O objetivo do estudo foi avaliar os aspectos clínicos epidemiológicos, as principais complicações maternas e os resultados perinatais nas gestações gemelares. Foi realizado estudo retrospectivo com análise de gestações gemelares, com idade gestacional maior que 20 semanas e parto no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no período de janeiro de 2003 a dezembro de 2006. Das 303 gestações gemelares, 289 apresentavam dados completos. A incidência de gestação gemelar foi de 3,3% e 96,2% naturalmente concebidas. Em relação à corionicidade, 60,5% eram dicoriônicas (DC), 30,8% monocoriônicas diamnióticas (MCDA), 6,6% monocoriônicas monoamnióticas (MCMA) e em 2,1% dos casos a corionicidade não foi determinada. A idade materna média foi de 29,1 anos e 39,4% eram nulíparas. Cerca de 30% das pacientes apresentavam patologia clínica prévia e as mais prevalentes foram: hipertensão arterial crônica (12,5%), cardiopatias (4,8%) e pneumopatias (4,5%). Complicações gestacionais foram observadas em 85,1% dos casos, sendo as principais: parto prematuro (65,7%), doença hipertensiva específica da gestação (15,6%) e rotura prematura de membranas (13,5%). Ocorreram 395 internações e tempo médio de internação de 6,1 dias. Dessas, 45,8% foram para resolução da gestação por trabalho de parto ou por indicação materno-fetal. A idade gestacional média no parto foi de 34,6 semanas, significativamente menor nas gestações monocoriônicas (MC) do que nas DC (33,5 versus 35,4 semanas, p< 0,001). A via de parto mais freqüente foi à cesárea (84,8%). Dos 578 produtos conceptuais, três eram acárdicos (0,5%), 35 natimortos (6,0%) e 540 nativivos (93,5%). A proporção de óbitos durante a internação no berçário foi de 11,5%, sendo 2,8 vezes maior nas gestações MC em relação às DC. As complicações neonatais mais freqüentes foram: prematuridade (65,7%), baixo peso ao nascer (71,8), restrição do crescimento fetal (18,7%) e as malformações (13,6%). Todos esses parâmetros apresentaram resultado significativamente piores para os recém-nascidos das gestações MC em relação às DC. No presente estudo, concluiu-se que, as gestações gemelares apresentam elevada incidência de complicações maternas, principalmente relacionadas ao parto prematuro, hipertensão arterial sistêmica e rotura prematura de membranas. O resultado perinatal adverso esteve relacionado à prematuridade, malformações e às complicações inerentes à monocorionicidade. A taxa de sobrevida nas gestações gemelares DC e MC sem malformações ou síndrome da transfusão feto-fetal é semelhante / The aims of this retrospective study were to describe clinical and epidemiological aspects of twin pregnancies delivered between January 2003 and December 2006 at the Hospital das Clínicas, São Paulo University Medical School. Maternal complications and perinatal outcome were also studied. Amongst 303 twin pregnancies delivered at a gestational age of more than 20 weeks, 289 cases had completed medical records. The incidence of twin deliveries was 3.3% and 96.2% were naturally conceived. 60.5% were dichorionic (DC), 30.8% monochorionic diamniotic (MCDA), 6.6% monochorionic monoamniotic (MCMA) and in 2.1% of cases, chorionicity was unknown. Mean maternal age was 29.1 years and 39.4% were nulliparous. About 30% of women had a prior clinical history and the most frequent conditions were: chronic hypertension (12.5%), cardiac disease (4.8%) and respiratory complications (4.5%). Pregnancy complications were observed in 85.1% of the cases, and the most common were preterm delivery (65.7%), pregnancy induced hypertension (15.6%) and premature rupture of membranes (13.5%). In this group, there were 395 hospital admissions (1.4 admissions per patient) and the average length of stay was 6.1 days (range 1 to 65 days). Of these, 45.8% were for pregnancy resolution due to labor or maternal-fetal complications. Mean gestational age at delivery was 34.6 weeks, being significantly lower in monochorionic compared to dichorionic twins (33.5 versus 35.4 weeks, p<0001). Cesarean section was the most common route of delivery (84.8%). Amongst the 578 fetuses/newborns, three were acardiac (0.5%), 35 were stillbirths (6.0%) and 540 were born alive (93.5%). Neonatal death occurred in 11.5%, and was 2.8 times higher in MC pregnancies compared to DC. The most common perinatal complications were preterm birth (65.7%), low birth weight (71.8%), fetal growth restriction (18.7%) and fetal malformations (13.6%). All these complications were significantly worse in MC compared to DC pregnancies. Twin pregnancies show high rates of maternal and perinatal complications, such as preterm birth, hypertension, premature rupture of membranes, fetal birth defects and complications inherent to monochorionicity

