129903 bytes, checksum: b70dec3ed107a87436028bcea80451dd (MD5) Previous issue date: 2007-12-21 / After the birth of a child, during the post-partum period, the exercise of fatherhood, the sexual relationships either marital or sexual as well as the definition of the male role are all aspects that can change. These changes are guarded and can contribute to strengthen the familiar bond or deprive it. Thus, this study aims to understand the male experience during the partner s puerperal period. In this period, the male interacts and participates according to his understanding of the post-partum period. The male experiences different situations with his partner, family and social environment. This research is descriptive-exploratory and has a qualitative approach. It was developed with 15 men that live with their live with their partners during the puerperal period. The data was collected through a semi-structured interview. These data was treated according to content analysis proposed by Bardin. These were analyzed through Symbolic Interacionism according to Blumer. Thus, three themes emergedshares of care in the home environment, meanings attributed to the puerperium, emotions emerged during the post-partum - the seven subcategories-taking care of the wife and child, supporting the family, moment to rest, fulfillment through fatherhood, sense of joy, feeling of concern and sense of exclusion. It was seen that the subjects experience post-partum mainly by taking care of their partner and child and providing support of the family. Besides the mentioned aspects, there was meaning attributed to the puerperal period, considering it a period of rest for the partner and above all, fatherhood. Thus, even understanding that it is excluded, the subjects expressed joy and worriness towards the child s future, related to the insecurity in which the country goes through in current conjuncture / Ap?s o nascimento de um filho, ou seja, durante o p?s-parto da companheira, o exerc?cio da paternidade, a paternagem, o relacionamento conjugal e sexual, assim como, a defini??o do papel masculino s?o aspectos pass?veis de mudan?as, ainda veladas, que podem contribuir tanto para o fortalecimento dos la?os familiares como para o empobrecimento conjugal. Assim sendo, o estudo em apre?o teve por objetivo compreender a viv?ncia do homem durante o puerp?rio de sua companheira, partindo do pressuposto que, nesse per?odo, ele interage e participa de acordo com seu entendimento acerca do p?s-parto, vivenciando diferentes situa??es junto ? parceira, fam?lia e meio social. Trata-se de uma pesquisa do tipo descritiva-explorat?ria, em uma abordagem qualitativa, desenvolvida junto a 15 homens que coabitam com suas esposas e as mesmas estavam no per?odo puerperal. Os dados foram coletados atrav?s de entrevista semi-estruturada, tratados de acordo com a t?cnica de an?lise de conte?do conforme Bardin e analisados a luz dos princ?pios do Interacionismo Simb?lico, segundo Blumer. Desse processo emergiram tr?s temas a??es de cuidado em ambiente dom?stico, significados atribu?dos ao puerp?rio, emo??es emergidas durante o p?s-parto e sete categorias cuidando da companheira e da crian?a, provendo o sustento da fam?lia, momento de descanso, realiza??o da paternidade, sentimento de alegria, sentimento de preocupa??o, sentimento de exclus?o. Desse modo, obtivemos que os entrevistados experienciam o p?s-parto cuidando de sua companheira e filho, como tamb?m, provendo o sustento da fam?lia. Al?m disso, atribu?ram significados ao puerp?rio considerando-o um per?odo de descanso, para a companheira, e de realiza??o da paternidade. Por fim, mesmo sentindo-se exclu?dos, expressaram alegria e preocupa??o com o futuro do filho em virtude da inseguran?a pela qual passa a atual conjuntura social do pa?s

A gestação e os primeiros tempos da vida de um bebê são fundamentais para o estabelecimento do vínculo com seus pais; além de garantir sua sobrevivência, fornecem matéria-prima para as tramas de seu psiquismo, formando um solo no qual se desenvolverão suas relações ao longo da vida. Concomitante a essa construção, transcorre um processo análogo com os pais, que se vão construindo gradativamente nessa condição ao se relacionar com o filho. No entanto, esses primeiros tempos podem ter um forte impacto em quem gera e cuida do bebê. Assim, a finalidade deste estudo é iluminar as vivências psíquicas da mulher no pós- -parto e verificar que recursos desenvolve para lidar com o trabalho psíquico necessário para enfrentar os lutos e construir e exercitar a parentalidade. Por meio de uma pesquisa qualitativa balizada teoricamente pela psicanálise, estudaram-se cinco duplas mãe-bebê. Houve ao menos quatro encontros como cada dupla: pelo menos um na gestação e três após o parto (uma semana, um mês e dois meses). Os encontros gestacionais se deram num lugar escolhido pela participante e os no puerpério, em sua casa. Com o instrumental da psicanálise, fizeram-se entrevistas semidirigidas e observação da relação que a mãe estabelecia com o bebê e com a pesquisadora. Analisou-se cada caso em separado e se verificaram possíveis confluências entre eles. Tendo em conta a especificidade do funcionamento psíquico materno e o impacto das exigências de um filho para quem deve ajudá-lo a viver, a pesquisa revelou a importância de considerar a amplitude dos fenômenos de gestar e cuidar. Esse papel, que toda mãe deve exercer, foi vivido, ao menos num primeiro momento, como brutal e desorganizador não só pela mulher, mas por toda a família. As dificuldades de se metabolizarem essas vivências e as perdas inerentes ao processo por exemplo, o bebê ideal, a maternidade idealizada, o narcisismo, o ritmo anterior e a rotina, entre