Dissertations / Theses on the topic 'Aborto spontaneo'

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.

Introdução: Constante na história da civilização, o abortamento tem sido tema relevante na saúde pública, trazendo repercussões físicas e emocionais à mulher. Este trabalho abordou aspectos históricos e culturais que delinearam o percurso feminino e a maternidade, contemplou a magnitude do abortamento e aspectos emocionais, em especial, a depressão. Teve como objetivos, analisar características sociodemográficas, a percepção das mulheres quanto às reações e condutas do parceiro e o diagnóstico de depressão, em duas capitais brasileiras, associando as variáveis entre os grupos de abortamento espontâneo e provocado de cada capital. Buscou, em cada grupo, relacionar a depressão com as variáveis estudadas. Método: Foram realizadas entrevistas semidirigidas, com questionário previamente elaborado com 285 mulheres que sofreram abortamento espontâneo (139 em Natal-RN e 146 em São Paulo-SP) e 31 mulheres que referiram tê-lo provocado (11 em Natal-RN e 20 em São Paulo-SP). Para o diagnóstico de depressão, utilizou-se o módulo de humor do Primary Care Evaluation of Mental Disorders (Prime-MD). Os dados foram analisados pela Técnica de Análise Temática, posteriormente foi utilizado o programa IBM SPSS Statistics Standard Edition. O nível de significância utilizado foi p<0,05. Resultados: Encontrou-se significância estatística relacionada ao abortamento provocado, em Natal-RN e São Paulo-SP, nas variáveis: ser solteira (p<0,01; p<0,01) e ter menor número de gestações (p<0,01; p=0,04) e de abortamentos espontâneos anteriores (p<0,01; p<0,01). Em Natal-RN evidenciou-se ainda, mulheres com trabalho (p=0,03), renda financeira (p<0,01) e que residiam com familiar (p<0,01) e, em São Paulo-SP, ter provocado abortamento anterior (p=0,01) e residir com amigos (p<0,01). Quanto à percepção das mulheres em relação às reações e condutas do parceiro, em ambas as capitais, ele foi referido como a pessoa que não poderia saber do abortamento (p<0,01 em Natal-RN; p=0,02 em São Paulo-SP), ao mesmo tempo, como aquele que poderia tê-lo evitado (p<0,01 em Natal-RN; p=0,03 em São Paulo-SP). A ausência do parceiro no momento da confirmação da gestação (p=0,02) foi relevante em Natal-RN, e em São Paulo-SP, ele ter apresentado reações negativas frente à notícia da gravidez (p=0,04) e não ter participado no processo do abortamento (p<0,01). Constatou-se elevado índice de depressão em ambas capitais e grupos. Sua presença, no abortamento provocado, não esteve associada às variáveis estudadas, enquanto no espontâneo, relacionou-se, em Natal-RN, a reações negativas do parceiro ao saber da gravidez (p=0,05) e sua ausência no processo do abortamento (p<0,01) e, em São Paulo-SP, ao desconhecimento dele sobre a gestação (p=0,04). Conclusão: Apesar dos avanços sociais, seguem enraizados na identidade feminina princípios culturais e sociais que diante da situação de abortamento, ainda hoje, despertam na mulher conflitos e ambivalências. Mesmo com a independência feminina, a participação masculina mostra-se importante dentro do processo do abortamento, seja pelo suporte ou mesmo, pelo compartilhamento da responsabilidade
Introduction: Constant in the history of civilization, abortion has been a relevant issue in public health, having physical and emotional repercussions for women. This study addressed the historical and cultural aspects outlining the female pathway and maternity and dealt with the magnitude of abortion and emotional aspects, especially depression. Its purpose was to analyze sociodemographic characteristics, women\'s perception as regards the partner\'s reactions and behavior, and depression diagnosis in two Brazilian capitals, associating the variables from the spontaneous abortion group and the induced abortion group. Within each group, the objective was to relate the variables to depression. Method: In two Brazilian capitals, semistructured, questionnaire-based interviews were conducted with 285 women who underwent spontaneous abortion (139 in Natal-RN and 146 in São Paulo-SP) and 31 who reported having induced the abortion (11 in Natal-RN and 20 in São Paulo-SP). For diagnosing depression, the mood module from the Primary Care Evaluation of Mental Disorders (PRIME-MD) was applied. The data were analyzed by the thematic analysis technique, and, subsequently, the IBM SPSS Statistics Standard Edition program was used. The significance level was set at p<0.05. Results: Induced abortion was statistically significant with respect to the following variables: in both Natal-RN and São Paulo-SP, being single ((p<0.01, p<0.01), a smaller number of previous pregnancies (p<0.01, p=0.04), and fewer previous spontaneous abortions (p<0.01, p<0.01); in Natal-RN alone, having a job (p=0.03), having a money income (p<0.01), and living with a family member (p<0.01); in São Paulo-SP only, induction of a previous abortion (p<0.01) and residence with friends (p<0.01). Concerning the perception the women had of their partners\' reactions and behavior, in both capitals, the partner was referred to as the one person who could not know about the abortion (p<0.01 in Natal-RN, p=0.02 in São Paulo-SP) and, simultaneously, as the one who could have avoided it (p<0.01 in Natal- RN, p=0.03 in São Paulo-SP). The partner\'s absence at the time of the pregnancy confirmation (p=0.02) was relevant in Natal- RN, and the partner\'s negative reaction when learning about the pregnancy (p=0.04) and his not participating in the abortion process (p<0.01) was relevant in São Paulo- SP. A high depression rate was found in both groups and in both capitals. Its presence in the induced abortion group was not associated with the study variables, while, in the spontaneous abortion group in Natal-RN, it was linked to the partner\'s negative reaction as he learned about the pregnancy (p=0.05) and to his absence during the abortion process (p<0.01), and in São Paulo-SP, to his not knowing about the pregnancy (p=0.04). Conclusion: Despite social advances, the cultural and social principles rooted in the female identity to this day still engender conflicts and ambivalent feelings in women when confronted with the situation of abortion. Notwithstanding women\'s independence, male participation has shown to be important in the abortion process, be it for support or for sharing the responsability

Introdução: A desesperança encontra-se amplamente associada com depressão maior e risco de suicídio. O suicídio, por sua vez, é um problema de saúde pública que está associado a uma diversidade de fatores e contextos econômicos, sociais e emocionais. No Brasil, a ocorrência de suicídio parece se relacionar diretamente com situações de perda, frustrações e sofrimento emocional, como a situação de abortamento na vida da mulher. Objetivos: este estudo tem como objetivos identificar desesperança em mulheres que viveram/provocaram abortamento; avaliar depressão maior; verificar a associação entre ocorrência de abortamento espontâneo ou provocado e depressão e desesperança. Método: este estudo foi composto por duas fases. Na primeira fase, foi verificado o prontuário de 162 mulheres que tiveram diagnóstico de abortamento e participaram do projeto anterior \"Culpa, ansiedade e depressão na vivência do abortamento provocado\", sendo que, destas 144 tinham vivido abortamento espontâneo e 18, abortamentos provocados. Nessa fase foram analisadas entrevista semidirigida; Primary Care Evaluation of Mental Disorders (PRIME-MD) e Escala de Desesperança de Beck (BHS). Após uma média de tempo de 95,75 meses da ocorrência do abortamento, foi realizado contato telefônico com as 162 mulheres, visando convidá-las a participar da segunda fase; 12 mulheres aceitaram retornar. Foram aplicados os seguintes instrumentos: entrevista semidirigida, o PRIME-MD e BHS. Foi realizada análise quantitativa e qualitativa dos dados, os quais foram analisados pela técnica de análise temática e posteriormente foi utilizado o programa IBM SPSS Statistics Standard Edition. O nível de significância utilizado foi p < 0,05. Também foi realizada analise qualitativa dos discursos das mulheres que compareceram na segunda fase deste estudo. Resultados: constatou-se que 14,6%(n=21) das mulheres que sofreram abortamento espontâneo apresentaram alto nível de desesperança (índice <= 9) e 30,6%(n=44) apresentaram diagnóstico de depressão maior. Desta forma, foi observada associação significativa entre alto nível de desesperança e diagnóstico depressivo em mulheres com abortamento espontâneo (p=0,03). Entre as mulheres que relataram abortamento provocado, contatou-se que 27,8% (n=5) apresentaram altos índices de desesperança e 55,6%(n=10) foram diagnosticadas com depressão maior. Ao associar as duas variáveis, não foi encontrada significância estatística (p=0,9). Os resultados da segunda fase revelaram que 2 mulheres encontravam- se com alta desesperança, sendo que uma referiu abortamento espontâneo e a outra, provocado, ambas também tinham diagnóstico de depressão maior. Conclusão: foi constatado alto nível de sofrimento emocional e de desesperança associado com a situação do abortamento independente de sua natureza, se espontânea ou provocada. Foi observada associação estatística significativa entre depressão e desesperança entre as mulheres que vivenciaram abortamento espontâneo. Nas avaliações da segunda fase, constatou-se que o sofrimento de algumas mulheres permanecia atual, independente do tempo decorrido ou do tipo do abortamento
Introduction: Hopelessness is widely associated with Major Depression and suicide risk. The suicide, on the other hand, is a public health problem that may be associated with economic, social and emotional factors. In Brazil, the ocurrence of suicide seems to be directly related to situations involving loss, frustrations and emotional distress, such as the abortion situation in woman\'s life. Objectives: This study aims to identify hopelessness in women who have received abortions or miscarriage diagnosis; to evaluate major depression; to verify the association between miscarriage, abortion; depression and hopelessness. Method: This study was composed of two phases. In the first phase, it was verified the medical records of 162 women who had a diagnosis of abortion and participated in the previous Project \"Guilt, anxiety and depression in the experience of induced abortion\". Of these, 144 had a miscarriage and 18 had a induced abortion. For this phase, a semidiriged interwiew; Primary Care Evaluation of Mental Disorders (PRIME-MD) and Beck`s Hopelessness Scale (BHS) was analyzed. In the second phase, after an average time of 95,75 months from the abortion, a telephone call was made to the 162 women in order to invite them to participate at this time; twelve women agreed to return to the second phase of this study. The following instruments were applied: semi-directed interwiew, PRIME-MS and BHS. Quantitative and qualitative analysis was performed. The data were analyzed by the thematic analysis technique and later using the IBM SPSS Statistics Standard Edition. The significance level was p < 0,05. A qualitative analysis of the discourses of the women who attended the second phase was also performed. Results: It was found that 14,6% (n=21) of the women who suffered miscarriage had a high level of hopelessness (índex <= 9) and 30,6% (n=44) presented a diagnosis of major depression. Statistical significance was observed between high level of hopelessness and depressive diagnosis in women with miscarriage (p=0,03). Among women reporting induced abortion, 27,8% (n=5) had high rates of hopelessness and 55,6% (n=10) were diagnosed with major depression. When the two variables were associated, no statistical significance was found (p=0,9). The results of the second phase revealed that 2 women presented a high level of hopelessness, 1 that reported miscarriage and 1 that reported induced abortion. Both had a diagnosis of Major Depression. Conclusion: It was observed a high level of emotional distress associated with the abortion experience regardless of its natures, whether spontaneous or induced. There were There were high rates of hopelessness among women who experienced abortion, whether spontaneous or induced; and a statistically significant association was found between depression and hopelessness among women who experienced spontaneous abortion. In the evaluations of the second phase it was found that the suffering of some women remained current, regardless of the time elapsed or the type of abortion

