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This literature review explored health care system experiences of women who miscarried. Particular attention was placed on the women's psychological well-being including coping and, grief needs along with cultural concerns. The findings indicated a need for future qualitative research to be conducted in order to examine the lived experience of women who miscarry. With new advanced home diagnostic technologies allowing women to confirm pregnancy before their first missed menstrual period, future research must place focus on early pregnancy loss occurring before the 12th week of gestation. With pregnancies capable of being identified prior to establishment of formal prenatal care, there is a need to provide better support and counseling services in the ambulatory setting. Additionally, in an effort to optimize pregnancy outcomes, perinatal care guidelines must include preconception counseling for all women of childbearing age. Lastly, the phenomenon of miscarriage requires further examination from the male partner's perspective in order to improve overall nursing care within an event that affects a family.

Diss. (sammanfattning) Linköping : Univ., 2003. / Härtill 4 uppsatser.

Bakgrund: I Sverige slutar ungefär 12-13 % av alla kända graviditeter med missfall. De flesta sker innan graviditetsvecka 13 och räknas därmed som tidiga. Många kvinnor upplever att vårdpersonalen inte ger dem det stöd de behöver. Detta kan bero på bristfällig kunskap om den känslomässiga processen vid tidiga missfall. Syfte: Syftet med denna litteraturstudie var att beskriva kvinnors upplevelser i samband med tidiga missfall. Metod: I litteraturstudien har 10 kvalitativa empiriska studier sammanställts och analyserats utifrån Fribergs analysmetod, inspirerad av beskrivande syntes. Artikelsökning utfördes i databaserna Cinahl, Pubmed och SweMed+. Resultat: Upplevelserna vid tidiga missfall innefattar psykiska, existentiella och sociala aspekter samt omvårdnadsrelaterade upplevelser. Missfallet upplevs ofta som en oväntad förlust vilket kan medföra reaktioner som sorg, ifrågasättande av den egna identiteten och skuldkänslor. Många kvinnor känner sig missförstådda av sina anhöriga och att vårdpersonalen inte uppmärksammar deras känslor, upplevelser och behov. Slutsats: Litteraturstudiens resultat visar att kvinnor vill bli bemötta med respekt och förståelse vid tidiga missfall. För att förbättra omvårdnaden av dessa kvinnor krävs personcentrerad omvårdnad som uppmärksammar deras individuella behov, utbildning bland vårdpersonalen samt ytterligare forskning inom området. / Background: About 12-13 % of all recognised pregnancies in Sweden end in a miscarriage. The majority of these occur before gestational week 13 and are therefore classified as early. Many women experience inadequate support from the nursing staff. This could be related to a limited knowledge about the emotional process subsequent to early miscarriages. Aim: The aim of this study was to describe women’s experiences associated with early miscarriages. Methods: In this literature study 10 empirical studies were compiled and analysed with Friberg’s method of analysis, inspired by descriptive synthesis. Article search was performed in the Cinahl, PubMed and SweMed+ databases. Results: The experiences of early miscarriages include psychological, existential and social aspects and experiences connected to nursing care. The miscarriage is often perceived as an unexpected bereavement that can bring about reactions such as grief, questioning of one’s identity and guilt. Many women feel misunderstood by their friends and families and that the nursing staff does not recognize their feelings, experiences and needs. Conclusion: The result of the literature study shows that women want to be met with respect and understanding during the time of early miscarriage. Person centred care that recognise the women’s individual needs, education among the staff and further research in this area is needed to improve the nursing care of these women.

