O aborto espontâneo recorrente (AER) caracteriza-se pela ocorrência de três ou mais abortos consecutivos espontâneos até a 20ª semana de gestação. É uma condição patológica multifatorial, em que alterações morfológicas uterinas, distúrbios endócrinos, alterações no cariótipo, polimorfismos genéticos relacionados aos genes envolvidos no metabolismo da homocisteína, hemostasia, infecções, autoanticorpos e o processo inflamatório podem contribuir para a ocorrência de AER. O estado fisiológico do endométrio é essencial para a implantação do embrião no útero durante a gestação. Na interface materno-fetal, há uma modulação de citocinas, necessária para o estabelecimento da angiogênese e desenvolvimento da placenta. Um desequilíbrio entre as citocinas pode diminuir a tolerância ao feto e ocasionar rejeição fetal. A concentração de citocinas pode ser modificada por conta de uma diminuição na expressão de alguns genes, e esta pode ser regulada pelo seu estado de metilação sítio-específica. A metilação do DNA é um mecanismo epigenético de regulação gênica, e que corresponde à incorporação de grupos metila em ilhas CpG localizadas próximas às regiões promotoras de genes humanos, e isso pode ser importante na avaliação do risco de complicações gestacionais. Além disso, o estado nutricional de vitaminas foi relacionado a alterações no padrão de metilação de alguns genes. Os objetivos deste trabalho foram avaliar as concentrações dos mediadores inflamatórios em mulheres com aborto e em grupo controle, verificar correlações entre as concentrações de vitaminas, homocisteína total e taxa de metilação do DNA, verificar correlações entre concentração de citocinas e taxa de metilação do DNA e determinar odds ratio (IC 95%) de ter aborto em modelos multivariados. Foram incluídas 253 mulheres com história de aborto recorrente e 264 mulheres saudáveis (controle). O DNA foi extraído de leucócitos de sangue periférico para o estudo de metilação. Foram separadas alíquotas de soro e plasma para dosagem de vitaminas, metabólitos e citocinas. Não foram encontradas diferenças nas taxas de metilação do DNA entre os grupos aborto e controle. A citocina TNFα está aumentada nos grupos de aborto em comparação ao controle. A taxa de metilação do DNA no gene IFNG foi correlacionada inversamente às concentrações de folato sérico e citocina IFNγ no grupo controle. E as concentrações de IL10 foram inversamente correlacionadas à taxa de metilação do DNA nos grupos de aborto secundário e controle. Neste trabalho, verificou-se que as vitaminas e as citocinas influenciam na taxa de metilação do DNA do gene IFNG e a citocina pró-inflamatória TNFα apresenta-se aumentada em mulheres com história de aborto. / Recurrent spontaneous abortion (RSA) is characterized by the occurrence of three or more consecutive spontaneous abortions until the 20th week of gestation. It is a multifactorial pathological condition in which morphological uterine, endocrine disorders, changes in the karyotype genetic polymorphisms related to genes involved in homocysteine metabolism, infection, autoimmunity and inflammatory processes may contribute to the occurrence of RSA. The physiological state of the endometrium is essential for embryo implantation in the uterus during pregnancy. In maternal-fetal interface, there is a modulation of cytokines necessary for the establishment and development of placental angiogenesis. An imbalance between cytokines can decrease tolerance to fetus and cause fetal rejection. Concentration of cytokines may be modified due to a decrease in the expression of genes related to some of these cytokines that can be regulated by DNA methylation, which is an epigenetic mechanism of gene regulation and which corresponds to the incorporation of groups Methyl CpG islands located near the promoter regions of human genes, and this may be important in assessing the risk of pregnancy complications. In addition, the nutritional status of vitamins was associated with changes in the methylation pattern of certain genes. The aims of this study were to determine the concentrations of inflammatory mediators in women with abortion and the control group, examine correlations between concentrations of vitamins, total homocysteine and DNA methylation rate, examine correlations between cytokine concentration and DNA methylation and determine odds ratio (95% CI) of having abortion in multivariate models. We included 253 women with a history of recurrent miscarriage and 264 healthy women (control). DNA was extracted from peripheral blood leukocytes for the study of methylation. Serum and plasma aliquots were used for determination of vitamins, metabolites and cytokines. There were no differences in rates of DNA methylation between control and abortion groups. The cytokine TNFα is increased in abortion groups compared to the control. DNA methylation rate in gene IFNG was inversely correlated with serum folate and serum cytokine IFNγ in the control group. Also IL10 concentrations were inversely correlated to DNA methylation rate in groups of miscarriage and secondary control. In this work, it was found that vitamins and cytokines influence DNA methylation rate in the promoter region and are different in the study and control groups.

