Diese Studie soll klären, ob und inwieweit zurückliegende Schwangerschaftsverluste und -abbrüche für eine stationäre Psychotherapie relevant sind. Aufbauend auf zwei Vorstudien wurden in die retrospektive, querschnittliche Hauptstudie 440 Patientinnen einer psychosomatischen Klinik und 585 Frauen aus der Allgemeinbevölkerung (AB) einbezogen. Die geburtshilfliche Anamnese und alle psychologischen Parameter wurden mittels standardisierter Fragebögen erhoben und deskriptiv sowie parametrisch ausgewertet. Sowohl in der AB als auch in der stationären Psychosomatik wiesen 26% der Teilnehmerinnen eine geburtshilfliche Vorbelastung(geb VB) auf, welche im Mittel 20 Jahre zurückliegt. 11% der betroffenen Frauen aus der AB und 31% der Betroffenen in der stationären Psychosomatik nehmen eine anhaltende psychische Belastung durch die geb VB wahr. Trotz der subjektiv anhaltenden psychischen Belastung bei 31% der betroffenen Patientinnen unterscheiden sich diese hinsichtlich ihres aktuellen psychischen Befindens nicht von Patientinnen ohne geb VB. Unterschiede bestehen hingegen zwischen betroffenen stationär psychosomatischen Patientinnen und ebenfalls betroffenen Frauen aus der AB: Bei Patientinnen in der stationären Psychosomatik sind dysfunktionale Verarbeitungsmuster und Trauerreaktionen stärker ausgeprägt. Regressionsanalysen an der Gruppe der Patientinnen mit geb VB in der stationären Psychosomatik zeigen, dass eine Attribution zurückliegender Schwangerschaftsverluste auf „Merkmale der eigenen Person“ mit einem schlechteren Allgemeinbefinden einhergeht. Auch das Ausmaß posttraumatischer Symptome lässt sich teilweise durch Attributionsmuster und Verarbeitungsstrategien erklären. Obwohl aufgrund des Studiendesigns keine kausalen Schlüsse gezogen werden können, liefern die Ergebnisse wichtige Hinweise auf Häufigkeiten von geb VB bei Patientinnen in der stationären Psychosomatik, auf mögliche psychische Beeinträchtigungen und entsprechende Ansatzpunkte in der Psychotherapie. / The aim of this study is to explore whether and to what extent earlier pregnancy losses and abortions are relevant for inpatient psychotherapy. Based on two preliminary studies, data of 440 inpatients of a psychosomatic hospital and 585 women from the general population were included in the retrospective, cross-sectional main study. Both the obstetric history as well as psychological parameters were collected using standardized questionnaires and evaluated by descriptive and parametric statistic methods. In both groups (general population and psychosomatic inpatients) 26% of the participants reported a negative obstetric history, dating back an average of 20 years. Of these women, 11% from the general population and 31% of psychosomatic inpatients perceive an ongoing psychological strain because of their negative obstetric experience. Despite the subjective persistent psychological strain in 31% of the affected inpatients, they do not differ from inpatients without negative obstetric history in terms of their current mental condition. However, there are differences between psychosomatic inpatients with a negative obstetric history and affected women from the general population: Dysfunctional coping patterns and grief reactions are more pronounced with women in inpatient psychosomatic treatment. Regression analyses regarding psychosomatic inpatients with a negative obstetric history show that attributing past pregnancy losses to “personal characteristics” results in poorer general health. The extent of post-traumatic symptoms can also be explained partly by attributional patterns and coping styles. Although due to the study''s design, no causal conclusions can be drawn, the results provide important information on the incidence of negative obstetric history of inpatients in psychosomatic treatment, on possible psychological impairments and on suitable approaches in psychotherapy.

