Dissertations / Theses: 'Pregnant women - Diseases'

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Tsun, Ka-lai Obe, and 秦家麗. "Cervical cytology screening in pregnant women." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2006. http://hub.hku.hk/bib/B4501100X.

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Kloprogge, Frank Lodewijk. "Pharmacokinetics and pharmacodynamics of antimalarial drugs in pregnant women." Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:79ce1a37-3ba2-45e4-9f80-0692a66837f1.

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Malaria is the most important parasitic disease in man and it kills approximately 2,000 people each day. Pregnant women are especially vulnerable to malaria with increased incidence and mortality rates. There are indications that pregnancy alters the pharmacokinetic properties of many antimalarial drugs. This is worrisome as lower drug exposures might result in lowered efficacy and lower drug exposures can also accelerate the development and spread of resistant parasites. The aim of this research was to study the pharmacokinetics and pharmacodynamics of the most commonly used drugs for the treatment of uncomplicated Plasmodium falciparum malaria during the second and third trimester of pregnancy using a pharmacometric approach. This thesis presents a number of important findings that increase the current knowledge of antimalarial drug pharmacology and that may have an impact in terms of drug efficacy and resistance. (1) Lower lumefantrine plasma concentrations at day 7 were evident in pregnant women compared to that in non-pregnant patients. Subsequent in-silico simulations with the final pharmacokinetic-pharmacodynamic lumefantrine/desbutyl-lumefantrine model showed a decreased treatment failure rate after a proposed extended artemether-lumefantrine treatment. (2) Dihydroartemisinin exposure (after intravenous and oral administration of artesunate) was lower during pregnancy compared to that in women 3 months post-partum (same women without malaria). Consecutive in-silico simulations with the final model showed that the underexposure of dihydroartemisinin during pregnancy could be compensated by a 25% dose increase. (3) Artemether/dihydroartemisinin exposure in pregnant women was also lower compared to literature values in non-pregnant patients. This further supports the urgent need for a study in pregnant women with a non-pregnant control group. (4) Quinine pharmacokinetics was not affected by pregnancy trimester within the study population and a study with a non-pregnant control group is needed to evaluate the absolute effects of pregnancy. (5) Finally, a data-dependent power calculation methodology using the log likelihood ratio test was successfully used for sample size calculations of mixed pharmacokinetic study designs (i.e. sparsely and densely sampled patients). Such sample size calculations can contribute to a better design of future pharmacokinetic studies. In conclusion, this thesis showed lower exposures for drugs used to treat uncomplicated Plasmodium falciparum malaria during the second and third trimester of pregnancy. More pharmacokinetic studies in pregnant women with a non-pregnant control group are urgently needed to confirm the current findings and to enable an evidence-based dose optimisation. The data-dependent power calculation methodology using the log likelihood ratio test can contribute to an effective design of these future pharmacokinetic studies.

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Shipley, William. "Assessment of the effects of malaria and anemia in pregnant Malawian women before and after treatment of moderate malnutrition." DigitalCommons@CalPoly, 2020. https://digitalcommons.calpoly.edu/theses/2182.

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ABSTRACT Assessment of the Effects of Malaria and Anemia in Pregnant Malawian Women Before and After Treatment of Moderate Malnutrition William Shipley Background: Moderate acute malnutrition (MAM) can lead to adverse maternal and infant outcomes and possibly further complications. Supplementary foods or treatments with high quality nutrients should be administered to those with MAM in hopes to increase the chance of healthy maternal and infant outcomes. Sometimes supplementary food is not enough to overcome MAM and disease may play a role, particularly in pregnant malnourished women. Objective: To determine if the effects of malaria and anemia moderated the effect of nutritional treatments (one of the three given nutritional interventions) used to improve malnutrition and achieve a MUAC ≥ 23 cm during study participation. Additionally, this research serves to assess whether the relationship between malaria and anemia is associated with malnutrition status. Methods: Women were given a dose of IPTp at each antenatal visit between zero and four total IPTp doses. Infant anthropometrics – length, weight, head circumference, and MUAC were taken at birth, 6 weeks, and 3 months. Maternal hemoglobin levels were assessed at enrollment and after 10 weeks of enrollment as well as infant hemoglobin at 3 months. Anemia was defined by a hemoglobin less than 11.0 g/dL. Mild anemia was defined as hemoglobin greater than 7.0 but less than 9.9 g/dL and moderate anemia was defined by hemoglobin values 9.9 or greater but less than 11.0 g/dL. Analysis was completed using ANOVA, and if any significant differences were observed, they were compared via Tukey HSD (continuous) or Chi-squared test (categorical). Results: Total number of IPTp doses was found to be a more statistically significant predictor of maternal weight gain during treatment than timing of the doses. It stands to reason that women receiving three or more IPTp doses was the most beneficial for women during treatment as it saw the highest increases in maternal weight gain. At baseline, women that achieved a MUAC > 23 cm during the study was 32.0% (n = 1805). The greatest proportion of women, after adjustment, that achieved a MUAC ≥ 23 cm was seen in women receiving four (47.3 %) and three (37.8 %) total IPTp doses during pregnancy. Maternal weight gain correlated closely with hemoglobin at enrollment (p-value = 0.0111). Total number of IPTp doses received during pregnancy was not found to have a statistical effect on infant hemoglobin or anemia at three months. Infant length at six weeks was higher in infants from mothers that received two or three IPTp doses compared to mothers that received one IPTp dose (p-value = 0.0218). A p-value below 0.05 by total number of IPTp doses was observed for infant weight, head circumference, and MUAC at birth, six weeks, and three months. Conclusion: At least three IPTp was effective in improving maternal weight gain and achievement of MUAC > 23 cm as well as improved many infant outcomes. Hemoglobin at enrollment was a predictor of maternal weight gain during tx but was not associated with any other outcomes.

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Psaros, Christina Geller Pamela A. "Psychological processes involved in adherence to art and prenatal care utilization among HIV infected, pregnant women /." Philadelphia, Pa. : Drexel University, 2008. http://hdl.handle.net/1860/2808.

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Lima, Thais Marques. "Corrimentos vaginais em gestantes: uma comparaÃÃo da abordagem sindrÃmica com exames da prÃtica clinica da enfermagem." Universidade Federal do CearÃ, 2011. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=7422.

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CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior
Objetivou-se comparar os achados de infecÃÃes vaginais em gestantes obtidos por meio do fluxograma de corrimento vaginal com exames presentes na prÃtica clÃnica. O estudo foi do tipo avaliativo, com delineamento transversal e abordagem quantitativa, desenvolvido no Centro de Parto Natural LÃgia Barros Costa em Fortaleza - CE, com amostra composta por 104 gestantes. Os dados foram coletados por meio de entrevista e exame ginecolÃgico de Janeiro a Julho de 2011. Foi realizada anÃlise estatÃstica, utilizando frequÃncia absoluta, mÃdia e Desvio PadrÃo. Realizou-se, tambÃm, testes de sensibilidade, especificidade, valores preditivos positivo e negativo, acurÃcia e as razÃes de verossimilhanÃa positiva e negativa, em que se estabeleceu significÃncia para valor de p<0,1. O projeto de pesquisa foi aprovado pelo ComitÃ de Ãtica em Pesquisa da Universidade Federal do CearÃ, conforme protocolo nÂ 298/10. As gestantes apresentaram mÃdia de idade de 23,7 anos, parceria fixa (78; 75%), mÃdia de 12,3 anos de estudo e renda familiar entre um e dois salÃrios mÃnimos (59; 56,7%). A menarca ocorreu em mÃdia com 12,8 anos e a sexarca com 16 anos. NÃo apresentavam histÃria pregressa de IST (90; 86,5%) e nÃo realizavam exame citolÃgico periodicamente (58; 55,8%). Houve predomÃnio de mulheres multÃparas (58; 55,8%), com uma mÃdia de 20,24 semanas gestacionais. As queixas ginecolÃgicas mais predominantes foram: corrimento vaginal (87; 83,7%), odor de secreÃÃo vaginal (45; 43,3%), dispareunia (36; 34,6%), prurido (27; 26%), disÃria (12; 11,5%), sinusorragia (6; 5,8%) e febre (4; 3,9%). Encontrou-se uma prevalÃncia de 13,5% de positividade para pelo menos uma das trÃs infecÃÃes vaginais investigadas de acordo com o exame a fresco. Observou-se predominantemente o pH de valor 5 (50; 48,1%) e o teste de aminas negativo (66; 63,5%). O fluxograma nÃo se mostrou eficaz na identificaÃÃo de candidÃase, apresentando uma baixa sensibilidade (0,0%) e Valor Preditivo Positivo (0,0%), uma alta especificidade (97,9%), Valor Preditivo Negativo (90,2%) e acurÃcia (88,5%), alÃm de RazÃo de VerossimilhanÃa Positiva nula e RazÃo de VerossimilhanÃa Negativa igual a 1. Para tricomonÃase, apresentou baixa sensibilidade (50%), especificidade (46%), Valor Preditivo Positivo (3,6%) e acurÃcia (46,2%), um alto Valor Preditivo Negativo (95,8%), RazÃo de VerossimilhanÃa Positiva igual a 0,9 e RazÃo de VerossimilhanÃa Negativa de 1,08. Para vaginose bacteriana, mostrou-se satisfatÃrio, com uma alta sensibilidade (100%), Valor Preditivo Negativo (100%) e acurÃcia (74%), uma baixa sensibilidade (64%) e Valor Preditivo Positivo (51,8%), alÃm de RazÃo de VerossimilhanÃa Positiva igual a 2,7 e RazÃo de VerossimilhanÃa Negativa nula. Conclui-se que o emprego da abordagem sindrÃmica das infecÃÃes vaginais em gestantes precisa ser reavaliada, visto que o fluxograma nÃo foi eficaz em identificar infecÃÃes como candidÃase e tricomonÃase. Os esforÃos para o desenvolvimento de testes simples e mais acessÃveis devem ser contÃnuos. Entretanto, devem-se empregar tÃcnicas mais avanÃadas, como o exame a fresco, na prÃtica clÃnica, com intuito de aprimorar as prÃticas em saÃde sexual e reprodutiva, evitando a disseminaÃÃo de infecÃÃes, reduzindo tratamentos desnecessÃrios e melhorando a qualidade de vida das gestantes.
The aim was to compare the findings of vaginal infections in pregnant women obtained from the vaginal discharge flowchart with tests present in the clinical practice. This was an evaluation study, with a transversal delineation and quantitative boarding, developed in the Center of Natural Birth LÃgia Barros Costa in Fortaleza â CE, with a sample of 104 pregnant women. The data was collected through interviews and gynecological examination from January to July of 2011. Statistical analysis was carried through, using absolute and average frequency and Standard Deviation. It was also conducted tests of sensitivity, specificity, predictive positive and negative values, accuracy and reasons of positive and negative probability, where it was established a significance value of p< 0,1. The research project was approved by the Research Ethics Committee of the Federal University of the CearÃ, under the protocol nÂ 298/10. The pregnant women presented an average age of 23,7 years, fixed partnership (78; 75%), average of 12,3 years of study and family income between one and two minimum wages (59; 56,7%). The menarche occurred with an average age of 12,8 years and the first sexual intercourse with 16 years. They did not present history of STDs (90; 86.5%) and did not take cytological examinations regularly (58; 55,8%). The majority of the women are multiparous (58; 55.8%), with an average of 20,24 weeks of gestation. The predominant gynecological complaints were: vaginal discharge (87; 83.7%), vaginal secretion odor (45; 43.3%), dyspareunia (36; 34.6%), itch (27; 26%), dysuria (12; 11.5%), sinusorragia (6; 5.8%) and fever (4; 3,9%). It was observed a prevalence of 13,5% of positivity for at least one of three vaginal infections investigated according to the fresh examination. It was observed predominantly a pH value of 5 (50; 48.1%) and whiff test negative (66; 63,5%). The flowchart did not reveal efficient in the identification of candidiasis, presenting a low sensitivity (0.0%) and positive predictive value (0.0%), a high specificity (97.9%), negative predictive value (90.2%) and accuracy (88.5%), as well as null positive likelihood ratio and negative likelihood ratio equal to 1. For trichomoniasis, it presented low sensitivity (50%), specificity (46%), positive predictive value (3.6%) and accuracy (46.2%), a high negative predictive value (95.8%), positive likelihood ratio equal to 0,9 and negativo likelihood ratio 1,08. For bacterial vaginosis, it revealed satisfactory, with a high sensitivity (100%), negative predictive value (100%) and accuracy (74%), a low sensitivity (64%) and positive predictive value (51.8%), as well as positive likelihood ratio equal to 2,7 and null negative likelihood ratio. In conclusion, the use of a syndromic boarding for vaginal infections in pregnant women needs to be reevaluated, since the flowchart was not efficient in identifying infections such as candidiasis and trichomoniasis. The efforts for the development of simple and accessible tests must be continuous. However, more advance and techniques, like the fresh examination, in the practical clinic, aiming to contribute to the improvement of the sexual health and reproductive practices, preventing the dissemination of infections, reducing unnecessary treatments and improving the quality of life of these women.

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HARUN-OR-RASHID, MD, UH FARIDA KHATUN, YOSHITOKU YOSHIDA, SATOSHI MORITA, NURUDDIN CHOWDHURY, and JUNICHI SAKAMOTO. "IRON AND IODINE DEFICIENCIES AMONG UNDER-2 CHILDREN, ADOLESCENT GIRLS, AND PREGNANT WOMEN OF BANGLADESH: ASSOCIATION WITH COMMON DISEASES." Nagoya University School of Medicine, 2009. http://hdl.handle.net/2237/11335.

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Dourado, Bianca Maria Ramos. "Doença periodontal em gestantes e repercussões gestacionais e ao recém-nascido." Botucatu, 2018. http://hdl.handle.net/11449/155852.