O aborto espontâneo recorrente (AER) é definido pela ocorrência de três ou mais abortos espontâneos consecutivos com idade gestacional de até 20 semanas. O AER é um evento multifatorial, tem um índice de elucidação da causa na ordem de 50% e, mesmo com os avanços da medicina diagnóstica ainda assim 40% dos casos permanecem com sua causa desconhecida. O crescimento fetal é totalmente dependente do aporte de nutrientes oirundos da mãe, dentre esses nutrientes a cobalamina e o ácido fólico desempenham um papel fundamental para a viabilidade fetal. O objetivo geral deste estudo foi investigar se existe associação entre polimorfismos em genes relacionados ao metabolismo da cobalamina (MTHFR c.677C>T, TCN2 c. 776C>G e TCN2 c. 67A>G), e o aborto espontâneo recorrente. Os objetivos específicos deste estudo foram: 1 determinar se os polimorfismos MTHFR c. 677C>T, TCN2 c. 776C>G e TCN2 c. 67A>G estão associados ao aborto primário e secundário. 2 - Avaliar se os genótipos dos polimorfismos estudados estão relacionados com as concentrações séricas de cobalamina, folato e homocisteína total em mulheres com aborto espontâneo recorrente. Foram incluídas 256 mulheres com história de abortos espontâneos recorrentes, provenientes do Ambulatório de Obstetrícia da Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da USP e 264 mulheres saudáveis, sem história de aborto espontâneo e que tenham tido pelo menos duas gestações normais (grupo controle), pareadas segundo as idades. Foram colhidas amostras de sangue para a realização das dosagens bioquímicas, hormonais e das vitaminas e também para a realização das genotipagens dos polimorfismos por meio de PCR-RPFL (MTHFR c.677C>T , TCN c.776C>G e c. 67A>G). As dosagens bioquímicas e hormonais apresentaram resultados dentro dos limites de variação do normal. Quanto as concentrações de folato e cobalamina, houve diferença estatística significante entre os grupos p<0,05. As frequências dos genótipos e alelos para os polimorfismos estudados comparadas entre os grupos abortos primário, aborto secundário e grupo controle não apresentaram diferença estatística significante. Optamos a seguir por dividir o grupo de estudo entre abortos primários, onde não existe história de feto viável, e secundário neste caso onde há história de feto viável. Desta forma foram refeitas as análises estatísticas entre os grupos e encontramos diferença estatísticamente significante p<0,05 quando confrontamos os genótipos do polimorfismo TCN c.776C>G entre o grupo primário e o grupo controle. Em conclusão, quando comparamos as frequência dos genótipos e alelos em conjunto não apresentaram associação com o AER. Quando comparado separadamente o grupo de aborto primário e grupo controle houve diferença estatística significante associando o polimorfismo TCN2 c.776C>G ao AER primário. / The recurrent spontaneous abortion (RSA) is defined by the occurrence of three or more consecutive miscarriages with gestational age up to 20 weeks. The AER is a multifactorial event, has an index of elucidating the cause of around 50% and, even with advances in diagnostic medicine still remain 40% of cases with a known cause. Fetal growth is totally dependent on the supply of nutrients from the mother oirundos among these nutrients cobalamin and folic acid play a key role in fetal viability. The aim of this study was to investigate whether there is an association between polymorphisms in genes related to metabolism of cobalamin (MTHFR c.677C> T, c TCN2. 776c> G and c TCN2. 67A> G), and recurrent miscarriage. The specific objectives of this study were: 1 determine whether MTHFR c. 677C> T, TCN2 c. 776c> G and c TCN2. 67A> G are associated with abortion primary and secondary. 2 - Assess whether the genotypes studied polymorphisms are associated with serum concentrations of cobalamin, folate and total homocysteine in women with recurrent spontaneous abortion. We included 256 women with a history of recurrent miscarriages, from the Clinic of Gynecology, Obstetrics, Hospital das Clinicas, Faculty of Medicine, USP and 264 healthy women with no history of miscarriage and have had at least two normal pregnancies (group control), matched according to age. Blood samples were collected to perform the biochemical, hormonal and vitamins and also to perform the genotyping of polymorphisms by PCR-RPFL (MTHFR c.677C> T, TCN c.776C> G and c. 67A> G). The biochemical and hormonal results presented within the limits of normal variation. As the concentrations of folate and cobalamin, statistically significant difference between groups p <0.05. The frequencies of genotypes and alleles for the polymorphisms studied compared between groups abortions primary, secondary and abortion control group showed no statistically significant difference. We chose then to divide the study group between primary abortions where there is a history of viable fetus, and secondary in this case where there is a history of viable fetus. Thus were repeated statistical analyzes between groups and found statistically significant difference p <0.05 when confronted TCN genotypes of polymorphism c.776C> G between the primary group and the control group. In conclusion, when comparing the frequency of genotypes and alleles together apresntaram no association with AER. When compared separately the group of abortion primary and control group was statistically significant associated polymorphism TCN2 c.776C> G the primary AER.

