Cadre théorique : Les représentations mentales que la mère possède de son enfant jouent un rôle prépondérant dans le développement de l'enfant. Les variables impliquées dans le développement de ces représentations maternelles restent cependant peu documentées. Dans le modèle actuel, l'état d'esprit de la mère constitue le seul précurseur connu des représentations maternelles. Ce projet a donc pour but de clarifier le rôle indépendant de la dépression et du contexte psychosocial sur les représentations maternelles de l'enfant. Méthode : L'entrevue d'attachement adulte, qui cerne l'état d'esprit de la mère (Adult Attachment Interview, AAI; George, Kaplan & Main, 1985), un questionnaire autorapporté pour évaluer la symptomatologie dépressive (Center for Epidemiological Studies Dépression Scale, CES-D; Radloff, 1977) et l'entrevue évaluant les représentations maternelles de l'enfant (entrevue québécoise des représentations maternelles, EQRM) ont été administrés à deux groupes de mères, le premier provenant d'un milieu à faible risque (N = 40) et le deuxième provenant d'une clientèle à risque élevé (N =79). Résultats : Une analyse factorielle a permis de cerner les facteurs principaux à la base de la variable dépendante, soit les représentations maternelles. D'une part, les résultats indiquent que la cohérence au AAI est positivement corrélée avec le facteur des représentations positives et négativement corrélée avec celui des représentations négatives. D'autre part, le contexte à risque est négativement corrélé avec le facteur des représentations positives et la dépression est positivement corrélée avec le facteur de représentations négatives. Afin de tester la contribution relative des variables indépendantes sur la variable dépendante, des analyses de régression ont été effectuées. Aucune médiation n'est présente entre le contexte à risque et le niveau de cohérence au AAI, suggérant que chacune de ces variables a un effet indépendant sur le facteur de représentations positives. Par ailleurs, la dépression explique la majeure partie de la variance des représentations négatives. Cet effet est particulièrement marqué pour les mères qui proviennent du groupe à haut risque psychosocial ou pour les mères qui présentent un niveau de cohérence faible à moyen au AAI. Discussion : Ces résultats montrent que le contexte psychosocial joue un rôle prédominant et indépendant sur le développement des représentations positives de l'enfant. De plus, l'augmentation des représentations négatives est en grande partie expliquée par la présence de symptomatologie dépressive chez la mère. Cependant, le contexte à risque et l'état d'esprit de la mère nuancent le lien entre la dépression et les représentations négatives : la dépression est associée aux représentations négatives particulièrement pour les mères vivant dans un contexte à risque élevé et pour celles moins cohérentes au AAI. Ces résultats peuvent notamment être expliqués par le fait que les mères vivant dans un contexte à faible risque ou ayant un niveau de cohérence élevé ont plus de ressources internes et externes pour gérer les effets néfastes de la dépression sur leur relation avec leur enfant.

L’importance de la problématique des vaches laitières non gestantes avec multiples inséminations (› 3) communément appelées « Repeat Breeder » (RB), au Québec, repose sur deux facteurs: son incidence et son impact économique. Actuellement, l’incidence du syndrome RB au Québec est de ± 25% (Rapport annuel, juin 2008, www.dsahr.ca). Les pertes monétaires associées à ce problème proviennent des frais vétérinaires et d’insémination, de la diminution de productivité ainsi que des pertes en lien avec la réforme involontaire. Afin d’avoir de meilleures connaissances sur ce syndrome, nous devons connaître les facteurs de risques généraux impliqués et ensuite explorer la condition individuelle de ces vaches problèmes. Dans la première partie de ce mémoire, une banque de données informatisées répertoriant 418 383 lactations fut analysée. L’objectif de ce projet de recherche était d’évaluer l’impact des problèmes reproducteurs post-partum et l’effet du nombre de lactations comme facteurs de risques de la vache Repeat Breeder. L’analyse a permis d’établir la dystocie comme étant la condition ayant le plus de conséquences sur la fertilité future. D’autres facteurs de risques à savoir le nombre de lactations influencent le pronostic reproducteur. La deuxième partie de ce mémoire consistait à explorer, à l’aide d’outils cliniques, la condition individuelle des vaches RB. Une étude cohorte fut menée sur des vaches Holstein en fin de période d’attente volontaire au jour 7 du cycle oestral. Les tests cliniques étudiés furent la vaginoscopie, l’examen transrectal, l’ultrasonographie du système reproducteur, la présence d’estérases leucocytaires, la bactériologie et la biochimie du liquide utérin, la cytologie endométriale et le profil de progestérone sérique. Les résultats de ces tests cliniques dévoilent que l’examen bactériologique du liquide utérin est révélateur du statut reproducteur futur. / Two factors underlie the Repeat Breeder (RB) concerns in Quebec: its incidence and economic impact. Currently RB incidence in Quebec is of ± 25% (yearly Report, June 2008, www.dsahr.ca). Monetary losses related to the RB are the result of veterinary expenses and insemination, loss of productivity and the involuntary culling. In order to have a better knowledge of this syndrome, one must understand the general risk factors involved and then explore the individual condition of these problem cows. The goal of the first part of the project was to assess the impact of the postpartum reproductive problems and the effect of the lactation number as risk factors of the Repeat Breeder cow. A computerized data bank listing 418 383 lactations was analyzed. The analysis established dystocia as being the condition with the most consequences on future fertility. Other risk factors namely the number of lactations influence the reproductive prognosis as well. The second part of the research was to explore the individual condition of the RB using clinical tools. A cohort study was conducted on Holstein cows at the end of the voluntary waiting period on day 7 of the oestrous cycle. The clinical tests studied were vaginoscopy, trans-rectal examination, ultrasonography of the reproductive system, presence of leukocyte esterase, bacteriology and biochemistry of uterine fluid, endometrial cytology and serum progesterone profile. The results of these clinical tests reveal that the bacteriological analysis of uterine fluid is indicative of future reproductive status.