Bakgrund: Av alla graviditeter slutar 10-20% med ett missfall, vilket betyder att det är vanligt förekommande och drabbar många kvinnor. Ett missfall kan innebära en väldigt traumatisk upplevelse för den drabbade och är både psykiskt och fysiskt påfrestande.   Syfte: Syftet med litteraturstudien är att beskriva kvinnors upplevelser av missfall.   Metod: Litteraturstudie där resultatet baseras på 10 vetenskapliga artiklar baserade på en kvalitativ ansats.   Resultat: Vid ett missfall upplevde kvinnorna i studierna ofta att vårdpersonal gav för lite information och hade bristande förståelse. Mer psykosocialt stöd var en återkommande önskan, då de sällan blev erbjudna det. Missfallet innebar mer än att förlora ett framtida barn. Det var en komplex situation, där kvinnan drabbades av både fysisk och psykisk smärta. Känslor såsom att förlora kontrollen, att skuldbelägga sig själv, oro och rädsla inför framtiden var ofta förekommande. Sorgen över vad de kunde haft var något som kunde vara i flera år efter missfallet. Att få bearbeta sorgen visade sig vara en väldigt viktig del för de flesta kvinnorna.   Slutsats: Sorg är något som de flesta kvinnor upplever efter ett missfall och många av dem efterfrågar mer stöd och hjälp i hanteringen av sorgearbetet. Att drabbas av psykisk ohälsa, såsom depression och ångest är vanligt förekommande efter ett missfall. Genom att erbjuda alla drabbade kvinnor psykosocialt stöd i anslutning till missfallet kan psykisk ohälsa och onödigt lidande förebyggas. Det finns ett behov av ett bättre bemötande samt mer information från vårdpersonal. Eftersom brist på information kan leda till att kvinnan skuldbelägger sig själv bör detta prioriteras. Sjukvårdspersonal behöver mer kunskap gällande upplevelser av missfall för att kunna ge en tillfredsställande omvårdnad där kvinnan känner sig trygg och väl bemött. Det bör dock tas hänsyn till att allas upplevelser av ett missfall är individuellt och vården bör därför anpassas därefter. / Background: Of all pregnancies, 10-20% end with miscarriage, which means that it is a common matter and affects many. It can be a very traumatic experience and the effects it has on women can be both mental and physical.   Purpose: The purpose of this literary study is to describe women's experiences of miscarriage.   Method: The method of the research is a literary study, which is based on 10 original articles, with a qualitative approach.   Results: When a miscarriage occurred, women often felt that the care staff offered limited information and had a lack of understanding. More psychosocial support was a recurring desire as the women seldom felt that they were provided with it. The miscarriage meant more to them than losing a future child. It was a complex situation where the woman was in both physical and mental pain. Emotions such as lack of control, self-blame, anxiety, fearing for the future and sorrow were frequent. Grieving over what they could have had was something that could be experienced over several years after the miscarriage. Processing the grief was a very important part for most women.    Conclusion: Grief is something that most women experience after a miscarriage and many of them are asking for more support and help in dealing with grief. To suffer from mental illness, such as depression and anxiety are common after a miscarriage. By offering all affected women psychosocial support after the miscarriage, mental illness and unnecessary suffering can be prevented. There is a need for a better refutation as well as more information from health professionals. Because of the lack of information woman sometimes blames themselves, therefore this should be a priority. Healthcare professionals need more knowledge regarding experiences of miscarriage in order to provide adequate care where the woman can feel safe and be treated well. However, it should be taken into account that everyone's experience of a miscarriage are individually and care should therefore be adjusted accordingly.