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Orientador: Cátia Regina Branco da Fonseca
Resumo: A Doença Periodontal na gestação desencadeia uma resposta imunológica exacerbada com altas concentrações locais e sistêmicas de marcadores inflamatórios. Objetivo: Investigar a repercussão da Doença Periodontal (DP) na gestante e suas complicações na gestação e no momento do parto, bem como desfechos negativos para o recém-nascido (RN) (infecção, prematuridade, baixo peso, restrição de crescimento fetal). Método: Estudo de coorte retrospectiva, a partir de registros de prontuários médicos de 142 gestantes atendidas em serviço de pré-natal de risco habitual entre 2012-2014, com avaliação odontológica para DP. Foram analisadas variáveis maternas gestacionais, do parto e do recém-nascido. Os RN foram estratificados em dois grupos: filhos de mães com DP (subdividido para Doença Periodontal grave -DPG) e, filhos de mães sem DP. Cada desfecho foi ajustado por um modelo de regressão logística múltipla, com significância se p<0,05, considerando todos os potenciais confundidores. Resultados: Observou-se entre as mulheres com diagnóstico de DPG o aumento de chance de vulvovaginite 3,45 vezes maior (OR=3,45; p=0,050) e de RPM 5,59 vezes maior (OR=5,59; p=0,017). Nos recém-nascidos, a chance de haver restrição de crescimento fetal foi 11,53 vezes maior nas gestantes com DPG (OR = 11,53; p=0,041). Conclusão: A Doença Periodontal aumentou a chance para desfechos neonatais e maternos negativos, sendo estes o recém-nascido nascer com restrição de crescimento fetal e a gestante apresentar vul... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: The Periodontal Disease on pregnancy triggers an intense immunological response with high levels of local and systemic concentration of stress biomarkers. Objective: To investigate the repercussion of periodontal disease (PD) on the pregnant woman and complications during pregnancy and delivery as well, negative outcomes for the newborn (infection, prematurity, low weight, fetal growth restriction). Method: Retrospective cohort study, based on records of medical records of 142 pregnant women attended at prenatal service at usual risk between 2012-2014, with odontological evaluation for PD. Gestational maternal, labor and newborn variables were analyzed. The newborns were stratified into two groups: newborns mothers with PD (subdivided for severe periodontal disease - SPD) and newborns mothers without PD. Each outcome was adjusted by a multiple logistic regression model, with significance if p <0.05, considering all potential confounders. Results: Was increased among women exposed the SPD the odds of vulvovaginitis was 3.45 times higher (OR = 3.45; p=0.050) and of PMR was 5.59 times higher (OR=5.59; p=0.017). In the newborn of mothers exposed the SPD, the increase in odds of the fetal growth restriction was 11.53 times higher (OR=11.53; p= 0.041). Conclusion: Periodontal disease increased the chance for neonatal and maternal negative outcomes, such as fetal growth restriction in the newborn and vulvovaginitis and premature rupture of the membrane in the pregnant woman in the p... (Complete abstract click electronic access below)
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Graner, Sophie. "Reproductive outcomes in rural Vietnam. Perspectives and experiences by pregnant women and health care professionals on pregnancy promotion and maternal health care." Doctoral thesis, Umeå universitet, Obstetrik och gynekologi, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-37266.

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Background Reproductive health and health events associated with pregnancy including induced abortions are among the most important factors for the health of fertile women. Adverse outcomes have an impact on women’s reproductive health and their overall health as well as the health of their offspring. Pregnancy and child bearing take place within a cultural context. Risk factors for adverse pregnancy outcomes depend on factors both associated with the individual woman as well as contextual factors. Aims This thesis investigates reproductive health indicators and their determinants for women in a rural district in Vietnam with special focus on adverse pregnancy outcomes and their determinants. In addition, this thesis explores the perspectives and experiences among pregnant women and health care professionals on maternal health care in Vietnam and risks during pregnancy and delivery. Methods The studies used quantitative and qualitative methods. In the quantitative studies a total of 4,396 women reporting 5,838 pregnancies, and 5,521 infants were included. Parametric and non parametric tests and univariate and multivariate logistic regression analysis was performed. For the estimation of small for gestational age a population-specific reference curve was constructed based on the mean birth weight at term in the study population. In the qualitative studies data were collected from eight focus group discussions, four with pregnant women and four with health care professionals. Manifest and latent content analysis was applied. Main findings Women belonging to an ethnic minority or women giving birth at home were at increased risk of stillbirth. The risk of induced abortion increased with maternal age. Neonatal mortality was estimated to 11.6 per 1000 live births and perinatal mortality to 25.0 per 1000 births. The prevalence of small for gestational age was estimated to 6.4%. Risk factors for small for gestational age included women in farming occupations and post-term birth. There was a marked decrease in perinatal mortality after 33 weeks of gestation. Contextual conditions influenced both pregnant women’s use of maternal health care and the performance of the health care professionals. The use of maternal health care was influenced by economical conditions as well as cultural norms that impeded women’s autonomy. Structural constraints included inadequate financing of the health system, including lack of staff, insufficient professional re-training, and inadequate equipment. Pregnant women in rural Vietnam created a strategy to promote a healthy pregnancy through lifestyle adjustments, gathering of information, and seeking timely medical care. Insights in pregnancy-related conditions were sought from various sources and were influenced both by Vietnamese traditions and modern medical knowledge. Conclusions Knowledge about pregnancy complications and their related signs and symptoms, and a high confidence in the maternal health care probably contribute to the relatively good maternal health status and pregnancy outcomes in Vietnam. To improve perinatal and neonatal outcomes there is a need to ensure access for all pregnant women to delivery units with surgical capacity in case of an obstetrical emergency. Also, a higher proportion of premature infants need to be born at units with access to neonatal care. This may be achieved by an improved system for referral including capacity of medical care during transportation. Other desirable improvements include antenatal identification of small for gestational age foetuses. In our study the induced abortion rate increased with maternal age and was highest among married women, indicating that induced abortions may be used as a method for family planning. The cultural norms in Vietnam limit women’s autonomy and reduce their possibility to make independent decisions about their reproductive health. Our studies emphasize the importance of adequate access for all women to maternal health care adjusted for their individual needs. A better understanding is needed of context-specific factors that influence couples’ choice of family planning methods, place of birth, and maternal health care. The communication between pregnant women and health care professionals needs further investigation. This knowledge is essential in order to develop reproductive health services that are accessible, acceptable and affordable to all.

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Capan, Melser Mesküre Verfasser], and Peter [Akademischer Betreuer] [Kremsner. "Endemic infectious diseases in pregnant women in central African Gabon : Epidemiology and Evaluation of new Interventions / Mesküre Capan Melser ; Akademischer Betreuer: Peter G. Kremsner." Tübingen : Universitätsbibliothek Tübingen, 2015. http://d-nb.info/1168057876/34.

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Capan, Melser Mesküre [Verfasser], and Peter [Akademischer Betreuer] Kremsner. "Endemic infectious diseases in pregnant women in central African Gabon : Epidemiology and Evaluation of new Interventions / Mesküre Capan Melser ; Akademischer Betreuer: Peter G. Kremsner." Tübingen : Universitätsbibliothek Tübingen, 2015. http://d-nb.info/1168057876/34.

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Persson, Margareta. "Gestational diabetes mellitus experiences of pregnant women, midwives, and obstetricians and the performance of screening /." Doctoral thesis, Umeå : Umeå university, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-27761.

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Barros, Michelle Pinto. "Prevalência de doença cardíaca em gestantes internadas em uma maternidade pública." Universidade Federal do Tocantins, 2017. http://hdl.handle.net/11612/745.

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Nos países ocidentais industrializados, aproximadamente 0,2 a 4,0% das gestações são complicadas por cardiopatias, e o número de pacientes que desenvolvem problemas cardíacos durante a gravidez vem aumentando. Os objetivos do trabalho foram verificar as cardiopatias em gestantes em uma maternidade pública do estado do Tocantins e descrever o perfil de morbidade das cardiopatias em gestantes. Optou-se por um estudo descritivo, exploratório e documental. O estudo foi realizado em uma maternidade pública, localizada no município de Palmas-TO, sendo referência no Estado em obstetrícia. Trata-se de uma população composta por gestantes portadoras de cardiopatias. A coleta foi realizada na avaliação dos prontuários das gestantes com cardiopatias que foram atendidas na referida instituição hospitalar nos meses de janeiro de 2014 a dezembro de 2014com a utilização de um formulário de pesquisa elaborado pela pesquisadora. Após o período de coleta de dados de dois meses, foi possível chegar ao quantitativo de 23 gestantes portadoras de cardiopatia. Nas características sociodemográficas, as mulheres tinham em média 23,95±4,47 anos de idade;21 (91,3%) gestantes foram declaradas como pardas;14 (60,9%) das gestantes eram residentes no interior do Estado do Tocantins;14 (60,9%) gestantes possuíam nível médio completo;12 (57,1%) gestantes eram do lar. No perfil de morbidade, 15 (71,4%) pacientes não apresentaram hipertensão; 01 (4,8%) gestante era diabética. No perfil obstétrico, 10 (43,5%) pacientes eram secundigestas;11 (47,8%) já haviam apresentado um parto;21 (91,3%) não tiveram aborto;12 (54,6%) realizaram entre quatro e nove consultas;16 (72,7%) se submeteram ao parto cesáreo. Dentre as cardiopatias identificadas, 5 (21,73%)gestantes apresentaram Arritmia e 5 (21,73%)Taquicardia; 4 (17,39%) gestantes apresentaram Insuficiência Mitral, todavia entre as gestantes estudadas encontramos 13 patologias. Diante da variedade de patologias encontradas e dos casos em que ha mais de uma patologia, reforça-se a necessidade de profissionais capacitados e com competência técnica para o manejo adequado dessas cardiopatias.
In western industrialized countries, about 0.2 to 4.0% of pregnancies are complicated by heart disease, and the number of patients developing heart problems during pregnancy has increased. The objectives of the study were to verify the cardiopathies in pregnant women in a public maternity hospital in the State of Tocantins and To describe the profile of morbidity of heart diseases in pregnant women. We chose a descriptive, exploratory and documentary. The study was conducted in a public hospital, located in the city of Palmas-TO, with reference in the state in obstetrics. This is a population composed of pregnant women with heart disease. Data collection was performed in the evaluation of medical records of pregnant women with heart disease who were seen at that hospital from January 2014 to December 2014 using a survey form developed by the researcher. After the data collection period of two months, it was possible to reach the quantity of 23 pregnant women with heart disease. In socio-demographic characteristics, women had an average of 23.95 ± 4.47 years old; 21 (91.3%) patients were declared as mixed; 14 (60.9%) of pregnant women were residents within the State of Tocantins; 14 (60.9%) women had completed secondary level; 12 (57.1%) women were housewives. In morbidity profile, 15 (71.4%) did not have hypertension; 01 (4.8%) was p regnant diabetic. In obstetrical profile, 10 (43.5%) patients had more than one pregnancy; 11 (47.8%) had presented a birth; 21 (91.3%) had no abortion; 12 (54.6%) were between four and nine consultations; 16 (72.7%) underwent cesarean section. Among the identified heart disease, 5 (21.73%) patients presented Arrhythmia and 5 (21.73%) Tachycardia; 4 (17.39%) patients presented Mitral Regurgitation, however among pregnant women studied found 13 diseases. Given the variety of pathologies found and where there is more than one condition, it reinforces the need for qualified professionals with expertise for the proper management of these diseases.

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Engelbrecht, Fredrika. "The antimicrobial susceptibility and gene-based resistance of Streptococcus Agalactiae (group B Streptococcus) in pregnant women in Windhoek (Khomas region), Namibia." Thesis, Cape Peninsula University of Technology, 2015. http://hdl.handle.net/20.500.11838/2238.

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Thesis (MTech (Biomedical Sciences))--Cape Peninsula University of Technology, 2015.
BACKGROUND AND OBJECTIVES: Group B Streptococci (GBS) can asymptomatically colonise the vagina and rectum of women. Studies have shown that this bacterium is the leading cause of septicemia, meningitis and pneumonia in neonates. In Namibia no known studies have investigated GBS colonisation and the antibiotic resistance profile of GBS isolates in pregnant women. This study accessed the GBS colonisation rate amongst the pregnant women who attended the Windhoek Central Hospital Antenatal Clinic (Khomas region), in Namibia for a period of 13 months. Furthermore, using the VITEK 2 system, the GBS isolates were tested against the following antimicrobial substances; benzylpenicillin, ampicillin, clindamycin, erythromycin, tetracycline, vancomycin, cefotaxime, ceftriaxone, linezolid and trimethoprim/sulfamethoxazole. Penicillin G is the drug of choice in the majority of studies, and seems to be the most effective drug for intrapartum antibiotic prophylaxis (IAP). All the GBS isolates found in this study were also analysed for the presence of selected genes known to be associated with resistance to key antibiotics using specific primers within a polymerase chain reaction (PCR).

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Santos, Pâmela Antoniazzi dos. "Prevalência de diabetes mellitus gestacional e fatores de risco associados em população do sistema único de saúde." reponame:Repositório Institucional da UCS, 2018. https://repositorio.ucs.br/11338/3939.

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Kroll-Desrosiers, Aimee R. "Understanding the Experience and Evaluating the Occurrence of Depression in a Sample of Pregnant Veterans." eScholarship@UMMS, 2019. https://escholarship.umassmed.edu/gsbs_diss/1006.