outras podem prejudicar a construção e o exercício da parentalidade e mesmo obstar a superação do baby blues, eventualmente desencadeando fenômenos depressivos (manifestos ou encobertos). Os ganhos reais decorrentes da chegada do bebê podem ser vividos a partir desse contato com as perdas e de sua elaboração. Concluiu-se também que se devem construir mecanismos de prevenção e cuidados para a família nesses primeiros tempos de vida do bebê, com a colaboração entre as várias disciplinas envolvidas e com políticas de saúde pública. Entre as questões levantadas a esse propósito, alerta-se para o risco de se negligenciarem ou, no outro extremo, patologizarem as dores inerentes à delicada construção da parentalidade / Gestation and the first times in a babys life are fundamental to the establishment of bonds with the parents; apart from guaranteeing their survival, it provides the basis for the webs of their psychism, forming the ground on which their relationships will develop throughout their life. Concomitant to this construction, the parents go through an analogue process, gradually building themselves in this condition as they relate to the child. However, these first times may have a strong impact on who generates and cares for the baby. Thus, the aim of this study is to enlighten the womans post-partum psychic experiences and to verify the resources developed to cope with the psychic work necessary to face the grieves and to build and exercise parenthood. Through a qualitative research theoretically bound by psychoanalysis, five mother-baby pairs were studied. There were a minimum of four encounters with each pair: at least one on gestation e three post-partum (one-week, one-month and two-month old). The gestational meetings took place at a location chose by the participant and the puerperium encounters, at her home. With psychoanalysis instrumental, semi-guided interviews and observation of the relationship established by the mother with the baby and with the researcher took place. Each case was separately analyzed and possible confluences between them were verified. Taking into account the specificity of the psychic maternal functioning and the impact of the demands of a child on who must help them live, the research revealed the importance of considering the amplitude of the carrying and caring phenomena. This role, that all mothers must play, was experienced, at least at first, as brutal and disorganizing not only by the woman, but by the whole family. The difficulties of metabolizing these experiences and the losses inherent to the process for instance, the ideal baby, idealized motherhood, narcissism, the previous rhythm and the routine, among others may damage the construction and the exercise of parenthood and even thwart the overcoming of the baby blues, eventually unfolding depressive phenomena (manifest or covered). The real gains resulting from the babys arrival may be lived from this contact with the losses and its elaboration. It was also concluded that prevention and care mechanisms for the family must be built in these first times of the baby\'s life, with collaboration between the various disciplines involved and with public health policies. Amongst the issues raised to this purpose, an alert is made to the risk of neglecting or, on the other end, pathologizing the pains inherent to the delicate construction of parenthood

Le post-partum immédiat recèle les fondamentaux de la situation anthropologique, tant pour le bébé que pour la mère et le père et pour le socius. La première matrice de la vie psychique subordonnée à « l’espace dyadique fondamental » procède de la complexe alchimie entre la tessiture de l’investissement maternel et le tempérament et les capacités de régulation du bébé, sans négliger la structure en abyme qui encadre le maternage. A partir d’une clinique étendue dans le champ de la périnatalité cette recherche s’intéresse avec une double méthodologie qualitative clinique (Chapitre 1) et quantitative « outillée » (Chapitre 2 et 3), à la construction d’un espace dyadique, indispensable à la croissance du bébé et à l’investissement maternel, aux vicissitudes de cette construction, à la fonction régulatrice des rituels (relayés par les dispositifs de soins périnataux actuels) qui offrent une scansion au travail de l’enfantement. La communication dyadique entre mère est bébé, dont nous repérons le point d’orgue précoce vers deux mois avec les premières protoconversations, est étudié comme une co-génése transmodale et asymétrique complexe, tant par la psychanalyse que par la théorie de l’attachement, l’approche développementale et les neurosciences. Cet espace unique et original, renouvelé à chaque nouvelle naissance se trame à partir des « les formants de l’investissement maternel », constituée par les vecteurs de la vie psychique et leur combinatoire qui fournissent l’économie nécessaire à la situation maternante. A partir des trois grands courants de pensée conceptuelle et de traitement thérapeutique des troubles du lien précoce nous recensons le formant « en transformation » celui de « la transmission » le formant « en séduction ». Ces avancées théorico-cliniques ont un triple objectif, construire une lecture nouvelle de l’intersubjectivité primaire, de l’édification de la conscience de soi chez le bébé, des mécanisme normaux et pathologiques des identifications et de l’empathie, soutenir le principe des soins, l’édification d’une sémiologie dyadique de la psychopathologie précoce et ouvrir sur un modèle incluant la dimension du précoce et de ses formes de symbolisation dans les cures d’adultes et la prise en charge institutionnelle des populations précaires ou limites. / The immediate postpartum period contains