Os objetivos da tese foram comparar a dinâmica folicular e luteínica (Experimento 1), bem como a eficiência reprodutiva (Experimento 2) de búfalas leiteiras submetidas a protocolos de IATF à base de progesterona/estrógeno (P4/E2) e eCG durante as estações reprodutivas favorável (ERF; maio, junho e julho) e desfavorável (ERD; novembro, dezembro e janeiro) do ano. No Experimento 1 foram utilizadas 51 búfalas leiteiras de uma propriedade e no Experimento 2, 351 búfalas leiteiras de 5 propriedades. Para comparar o efeito das ER, cada propriedade teve semelhante número de animais submetidos à IATF nas respectivas ERF e ERD, tanto no Experimento 1 (n=25 vs. n=26) quanto no Experimento 2 (n=168 vs. n=183). Todas as propriedades se localizavam na região do Vale do Ribeira, Estado de São Paulo. Em dias aleatórios do ciclo estral (D-12; 16:00 h), todas as búfalas receberam um dispositivo intravaginal contendo 1 g de P4 (iP4; Sincrogest&reg;, Ourofino Agronegócio) mais 2,0 mg de benzoato de estradiol i.m. (Sincrodiol&reg;, Ourofino Agronegócio). No D-3 (16:00 h), as fêmeas receberam 0,53 mg de PGF2&#945; i.m. (Cloprostenol, Sincrocio&reg;, Ourofino Agronegócio) e 400 UI de eCG i.m. (Novormon&reg; MSD Saúde Animal), seguido de remoção do dispositivo de progesterona. No D-1 (16:00 h), 10 &micro;g de acetado de buserelina (GnRH, Sincroforte&reg; Ourofino Agronegócio) foram administrados i.m. A IATF foi realizada 16 horas após a administração de GnRH (D0; 8:00 h). No D0 foram determinados o intervalo de dias em lactação (DEL) e o escore de condição corporal das fêmeas (ECC; 1-5). Avaliações ultra-sonográficas (Chison D600Vet, China) foram realizadas no Experimento 1 para determinar: diâmetro do folículo dominante entre a retirada do iP4 e a IATF (&#216;FD), o diâmetro do folículo ovulatório (&Oslash;FO), o momento da ovulação, a dispersão das ovulações, a presença e o diâmetro do corpo lúteo (&#216;CL) após a ovulação. No Experimento 2, determinaram-se a taxa de ciclicidade (presença de corpo lúteo no D-12 e/ou no D-3); o diâmetro do folículo dominante nos D-3 e D0 (&#216;FD); a taxa de ovulação e diâmetro do corpo lúteo 10 dias após a IATF (&#216;CL D+10); os diagnósticos de gestação aos 30 (P/IA 30 d) e 45 dias (P/IA 45 d) após a IATF, além da taxa de mortalidade embrionária (ME) entre 30 e 45 dias, a mortalidade fetal (MF) entre 45 dias e o nascimento e a perda gestacional (PG) entre 30 dias e o nascimento. As variáveis contínuas foram apresentadas como média e erro padrão da média (média±EPM) e as frequências como porcentagem [% (n/n)]. A comparação entre as variáveis foi realizada por análise de variância (ANOVA), por meio do programa SAS&reg;. Foi considerada diferença quando P < 0,05. No Experimento 1, observou-se que a dinâmica ovariana não foi influenciada pelas respectivas ERF e ERD para as seguintes variáveis: &#216;FD (0 h 10,3±0,4 vs. 9,9±0,5 mm; 24 h 11,8±0,5 vs. 12,0±0,4; 48 h 12,8±0,5 vs. 13,2±0,4; e 60 h 13,8±0,6 vs. 13,1±0,5; P=0,80); &#216;FO (14,3±0,4 vs. 14,2±0,3 mm; P=0,94); momento da ovulação (76,5±1,9 vs. 72,0±2,5 h; P=0,85); dispersão das ovulações (24 |- 48 h 0,0 vs. 0,0%; 48 |- 60 h 12,5 vs. 37,5%; 60 |- 72 h 41,7 vs. 33,3%; 72 |- 84 h 41,7 vs. 25,0%; 84 |- 96 h 4,2 vs. 0,0%; e 96 |- 108 h 0,0 vs. 4,2%; P=0,18) e &#216;CL (D+6 17,3±0,5 vs. 16,9±0,4; D+10 21,5±0,6 vs. 18,4±0,5; e D+14 20,6±0,6 vs.19,9±0,6; P=0,06). No Experimento 2, pôde-se observar que apesar das búfalas apresentarem semelhança em DEL (111,1±8,8 vs. 144,3±8.6 dias; P=0,27) e ECC (3,3±0,0 vs. 3,3±0,0; P=0,41) nas respectivas ERF e ERD, houve diferença nas taxas de ciclicidade [76,2 (128/168) vs. 42,6% (78/183); P=0,02]. Nenhuma das outras respostas diferiu entre as ERF e ERD, respectivamente: &#216;FD D-3 (9,6±0,2 vs. 9,8±0,2 mm; P=0,35); &#216;FD D0 (13,1±0,2 vs. 13,2±0,2 mm; P=0,47); taxa de ovulação [86,9 (146/168) vs. 82,9% (152/182); P=0,19]; &#216;CL D+10 (19,0±0,3 vs. 18,4±0,3 mm; P=0,20); P/IA 30 d [66,7 (112/168) vs. 62,7% (111/177); P=0,31]; P/IA 