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No. of bitstreams: 1 texto completo.pdf: 745153 bytes, checksum: 2b8b7c8496369cbf296f16b6798619a4 (MD5) Previous issue date: 2016 / Introdução: a gestação que atinge o pós-datismo, definido em 42 semanas de duração, está sob o risco de intercorrer com aumento de morbi-mortalidade materno-infantil. Visando a diminuição das intercorrências do pós-datismo, o protocolo do serviço da maternidade do Hospital Universitário Risoleta Tolentino Neves (HURTN) estabelece que pacientes com 41 semanas completas de gestação sejam admitidas para indução do parto. O misoprostol é um análogo sintético da prostaglandina utilizado para o amadurecimento cervical que antecede a indução. Objetivo: o estudo se propõe a avaliar o desfecho do processo de amadurecimento cervical com misoprostol em gestações prolongadas com 41 semanas ou mais no HURTN. Pacientes e métodos: foram analisadas 607 gestantes submetidas ao processo de amadurecimento cervical com misoprostol, no período de julho de 2007 a dezembro de 2015. Os dados foram colhidos retrospectivamente nos prontuários e as variáveis analisadas foram: via de parto, idade, paridade, medida de útero pela fita, uso de ocitocina, quantidade de comprimidos de misoprostol, taquissistolia uterina, amniotomia, vitalidade fetal, APGAR de 1 e 5 minutos e peso do recém-nascido. Resultados: Das 607 pacientes submetidas ao amadurecimento cervical com misoprostol, 189 pacientes (31,1%) foram submetidas a parto cesariano e 418 pacientes (68,9%) evoluíram para o parto vaginal, sendo 2 auxiliados com vácuo extrator e 46 auxiliados com fórcipes. As variáveis preditoras do modelo final que apresentam influência estatisticamente significativa (p < 0,05) no desfecho tipo de parto (cesariano ou vaginal) são: idade da paciente (anos), paridade (nenhuma ou ≥ 1), medida de útero com fita (cm), quantidade de misoprostol (comprimidos de 25 μg utilizados), índice de Bishop (medida real do índice) e taquissistolia (sim ou não). Conclusões: A taxa de 31,1% de parto cesariano em pacientes submetidas ao amadurecimento cervical está próxima da preconizada pela OMS- 30% e de outros estudos já publicados. De acordo com os resultados obtidos no estudo, as mulheres com idade mais avançada, nulíparas, que possuem maior medida de útero-fita, maior quantidade de misoprostol utilizado, com índice de Bishop mais baixo e com presença de taquissistolia uterina, submetidas a amadurecimento cervical com misoprostol, têm mais chance de serem submetidas ao parto cesariano. O modelo de cálculo proposto para prever o parto cesariano ainda precisa ser aperfeiçoado por outras variáveis e fatores. / Introduction: pregnancy that reaches the post-term, defined in 42 weeks, is at risk of increased maternal and child morbidity and mortality. Aiming at the reduction of post term pregnancy complications, the Risoleta Tolentino Neves University Hospital's maternity service protocol states that patients with 41 completed weeks of gestation are admitted for induction of labor. Misoprostol is a synthetic prostaglandin analogue used for cervical ripening prior to induction. Objective: The study aims to evaluate the cervical ripening process outcome with misoprostol in pregnancies with 41 completed weeks or more. Patients and Methods: They were analyzed 607 pregnant women undergoing cervical ripening process with misoprostol, from July 2007 to December 2015. Data were collected retrospectively from medical records and the variables analyzed were type of delivery, age, parity, fundal height, use of oxytocin, amount of misoprostol tablets, tachysystole, amniotomy, fetal vitality, APGAR 1 and 5 minutes and weight of the newborn. Results: of 607 patients undergoing cervical ripening with misoprosol, 189 patients (31.1%) underwent cesarean section and 418 patients (68.9%) underwent vaginal delivery, 2 assisted with vacuum extractor and 46 assisted with forceps. Predictors of the final model that have statistically significant influence (p <0.05) and combined with the outcome variable Type of delivery (cesarean section or vaginal) are: patient's age (years), parity (None or ≥ 1), fundal height (cm), Misoprostol quantity (25 μg), Bishop index (real index measurement) and tachysystole (Yes or No). Conclusions: the cesarean delivery rate in patients undergoing cervical ripening- 31.1% - is close to that advocated by World Health Organization- 30% and of that published by other studies. According to the results obtained in the study, the probability of an older women, nulliparous, that has greater fundal height measure, a greater amount of misoprostol used, lower Bishop Score and presence of uterine tachysystole has more chances of delivering by a cesarean section. The proposed model to predict cesarean delivery needs to be improved by other variables and factors. / Não foi apresentado título em inglês. Não foi localizado o cpf do autor.