Bakgrund En normal graviditet hos en gravid kvinna (det biologiska könet) i fertil ålder fortlöper i genomsnitt i cirka 40 veckor. När en kvinnas graviditet avstannar utan medicinsk intervention innan graviditetsvecka 22 kategoriseras det som en spontan abort. Det finns ingen behandling som kan stoppa en hotande eller en pågående spontan abort vilket gör att sjuksköterskans bemötande blir desto mer viktig. Forskning har visat att stöd vid spontan abort kan hjälpa till att minska den negativa upplevelsen och att stöd även har en positiv inverkan på den mentala hälsan. Det ligger i allmänsjuksköterskans professionella ansvar att ge stöd och omvårdnad utifrån ett personcentrerat förhållningssätt. Syfte Syftet var att belysa kvinnors upplevelser av stöd och omvårdnad vid spontan abort. Metod Vald design var litteraturöversikt där databassökning genomfördes i databaserna PubMed, CINAHL och Google Scholar. Femton vetenskapliga artiklar valdes och granskades med Sophiahemmets Högskolas kvalitetsgranskningsprotokoll och genomgick en integrerad analys. Resultat Resultatet sammanställdes i fem huvudkategorier: ”Bemötandets betydelse för kvinnan”, ”Kommunikation”, ”Vårdmiljöns betydelse”, ”Aspekter av stöd” och ”Den fysiska vården”. Resultatet belyser vikten av bemötandets roll i utformandet av kvinnans upplevelse av stöd och omvårdnad i samband med spontan abort. Slutsats Att genomgå en spontan abort var för de flesta kvinnor en traumatisk händelse. Det framkom att sjuksköterskan inte fullföljde sitt professionella ansvar att främja hälsa, återställa hälsa och lindra lidande för de kvinnor som genomgick en spontan abort. För att kvinnor som genomgår en spontan abort ska få stöd och omvårdnad anpassad efter hennes behov bör sjuksköterskan arbeta utifrån ett personcentrerat förhållningssätt för att minska risken för vårdlidande.
Background A normal pregnancy for a woman (the biological sex) is on average 40 weeks. If a woman's pregnancy ends before pregnancy week 22 without medical intervention it is categorized as a spontaneous abortion. No treatment can stop a threatening or ongoing spontaneous abortion, which makes the nurse's response to the situation all the more important. Research has shown that support during a spontaneous abortion can help reduce the negative experiences for the woman and also have a positive impact on the woman’s mental health. It is in the general nurse's professional responsibility to provide support and care based on a person-centred approach. Aim The purpose is to highlight women's experiences of support and care during a spontaneous abortion. Method Chosen design was literature review where 15 scientific articles were selected. Database search was performed in databases PubMed, CINAHL and Google Scholar. Data analysis was carried out using an integrated analysis. Results The results were compiled into five main categories which highlighted the woman's experience of support and care during a spontaneous abortion. The main categories are "The importance of care for the woman", ”Communication”, "The impact of health facility environment", "Aspects of support" and ”Physical care”. Results highlights the importance of the caregiver in shaping the woman's experience of support and care in connection with spontaneous abortion. Conclusions For most women, a spontaneous abortion was a traumatic event to undergo. It emerged in the results that nurses did not always fulfil their professional responsibilities in promoting the woman’s health, restoring health and relieving the woman’s suffering who underwent a spontaneous abortion. In order for women to receive support and care tailored to their needs, the nurse should work applying a person-centered approach which can help reduce the risk of suffering and meet the unmet needs of the woman.

Die Schwangerschaft ist ein komplexer Vorgang, bei dem es zu einer Interaktion zwischen dem mütterlichen Immunsystem und dem Fetus kommt. Der allogene Fetus kann als natürlich auftretendes Allotransplantat angesehen werden. Man nimmt daher an, dass die Toleranzmechanismen, die im Rahmen einer erfolgreichen Schwangerschaft auftreten, den Mechanismen zur Akzeptanz eines Transplantates ähnlich sind. HO-1 wurde als ein gewebe-schützendes und anti-apoptotisches Molekül beschrieben, welches eine wichtige Rolle bei der Akzeptanz von Transplantaten spielt. Verschiedene Studien konnten zeigen, dass HO-1 in der Plazenta verschiedener Spezies exprimiert wird und dass die Expression von HO-1 bei Schwangerschaftskomplikationen, wie dem spontanen Abort, vermindert ist. Dies lässt vermuten, dass HO im Laufe der Schwangerschaft eine Rolle spielt. In diesem Kontext sollte die vorliegende Arbeit das Verständnis über die Funktion von HO-1 bei den beiden Schwangerschaftskomplikationen spontaner Abort und Präeklampsie (Schwangerschaftshypertonie) erweitern. Mit Hilfe des Mausmodells für einen spontanen Abort, bei dem weibliche CBA/J Mäuse mit männlichen DAB/2J Mäusen verpaart werden, wurde der Einfluss der HO-1 Expression auf die Abortrate untersucht und mit BALB/c-verpaarten CBA/J Weibchen, welche eine normale Schwangerschaft aufweisen, verglichen. In Mäusen mit spontanem Abort zeigte sich eine Reduktion der HO-1 und HO-2 Expression. Die Induktion von HO-1 mittels Co-PP war in der Lage, die Abortrate zu senken, wohingegen eine Reduktion der HO-1 mittels Zn-PP die Abortrate erhöhte. Es zeigte sich, dass es neben der Induktion von HO-1 auch zu einer erhöhten Expression des anti-apoptotischen Moleküls Bag-1 kam. Im Mausmodell für Präeklampsie wurde ebenfalls die Expression von HO-1 und möglicher Interaktionspartner untersucht. Des Weiteren wurde der Einfluss einer erhöhten bzw. verminderten HO-1 Expression auf die Präeklampsie-ähnlichen Symptome in diesem Mausmodell analysiert. Im Laufe der Arbeit zeigte sich jedoch, dass HO-1 Veränderungen keinen Einfluss auf die Präeklampsie-ähnlichen Symptome hat. Die Daten dieser Arbeit lassen vermuten, dass eine erhöhte Expression von HO-1 zum Zeitpunkt der Implantation den Fetus vor einem spontanen Abort schützt und dass die protektive Funktion von HO-1 durch eine Interaktion mit anti-apoptotischen Molekülen wird. Bei der Präeklampsie hingegen scheint HO-1 keine bzw. nur eine untergeordnete Rolle zu spielen.
Pregnancy maintenance is a very complex phenomenon, involving interactions between the maternal immune system and the semiallogenic foetus, which does not lead to immune rejection but to tolerance. Thus it is thought that the tolerance mechanisms involved in a successful pregnancy are closely related to those allowing graft acceptances. Heme Oxygenases (HO) were described to be tissue-protective and to have anti-apoptotic properties. Up-regulation of HO, particularly of HO-1, allows tissue tolerance after transplantation. The presence of HO-1 had been reported in the placenta of different species during normally progressing pregnancies; in pregnancy complications like spontaneous abortion the levels of HO-1 were reduced. This led to the proposal that HO-1 may play a protective role. The aim of this work was to analyze the influence of HO-1 changes in the outcome of pregnancy, using two different murine models for pregnancy complications, namely of spontaneous abortion and pre-eclampsia. The influence of HO-1 expression on the abortion rate was analysed in DBA/2J-mated CBA/J females, which spontaneously show high abortion rates compared to BALB/c-mated CBA/J females, having fully normal pregnancy. The induction of HO-1 by Co-PP led to diminished abortion rates, while the blocking of HO-1 and HO-2 by Zn-PP boosted abortion. In mice with reduced abortion rates after HO-1 induction, up-regulated levels of the anti-apoptotic molecule Bag-1 could be observed. In mice showing signs for preeclampsia after transfer of Th1 activated cells, the expression of HO-1, Th1/Th2 and eNOS was analysed. Furthermore HO-1 was of up- or down-regulated by using Co-PP or Zn-PP respectively. HO-1 changes did not influence the outcome of the disease, as we could not observe a diminution in the blood pressure levels. In summary, the results of this study indicate that high levels of HO-1 during implantation are able to prevent foetal rejection and that the beneficial effects of the HO-1 induction are related to the up-regulation of tissue protective molecules as Bag-1. No relationship could be observed between HO-1 levels and preeclampsia outcome.

Made available in DSpace on 2015-07-22T20:50:38Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-03-25
Por ser uma prática criminosa, o aborto provocado acaba sendo realizado clandestinamente tornando-se um grave problema de Saúde Pública. O objetivo deste estudo foi o de estimar a prevalência de mulheres em idade fértil com histórico de aborto. O estudo é transversal, resultante de uma amostra aleatória de mulheres 15 a 49 anos-, residentes no subdistrito da Vila Mariana, 2006. Os dados foram coletados mediante aplicação de questionários. Foi considerada como variável dependente classificação da mulher quanto ao aborto: sem aborto, aborto espontâneo e aborto provocado; e independentes: idade, defasagem do número ideal de filhos, atividade remunerada, escolaridade, estado civil, uso de contraceptivos e opinião sobre o aborto provocado. Para análises foram utilizados testes de qui-quadrado e modelos de regressão logística multinomial policotômica. Dentre o total de mulheres entrevistadas (n=1121), 84,4% (n=946) são de mulheres sem histórico de aborto; 11,2% (n=126) são de mulheres com histórico de aborto espontâneo e, 4,4% (n=49) são de mulheres com histórico de aborto provocado. A razão de chances de ter realizado aborto provocado sobre a sem aborto é 6,33 vezes maior (p0,001) entre mulheres que aceitam esta prática; 4,58 vezes maior (p=0,002) entre as mulheres que possuem menos de 4 anos de estudo e ainda, as chances da mulher declarar um aborto provocado comparado às sem aborto é 7% maior a cada ano em que a mulher envelhece. Dentre as 1121 mulheres, 49,5% (n=555) declararam ter tido alguma gravidez. Para que engravidaram a prevalência de mulheres com aborto espontâneo foi de 22,7% (n=126) de aborto provocado 8,85 (n=49). A razão de chances de ter realizado aborto provocado sobre a sem aborto é 28,34 vezes maior (p0,001) entre as que não possuem nenhum filho nascido vivo; 6,42 vezes maior (p0,001) entre as que aceitam esta prática; 4,96 vezes maior (p=0,002) entre as que possuem menos de 4 anos de estudo; e as chances de declarar um aborto provocado comparado as sem aborto é 8% maior a cada ano a mais de vida. Por outra parte, este estudo revela ainda que entre o total de mulheres a razão de chances de ter tido aborto espontâneo sobre a sem aborto é 0,34 (p0,001) entre as mulheres que não possuem nenhum filho nascido vivo; e, as chances da mulher declarar um aborto espontâneo comparado às sem aborto é 4% maior a cada ano de idade da mulher. O comportamento reprodutivo das mulheres deste estudo é equiparável ao das residentes em países desenvolvidos. Ao ter acesso a métodos contraceptivos considerados eficazes o aborto provocado legalizado, não seria utilizado de forma irresponsável.
Induced abortions are illegal in Brazil, leading many women to seek out clandestine clinics and practitioners, resulting in a serious public health problem. The purpose of this study was to estimate the number of women in the general population of fertile age with a history of abortion. This is a retrospective transversal study, based on a random sample of women – 15 to 49 years old –, residing at the Vila Mariana neighborhood of São Paulo in 2006. Data was collected through questionnaires. As the dependent variable we used different abortion categories, reflecting different types of experiences with abortion, which included: no abortion, spontaneous abortion and induced abortion. As independent variables we used: age, the difference between number of children and ideal number of children, employment and marital status, level of education, use of contraceptives, and personal opinion about induced abortion. Analyses were carried out using chi-square tests and polytomous multinomial logistic regressions. Furthermore, 84,4% (n=946) had no history of abortion; 11,2% (n=126) indicated having had a spontaneous abortion; and 4.4% (n=49) indicated having had an induced abortion. We found that it is 6,33 times more likely (p0,001) to have had an induced abortion versus no abortion among women who are pro-choice; 4,58 times more likely (p=0,002) among women who have less than 4 years of formal education; and the chances of a woman admitting an induced abortion compared to no abortion are 7% higher for each additional year of age. We surveyed a total of 1121 women, among which 49.5% (n=555) indicated that they had been pregnant at least once. Among the latter, 22,7% (n=126) indicated having at least one spontaneous abortion and 8,85% (n=49) indicated having at least one induced abortion. Our results show that among women with no live birth pregnancies it is 28,34 times more likely that they have undergone induced abortion versus no abortion (p0,005); among those that are pro-choice it is 6,42 times more likely (p0,001); among those who have less than 4 years of formal education it is 4,96 times more likely (p=0,002); and the chances of admitting to an induced abortion versus no abortion increases by 8% higher for each additional year of age. Finally, this study reveals that women with no live births are 0,34 more likely (p0,001) to have had an spontaneous abortion versus no abortion; and the chances of a woman admitting spontaneous abortion compared to no abortion is 4% higher for each additional year of age. In conclusion, the reproductive behavior of women in this study is comparable to the behavior of women who live in developed countries. With broad access to effective contraceptive methods, legalized induced abortion would not be carried out irresponsibly.
TEDE