the basics of the anthropological situation, for the baby as well as for the mother and the father and the socius. Psychic life first matrix subject to “the basic dyadic space” comes from the complex alchemy between the range of maternal investment and disposition and the baby’s original control abilities, without ignoring the play within a play which surrounds mothering. From an extended study in the perinatal field, this research takes an interest, with a double methodology of qualitative study (chapter 1) and quantitative “equipped” one (chapter 2 and 3), in the construction of a dyadic space, essential for the baby’s development and for the maternal investment, to this construction ups and downs, for regulatory functions of these rituals (relayed by current perinatal cares) which gives a scansion to childbirth work. Dyadic communication between mother and baby, with a climax around two months old with the first protoconversations, is studied as an asymmetrical transmodal complex co-genesis by both psychoanalysis and attachment theory, by developmental approaches and neurosciences. This unique and original space, which is renewed after every birth, is woven from “the forming of maternal investment” composed from psychic life vectors and their combination which provides enough energy for the mothering situation. From the three major schools of conceptual thoughts and from therapeutic treatments of early relationship disorder, we identify the forming “in transformation”, the “transmission” one and the forming “in seduction”. These breakthroughs have a triple purpose: to built a new reading of primary intersubjectivity, the building of baby’s self-awareness, normal and pathological mechanism of identification and empathy, to support the principle of cares and the edification of a dyadic semiology of the early psychopathology and to lead to a model that will include the aspect of the “early” and its symbolism form in adult therapy and the institutional support of fragile or borderline population.

Il a été démontré dans plusieurs études épidémiologiques qu’il existe un risque important de dépression chez les femmes souffrant d'asthme en dehors de la grossesse. Cependant, on en connait peu sur l'association entre l'asthme pendant la grossesse et la dépression post-partum. Par conséquent, le but de cette étude était de quantifier la force de l’association entre l'asthme pendant la grossesse et la dépression post-partum. À l’aide des bases de données administratives du Québec, nous avons construit une cohorte de 35,520 grossesses de femmes asthmatiques et 197,057 grossesses de femmes non asthmatiques qui ont accouchées entre 1998 et 2009. Les femmes asthmatiques ont été identifiées à l'aide d’une définition opérationnelle validée. Nous avons utilisé la définition de Statistiques Canada pour détecter la dépression post-partum. Cette définition se base sur les codes diagnostics de la dépression enregistrés dans les bases de données de la RAMQ et de MED-ECHO dans l’année suivant l’accouchement. Un modèle d'équations généralisées a été utilisé pour estimer les ratios de cotes (RC) brutes et ajustés et les intervalles de confiance (IC) à 95% entre l’asthme pendant la grossesse et la dépression post-partum. La proportion de femmes ayant eu une dépression post-partum au cours de l’année suivant l’accouchement était plus élevée chez les asthmatiques que chez les non-asthmatiques (6,1% contre 2,9%). Après ajustement pour les variables potentiellement confondantes, nous avons observé que les femmes asthmatiques étaient 58% plus susceptibles de souffrir de dépression post-partum que les femmes non-asthmatiques (RC ajusté : 1,58 ; IC 95%, 1,50 à 1,67). Les résultats de notre étude suggèrent un risque accru de dépression post-partum chez les femmes asthmatiques. Une attention particulière devrait être accordée aux symptômes dépressifs chez les femmes asthmatiques dans l’année suivant l’accouchement pour détecter la dépression post-partum plus rapidement et intervenir plus efficacement. / There is evidence from several epidemiological studies on the increased risk of depression among women with asthma outside of pregnancy. However, we found no studies designed to investigate the association between asthma during pregnancy and postpartum depression. Therefore, the purpose of this study was to assess the association between asthma during pregnancy and postpartum depression. Based on Quebec administrative databases, we constructed a cohort of 35,520 pregnancies from asthmatic women and 197,057 pregnancies from non-asthmatic women who delivered between 1998 and 2009. Asthmatic women were identified using a validated operational definition. Postpartum depression was defined and specified with diagnostic codes for depression from the definition of Statistics Canada recorded in the RAMQ or MED-ECHO databases and assessed 1 year postpartum. A generalized estimating equation model was used to estimate the crude and adjusted odds ratios (ORs) of postpartum depression and 95% confidence intervals (CI) comparing women with and without asthma during pregnancy. The proportion of postpartum depression 1 year after delivery was higher among asthmatic compared to non-asthmatic pregnant women (6.1% vs. 2.9%). After adjusting for potential confounders, we observed that women with asthma were 58% more likely to have postpartum depression (adjusted OR: 1.58; 95%CI, 1.50-1.67) than women without asthma during pregnancy. The findings of our study suggest an increased risk of postpartum depression among asthmatic women. Attention should be given to depressive symptoms in asthmatic women in the year postpartum to detect postpartum depression more rapidly and intervene more efficiently.