45 d [64,8 (107/165) vs. 60,2% (106/176); P=0,37]; ME [1,8 (2/111) vs. 3,6% (4/110); P=0,95]; MF [21,9 (18/82) vs. 8,0% (7/87); P=0,13]; e PG [23,8 (20/84) vs. 12,1% (11/91); P=0,13]. Foi possível concluir que búfalas leiteiras apresentam semelhantes respostas ovarianas ao protocolo de sincronização e equivalente eficiência reprodutiva nas ERF e ERD do ano, quando submetidas a programas de IATF à base de P4/E2 e eCG. / This thesis aimed to compare the follicular and luteal dynamics (Experiment 1) and reproductive efficiency (Experiment 2) of dairy buffaloes submitted to TAI protocols based on progesterone/estrogen (P4/E2) and eCG during the breeding (On-BS; May, June and July) and nonbreeding seasons (Off-BS; November, December and January). In Experiment 1, 51 dairy buffalo of one farm were used, and in Experiment 2, 351 dairy buffaloes of 5 farms were used. To compare the effect of BS, each property had similar number of animals submitted to TAI in each, both in Experiment 1 (n = 25 vs. n = 26) as in Experiment 2 (n = 168 vs. n = 183). All properties were located in the Vale do Ribeira, State of São Paulo, Brazil. On random days of the estrous cycle (D-12; 4:00 PM), all buffaloes received an intravaginal device containing 1 g of P4 (Sincrogest&reg;, Ourofino Agronegócio) plus 2.0 mg of estradiol benzoate im (Sincrodiol&reg;, Ourofino Agronegócio). On D-3 (4:00 PM), females received 0.53 mg of PGF2&#945; im (Cloprostenol, Sincrocio&reg;, Ourofino Agronegócio) and 400 IU of eCG im (Novormon&reg;, MSD Animal Health), followed by removal of progesterone device. On D-1 (4:00 PM), 10 mg of buserelin acetate (GnRH Sincroforte&reg;, Ourofino Agronegócio) were administered im. The TAI was performed 16 hours after application of GnRH (D0; 8:00 AM). At the beginning of each protocol (D-12), it was recorded the number of days in milk (DIM) and body condition score of females (BCS, 1-5). Ultrasonography (Chison D600Vet, China) were performed in Experiment 1 to determine: the diameter of the dominant follicle between withdraw of iP4 and TAI (&#216;DF), the diameter of the ovulatory follicle (&#216;OF), the time of ovulation, the dispersion of ovulation, and the presence and diameter of the corpus luteum (&#216;CL) after ovulation. In Experiment 2, was determined cyclicity rate (the presence of corpus luteum in the D-12 and/or D-3), diameter of the dominant follicle in the D-3 and D0 (&#216;DF), ovulation rate, diameter of the corpus luteum 10 days after artificial insemination (&#216;CL D+10); pregnancy rates to 30 (P/AI 30 d) and 45 days (P/AI 45 d) after TAI, embryonic mortality (EM) between 30 and 45 days, fetal mortality (FM) between 45 days and birth, and pregnancy loss (PL) between 30 days and birth. Continuous variables were presented as mean and standard error of the mean (mean±SEM) and frequencies as a percentage [% (n/n)]. The comparison between variables was performed through analysis of variance (ANOVA) using the SAS&reg; program. Difference was considered when P < 0.05. In Experiment 1, it was found that the ovarian dynamics was not influenced by the respective On-BS and Off-BS for the following variables: &#216;DF (0 h 10.3±0.4 vs. 9.9±0.5 mm; 24 h 11.8±0.5 vs. 12.0±0.4; 48 h 12.8±0.5 vs. 13.2±0.4; and 60 h 13.8±0.6 vs. 13.1±0.5; P = 0.80); &#216;OF (14.3 ± 0.4 vs. 14.2 ± 0.3 mm; P = 0.94); timing of ovulation (76.5 ± 1.9 vs. 72.0 ± 2.5 h; P = 0.85); dispersion of ovulations (24 |- 48 h 0.0 vs. 0.0%; 48 |- 60 h 12.5 vs. 37.5%; 60 |- 72 h 41.7 vs. 33.3%; 72 |- 84 h 41.7 vs. 25.0%; 84 |- 96 h 4.2 vs. 0.0%; and 96 |- 108 h 0.0 vs. 4.2%; P = 0.18) and &#216;CL (D+6 17.3±0.5 vs. 16.9±0.4; D+10 21.5±0.6 vs. 18.4±0.5; and D+14 20.6±0.6 vs.19.9±0.6; P = 0.06). In Experiment 2, it was observed that despite the similarity of DIM (111.1 ± 8.8 vs. 144.3 ± 8.6 d, P = 0.27) and BCS (3.3 ± 0.0 vs. 3.3 ± 0.0; P = 0.41) on respective On-BS Off-BS, buffalo females showed different cyclicity rates [76.2 (128/168) vs. 42.6% (78/183); P = 