Dissertação(mestrado) - Universidade Federal do Rio Grande, Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, 2005.
Submitted by eloisa silva (eloisa1_silva@yahoo.com.br) on 2012-10-30T14:40:56Z No. of bitstreams: 1 patriciadasilva.pdf: 907631 bytes, checksum: 0d9864df80aaed22f5d58742aa1f439c (MD5)
Approved for entry into archive by Bruna Vieira(bruninha_vieira@ibest.com.br) on 2013-06-13T17:26:52Z (GMT) No. of bitstreams: 1 patriciadasilva.pdf: 907631 bytes, checksum: 0d9864df80aaed22f5d58742aa1f439c (MD5)
Made available in DSpace on 2013-06-13T17:26:52Z (GMT). No. of bitstreams: 1 patriciadasilva.pdf: 907631 bytes, checksum: 0d9864df80aaed22f5d58742aa1f439c (MD5) Previous issue date: 2005
Com a intenção de contribuirmos para o conhecimento dos riscos da exposição ambiental e a influência de outros fatores sobre a saúde, realizou-se este estudo transversal, com mulheres em idade fértil (15-49 anos)residentes nas comunidades próximas ao parque industrial do município do Rio Grande/RS, sendo identificado a prevalência de abortos espontâneos e os fatores relacionados a este desfecho. A amostra compreendeu 565 mulheres, residentes nas áreas consideradas exposta (E) e não exposta(NE), de acordo com a distância do parque industrial e a análise do mapa dos ventos do município. Foram entrevistadas 285 mulheres da área E e 280 da área NE. Para avaliação dos fatores de risco, foi aplicado um questionário, o qual contemplava as condições socioeconômicas, os fatores ambientais e as condições de moradia, a história reprodutiva prévia e morbidades. Para análise dos dados foram utilizados o teste qui-quadrado e regressão logística não-condicionada. Das mulheres entrevistadas que já gestaram (n=412) 17,7% referiram ocorrência de aborto espontâneo. Na análise bivariada verificou-se que o desfecho estudado mostrou associação significativa com idade da menarca, apresentando-se como fator de proteção(OR=0,26 (IC=0,11-0,55); p=0,0008) a idade da menarca entre 11 e 13 anos. O número de filhos também mostrou associação com a ocorrência de aborto espontâneo, apresentando um aumento do risco para três ou mais filhos (OR=4,00 (IC=1,86-8,58); p=0,001). A história de doença sexualmente transmissível(DST) também apresentou tendência à significação (OR=2,01 (IC=0,97-4,15); p=0,06). Após ajuste com as variáveis do modelo teórico hierarquizado, a presença de três ou mais filhos (OR=2,94(IC=1,28-6,77); p=0,009) e a história de DST(OR=2,55 (IC=1,13-5,77); p=0,02) permaneceram significativamente associados ao desfecho estudado. Nesta análise, o fato da mulher não possuir água encanada dentro de casa mostrou uma tendência de associação com a ocorrência de aborto espontâneo (OR=4,01 (IC=0,85-18,87); p=0,08). Não foi observada associação significativa entre o local de moradia nas proximidades do parque industrial e o desfecho investigado. Além desta análise, este estudo também mostrou dados importantes sobre a saúde reprodutiva dessas mulheres: 51,2% (E) e 40,6% (NE) das mulheres tiveram a primeira gestação entre 12 e 19 anos (n=412); 30,5% possuíam três ou mais filhos (n=393); 13,6% (E) e 8,3% (NE) das mulheres que não menstruavam era devido à menopausa precoce (n=80); 72,7% utilizavam algum método contraceptivo (n=513), sendo 52,3% de pílula e 23,6% de laqueadura (n=373); 56,0% das esterilizações ocorreram entre 19 e 30 anos (n=75); 39,5% nunca realizaram preventivo de câncer uterino (n=565). Quanto à influência da exposição ambiental sobre o desfecho estudado, sugerimos a realização de outros estudos com o uso de biomarcadores, para identificar uma possível influência do ambiente sobre a saúde reprodutiva nessa população ou para afastar definitivamente essa suspeita. Os resultados desse estudo poderão subsidiar novas políticas de saúde, relacionadas com a saúde da mulher neste município. Contribuirão também para uma nova prática assistencial dos profissionais de enfermagem/saúde, onde a questão ambiental seja levada em consideração e priorizada a educação em saúde, sobretudo com relação às questões que se referem aos resultados encontrados.
With the intention of contributing for the knowledge of risks of environmental exposure and the influence of other factors on health, this cross-section study hás been done, with women in fertile age (15-49 years)living in communities close to the industrial district in the city of Rio Grande/RS, being identified the prevalence of spontaneous abortion and the factors related to this result. The sample involved 565 women, all living in the areas considered as exposed(E) and non exposed (NE), according to the distance of the industrial district and the analysis of the map of winds in the city. 285 women of the E area were interviewed as well as 280 from the NE area. For the evaluation of risk factors, a questionnaire was applied, which involved the socioeconomic conditions, environmental factors and housing conditions, the previous reproductive history and sicknesses. In order to analyse the data collected the qui-squared test and thenon-conditioned logistic regression were used. Among the interviewed women who have already given birth (n=412) 17,7% referred occurrence of spontaneous abortion. In the bivaried analysis it was noticed that the result studied showed significative association with the age of the first menstruation, presenting itself as a protection factor (OR=0,26 (IC=0,11- 0,55); p=0,0008) the age of the first menstruation between 11 and 13 years of age. The number of children also presented association with the occurrence of spontaneous abortion, presnting an increase of risk for three or more children (OR=4,00 (IC=1,86-8,58); p=0,001). The history of sexually transmissible disease (STD) also presented a tendency to signification (OR=2,01 (IC=0,97-4,15); p=0,06). After adjusting with the variables of the hierarchized theoretical model, the presence of three or more children (OR=2,94 (IC=1,28-6,77); p=0,009) and the history of STD (OR=2,55 (IC=1,13-5,77); p=0,02) remained significantly associated to the result studied. In this analysis, the fact that the woman does not have canalized water at home showed a tendency of association with the occurrence of spontaneous abortion (OR=4,01 (IC=0,85-18,87); p=0,08). It was not observed a significative association between the place of residence close to the industrial district and the result investigated. Besides this analysis, this study hás also shown important data about the the reproductive health of these women: 51,2% (E) and 40,6% (NE) of the women had their first pregnancy between 12 and 19 years of age (n=412); 30,5% had three or more children (n=393); 13,6% (E) and 8,3% (NE) of the women who did not menstruate was due to the precocious menopause (n=80); 72,7% used some kind of contraceptive method (n=513), being 52,3% the pill and 23,6% the ligature (n=373); 56,0% of the sterilizations took place when they were between 19 and 30 years of age (n=75); 39,5% have never done any preventive exam of uterine cancer(n=565). In terms of the influence of the environmental exposure on the result studied, we suggest that other studeis are done with the usage of biomarkers, in order to identify a possible influence of the environment on the reproductive health of this population or to definitely put away this suspicion. The results of this study may give a subsidy to new policies on health, related to the health of the women in this city. This will also contribute for a new assistance practice of the professionals of nursing / health, where the environmental matter will be taken into consideration and made a priority for the education in health, specially in which it relates to questions referring to the results found.
Con la intención de contribuir al conocimiento de los riesgos de la exposición ambiental y la influencia de otros factores sobre la salud, se realizó este estudio transversal, con mujeres en edad fértil (15-49 años) residentes en las comunidades cercanas al parque industrial de la ciudad de Rio Grande/RS, siendo identificado la prevalencia de abortos espontáneos y los factores relacionados a este desenlace. La muestra comprendió 565 mujeres, residentes en las áreas consideradas expuestas (E) y no expuesta (NE), de acuerdo con la distancia del parque industrial y el análisis del mapa de los vientos de la ciudad. Fueron entrevistadas 285 mujeres del área E y 280 del área NE. Para evaluación de los factores de riesgo, fue aplicado un cuestionario, lo cual contemplaba las condiciones socioeconómicas, factores ambientales y condiciones de vivienda, la historia reproductiva previa y morbilidades. Para análisis de los datos fueron utilizados el test Qui-cuadrado y regresión logística no condicionada. De las mujeres entrevistadas que ya gestaron (n=412) 17,7% refirieron ocurrencia de aborto espontáneo. En el análisis bivariado se verificó que el desenlace estudiado mostró asociación significativa con edad de la menarquia, presentándose como factor de protección (OR=0,26 (IC=0,11-0,55); p=0,0008) la edad de la menarquia entre 11 y 13 años. El número de hijos también mostró asociación con la ocurrencia de aborto espontáneo, presentando un aumento del riesgo para tres o más hijos (OR=4,00 (IC=1,86-8,58); p=0,001). La historia de enfermedad transmisible sexualmente (ETS) también presentó tendencia a la significación (OR=2,01 (IC=0,97-4,15); p=0,06). Después de ajuste con las variables del modelo teórico jerarquizado, la presencia de tres o más hijos (OR=2,94 (IC=1,28-6,77); p=0,009) y la historia de ETS (OR=2,55 (IC1,13-5,77); p=0,02 permanecieron significativamente asociados al desenlace estudiado. En este análisis, el factor de la mujer no poseer agua potable dentro de casa mostró una tendencia de asociación con la ocurrencia de aborto espontáneo (OR=4,01(IC=0,85-18,87); p=0,08). No fue observada asociación significativa entre el lugar de vivienda en las proximidades del parque industrial y el desenlace investigado. Además del análisis, este estudio también mostró datos importantes sobre la salud reproductiva de esas mujeres: 51,2% (E) y 40,6% (NE) de las mujeres tuvieron la primera gestación entre 12 y 19 años (n=412); 30,5% poseían tres o más hijos (n=393); 13,6% (E) y 8,3% (NE) de las mujeres que no menstruaban era debido a la menopausia precoz (n=80); 72,7% utilizaban algún método contraceptivo (n=513), siendo 52,3% de píldora y 23,6% de ligadura (n=373); 56,0% de las esterilizaciones ocurrieron entre 19 y 30 años (n=75);39,5% nunca realizaron preventivo de cáncer uterino (n=565). Con relación a la influencia de la exposición ambiental sobre el desenlace estudiado, sugerimos la realización de otros estudios con uso de biomarcadores, para identificar una posible influencia del ambiente sobre la salud reproductiva en esa población o para alejar definitivamente esa sospecha. Los resultados de ese estudio podrán subsidiar nuevas políticas de salud, relacionadas con la salud de la mujer en esta ciudad. Contribuirán también para una nueva práctica asistencial de los profesionales de enfermería/salud, en la que la cuestión ambiental sea considerada y priorizada la educación en salud, sobretodo con relación a las cuestiones que se refieren a los resultados encontrados.

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.

