Orientadores: Paulo César Giraldo, Ana Katherine da Silveira Gonçalves / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-11-07T13:39:58Z (GMT). No. of bitstreams: 1 Araujo_EdilsonDiasde_D.pdf: 2801870 bytes, checksum: 056091a8cfb4211f4402aa3462d60140 (MD5) Previous issue date: 2010 / Resumo: As infecções urogenitais (IUG) são muito prevalentes durante a gestação e são reconhecidamente uma das principais causa de trabalho de parto prematuro. Entretanto, a prevalência de IUG no período intraparto é pouco conhecida. Diversas variáveis podem alterar a concentração das imunoglobulinas no colostro. A prematuridade e as infecções urogenitais têm sido estudadas como um destes fatores. Objetivos: Avaliar a prevalência de infecções urogenitais em gestantes durante o trabalho de parto pré-termo e a termo; quantificar os níveis de IgA secretória no colostro de puérperas de parto pré-termo e a termo com e sem infecção urogenital e correlacionar os níveis de IgA secretória nos colostros das puérperas com a presença de infecções urogenitais. Metodologia: No per iodo de janei ro a junho de 2009, 94 gestantes em trabalho de parto, atendidas na Maternidade Escola Januário Cicco (MEJC) da Universidade Federal do Rio Grande do Norte (UFRN), foram alocadas em dois grupos, 49 gestantes em trabalho de parto pré-termo e 45 gestantes em trabalho de parto a termo, foram convidadas a participar do estudo. Para uma melhor homogeneização dos resultados, apenas 34 mães de recém nascidos pré-termo (RNPT) e 38 mães de recém nascidos a termo (RNT), totalizando 72 mães que expressaram colostro no segundo dia de puerpério tiveram seus níveis de IgAs quantificados mediante a utilização de ensaio imunoenzimático (ELISA). Todas as gestantes assinaram o Termo de Consentimento Livre e Esclarecido e passaram por exame ginecológico, quando foi coletado material urinário, vaginal e perianal para estudo microbiológico. Resultados: Nos 94 casos estudados, a prevalência de infecções urogeni tais nas gestantes de parto pré-termo foi d 49,0% e nas gestantes de parto a termo de 53,3% (p=0,8300). Considerando-se os casos de infecções urogenitais, nas gestantes de parto pré-termo e a termo, encontrou-se ITU em 36,7% e 22,2%, candidíase vaginal em 20,4% e 28,9%, vaginose bacteriana em 34,7% e 28,9% e estreptococos do grupo B em 6,1 e 15,6%, respectivamente. Entre as 72 puérperas de recém nascidos de par to prétermo (34) e a termo (38) estudadas, a prevalência de infecções urogenitais nas gestantes de parto pré-termo foi de 50,0% e nas a termo de 52,6%. Considerando-s os casos de infecções urogenitais específicas, nas gestantes de parto pré-termo e a termo, encontraram-se infecção do trato urinário ( ITU) em 32,4% e 15,8%, candidíase vaginal em 17,6% e 26,3%, vaginose bacteriana em 38,2% e 31,6% e estreptococos do grupo B em 5,9% e 15,8%, respectivamente. As concentrações de IgAs foram significativamente mais elevadas no grupo de puérperas de RNPT (1051,3 mg/dL) que no grupo de puérperas de RNT (396,3 mg/dL). Conclusões: Os níveis de IgAs no colostro de mães de RN pré-termo foram significantemente mais elevados que os encontrados em mães de RN a termo. Entretanto apesar da elevada prevalência de diferentes infecções genitais intrapartais, estas não tiveram influência sobre os níveis médios de IgAs, sugerindo que este aumento observado no colostro de mães de RN pré termo esteja relacionado a fatores adaptativos da prematuridade e não a presença das infecções / Abstract: Urogenital Infections (UGI) are very prevalent during pregnancy and are admittedly one of the main causes of premature labor. Still, very little is known about the prevalence of UGI in the intrapartum period. Several variables can change the concentration of immunoglobulins in the colostrum. Prematurity and urogenital infections have been studied as some of these factors. Goal: Assessing the prevalence of urogenital infections in pregnant women during pre-term and fullterm labor; quantifying secretory IgA levels in the colostrum of pre-term and fullterm puerperal women with and without urogenital infection and correlate the levels of secretory IgA levels in the colostrum of pre-term and full-term mothers with urogenital infection. Methodology: 94 pregnant women in labor, who were admitted to Maternidade Escola Januário Cicco - Universidade Federal do Rio Grande do Norte, allocated in two groups, 49 in pre-term labor (PTL) and 45 in full-term labor (FTL), and were invited to participate in the study. For a better homogenization of results, only 72 mothers of PTL (34) and FTL (38) who manifested colostrum on the second day of puerperium had their levels of lgA quantified by immunoassay (ELISA). All these women signed a free and clarified consent term and underwent gynecological examination, when urine, vaginal and perianal samples were collected for microbiological study. Results: In 94 of the cases studied, the prevalence of general infections was 49.0% in the pregnant women in pre-term labor and 53.3% in the pregnant women in full-term labor (p=0.8300). Considering the cases of urogenital infections in both pre-term and full-term pregnant women, Urinary Tract Infection (UTI) was found in 36.7% and 22.2%, as well as Vaginal Candidiasis in 20.4% and 28.9%, Bacterial Vaginosis in 34.7% and 28.9% and Group B Streptococci in 6.1% and 15.6% respectively. Among the 72 PTN (34) and FTN (38) puerperal women studied, the prevalence of urogenital infections was 50.0% in PTN and 52.6% in FTN. Considering the cases of specific urogenital infections, in both PTN and FTN, Urinary Tract Infection (UTI) was found in 32.4% and 15.8%, and Vaginal Candidiasis in 17.6% and 26.3%, Bacterial Vaginosis in 38.2% and 31.6% and Group B Streptococci in in 5.9% and 15.8% respectively. The lgA concentrations were significantly higher in PTN puerperal women (1051.3 mg/dL) than in FTN puerperal women (396.3 mg/dL). Conclusions: The lgA levels in the colostrum of PTN mothers were significantly higher than that found in FTN mothers. However, in spite of the high prevalence of intrapartal genital infections, they did not have influence on the average levels of lgAs, suggesting this increase observed in the colostrum of PTN mothers might be related to adaptive factors of prematurity and not to the presence of infections / Doutorado / Fisiopatologia Ginecológica / Doutor em Ciências da Saúde