The objective of the studies was evaluate the effects of the animal category, season of calving, season of artificial insemination (AI), parity, numbers of previous inseminated and days in milk (DIM) at AI on pregnancy losses (PL) and the incidence of pregnancy loss before and after 60th day post-AI from females repeat breeders (FRB) and the effects of the animal category, season of calving, parturition condition and parity on the incidence of FRB. Data from Study 1 were collected from 462 pregnancies and calving of lactating dairy cows and from 118 pregnancies of heifers and the Study 2 from 997 pregnancies and calving of lactating dairy cows and from 371 pregnancies of heifers. Pregnancy check was performed by ultrasound between days 28 and 44 post-AI and re-checked between days 45 and 60 post-AI. The rates of pregnancy loss before 60th day and the incidence of RB were higher in lactating dairy cows than heifers (11.90% vs. 3.4%, P=0.01 and 24.5% vs. 6.5%, P<0.001, respectively) and pregnancy loss after day 60 was not affected by animal category (P=0.58). The season of calving affected the pregnancy loss before 60th day (which was higher in spring/summer) and there was only tendency (P=0.078) in affecting the incidence of RB cows probably due to the worst postpartum recovery. There was no relationship between season of AI, parity, number of previous inseminated and DIM at IA and pregnancy loss before and after 60th day in lactating dairy cows. The parturition condition had no effects on RB incidence, however, the effect of parity was detected. Even in crossbred lactating dairy cows the incidence of overall pregnancy loss and RB condition was higher and could be considered as a factor that compromised the reproduction efficiency. / Objetivou-se com este estudo avaliar os efeitos da categoria animal, estação do parto, estação da inseminação artificial (IA), ordem de lactação, número de inseminações prévias e dias em lactação (DEL) na IA sobre as perdas de gestação (PG) e a incidência de PG antes e após 60 dias da IA de fêmeas repetidoras de estro (FRE), bem como os efeitos da categoria animal, estação do parto, tipo de parto e ordem de lactação na incidência de FRE. Os dados do experimento 1 foram coletados de 462 gestações e partos de vacas leiteiras em lactação e de 118 gestações de novilhas, e do experimento 2 de 997 gestações e partos de vacas leiteiras em lactação e 371 gestações de novilhas. O diagnóstico de gestação foi realizado por ultrassonografia entre os dias 28 e 44 pós-IA e a confirmação entre 45 e 60 dias pós-IA. As taxas de PG antes do 60º dia e a incidência de FRE foram maiores em vacas leiteiras lactantes que em novilhas (11,90% vs. 3,4%; P=0,01 e 24,5% vs. 6,5%; P<0,001, respectivamente), e a perda após 60 dias não foi afetada pela categoria animal (P=0,58). A estação do parto afetou a perda antes do 60º dia (que foi maior na primavera/verão) e houve apenas uma tendência (P=0,078) em afetar a incidência de vacas RE, provavelmente devido à pior recuperação no pós-parto. Não houve relação entre estação da IA, ordem de lactação, número de inseminações prévias e DEL na inseminação e PG antes e depois do 60º dia em vacas leiteiras lactantes. O tipo de parto não afetou a incidência de FRE, porém, o efeito da ordem de lactação foi detectado. Até mesmo em vacas leiteiras mestiças a incidência de perda geral de gestação e de FRE foi alta e pode-se considerá-los como problemas reprodutivos que comprometem a eficiência reprodutiva. / Mestre em Ciências Veterinárias

Antecedentes: El aborto espontáneo es la pérdida fetal espontánea antes de la 20va semana gestacional. 1 de 4 embarazos identificados terminan en aborto, resultando en una complicación frecuente del primer trimestre. El índice neutrófilo-linfocito (INL) surge como posible marcador pronóstico por su utilidad en otras enfermedades inflamatorias. Nuevas evidencias comprueban su asociación en pacientes con y sin amenaza de aborto, sin embargo aún hay estudios que no terminan de establecer una asociación. Objetivos: Evaluar si existe asociación entre un mayor valor de INL con una mayor probabilidad de aborto espontáneo en gestantes con y sin amenaza de aborto. Materiales y métodos: Se realizó una búsqueda sistemática de casos y controles y cohortes en PubMed, Scopus, Medline, Embase, Google Scholar, y Web of Science hasta agosto de 2020. Se evaluaron las medias del INL en todos los casos. El análisis por subgrupos permitió evaluar causas de heterogeneidad. Se aplicó la escala Newcastle Ottawa y el test de Egger para evaluación de sesgos. Se usó Revman 5.2 y Stata 14 para el análisis. Resultados: Se obtuvieron 10 estudios para el meta-análisis. El Odds Ratio (OR) favorecía al aborto, pero no fue significativo (OR = 0.83; IC 95% = 0.55, 1.26). Se halló una heterogeneidad alta (I2 = 88%) y el test de Egger descartó el efecto de pequeños estudios (p = 0.812). Conclusiones: No hay asociación entre el valor de INL y una mayor probabilidad de desenlace en aborto espontáneo en las gestantes que presenten o no amenaza de aborto. / Background: Spontaneous abortion is the spontaneous loss of the fetus before the 20th week of gestation. One out of four of identified pregnancies end in abortion, resulting in a frequent first trimester complication. The neutrophil-lymphocyte ratio (NLR) emerges as a possible prognostic marker in view of its usefulness in other inflammatory diseases. Recent studies have confirmed its association in patients with and without threatened abortion, however there are still studies that do not establish an association. Objective: To assess whether there is an association between a higher NLR value and a higher probability of spontaneous abortion in pregnant women with and without threatened abortion. Material and methods: A systematic search for cases and controls and cohorts was carried out in PubMed, Scopus, Medline, Embase, Google Scholar, and Web of Science until August 2020. NLR means were evaluated in all cases. Subgroup analysis was used to assess causes of heterogeneity. The Newcastle Ottawa scale and Egger's test were applied to assess biases. Revman 5.2 and Stata 14 were used for the analysis. Results: Ten studies were obtained for the meta-analysis. The Odds Ratio (OR) was not significant despite favoring the occurrence of abortion (OR = 0.83; IC 95% = 0.55, 1.26). High heterogeneity was found (I2 = 88%) and the Egger test ruled out the effect of small studies (p = 0.812). Conclusions: There is no association between the NLR value and a higher probability of a spontaneous abortion outcome in pregnant women with or without threat of abortion. / Tesis