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Previous issue date: 2017-12-06 / Durante a gravidez e lacta??o, as mamas apresentam altera??es importantes que ainda n?o s?o totalmente compreendidas. A ultrassonografia e a resson?ncia magn?tica s?o os m?todos mais apropriados para avaliar as altera??es mam?rias durante a gravidez e lacta??o, sendo fundamental um conhecimento s?lido da anatomia e das doen?as mam?rias. Al?m disso, existem poucas publica??es sobre a imagem da mama, relacionando a anatomia e fisiologia durante o ciclo gr?vido-puerperal. A presente pesquisa teve como objetivo avaliar as altera??es fisiol?gicas mam?rias mediante ultrassonografia mam?ria e Dopplerfluxometria das art?rias mam?rias internas (AMI) em gestantes e lactantes normais, comparadas com um grupo de mulheres n?o gr?vidas, avaliadas na fase folicular do ciclo menstrual. Este estudo, classificado como observacional, de corte transversal, foi realizado entre agosto de 2013 e agosto de 2016, com 165 mulheres. As vari?veis dependentes foram as medidas da pele, do tecido adiposo subcut?neo, do tecido fibroglandular, do tecido adiposo retromam?rio, o di?metro dos ductos, assim como os ?ndices de pulsatilidade (IP) e resist?ncia (IR) das art?rias mam?rias internas. As vari?veis independentes foram os diversos momentos de avalia??o, representados pelos cinco grupos estabelecidos. Para a an?lise estat?stica, foram calculadas m?dias e desvios-padr?o, sendo usados dois modelos MANOVA (An?lise de Vari?ncia Multivariada) para avaliar o efeito dos grupos sobre os valores m?dios encontrados, bem como foram ajustados modelos ANOVA univariados para os valores m?dios individualmente. O teste de compara??es m?ltiplas de Tukey-Kramer foi usado para a an?lise da diferen?a e das caracter?sticas entre os grupos. Foi considerado o n?vel de signific?ncia de 5%. Na compara??o entre os tr?s grupos de gr?vidas, observou-se que a localiza??o da mama (direita/esquerda) e o per?odo gestacional n?o tiveram efeito significativo sobre as espessuras mam?rias da pele, tecido celular subcut?neo e tecido adiposo retromam?rio, por?m a espessura do tecido fibroglandular e o di?metro dos ductos, apresentaram diferen?a significativa com o per?odo gestacional (p<0,001), do primeiro para o segundo e do primeiro para o terceiro trimestres. A Dopplerfluxometria das art?rias mam?rias internas revelou diferen?a entre as mamas e o per?odo gestacional, ou seja, o lado direito apresentou medidas superiores ao lado esquerdo e os valores foram decrescentes ao longo da gesta??o (p<0,001). Quando comparados os grupos de gr?vidas do terceiro trimestre e de lactantes, n?o foram observadas diferen?as entre si, mas apresentaram diferen?as significativas com um grupo controle, quanto ?s medidas da pele (p = 0,001), do tecido fibroglandular, di?metro dos ductos e ?ndices dopplerfluxom?tricos das AMI (os tr?s com p < 0,0001) e ao tecido adiposo subcut?neo (p = 0,045). Conclui-se que esta pesquisa contribuiu com informa??es mais espec?ficas acerca das caracter?sticas ultrassonogr?ficas das mamas e aspectos dopplerfluxom?tricos das art?rias mam?rias internas, durante a gravidez e lacta??o normais, caracterizando mediante quantifica??o de valores, as mudan?as fisiol?gicas pr?prias de cada per?odo do ciclo gr?vido-lactacional estudado, podendo servir de par?metro para estudos posteriores. / During pregnancy and lactation breasts undergo important changes that are not fully understood. Ultrasound and magnetic resonance are the most suitable methods to assess breast alterations during pregnancy and lactation, making a solid knowledge of anatomy and breast diseases essential. Moreover, there are few articles on breast imaging, relating anatomy and physiology during the pregnancy-postpartum cycle. The present study aimed to assess physiological breast changes using ultrasound and dopper flowmetry of internal mammary arteries (IMA) in normal pregnant and lactating women, compared to a group of non-pregnant women evaluated in the folicular phase of the menstrual cycle. This cross-sectional observational study was conducted between August 2013 and August 2016, with 165 women. The dependent variables were measures of skin, subcutaneous adipose tissue, fibroglandualr tissue, retromammary adipose tissue, duct diameter, as well as pulsatility (PI) and resistive indices (RI) of internal mammary arteries. The independent variables were the different assessment moments, represented by the five groups established. Statistical analysis involved calculating the means and standard deviations using two MANOVA models (Multivariate analysis of variance) to assess the group effect on the average values obtained. ANOVA univariate models were individually fit to the mean values. The Tukey-Kramer multiple comparisons test was applied to analyze intergroup differences and characteristics, at a 5% significance level. In the comparison between three groups of pregnant women, it was observed that fibroglandular tissue thickness and duct diameter showed a significant difference with gestational period (p< 0.001), from the first to the second and from the first to the third trimesters. Doppler fluxometry of the internal mammary arteries showed a difference between breasts and between gestational period, i.e. the right breast exhibited higher measures than the left and these values decreased throughout the pregnancy (p< 0.001). No differences were found when the groups of pregnant and lactating women were compared, but significant differences with a control group were observed in terms of skin (p = 0.001), fibroglandular tissue thickness, duct diameter and laser Doppler flow measurements of the IMA (all three with p < 0.001) and subcutaneous adipose tissue (p = 0.045). This study provides more specific information on the ultrasound characteristics of breasts and Doppler flowmetry aspects of internal mammary arteries during normal pregnancy and lactation, quantifying the values and characterizing the physiological changes of each period of the pregnancy-lactation cycle, which may serve as parameters for future studies.
| Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.ufrn.br:123456789/24927 |
| Date | 06 December 2017 |
| Creators | Holanda, Ant?nio Arildo Reginaldo de |
| Contributors | 13049127449, Ara?jo, Ana Cristina Pinheiro Fernandes de, 70410798487, Micussi, Maria Thereza Albuquerque Barbosa Cabral, 04566613445, Andrade, Cl?ber de Mesquita, 76146561487, N?brega, Cristyanne Samara Miranda de Holanda da, 75098296404, Oliveira, Ana Katherine da Silveira Gon?alves de, Maranh?o, Tecia Maria de Oliveira |
| Publisher | PROGRAMA DE P?S-GRADUA??O EM CI?NCIAS DA SA?DE, UFRN, Brasil |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Source | reponame:Repositório Institucional da UFRN, instname:Universidade Federal do Rio Grande do Norte, instacron:UFRN |
| Rights | info:eu-repo/semantics/openAccess |
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