Bakgrund: Spontan abort är den vanligaste komplikationen under en graviditet och kan ha flera orsaker, men är oftast okänd. Vid händelsen sker en spontan avgång av fostret som lämnar livmodern innan det är livsdugligt. Kvinnlighet är för många att kunna föda ett barn. Syfte: Beskriva kvinnors upplevelser av spontana aborter. Metod: Litteraturstudie med deskriptiv design. Analysmetoden var en innehållsanalys inspirerad av Graneheim och Lundman. Resultat: Upplevelser av spontan abort var: chock och oförberedelse, förlust, hopp och hopplöshet, skuld, sökandet efter mening, oförståelse från omgivningen, sorg, lättnad samt upplevelser av att gå vidare i livet. När orsaken till den spontana aborten var okänd och kvinnor inte upplevde någon mening med händelsen, lade de skulden på sig själva. De upplevde sig inte vara lika viktiga som andra människor som hade barn. Slutsats: Kvinnors upplevelser av spontan abort är individuell och varierar i stor utsträckning. Kvinnor vill ha en orsak och söker en mening med händelsen. De som upplever spontan abort som emotionellt påfrestande kan hamna i en kris och många blir påverkade under nästa graviditet. Sjuksköterskan bör individanpassa omvårdnaden och ha förståelse och stödja kvinnan i att kunna gå vidare i livet.

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.

L’avortement spontané (AS) désigne la perte du produit de conception avant sa viabilité, c'est-à-dire avant la 22e semaine d’aménorrhée, ou un poids fœtal inférieur à 500 g. La cause génétique est à l’origine de plus des deux tiers des AS, les aneuploïdies autosomiques, représentant à elles seules jusqu’à 70% des pertes fœtales du 1er trimestre. Le caryotype présente une très bonne sensibilité en ce qui concerne le dépistage des trisomies autosomiques (13, 18 et 21) et des aneuploïdies affectant les chromosomes sexuels, mais il montre d’importantes limites, d’une part en raison des échecs de culture cellulaire et d’autre part en raison de l’existence de remaniements non détectables au caryotype standard. Actuellement plusieurs techniques moléculaires de dépistage rapides des aneuploïdies liées aux échecs de grossesses ont été vérifiées : 1°) la fluorescence in situ par hybridation (FISH) 2°) l’amplification multiplex de sondes nucléiques dépendant des ligatures (MLPA). Ces deux méthodes présentent l’avantage d’être réalisables, sans culture préalable, sur noyaux en interphase ou sur ADN extrait et de permettre la détection d’anomalies cryptiques. Notre étude repose sur l’étude cytogénétique des produits d’AS pour mettre en évidence les anomalies chromosomiques les plus fréquentes à l’origine de ces pertes fœtales et d’en mieux appréhender les mécanismes de survenue. Elle a été réalisée sur 220 patientes âgées de 19 à 45 ans, et était fondée sur l’analyse directe par FISH sur noyaux interphasiques (AneuVysionTM) de prélèvements de villosités choriales et sur l’analyse de l’ADN extrait de tissus fœtaux par MLPA afin de révéler d’éventuelles aneuploïdies et micro-remaniements. L’âge gestationnel au moment des prélèvements était compris entre 7 et 38 semaines d’aménorrhée. Sur un total de 151 échantillons analysés par AneuVysionTM, 10 anomalies chromosomiques ont été observées: 3 trisomies 21, 1 trisomie 18, 1 trisomie 13, 1 mosaïque 46,XX/47,XX+21, 3 triploïdies et 1 monosomie X (Turner). Par ailleurs, sur les 69 autres échantillons analysés par MLPA, 6 étaient ininterprétables. Les anomalies trouvées par cette technique étaient: 2 monosomies X. Pour les échantillons restants, la MLPA a été négative. Nous avons en parallèle réalisé une étude rétrospective fondée sur l’analyse comparative d’un échantillon recruté à Sidi Bel Abbès, de femmes ayant subi un AS et admises à la maternité del’hôpital Hassani Abdelkader de Sidi Bel Abbès et d’un échantillon recruté à Clermont-Ferrand de femmes ayant subi un AS et pour lesquelles un prélèvement pour établir le caryotype du produit de fausse-couche avait été adressé dans le service de cytogénétique du CHU Estaing de Clermont-Ferrand. Cette étude a couvert une période de six années, allant de janvier 2005 à décembre 2010. Les techniques de FISH et de MLPA représentent des outils simples, rapides et sensibles pour la détection des remaniements chromosomiques. Elles représentent une alternative très intéressante à la culture cellulaire, et permettent le diagnostic de désordres génomiques indécelables par les techniques conventionnelles
Spontaneous abortion (SA) is the loss of the product of fertilization before its viability, that is, before22 weeks of gestation or fetal weight less than 500 g. Genetic causes account for more than two thirds of SA, autosomal aneuploidies alone accounting for up to 70% fetal loss. Chromosomal cytogenetic techniques show significant limitations on the one hand because of the failures of cell culture, and secondly because of the existence of undetectable alterations to the standard karyotype. It was therefore planned to use molecular techniques :- Fluorescent in situ hybridization (FISH)- Multiplex ligation-dependent probe amplification (MLPA). Both techniques have the advantage of being achievable without prior culture of cores interphase or DNA extracted and to enable detection of cryptic abnormalities. The project is based on cytogenetic study of AS products to highlight the most frequent chromosomal abnormalities causing fetal losses, and to better understand their occurrence. Our study was performed on 220 patients from 19 to 45 years, and was based on the direct analysis by FISH on interphase nuclei (AneuVysionTM) of chorionic villus sampling and analysis of DNA extracted fetal tissue by MLPA to reveal any aneuploidy and rearrangements. The gestational age of the samples ranged from the 7th to the 38th week of gestation. In a total of 151 samples analyzed by AneuVysionTM, 10 chromosomal abnormalities were observed: three trisomies 21, one trisomy 18, one trisomy 13, one mosaic 46,XX/47,XX+21, 3 triploidies and one monosomy X (Turner). In addition, among the other 69 samples analyzed by MLPA, 6 were uninterpretable. The abnormalities found by this technique were 2 monosomies X. For the remaining samples, the MLPA was negative. We conducted a retrospective parallel study based on the analysis of a sample recruited in Sidi Bel Abbes, women who have had an AS and were admitted to the maternity hospital Abdelkader Hassani, Sidi Bel Abbes ; and a sample recruited in Clermont-Ferrand : women who underwent AS for which a levy to establish the karyotype product miscarriage had been addressed in the Department of Cytogenetics of CHU Estaing, Clermont-Ferrand. This study covered a period of six years, from January 2005 to December 2010. The techniques of FISH and MLPA are simple, rapid and sensitive tools for the detection of chromosomal rearrangements. They represent a very interesting alternative to cell culture and allow diagnosis for genomic disorders undetectable by conventional techniques

Introducción. La adquisición del grado de maestre contribuye al desarrollo profesional en Salud Materna. Basándose en la experiencia teórica y clínica, es sustentado por la evidencia científica. Objetivo. Relatar experiencias supervisadas durante el Estadio de Naturaleza Profesional, describiendo a través de una incursión en investigación aplicada a la clínica, una temática de interés. Metodología. Actividades supervisadas en diferentes contextos clínicos cumpliendo objetivos curriculares. Se describen campos clínicos y se presentan y reflexionan las actividades. La muestra de investigación se introduce con estadísticas descriptivas. Resultados. Conocimiento y adquisición de competencias clínicas tuvieron resultado positivo en la desenvoltura para la práctica profesional. La investigación resultó en el conocimiento de las experiencias de las mujeres con pérdida perinatal, permitiendo el desarrollo de una intervención adecuada para cubrir necesidades reales. Conclusiones. La adquisición de habilidades permitió la apertura para la clínica especializada. El abordaje en investigación ha dado visibilidad al fenómeno, promoviendo reconocimiento sanitario; ABSTRACT: TITLE: “Perinatal loss. A experience in Andalusian women.” Introduction. The master’s degree acquisition contributes to professional development in Maternal Health. It is based in both theoretical and clinical experience, and it is supported by scientific research. Objective. To report supervised experiences during the Professional Nature Stage, describing through a launch into applied, a topic of interest. Methodology. Supervised activities on different clinical contexts achieving curricular objectives. Clinical fields are described, presented and reflection on the activities takes place. The research sample is introduced through descriptive statistics. Result. Knowledge and acquisition of clinical competences had a positive result through performance for the professional practice. From research, it was noticeable that the knowledge of perinatal loss experience in women enables an appropriate intervention to meet real needs. Conclusions. The acquisition of abilities allowed the opening for the specialist clinic. Addressing the topic in research has provided this phenomenon visibility, promoting its heath recognition.

Thesis (Ph. D.)--Boston University
Spontaneous abortion (SAB) is the unexpected loss of a conceptus early in pregnancy. Methodologic limitations such as left truncation bias, recall bias, and misclassification have prevented investigators from identifying risk factors related to this adverse pregnancy outcome. The objective of this dissertation was to examine the associations of body size, caffeine consumption, and history of oral contraceptive (OC) use with SAB risk among a prospective cohort of pregnancy planners in Denmark. In study 1, we examined SAB risk in relation to body size as measured by body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), height, and location of typical weight gain. We found that overall obesity (defined as BMI230) was associated with an increased risk of SAB, especially for pregnancy losses before 8 gestational weeks. Increasing WHR and increasing height were associated with a decreased risk ofSAB. Underweight, WC, and location of weight gain were not materially associated with SAB risk. The second study evaluated risk of SAB in relation to consumption of caffeine and caffeinated beverages before conception and during early pregnancy. We found that women who consumed higher amounts of coffee per day before pregnancy had a slightly higher risk of SAB. Overall, increased caffeine consumption during early pregnancy was also associated with higher risk of SAB. Study 3 assessed the risk of SAB in relation to self-reported history of OC use, evaluated in terms of recency, duration, and formulation of the most recent pill. Recent and longer durations of OC use were independently associated with a decreased risk of SAB. When stratified by maternal age, younger women ( < 30 years) had an increased risk of SAB with longer duration but older women (~30 years) had a decreased risk of SAB.