O aborto espontâneo recorrente (AER) é caracterizado pela ocorrência de três ou mais abortos consecutivos e acomete 2-4% das mulheres em idade fértil. A etiologia está associada a vários fatores de risco, tais como anomalias uterinas, aberrações cromossômicas, autoimunidade, trombofilias, elevação na concentração de homocisteína (tHcy), porém cerca de 40% dos casos permanece sem causa definida. O metabolismo de unidades de carbono desempenha papel fundamental na disponibilidade de folato na célula, sendo essencial para o desenvolvimento placentário e fetal. Deficiência de vitaminas que regulam este metabolismo, como o ácido fólico, e polimorfismos em genes que codificam enzimas relacionadas ao metabolismo de folato (MTHFR, RFC1, GCP2 e MTHFD1) podem levar à redução das concentrações desta vitamina e ao aumento das concentrações de tHcy. Objetivo foi avaliar a associação entre polimorfismos em genes relacionados ao metabolismo do folato (RFC1, GCP2, MTHFR e MTHFD1) e o risco de se ter AER, bem como avaliar a associação entre estes polimorfismos e as alterações nas concetranções de folato, cobalamina e homocisteína. Foram constituídos três grupos: AER primário: 117 mulheres com AER e nenhum feto viável; AER secundário: 139 mulheres com AER e pelo menos um feto viável; e Controle: 264 mulheres sem história de aborto espontâneo. Nenhuma das mulheres estava grávida no momento da coleta do sangue. Amostras de sangue foram obtidas para dosagens bioquímicas (folato, Cbl, tHcy, entre outras), imunológicas e extração de DNA genômico. As genotipagens foram feitas por PCR-RFLP ou PCR em tempo real. As concentrações séricas de folato e Cbl foram maiores no AER primário e secundário (p<0,05). A distribuição dos genótipos de todos os polimorfismos foi semelhante nos três grupos. O aumento nas concentrações de folato sérico (OR: 1,05, 95% IC: 1,03 - 1,07, p<0,001), Cbl (OR: 1,00, 95% IC: 1,00 - 1,00, p= 0,016), tHcy (OR: 1,03, 95% IC: 0,97 - 1,11, p= 0,033) e T4 (OR: 1,02, 95% IC: 1,00 - 1,03, p= 0,006) e a presença de FAN reagente (1:160) (OR: 2,90, 95% IC: 1,25 - 6,75, p= 0,013) foram considerados fatores de risco para aborto primário. Para o aborto secundário, foram considerados fatores de risco o aumento nas concentrações de folato sérico (OR: 1,04, 95% IC: 1,02 - 1,05, p<0,001), Cbl (OR: 1,00, 95% IC: 1,00 - 1,00, p= 0,019) e tHcy (OR: 1,05, 95% IC: 1,00 - 1,09, p= 0,039), maiores idades (OR: 1,02, 95% IC: 0,98 - 1,06, p= 0,031), hábito de fumar (OR: 2,54, 95% IC: 1,41 - 4,60, p= 0,002) e ter maior IMC (OR:1,42, 95% IC: 1,07 - 1,88, p= 0,015). Os polimorfismos estudados não foram associados ao maior risco de se ter AER, quando analisados isoladamente, e também não foram associados a alterações nas concentrações séricas de folato, Cbl e tHcy, com exceção do genótipo MTHFR 677TT, cujas portadoras apresentaram maior concentração de tHcy, quando comparadas com as portadoras de genótipos 677CC e 677CT nos três grupos. As variáveis concentrações de folato, Cbl, tHcy e T4 e presença de FAN reagente foram associadas ao maior risco de se ter aborto primário. As variáveis idade, IMC, tabagismo, concentrações de folato, Cbl e tHcy foram associadas ao maior risco de aborto secundário. / The recurrent spontaneous abortion (RSA) is characterized by the occurrence of three or more consecutive miscarriages and affects 2-4% of women of childbearing age. The etiology is associated with several risk factors such as uterine abnormalities, chromosomal aberrations, autoimmunity, thrombophilia, increased concentration of homocysteine (tHcy). About 40% of cases remains unknown cause. The units of carbon metabolism plays an essential role in the availability of the cell folate, is essential for the placental and fetal development. A deficiency of the vitamins that regulate this metabolism, like folic acid, and polymorphisms in genes encoding enzymes related to folate metabolism (MTHFR, RFC1, and GCP2 MTHFD1) may lead to decreased concentrations of this vitamin and increased concentrations of tHcy. Objective was to evaluate the association between polymorphisms in genes related to folate metabolism (RFC1, GCP2, MTHFD1 and MTHFR) and the risk of having AER, and to evaluate the association between these polymorphisms and changes in concetranções folate, cobalamin, and homocysteine. Three groups were divided: AER primary: 117 women with RSA and no viable fetus, AER secondary: 139 women with RSA and at least one viable fetus and Control: 264 women with no history of miscarriage. None of the women was