No description available.

Approximately 1 in 11 births in the United States are preterm (gestation). Within the United States, there are huge racial disparities for risk of preterm birth, an issue understudied and rarely addressed by research in the field. There is a wealth of biological knowledge surrounding pregnancy and labor, but causes for preterm birth are poorly understood. A genetic factor that has been shown to play a key role in many biological processes crucial to a healthy pregnancy and timely labor is microRNA (miRNA). MiRNA have an active role in the regulation of various tissues, especially developing tissues like those found in the placenta and uterus. Additionally, oxidative stress has been shown essential to placental development and the initiation of labor. Here, a study is proposed that aims to address the effect of oxidative stress on myometrial miRNA expression, specifically the miR-200 family and miR-199/214 cluster. This work also underscores the importance of addressing racial disparities with regards to preterm labor during research, while bringing up ethical considerations for conducting such research. The thesis will conclude with an outline of the many considerations vital for discussing the research and analysis of preterm birth disparities using a feminist, antiracist, queer self-reflexive analysis.

Neutrophils infiltrate myometrium and decidual tissue prior to parturition. Activated neutrophils release reactive oxygen species (ROS) and tumor necrosis factor α (TNFα), which might increase expression of pro-labor genes such as matrix metalloproteinase-1 (MMP-1), progesterone receptor (PR) A/B ratio, and cause demethylation of DNA. These changes might cause labor. Decidual tissue was obtained from consented, healthy women at term (37+ weeks of gestation) not in labor (no contractions, without cervical effacement), term labor and preterm labor (under 37 weeks of pregnancy). Decidual and myometrial cells in culture were treated with (1) ROS, (2) TNFα, or (3) 5-aza-2’-deoxycytidine. Total RNA was extracted, converted to cDNA and evaluated by qRT-PCR for MMP-1, PR-A+B and PR-B. TNFα increased MMP-1 by 17 fold in decidual cells and more than 12 fold in myometrial cells. PR-A/B was increased by 5.6 fold in decidua. ROS up-regulated MMP-1 by 6 fold and elevated the PR-A/B ratio by 4.5 fold in decidual tissue. DNA demethylation increased MMP-1 by about 4 and 11 fold in decidual and myometrium, respectively. The PR-A/B ratio was increased by 4 fold in decidua and the PR-B was decreased by 40% in the myometrium due to DNA demethylation. Decidual tissue in preterm labor showed a 7-fold increase in MMP-1 over term laboring and over a 15-fold increase over term not in labor tissue. In conclusion, MMP-1 expression and PR-A/B ratio was increased by neutrophil products possibly through a mechanism of DNA methylation in decidua and myometrium. Preterm decidua showed a dramatic increase in MMP-1 over normal labor tissue. TNFα and ROS increased expression of MMP-1 to possibly initiate parturition. These data might help explain mechanisms responsible for preterm labor unrelated to infection or premature rupture of membranes.