This study represents an attempt to describe the extent and features of safe haven legislation in the United States, discuss implementation issues, and to examine if the legislation is reaching its intended target audience in order to answer the question, "Is safe haven legislation an efficacious response to infant abandonment?" Safe havens are designated locations where infants can be anonymously abandoned without fear of prosecution or incarceration. As of May of 2006, forty-seven states have passed such legislation, citing the need for an alternative to unsafe infant abandonment leading to an infant's death, and an alternative to infanticide (the killing of an infant within one year of its birth). Since the initial passage of this legislation in Texas in 1999, there have been more unsafe infant abandonments than accounts of safe haven abandonments. As this legislation provides for anonymous infant abandonment researchers cannot study the population of women actually utilizing safe havens. Therefore, the study of women seeking connection with safe havens in comparison to the population of women who have engaged in infant abandonment resulting in an infant's death is considered one of the sole viable sources of insight into this problem. The scope of the research is exploratory in nature and analyses are considered preliminary due to the lack of data that exists in this area and the relative newness of the legislation.A quantitative analysis of women likely to utilize safe havens reveals that they have a mean age of 19, are unmarried, have entered into prenatal care late, have disclosed their pregnancy to someone, and are currently dating the birthfather. The findings from this analysis were compared to those from a national linked birth and infant death dataset to ascertain if women seeking safe havens have similar biopsychosocial characteristics as those engaging in unsafe abandonment leading to an infant's death. Similar biopsychosocial characteristics were found including mother's age, marital status, late entry into prenatal care, disclosure of pregnancy, and dating status. A regression analysis was used to construct a biopsychosocial profile of women likely to abandon an infant. Findings suggest that legislators and those involved with safe havens have some knowledge of their target population, but are not effectively reaching this audience, nor promoting the existence of safe havens. They also appear to be utilizing research findings on infanticide inappropriately, in order to profile their target audience. This effectively limits the promulgation of education and early identification services that could prevent both safe haven and unsafe infant abandonments. This study concludes with policy reform recommendations.