pregnant at time of blood collection. Blood samples were taken for biochemical (folate, Cbl, tHcy, etc.), immunological and genomic DNA extraction. The genotyping were carried out by PCR-RFLP or real time PCR. Serum concentrations of folate and Cbl were higher in groups 1 and 2 (p <0.05). The distribution of genotypes of MTHFR c.677C> T, MTHFR c.1298A> C, MTHFD1 c.1958G> A, RFC1 c.80G>GCP2 A and c.1561C> T was similar among the three groups. The increased concentrations of serum folate (OR: 1.05, 95% CI: 1.03 - 1.07, p <0.001), Cbl (OR: 1.00, 95% CI: 1.00 to 1.00, p = 0.016), tHcy (OR: 1.03, 95% CI: 0.97 to 1.11, p = 0.033) and T4 (OR: 1.02, 95% CI: 1.00 to 1.03, p = 0.006) and the presence of ANA (1:160) (OR: 2.90, 95% CI: 1.25 - 6.75, p = 0.013) were considered risk factors primary for abortion. For secondary abortion, were considered risk factors increased the concentrations of serum folate (OR: 1.04, 95% CI: 1.02 - 1.05, p <0.001), cobalamin (OR: 1.00, 95 % CI: 1.00 to 1.00, p = 0.019) and tHcy (OR: 1.05, 95% CI: 1.00 to 1.09, p = 0.039), higher age (OR: 1.02, 95% CI: 0.98 to 1.06, p = 0.031), cigarette smoking (OR: 2.54, 95% CI: 1.41 to 4.60, p = 0.002) and had a higher BMI (OR : 1,42,95% CI: 1.07 to 1.88, p = 0.015). The studied polymorphisms were not associated with increased risk of having RSA when analyzed separately, and were not associated with changes in serum folate, Cbl and tHcy, with the exception of the MTHFR 677TT genotype, whose patients had a higher concentration of total tHcy compared with those with 677CC and 677CT genotypes in the three groups. The variable concentrations of folate, Cbl, tHcy, and T4, presence of ANA and have been associated with increased risk for miscarriage primary. The variables age, BMI, smoking, concentrations of folate, Cbl and tHcy were associated with increased risk of secondary miscarriage.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 4 uppsatser.

Submitted by Viviane Lima da Cunha (viviane@biblioteca.ufpb.br) on 2017-07-18T16:12:11Z No. of bitstreams: 1 arquivototal.pdf: 1825560 bytes, checksum: 9338560f6c004fb68497bc1ae372422b (MD5) / Made available in DSpace on 2017-07-18T16:12:11Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1825560 bytes, checksum: 9338560f6c004fb68497bc1ae372422b (MD5) Previous issue date: 2017-07-12 / Abortion can be defined as spontaneous or induced expulsion of the fetus weighing less than 500g. Abortion is classified as spontaneous when natural expulsion of the fetus occurs before the twentieth week of pregnancy. When there is the use of some mechanism of induction is called abortion provoked. The existence of a process of mourning for spontaneous abortion is accompanied by depressive reactions and a compulsive search for new pregnancies. In addition to political, religious and physical problems, abortion can also severely affect women's psychic health and resilience. This is defined as being human capacity to overcome challenges and difficulties, and to experience a healthy development after exposure to risks. Resilient people respond better to challenges and situations, according to their internal and external dynamics, as well as the efficiency and quality of their responses, in the face of a new situation. The project has been approved by the Ethics and Research Committee to which it was submitted through the Brazil Platform. The present study has the objective of analyzing the level of resilience of women who suffered miscarriage and who were attended at a referral maternity hospital. As an alternative to study this type of population, the Network Scale Up method was efficient because it is used to estimate social network sizes with a rare characteristic. Thus, the method estimated the size of the target population in João Pessoa, is approximately 2,512 women. In this context, the sample consisted of 52 women aged between 18 and 35 years, who underwent abortion in the period studied. It was possible to observe that most of these women declared themselves to be brown (96%), with a mean age of 29 years, single (31%), but with stable union (55%) and love relationship with the baby's father (62%). It was also possible to see that 69% had incomplete secondary education and 60% were unemployed, more than half did not have a home (67%), 19% had had previous abortions, (81%) planned the pregnancy.Regarding resilience, the CD-RISC10 considered the low level of resilience (65%) of the women studied. The present study shows the importance of effective public policies to assist