Orientador: Renato Passini Júnior / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-11-27T13:00:34Z (GMT). No. of bitstreams: 1 Gouveia_HelgaGeremias_D.pdf: 931546 bytes, checksum: 649c57d45b2bb56f7b161a505e6ccfcc (MD5) Previous issue date: 2010 / Resumo: Introdução: A prematuridade é definida como o nascimento que ocorre antes da 37º semana de gestação, sendo responsável por 75% da morbidade e mortalidade no período neonatal. Situações de risco para o desfecho da gestação influenciam de modo negativo a percepção de uma mulher sobre a qualidade de vida. Objetivo: Avaliar a qualidade de vida durante a gestação associada ao risco para parto prematuro. Método: revisão de literatura, seguida de estudo de corte transversal e comparativo, com três grupos de 54 gestantes (Grupo 1: sem risco atual para parto prematuro; Grupo 2: com fatores de risco para parto prematuro; Grupo 3: com trabalho de parto prematuro), totalizando 162 mulheres, realizado entre abril de 2008 a agosto de 2009 em maternidade de alto risco e unidade básica de saúde da cidade de Campinas (SP). Após assinatura de Termo de Consentimento Livre e Esclarecido foram verificadas informações sociodemográficas e obstétricas das mulheres e para avaliação da qualidade de vida foi aplicado o instrumento MOS-SF 36. Os dados foram analisados utilizando frequências, média e desvio-padrão. A homogeneidade entre os grupos foi avaliada pelos testes qui-quadrado de Pearson e exato de Fisher, para as variáveis categóricas e Kruskall-Wallis, seguido de Mann-Whitney para as variáveis contínuas. Ajustou-se um modelo de análise de variância (Anova) para comparar os domínios do SF-36 entre os grupos, contendo as variáveis: idade, renda familiar, número de gestações e número de abortos, seguido pelo teste de Bonferroni. O nível de significância adotado foi 5% e o software SAS, versão 9.1.3, foi utilizado na análise estatística. Resultados: há poucos estudos abordando a qualidade de vida durante a gestação. No estudo de corte os grupos apresentaram diferenças significativas em relação à idade e renda familiar (1X2 e 2X3); entre as gestantes dos Grupos 2 e 3, o principal antecedente obstétrico foi o trabalho de parto prematuro e a prematuridade foi a principal causa de filhos mortos; no Grupo 2 a insuficiência istmo-cervical foi a condição mórbida mais frequentemente encontrada. As características obstétricas que apresentaram diferença significativa entre os grupos (1X2 e 2x3) foram idade gestacional, número de gestações e aborto. Nos aspectos da Qualidade de Vida, verificamos, no total das gestantes analisadas, que o Estado Geral de Saúde foi o domínio de maior escore (71,9 pontos) enquanto que o item Aspectos Físicos foi o de menor escore (30,1). Na comparação entre grupos houve diminuição progressiva dos valores dos escores dos domínios do SF - 36, do Grupo 1 em relação ao 2 e deste em relação ao 3, com exceção da Capacidade Funcional, que foi menor no Grupo 2. Diferenças estatisticamente significativas foram observadas entre os Grupos 1 e 2 nos domínios Capacidade Funcional, Dor e Aspectos Sociais e entre os Grupos 1 e 3 nos domínios Capacidade Funcional, Aspectos Físicos, Dor, Aspectos Sociais, Aspectos Emocionais e Saúde Mental. Entre os Grupos 2 e 3 não houve diferenças entre os domínios. Conclusão: Gestantes de baixo risco (Grupo 1) apresentam melhor qualidade de vida quando comparadas com as de risco de parto prematuro (Grupos 2 e 3); a qualidade de vida entre as gestantes em trabalho de parto prematuro não foi diferente daquelas com fatores de risco de parto prematuro / Abstract: Introduction: Preterm birth occurs before 37 weeks' gestation, and accounts for 75% of neonatal morbidity and mortality. Situations of risk for the outcome of pregnancy would adversely affect a woman's perception on the quality of life. Objective: To evaluate