Nous avons réalisé un état des lieux de la prise en charge des femmes au moment d’un accouchement en France, dans un contexte où la médecine fondée sur les preuves occupe une place de plus en plus importante dans la pratique des professionnels, où la fermeture de nombreuses maternités entraîne une concentration des naissances dans des établissements publics et spécialisés de plus en plus grands, et où l’on souhaite répondre aux besoins des femmes et à certaines de leurs demandes.Dans une première partie nous avons décrit comment les caractéristiques des maternités contribuent à expliquer les variations dans la prise en charge des femmes. Nous avons abordé la question pour la durée du séjour en post-partum et l’organisation de la prise en charge médicale à la sortie de la maternité, et pour les actes réalisés pendant l’accouchement chez des femmes à bas risque (déclenchement, césarienne, extraction instrumentale et épisiotomie). Dans une deuxième partie nous avons cherché à estimer la part des césariennes avant travail potentiellement évitables et la part des déclenchements sans motif médical et nous avons recherché quels facteurs étaient associés à ces actes.Le contenu des soins différait peu selon la taille ou le niveau de spécialisation de la maternité, sauf pour les interventions potentiellement évitables ou sans motif médical, plus fréquentes dans les petites maternités moins spécialisées, et les durées de séjour en maternité, beaucoup plus courtes dans les grandes maternités et celles de type 3. A l’inverse, le statut privé de la maternité influençait de manière forte la prise en charge des femmes : les interventions y étaient plus fréquentes, parfois en réponse à des demandes des femmes (déclenchements sans motif médical). Les caractéristiques médicales des femmes avaient un impact sur la réalisation des interventions obstétricales, avec des associations similaires à celles déjà publiées, mais les caractéristiques sociales des femmes influaient peu sur le contenu des soins.Les résultats fournissent un bilan général, utile pour évaluer les politiques de santé publique. Ils soulèvent des questions sur l’organisation des services et les processus qui conduisent aux décisions de réaliser certaines interventions obstétricales. / We assessed practices during delivery and the postpartum period in France, in a context where evidence based medicine plays a more and more important role in professional practice, where the closure of maternity units leads to a concentration of births in large public and specialized units, and where professionals want to meet the needs of women and some of their requests.We first described how maternity units’ characteristics contribute to explain variations in obstetrical intervention’s rates. We studied postpartum length-of-stay and support for women after discharge from maternity unit, and interventions performed during labor among low-risk women (inductions, cesareans, instrumental deliveries and episiotomy).In a second part we estimated the proportions of potentially avoidable cesarean deliveries and inductions without medical indications; we also investigated which factors were associated with these interventions.Obstetrical practices differed slightly depending on the size or the level of care of maternity units, except potentially avoidable cesareans, which were more frequent in small and low-specialized units, and postpartum length-of-stay, which were shorter in large and type 3 units. On the contrary, the private status of the unit strongly influenced the management of delivery: all studied interventions were more frequent in private units, sometimes in response to maternal requests (inductions without medical indications for example). Women’s medical characteristics had an impact on obstetric intervention rates; the associations were similar to those previously reported in other publications. However social characteristics had little influence on the content of care.The results provide an overall evaluation, useful for assessing perinatal public health policies. They raise questions about maternity unit organization and processes that lead to decisions to perform obstetrical interventions.

L’importance de la problématique des vaches laitières non gestantes avec multiples inséminations (› 3) communément appelées « Repeat Breeder » (RB), au Québec, repose sur deux facteurs: son incidence et son impact économique. Actuellement, l’incidence du syndrome RB au Québec est de ± 25% (Rapport annuel, juin 2008, www.dsahr.ca). Les pertes monétaires associées à ce problème proviennent des frais vétérinaires et d’insémination, de la diminution de productivité ainsi que des pertes en lien avec la réforme involontaire. Afin d’avoir de meilleures connaissances sur ce syndrome, nous devons connaître les facteurs de risques généraux impliqués et ensuite explorer la condition individuelle de ces vaches problèmes. Dans la première partie de ce mémoire, une banque de données informatisées répertoriant 418 383 lactations fut analysée. L’objectif de ce projet de recherche était d’évaluer l’impact des problèmes reproducteurs post-partum et l’effet du nombre de lactations comme facteurs de risques de la vache Repeat Breeder. L’analyse a permis d’établir la dystocie comme étant la condition ayant le plus de conséquences sur la fertilité future. D’autres facteurs de risques à savoir le nombre de lactations influencent le pronostic reproducteur. La deuxième partie de ce mémoire consistait à explorer, à l’aide d’outils cliniques, la condition individuelle des vaches RB. Une étude cohorte fut menée sur des vaches Holstein en fin de période d’attente volontaire au jour 7 du cycle oestral. Les tests cliniques étudiés furent la vaginoscopie, l’examen transrectal, l’ultrasonographie du système reproducteur, la présence d’estérases leucocytaires, la bactériologie et la biochimie du liquide utérin, la cytologie endométriale et le profil de progestérone sérique. Les résultats de ces tests cliniques dévoilent que l’examen bactériologique du liquide utérin est révélateur du statut reproducteur futur. / Two factors underlie the Repeat Breeder (RB) concerns in Quebec: its incidence and economic impact. Currently RB incidence in Quebec is of ± 25% (yearly Report, June 2008, www.dsahr.ca). Monetary losses related to the RB are the result of veterinary expenses and insemination, loss of productivity and the involuntary culling. In order to have a better knowledge of this syndrome, one must understand the general risk factors involved and then explore the individual condition of these problem cows. The goal of the first part of the project was to assess the impact of the postpartum reproductive problems and the effect of the lactation number as risk factors of the Repeat Breeder cow. A computerized data bank listing 418 383 lactations was analyzed. The analysis established dystocia as being the condition with the most consequences on future fertility. Other risk factors namely the number of lactations influence the reproductive prognosis as well. The second part of the research was to explore the individual condition of the RB using clinical tools. A cohort study was conducted on Holstein cows at the end of the voluntary waiting period on day 7 of the oestrous cycle. The clinical tests studied were vaginoscopy, trans-rectal examination, ultrasonography of the reproductive system, presence of leukocyte esterase, bacteriology and biochemistry of uterine fluid, endometrial cytology and serum progesterone profile. The results of these clinical tests reveal that the bacteriological analysis of uterine fluid is indicative of future reproductive status.