Candida albicans is an opportunistic pathogen that is present in the normal flora in a majority of individuals. One key factor in C. albicans virulence is the ability to change its morphology from yeast to an elongated or hyphal form. The regulation of this morphogenesis relies in part upon quorum sensing (QS) molecules. C. albicans often exists as part of a mixed culture alongside other microbes and is influenced by their presence as well as the presence of QS molecules that they produce. In this study, a library of diploid homozygous transcriptional regulator knockout (TRKO) mutants were screened to identify strains capable of forming hyphae in the presence of Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli. We identified three strains that showed increased hyphae development compared to wild type C. albicans. The strains identified had deletions of the transcriptional regulating genes Orf19.3928, Orf19.2842 (GZF3), and Orf19.3865 (RFX1). These strains were tested for alterations of filamentation in liquid media, and biofilm formation. All three strains showed increased rates of biofilm formation compared to the wild type. Orf19.3928 showed altered response to farnesol, a marked in biofilm formation and no inhibition of filamentation when farnesol was present in liquid media. The GZF3 deletion strain showed enhanced filamentation with all three bacterial species while the RFX1 deletion strain showed increased filamentation only with E. coli and S. aureus. In spent media, GZF3 showed slight increases in filamentation in E. coli and S. aureus while RFX1 had moderate increases in filamentation in E. coli and S. aureus and slight increases with P. aeruginosa.

Disinfection by-products (DBPs) are a major group of water contaminants and their role in causing adverse health outcomes, including adverse pregnancy outcomes, endocrine disruption, respiratory related adverse health outcomes and cancer has been subject to extensive epidemiological and toxicological research and review. Determination of safe exposure to DBPs, particularly within drinking water supplies, has been a topic of extensive debate, with a wide range of acceptable levels set across the industrialized world. The focus of the research in this thesis was on two of the main health outcomes associated with DBP exposure, namely adverse pregnancy outcomes and asthma related symptoms. To assess adverse pregnancy outcomes in Perth, an extensive classification quantification of the major DBPs in Perth drinking water was conducted. A registrybased prevalence study was carried out to assess birth defects in relation to high, medium and low DBP areas (defined by the water sampling and analysis). It was found that women living in high THM areas are 22% (odds ratio (OR) 1.22, 95% confidence interval (95% CI) 1.01-1.48) more likely of having a baby with any birth defect. High exposure was also strongly associated with an increased risk of having a baby with a cardiovascular defect (62% increased risk). Low birth weight and prematurity were also assessed; however these outcomes were not associated with an increased risk through an increase in exposure. Following on from this analysis, a population risk assessment model was developed for DBPs in high exposure environments. This involved a three step process: (i) Firstly a questionnaire-based validation and reliability study was used to assess water consumption patterns of a population of pregnant women in Perth. (ii) Secondly a prediction model for teratogenic burden of DBPs in Perth was developed, related to the exposure patterns of the population of pregnant women involved in the validation and reliability study. (iii) Finally, combining the information collected in (i) and (ii), along with the regression slope estimates for birth weight from the prevalence study (defined in Section 2.2.1), a dose-response model for THMs and birth weight was developed. Predictive simulations for birth weights at given THM levels were then conducted. It was estimated that pregnant women in Perth are exposed to between 0.3 – 4.10 µg/day ingested TTHM, and of this, the more toxic brominated forms accounted for between 0.27 – 3.69 µg/day. Based on a dose-response model used, birthweights calculated for the ‘hypothetical’ exposures ranged from 3403.2g for the highest exposure to 3503.5g in the lowest exposure, which is a difference of over 100g. Although the resulting reduction in birth weight is not extreme, there is still a significant reduction in birth weight present as exposure to TTHMs increases. This is the first doseresponse model to be developed to assess an adverse pregnancy outcome based on pregnant women exposure data, and will be a useful tool for assessing varying exposures throughout not only Australia but also throughout the industrialised world, where DBP exposure is highly prevalent.