RESUMO: O aborto recorrente (AR) é um evento extremamente traumático com grande impacto na vida dos casais. Apesar de avanços significativos verificados na investigação médica, cerca de 50% dos casos continua sem uma causa identificada. Alguns aspectos como a caracterização inadequada das doentes e das perdas gestacionais, assim como diferentes metodologias utilizadas no seu estudo, têm influenciado a prevalência de alguns dos factores causais e dificultado a compreensão do AR. Da mesma forma, pouco se sabe sobre as diferenças de género na vivência psicológica do aborto recorrente e das suas eventuais repercussões para o relacionamento do casal, centrando-se os poucos estudos existentes preferencialmente na mulher. Por esta razão, o objectivo desta tese foi a caracterização dos factores médicos associados ao AR e das consequências psicológicas desta entidade, contribuindo para promover estratégias clínicas baseadas na evidência específica. Na primeira parte desta tese (capítulos 1 e 2), após uma breve introdução geral e através de uma revisão da literatura, efectua-se uma reflexão sobre o tema, abordando a epidemiologia do aborto recorrente, os factores médicos e os aspectos psicológicos associados. Nos capítulos 3 e 4 descrevemos três estudos efectuados em mulheres portuguesas com aborto recorrente. O primeiro estudo teve por objectivo caracterizar os factores médicos e determinar o padrão da perda recorrente de gravidez, numa coorte de mulheres submetidas a um protocolo de diagnóstico definido. As participantes foram agrupadas de acordo com a paridade (AR primário ou secundário) e a idade gestacional das perdas (embrionárias ou fetais). As anomalias da cavidade uterina, a SAAF e as translocações equilibradas parentais foram os factores mais prevalentes. 15,6% das participantes eram obesas. Em 55,5% dos casos não foi identificado nenhum factor. A história obstétrica materna influenciou significativamente os resultados encontrados: os factores anatómicos e a SAAF foram mais prevalentes em nulíparas e as perdas inexplicadas foram mais frequentes em mulheres com AR secundário. Assim, os nossos dados reforçam os resultados de pesquisas anteriores sobre a importância da obesidade, da síndrome de anticorpos antifosfolípidos e das anomalias uterinas estruturais como factores associados ao AR e mostram que os a paridade é um moderador da importância desses factores. Capítulo 6 94 A ausência de resultados consensuais na literatura sobre a etiologia do AR condiciona a pesquisa sistemática de alguns factores, envolvendo exames dispendiosos, muitas vezes sem que exista evidência que suporte a sua associação com esta entidade. A trombofilia hereditária é uma das condições frequentemente investigadas nestas doentes. O nosso segundo estudo pretende contribuir para clarificar o papel de duas mutações (factor V Leiden e protrombina G20210A) na perda recorrente de gravidez e esclarecer a necessidade do seu rastreio nestas situações. Foi efectuada a pesquisa destes polimorfismos em 100 mulheres com AR inexplicado e num grupo de controlo de multíparas sem história de perdas de gravidez. Na nossa amostra não se verificou uma associação entre perdas embrionárias recorrentes e estas mutações. Nas mulheres com este tipo de perdas, a prevalência do FLV foi inclusive menor do que a verificada nos controlos. Pelo contrário, nas participantes com perdas fetais a prevalência destes polimorfismos foi muito superior à verificada nos controlos, sugerindo uma possível associação entre estas duas entidades. A pequena dimensão deste último subgrupo de mulheres, não nos permitiu contudo tirar conclusões. Uma investigação prospectiva multicêntrica é necessária antes de recomendar a pesquisa da trombofilia hereditária na investigação do AR. Procurámos incluir também nesta tese uma dimensão psicológica e contribuir assim para o conhecimento dos processos relacionais originados pelo AR. No terceiro estudo foram investigadas as diferenças de género na vivência do AR e o seu impacto no relacionamento e sexualidade do casal. Participaram neste estudo 30 casais sem filhos, com pelo menos 3 abortos espontâneos consecutivos. Cada membro do casal respondeu a um conjunto de questionários (Impact of Events Scale, Perinatal Grief Scale, Partnership Questionnaire e Intimate Relationship Scale). Os resultados mostram que as mulheres sofrem mais intensamente do que os homens com o AR, relacionando-se a intensidade do seu sofrimento com a qualidade do relacionamento conjugal. A sexualidade do casal é também afectada pelo stress e pelo sofrimento associados ao AR. Uma avaliação e acompanhamento deste tipo de problemas são imprescindíveis para ajudar estes casais a manterem a qualidade afectiva e sexual da sua relação. Finalmente, no capítulo 5 sumariámos as conclusões de toda a contribuição pessoal para a investigação sobre os factores associados e repercussões para o casal da perda recorrente de gravidez.-------------------ABSTRACT: Recurrent miscarriage (RM), a rare condition, has been described as a traumatic event for couples. Parental chromosomal anomalies, maternal thrombophilic disorders and structural uterine anomalies have been directly associated with RM. However, despite significant advances in medical research, the vast majority of cases remain unexplained. Aspects as the ethnic diversity of the population with different expression of genes, the inappropriate characterization of patients and of pregnancy losses, as well as different methodologies used in their study, have influenced the prevalence of etiological factors and have hampered the understanding of this problem. Similarly, little is known about gender differences in psychological experience of RM and its implications for the relationship of the couple. The first objective of this thesis is the characterization of the medical factors and of the psychological consequences related with RM, in the Portuguese population, helping to promote specific evidence-based clinical strategies. In the first part of this thesis, and after a brief general introduction (Chapter 1), a critical review of literature on the definition, the epidemiology and the dimensions involved, with a special emphasis on associated medical and psychological aspects of recurrent miscarriage, is presented (Chapter 2). In Chapters 3 and 4 we describe three studies carried out in Portuguese couples with RM. The first study aimed to investigate the etiological factors and the pattern of pregnancy loss in a cohort of women with RM. Subjects were divided in groups according to their parity (primary or secondary RM) and time of pregnancy loss (embryonic or fetal). Parental chromosome anomalies, uterine anomalies and antiphospholipid syndrome were the most prevalent medical factors. 15.6% of the women were obese. In the majority of cases (55.5%) no identifiable cause was detected. Parity influenced significantly our results. There was a higher prevalence of anatomic factors and antiphospholipid syndrome in primary RM. On the other hand, unexplained losses were more frequent in secondary RM. Except for the parental chromosomal abnormalities; the frequency of risk factors was similar among women with fetal or embryonic losses. Our data emphasizes the results of previous research on the importance of obesity, antiphospholipid syndrome and structural uterine abnormalities as known risk factors for RM, and shows that parity is an important moderator of the weight of those risk factors. Our second study aims to clarify the role of two mutations (factor V Leiden and prothrombin G20210A) and elucidate the need for their screening in Portuguese women with RM. FVL and PT G20210A analysis was carried out in 100 women with three or more consecutive miscarriages and a control group of 100 parous controls with no history of pregnancy losses. Secondary analysis was made regarding gestational age at miscarriage (embryonic and fetal loss). Overall the prevalence of FVL and PT G20210A was similar in RM women compared with controls. In the RM embryonic subgroup of women, FVL prevalence was inclusively lower than that of controls. Conversely in women with fetal losses both polymorphisms were much more frequent, although statistical significance was not reached due to the small size of this subgroup of patients. These data indicate that inherited maternal thrombophilia is not associated with RM prior to 10 weeks of gestation. Therefore, its screening is not indicated as an initial approach in Portuguese women with RM and a negative personal history of thromboembolic.96 Our second study aims to clarify the role of two mutations (factor V Leiden and prothrombin G20210A) and elucidate the need for their screening in Portuguese women with RM. FVL and PT G20210A analysis was carried out in 100 women with three or more consecutive miscarriages and a control group of 100 parous controls with no history of pregnancy losses. Secondary analysis was made regarding gestational age at miscarriage (embryonic and fetal loss). Overall the prevalence of FVL and PT G20210A was similar in RM women compared with controls. In the RM embryonic subgroup of women, FVL prevalence was inclusively lower than that of controls. Conversely in women with fetal losses both polymorphisms were much more frequent, although statistical significance was not reached due to the small size of this subgroup of patients. These data indicate that inherited maternal thrombophilia is not associated with RM prior to 10 weeks of gestation. Therefore, its screening is not indicated as an initial approach in Portuguese women with RM and a negative personal history of thromboembolic. In our third study, we investigate gender differences in RM experience and its impact on the couple's relationship and sexuality. Each member of 30 couples with RM answered a set of questionnaires, including the Impact of Events Scale (Horowitz et al., 1979), the Perinatal Grief Scale (Toedter et al., 1988), the Partnership Questionnaire (Hahlweg, 1979) and the Intimate Relationship Scale (Hetherington e Soeken, 1990). Results showed that men do grieve, but less intensely than women. Although the quality of the couple‟s relationship seemed not to be adversely affected by RM, both partners described sexual changes after those events. Grief was related to the quality of communication in the couple for women, and to the quality of sex life for men. An understanding of such issues is critical in helping these couples to maintain sexual and affective quality of their relationship. Finally, in Chapter 5, conclusions and clinical implications of all personal contribution to the investigation on associated factors and relational consequences of recurrent miscarriage are presented.

This pilot study sought to describe the patterns of health risk factors and objective physical findings in well rural Appalachian women. A retrospective chart review was conducted of the records of 50 women who received a health history, physical examination, and appropriate laboratory testing as part of a rural community wellness project. The most prevalent risk factors found were past or present smoking, history of lung disease, physical inactivity, obesity, and hypercholesterolemia. Higher numbers of risk factors per person were correlated with lower levels of education. The most prevalent physical findings were systolic blood pressure greater than 140 and diastolic greater than 90, diastolic blood pressure greater than 90 with normal systolic, total cholesterol greater than 240, low-density lipoprotein levels greater than 130, and greater than 20% over ideal weight. This sample reveals a high prevalence of risk factors for the leading causes of mortality in middle-aged women, partially accounted for by low formal education levels, poverty, and limited access to health care.

Introduction Radiologic Technologists exposed to continuous low dose radiation may have an increased risk for spontaneous abortions. Although the federally mandated radiation dose limit to the developing fetus of an occupational worker is 5mSv, well below the documented threshold of 100mSv, some studies have suggested an increased risk for spontaneous abortions in occupationally exposed females. The effects of exposure to low levels of radiation are difficult to discern from the usual occurrence and are limited in the literature because of the large sample size needed to achieve statistical power. This study contains data from 152,439 self-reported pregnancies and possesses the appropriate sample size to assess the risk of spontaneous abortions incident to radiologic technologists who maintain fetal radiation dose levels within federal guidelines. Methods This non-experimental retrospective designed study uses data from the United States Radiologic Technologist Study (USRTS). The USRTS began in 1982 as a joint effort between the American Registry of Radiologic Technologists (ARRT),UniversityofMinnesotaand the National Cancer Institute to study the radiation effects from low-dose occupational exposure. This longitudinal study follows more than 90,000 current and former technologists through periodic surveys and contains a sufficient sample size to overcome statistical power concerns. The provided data included the order and outcome of each self-reported pregnancy as well as the year of each live birth. The data were therefore manipulated to provide a likely gestational interval for both a reported live birth and spontaneous abortion. After calculating the spontaneous abortion rate for the final sample, a binary logistic regression was performed to determine if levels of estimated fetal radiation dose are associated with predicting the odds of a reported spontaneous abortion. A linear regression analysis was then performed to assess the relationship between the calculated odds ratios of a reported spontaneous abortion as a function of estimated fetal radiation dose, specifically to determine the significance of the linear relationship Results The overall spontaneous abortion incidence to the cohort reporting at least one live birth or spontaneous abortion was 14.8%, lower than the reported national incidence of 15-20%. Using up to 1mSv as the reference fetal radiation dose category, the odds ratios of a spontaneous abortion for 1-2mSv, 2-3mSv, 3-4mSv and 4-5mSv were calculated as 1.57, 1.82, 2.11 and 2.15 respectively. This increase in odds was linear with estimated fetal radiation dose as demonstrated by the significant regression equation (F=29.93, p = .01) and an R2 of 0.9089. Conclusions By demonstrating an increased risk at levels of radiation as low as natural background, and further demonstrating the risk increases linearly with radiation dose, the Linear Non-Threshold Theory appears to be the more likely risk model for predicting spontaneous abortions in lieu of the belief that a 100mSv threshold must first be exceeded for a radiation induced spontaneous abortion to occur. Application of this model demonstrates the risk of a spontaneous abortion is twice as likely in occupational workers whose fetal radiation doses are closer to the maximum allowable limit of 5mSv compared with those who maintain fetal radiation doses below 1mSv.

Made available in DSpace on 2016-04-04T18:27:26Z (GMT). No. of bitstreams: 1 Miriam Tachibana.pdf: 1018235 bytes, checksum: d260b46d844da4acfd0bb3d85ab02f84 (MD5) Previous issue date: 2006-12-04
This study aimed at investigating psychoanalytically the mutative potential of a different feature which was called therapeutic meetings , destinated to women who had recently suffered spontaneous abortion. This practice consisted in three or four individual encounters, which were realized a few days after those women had lost their babies, in which the verbal communication was completed by using the Drawing-and-Story Procedure of Trinca, according to the paradigm present in the Squiggle Game of Winnicott, a combination that allowed a mutual interaction. After realizing each one of the therapeutic encounters, psychoanalytical narratives were written, and were presented to the group of researchers, so that it was possible to apprehend the clinical occur by identifying the psychological fields, what would permit the viewing of the movements of integration. It was possible to observe, through constratransferencial feelings, that the two participants of this study could integrate, through the therapeutic encounters realized, aspects that were related to their functions as daughters and women, associated to their difficulties in walking towards the motherhood. It was possible to apprehend the clinical efficacy of this different feature, what indicates its implementation in hospital institutions of the areas of ginecology and obstetrics.
O presente estudo objetivou investigar psicanaliticamente o potencial mutativo de um enquadre diferenciado, denominado encontros terap?uticos, destinado ao atendimento da mulher que sofreu aborto espont?neo recente. Tal pr?tica consistiu na realiza??o de encontros individuais, em s?ries constitu?das por tr?s a quatro sess?es, poucos dias ap?s a ocorr?ncia da perda, durante as quais a comunica??o verbal podia ser complementada pela utiliza??o do Procedimento de Desenhos Est?rias de Trinca, paradigmaticamente inspirada no Jogo do Rabisco, configurando uma intera??o marcada pela mutualidade. Ap?s a realiza??o de cada encontro terap?utico, foram redigidas narrativas psicanal?ticas, que foram compartilhadas no espa?o de interlocu??o do grupo de pesquisa, visando apreender o acontecer cl?nico, pela via da identifica??o dos campos psicol?gico- vivenciais, no contexto dos quais se tornam vis?veis eventuais movimentos de supera??o de dissocia??es. P?de-se observar, a partir dos sentimentos contratransferenciais, que as duas pacientes puderam, a partir do encontro inter-humano que lhes foi proporcionado, integrar aspectos relacionados aos modos de serem filhas e mulheres, associados ?s suas dificuldades em caminhar rumo ? maternidade. Foi poss?vel, dessa maneira, vislumbrar a efic?cia cl?nica deste enquadre diferenciado, o que indica sua implementa??o em institui??es ambulatoriais e hospitalares da ?rea da gineologia e obstetr?cia.