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Background: The Veterans Health Administration (VHA) encourages depression screening and treatment for pregnant veterans; however, rates of depression symptoms and treatment utilization during pregnancy have not been well-studied. Methods: We used data from the Maternity Care Coordination for Women Veterans cohort study. Specifically, our aims were to: 1) examine rates and correlates of depression symptoms in a sample of pregnant veterans; 2) understand mental health care treatment utilization and explore the experiences of veterans accessing mental health care at the VHA during pregnancy; and 3) examine VHA mental health provider's perspectives on depression screening and treatment in the perinatal period. Findings: Depression symptoms were present in 28% of pregnant veterans in our sample. Social support and employment decreased odds of symptoms; history of anxiety, antidepressant use, and active duty service resulted in increased odds of symptoms. Nearly 70% of women veterans with prenatal depression symptoms received at least one mental health visit or antidepressant prescription during pregnancy. However, symptomatic pregnant women without a history of depression were less likely to receive care. Mental health providers identified absence of screening protocols and referral procedures and variability in risk/benefit conversations surrounding antidepressant use as areas of weakness for VHA mental health care during the perinatal period. Conclusions: Depression symptoms were present in nearly one in every three pregnant veterans. Depression treatment during pregnancy is complex, requiring individualized care. Policies for depression screening, referrals to providers, and medication review could be better encouraged to improve standardized care across the VHA.

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Nkomo, Faith Dineo. "HIV testing barriers pregnant women - a case study /." Pretoria : [s.n.], 2007. http://upetd.up.ac.za/thesis/available/etd-09232008-150105.

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Mundell, Jonathan Peter. "The impact of structured support groups for pregnant women living with HIV." Pretoria : [s.n.], 2006. http://upetd.up.ac.za/thesis/available/etd-08042008-182140.

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18

Shub, Alexis. "Periodontal disease and adverse pregnancy outcomes." University of Western Australia. School of Women's and Infants' Health, 2007. http://theses.library.uwa.edu.au/adt-WU2007.0184.

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[Truncated abstract] Periodontal disease is a common and underdiagnosed disease in humans that may have adverse effects on pregnancy outcomes. The aim of this thesis was to investigate the effects of periodontal disease in pregnancy by means of two observational human studies and the development of animal models of fetal and uterine exposure to periodontopathic bacteria and lipopolysaccharide. I performed a prospective study examining the rates of preterm birth, small for gestational age neonates and neonatal inflammation in 277 women who had undergone a detailed antenatal periodontal examination and oral health questionnaire. Periodontal disease was associated with small for gestational age neonates, and increased CRP levels in umbilical cord blood, but no effect was seen on the rate of preterm birth. Maternal oral health symptoms predicted both periodontal disease and newborn biometry. In a retrospective case control study, I examined the role of periodontal disease in perinatal mortality. Participants included 53 women who had experienced a perinatal loss for which no cause could be found after thorough investigation, and 111 control women. Women who had experienced a perinatal loss were more than twice as likely as controls to have periodontal disease. The incidence of periodontal disease was even higher in women in whom the perinatal loss was due to extreme prematurity. In contrast to my prospective study, risks to the pregnancy could not be predicted by maternal oral health behaviours or oral health symptoms. In order to better understand the mechanisms regulating the associations described in the human studies, two animal models were developed; one to investigate acute exposure and the second to investigate long-term exposure to periodontal pathogens. The first study examined the effects of administration of a bolus of periodontopathic bacteria and lipopolysaccharide to the pregnant sheep. Injection of bacteria and lipopolysaccharide in the amniotic fluid of the pregnant preterm sheep caused a high rate of fetal lethality, disturbance of fetal acid base status and inflammation of the fetus and membranes. Given the circumstances of exposure to periodontopathic pathogens in human periodontal disease, a model investigating long-term exposure to periodontopathic lipopolysaccharide on pregnancy outcomes was developed. ... Overall, I have demonstrated that maternal periodontal disease is associated with adverse pregnancy outcomes including fetal growth restriction and possibly perinatal loss. Mechanisms regulating these effects are likely to be mediated by fetal adaptations to intrauterine inflammation resulting in altered fetal development, growth or survival. Randomised controlled trials that are currently in progress will provide further information on the effects of periodontal disease in human pregnancy, and the efficacy of treatment to reduce these adverse outcomes.

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Cauldwell, Matthew. "The management of pregnancy and labour in women with cardiac disease." Thesis, Imperial College London, 2016. http://hdl.handle.net/10044/1/53283.

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Within my thesis I have shown that women with congenital heart disease are amenable to preconception counselling, but that many women are not referred to see a specialist cardiologist or obstetrician prior to pregnancy. Women with more severe forms of heart disease such as a Fontan repair have worse obstetric outcomes with high rates of miscarriage, preterm delivery and postpartum haemorrhage (PPH), hence the importance of comprehensive counselling prior to pregnancy. When women are counselled prior to pregnancy regarding the potential risks that they face, I have shown that the quoted risk of an adverse event assessed by an experienced clinician has a better correlation with actual outcome than other validated scoring systems such as the modified WHO score. Women with congenital heart disease are at much greater than average risk of postpartum haemorrhage (PPH). My analysis has shown that after correcting for known risk factors for PPH, women with a Fontan repair are at the highest risk of increased blood loss, and that low molecular weight heparin at both a prophylactic and therapeutic dose is associated with higher rates of PPH even when stopped at an appropriate time prior to delivery. I have focussed on the management of labour in women with heart disease, in particular of the second and third stages. Having shown that a restricted second stage for women with heart disease recommended by the multidisciplinary team (MDT) is often not adhered to in our actual clinical practice, my pilot study showed that there was only a modest measured haemodynamic effect of pushing (bearing down), with a small but significant increase in maternal heart rate in the active second stage of labour. I have found from a literature review and from our own historical dataset that the practice of a restricted oxytocin regimen for the management of the third stage (designed to minimise cardiovascular side-effects) is associated with greater rates of PPH, mainly due to uterine atony. In a prospective cohort study, women with heart disease were allocated to either a low dose infusion or a combination of the low dose infusion with an initial bolus of 2IU of oxytocin over ten minutes; those receiving the additional oxytocin had a significantly lower volume of blood loss and rate of PPH. Importantly, the women receiving the higher dose of oxytocin had no measured deleterious cardiovascular side effects.

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Zhao, Jieyu, and Yanling Zhang. "Experience of pregnancy in women with heart disease: A descriptive review." Thesis, Högskolan i Gävle, Avdelningen för vårdvetenskap, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-36617.

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21

Toivo, Aini-Kaarin. "Perceptions and experiences of pregnant women towards HIV voluntary antenatal counselling and testing in Oshakati Hospital, Namibia." Thesis, University of the Western Cape, 2005. http://etd.uwc.ac.za/index.php?module=etd&amp.

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This study focused on perceptions and experiences of pregnant women who opted in against those who opted out of voluntary antenatal HIV counseling and testing. The pregnant women's perceptions and experiences were assessed in order to gain insight into their views towards voluntary antenatal counseling and testing.

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22

Ives, Angela Denise. "Breast cancer and pregnancy : how does a concurrent or subsequent pregnancy affect breast cancer diagnosis, management and outcomes?" University of Western Australia. School of Surgery, 2010. http://theses.library.uwa.edu.au/adt-WU2010.0038.

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[Truncated abstract] A diagnosis of breast cancer is a life-changing event for any woman. For young women and their families it can be devastating. Women aged less than 45 years make up 20% of new cases of breast cancer diagnosed annually in Australia. With the trend for women to delay pregnancy, young women diagnosed with breast cancer may want at least the option to become pregnant after diagnosis and treatment but little is known about how pregnancy affects breast cancer or how breast cancer affects pregnancy. The aims of this thesis were to investigate how concurrent and subsequent pregnancy affects the development and outcomes of breast cancer and how breast cancer affects a concurrent or subsequent pregnancy. This study describes two groups of women identified from the entire Western Australian population less than 45 years of age when diagnosed with: 1. Gestational breast cancer, defined as breast cancer diagnosed while a woman is pregnant or in the first twelve months after completion of a pregnancy; and 2. Breast cancer who subsequently conceive. This study focused on three main areas; patterns of care and outcomes for women diagnosed with gestational breast cancer and those women diagnosed with breast cancer who subsequently conceived; the imaging and pathological characteristics of gestational breast cancer; and lastly the psychosocial issues associated with gestational breast cancer. ... This result was statistically significant. In an age and staged matched case control study lymph node negativity did not purvey a survival advantage for women diagnosed with gestational breast cancer as it did for the non- gestational breast cancer controls. Women diagnosed with breast cancer who have good prognosis tumours need not necessarily wait two years to become pregnant. In an age matched case control study women diagnosed with gestational breast cancer were more likely to have extensive insitu carcinoma, higher mitotic rates and tumours with medullary like features than their age matched controls. In a Cox's proportional hazards regression model which included pathological characteristics, there was no significant difference in survival for women diagnosed with gestational breast cancer were compared to women diagnosed with non-gestational breast cancers. The psychosocial issues for women diagnosed with gestational breast cancer are similar to other young women diagnosed with breast cancer but the effect on the 9 lives of women dealing with pregnancy and breast cancer simultaneously was much greater. The issues of breast cancer and pregnancy are complex at both a physical and psychological level. Much more research is needed to understand the mechanisms of how pregnancy affects breast cancer and its spread. Women who are pregnant when diagnosed with breast cancer or who consider pregnancy after their diagnosis need unbiased support from those around them. Survival is important but other survivorship issues may be just as important. To translate these findings into clinical practice and offer directions for future research eleven recommendations are proposed.

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Harkness, Mairi. "Policy and practice concerning women with an RhD negative blood type : a midwifery perspective." Thesis, University of Edinburgh, 2014. http://hdl.handle.net/1842/9625.

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In May 2002 the National Institute for Clinical Excellence (NICE) made the recommendation that all pregnant women with an RhD negative blood type should be offered routine antenatal anti-D immunoglobulin (Ig) prophylaxis (RAADP). Midwives were the key professional group who would be involved in administration of anti-D Ig and yet they had little input to formation of policy and contributed little to the evidence base that informs policy and practice. A midwifery perspective is however important and relevant, and forms the basis of this work. The thesis comprises three distinct, but related, pieces of research: a survey conducted in 2005 to determine implementation of RAADP at UK maternity units; secondary analysis of anti-D Ig errors involving midwives that were reported to the Serious Hazards of Transfusion (SHOT) scheme in 2007/8; and focus group interviews conducted in 2010 to explore midwives’ views on issues that impact the care provided for women with an RhD negative blood type. The aim of the RAADP survey was to establish current {2005} policy in the United Kingdom in relation to the NICE recommendation for RAADP (NICE, 2002). The survey formed the foundation on which to build the thesis by determining that by 2005 RAADP had become an integral aspect of maternity care within the UK. However it also found that there were significant variations within local policies and among the information that was provided to pregnant women and healthcare professionals. The aim of the survey was to determine implementation of policy and not to explain findings, raising important questions which were used to inform the subsequent research. The second piece of research was secondary analysis of existing anti-D Ig error reports collated by SHOT. The analysis was unique in that it included only those errors involving midwives. The findings highlight both individual and organisational impact on errors, building on the findings of the RAADP survey. The research identified proximal errors, trigger events and fallible practices providing a framework within which the common pathways to error involving anti-D Ig can be understood. This will allow midwives to better understand and improve the care they provide. This piece of research also raised further questions about midwifery practice and those questions informed the focus group research. The focus group research aimed to consolidate the findings of the previous research by gaining direct input from midwives. Two focus group interviews were held, with clinical midwives as participants. The research found that the midwives and the organisations within which they worked provided care in line with policy and procedure at the apparent expense of a woman centred approach. This appeared to be linked to the midwives’ understanding of their responsibility, accountability and the education and information that underpinned the care they provided. The other important finding from the focus group research was that the midwives regarded RAADP as a less important intervention than they did anti-D Ig given following a potentially sensitising event (PSE) during pregnancy or given following delivery. When considered as a whole body of work, this research provides unique and valuable insight to midwifery involvement in the care of women with an RhD negative blood type. The research highlights the challenge of achieving government objectives for individualised, woman centred care within the present framework of clinical governance and evidence based care. In doing so it also raises questions about how individual midwives and the midwifery profession have engaged with medical colleagues and policy makers to maintain a midwifery context to the care they provide. Although the research findings relate to care provided for women with an RhD negative blood type the findings are pertinent to other aspects midwifery practice, particularly those originating within the medical profession that are now a routine part of midwifery care.

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Hatchard, Jared, Brent Houston, and Jenene Spencer. "Assessing Pharmacist’s, Pharmacy Technicians’, and Pharmacy Interns’ Knowledge of Current Centers for Disease Control and Prevention (CDC) Immunization Guidelines for Pregnant Women." The University of Arizona, 2014. http://hdl.handle.net/10150/614184.

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Class of 2014 Abstract
Specific Aims: The purpose of this study was to assess pharmacists’, pharmacy technicians’, and pharmacy interns’ knowledge of current Centers for Disease Control and Prevention (CDC) immunization guidelines for pregnant women. Methods: Questionnaires administered to volunteers during the Arizona Pharmacy Association (AzPA) 2013 Annual Convention and Trade Show collected data showing the volunteers’ level of knowledge about current immunization guidelines; data on professional roles (pharmacist, pharmacy intern, or pharmacy technician), years in practice, current immunization certification status and activity, and practice setting were also collected. Main Results: Questionnaires were completed by 112 volunteers, including 48 pharmacists, 25 pharmacy technicians, and 39 pharmacy interns. The overall percentage of correct answers from all participants was 33%. Pharmacists, pharmacy technicians, and pharmacy interns had correct answer percentages of 41%, 16%, and 34%, respectively. Pharmacy practitioners who were state certified to perform immunizations performed statistically significantly better than the non-certified group (44.2% correct versus 33% correct, P=0.012). Practitioners who work at a practice site that provides immunizations were compared with practitioners who do not, with results trending toward statistical significance, but falling just short (45.7% correct versus 36% correct, P=0.054). Conclusion: The general level of knowledge about CDC immunization guidelines appears to be inadequate among the volunteer group of pharmacy practitioners, possibly leading to missed opportunities for needed immunizations.

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Sato, Neusa Nakao. "A suscetibilidade à rubéola das gestantes, Bauru, 1987." Universidade de São Paulo, 1993. http://www.teses.usp.br/teses/disponiveis/6/6132/tde-15012018-105529/.