0.02]. None of the other answers differ between On-BS and Off-BS respectively: &#216;DF D-3 (9.6 ± 0.2 vs. 9.8 ± 0.2 mm; P = 0.35); &#216;DF D0 (13.1 ± 0.2 vs. 13.2 ± 0.2 mm; P = 0.47); ovulation rate [86.9 (146/168) vs. 82.9% (152/182); P = 0.19]; &#216;CL + D 10 (19.0 ± 0.3 vs. 18.4 ± 0.3 mm, P = 0.20); P/AI d 30 [66.7 (112/168) vs. 62.7% (111/177); P = 0.31]; P/AI d 45 [64.8 (107/165) vs. 60.2% (106/176); P = 0.37]; EM [1,8 (2/111) vs. 3.6% (4/110); P = 0.95]; FM [21.9 (18/82) vs. 8.0% (7/87); P = 0.13]; and PL [23.8 (20/84) vs. 12.1% (11/91); P = 0.13]. It was concluded that dairy buffaloes have similar responses to ovarian synchronization protocol and equivalent reproductive efficiency during OnBS and OffBS, when subjected to TAI programs based on P4 / E2 and eCG.

O presente experimento foi realizado com o objetivo de avaliar o impacto da inseminação artificial em tempo fixo (IATF) na eficiência reprodutiva de vacas de leite de alta produção inseminadas no período pós-parto. Vacas Holandesas com média de 50 dias pós-parto foram distribuídas homogeneamente em um de dois grupos experimentais, levando em consideração a presença ou ausência de corpo lúteo (CL), o escore de condição corporal e a produção de leite. No grupo Controle (G-Controle; n = 490), as vacas foram submetidas à observação do comportamento de aceitação de monta (duas vezes ao dia por uma hora) e inseminadas 12 horas após a primeira detecção. No grupo IATF (G-IATF; n = 495), as vacas receberam um implante auricular de norgestomet, mantido por oito dias, e 2 mg de benzoato de estradiol IM no dia 0 (D0; dia aleatório do ciclo estral). No momento da retirada do implante (D8) foram administrados 150 &micro;g de prostaglandina F2&alpha;, 400 UI de gonadotrofina coriônica eqüina e 1 mg de cipionato de estradiol. A IATF foi realizada de 54 a 56 h após a retirada do implante auricular, concomitante à administração de 100 &micro;g de gonadorelina. Após a IATF, as vacas foram submetidas à observação de cio com subseqüente inseminação, seguindo os mesmos critérios descritos para o G-Controle. Amostras de sangue foram colhidas de um subgrupo de animais (G-Controle, n = 50; G-IATF, n = 58) 5 e 11 dias após a primeira inseminação artificial (IA) para dosagem de progesterona (P4) circulante. Todos os animais foram mantidos no experimento até a terceira IA ou 150 dias após o parto e os tratamentos foram realizados no inverno e no verão. O diagnóstico de gestação foi realizado aos 30 dias pós-IA por ultrassonografia e aos 60 dias pós-IA por palpação transretal. Os dados binomiais foram analisados por regressão logística utilizando o PROC GLIMMIX e as variáveis contínuas por ANOVA utilizando PROC GLM do SAS. Não se verificou interação entre estação do ano e tratamento na análise das taxas de concepção, perda gestacional, intervalo entre IAs, intervalo parto-concepção (IPC) e taxa de prenhez aos 150 dias pós-parto. Os resultados são indicativos de que não existem diferenças nas taxas de concepção entre os diferentes grupos após as IAs (primeira, segunda e terceira). A perda gestacional relativa à primeira IA foi maior nas vacas do G-IATF. Os intervalos parto-primeira IA, parto-segunda IA e parto-concepção foram inferiores para as vacas do G-IATF. Entretanto, o intervalo entre a primeira e a segunda IA foi maior para o G-IATF. Não houve diferença na taxa de prenhez aos 150 dias entre os grupos. Ainda, a taxa de serviço (TS) nos primeiros 21 dias após o período voluntário de espera (PVE) foi maior para o grupo IATF. Entretanto, a TS entre 21 e 42 dias após o PVE foi maior para o G-Controle. As concentrações circulantes de P4 não diferiram entre os grupos e as estações do ano. Concluiu-se que o emprego da IATF 60 dias pós-parto foi eficiente para diminuir o IPC. Contudo, a porcentagem de vacas prenhes aos 150 pós-parto foi semelhante entre os dois tratamentos (Controle e IATF) / The aim of the present study was evaluate the impact of fixed-time artificial insemination (FTAI) on reproductive