women seeking care due to the occurrence of abortion. In all its context, not only physical but psychological and emotional, making use of risk and protection factors as strategies to help it increase its level of resilience and not develop other diseases. It was notorious in this study the influence of the age of the women and the amount of children in relation to the level of resilience, that is, an older woman with fewer children is able to have lower levels of resilience. / O aborto pode ser definido como sendo a expulsão espontânea ou provocada do feto pesando menos de 500g. O aborto é classificado como espontâneo quando ocorre expulsão natural do feto antes da vigésima semana de gravidez. Quando há o uso de algum mecanismo de indução é dito aborto provocado. A existência de um processo de luto por um abortamento espontâneo vem acompanhada por reações depressivas e uma busca compulsiva de novas gestações. Além dos problemas políticos, religiosos e físicos, o aborto também pode afetar gravemente a saúde psíquica e a resiliência das mulheres. Esta é definida como sendo capacidade que o ser humano possui em superar os desafios e dificuldades, e vivenciar um desenvolvimento saudável após a exposição a riscos. Pessoas resilientes respondem melhor aos desafios e situações, de acordo com sua dinâmica interna e externa, assim como a eficiência e qualidade de suas respostas, diante de uma situação nova. O projeto possui aprovação pelo Comitê de Ética e pesquisa ao qual foi submetida através da Plataforma Brasil. O presente estudo tem por objetivo analisar o nível de resiliência de mulheres que sofreram aborto espontâneo e que foram atendidas em uma maternidade de referência. Como alternativa para estudar esse tipo de população o método Network Scale Up se mostrou eficiente, pois é utilizado para estimar tamanhos de rede sociais com uma característica rara. Assim, o método estimou o tamanho da população alvo em João Pessoa, é de aproximadamente 2.512 mulheres. Nesse contexto, a amostra foi composta por 52 mulheres com idades entre 18 e 35 anos, que sofreram aborto no período estudado. Foi possível observar que a maioria destas mulheres se autodeclararam parda (96%), com idade média de 29 anos, solteira (31%), porém com união estável (55%) e relacionamento amoroso com pai do bebê (62%). Foi possível ver ainda que 69% possuíam ensino médio incompleto e 60% estavam desempregadas, mais da metade não tem casa própria (67%), 19% já tinham tido abortos anteriores, (81%) planejou a gravidez. Em relação à resiliência, o CD-RISC10 atentou para o baixo nível de resiliência (65%) das mulheres estudadas. O presente estudo mostra a importância de políticas públicas eficazes para auxiliar as mulheres que buscam atendimento devido à ocorrência de aborto. Em todo seu contexto, não somente físicas, mas psicológicas e emocionais, fazendo uso dos fatores de risco e de proteção como estratégias para ajudá-la a aumentar seu nível de resiliência e não desenvolver outras doenças. Foi notória, neste estudo a influência da idade das mulheres e a quantidade de filhos com relação ao nível de resiliência, ou seja, uma mulher com mais idade e menos filhos é capaz de ter níveis de resiliência mais baixo.

Introduction: Spontaneous abortion (SA) is the most common complication in pregnancy. The aim of the study was to investigate the causality of selected genetic factors - Apolipoprotein E (Apo E) gene polymorphisms, factor V Leiden (FVL), Prothrombin (PT G20210A) and nongenetics factors - Thyroid stimulating hormone (TSH), free thyroxine (fT4), antibodies against thyroid peroxidase (a-TPO) in the role of early SA. Materials and methods: For genotyping of APO E polymorphism was used PCR-RFLP. The detection of mutations in genes FV and FII was performed using by HRM. Laboratory markers of thyroid (TSH, a-TPO and fT4) were determined by an automated analyzer using chemiluminescent immunoassay. Results: APOE genotypes of investigated group of 410 samples abortioned embryonic/ fetal tissues were not significantly different from 2 606 adult controls (P = 0.653). In observed infertile group of 75 women with isolated SA was FVL detected in heterozygous constitution with a prevalence of 12 %. The prevalence of FVL in a group of women with early insulated SA was significantly higher than 76 controls (12 % vs. 2.6 %, P = 0.031). The difference of PTG20210A prevalence between women with isolated SA and controls was not significant (4 % vs. 5.3 %, P = 1). The prevalence of elevated TSH levels (higher than 2.5...