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A vacinação contra a rubéola tem como objetivo único, a proteção de futuras gerações de crianças em desenvolver a rubéola congênita. Gregg40, em 1941, levantou a hipótese de a rubéola ser a causa do nascimento de crianças com graves malformações congênitas. A confirmação etiológica só foi possível em 1962, com o isolamento do vírus, o que permitiu o desenvolvimento da vacina. A vacina foi utilizada, a partir de 1969, nos Estados Unidos e na Inglaterra e, atualmente, faz parte dos programas de vacinação de rotina na maioria dos países desenvolvidos. As experiências de mais de duas décadas no uso da vacina nos programas de controle da SÍNDROME DA RUBÉOLA CONGÊNITA (SRC) mostraram que a epidemiologia da rubéola, assim como a operacionalização das metas propostas para a cobertura vacinal são bastante complexas. As características do vírus, na sua interação com a população humana, determinam um padrão de transmissibilidade que propicia a formação de bolsões de indivíduos suscetíveis na idade adulta. Em condições naturais, a rubéola infecta cerca de 80 por cento a 90 por cento das pessoas até os 20 anos de idade, deixando um resíduo de indivíduos suscetíveis a partir desta idade, que, aparentemente, se mantém mesmo com epidemias sucessivas. O nascimento de crianças com SRC está condicionado à infecção rubeólica durante a gestação das mães destas crianças, portanto, a existência de mulheres suscetíveis à rubéola na idade fértil é uma condição fundamental à ocorrência da doença. O óbito de crianças malformadas detectadas em alguns meses do ano de 1986 chamou a atenção dos epidemiologistas do Município de Bauru para uma possível associação com a epidemia de rubéola ocorrida na cidade em 1985. Conhecer a proporção de suscetibilidade à rubéola entre gestantes é uma das maneiras para se estimar o risco de ocorrência de SRC. Em 1987, 689 gestantes residentes no Município de Bauru foram entrevistadas e submetidas a teste de inibição de hemaglutinação para determinação de suscetibilidade à rubéola. Destas gestantes, 66 (9,7 por cento ) foram consideradas suscetíveis à rubeóla. Não houve diferença estatisticamente significante na proporção de suscetibilidade das gestantes em relação à idade, número de gestações, paridade e idade gestacional, o que de certa forma confirma a dificuldade do vírus da rubéola em infectar todas as pessoas até o início da idade adulta, mesmo após uma epidemia. Este resíduo de suscetibilidade dificilmente seria eliminado naturalmente, como mostram as diferentes experiências nos países que iniciaram um programa de controle da SRC. Seria necessária uma alta cobertura vacinal (cerca de 95 por cento ) de todas as coortes de crianças e adolescentes para se conseguir a quebra na cadeia do processo infeccioso. Concomitantemente, é decisiva a proteção de todas as mulheres em idade fértil até que, estas coortes de indivíduos bem imunizados atinjam a idade fértil. Uma intervenção desta natureza não poderia ser implementada sem o respaldo de um sistema de vigilância epidemiológica fortalecido e atuante, capaz de monitorar não apenas o andamento do programa, mas, fundamentalmente, medir o impacto desta intervenção em termos de incidência de SRC. Considerando as características de polimorfismo da SRC e as dificuldades em se medir a magnitude da infecção congênita, a avaliação de um programa que envolve pelo menos duas gerações de indivíduos é um grande desafio para os administradores de saúde, principalmente, nos países em desenvolvimento.
The vaccination against rubella has as the only objectif to protect the future generations of children from the congenital rubella. Gregg, in 1941, supposed that the rubella should be the cause of birth of children with serious congenital abnormalities. The etiologial confirmation was only possible in 1962, by the isolation of virus, which allowed the development of vaccine. Firstly, utilized in the United States and Great Britain, in 1969, nowadays the vaccine is used in most developed countries. Experiences performed during more than two decades in usage of the vaccines during the Congenital Rubella Syndrome Control Program, showed that the epidemiology of the rubella, as well as, the exequibility of proposed aims for the vaccinal coverture are quite complex. The virus characteristics and its interactions with the population, determine a transmissibility pattern, which provides the formation of susceptible \"cluster\" in the adult age. In natural conditions, the rubella infects about 80 per cent to 90 per cent of people up to the age of twenty, leaving a susceptible remains after this age, which, apparently, it is maintained even with continuous epidemics. As the CRS children birth is connected to the rubella infection during the gestacional age of those mothers, the existence of susceptible childbearing age women is the most important condition for the disease to break out. In 1985, in the City of Bauru (São Paulo), abnormal number of death of congenital abnormalities children was focused by local epidemilogists. This fact was supposed, by the epidemiologists, being associated to a rubella epidemic in the year before. One of the ways to estimate the risk of occurance of RCS is to know the level of susceptibility among pregnant women. In 1987, 689 pregnant women, dwelling in the City of Bauru, were interviewed and went through a haemagglutination-inibition test in order to determine the susceptibility to rubella. Sixty-six out of these pregnant women was considered susceptible to rubella. There was not any difference statistically significant in the susceptible proportion of the pregnant women related to age, number of pregnancies, number of deliveries and gestacional age which somehow confirm the difficult of the rubella virus to infect all people up the beginning of the adult age, even after an epidemic. This susceptible remains would hardly ever be eliminated naturaly, as it is shown in the different experiences in countries, which began the RCS Control Program. The experiences showed that it would possibly, be necessary a high vaccinal coverture (about 95 per cent ) of all generations of children and adolescents in order to get the break of the infection process chain. Concomitantly, the protection of all women in childbearing age is important, until these generations of well vaccinated individuais reach the childbearing age. Such intervention should not be implemented without the agreement of an epidemiological surveillance system, both dynamic and strong, in order to monitore not only, the follow up of the program, but also, to measure the impact of this intervention in terms of RCS incidence. Considering the RCS characterists of polimorfism and the difficulties to evaluate the magnitude of congenital infection, the evaluation of a program that involves, at least, two generations of individuais, is a great challenge for the health administars, specially, in developing countries.

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Timerman, Lilia. "Avaliação clínica e microbiológica periodontal em portadores de cardiopatia valvar na gestação." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/5/5131/tde-14102008-151718/.

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Microorganismos da cavidade oral têm sido admitidos como causadores de doenças sistêmicas com reconhecido mecanismo de disseminação via corrente sangüínea. Diferentes fatores, incluindo a presença da doença periodontal, têm influência no risco de bacteremia oral, podendo ocasionar endocardite infecciosa por Streptococcus viridans. Sendo assim, a manutenção da saúde bucal adquire elevado grau de importância em gestantes portadoras de doença valvar reumática, em que o risco de endocardite infecciosa é eminente. A escassez científica fez deste tema o objetivo deste estudo: investigar a condição clínica periodontal de gestantes portadoras de cardiopatia valvar, identificando agentes periodontopatógenos nas amostras coletadas de saliva, sulco/bolsa periodontal, Para tanto, foram estudadas 52 gestantes cardiopatas (GC) e 70 gestantes não-cardiopatas (GNC). A condição periodontal foi avaliada empregando-se profundidade clínica de sondagem (PCS), nível clínico de inserção (NCI), linha esmalte cemento/margem gengival (LEC/MG), índice de sangramento (IS) e índice de placa bacteriana (IP). As seguintes médias foram obtidas para os parâmetros periodontais avaliados: PCS: 1.52 (GC) e 1.45 (GNC); NCI: 1.13 (GC) e 1.02 (GNC); LEC/MG: 0.41 (GC) e 0.40 (GNC); IS: 7.34 (GC) e 6.27 (GNC) e IP: 12.19 (GC) e 13.48 (GNC). Não houve diferença entre os grupos para o NCI (p= 0,612). A presença da Porphyromonas gingivalis na saliva foi maior (p= 0,007) no GNC, porém não houve diferença nas amostras de sulco/bolsa periodontal.
Microorganisms of the oral cavity are known to cause systemic diseases, spread through sanguine current. Different factors, including the presence of periodontal disease, influencing the risk of oral bacteremia could cause infectious endocarditis for Streptococcus viridans. Nevertheless, the maintenance of the oral health is extremely important in pregnant women with rheumatic valvar disease, in which the risk of infectious endocarditis is eminent. The aim of this study was to investigate the clinical periodontal condition of pregnant women with valvar disease and to identify the presence of Porphyromonas gingivalis in saliva and subgingival samples. For these purposes, we studied 52 pregnant with valvar disease (GC) and 70 healthy pregnant women (GNC). The following periodontal parameters were evaluated: probing depth (PCS), clinical attachment level (NCI), gingival margin location (LEC/MG), bleeding on probing (IS) and plaque index (IP). The following mean periodontal parameters were obtained: PCS: 1.52 (GC) e 1.45 (GNC); NCI: 1.13 (GC) e 1.02 (GNC); LEC/MG: 0.41 (GC) e 0.40 (GNC); IS: 7.34 (GC) e 6.27 (GNC) e IP: 12.19 (GC) e 13.48 (GNC). There was no statistical difference for NCI among the groups. There was no difference between periodontal clinical conditions in pregnant women with valvar disease and healthy pregnant women. The presence of the Porphyromonas gingivalis in saliva samples of healthy pregnant women is statistically higher than in pregnant woman with valvar disease; however, there was no difference in periodontal samples

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Guidugli, Simone Kelly Niklis. "Coração aflito: repercussões emocionais na gestante de feto cardiopata." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/47/47133/tde-24092015-151435/.

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Minha experiência clínica atendendo gestantes com diagnóstico de cardiopatia fetal pôde propiciar a observação de alterações na condição emocional das pacientes que se mantinham em acompanhamento psicológico no hospital de Cardiologia, que passou a recebê-las desde o período pré-natal até o nascimento do bebê, para que estes fossem submetidos às intervenções cardíacas necessárias. Esta percepção motivou a pesquisa sobre a natureza destas repercussões emocionais uma vez que a gestação é considerada um período de transição e de crise para a mulher, no qual precisa se reorganizar emocionalmente devido às mudanças com a vinda do filho, bem como às expectativas e idealizações inerentes. O objetivo foi identificar as repercussões emocionais mais significativas a partir de aspectos da psicodinâmica das gestantes, visando contribuir para a assistência a esta população. O método utilizado foi o clínico qualitativo, tendo como instrumentos: a entrevista semidirigida e as técnicas projetivas, Desenho da Figura Humana (DFH) e Teste de Apercepção Temática (TAT). Foi realizada a análise de conteúdo, conforme Bardin, de uma sessão de atendimento psicológico, gravada, com o consentimento das participantes, e transcrita posteriormente. Os resultados confirmaram a presença de repercussões emocionais significativas, dentre elas: os sentimentos de impotência e de posse em relação ao bebê, sentimento de culpa pelo diagnóstico fetal, angústia de morte, desamparo, não aceitação do diagnóstico e medo do desconhecido. A partir da análise psicodinâmica, identificou-se também: as principais ansiedades das gestantes - conhecer o bebê, de separação e do parto; os mecanismos de defesa atuantes - negação, regressão, identificação, racionalização e idealização- e as principais formas de enfrentamento - confiança na equipe, acreditar que a barriga é a forma possível de proteção do bebê, controle emocional, busca de conhecimento sobre a cardiopatia, identificação com outros pais na mesma situação e oferecimento de ajuda a estes, e a fé. No DFH destacaram-se: a inclinação das figuras femininas e masculinas, que pode estar relacionado à tentativa de manter um equilíbrio corporal em virtude das modificações físicas ao final da gestação; a assimetria apresentada em metade dos desenhos, analisada como possível forma de expressar a percepção das anomalias corporais dos bebês, embora a cardiopatia não possa ser visualmente observada, pode se relacionar às fantasias sobre a aparência do bebê malformado. No TAT perceberam-se importantes conflitos como dependência x independência e maternidade x afiliação, com o uso de mecanismos de defesa tais como a regressão, racionalização e idealização. Concluiu-se que o diagnóstico de cardiopatia fetal traz intensas repercussões emocionais, relacionadas às fantasias de morte sobre o nascimento do filho, sendo atribuída ao parto uma representação simbólica ainda mais angustiante que nas gestações comuns ou não caracterizadas como de alto risco, pois parece ser vivenciada inicialmente como uma situação quase-certa de morte, o que torna importante que o acompanhamento psicológico seja oferecido nas instituições de saúde, por todo o ciclo gravídico-puerperal
My clinical experience serving pregnant women with diagnosis of fetus with heart disease made it possible to observe changes in the emotional condition of the patients who remained in counseling in the Cardiology Hospital, which has been admitting them from the prenatal period to childbirth, so that they were subjected to the necessary cardiac interventions. This realization led to research into the nature of these emotional repercussions since pregnancy is considered a period of transition and crisis to the woman, who needs emotional restructuring due to changes related to the child\'s coming, and the inherent expectations and idealizations. The objective was to identify the most significant emotional repercussions from the psychodynamic aspects of pregnant women, in order to contribute to their assistance. The research followed a clinical-qualitative method, with the following instruments: semi-structured interviews and projective techniques, the Human Figure Drawing Test (HFD) and Thematic Apperception Test (TAT). Content analysis was carried out according to Bardin during psychological counseling sessions, recorded with the consent of the participants, and later transcribed. The results confirmed the presence of significant emotional repercussions, such as: feelings of powerlessness and possession over the baby, guilt over fetal diagnosis, death anxiety, helplessness, denial and fear of the unknown. The psychodynamic analysis also identified: the main anxieties of pregnant women knowing the baby, separation and childbirth; the active defense mechanisms denial, regression, identification, rationalization and idealization; and the main coping mechanisms confidence in the team, belief in the bellys protection, emotional control, pursuit of knowledge about the disease, identification with other parents in similar situations and the ability to extend help to them, and faith. HFD highlighted: the angle of the female and male figures, which may be related to trying to maintain body balance because of physical changes at the end of pregnancy; the asymmetry identified in half of the drawings, analyzed as a possible way to express the perception of bodily abnormalities of babies which, even in the absence of visual observation of the abnormalities, can relate to fantasies about the appearance of a malformed baby. TAT showed important conflicts such as dependence vs. independence and motherhood vs. affiliation with the use of defense mechanisms such as regression, rationalization and idealization. The research concludes that the diagnosis of fetal heart disease causes intense emotional distress, related to death fantasies during childbirth with childbirth having a more distressing symbolic representation than during ordinary or low-risk pregnancies, since it seems to be early experienced as a situation of almost certain death, which makes it important that health institutions offer psychological counseling throughout the pregnancy and childbirth

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28

Massawe, Siriel Nanzia. "Anaemia in women of reproductive age in Tanzania : A study in Dar es Salaam." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2002. http://publications.uu.se/theses/91-554-5308-2/.