efficiency of high-producing dairy cows inseminated during the postpartum period. Holstein cows with average 50 days in milk were allocated to one of two groups considering the presence or absence of corpus luteum (CL), body condition score and milk production. On Control group (Control-G; n = 490), the cows were submitted to estrus detection twice per day for one h and were inseminated 12 hours after the first detection. On FTAI group (FTAI-G; n = 495), the cows received a norgestomet ear implant (kept for eight days) plus administration of 2 mg of estradiol benzoate i.m. on Day 0 (random day of the estrous cycle). The implant was removed on Day 8 followed by FTAI 54 to 56 h later and the administration of 100 &micro;g of gonadorelin. On Day 8, cows received 400 IU eCG, 150 &micro:g of prostaglandin F2&alpha; and 1 mg of estradiol cypionate. After FTAI, cows were submitted to estrus detection and artificial insemination (AI) 12 h after. Blood samples were collected from a subset of animals (Control-G, n = 50; FTAI-G, n = 58) on Day 5 and 11 after the first AI to investigate serum progesterone concentration (P4). All animals were maintained on the experiment until 150 days post-partum and the treatments were conducted during the winter and summer. Pregnancy diagnosis was performed by ultrasonography 30 days after AI (Day 30) and by rectal palpation 60 days after AI (Day 60). Binomial data were analyzed by logistic regression using the PROC GLIMMIX and continuous variables by ANOVA using PROC GLM of SAS. No interaction was found between season and treatment when conception rate, pregnancy loss, interval between inseminations, interval from calving to conception and pregnancy rate 150 post-partum were analysed. The results indicate no differences on conception rate among both experimental groups after AI (first, second and third). However, the interval from calving to first and second AI and interval from calving to conception were lower on FTAI-G. No difference on pregnancy rate 150 days post-partum was found among groups. Pregnancy loss after first AI was greater on FTAI-G. The interval from calving to first AI, from calving to second AI and the interval from calving to conception were shorter on FTAI-G. However, the interval between first and second AI was longer on FTAI-G. There was no difference on pregnancy rate 150 days post-partum among treatments. Also, the service rate (SR) 21 days after the voluntary waiting period (VWP) was greater on FTAI-G compared to Control-G. Conversely, the SR was lower between 21 and 42 days after the VWP on FTAI-G. No difference was found in serum concentration of P4 among treatment groups and season. Thus, the use of FTAI 60 days post-partum was efficient to anticipate the conception of high-producing dairy cattle by reducing the interval from calving to conception, but did not increase the pregnancy rate 150 days post-partum

Two types of placentitis were studied: ascending and nocardioform placentitis. Although the first diagnosis of nocardioform placentitis was made three decades ago, little is known about the disease, due to the lack of an experimental model. In attempt to develop a research model, Crossiela equi was inoculated through intrauterine, intravenous, intrapharyngeal, and oral routes, but none of the routes resulted in nocardioform placentitis. This may indicate that unidentified factors may play a role in disease pathogenesis and that simple presence of bacteria is not sufficient to induce nocardioform placentitis. The second and major component of this dissertation involved the identification of diagnostic markers for placentitis. Because ascending bacterial placentitis is readily and predictably induced using existing experimental models, this model was used to identify diagnostic markers for placentitis in maternal plasma and fetal fluids. Three potential biomarkers were examined: acute phase inflammatory proteins, steroid hormones produced by the fetoplacental unit, and