Abstract Each year approximately 11,000 induced abortions are performed in Finland, the majority of these women being younger than 25 years of age. Medical abortion with the antiprogestin mifepristone and the prostaglandin analogue misoprostol is increasingly being used instead of surgical method (dilatation of cervix and uterine evacuation with instruments). Similarly, miscarriages can be treated with medical or surgical management. Still, clinical outcomes of the medical treatment of miscarriage are not well established, and various different regimens exist. The aim of this study was to investigate the frequency and risk factors of repeat abortions and immediate post-abortal complications, focusing especially on the impact of the method of abortion. National health registries were used as a data source. Another part of the study was aimed at comparing the efficacy, acceptability and cost-effectiveness of the medical and surgical treatment of miscarriage. In national cohort, the risk of repeat abortion was associated with sociodemographic characteristics (parity, previous abortion, low socioeconomic status, being unmarried but cohabiting or single), but not with the method of abortion. The risk of repeat termination of pregnancy decreased with age, among women living in rural area, and when intrauterine devices or sterilization were planned for future contraception. The overall incidence of adverse events was 4-fold greater in the medical compared to the surgical abortion cohort. Hemorrhage and incomplete abortion were more common following medical abortion, but the incidence of infections did not differ. Medical and surgical treatment of miscarriage were compared in a randomized setting; the efficacy of the treatment did not differ. Medically treated patients were less satisfied with the treatment and had experienced more pain. In the cost analysis, the primary costs of the surgical treatment were higher, but more unexpected events and complications increased the secondary costs in the medical group. In summary, medical abortion offered a good alternative to surgical method without increasing the risk of repeat abortions, but with an increased risk of short-term adverse events. The medical method was efficient in treating miscarriages, and the majority of women were satisfied with the treatment. Neither of the methods was economically superior in treating miscarriage.

La presente es una investigación bibliográfica y tuvo como objetivos describir, comprender y analizar el contexto bioético de la venta del misoprostol en las farmacias y boticas del Perú. Se analizó la documentación científica así como oficial de instituciones públicas y privadas, nacionales e internacionales, como los riesgos para la salud y vida de la mujer del uso del misoprostol de manera clandestina, la vigencia de este medicamento en las terapias como protector de la mucosa gástrica, su venta en las farmacias y boticas de manera oficial y clandestina. Los resultados indicaron que sí existen por la venta del misoprostol al público transgresiones contra principios bioéticos y regulatorios que ponen en riesgo la vida y la salud de la mujer y del concebido. Las conclusiones proponen alternativas a los problemas bioéticos que plantea este medicamento en su venta en farmacias y boticas del Perú.