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29

Carmo, Márcio Penha do [UNESP]. "Doença periodontal em gestantes e nascimento de bebê prematuro e baixo peso." Universidade Estadual Paulista (UNESP), 2009. http://hdl.handle.net/11449/95404.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
A manifestação da Doença Periodontal durante a gestação, em conjunto com variáveis sócio-econômico-demográficas e de assistência à saúde, tem sido citadas como importantes fatores de risco para o parto prematuro (PP) e recém-nascido de baixo peso (BP). Através de ações que intensificam a atenção básica em saúde, o Programa Saúde da Família (PSF) tem adotado como princípio norteador a intervenção nos fatores que colocam em risco a saúde da população. Os objetivos deste estudo foram avaliar a condição periodontal de gestantes, analisar a influência de variáveis sócio-econômicas e a existência do PSF na prevalência da doença periodontal e verificar a associação desta condição e do PSF com a prevalência de PP e BP. Trata-se de estudo de coorte, abrangendo gestantes e crianças, desenvolvido em dois municípios do Estado de São Paulo, sendo um deles com PSF implantado. Foram realizados exames bucais, utilizando-se o Índice Periodontal Comunitário (IPC) e o de Perda de Inserção Periodontal (PIP) e entrevistas semi-estruturadas com as gestantes (n=119) cadastradas nos serviços públicos de saúde de ambos os municípios e o acompanhamento das mesmas até o nascimento da criança. Os resultados foram verificados por meio de análises estatísticas bivariadas (α=0,05). A idade média foi 24,7 anos; 61,4% pertenciam à raça negra/parda e 38,7% branca. A maioria (65,5%) recebia entre 2-3 salários mínimos. Somente 35,3% completaram o ensino médio. Apenas 8% das pacientes examinadas mostraram periodonto saudável (IPC=0). Sangramento e cálculo (IPC=1-2) foram observados em 66% do total, bolsas periodontais rasas em 16% e profundas em 4%, enquanto a perda de inserção periodontal superior a 4mm foi verificada em 24%. A gengivite foi a alteração periodontal mais recorrente neste grupo, visto que na gestação a mulher está mais susceptível...
The disease‟s appearing during pregnancy, along with other socio-economic-demographical varieties and health care, has been pointed out as the main risk factor to premature birth (PB) and underweight newborns (UN). Through actions that reinforce basic health care and assistance, the Health Family Program (HFP) has made an intervention in those factors which may threat health as a whole. The aims of this work were to assess the pregnant women‟s periodontal conditions, analyze socio-economical varieties influences and the existence of HFP in the periodontal disease prevalence, besides checking the possible relation to this condition and PB and UN prevalence. The present is a study comprehending pregnant women and children, held in two cities of São Paulo State. In one city, the HFP is on duty. Odontological exams were done having the Community Periodontal Index (CPI) and the Periodontal Insertion Loss (PIL) as references, in addition to interviews with the mothers. There was continuous patients‟ aid on pregnant women registered in health programs in both cities until child‟s birth. Results were evaluated through bivaried statistical analyzes (α=0.05). The average age was 24,7 years old; 61,4% belonging to black/yellow race and 38,7% to the white one. Most of them (65,5%) made between 2-3 minimum wages a month. Only 35,5% had their high-school degree. Only 8% of the examined patients presented healthy paradenitum (CPI=0). Bleeding and calculus (CPI=1-2) were observed in 66% of the total, shallow periodontal pockets in 16% and deep ones in 4%, while the four-mm superior periodontal insertion loss was observed in 24%. Gingivitis was the most recurrent periodontal alteration in this group, once during the pregnancy period women are more susceptible to periodontal inflammations. Premature children were observed in 15,8% and underweight ones in 10,5% of the population... (Complete abstract click electronic access below)

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Van, Niekerk Elizabeth C. "Evaluation of a quality improvement cycle intervention in the provision of PMTCT at a regional hospital." Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/85669.

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Thesis (MMed)-- Stellenbosch University, 2013.
ENGLISH ABSTRACT: The vast majority of new Human Immunodeficiency Virus (HIV) infections in infants and young children occur through mother-to-child-transmission (MTCT), either during pregnancy, labour or delivery or by breastfeeding. Without access to perinatal MTCT (PMTCT) programmes approximately 30% of all babies born annually will be infected with HIV. OBJECTIVES The aim was to implement and audit a quality improvement cycle at the Worcester Obstetric Unit, which comprises of Worcester Hospital, a regional hospital in the Western Cape Province and its level one midwife obstetric Unit (MOU), in order to improve the quality of the PMTCT programme. The intervention included the implementation of easy changes and tools in the Antenatal Clinic, Infectious Diseases Clinic and Labour ward. METHODS The files and antenatal records of all HIV positive patients and patients with an unknown HIV status, who delivered at the Worcester Obstetric Unit during January, February and March of 2010 and 2011, were reviewed. All HIV negative patients and patients that had stillbirths and miscarriages were excluded. The pre-interventional findings of 2010 were compared with the post-interventional findings of 2011. RESULTS At the Worcester Obstetric Unit, for the study time period, there were 907 deliveries in 2010, of which 102 (11.2%) patients were HIV positive and 4 (0.4%) had an unknown HIV status compared to 2011, with 865 deliveries of which 108(12.5%) patients were HIV positive and no patients had an unknown HIV status. Significantly more patients were diagnosed with HIV before they fell pregnant than during pregnancy in the 2011 group, when compared with the 2010 group. A CD4 count was done on 94% of patients who were newly diagnosed with HIV and those with an unknown CD4 count result in the 2010 group, compared to 92% in 2011. There was a significant improvement after the intervention in the time it took from when blood was drawn for a CD4 count until the result was followed up, the median time decreased from 34 to 8 days (p=0.000001). Significantly more patients qualified for highly active antiretroviral therapy (HAART) after the guidelines were changed and the CD4 cut off was increased to 350 cells/l (p=0.001). Prior the intervention 18 patients did not receive the correct management before delivery due to preventable reasons, compared to one at the MOU. After the intervention this decreased significantly to only one patient at Worcester Hospital and none at the MOU (p=0.000001). Before the intervention adherence to the PMTCT protocol at the MOU was significantly better than at the hospital (p=0.0005) and after the intervention there was no significant difference (p=1.0). CONCLUSION Although the audit and quality improvement cycle was performed at a single hospital, with specific changes geared towards their needs, the basic principles can be applied to any Unit in the country providing a PMTCT service. Educating staff, creating awareness and reminding staff of the basic principles of PMTCT, implementing small changes and streamlining processes and setting specific goals or timelines, can lead to significant improvements in care, which ultimately will lead to a decrease in PMTCT of HIV and HIV related maternal and infant morbidity and mortality.
AFRIKAANSE OPSOMMING: Die oorgrote meerderheid (>90%) van nuwe Menslike Immuniteitsgebreksvirus (MIV) infeksies in babas en jong kinders vind plaas deur middel van moeder-na-kind-oordrag, hetsy gedurende swangerskap, die kraamproses of borsvoeding. Sonder toegang tot perinatale voorkomingsprogramme (PMTCT) sal ongeveer 30% van alle babas jaarliks met MIV geïnfekteer word. DOELWITTE Die doel van die studie was om ‘n gehalteverbeteringsiklus by die Worcester Verloskunde Eenheid, wat bestaan uit Worcester Hospitaal, 'n streekshospitaal in die Wes-Kaapprovinsie en sy vlak een vroedvrou verlossingseenheid (VVE), te implementer en daarna te oudit, om sodoende die gehalte van die PMTCT-program te verbeter. Die intervensie het bestaan uit die implementering van eenvoudige veranderinge en prosesse in die voorgeboortekliniek, infeksiesiekte-kliniek en kraamsaal. METODES Die lêers en voorgeboorte rekords van alle MIV-positiewe pasiënte en pasiënte met 'n onbekende MIV-status, wat gedurende Januarie, Februarie en Maart van 2010 en 2011 verlos het by die Worcester Verloskunde Eenheid, is nagegaan. Alle MIV-negatiewe pasiënte en pasiënte met doodgebore babas en miskrame is uitgesluit. Die pre-intervensie bevindings van 2010 is vergelyk met die post-intervensie bevindings van 2011. RESULTATE By die Worcester Verloskunde Eenheid was daar 907 geboortes gedurende die studietydperk in 2010, waarvan 102 (11,2%) pasiënte MIV-positief was en 4 (0,4%) met ‘n onbekende MIV-status. In 2011 was daar 865 geboortes waarvan 108 (12,5%) pasiënte MIV-positief was en geen met 'n onbekende MIV-status. In die 2011-groep is beduidend meer pasiënte gediagnoseer met MIV voor as tydens swangerskap. In die 2010-groep is daar 'n CD4-telling gedoen vir 94% van nuut gediagnoseerde pasiënte en diegene met 'n onbekende CD4-telling, in vergelyking met 92% in 2011. Daar was 'n beduidende verbetering na die intervensie in die tyd wat dit geneem het vandat bloed getrek is vir 'n CD4-telling totdat die resultaat opgevolg is. Die mediane tyd het verminder vanaf 34 na 8 dae (p = 0.000001). Nadat die riglyne vir kwalifisering vir hoogs aktiewe antiretrovirale terapie (HAART) verander is na ‘n CD4 telling 350 selle/l het daar beduidend meer pasiënte gekwalifiseer vir HAART. By Worcester Hospitaal het 18 pasiënte voor die intervensie nie die korrekte behandeling intrapartum ontvang nie weens voorkombare redes, in vergelyking met slegs een pasiënt by die VVE. Na die intervensie was daar ‘n beduidende afname na slegs een pasiënt by Worcester Hospitaal en geen by die MOU (p = 0.000001). Voor die intervensie was die korrekte uitvoering van die PMTCT-protokol by die MOU beduidend beter as by die hospitaal (p = 0,0005) en na die intervensie was daar geen beduidende verskil (p = 1.0). GEVOLGTREKKING Alhoewel die oudit en gehalteverbeteringsiklus uitgevoer is by 'n enkele hospitaal, met spesifieke veranderinge gerig tot hul behoeftes, kan die basiese beginsels toegepas word in enige eenheid in die land wat ‘n PMTCT diens verskaf. Opvoeding van personeel en bewusmaking rakende die basiese beginsels van PMTCT, klein veranderinge en die vaartbelyning van prosesse by die voorgeboorte klinieke en die stel van spesifieke doelwitte of tydlyne, kan lei tot aansienlike verbeteringe in pasiënte sorg. Dit sal uiteindelik lei tot 'n afname in die MIV oordrag van moeder na kind, asook MIV-verwante morbiditeit en mortaliteit in moeders en kinders.

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Lönn, Linnea, and Elin Norström. "Unga kvinnors preventivmedelsanvändning och riskbeteende vad gäller könssjukdomar och oönskade graviditeter." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-174147.

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Syfte: Undersöka preventivmedelsanvändning, sexuellt riskbeteende gällande könssjukdomar och oönskade graviditeter samt skillnader i sexuellt riskbeteende mellan olika ursprung, självförtroende och ålder vid sexuell debut hos kvinnor i åldern 14-31 år. Metod: En enkätundersökning, konsekutivt urval, utförd på RFSU-kliniken under år 2011 inkluderade 419 kvinnor. Resultat: Kondom var det vanligaste preventivmedlet vid första samlaget och p-piller var vanligast vid senaste samlaget. Nästan hälften, 48,7 %, hade haft en könssjukdom, klamydia var vanligast. Över hälften, 60,2 %, hade riskerat att få en könssjukdom och 45,6 % hade riskerat att bli oönskat gravid under de senaste tolv månaderna. Den främsta anledningen till detta var på grund av att de struntade i kondom ”i stundens hetta”. Kvinnor som haft sin sexuella debut i yngre ålder angav oftare att de haft en könssjukdom och någon gång under de senaste tolv månaderna riskerat att bli oönskat gravid. Kvinnor som skattat sitt självförtroende som högt struntade oftare i att använda kondom ”i stundens hetta”. Slutsats: Över hälften hade ett sexuellt riskbeteende gällande könssjukdomar och oönskade graviditeter. Kvinnor som hade sin sexuella debut i yngre ålder samt kvinnor som skattade sitt självförtroende högt visade oftare på ett sexuellt riskbeteende. Det fanns ingen signifikant skillnad mellan svenskfödda och utlandsfödda gällande ett sexuellt risktagande.
Aim: Investigate contraceptive use, sexual risk behavior regarding sexually transmitted diseases (STD’s) and unwanted pregnancies and examine differences in sexual risk behavior regarding different backgrounds, self-confidence and age at first intercourse in women aged 14-31 years. Method: Consecutive sample including 419 women with a questionnaire, at a RFSU-clinic in Stockholm, 2011. Results: Condoms were most common at first intercourse and oral contraceptives most common at latest intercourse. Almost half had had an STD, Chlamydia the most common. Almost 60 % risked getting STD’s and 45,6 % risked unwanted pregnancies at sometime during the last twelve months. Main reason why participants risked this was because they ignored the condom in “the heat of the moment”. Women who had their first intercourse at a young age more often have had an STD and during the last twelve months risked an unwanted pregnancy. Women with a high self-confidence more often ignored using a condom in “the heat of the moment”. Conclusion: Over half of the participants had a sexual risk behavior regarding STD’s and unwanted pregnancies. Women who had their first intercourse at a young age and women with a high self-confidence showed signs of sexual risk-taking. There’s no significant difference between Swedish born and foreign born participants regarding sexual risk-taking.