protein composition of the fetal fluids. Of the three acute phase proteins investigated, serum amyloid A and haptoglobin but not fibrinogen increased in association with experimentally induced ascending placentitis. Androgens and progestins appear to be poor markers for placentitis. Serum estradiol 17β concentrations were reduced in mares with experimentally induced placentitis and appear to be a good marker for placentitis in mares. Different methods were used to study the protein composition of the fetal fluids. Alpha-fetoprotein was characterized as a major protein present in the equine fetal fluids, and this protein was elevated in plasma of mares with placentitis. In another study, using a high-throughput proteomic technique several new proteins were characterized in the amniotic and allantoic fluids of mares carrying normal pregnancies, and several previously uncharacterized proteins were detected in the allantoic fluid of mares with placentitis. Three secreting proteins were elevated in allantoic fluid of mares with experimentally induced ascending placentitis.

Orientador: José Luiz Moraes Vasconcelos / Banca: Amauri Alcindo Alfieri / Banca: Marcos Bryan Heinemann / Resumo: O objetivo deste estudo foi determinar a incidência de perdas gestacionais em vacas de corte e avaliar o efeito da vacina contra IBR/BVD/Leptospirose (5,0 mL, Cattle Master® 4 + L5) na taxa de prenhez e perdas de gestação de vacas submetidas à Inseminação Artificial em Tempo Fixo [IATF, Protocolo; D0: benzoato de estradiol (2mg, Estrogin����) e inserção do dispositivo intravaginal de P4 (CIDR����, P4,1,9g); D7: dinoprost trometamina (PGF2α, 12,5mg, Lutalyse����); D9: retirada do dispositivo intravaginal de P4, administração cipionato de estradiol (0,5mg, ECP����) e remoção temporária de bezerros (RTB) por 48 horas; D11: IATF]. A avaliação de gestação foi realizada aos 30 e 120 dias pós IATF, para identificação de vacas prenhas e identificação de perdas gestacionais. No EXP1, foram avaliadas 8725 vacas para determinar a taxa de perda de gestação entre 30 e 120 dias. Foram usadas vacas pertencentes a dezenove propriedades com programas sanitários diferentes: sem imunização para doenças da reprodução (Grupo Sem, n = 7.311); com imunização semestral para Leptospirose (Grupo Leptospirose, n = 738); ou com imunização semestral para leptospirose e anual para Rinotraqueíte Infecciosa Bovina e Diarréia Viral Bovina (Grupo IBR/BVD/Leptospirose, n = 676). No EXP2 (n=1968) e EXP3 (n=2793), as vacas foram divididas aleatoriamente dentro do mesmo lote para receberem ou não a vacina contra IBR/BVD/Leptospirose (5,0 mL, Cattle Master®4 + L5): a primeira dose foi aplicada no início do protocolo de IATF e a segunda dose no momento do primeiro diagnóstico gestacional (US1/30d). No EXP2 as fazendas não utilizavam nenhum tipo de vacina preventiva para as doenças da reprodução, já no EXP3 as fazendas utilizavam vacinação contra Leptospirose. No EXP 4 foram utilizadas 367 vacas da raça Nelore... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The aim of this study was to determine the incidence of pregnancy loss in beef cows, and evaluate the effect of the vaccine against IBR/BVD/Leptospirosis (5.0 mL, Cattle Master ® 4 + L5) in pregnancy rate and pregnancy loss of cows subjected to fixed-time artificial insemination [TAI, Protocol; D0: estradiol benzoate (2mg, Estrogin) and insertion of intravaginal P4 device (CIDR, P4, 1.9 g); D7: dinoprost tromethamine (PGF2, 5mg Lutalyse), D9: withdrawal of intravaginal P4 device, administration of estradiol cypionate (0.5 mg, ECP®) and temporary calf removal for 48 hours; D11: TAI]. The pregnancy diagnosis was performed at 30 and 120 days after TAI for identify cows pregnant and pregnancy loss respectively. In EXP1 8725 cows were evaluated to determine the rate of pregnancy loss between 30 and 120 days. The cows were from nineteen farms with different health programs. Cows without immunization reproductive diseases (Group No, n = 