Abstract not available

Ett missfall är en stor och omtumlande händelse i en kvinnas liv. Under denna tid har vårdgivaren stor betydelse i hur kvinnan klara sin situation och för att kunna gå vidare. Syftet med denna litteraturstudie var att beskriva kvinnors upplevelser av stöd vid missfall. Detta kan hjälpa sjuksköterskor att förstå kvinnan bättre i hennes situation vid missfall.  Metoden var en litteraturöversikt enligt Friberg (2006). Materialet som använts för att få fram översikten är nio stycken vetenskapliga artiklar. I resultatet framkom två huvudområden: känslomässigt stöd och praktiskt stöd med fem olika underområden: socialt stöd, professionellt stöd, bemötande och attityd, uppföljning och information. För kvinnor spelade bemötandet en stor roll i hur de upplevde sin situation. En negativ aspekt var att personalen i vissa fall inte behandlade kvinnorna individuellt. Det stöd och den vård som ges vid ett missfall ska göras så bra som möjligt med tanken att varje fall är individuellt och unikt. Detta genom att lyssna till vad kvinnan behöver och forma vården efter henne. / A miscarriage is a big and chaotic event in a woman's life. During this time caregiver has an important role in how women cope with their situation and how they move forward. The purpose of this literature review was to highlight women’s experiences of support at miscarriage. This can help nurses to better understand the woman in her situation in a miscarriage. The method was a literature review according to Friberg (2006). Nine scientific articles formed the base of the review. The results revealed two main areas: emotional support and practical assistance with five different sub-areas: social assistance, professional support, treatment and attitude, follow up and information. It appeared both positive and negative experiences of the provided care. The support and care provided by nurses at an miscarriage should be as good as possible with the idea that each case is individual and unique. This by listening to what the women need and shaping health care for her.