Every year about half a million women die from complications of pregnancy, parturition and puerperium, most of which are preventable. The purpose of this thesis was to chart the distribution and decline in maternal mortality in Sweden between 1751 and 1980, and furthermore to characterize positive (predisposing) factors and negative (protective) factors of maternal mortality. Maternal mortality declined from 900 to 6.6 per 100,000 live births in these 230 years. Maternal deaths accounted for 10070 of all female deaths in the reproductive ages between 1781 and 1785, but only 0.2.0/0 between 1976 and 1980. However, in the 19th century 40-450/0 of the female deaths in the most active childbearing ages were maternal deaths. The children left motherless had an extremely high mortality. Indirect maternal deaths and puerperal sepsis accounted for the bulk of maternal deaths in the rural areas. Only a minority of maternal deaths occurred in lying-in hospitals. Midwifery services in rural areas and antiseptic techniques were most effective in preventing maternal deaths during the late 19th century. The changing distribution ofage and parity amongst the parturients had a definite impact on the mortality decline, enhanced by time, contributing to 500/0 of the mortality decline over the last 15 years. The expontential decline of cause-specific mortality and case fatality rates during the last 40 years is furthermore explained by the emergence ofmodern medicine - antibiotics, antenatal and obstetric care. The earlier serious problem of illegal abortions was eradicated by legislation and changes in hospital practice. The maternal mortality decline has levelled out during the 1970s, the relative importance of embolism as a cause of death is increasing. Advanced age and intercurrent disease are the most difficult risk factors to overcome. To conclude, this study indicates that the reason why maternal mortality has declined faster than otherhealth indices is that the major part of the maternal deaths can be prevented by medical technology, including family planning, antenatal and obstetric care. This experience should be of interest to developing countries where high rates of maternal mortality prevails.

Diss. (sammanfattning) Umeå : Umeå universitet, 2009. / Felaktigt serienummer 1251. Härtill 4 uppsatser.

Tyrimo tikslas – nustatyti nėščiųjų su gimdymu susijusio saviveiksmingumo, nėštumo nerimo ir sveikatos rodiklių sąsajas. Tyrime dalyvavo 146 Šiaulių rajono gyventojos (moterys), kurioms buvo pateikiamos tyrimo anketos prieš ar per vizitą pas gydytoją. Tiriamosios užtruko apie 20 pildydamos tyrimo anketą. Siekiant įvertinti su gimdymu susijusį saviveiksmingumą, buvo pateikta gimdymo saviveiksmingumo vertinimo skalė; siekiant įvertinti nėštumo nerimą, buvo pateikta nėštumui specifiško nerimo skalė; siekiant įvertinti nėštumo komplikacijas, buvo pateikta komplikacijų nustatymo skalė; siekiant nustatyti miego kokybę, fizinio aktyvumo lygį ir sveikatai nepalankų elgesį, buvo pateiktos atitinkamos vertinimo skalės. Tyrimo rezultatai parodė, kad nėštumo nerimas didėja, mažėjant su gimdymu susijusiam saviveiksmingumui. Didėjant su gimdymu susijusiam saviveiksmingumui, nustatytų komplikacijų skaičius mažėja, be to, gimdymo saviveiksmingumas yra mažesnis, jei nustatomos šios nėštumo komplikacijos: ”inkstų ir šlapimo takų infekcija”, “pilvo ir strėnų skausmai”, “pykinimas”, “vėmimas”. Didesnis saviveiksmingumo skalės vidurkis nustatytas toje nėščiųjų imtyje, kurių fizinis aktyvumas darbo (ar kitos dienos veiklos) metu yra didesnis bei toje nėščiųjų imtyje, kurios dažniau atlikdavo įvairius jėgos lavinimo pratimus ištvermės ugdymui. Didėjant su gimdymu susijęs saviveiksmingumui, miego kokybė taip pat didėja. Saviveiksmingumas yra didesnis tų nėščiųjų, kurios nėštumo metu nerūkė... [toliau žr. visą tekstą] / The aim of the study was to assess the associations between pregnancy self-efficacy, pregnancy anxiety and health indexs. The subjects of the study were 146 pregnant women, Šiaulių rajonas residents. They were asked to complete a questionnaire; the completion of it took about 20 min. The participats were asked about various aspects related to pregnancy. In order to evalute pregnancy self-efficacy, pregnancy self-efficay scale was given; in order to esstimate pregnancy anxiety, pregnancy specific anxiety scale was given; in order to eveluate pregnancy complications, questions about specific pregnancy outcomes were asked; in order to esstimate sleep quality, physical activity level and unflavuorable to health behavior, questions about these aspects were given respectively. The results of the study showed that pregnancy specific anxiety declines, when pregnancy self-efficacy enlarges. The increscent of self-efficacy is associated with decline of pregnancy complications. Moreover, lower self-efficacy is associated with these pregnancy complications: „the infection of kidney“, „pelvic pain”, ”nausea” and ”vomiting”. Major mean of pregnancy self-efficacy scale was identified in the contingent of those pregnant women, whose physical activity leveles were bigger. Futhermore, the increscent of self-efficacy is associated with better sleep quality. Major mean of pregnancy self-efficacy scale was indentified in the contingent of those pregnant women, who didn’t smoke during... [to full text]