7311), with immunization semester to leptospirosis (Leptospirosis Group, n = 738) or semester immunization against leptospirosis and annual against infectious rhinotracheitis bovine and bovine viral diarrhea (Group IBR/BVD/Leptospirosis, n = 676). In EXP2 (n = 1968) and EXP3 (n = 2793) cows were randomly assigned within the same batch to receive or not vaccine against IBR/BVD/Leptospirosis (5.0 ml, 4 Cattle Master® L5 +): the first dose was administered at the beginning of the TAI protocol and the second dose at the time of first diagnosis of pregnancy (US1/30d). In EXP2 farms did not use any kind of preventive vaccine for diseases of reproduction, as in exp3 farms used vaccination against Leptospirosis. In EXP 4 367 nelore cows were submitted to TAI, the animals were randomly assigned to receive the vaccine at different times. Animals from groups:...(Complete abstract click electronic access below) / Mestre

Background: Physical activity (PA) may influence fecundability through alterations in endocrine function. The limited studies that have evaluated PA and fecundability in non-clinical populations have utilized internet-based recruitment, contain potential issues in measurement, and have yielded inconclusive results. Methods: We evaluated the association between PA and time-to-pregnancy in the Effects of Aspirin in Gestation and Reproduction trial, which included 1228 women attempting pregnancy ages 18–40 with prior pregnancy loss. PA was measured at baseline using the short form of the International Physical Activity Questionnaire to determine hours/week of activity (vigorous, moderate, and walking) and hours/day of sedentary (sitting) behavior. Pregnancy was assessed using urine hCG assays. Discrete time Cox models were used to estimate fecundability odds ratios (FORs) adjusted for marital status and parity, accounting for left truncation and right censoring. Results: We observed a positive association between fecundability and vigorous PA of ≥ 4 hrs/week vs. none (FOR= 1.55, 95% CI: 1.17, 2.07) adjusted for marital status and parity. In stratified multivariable models, this association was most pronounced among overweight/obese women reporting vigorous PA of ≥ 4 hrs/week compared to none (FOR=2.27, 1.41, 3.65); however, there was no significant effect modification. Fecundability was not associated with categorical measures of moderate PA, walking, or sitting. Conclusion: In this study, fecundability was positively associated with vigorous PA. Further study is necessary to clarify possible mechanisms to explain the relationship through which vigorous PA might affect time-to-pregnancy; however, such improvements in fecundability may be related to a reduction in ovulatory disorders.

This thesis examines the social context of stillbirth and its impact on women's life and on their relationships with their family members. The study sample includes 8 adult women from Israel. Israel is a country characterized by a high number of children in families and the centrality of religion in society. The methodology used in this study was semi-structured interviews. Our results were similar to those of previous studies in terms of the partner's attitude to the event. On the other hand, the results included novel findings regarding other family members' coping with the stillbirth event. Solidarity and other types of empathy were found to be relevant according to women's stories; whereas some filial norms were met with more ambivalent responses. This thesis demonstrates the importance of intergenerational solidarity, the mass influence of cultural context and ambivalence within everyday situations and the meaning of empathy from close family members. Particular attention needs to be paid to the intergenerational perspective, which focuses on the family (couple, divorced or single units) or the wider society in which they live. Moreover, the experience of particular social groups further exploration; for instance, single mothers and surrogates.