This dissertation addresses three novel aspects of children’s future thinking: First is a study of 3- to 5-year-olds’ capacity to think about the future across two different conceptual domains. Specifically, children had to think ahead to meet either a future physiological need (desire for food) or psychological need (avoiding boredom). Most future thinking tasks only require children to plan in one domain, this despite that future thinking is presumably domain general in humans. Children were better at addressing a future need for food than a future need for toys, with even 3-year-olds succeeding above chance. This study also served as an opportunity to replicate the results of a previous similar task (Atance et al., 2015) and improve the task by removing unnecessary components (social, pretense). Second is a study of 3- to 5-year-olds’ spontaneous talk (as a proxy for spontaneous thought) about the future and past within the context of a behavioural future thinking task. Spontaneous or involuntary thought about the past and future are ubiquitous in adult cognition. Few developmental studies have investigated past spontaneous thought, and none have investigated future spontaneous thought. Children of all ages spontaneously spoke about the future and past and some children even spontaneously solved the future thinking task. Further, children who spontaneously spoke more about the past and future were more likely to correctly answer an explicit test question. Third is an attempt at addressing a limitation in all existing behavioural future thinking tasks: That is, tasks used to assess the development of future thinking do not require children to think ahead about a future state of the world that differs from the present. Children could potentially be solving behavioural future thinking tasks without having to represent the future. However, representing a future that differs from the present is argued to be core to adaptive future thinking in humans. To overcome this limitation, we modified an existing task so that children could not succeed based on their representation of how the world currently is but, rather, how it will be at a future point in time. Four- to 7-year-olds all remembered the information required to solve the modified task; however, only 7-year-olds made a future-oriented decision more often than chance. With the task modification removed (so the correct answer for the present and future matched), even 4-year-olds succeeded above chance. These findings challenge the current accounts that suggest by age 4, children can reliably succeed in future thinking tasks. Taken together, this research program contributes new insights to the development of future thinking in early childhood and suggests directions for novel research.

This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.
Bachelors
Nursing
Nursing

Bakgrund: Ett missfall kan innebära ett lidande för de kvinnor som drabbats. Många upplever känslor som sorg, skuld och ångest. Tidigare forskning tyder på att de fysiska och medicinska behoven efter ett missfall är prioriterade i den vård som bedrivs idag. Sjuksköterskan behöver uppmärksamma kvinnans emotionella behov och erbjuda stöd, samtal och information för att även lindra det emotionella och psykiska lidandet. Syfte: Syftet var att beskriva sjuksköterskors och barnmorskors erfarenheter av att vårda kvinnor som drabbats av tidigt missfall. Metod: En kvalitativ intervjustudie genomfördes där fem informanter intervjuades enligt den semistrukturerade intervjuformen. Materialet transkriberades och analyserades sedan utefter Graneheim och Lundmans kvalitativa innehållsanalys. Resultat: Analysen resulterade i två kategorier – Erfarenheter av att lindra lidande och Erfarenheter av vårdandets förutsättningar. Erfarenheterna var att kvinnans lidande kan lindras genom stöd, bemötande, kommunikation och smärtlindring. Förutsättningar som vårdmiljö, personal- och bemanningsbrist, kompetens, personliga förutsättningar samt stöd till vårdaren erfors inverka på vårdandet. Slutsats: För att erbjuda en god vård till kvinnor som drabbats av tidigt missfall krävs förutsättningar i form av tillräckligt med personal, bemanning, tid och kompetens. Stöd i form av närvaro och tillgänglighet, ett individanpassat bemötande och en följsam kommunikation kan lindra såväl kvinnans psykiska som fysiska lidande.

Bakgrund Missfall är vanligt förekommande och innebär att en kvinnas graviditet spontant avbryts innan fostret har möjlighet till överlevnad utanför livmodern före graviditetsvecka 22 avslutats eller då fostret väger mindre än 500 gram. Omvårdnaden vid missfall varierar utifrån diagnos och sjukvårdsinrättning. Omvårdnad är sjuksköterskans specifika kunskapsområde. Omvårdnadsarbetet grundar sig i en humanistisk människosyn som tar hänsyn till hela människan. Sjuksköterskan ska arbeta personcentrerat och synliggöra hela personen och dennes upplevelse. Syfte Syftet var att beskriva kvinnors upplevelser av omvårdnad i samband med missfall fram till graviditetsvecka 22. Metod Vald metod var en litteraturöversikt. Datainsamlingen gjordes i databaserna Public Medline och Cumulative Index to Nursing and Allied Health Literature. Efter urval och kvalitetsgranskning analyserades 17 vetenskapliga artiklar enligt Kristenssons integrerade analys. Resultat Resultatet består av tre teman vilka övergripande beskrev aspekter av kvinnans upplevelse av omvårdnaden vid missfall. Dessa teman var mötet med sjuksköterskan, kommunikation och sjukhusvistelsen. Kvinnors upplevelser vid missfall i samband med omvårdnaden påverkades av avsaknad av personcentrerad omvårdnad och information, sjuksköterskans empati eller brist därav, samt bristande vårdmiljö. Slutsats Ett missfall kan vara en betungande händelse för kvinnan. I mötet med vården har kvinnan ett starkt behov av att få förståelse för sin förlust. Vården vid missfall utövas ibland med ett alltför kliniskt förhållningssätt där det emotionella stödet för kvinnan är eftersatt. Omvårdnaden vid missfall skulle kunna förbättras genom att sjuksköterskan arbetar mer personcentrerat. Genom att skapa gemensamma nationella riktlinjer för omvårdnadsarbetet kring missfall kunde bättre förutsättningar för kvinnan nås och leda till ökad jämlikhet.
Background Miscarriage is common and means that a women's pregnancy spontaneously ends before the fetus has a possibility for survival outside the womb and before the end of pregnancy week 22 or when it weighs less than 500 grams. The nursing care around miscarriage varies depending on diagnosis and healthcare facility. Nursing care is the nurse’s specific knowledge area and the care is based on a humanistic view of human beings, regarding the whole person. The nurse should work person-centered and acknowledge the whole person and her experience. Aim The aim was to describe women's experiences of nursing care in connection with miscarriage up until pregnancy week 22. Method The chosen method was a literature review. The data collection was done in the databases Public Medline and the Cumulative Index to Nursing and Allied Health Literature. After selection and quality review 17 scientific articles were analyzed according to Kristensson’s integrated analysis. Results The results consist of three themes which generally describes aspects of the woman’s experience of the nursing care in connection with miscarriage. These themes were interactions with the nurse, communication and hospital stay. Women’s experiences of nursing care in connection with miscarriage is affected by the lack of person-centered care and information, the nurse's empathy or lack thereof as well as insufficient care environment. Conclusions A miscarriage can be burdensome for the woman. When receiving care, the woman has a strong need to have her loss acknowledged by the nurse. The care during miscarriage is sometimes practiced with an overly clinical approach where the emotional support is neglected. The nursing care around miscarriage could improve by the nurse working more person-centered. Creating national guidelines for the nursing care regarding miscarriage could give the woman better preconditions and lead to increased equality

SAMMANFATTNING Bakgrund Definitionen av missfall är ett spontant avslut av graviditeten utan att aktiva åtgärder vidtas. Ett missfall innebär att graviditeten avslutas innan vecka 22 och 80–85 procent av samtliga missfall inträffar i tidigt stadie. Varför en kvinna drabbas av missfall kan ha flera orsaker. Vid ett missfall står kvinnan inför fysiska såväl som psykiska utmaningar och vänder sig därför till akutsjukvården där ett personcentrerat bemötande är önskvärt. Syfte Syftet var att lyfta kvinnors upplevelser i mötet med sjuksköterskan inom akutsjukvården vid missfall. Metod Resultatet i litteraturöversikten baserades på 16 vetenskapliga artiklar där kvinnors upplevelse av akutsjukvården vid missfall presenterades. För att finna de vetenskapliga artiklarna hade författarna databaserna PubMed och CINAHL till hjälp. I litteraturöversikten beskrevs ett tydligt urval. En kvalitetsgranskning utfördes med stöd av Sophiahemmet Högskolas bedömningsunderlag för vetenskaplig klassificering. Data analyserades stegvis. Resultat Resultatet beskriver att kvinnor upplevde brister vid besöket med sjuksköterskan inom akutsjukvården. Kvinnorna kunde uppfatta kommunikationen och informationen som oärlig och otillräcklig samt brister i kontinuiteten som gjorde dem förvirrade. De påpekade brister i det emotionella stödet och respekten till deras integritet, vilket för kvinnorna inte främjade förlusthanteringen. I resultatet framhävs fyra kategorier som författarna genom analys lyfte som grundpelare i kvinnornas upplevelse av akutsjukvården. Dessa var information och kommunikation, emotionellt stöd, hotad integritet i den akuta miljön samt uppföljning och framtid. Slutsats Kvinnans upplevelse av akutsjukvården var ett resultat av olika faktorer. Att drabbas ett missfall kunde vara en traumatisk upplevelse. Denna litteraturöversikt visar att kvinnorna önskade ett empatiskt bemötande, tydlig information och att sjuksköterskan i omvårdnaden inom akutsjukvården behövde ett helhetsperspektiv. Vid ett missfall, en förlust, framträdde känslor som sjuksköterskan behöver ha kompetens, respekt och visa emotionellt stöd för. Detta för att kvinnorna skulle uppleva mindre lidande och förbättra deras upplevelse som i dagsläget innefattar betydande brister. Nyckelord: Akutsjukvård, empati, kommunikation, känslor, missfall
ABSTRACT Background Definition of miscarriage is a spontaneous termination of pregnancy without any action being taken. A miscarriage means that the pregnancy ends within week 22, 80–85 percent of all miscarriages occur at an early stage. Why a woman suffer from miscarriage can have several causes. In case of miscarriage, the women face physical and mental challenges and therefore seek care at emergency departments, were a person-centered care is useful. Aim Women’s experiences encountering nurses in the emergency care of miscarriage. Method This literature review was based on 16 scientific articles presenting women's experience with nurses of emergency care in case of miscarriage. To find the scientific articles, the authors used the databases PubMed and CINAHL. A clear selection was described. A quality examination was performed with the support of Sophiahemmet Högskola's assessment basis for scientific classification. Data were analyzed step by step. Results The result describes that women experienced deficiencies of various kinds during their visit with nurses at the emergency department. The women could perceive communication and information as dishonest and insufficient. They pointed out deficiencies in the emotional support and respect for their integrity, which for women did not promoted the management of the loss. The result highlights four categories that lifted as mainstays of women's experience of emergency care. These were information and communication, emotional support, threatened integrity in the emergency environment, and follow-up and future. Conclusions A miscarriage can be a traumatic experience. This literature review shows that women want empathic care, evident information, and a nurse with a holistic perspective. In case of miscarriage, women will show emotions that requires the nurse to have necessary skills, respect and be able to support emotionally. This was helpful for the women so that they shall suffer less and also improve their experience that have great flaws. Keywords: Abortion spontaneous, communication, emergency medical services, emotions, empathy