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Griffith, Gillian J. "Contraceptive Utilization and Downstream Feto-Maternal Outcomes for Women with Substance Use Disorders: A Dissertation." eScholarship@UMMS, 2016. https://escholarship.umassmed.edu/gsbs_diss/824.

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Background: One in ten people in the U.S. are affected by a substance use disorder (SUD), roughly one third of whom are women. Rates of unintended pregnancy are higher in this population than in the general public. Little is understood about how women with SUD use prescription contraception and think about pregnancy. Methods: By analyzing Medicaid claims data and conducting qualitative interviews with women with SUD, this doctoral thesis seeks to: 1) compare any use of and consistent, continued coverage by prescription contraceptives between women with and without SUD; 2) determine the extent to which SUD is associated with pregnancy, abortion, and adverse feto-maternal outcomes in women who use prescription contraception; and 3) explore facilitators of and barriers to contraceptive utilization by women with SUD, using qualitative interviews. Results: Compared to women without SUD, women with SUD are less likely to use any prescription contraceptive, particularly long-acting reversible methods. Among women who do use long-acting methods, SUD is associated with less continued, consistent coverage by a prescription contraceptive. Among women who use contraception, SUD is also associated with increased odds of abortion. When interviewed, women with SUD report fatalistic attitudes towards pregnancy planning, and have difficulty conceptualizing how susceptibility to pregnancy may change over time. Women with SUD also report that pregnancy has substantial impact on their drug treatment prospects. Conclusions: This study is the first to examine contraceptive utilization by women with SUD who are enrolled in Medicaid or state-subsidized insurance. Our study may help to inform clinical practice and policy development to improve the reproductive health and wellbeing of women with SUD.

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Griffith, Gillian J. "Contraceptive Utilization and Downstream Feto-Maternal Outcomes for Women with Substance Use Disorders: A Dissertation." eScholarship@UMMS, 2003. http://escholarship.umassmed.edu/gsbs_diss/824.

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Background: One in ten people in the U.S. are affected by a substance use disorder (SUD), roughly one third of whom are women. Rates of unintended pregnancy are higher in this population than in the general public. Little is understood about how women with SUD use prescription contraception and think about pregnancy. Methods: By analyzing Medicaid claims data and conducting qualitative interviews with women with SUD, this doctoral thesis seeks to: 1) compare any use of and consistent, continued coverage by prescription contraceptives between women with and without SUD; 2) determine the extent to which SUD is associated with pregnancy, abortion, and adverse feto-maternal outcomes in women who use prescription contraception; and 3) explore facilitators of and barriers to contraceptive utilization by women with SUD, using qualitative interviews. Results: Compared to women without SUD, women with SUD are less likely to use any prescription contraceptive, particularly long-acting reversible methods. Among women who do use long-acting methods, SUD is associated with less continued, consistent coverage by a prescription contraceptive. Among women who use contraception, SUD is also associated with increased odds of abortion. When interviewed, women with SUD report fatalistic attitudes towards pregnancy planning, and have difficulty conceptualizing how susceptibility to pregnancy may change over time. Women with SUD also report that pregnancy has substantial impact on their drug treatment prospects. Conclusions: This study is the first to examine contraceptive utilization by women with SUD who are enrolled in Medicaid or state-subsidized insurance. Our study may help to inform clinical practice and policy development to improve the reproductive health and wellbeing of women with SUD.

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Jama, Nontembiso Mary. "Strategies used by professional nurses to manage newly diagnosed HIV positive pregnant women who fail to return within a month for further management and care." Thesis, University of Fort Hare, 2012. http://hdl.handle.net/10353/444.

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This study explored and described the strategies used by nurses to manage newly diagnosed HIV positive pregnant women who do not return to the clinic within a month following diagnosis, for continuity of care. The main aim was to prevent mother-to-child transmission of HIV (PMTCT). Method: The study sites were two accredited antiretroviral- ante-natal care (ARV-ANC) clinics at the Dimbaza community health centre (CHC) and the East London Hospital Complex (ELHC) which comprises of Cecilia Makiwane and Frere hospitals, in the Buffalo City Metropolitan Municipality (BCM). The majority of health personnel at these clinics are professional nurses. An in-depth semi structured interview guide was used to collect data through focus group interviews from professional nurses who work in these units. They were required to share their experiences about intervention strategies used for newly diagnosed HIV- positive, pregnant women who fail to return for continuity of care within a month after diagnosis. Results: Follow up of these women is done by tracking them (by calling them; calling the clinic nearest to their homes and doing home visits). Decentralisation of further management and care to the nearest clinic was also cited, especially for the patients who stay far from these accredited sites. Family support was also mentioned as a strategy to intervene for the non-compliant patients. Challenges: The challenges that were encountered with these interventions include wrong contact details, wrong addresses and being evasive when visited at home. Another challenge cited was related to the stigma attached to the diagnosis and the tracking devices used, for example, the car as it is familiar to the community it serves. Despite known benefits for early initiation of HIV treatment newly diagnosed HIV- positive, pregnant women continue to refrain from accessing care after diagnosis, thus posing a risk to the transmission of HIV to the baby and further comprising their own health. They miss out on general HIV management and ante-natal care. Conclusion: The identified intervention strategies used by nurses to follow up newly diagnosed HIV- positive, pregnant women need to be reinforced and strategies put in place to control the related challenges for a better response by the patients.

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Kenana, Motlatsi Queen. "An evaluation of the attitudes and understanding of HIV/AIDS that underpins the decision to comply or not comply with prenatal HIV/AIDS testing." Thesis, University of the Western Cape, 2007. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_9853_1256911768.

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This study aimed to explore the attitudes to HIV testing among a group of black, low socio-economic status pregnant women from Gugulethu, South Africa. The key research interest was to evaluate the attitudes and understandings of HIV/AIDS that underpin the decision to comply or not comply with prenatal HIV testing. Theories of health behaviour concur that the extent to which an individual will engage in a given health behaviour, such as HIV test compliance, will be a function of the extent to which a person believes she is personally susceptible to the particular illness and her evaluation of the severity of the consequences of contracting the disease.

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Irukulla, Pavan Kumar. "Is Number of Pregnancies a Risk Factor for Heart Attack in Women?" VCU Scholars Compass, 2004. http://scholarscompass.vcu.edu/etd/947.

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Background: Studies regarding number of pregnancies and coronary heart disease have shown inconsistent results. In the present study, we assessed the association between number of pregnancies and heart attack (HA) in women.Methods: Using data from NHANES III a cross sectional data analysis of 10634 women aged 17 and above was conducted. We considered socio-demographic factors and other potential risk factors including physical activity, smoking, alcohol, diabetes, hypertension, hypercholesterolemia, BMI, age, and family history of heart attack. We conducted Bivariate analysis to determine prevalence and crude odds ratios. Multivariate logistic regression analysis was used to adjust for confounding variables using SPSS. Results: The prevalence and 95% CI of HA was 3.4% (3.0% 3.7%). The age adjusted odds ratios for 7+ pregnancies was 2.33 95% CI [1.42-3.81], but this became insignificant when a fully adjusted model was used (odds ratio, 1.68: 95% CI, 0.89 to 3.16). For those with 4 pregnancies the risk was lowest in both age adjusted and fully adjusted models confirming the well known "J" shaped non linear relationship between number of pregnancies and heart attack. Conclusion: We found an association that was not significant between number of pregnancies and heart attack. Further studies using physician-confirmed diagnosis is needed to appropriately asses the potential relationship of gravidity and heart attack.

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Oliveira, Aline da Silva. "Cárie dentária e doença periodontal em gestantes : um estudo de prevalência em usuárias do serviço público de Juiz de Fora - MG." Universidade Federal de Juiz de Fora (UFJF), 2009. https://repositorio.ufjf.br/jspui/handle/ufjf/3868.

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CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
O conhecimento da prevalência de doenças bucais em gestantes pode subsidiar o planejamento de ações e programas específicos para a promoção da saúde da mãe e de seu filho. Este estudo transversal determinou a prevalência de cárie dentária e doença periodontal, necessidades de tratamento, e fatores de risco associados, em gestantes usuárias do serviço público de Juiz de Fora, MG. Foram incluídas 312 gestantes, com idade entre 13 e 43 anos, após cálculo amostral. Condição dentária e periodontal, e necessidades de tratamento foram determinadas por meio do índice de condição dentária e necessidade de tratamento (ICDNT), índice de dentes permanentes cariados, perdidos e obturados (CPO-D), índice periodontal comunitário de necessidade de tratamento (CPITN) e perda de inserção periodontal (PIP). A análise estatística incluiu o teste Qui-quadrado e análise de regressão logística, com nível de significância de 5%. A prevalência de cárie dentária foi 96,5%; 71,5% da amostra apresentaram necessidade de tratamento. O índice CPOD médio foi 10,79. Demonstrou-se associação entre lesões de cárie e etnia (OR=1,7; IC95%: 1,1-2,9), escolaridade (OR=2,4; IC95%: 1,3-4,5), ter mais de um filho (OR=2,0; IC95%: 1,1-3,9) e realizar até duas escovações diárias (OR=3,2; IC95%: 1,5-7,0). A ocorrência de enjoos comportou-se como fator de proteção (OR=0,7; IC95%: 0,5-0,9). A prevalência de doença periodontal foi 87,5%; 82% da amostra apresentaram necessidade de tratamento. A presença de doença periodontal associou-se à baixa escolaridade (OR=2,8; IC95%: 1,1-7,5) e à não utilização de fio dental (OR=1,8; IC95%: 1,1-2,8). A gravidade da doença periodontal associou-se à residência em região mais populosa (OR=3,7; IC95%: 1,9-7,3), baixa escolaridade (OR=3,2; IC95%: 1,6-6,3), ser multigesta (OR=2,7;IC95%: 1,2-6,3) e hipertensa (OR=2,6; IC95%: 1,1-6,2). Os resultados obtidos reforçam a necessidade de implementação de estratégias educativo-preventivas dirigidas às gestantes e de garantia de acompanhamento odontológico como parte do programa de pré-natal do Sistema Único de Saúde.
The knowledge of the prevalence of oral diseases in pregnant women supports action planning and specific programs directed to them in order to promote the health of the mother and child. This cross-secctional study determined the prevalence of dental caries and periodontal disease, needs for treatment and risk factors in pregnant public service users from Juiz de Fora, MG. A total of 312 pregnant women with ages between 13 and 43 was included after sample estimates. Dental and periodontal conditions and treatment needs were determined by the index of dental condition and treatment needs (ICDNT), index of decayed, missing and filled permanent teeth (DMF-T), Community Periodontal Index of Treatment Needs (CPITN), and clinical attachment loss (CAL). The statistical analysis included Chisquare test and logistic regression analysis. The statistical significance level was set at 5%. The prevalence of dental caries was 96.5%; 71.5% of the sample presented the need for treatment. The mean DMF-T was 10.79. The logistic model showed an association between the presence of caries lesions and ethnic groups (OR=1.7; CI95%: 1.1-2.9), education status (OR=2.4; CI95%: 1.3-4.5), having more than one child (OR=2.0; CI95%: 1.1-3.9) and toothbrushing up to least twice a day (OR=3.2; CI95%: 1.5-7.0). The occurrence of nausea acted as a protection factor against the disease (OR= 0.7; CI95%: 0.5-0.9). The prevalence of periodontal disease was 87.5%; 82% of the sample presented the need for treatment. The presence of periodontal disease was associated to low education status (OR=2.8; CI95%: 1.1-7.5) and the non use of dental floss (OR=1.8; CI95%: 1.1-2.8). The severity of periodontal disease was associated to living in more populated regions (OR=3.7; CI95%: 1.9-7.3), low education status (OR=3.2; CI95%: 1.6-6.3), having child (OR=2.7; CI95%: 1.2-6.3) and being hypertensive (OR=2.6; CI95%: 1.1-6.2). The results reinforce the need for educational-preventive strategies for pregnant women and the guarantee of dental follow-up, as part of the pre-natal program of Public Health Service (Sistema Único de Saúde).

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Sinyanya, Yoliswa. "An analysis of policy implementation on HIV and AIDS in pregnant women : a case study of Lukhanji sub-district Municipality in the Eastern Cape Province in South Africa." Thesis, University of Fort Hare, 2015. http://hdl.handle.net/10353/2282.

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This research was conducted with the aim to evaluate the policy interventions on HIV and AIDS in pregnant women in the Lukhanji sub district of Chris Hani District Municipality. The study would also propose policy improvement strategies towards curbing the spread of HIV and AIDS in pregnant women. In realizing these goals, the entire research process was guided by the research objectives and questions which sought to evaluate policies and strategies relevant to HIV prevalence in pregnant women. The secondary research objectives were accomplished through the review and analysis of the relevant literature and theories. Qualitative research approach was used in determining the findings and conclusions from the study. Data was collected using qualitative research methods and in this case a structured questionnaire was developed and distributed to the study participants. The Questionnaires were handed and discussed with each participant. Demographics, socioeconomic and cultural factors were considered in designing the data collection tool. These factors are known to have an impact on the prevalence of HIV. It has been shown through the study that demographic variables have an effect on HIV prevalence. Hence when considering policy interventions these should be taken into account. All the respondents were given enough time and they provided clear and comprehensive responses to the questionnaire and follow up discussions. The evaluation of the responses showed that various HIV prevention related policies are being implemented within the Lukhanji sub-district. Numerous programmes relating to HIV and AIDS, also specifically covering pregnant women are being rolled out across the sub-district. HIV prevalence in the study population is rated as average to low when comparing with the district, provincial and national statistics. Current data obtained from the study indicates that HIV prevalence stands at 17%. This finding demonstrates the heterogeneity of HIV prevalence when comparing this result with current provincial and national statistics. Evaluation of the different HIV and AIDS programmes that are aligned to provincial and national policy somehow explain the positive outcomes observed in the Lukhanji sub-district The study recommends that more work be done in reaching out to the communities using various communication channels and strategies. This could address the challenges associated with the lack of cooperation with local traditional leaders, because this has been found to have a negative impact on implementation of some programmes such as circumcision. One of the positive findings from the study is the accessibility of health care facilities to the local rural communities. Further research on the subject should be undertaken to ensure continuous evaluation as this topic is viewed as a continuous global issue.