Bakgrund: Av alla graviditeter är 2–3 % extrauterina och innebär i stort sett alltid en förlorad graviditet eftersom infästningen av det befruktade ägget oftast sker i äggledaren.En extrauterin graviditet kan skapa olika typer av lidande hos kvinnan som kan leda till långvariga psykologiska konsekvenser och i värsta fall kvinnans död. Det är sjuksköterskans ansvar att stödja kvinnan och lindra hennes lidande. Syfte: Att belysa kvinnors upplevelse av lidande i samband med extrauterin graviditet. Metod: En kvalitativ studie har utförts baserad på 11 bloggar som analyserats på en manifest nivå med en kvalitativ innehållsanalys. Resultat: Analysen resulterade i tre kategorier: En psykisk kamp, Att bli ignorerad samt En fysisk kamp. Samt sju underkategorier. En stor del av kampen var sorgen över ett förlorat barn. Konklusion: Det visade sig att en extrauterin graviditet involverade livslidande, vårdlidande och sjukdomslidande. Det var inte bara fysiskt smärtsamt att vara med om utan också psykiskt påfrestande och ledde till en stor sorg som påverkade kvinnan i flera år. För en snabbare återhämtning av sorgen var det viktigt med professionellt och socialt stöd. Det var även av stor vikt att kvinnornas sorg togs på allvar av vården för att minska risken för vårdlidande. / Background: Of all pregnancies, 2–3% are ectopic and almost always ends in a pregnancy loss because the attachment usually takes place in the fallopian tube. An ectopic pregnancy can create different types of suffering that can lead to long-term psychological consequences and in the worst case result in the death of the mother. It is the nurse's responsibility to support the woman and alleviate her suffering. Purpose: To illustrate women's experience of suffering associated with ectopic pregnancy. Method: A qualitative study has been conducted based on 11 blogs that have been analysed at a manifest level with a qualitative content analysis. Results: The analysis resulted in three categories: Amental struggle, Being ignored and A physical struggle. As well as seven subcategories. Abig part of the struggle was the grief over a lost child. Conclusion: It turned out that anectopic pregnancy involved suffering of life, suffering of care given and suffering of illness. It was not only physically painful but also psychologically stressful and led to agreat grief that affected the women for several years. For a faster recovery from grief, professional and social support was important. It was also of great importance that women's grief was taken seriously by health care professionals to reduce the risk of suffering from care.

Graviditetsförlust i form av tidiga missfall är en vanlig diagnos i sjukvården. En mer sällsynt diagnos är utomkvedshavandeskap som kan ha ett dramatiskt förlopp och vara direkt livshotande. Sjuksköterskan kan inom flera olika områden i sjuk-vården träffa på kvinnor som har råkat ut för någon av dessa förluster och behöver omvårdnad. Syftet med litteraturöversikten var att ta reda på vad eventuell forsk-ning visade angående kvinnors känslomässiga upplevelser vid graviditetsförlust samt att ur ett omvårdnadsperspektiv belysa kvinnors reaktioner på vården. För att uppnå syftet gjordes en litteraturöversikt enligt Friberg (2006). Resultatet ledde fram till tre teman; Känslomässiga upplevelser, Hur dessa hanterades och Reak-tioner på omvårdnaden. Kvinnorna upplevde graviditetsförlusten olika men gemensamt för dem var att bemötandet från vårdpersonalen hade betydelse för hur de känslomässigt hanterade situationen. Om vårdpersonalen var sympatisk, enga-gerad och hade tid för dem klarade de av att hantera situationen på ett bättre sätt än när personalens bemötande upplevdes känslokallt och rutinmässigt. Resultatet diskuterades i förhållande till Travelbees omvårdnadsfilosofi. Kvinnorna behöver ges omvårdnad utgående från varje enskild individs unika situation. Det är en patientkategori som oftast har kort vårdtid vilket gör det till en utmaning för sjuk-sköterskor att i omvårdnaden hinna bemöta dem individuellt och uppfatta deras behov. / Pregnancy loss and early miscarriage are common adverse outcome in pregnancy. A more rare diagnosis is ectopic pregnancy that can be very dramatic and life-threatening. Nurses from different areas in hospitals meet women in need of care after such a loss. The purpose of this literature review was to find out what the research show about women’s emotional experience of pregnancy loss and from a nursing view find out how the women experienced the care they received. To reach the purpose, a literature review was done according to Friberg (2006). The results showed three different themes; Emotional experiences, How the women coped with the emotional experiences and How the women reacted to the care given. The women experienced the pregnancy loss differently but they had one thing in common: The way they handled the situation depended on how the health professional treated them. If the caregivers were sympathetic, compassionate and gave time to the women they coped a lot better than if the caregivers were insensi-tive, callous and showed a matter of fact attitude. The result is discussed in rela-tion to Travelbees nursing philosophy. The women need to be provided with targeted care. The care must be based on every woman’s individual needs. These patients often spend a very short time at the hospital with short time for treatment witch leads the nurses to a challenge of how to get the time to treat every woman individually. This would lead to a better understanding for the women’s needs

No description available.