O objetivo deste estudo é estimar o risco de infecção congênita pelo vírus da vacina contra rubéola e estimar o risco de ocorrência de aborto, baixo peso e prematuridade nas gestantes suscetíveis e imunes para rubéola identificando os fatores de risco associados a estes eventos. Embora não tenham havido manifestações clínicas compatíveis com SRC, observou-se uma ocorrência aumentada de baixo peso ao nascer e prematuridade entre os RN infectados quando comparados com as crianças não infectadas também nascidas de mães susceptíveis. No modelo final das análises utilizando a regressão logística multivariada, entretanto, a suscetibilidade para rubéola não esteve associada com a ocorrência de baixo peso e nem com prematuridade. Estes resultados sugerem que a recomendações de não vacinar gestantes para rubéola ainda deve ser mantida
The objective of this study is to evaluate the risk of congenital infection due to rubella vaccine virus and the occurrence of premature labor, miscarriage, and low birth weight in susceptible and immune pregnant women vaccinated during pregnancy, identifying the risk factors associated. We observe a high incidence of low birth weight and prematurity in the infected newborns, when compared with the children not infected, also born of susceptible mothers. In the final model of the logistic regression we didn't find association with rubella susceptibility and the predictors miscarriage, low birth weight and premature labor. These results suggest that the recommendations to not vaccinate pregnant women against rubella must be sustained

Spontaneous abortion, or miscarriage, is an event that affects approximately one in four women during their reproductive years. Despite the psychological and physiological trauma associated with the loss of pregnancy, few evidence-based practice recommendations exist to guide nursing care of women experiencing first trimester miscarriage. The purpose of this integrative review of literature was to examine research related to women's health care experiences of first trimester miscarriage and discuss common themes relating to nursing care. Inclusion criteria consisted of peer review research articles published after 2001 and available in the English language and women that experienced miscarriage during the first 12 weeks of pregnancy. Current literature was collected from Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE- EBSCOhost and PsycINFO databases using combinations of various key words. Six qualitative studies and one quasi-experimental study met the inclusion criteria and were reviewed. The results indicated that nursing care of women experiencing miscarriage should include therapeutic communication, psychological support, and provision of information and follow-up care. While there is little research reviewing nursing interventions related to first trimester miscarriage, these themes may help guide the development of further research reviewing the efficacy and effectiveness of specific nursing interventions.
B.S.N.
Bachelors
Nursing
Nursing

Abstract Fertility declines with advancing age and the number of couples seeking infertility treatment at an older age is constantly increasing. A top quality embryo is believed to have the highest potential for implantation and development into a child. A better understanding of the relative importance of patient and treatment characteristics and of embryo quality could help to optimise the existing therapeutic schemes and the safety of in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI). In this work, databases of five Finnish infertility clinics were studied retrospectively. Data on treatments performed in the years 1994–2005 were collected. A total of 19,000 treatment cycles were analysed. Special attention was paid to the relative significance of the transfer of top quality embryos with regards to pregnancy, miscarriage, live birth and cost of treatment in the general IVF/ICSI patient population and in groups with expected poor outcome. The results showed that the transfer of a top quality embryo is associated with a better chance of pregnancy and live birth. However, it does not diminish the probability of miscarriage. Both low and high BMI increase the miscarriage rate. Advancing age and a positive history of previous miscarriages are also associated with a higher probability of miscarriage. In addition, the need for hormonal substitution in cases of frozen-embryo transfer is a risk factor of miscarriage, probably because of suboptimal endometrial function. Since the transfer of several embryos leads to multiple pregnancies, which are associated with a high risk of maternal and fetal complications, elective single embryo transfer (eSET) of a top quality embryo allows all additional good quality embryos to be frozen and transferred later in frozen-thawed embryo transfer cycles. The present work demonstrates that eSET is a safe treatment strategy at least until the age of 40. However, it might not be performed in women with fewer than four collected oocytes, since the prognosis might remain poor even if the response is improved in a following cycle. When eSET is applied routinely and on a large scale, it diminishes treatment costs while increasing the number of deliveries occurring at term, making IVF/ICSI at the same time safer and more affordable even to patients without access to reimbursed IVF treatment.

Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2008.
Title from electronic title page (viewed Feb. 26, 2009). "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Maternal and Child Health reproductive epidemiology, School of Public Health." Discipline: Maternal and Child Health; Department/School: Public Health.

Many women experience miscarriage every year. Every fourth woman who has given birth reports that she has previous experience of miscarriage. In a study of all women in the Swedish Medical Birth Register 1983-2003, we found that the number of cases of self reported miscarriage had increased in Sweden during this 21 year period. This increase can be explained by the introduction of sensitive pregnancy tests around 1990, as well as an increase in the mean age of the mothers, by approximately 3 years, during the observation period. The risk of miscarriage is 13% with the first child. With subsequent pregnancies, the risk of miscarriage is 8%, 6% and 4% with the second, third and fourth child, respectively. Thirteen of these women who had suffered a recent miscarriage were interviewed four months later, and their feelings of guilt and emptiness were explored. Their experience was that they wanted their questions to be answered, and that they wanted others to treat them as the mothers to be that they felt themselves to be. They also experienced the need for time to grieve their loss. Measurement of grief by means of the Perinatal Grief Scale (PGS) is used in research but has also been proposed for clinical use. We have translated this psychological instrument to Swedish, back-translated and tested it in a small pilot study. In a randomized controlled study, women with early miscarriage were allocated, either to a structured visit (study group) or a regular visit (control group) to a midwife. The structured visit was conducted according to the Swanson caring theory. We could conclude that the structured visit had no significant effect on grief compared to the regular visit, as measured using the PGS. However, women with the sub-diagnosis missed abortion have significantly more grief four months after early miscarriage, regardless of visit type. We also performed a content analysis of the tape-recorded structured follow-up visit. The code-key used was Bonanno and Kaltman’s general grief categorization. Women’s expression of grief after miscarriage was found to be very similar to the grief experienced following the death of a relative. Furthermore, the grief was found to be independent of number of children, women’s age, or earlier experience of miscarriage. Conclusions: Every fourth woman who gives birth reports that she has also experienced early miscarriage. The experience of these women is that they have suffered a substantial loss and their reaction is grief similar to that experienced following the death of a relative.
On the day of the public defence of the doctoral thesis the status of article III was In Press and article IV was In Press.

[Truncated abstract] Veterinarians have considerable potential for exposure to several known reproductive hazards such as radiation, anaesthetic gases, pesticides, long working hours and occupational stress. Reproductive effects are a concern to female veterinarians, especially now that about 65% of graduates from Australian veterinary science schools are female. In the last two decades, there have been reports on the possible associations between occupational exposures and adverse reproductive outcomes in female veterinarians, but most of them have been equivocal and the whole area remains controversial. More evidence is needed before firm conclusions can be drawn. The Health Risks of Australian Veterinarians project (HRAV) was conducted as a questionnaire-based survey of all graduates from Australian veterinary schools during the 40-year period 1960-2000. Of 5,748 eligible veterinarians who were sent the questionnaires (73% of the whole cohort), 2,800 replied including 1,197 females (42.8%). Among women veterinarians eligible to participate, 59% participated . . . Identification of these associations may provide the opportunity for preventing harmful exposures and thus reduce the risk of any adverse reproductive outcomes not only for veterinarians, but also for other groups exposed to these risks such as veterinary nurses, animal laboratory technicians, anaesthetists, dentists, dental assistants, and other similar professional groups. The author of this thesis, having completely addressed the research objectives of her doctoral candidacy, has set out and acted on a future research agenda designed to explore the association between perceived occupational stress and pregnancy outcomes and infertility in Australian female veterinarians.

L’embrione, esprime molecole MHC di classe I paterne e può dunque essere assimilato ad un semiallotrapianto. Rappresenta quindi un potenziale bersaglio per il sistema immunitario materno e in particolare per i linfociti T helper CD4+ responsabili della tolleranza e del rigetto all’allotrapianto. Recentemente è stata identificata una nuova sottopopolazione di linfociti T helper, diversa dalle sottopopolazioni Th2 e Th1, definita Th17, caratterizzata dalla produzione di IL-17A, IL-17F, IL-21, IL-26 e IL-22 ed è responsabile della difesa contro patogeni extracellulari e funghi, e dell’infiammazione. Inoltre i linfociti Th17, come le cellule Th1, sembrano avere un ruolo nel rigetto dei tessuti trapiantati ed è stato quindi studiato il loro ruolo nel riassorbimento fetale. E’ stato riportato da Wang et al che il numero delle cellule CD4+ deciduali producenti IL-17 è significativamente maggiore nelle donne poliabortive rispetto ai controlli con gravidanza normale. Mentre Nakashima et al riporta che il numero di linfociti CD4+ Th17 deciduali è aumentato solo in caso di aborto spontaneo detto “inevitabile”, caratterizzato da sanguinamento vaginale e crampi. Quest’ultimo studio suggerisce quindi, che le cellule Th17 potrebbero essere coinvolte nell’infiammazione che si instaura nelle fasi finali dell’aborto e non essere la causa dell’aborto. Il ruolo delle cellule Th17 nel rigetto dell’allotrapianto fetale e nell’aborto spontaneo rimane quindi ancora non chiaro. Lo scopo della tesi è stato dunque di studiare il ruolo delle cellule Th17, ma anche delle sottopopolazioni Th17/Th2 e Th17/Th1, nella gravidanza normale e nell’aborto spontaneo in donne poliabortive “sine causa”. In queste donne, una disfunzione immunologica a livello dei linfociti T CD4+ effettori deciduali potrebbe spiegare gli aborti spontanei ricorrenti. Inoltre è stato analizzato il possibile coinvolgimento delle cellule Th17, ma anche delle sottopopolazioni Th17/Th2 e Th17/Th1, nell’impianto dell’embrione studiando queste cellule nella tuba di Falloppio al sito e lontano dal sito dell’impianto dell’embrione. Infine è stato studiato il ruolo dell’HLA-G5, un classe I prodotto dal trofoblasto sul differenziamento delle cellule T CD4+ Th17 in Th17/Th2 o Th17/Th1. I risultati ottenuti dimostrano che le cellule T helper CD3+CD4+ ottenute dalla decidua di donne con gravidanza normale producono spontaneamente livelli di IL-4 e di IL-17A maggiori in confronto al sangue periferico. Queste cellule esprimono contemporaneamente e spontaneamente i marcatori CD161, CCR4 e CCR8, suggerendo una possibile associazione nella produzione di citochine di tipo Th2 e Th17. Inoltre è stato messo in evidenza nella gravidanza normale un elevato numero di cloni cellulari T CD4+ caratterizzati da una produzione combinata di IL-4 e IL-17A (Th17/Th2), mentre in caso di aborto spontaneo nelle pazienti poliabortive prevalgono i cloni T CD4+ che secernono solo IL-17A (Th17 puri) o una combinazione di IFN-γ e IL-17A (Th17/Th1). Sembrerebbe quindi che la combinazione dell’IL-17A con l’IL-4 sia favorevole al mantenimento della gravidanza, mentre l’associazione dell’IL-17A con l’IFN-γ, o la produzione di IL-17A da sola, osservata nell’aborto spontaneo, potrebbe avere un ruolo deleterio sulla gravidanza e indurre un riassorbimento fetale. Nella tuba di Falloppio, lontano dal sito dell’impianto dell’embrione è stata osservata una prevalenza di cellule Th17 pure e Th17/Th1 rispetto al sito dell’impianto, mentre le cellule Th17/Th2 sono localizzate esclusivamente a livello del sito dell’impianto e non sono presenti lontano da tale sito. Questi dati suggeriscono dunque che le cellule Th17/Th2 siano responsabili del controllo dell’impianto dell’embrione, probabilmente favorendo la recettività dell’endometrio all’embrione mediante meccanismi legati, in parte alla tolleranza materna verso l’allotrapianto fetale, e in parte ad una protezione contro patogeni extracellulari responsabili di aborto spontaneo. Infine sono stati derivati cloni cellulari T CD4+ da linee cellulari T specifiche per la streptochinasi coltivate in assenza o in presenza di HLA-G5. I cloni cellulari T CD4+ derivati dalle linee ottenute in presenza di HLA-G5 producono livelli significativamente più elevati di IL-4 e di IL-17A rispetto ai cloni T CD4+ derivati dalle linee ottenute in assenza di HLA-G5. Questi dati indicano che l’HLA-G5 prodotto dall’embrione e dal citotrofoblasto extravilloso potrebbe essere responsabile dello “switch” di cellule T CD4+ deciduali in cellule Th17/Th2 importanti per l’impianto dell’embrione.