Introduction: La stratégie diagnostique de l’EP au cours de la grossesse est incertaine du fait du manque d’études solides d’un point de vue méthodologique, et du risque lié à l’irradiation des examens diagnostiques (angioscanner thoracique et scintigraphie pulmonaire). L’enjeu est donc de valider des stratégies performantes d’une part, et d’identifier des marqueurs cliniques permettant de réduire le recours aux examens irradiants d’autre part. Notre premier objectif a été d’identifier les pièges au cours de la stratégie diagnostique de l’EP (baisse de la performance du dosage des D‐dimères, des scores de probabilité clinique et de l’imagerie) au cours de la grossesse. Le deuxième objectif a été de comparer les performances diagnostiques et les risques des deux examens d’imagerie de référence que constituent la scintigraphie pulmonaire et l’angioscanner thoracique. Le troisième objectif a été de valider une stratégie diagnostique permettant une réduction du recours aux examens irradiants (ajustement du taux de D-dimères sur la probabilité clinique). Le dernier objectif a été de mettre en place un programme de recherche centré sur le poids des antécédents familiaux de MVTE, paramètre lui aussi susceptible de réduire le recours aux examens paracliniques. Conclusion : Au terme de ces analyses, nous avons développé un programme de validation d’une stratégie diagnostique de l’EP chez la femme enceinte ; en outre, l’identification d’un ajustement du taux de D‐dimères sur la probabilité clinique ainsi que, en termes de perspective, sur les antécédents familiaux de MVTE a le potentiel de conduire à des stratégies diagnostiques moins irradiantes et plus performantes chez les femmes enceintes ayant une suspicion d’EP. / Introduction : The diagnostic strategy for PE during pregnancy is uncertain due to the lack of high quality studies and the risk of radiation exposure with computed tomography pulmonary angiography (CTPA) and ventilationperfusion (V-Q) lung scan. The challenge is to validate diagnostic strategies, and to identify predictive factors to reduce the number of additional imaging tests with radiation exposure.First, we aim to identify pitfalls during the diagnostic strategy of PE (the D-dimer assay threshold, clinical probability scores, imaging) during pregnancy. Second, our objective was to compare the diagnostic efficiency of CTPA and (V-Q) lung scan during pregnancy.Third, our objective was to validate a diagnostic strategy wich reduces the number of imaging tests (adjustment of the D-dimer level on the clinical probability). Finally, the last objective was to set up a research program focused on the weight of the family history of MVTE, that may also reduce the need of additional tests. Conclusion : We identified an ongoing validation protocol with a new diagnostic algorithm in pregnant patients withPE suspicion ; Furthermore, identifying a D-dimer level adjustement as well as a family history of VTE can lead tomore effective diagnostic stragegies with less radiation exposure for pregnant women with suspected PE.

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

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.