Bakgrund: Missfall är en vanlig komplikation till graviditet. Upplevelsen är individuell och kan innebära ett behov av stöd. Det finns olika typer av stöd, emotionellt och kognitivt stöd. I Sverige är det vanligt att kvinnor som fått missfall blir inlagda på en gynekologisk avdelning vilket gör att sjuksköterskan möter dessa kvinnor. Syfte: Syftet var att beskriva kvinnors behov av stöd från sjuksköterskan vid missfall. Metod: En litteraturstudie innehållande tio kvalitativa och kvantitativa vetenskapliga originalartiklar gjordes. Artiklar söktes i databaserna Cinahl, PubMed och PsychInfo, därefter kvalitetsgranskades och analyserades de. Resultat: Ur analysen framkom det att kvinnor som vårdats för missfall hade behov av både emotionellt och kognitivt stöd. Några kvinnor fick behovet av stöd tillgodosett, andra var missnöjda med stödet. Slutsats: Sjuksköterskan bör se till att kvinnan känner sig sedd och förstådd i sin situation och vara medveten om att kvinnor upplever missfallet på olika sätt Därför kan stödet som kvinnorna behöver och efterfrågar vara olika. Sjuksköterskan bör bemöta med empati, detta för att kvinnan ska känna sig optimalt stöttad och återhämta sig bättre. / Background: Miscarriage is a common complication of pregnancy. The experience is individual and may imply a need for support. There are different types of support, emotional and cognitive support. In Sweden it is common that women who have had a miscarriage are admitted to a gynaecological ward which means that the nurse meets these women. Aim: The aim was to describe women's need of support from the nurse at miscarriage. Method: A literature review was made and was based on ten qualitative and quantitative original scientific articles. Articles were searched in the databases Cinahl, PubMed and PsychInfo. The articles were reviewed for quality and analyzed. Results: From the analysis it was found that women who received treatment for miscarriage had need of both emotional and cognitive support. Some women were satisfied with the support that was given to them others were dissatisfied with the support. Conclusion: Nurses should ensure that women feel seen and understood in their situation, and be aware that women experience miscarriage differently. Therefore, the support that women need and demand may vary. The nurse should respond with empathy, in order that the woman will feel optimally supported and recover better.

How would you feel if after having spent many years incarcerated for a crime that you did not commit and when finally you are released to a broken life where there is nobody to respond effectively to all the damages that you have and that you will continue to endure due to an unfortunate miscarriage of justice? In Canada, compensation for wrongful convictions is a legal issue which has yet to find a solution for those who the government has denied to pay compensation for and the damages such wrongful conviction brought to their lives. This thesis will analyze the legal problem of compensation for wrongful convictions in Canada from a tort law perspective and will present an alternative to the existing regime to serve justice to those who have been victims of miscarriages of justice.

How would you feel if after having spent many years incarcerated for a crime that you did not commit and when finally you are released to a broken life where there is nobody to respond effectively to all the damages that you have and that you will continue to endure due to an unfortunate miscarriage of justice? In Canada, compensation for wrongful convictions is a legal issue which has yet to find a solution for those who the government has denied to pay compensation for and the damages such wrongful conviction brought to their lives. This thesis will analyze the legal problem of compensation for wrongful convictions in Canada from a tort law perspective and will present an alternative to the existing regime to serve justice to those who have been victims of miscarriages of justice.