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Hrycyk, Joris [Verfasser], Bettina [Akademischer Betreuer] Kuschel, Bettina [Gutachter] Kuschel, Marion B. [Gutachter] Kiechle, and Karl-Ludwig [Gutachter] Laugwitz. "Mode of Delivery and Pregnancy Outcome in Women with Congenital Heart Disease / Joris Hrycyk ; Gutachter: Bettina Kuschel, Marion B. Kiechle, Karl-Ludwig Laugwitz ; Betreuer: Bettina Kuschel." München : Universitätsbibliothek der TU München, 2018. http://d-nb.info/1164156640/34.

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Brisbois, Maryellen D. "Chemotherapy-Induced Premature Menopause Among Latina Women With Breast Cancer: An Interpretive Description: A Dissertation." eScholarship@UMMS, 2013. https://escholarship.umassmed.edu/gsn_diss/29.

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The description and interpretation of Latinas’ experience with chemotherapyinduced premature menopause from breast cancer treatment were explored in this study, which utilized an interpretive descriptive method from a feminist lens, and Knobf’s (1998, 2002) “Carrying on” theory. The specific aims of the study and the interview questions were guided by the state of the science literature. Overall, the impact of physiological effects, psychosocial effects, barriers, influencing factors that made their experience easier or harder, and how participants adjusted to a cancer diagnosis, treatment course, and menopause transition were described as bigger than the menopause experience alone. Participants also described a period of uncertainty or “ever-changing landscape” that began at the time of diagnosis and continued through survivorship. The impact of information, access to healthcare, acculturation levels, support, and a sense of control were elucidated as important factors in “working through” the experience. A range of collateral data sources were employed. Study limitations and future implications for practice, research, and health policy were demarcated.

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Isaacs, Ferial. "An evaluation of fetal growth in human immunodeficiency virus infected women at Khayelitsha and Gugulethu midwifery obstetric units in the Western Cape." Thesis, Cape Peninsula University of Technology, 2006. http://hdl.handle.net/20.500.11838/1547.

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Thesis (MTech (Radiography))--Cape Peninsula University of Technology, 2006
A prospective cohort study was done on Human Immunodeficiency Virus (HIV) infected and uninfected women attending Khayelitsha Midwifery Obstetric Unit (MOU) and Gugulethu MOU from June 2003 to December 2004, primarily to establish whether there is an association between HIV infection and Intra-uterine growth restriction (lUGR). B-Mode real time ultrasound imaging was used to monitor fetal growth from ±22 weeks to 36 weeks gestational age. Birth weight, gestational age at delivery, gender, placental weight, and maternal complications were also included. Maternal factors considered included age, weight parity, singleton versus multiple pregnancy, previous IUGR or preterm delivery, previous fetal abnormality, social habits viz. cigarette smoking, alcohol and drug use, and vascular disease viz. Diabetes, hypertension, renal disease, cardiac disease and collagen disease. A secondary objective was to establish whether the CD4 T-lymphocyte count possibly modulated the presence of IUGR. All HIV infected women were given antiretroviral therapy according to the standard Protocol of the Provincial Government of Western Cape (2002). The research questions were: • Does maternal HIV infection increase the risk of intrauterine growth restriction and associated preterm delivery? • Does the immune status of (CD4 T-lymphocyte count) of HIV infected pregnant women modulate fetal growth? The primary objective of this study was to establish whether there is an association between HIV infection and IUGR, and hence that HIV infection leads to an adverse perinatal outcome. Ultrasound was used as a diagnostic tool to establish normal or abnormal fetal growth patterns. Anecdotal reports from health workers in the obstetric field suggested that IUGR and preterm delivery may be associated with low birth weight infants in HIV infected pregnant women. However, preterm delivery is associated with various other factors including low socio-economic status (poor nutrition), cigarette smoking, drug and alcohol abuse, previous history of preterm delivery, over distention of the uterus (hydramnios, multiple gestation), premature rupture of membranes, cervical incompetence, vaginal infections (bacterial vaginosis) and maternal disease e.g. hypertension, heart disease (Lizzi, 1993: Symmonds, 1992; Odendaal et aI, 2002). HIV is now thought to be an added factor. Afier doing a systematic review and meta-analysis of 31 studies, Brocklehurst and French (1998) reported that there is an association (although not strong) between HIV infection and adverse perinatal outcome in developed countries; but in developing countries, there is an increased risk of infant death. By excluding or controlling for confounding variables that could affect fetal growth, this study aimed to determine whether there is a significant association between HIV and fetal growth by comparing fetal growth in HIV infected and uninfected women from midsecond trimester to the time of delivery. A secondary objective was to establish whether there is an association between the immune status (CD4 T-lymphocyte count) of the mother and IUGR. The immune status of the mother is probably one of the most important factors affecting the fetus and perinatal outcome. As the mother's viral load increases, her immune system is increasingly compromised, resulting in the occurrence of HIV-related diseases, and a concurrent increase in fetal complications. In this study a CD4 T-lymphocyte count was used to assess the level of immunodeficiency of all the HIV infected participants. Ideally the test should have been done each time the participant was scanned so that the CD4 T-lymphoc)1e count could be monitored simultaneously with the fetal growth parameters, however due to financial constraints and ethical considerations, one test was done on each HIV infected women. This study was based at two MOU's where different antiretroviral therapy (ARVT) regimens were used. The one MOU offered Zidovudine (ZDV) to mothers from 34 weeks gestation to the onset of labour, and the other MOU offered Nevirapine (NVP) as a single dose to the mother at the onset of labour and to the neonate within 72 hours of birth (Provincial Government Western Cape, 2002). This presented an opportunity to compare two groups of HIV infected women on different regimes. The intention was to establish whether ZDV had an adverse effect on fetal growth and resulted in low birth weight. However, 6 months after the study started a revised Prevention of Mother to Child Transmission (PMTCT) Protocol was implemented where women at both MOU's received the same ARVT i.e. ZDV and NVP. This objective was therefore abandoned due to a change in the PMTCT Protocol in the Western Cape. The study was based at two Midwife Obstetric Units (MOU) in the Western Cape where the prevalence of HIV in pregnant women is relatively high i.e. 20 - 24 % (Mother-to-child transmission Monitoring Team, 2001), viz. Gugulethu MOU and Khayelitsha MOU. A prospective cohort study was done with the intention of recruiting a sample of 400 pregnant women, 200 HIV infected and 200 uninfected. The actual sample size was 415. The study group was 194 HIV infected women and the control group was 221 uninfected women. Confounding variables such as cigarette smoking, alcohol and drug abuse. multiple gestation. grand multipara pregnancy, history of IUGR or preterm delivery. fetal abnormality detected at the time of the first scan in the current pregnancy, and maternal vascular disease - were excluded. Confounding variables such as maternal age, maternal weight and gestational age were controlled. Ultrasound imaging was used as a diagnostic tool to establish normal and abnormal fetal growth patterns. A B-mode real time ultrasound unit was used to confirm the gestation age and rule out any obvious fetal abnormalities at 20-24 weeks gestation. Fetal growth scans were done at 28 weeks, 32 weeks and 36 weeks gestation to compare fetal growth patterns in the study and control groups. Fetal biometry used to monitor fetal growth included biparietal diameter (BPD), head circumference (HC), femur length (FL), abdominal circumference (AC) and estimated fetal weight (EFW). Amniotic fluid index (AFI), placental thickness & placental grading were also included. The following variables were analyzed post delivery: • Gestation age at delivery: Normal term delivery is considered to be at 37 - 42 weeks and premature delivery is considered to be less than 37 weeks gestation. The HIV infected and uninfected groups were compared to assess if there \vas a significant difference in the number of preterm deliveries. • Birth weight: The HIV infected and uninfected groups were compared to assess if there was a significant difference in the number of infants with low birth weight. • Perinatal complications: The HIV infected and uninfected groups were compared to assess if there was a significant difference in the number of perinatal complications and to assess if there was an association between the immune status (CD4 T-lymphocyte count) of HIV infected women and perinatal complications. Appropriate ethical principles in medical research were applied. The participant's autonomy, rights and best interests were always considered a priority. Informed consent was obtained from all the participants. Strict confidentiality was adhered to regarding any data collected throughout the study. The Research Ethics Committees at Cape Peninsula University of Technology and University of Cape Town granted ethics approval for the study. Statistical analysis was performed using the statistical package SPSS 12.0.

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Berg, Marie. "Genuine Caring in Caring for the Genuine : Childbearing and high risk as experienced by women and midwives." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2002. http://publications.uu.se/theses/91-554-5299-X/.

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43

Korsman, Stephen Nicolaas Jacques. "Molecular epidemiology of mother-to-child transmission of HIV-1 in children at Tygerberg Hospital." Thesis, Link to the online version, 2006. http://hdl.handle.net/10019/1074.

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Pimenta, Rodolfo Macedo Cruz. "N?veis de gravidade da periodontite e anemia de doen?a cr?nica em gestantes." Universidade Estadual de Feira de Santana, 2016. http://localhost:8080/tede/handle/tede/559.

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Submitted by Ricardo Cedraz Duque Moliterno (ricardo.moliterno@uefs.br) on 2018-01-25T21:40:52Z No. of bitstreams: 1 Disserta??o RODOLFO MACEDO CRUZ PIMENTA 2016.pdf: 1776621 bytes, checksum: 84d75a47f94adf77467c9412416adcf6 (MD5)
Made available in DSpace on 2018-01-25T21:40:52Z (GMT). No. of bitstreams: 1 Disserta??o RODOLFO MACEDO CRUZ PIMENTA 2016.pdf: 1776621 bytes, checksum: 84d75a47f94adf77467c9412416adcf6 (MD5) Previous issue date: 2016-03-29
Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES
Periodontitis is the second most frequent oral disease in the world and it is defined as an infection of periodontal supporting tissues associated with bacterial biofilm accumulation on the tooth surface. The hypothesis that periodontitis is associated with systemic repercussions has drawn the attention of the scientific community, including its contribution to the development of anemia, which in pregnancy may be related to undesirable outcomes. Most cases of anemia during pregnancy can not be originally iron deficiency, but due to chronic inflammation that characterizes anemia of chronic disease (ACD). Nonetheless, the possible association between the two diseases is related to iron metabolism. This study investigated the influence of different levels of periodontitis severity in anemia of chronic disease in pregnant women. Methods: Cross-sectional study was conducted in Santo Antonio de Jesus, Bahia, Brazil, from February 2014 to January 2016. The data collection was the application of a questionnaire to obtain socioeconomic-demographic, lifestyle, health condition and related to pregnancy information, blood collection and oral assessment, with full mouth examination which included the following parameters: probing depth, clinical attachment level and bleeding on probing. Participants were classified according to the level of periodontitis severity, mild, moderate and severe, using two defining criteria. They were also classified according to the presence or absence of ACD. Association measurements between exposure and outcome were estimated using Poisson regression analysis, obtaining the prevalence ratio (PR) and confidence intervals at 95% (95% CI). Results: the final sample included 616 pregnant women, of which 16.56% (102) were diagnosed with ACD. The presence of periodontitis ranged from 16.72% to 67.53%, according to the definition criterion. There was no association between levels of periodontitis severity and ACD nor between periodontitis and ACD for both studied criteria: PRcrude = 0.60, 95% CI: [0.33 to 1.08] and PRcrude = 0.89, 95% CI: [0.76 to 1.05], even after adjustment for the following confounders: schooling level, smoking habit, age, number of prenatal consultations, parity and toothache in the last six months, PRadjusted = 0.61, 95% CI: [0.34 to 1.09] and PRadjusted = 0.90 , 95% CI: [0.76 to 1.05]. Conclusions: the findings of this research indicated that the presence of periodontitis, regardless of the severity level is not associated with the ACD, although there is a high frequency of these diseases in the studied group. Additional studies are needed to confirm these results, considering the importance of the two diseases as public health problems, as well as the relevance of the pregnancy.
A periodontite ? a segunda doen?a bucal mais frequente no mundo e ? definida como uma infec??o dos tecidos periodontais de suporte associada ao ac?mulo de biofilme bacteriano na superf?cie dent?ria. A hip?tese de que a periodontite se associa a repercuss?es sist?micas tem chamado a aten??o da comunidade cient?fica, incluindo a sua contribui??o para o desenvolvimento de anemia, que na gravidez pode estar relacionada a desfechos indesej?veis. A maioria dos casos de anemia na gesta??o pode n?o ser originalmente ferropriva, por?m decorrente de inflama??es cr?nicas, caracterizando a anemia de doen?a cr?nica (ADC), mas a possibilidade de associa??o entre as duas doen?as est? relacionada ao metabolismo do ferro. Este estudo investigou a influ?ncia dos diferentes n?veis de gravidade da periodontite na anemia de doen?a cr?nica em gestantes. M?todos: estudo transversal foi realizado em Santo Antonio de Jesus, Bahia, Brasil, entre Fevereiro de 2014 e Janeiro de 2016. A caracteriza??o da amostra foi feita a partir da aplica??o de um question?rio para obten??o de informa??es socioecon?mico-demogr?ficas, de estilo de vida e condi??es de sa?de e relacionadas ? gesta??o, coleta sangu?nea e avalia??o bucal, com o exame periodontal completo que incluiu os seguintes descritores: profundidade de sondagem, n?vel de inser??o e sangramento ? sondagem. As participantes foram classificadas segundo o n?vel de gravidade de periodontite, em leve, moderada ou grave, a partir de dois crit?rios de defini??o. Foram classificadas tamb?m quanto ? presen?a ou aus?ncia de ADC. Procedeu-se an?lise de regress?o de Poisson, obteve-se Raz?o de Preval?ncia (RP) e seus intervalos de confian?a a 95% (IC95%). Resultados: a amostra final incluiu 616 gestantes, das quais 16,56% (102) apresentaram diagn?stico de ADC. A ocorr?ncia de periodontite variou de 16,72% a 67,53%, de acordo com o crit?rio de defini??o. N?o foi encontrada associa??o entre os n?veis de gravidade de periodontite e ADC e tampouco entre periodontite e ADC, para ambos os crit?rios estudados: RPbruta = 0,60, IC95%: [0,33 ? 1,08] e RPbruta = 0,89, IC95%: [0,76 - 1,05], mesmo ap?s ajuste para os seguintes confundidores: n?vel de escolaridade, h?bito de fumar, idade, n?mero de consultas de pr?-natal, paridade e dor de dente nos ?ltimos seis meses, RPajustada = 0,61, IC95%: [0,34 ? 1,09] e RPajustada= 0,90, IC95%: [0,76 - 1,05]. Conclus?es: os achados da presente investiga??o sinalizaram que a presen?a de peridontite, independentemente do n?vel de gravidade, n?o tem associa??o com a ADC, muito embora haja altas frequ?ncias das doen?as no grupo estudado. Estudos adicionais s?o necess?rios para confirmar esses resultados, diante da import?ncia das duas enfermidades como problemas de sa?de p?blica, bem como da relev?ncia do per?odo gestacional.