Einleitung: Fehlgeburten können nachhaltige seelische Folgen für die Betroffenen haben. Ihre Folgen für eine nachfolgende Schwangerschaft sind bislang kaum untersucht worden. Untersuchungsmethoden: In einer prospektiven Längsschnittuntersuchung werden 342 Frauen nach Frühabort (bis 16. Schwangerschaftswoche) jeweils wenige Wochen, 6 und 12 Monate nach dem Schwangerschaftsverlust postalisch über standardisierte Erhebungsinstrumente zu ihren Verarbeitungsmustern befragt. Bei 108 Frauen trat im Untersuchungszeitraum eine neue Schwangerschaft ein, sie wurden jeweils in jedem Schwangerschaftstrimenon befragt. Über standardisierte Symptomskalen werden schwangerschaftsbezogene Ängste, State-Ängste und Trait-Angst (STAI) sowie Depressivität dieser Schwangeren erhoben und mit der Symptomatik von jeweils 69 (1. Trimenon), 82 (2. Trimenon) und 97 (3. Trimenon) anamnestisch nicht durch frühere Schwangerschaftsverluste belasteten Schwangeren verglichen. Ergebnisse: Im ersten Trimenon einer neuen Schwangerschaft sind Frauen nach Frühaborten signifikant stärker belastet durch schwangerschaftsbezogene Ängste und – vor dem Überschreiten des kritischen Zeitpunktes der zurückliegenden Fehlgeburt(en) – auch durch situative Ängste als anamnestisch nicht belastete Schwangere. Sie haben darüber hinaus ein erhöhtes Risiko für Blutungen in der Frühschwangerschaft. Muster einer depressiven und pessimistisch-traurigen Verarbeitung der Fehlgeburt sagen ausgeprägtere Angst- und depressive Symptome im ersten Trimenon einer nachfolgenden Schwangerschaft vorher. Schlussfolgerungen: Frauen nach Frühabort sind hinsichtlich psychischer Befindensstörungen in einer neuen Schwangerschaft besonders gefährdet. Es lassen sich Risikofaktoren bestimmen, anhand derer besonders gefährdete Frauen schon unmittelbar nach der Fehlgeburt erkannt werden und einer entsprechenden Behandlung zugeführt werden können. / Background: It is well known that miscarriages have enduring mental consequences for the persons affected and may also have implications for the course of a new pregnancy. So far, however, not many studies investigated the physical and mental stress of pregnant women with previous miscarriages. Methods: In this study, 342 women who had early miscarriages were interviewed in writing a couple of weeks, half a year and one year after the prenatal loss. 108 of these women became pregnant during the research period and answered further questionnaires in each trimenon of the pregnancy. In addition, the data of a comparative group was collected consisting of 69 (first trimenon), 82 (second trimenon) and 97 (third trimenon) women without any previous miscarriages. The symptoms (anxiety and depression) of any new pregnancy were collected by using standardised data collection instruments and specific methods for recording specific pregnancy-related anxieties, subjective pregnancy problems and complications during the pregnancy. Results: In the first trimenon of a pregnancy, those women who had previous miscarriages are more stressed by pregnancy-related and – before the critical moment of the previous miscarriage – situational (State) anxieties than those women without any anamnesis of miscarriage. Furthermore they show a higher risk of bleedings in early pregnancy. The women''s health during the first trimenon of a new pregnancy can be predicted based on coping processes after the miscarriage. Women who show depressive or pessimistic-anxious coping styles after the prenatal loss, have a higher risk of anxieties and depressive disorders in their new pregnancy. Conclusions: The results are discussed in relation to the care to women after a miscarriage and during a new pregnancy.