the quality of life during pregnancy associated with risk for preterm delivery. Methods: literature review, followed by was a cross-sectional and comparative study, with three groups of 54 patients (group 1: no current risk for preterm delivery, group 2: with risk factors for preterm delivery and group 3, with preterm labor), totalizing 162 women, conducted from April 2008 to August 2009 in a high-risk maternity and in a primary care unit in Campinas (SP). After signing the consent form, demographic and obstetric information were collected, and the instrument MOS SF-36 was applied to evaluate quality of life. Data were analyzed using frequencies, mean and standard deviation. Homogeneity between groups was assessed using the Pearson chi-square test and Fisher exact test for categorical variables and Kruskall-Wallis followed by Mann-Whitney test for continuous variables. A model of analysis of variance (ANOVA) was set up to compare the domains of the SF-36 between groups, containing the variables: age, family income, number of pregnancies and abortions, followed by Bonferroni test. The level of significance was 5% and SAS software, version 9.1.3, was used for statistical analysis. Results: there are few studies addressing quality of life during pregnancy. In cross-sectional study groups showed significant differences on the subject of age and family income (1 versus 2 and 2 versus 3); among groups 2 and 3, main obstetric history was preterm labor and preterm birth was the main cause of child deaths; in group 2 cervical insufficiency was the most frequent morbid condition; obstetric characteristics that showed significant differences between groups (1 versus 2 and 2 versus 3) were gestational age, number of pregnancies and abortion. Regarding quality of life, among all women tested, General State of Health was the area of highest score (71.9 points) while Physical Aspects had the lowest scores (30.1). In the comparison between groups, there was a progressive decrease in scores in the domains of the SF - 36, group 1 compared to 2 and this in relation to 3, with the exception of Functional Capacity, that was lower in group 2. Statistically significant differences were observed between groups 1 and 2 in the domains Functional Capacity, Pain and Social Aspects and between groups 1 and 3 in the domains Functional Capacity, Physical Aspects, Pain, Social Aspects, Emotional Aspects and Mental Health. Between groups 2 and 3 there was no statistically significant difference in any of the domains. Conclusion: low risk pregnant women (group 1) had better quality of life compared to women who had risk factors or who were in preterm labor (group 2 and 3); quality of life among women in preterm labor was not different from those with risk factors for preterm birth / Doutorado / Saúde Materna e Perinatal / Doutor em Ciências da Saúde

Pregnancy in women with hemoglobinopathy has been associated with an increased risk of adverse pregnancy outcomes. We conducted a historical cohort study using Discharge Abstract Database for the fiscal year 1991-1992 through 2007-2008. We estimated the frequency of pregnant women with hemoglobinopathy and examined their associations with adverse pregnancy outcomes. Women with sickle cell disease are more likely to develop pre-eclampsia and preterm labor, and to undergo cesarean delivery than women with nutritional deficiency anemia, suggesting that there are other mechanisms beyond anemia that may be responsible for an increased risk of adverse pregnancy outcomes. The data suggested a synergistic effect of hemoglobinopathy and pre-eclampsia on preterm labor and cesarean delivery. Prediction models for pre-eclampsia, preterm labor and cesarean delivery were created and internally validated for women with hemoglobinopathy, with satisfactory discrimination and calibration.