[Truncated abstract] Fetal inflammatory response syndrome (FIRS) has only recently been recognised as an important cause of spontaneous preterm delivery (PTD). In addition, it has been associated with a number of other short-term and long-term adverse neonatal outcomes, including early onset neonatal sepsis, necrotising enterocolitis, periventricular leucomalacia, cerebral palsy, and bronchopulmonary dysplasia, although the causal mechanisms are unclear. The hallmark of FIRS is histologic chorioamnionitis (HCA). Mothers with HCA are often asymptomatic and it remains unclear whether elevated maternal inflammatory markers, such as C-reactive protein (CRP) and procalcitonin (PCT), are predictive of preterm birth. Furthermore neonatal inflammatory markers such as CRP, PCT, white cell count (WCC) and absolute neutrophil count (ANC), are commonly used in clinical practice to diagnose infection in the neonatal period. Although both intrauterine inflammation and FIRS may have effects on inflammatory markers for up to 10 days following delivery, the extent to which intrauterine infection and FIRS confound these diagnostic surrogates of neonatal infection is unknown. This work addressed the hypothesis that HCA is associated with inflammatory changes that may be detected in the: (a) maternal circulation at the time of delivery, (b) umbilical cord blood at delivery and (c) post-natal circulation within the first 48 hours of life. The primary aim of this study was to investigate the relationship between the presence of HCA and maternal inflammatory markers (serum CRP and PCT on the day of delivery) as well as neonatal inflammatory markers (haematological parameters, CRP and PCT up to 48 hours following delivery). ... Cord platelet counts were likely affected by platelet activation. For both intra-rater and inter-rater reproducibility, the corrected WCC, ANC and NRBC were shown to be reliable with an ICC of >0.90 for all comparisons. However, I:T ratio was poorly reproducible. HCA appears to be a minor inflammatory insult for the mother. In the majority of cases it is asymptomatic and results in minor increases in PCT and CRP levels on the day of delivery. Conversely HCA results in significant inflammatory changes in the newborn that can be seen in the cord blood. Sensitive markers of inflammation in the cord blood are significantly higher in affected infants (CRP and PCT), while less sensitive markers, such as WCC and ANC are not significantly different. This study has shown that fetal inflammation has sustained effects on CRP and haematological parameters in early neonatal life; CRP, WCC and ANC are significantly higher in newborns exposed to HCA, peaking 24 hours following delivery. These effects may confound the interpretation of common diagnostic tests for early onset neonatal sepsis. Conclusion: HCA results in mild elevations in CRP and PCT in the cord blood. Over the subsequent 24 hours CRP, WCC and ANC increase significantly in these neonates. Intrauterine exposure to HCA may influence surrogate diagnostic markers for early onset sepsis in newborn infants. Future research to investigate novel diagnostic markers, such as CD64 and soluble triggering receptor expressed on myeloid cells (TREM-1), or enhanced microbiological molecular diagnosis, will help distinguish true invasive infection from HCA-driven inflammation in the newborn infant.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2002. / Härtill 5 uppsatser.

Diss. (sammanfattning) Uppsala : Univ., 2002. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2002. / Härtill 4 uppsatser.