Trots att så många kvinnor drabbas av missfall är det ett ämne som det inte talas om i Västerländsk kultur. Kvinnor som genomgår missfall upplever därför ofta brister i socialt stöd i samband med missfallet. Av denna anledning spelar bemötandet från vårdpersonal en betydande roll då det kanske är den enda möjligheten kvinnan har att tala med någon om sitt missfall, men också för att få svar på viktiga frågor.      Den här uppsatsen syftar till att öka kunskapen om kvinnors upplevelser av missfall och bemötande från vårdpersonal. En induktiv forskningsansats med en kvalitativ metod har använts i denna studie. Sex halvstrukturerade intervjuer har genomförts med kvinnor från olika geografiska områden i Sverige.      Resultatet visar att kvinnorna delar upplevelsen av att ha förlorat ett önskat barn. De beskriver även sina upplevelser av de känslomässiga reaktioner som följer efter ett missfall och som handlar och chock, skuld och om sorg. Vidare beskrivs vilka reaktioner de fått från personer i omgivningen i samband med sin förlust och hur de upplevt den fysiska smärtan i samband med missfallet. Slutligen framkommer kvinnornas upplevelser av bemötandet från vårdpersonal som de beskriver i form av att få information, förmågan att förmedla en känsla och visa sig personligt berörd, att ge tid och utrymme för samtal och även återkoppling och uppföljning.      Diskussionen av resultatet har gjorts med hjälp av Cullbergs kristeori och tidigare forskning. Som avslutning redovisas allmänna reflektioner och förslag på fortsatt forskning. / Despite the significant number of miscarriages that occur, miscarriage is not an often discussed topic in Western culture. Therefore, women that are affected by miscarriage often experience a lack of social support from people in the environment.      Because of this reason, treatment from healthcare providers has an important role because it may be the only opportunity the women have to discuss her feelings about the miscarriage and to get answers about important questions that she may have.      This essay is referring to increase the knowledge about women’s experience of miscarriage and healthcare providers. An inductive research approach with a qualitative method has been used in this essay. Six semi structured interviews has been fulfilled with women from different geographical areas around Sweden.      My results show that women share the experience of the loss of child that they have been longing for. They describe their experience of their emotional reactions that fallows after miscarriage in the variety of chock, guilt and grief. They also describe different reactions from people in the environment in association with their loss and how they experience the physical pain.      Finally, women’s experience of the treatment from healthcare providers are described in the variety of information, the ability to convey a feeling and express personal concerns, time and space to talk but also feedback and fallow up care.      Discussion of the results has been done with help from Cullbergs crisis theory and previous research. As a finish, general reflections and suggestions to further research is presented.

<p>Ett missfall är en stor och omtumlande händelse i en kvinnas liv. Under denna tid har vårdgivaren stor betydelse i hur kvinnan klara sin situation och för att kunna gå vidare. <strong>Syftet</strong> med denna litteraturstudie var att beskriva kvinnors upplevelser av stöd vid missfall. Detta kan hjälpa sjuksköterskor att förstå kvinnan bättre i hennes situation vid missfall.  <strong>Metoden</strong> var en litteraturöversikt enligt Friberg (2006). Materialet som använts för att få fram översikten är nio stycken vetenskapliga artiklar. I <strong>resultatet</strong> framkom två huvudområden: känslomässigt stöd och praktiskt stöd med fem olika underområden: socialt stöd, professionellt stöd, bemötande och attityd, uppföljning och information. För kvinnor spelade bemötandet en stor roll i hur de upplevde sin situation. En negativ aspekt var att personalen i vissa fall inte behandlade kvinnorna individuellt. Det stöd och den vård som ges vid ett missfall ska göras så bra som möjligt med tanken att varje fall är individuellt och unikt. Detta genom att lyssna till vad kvinnan behöver och forma vården efter henne.</p> / <p>A miscarriage is a big and chaotic event in a woman's life. During this time caregiver has an important role in how women cope with their situation and how they move forward. <strong>The purpose</strong> of this literature review was to highlight women’s experiences of support at miscarriage. This can help nurses to better understand the woman in her situation in a miscarriage. <strong>The method</strong> was a literature review according to Friberg (2006). Nine scientific articles formed the base of the review. <strong>The results</strong> revealed two main areas: emotional support and practical assistance with five different sub-areas: social assistance, professional support, treatment and attitude, follow up and information. It appeared both positive and negative experiences of the provided care. The support and care provided by nurses at an miscarriage should be as good as possible with the idea that each case is individual and unique. This by listening to what the women need and shaping health care for her.</p>

Thesis (D. Min.)--New Orleans Baptist Theological Seminary, 2007. / Abstract and vita. Includes final project proposal. Includes bibliographical references (leaves 139-142, 56-57).