Il trofoblasto, che esprime molecole Major Histocompatibility Complex (MHC) di classe I paterne (HLA-C), è considerato un semi-allotrapianto e potrebbe, quindi, essere rigettato dai linfociti T materni. L’IL-22, citochina appartenente alla famiglia dell’IL-10 e prodotta dai linfociti T (Th1, Th0, Th22 e Th17), sembra essere coinvolta nel rigetto dell'allotrapianto e, quindi, potrebbe essere responsabile dell’aborto. Il recettore dell’IL-22, l’IL-22R1, è presente sulle cellule di trofoblasto e sui villi umani, quindi l’IL-22 potrebbe agire direttamente sulle cellule fetali. Le prime evidenze hanno mostrato che l’IL-22 potesse essere coinvolta nell’aborto spontaneo, in quanto determina sia l’aumento, da parte dei linfociti Th1 e Tc1, della produzione di IFN-γ, citochina responsabile del rigetto acuto dell’allotrapianto fetale, sia la riduzione, da parte delle cellule Th2 e Treg, della produzione di IL-10, citochina responsabile della tolleranza dell’allotrapianto fetale. Il primo scopo del nostro studio è stato quello di esaminare il ruolo delle cellule T CD4+ della decidua producenti IL-22 nella gravidanza umana. Abbiamo osservato che in donne con gravidanza normale ed in donne con aborto spontaneo ricorrente (ASR), i livelli di IL-22 prodotti dalle cellule T CD4+ deciduali sono superiori rispetto a quelli prodotti delle cellule T del sangue periferico delle stesse donne. Abbiamo, inoltre, riscontrato una correlazione tra l’IL-22 e l’IL-4 prodotte dalle cellule T CD4+ deciduali in donne con gravidanza normale, ma non in donne con ASR. La correlazione tra l’IL-22 e l’IL-4 è stata osservata anche nel siero di donne con gravidanza normale. Inoltre, abbiamo osservato una prevalenza di cellule T CD4+ che producono IL-22 ed IL-4 (Th17/Th2/IL-22+, Th17/Th0/IL-22+, Th2/IL-22+ e Th0/IL-22+) nella decidua di donne con gravidanza normale, mentre in donne con ASR sono prevalenti le cellule Th17/Th1/IL-22+, che non producono IL-4. Le cellule Th17/Th2/IL-22+ e le cellule Th17/Th0/IL-22+ sono presenti esclusivamente in corrispondenza del sito di impianto dell'embrione nella tuba di Falloppio di donne con gravidanza ectopica, in cui sono espressi gli mRNA per IL-4, GATA-3, IL-17A, ROR-C, IL-22 ed AHR, pertanto, sembrano essere cruciali per l'impianto dell'embrione. Gli mRNA per T-bet ed IFN-γ, invece, sono espressi lontano dal sito di impianto nella tuba di Falloppio di donne con gravidanza ectopica. L’IL-22, se prodotta, quindi, in associazione con l’IL-4, non è deleteria per la gravidanza. L’IL-22 potrebbe inibire l’apoptosi del trofoblasto ed indurne la sopravvivenza e la rigenerazione ed, infine, stimolando la produzione di peptidi antimicrobici da parte delle cellule epiteliali, potrebbe proteggerlo dall’attacco dei patogeni extracellulari e, quindi, impedire l’aborto. L’IL-22, inoltre, sembra essere coinvolta nella patogenesi di molte malattie autoimmuni (Lupus Eritematoso Sistemico, Artrite Reumatoide, Sclerosi Multipla, Diabete di tipo I, Tiroidite di Hashimoto, Malattia di Graves, Psoriasi, Morbo di Crohn). Pertanto, il secondo scopo del nostro studio è stato quello di indagare le variazioni dei livelli sierici di IL-22 in donne affette da patologie autoimmuni durante la gravidanza e in soggetti di controllo e di stabilire se l’IL-22, da sola o in associazione con altre citochine di tipo Th1, Th2 e Th17, potesse diventare un biomarcatore predittivo utilizzato per seguire l’attività clinica dei disordini autoimmuni durante la gravidanza. A questo scopo, abbiamo misurato i livelli sierici di 28 citochine e chemochine in donne gravide e non gravide affette da malattie autoimmuni e donne sane non gravide ed abbiamo osservato che i livelli di IL-22 non sembrano alterati nelle donne affette da malattie autoimmuni quando si trovano in uno stato di gravidanza. I livelli sierici di IL-22 non risultano alterati, inoltre, in donne gravide affette da malattie autoimmuni di tipo Th1/Th17 (Malattia di Behçet, Tiroidite di Hashimoto, Sindrome da Anticorpi-antifosfolipidi, Artrite Reumatoide, Sclerosi Multipla, Diabete di tipo 1, Granulomatosi di Wegener) rispetto alle donne non gravide affette da malattie autoimmuni di tipo Th1/Th17 e alle donne sane gravide. Analizzando, più nel dettaglio, i livelli di citochine e chemochine presenti in donne affette da malattie autoimmuni di tipo Th1/Th17 durante il primo, il secondo ed il terzo trimestre di gravidanza, abbiamo riscontrato, durante il primo trimestre di gravidanza rispetto al secondo trimestre, un aumento statisticamente significativo della produzione di IL-4, citochina prodotta dai linfociti Th2 ed importante per la tolleranza dell’allotrapianto fetale, e di EOTASSINA, responsabile del reclutamento dei linfociti Th2 che favoriscono lo sviluppo della gravidanza. Paragonando, invece, il primo ed il terzo trimestre di gravidanza in donne affette da malattie autoimmuni di tipo Th1/Th17, abbiamo riscontrato un aumento statisticamente significativo della produzione di IL-5, FGF, IFN-γ, MCP-1 e MIP-1α ed una riduzione statisticamente significativa della produzione di IL-9. L’aumento, nel primo trimestre di gravidanza rispetto al terzo trimestre, di MCP-1 e MIP-1α, due chemochine che stimolano il reclutamento dei macrofagi, associato ad una aumentata produzione di IFN-γ, potrebbe determinare un maggiore stato infiammatorio e, quindi, causare un peggioramento della malattia. La riduzione della produzione di IL-9, che stimola le risposte T regolatorie, in donne affette da malattie autoimmuni durante il primo trimestre di gravidanza rispetto al terzo trimestre, potrebbe indurre un peggioramento della malattia. Per quanto riguarda l’IL-22, i suoi livelli sierici non sembrano, invece, variare in modo significativo durante il corso della gravidanza sia in donne affette da malattie autoimmuni di tipo Th1/Th17 che in donne affette da malattie autoimmuni di tipo Th2/Th17. Nelle donne non affette da malattie autoimmuni e non gravide si osserva un profilo di tipo Th1/Th17, caratterizzato da una correlazione positiva tra l’IFN-γ e l’IL-17, mentre nelle donne affette da malattie autoimmuni e non gravide si osserva un profilo di tipo Th0/Treg e Th2/Th17/Treg, caratterizzato da una correlazione tra l’IL-10 e l’IFN-γ e tra l’IL-10 e l’IL-17. Nelle donne affette da malattie autoimmuni e non gravide la presenza di una correlazione positiva tra l’IL-10 e l’IFN-γ e tra l’IL-10 e l’IL-17 potrebbe essere dovuta al tentativo, da parte dell’organismo, di sopprimere, mediante la produzione di IL-10, citochina anti-infiammatoria, lo stato infiammatorio legato alla presenza della malattia autoimmune e causato dall’aumento dei livelli di IL-17 ed IFN-γ. Nel siero delle donne affette da malattie autoimmuni e gravide osserviamo, invece, che l’IL-22 correla positivamente con l’IL-4, probabilmente in relazione allo stato di gravidanza delle donne affette da malattie autoimmuni. L’IL-22 è una citochina pro-infiammatoria che, aggiungendosi alla produzione di IL-17 ed IFN-γ, associate allo stato di patologia, potrebbe determinare un peggioramento dello stato di salute di queste pazienti. In conclusione, l’IL-22 potrebbe causare il peggioramento dello stato di salute delle pazienti, che si osserva in molte malattie autoimmuni durante la gravidanza. Questi dati preliminari dovranno essere confermati con l’arruolamento di altri pazienti, già previsto dallo studio in corso che è stato approvato dal Comitato Etico di Area Vasta Centro (CEAVC) della Toscana.

M.Cur.
The story of loss, after the experience of spontaneous abortion affects the women’s being as a whole. It impacts her emotional, physical, intellectual, social and spiritual dimensions. The woman finds herself robbed of her voice by her social network. She stands isolated in her new reality of loss and bereavement. This research tells the story of the women’s loss after the experience of spontaneous abortion. The objectives of the research are to • explore and describe the women’s experience after a spontaneous abortion, and • describe guidelines for the advanced psychiatric nurse practitioner according to which he/she can provide support to women after the experience of spontaneous abortion and facilitate mental health through the mobilisation of resources. The paradigmatic perspective of this study is guided by the Theory for Health Promotion in Nursing (Rand Afrikaans University, Department of Nursing Science, 2002: 2-8). A functional approach was followed, based on Botes’s model for nursing research (Botes in Rand Afrikaans University: Department of Nursing, 2002: 9-15). A qualitative, descriptive, exploratory and contextual design was used. In-depth, semi-structured, phenomenological interviews were held with seven women who fitted the sample criteria. Consent for the research was obtained from the Rand Afrikaans University as well as informed consent from the women volunteering to participate in the research. Trustworthiness was maintained by using strategies of credibility, applicability, dependability and confirmability, as described by Lincoln and Guba (1985: 289-331). Recorded interviews were transcribed and analysed using Tesch’s data analysis techniques (in Creswell, 1994: 155-136). An independent coder was utilised in coding the data, and a consensus discussion was held between the researcher and the independent coder. A central storyline was identified and themes highlighted. A literature control was undertaken to highlight similarities and differences between this and other research. The results were described in a narrative manner, which included the content as well as the processes of the women’s emotional experiences after the experience of spontaneous abortion. The impact of the loss affected her social dimension in terms of emotional processes as well as emotional expression. Participants experienced a strong need for acknowledgment of their loss and understanding of their reality of loss and bereavement. The spontaneous abortion has an impact on the women’s physical dimension. She experiences physical discomfort. The impact also effects her spiritual dimension by influencing her relationship with herself and God. The impact also touches her social dimension by robbing her of her voice through her social network’s response to the spontaneous abortion. There is also an impact on her relationship with her partner, as men and women experience and express loss differently. In the reality of loss and bereavement, the participants identified hope givers and hope stealers. Hope givers include • a strong connection with women who experienced spontaneous abortion themselves, • strengthening their relationship with God, • time as a healing faktor, • the value of sharing their stories, • the ability to find meaning after spontaneous abortion, and • the need for emotional growth. Hope stealers include • the response from people in her social network with regard to the spontaneous abortion, • experience of loss of control, • insufficient support in their interpersonal relationships and social network, • confronting the finality of the loss, and • being confronted with pregnant women en babies. Guidelines for the advanced psychiatric nurse practitioner to provide support to women after the experience of spontaneous abortion will be described to assist them in mobilising their resources to facilitate the promotion of their mental health.