Pregnancy in women with hemoglobinopathy has been associated with an increased risk of adverse pregnancy outcomes. We conducted a historical cohort study using Discharge Abstract Database for the fiscal year 1991-1992 through 2007-2008. We estimated the frequency of pregnant women with hemoglobinopathy and examined their associations with adverse pregnancy outcomes. Women with sickle cell disease are more likely to develop pre-eclampsia and preterm labor, and to undergo cesarean delivery than women with nutritional deficiency anemia, suggesting that there are other mechanisms beyond anemia that may be responsible for an increased risk of adverse pregnancy outcomes. The data suggested a synergistic effect of hemoglobinopathy and pre-eclampsia on preterm labor and cesarean delivery. Prediction models for pre-eclampsia, preterm labor and cesarean delivery were created and internally validated for women with hemoglobinopathy, with satisfactory discrimination and calibration.

Analysis of the genomic sequences of Streptococcus mutans UA159 and Group B Streptococcus (GBS) strains Streptococcus agalactiae NEM316 and S. agalactiae 2603V/R indicated the presence of two putative collagenase genes in each organism. smcol1 from S. mutans was previously cloned and analyzed and the results indicated that the enzyme belonged to the U32 family of collagenases/peptidases. This enzyme shares homology with the prtC of Porphyromonas gingivalis, one of the principal examples of the U32 family of peptidases. Considering the potential role of these enzymes in the pathogenicity of P. gingivalis (periodontitis or gum disease), GBS (premature rupture of the amniochorionic membrane) and S. mutans (dental root decay), it is necessary to study these enzymes and establish their role in the virulence of these organisms. Toward this goal the present study has focused on cloning collagenase 2 (smcol2) from S. mutans and cloning collagenase 1 (gbscol1), and collagenase 2 (gbscol2), from GBS. The information obtained will contribute to a further understanding of the U32 peptidase family.

Pregnancy in women with hemoglobinopathy has been associated with an increased risk of adverse pregnancy outcomes. We conducted a historical cohort study using Discharge Abstract Database for the fiscal year 1991-1992 through 2007-2008. We estimated the frequency of pregnant women with hemoglobinopathy and examined their associations with adverse pregnancy outcomes. Women with sickle cell disease are more likely to develop pre-eclampsia and preterm labor, and to undergo cesarean delivery than women with nutritional deficiency anemia, suggesting that there are other mechanisms beyond anemia that may be responsible for an increased risk of adverse pregnancy outcomes. The data suggested a synergistic effect of hemoglobinopathy and pre-eclampsia on preterm labor and cesarean delivery. Prediction models for pre-eclampsia, preterm labor and cesarean delivery were created and internally validated for women with hemoglobinopathy, with satisfactory discrimination and calibration.

Pregnancy in women with hemoglobinopathy has been associated with an increased risk of adverse pregnancy outcomes. We conducted a historical cohort study using Discharge Abstract Database for the fiscal year 1991-1992 through 2007-2008. We estimated the frequency of pregnant women with hemoglobinopathy and examined their associations with adverse pregnancy outcomes. Women with sickle cell disease are more likely to develop pre-eclampsia and preterm labor, and to undergo cesarean delivery than women with nutritional deficiency anemia, suggesting that there are other mechanisms beyond anemia that may be responsible for an increased risk of adverse pregnancy outcomes. The data suggested a synergistic effect of hemoglobinopathy and pre-eclampsia on preterm labor and cesarean delivery. Prediction models for pre-eclampsia, preterm labor and cesarean delivery were created and internally validated for women with hemoglobinopathy, with satisfactory discrimination and calibration.