Sucralfate is a drug that effectively heals duodenal, gastric and oesophageal ulcers. It is not absorbed systemically and it has been shown to act locally by coating the ulcer base. However when it was also shown to prevent stress ulcers and ethanolinduced gastric mucosa! lesions, it seemed likely that it acted in some way to improve the effectiveness of the gastric mucosa! barrier. Some investigators suggested that it did so by stimulating local prostaglandin release. The Slomiany group, on the basis of in vitro work on the effects of Sucralfate on pig gastric mucus, claimed that Sucralfate acted by altering the physico-chemical properties of mucus to increase the viscosity and retard the back diffusion of H+ ions. The work described in this dissertation set out to verify, in vivo, these claimed effects on mucus, using an experimental porcine model of peptic ulceration, the bile duct ligated pig. In addition, the effects of Sucralfate were compared with those of Famotidine and Misoprostol, and changes in mucous prostaglandins, gastric juice pepsin and gastric flora were sought. By way of introduction, the known and postulated actions of Sucralfate, current understanding of gastric mucus physiology and pathogenesis of peptic ulceration, have been reviewed, as have experimental animal models of peptic ulceration, in order to justify using the bile duct ligated pig model.

Erosive und ulzerative Schleimhautveränderungen sind die häufigste Erkrankung des Pferdemagens, stellen jedoch den Praktiker häufig therapeutisch vor Herausforderungen. Insbesondere der drüsenhaltige Anteil des Magens spricht bei Ausbildung einer Equine Glandular Gastric Disease (EGGD) häufig nicht zufriedenstellend auf die gängigen Medikationsprotokolle an. Ziel dieser Studie war daher der Vergleich der Standardtherapie mit Omeprazol und Sucralfat mit einer Misoprostol-Monotherapie und einer kombinierten Therapie aus Omeprazol und Misoprostol bei Pferden mit EGGD. Zu diesem Zweck wurden die gastroskopischen Befunde an Pars glandularis und Pars non-glandularis von 67 Pferden vor und nach Therapie an einer Pferdeklinik retrospektiv nach einem klinikinternen Scoringsystem beurteilt. 29 Pferde wurden mit Omeprazol (2 – 4 mg/kg KM q. 24h) und Sucralfat (12 mg/kg KM q. 12h), 28 Pferde mit Misoprostol (5 µg/kg KM q. 12h) und 10 Pferde mit Omeprazol (2 – 4 mg/kg KM q. 24h) und Misoprostol (5 µg/kg KM q. 12h) therapiert. Mittlere Therapiedauer waren 28 Tage (Omeprazol/Sucralfat und Misoprostol) und 35 Tage (Omeprazol/Misoprostol). Nach der Therapie mit Misoprostol kam es zu einer Verbesserung von EGGD-Befunden mit signifikant niedrigeren Median-Werten. Bei der Therapie mit Omeprazol/Sucralfat kam es an der Pars glandularis zu ausbleibenden Veränderungen oder nur geringgradigen Verbesserungen. Omeprazol/Misoprostol bewirkten ein nicht signifikantes Sinken des Medians der gescorten EGGD-Befunde. An der Pars squamosa fielen nach der Therapie mit Omeprazol und Sucralfat ausbleibende Verbesserungen und teils Verschlechterungen der ESGD-Befunde auf. Die Monotherapie mit Misoprostol war sowohl der Therapie mit Omeprazol und Sucralfat als auch einer kombinierten Therapie mit Omeprazol und Misoprostol bei Pferden mit EGGD überlegen. Zudem zeigten sich Schwächen der Omeprazol/Sucralfat-Therapie bei der ESGD-Therapie.:1. Einleitung 2. Literaturübersicht 2.1 Terminologie Magengeschwüre 2.2 Pathogenese 2.2.1 ESGD 2.2.2 EGGD 2.3 Ätiologie 2.4 Klinik 2.5 Diagnostik 2.6 Scoring 2.7 Therapie 2.7.1 Omeprazol 2.7.2 Ranitidin 2.7.3 Cimetidin 2.7.4 Sucralfat 2.7.5 Misoprostol 2.7.6 Weitere Therapieansätze bei EGGD 3. Publikation 5. Zusammenfassung 6. Summary 7. Literaturverzeichnis 8. Anhang 8.1 Veröffentlichte Artikel 8.2 Veröffentlichte Konferenzbeiträge 9. Danksagung

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