Sammanfattning                                 Bakgrund:Tiden efter förlossning benämns som den mest kritiska men också mest försummade perioden i en nybliven moders liv. Det är barnmorskans uppgift att bl. a. handlägga postnatal period samt bedöma behov av uppföljning. Det har framkommit att det finns brister och behov av utveckling i eftervården. Det finns få eller inga studier som visar styrkorna som finns i eftervården i Sverige. Syfte:Att undersöka hur mödrar och barnmorskor erfar eftervården.  Metod:Kvalitativa intervjuer med induktiv ansats har utförts. Analysen av insamlat datamaterial är genomförd med kvalitativ innehållsanalys. Fyra nyförlösta mödrar och fyra barnmorskor i en region i södra Sverige har intervjuats.  Resultat:Mödrarna var överlag nöjda med eftervården men det fanns en önskan om tidigare uppföljning och bättre amningsstöd. Barnmorskorna beskrev hur de flesta mödrar är välmående och att de inte anser att det finns några större brister i dagens eftervård. De har dock önskemål om tidigare uppföljning för möjligheten att kunna utforma en individuell plan för varje familj, mer utbildning och bättre samarbete mellan olika instanser. Konklusion: Eftervården har länge sett likadan ut och är i dagsläget icke flexibel med begränsade resurser. Det finns behov av förbättring och utveckling samt en önskan om en mer individanpassad vård. / Background:The time after childbirth is known as the most critical but also the most neglected time in every new mothers life. It is part of the midwifes’ task to care for the mother during the postnatal period and assess the need for follow-up. It has been shown that there are shortcomings and a need for development in the postpartum care. There are few or no studies which examines the strengths of the Swedish postpartum care. Purpose:To examine the experiences of postpartum care among midwifes and mothers. Method:Qualitative interviews with an inductive approach, which were analyzed with a qualitative content analysis. Four new mothers and four midwifes in a region in the south of Sweden were interviewed. Results:The mothers were mostly satisfied with the postpartum care but there was a wish for an earlier follow-up after birth and better breastfeeding support. The midwifes described that most mothers are feeling well and that there are no serious shortcomings with the postpartum care today. They do however wish for an earlier follow-up after birth in order to establish an individual plan of care for every family, more education and a better cooperation between different instances. Conclusion:The postpartum care has been designed in the same way for a long time and is inflexible with few resources. There is a need for improvement and development as well as a wish for more individualized care.

Childbirth can be associated with short and long-term psychological morbidity including depression, anxiety and trauma symptoms. Some previous studies have used psychological interventions to reduce postpartum distress but have primarily focussed on attempting to relieve symptoms of depression with little recognition of trauma symptoms. Furthermore, the intervention used in these studies has generally been poorly documented. The first aim of the present study was to develop a counselling framework, suitable for use by midwives, to address psychological trauma following childbirth. Multiple methods were used to develop the intervention including focus groups with women and midwives. Both the women and midwives gave unequivocal support for postpartum debriefing. Themes that emerged from the focus groups with women included the need for opportunities to talk about their birth experience, an explanation of events, an exploration of alternative courses of action that may have resulted in a different birth experience, talking about their feelings such as loss, fear, anger and self-blame, discussing social support, and discussing possible future childbearing. There was a high level of agreement between the women's and midwives' views. These themes were synthesized with contemporary literature describing counselling interventions to assist in reconciling a distressing birth experience and a model for understanding women's distressing birth experiences to develop a counselling framework. The counselling intervention was then tested using a randomised controlled study involving 400 women recruited from antenatal clinics of three public hospitals. When interviewed within seventy-two hours of birth, 103 women reported a distressing birth experience and were then randomised into either the treatment or control group. Women in the intervention group had the opportunity to debrief at the initial postpartum interview (< 72 hours postpartum) and at four to six weeks postpartum. The prevalence of posttraumatic stress disorder was quite high; 9.6% of participants meeting the diagnostic criteria for acute PTSD at four to six weeks postpartum. Fewer participants (3.5%) met the diagnostic criteria for chronic PTSD at three months postpartum. As with previous research relating to childbearing women, few demographic factors or antenatal psychological factors were associated with the development of a PTSD symptom profile following childbirth. The development of PTSD symptom profile was strongly associated with obstetric intervention and a perception of poor care in labour. This finding is also consistent with previous research. Emotional distress was reduced for women in the intervention group in relation to the number of PTSD symptoms [t (101) = 2.144, p = .035], depression [c2 (1) = 9.188, p = .002], stress [c2 (1) = 4.478, p = .029] and feelings of self-blame [t (101) = -12.424, p <.001]. Confidence about a future pregnancy was higher for these women [t (101) = -9.096, p <.001]. Although there was not a statistically significant difference in the number of women with a PTSD symptom profile at three months postpartum, fewer women in the intervention group (n=3) than in the control group (n=9) met PTSD criteria. Likewise, there were fewer women in the intervention group (n=1) with anxiety levels above mild than in the control group (n=6). Importantly, this study found that offering women who have had a traumatic birth the opportunity for counselling using the framework documented in this dissertation was not harmful. This finding is in contrast to previous findings of other studies. The intervention was well received by participants. All the women in the intervention group found the counselling sessions helped them come to terms with their birth experience. Maternity service providers need to be cognizant of the prevalence of this debilitating condition and be able to identify women at risk for early intervention and referral to a mental health practitioner if appropriate. This research offers further support for the compelling need to implement changes to the provision of maternity services that reduce rates of obstetric intervention and humanise service delivery as a means of primary prevention of birth-related PTSD.