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45

Stenson, Kristina. "Men's Violence against Women – a Challenge in Antenatal Care." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4140.

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46

Arroyo, Juan Pablo. "Exploring Potential Risk Factors of Fetal Origins of Diabetes| Maternal Stressors during Pregnancy and Birth Outcomes among Women in a Hospital in the Municipality of Caguas, Puerto Rico." Thesis, University of South Florida, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=1543402.

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Puerto Rico has the highest prevalence of type 2 diabetes, low birth-weight, and the second highest prevalence of preterm-birth in all the U.S. and its non-incorporated territories. These conditions are related. Birth-weight at both ends of the spectrum and preterm-birth are associated with an increased risk for developing type 2 diabetes and immune-inflammatory dysregulations. Maternal psychosocial stressors during pregnancy have also been recognized as potential risk factors for type 2 diabetes, and have been consistently associated with preterm-birth and low birth-weight across populations. Current evidence points toward epigenetic fetal metabolic-programming as the mechanism that underlies the increased risk for the previously mentioned morbidities. However, the particular psychosocial stressors that may contribute to the high prevalence of low birth-weight and preterm-birth in the population of Puerto Rico have not been well studied.

The present study assesses the relationships between particular psychosocial stressors, socioeconomic status, food insecurity, and birth outcomes. The results of this study show that low-risk pregnancy women were more likely to have babies with a higher ponderal index if they were exposed to stressors during gestation months 5, 6, and 7, or if exposed to "relationship stress" at any time during pregnancy. Women exposed to "financial difficulties" at any time during pregnancy were more likely to deliver babies at an earlier gestational age. Differences in birth outcomes between the exposed and non-exposed women were independent of maternal anthropometric measurements, maternal age at birth, number of previous births, and sex of the baby. Significant differences in birth outcomes were found between categories of father's self-identified and identified by others ethnicity, but sample size within categories was small. Although mothers with children at home had higher levels of food insecurity, and the level of food insecurity was correlated with higher levels of stress, no birth outcome measure was associated with food insecurity.

Some results are atypical in comparison with other populations, and therefore these findings may contribute to the understanding of population differences in the relationship between maternal stress during pregnancy and birth outcomes. The relatively small sample size and strict exclusion criteria of this study may limit the generalizability of the findings. Epidemiological similarities between Puerto Rico and other populations, and the possibility of a higher ponderal index increasing the risk for type 2 diabetes in the population of Puerto Rico need to be examined in future research.

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Pinho, Neto Otávio Soares 1954. "Resultados de um protocolo de atenção a gestantes portadoras do vírus da imunodeficiência humana em um serviço do nordeste do Brasil = Assessed results for a treatment protocol for HIV-positive pregnant women in northeastern Brazilian healt service." [s.n.], 2014. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312689.

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Orientador: Helaine Maria Besteti Pires Mayer Milanez
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: OBJETIVO: Analisar os protocolos de Antirretrovirais em uma coorte de gestantes HIV positivas e recém-natos expostos em seguimento no Serviço de Assistência Especializada (SAE) Familiar/Hospital Universitário Lauro Wanderley (HULW)/Universidade Federal da Paraíba (UFPB) no período de 2005 a 2012. SUJEITOS E MÉTODOS: Estudo descritivo, do tipo coorte, retrospectivo, numa abordagem quantitativa, a partir de um grupo de gestantes HIV+ e seus recém-nascidos (RN) expostos, atendidas no SAE Familiar do HULW/UFPB. Os dados foram codificados, digitados e armazenados em um banco de dados criado com esse propósito. Cada par mãe-RN foi identificado com um número. Foi realizada uma análise descritiva das características sociodemográficas da gestante, do acompanhamento pré-natal, do uso de terapia antirretroviral (TARV), do parto e do recém-nascido, através de distribuição percentual ou média. Posteriormente, foi realizada a análise das classes dos antirretrovirais e seus desfechos para a mãe e recém-nascidos expostos. As possíveis associações entre as variáveis categóricas foram testadas através do teste t (dados paramétricos). Não foi possível a realização de análise multivariada devido ao pequeno número de crianças infectadas. RESULTADOS: A taxa de transmissão vertical (TV) no SAE Familiar HULW/UFPB entre 2005 e 2012 foi de 3,9% em uma coorte de 153 gestações analisadas. A média de idade das gestantes foi de 25 anos e a de escolaridade de 7 anos. A maioria era de mulheres negras (78,7%), com união estável (59%), e a principal categoria de exposição foi a sexual (96,5%). Mais de cinquenta por cento já apresentavam diagnóstico do HIV anterior à gravidez estando 41% em uso de TARV. A média de CD4 inicial foi de 440 células/ml e, após uso de TARV de 516,07 células/ml. A média de carga viral (CV) pré uso de TARV foi de 24.022. Mais de 70% apresentaram carga viral indetectável com 34 semanas de gestação. Usaram TARV com IP 92% e 8% um esquema com nevirapina. Não foi utilizada monoterapia com AZT nessa coorte. A média de idade gestacional no parto foi de 36 semanas e em 95% dos casos a via de parto foi cesárea. A grande maioria dos casos (98%) recebeu AZT endovenoso no parto. O peso médio dos recém-nascidos foi de 2,89 gramas e apenas 17,64% tiveram baixo peso. A presença de prematuridade, patologias neonatais e o não uso do AZT intraparto foram fatores que se associaram a um maior risco de transmissão vertical. Não foi possível a realização de análise multivariada devido ao pequeno número de crianças infectadas. Houve poucos efeitos colaterais associados ao uso da TARV na gestação, sendo o mais frequente a presença de anemia materna (58,4%) e de anemia neonatal (21,6%). Não se observaram efeitos adversos graves, tanto na mãe quanto no recém-nascido. CONCLUSÃO: A taxa de TV no serviço universitário de João Pessoa foi de 3,9%, principalmente associada à prematuridade, patologia neonatal e não uso do AZT venoso intraparto. Houve baixa ocorrência de efeitos adversos, sendo mais frequente a anemia, tanto na mãe quanto no recém-nascido
Abstract: OBJECTIVE: To analyze antiretroviral therapy protocols in a cohort of HIV-positive pregnant women and exposed newborns followed at Serviço de Assistência Especializada (SAE) Familiar / Hospital Universitário Lauro Wanderley (HULW), Universidade Federal da Paraíba (UFPB), from 2005 to 2012. SUBJECTS AND METHODS: Descriptive, retrospective cohort study, using a quantitative approach, conducted on a group of HIV-positive pregnant women and their exposed newborns followed at SAE/HULW. Data were codified, entered and stored in a database created specifically for this purpose. Each mother-child pair was identified by a number. A descriptive analysis of the sociodemographic characteristics of pregnant women, prenatal care, use of antiretroviral therapy (ART), and delivery and neonate parameters was conducted using percentages or means. An analysis of the classes of antiretroviral drugs and their associated outcomes for mothers and exposed newborns was then conducted. Potential associations between categorical variables were assessed with the t-test (parametric data). Multivariate analysis could not be performed due to the small number of children infected. RESULTS: The mother-to-child transmission rate at SAE/HULW-UFPB between 2005 and 2012 was 3.9%, in a cohort of 153 pregnancies. The mean patient age was 25 years and the mean educational attainment was 7 years of schooling. Most subjects were black women (78.7%), in a stable relationship (59%), and the main risk factor was sexual contact (96.5%). More than 50% already had a diagnosis of HIV infection prior to pregnancy, and 41% were on ART. The mean CD4 count was 440 cells/ml at baseline and 516.07 cells/ml after ART. The median viral load before ART was 24.022. Over 70% had an undetectable viral load at 34 weeks of gestation. Overall, 92% were on PI-containing ART regimens and 8% were on nevirapine-containing regimens. AZT monotherapy was not used in this cohort. The mean gestational age at delivery was 36 weeks, and in 95% of cases, the mode of delivery was cesarean. The vast majority of cases (98%) received intrapartum intravenous AZT. The average birth weight of newborns was 2,890 g, and only 17.6% were underweight. Presence of prematurity, neonatal morbidity, and failure to administer intrapartum AZT were factors associated with higher risk of vertical transmission. Multivariate analysis could not be performed due to the small number of infected children. There was a low incidence of side effects associated with ART during pregnancy, the most common being maternal anemia (58.4%) and neonatal anemia (21.6%). No serious adverse effects were observed in either mothers or newborns. CONCLUSION: The rate of mother-to-child transmission at this university-based facility in João Pessoa was 3.9%, and was mainly associated with prematurity, neonatal morbidity, and failure to administer intrapartum intravenous AZT. There was a low rate of adverse effects, the most common being anemia, in both mothers and newborns
Doutorado
Saúde Materna e Perinatal
Doutor em Ciências da Saúde

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48

Irambona, Renovate. "Contribution à l'étude de l'accompagnement psychosocial de la femme enceinte dans les services de Prévention de la Transmission Mère-Enfant du VIH au Burundi." Doctoral thesis, Universite Libre de Bruxelles, 2012. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209773.

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L’annonce des résultats du diagnostic d’une maladie grave est toujours un moment difficile à vivre pour le patient et, dans une moindre mesure, pour le médecin. Lorsqu’il s’agit du VIH/SIDA, la difficulté est d’autant plus importante que bien souvent, cette maladie véhicule honte et culpabilité avec risque de stigmatisation de la personne séropositive. Chez les femmes enceintes burundaises, cette situation est encore plus préoccupante. Des barrières liées au contexte socio-culturel les poussent à des conduites d’évitement du test du VIH, alors que le dépistage constitue une porte d’entrée pour les soins de prévention de la transmission du VIH de la mère à l’enfant.

L’objectif de cette thèse était de comprendre l’état psychologique des femmes enceintes lors du dépistage du VIH dans les services de Prévention de la Transmission Mère-Enfant (PTME) du VIH à Bujumbura. Cette compréhension permettrait d’optimiser la prise en charge psychologique de ces femmes enceintes au moment du dépistage du VIH et de mettre en place un accompagnement psychosocial dans leur milieu de vie. De façon spécifique, ce travail visait à :(1) analyser le contenu verbal des entretiens de conseils pré et post-test tels qu’ils sont faits dans les services de PTME, et de les comparer avec les normes proposées en la matière par l’OMS ;(2) évaluer l’anxiété chez les femmes enceintes à différents moments du dépistage du VIH; (3) analyser les raisons du refus du dépistage et du renoncement aux soins par les femmes enceintes séropositives à VIH.

La recherche a été réalisée principalement auprès des femmes enceintes rencontrées dans les services de consultation prénatale à Bujumbura, capitale du Burundi. Les outils de récolte des données étaient des entretiens conseillers-femmes enceintes au cours des activités de dépistage, les échelles d’évaluation de l’anxiété (HADS et STAI), des questionnaires de rétention/impact de l’information, des focus groups et un récit de vie. Ces outils nous ont permis de recueillir des données que nous avons traitées qualitativement par analyse de contenu et quantitativement par des analyses statistiques avec le logiciel SPSS.

Les résultats sont présentés dans cinq études. Notre première étude a montré que l’adaptation locale du schéma proposé par l’OMS pour les conseils pré et post-test en dépistage prénatal du VIH est une nécessité. Cela permettrait aux conseillers de mieux communiquer avec les femmes enceintes. Les trois autres études portant sur l’évaluation de l’anxiété ont montré que les besoins psychologiques des femmes enceintes au cours du dépistage du VIH devraient être reconnus et pris en compte. La détection de l’anxiété devrait être systématique afin de commencer une prise en charge psychologique dès le début du processus de dépistage et ainsi aller au devant des conduites d’évitement. La cinquième et dernière étude a montré que la stigmatisation et ses conséquences seraient à la base du refus du dépistage du VIH et du traitement en cas de séropositivité. Dès lors, le suivi médical doit être associé à un suivi psychologique pour réaliser une prise en charge intégrée des femmes enceintes dans les services de PTME. En continuité avec cette prise en charge au niveau des structures de santé, des stratégies d’accompagnement psychosocial adéquates devraient être planifiées au niveau des communautés. En outre, nous recommandons des études visant les problématiques psychologiques et sociales liées au VIH/SIDA chez la femme enceinte au Burundi.

Abstract:The announcement of the diagnosis of a serious illness is always a difficult experience for the patient and to a lesser extent, to the doctor. When it comes to HIV / AIDS, the challenge is even more important that in many cases, this disease vehicle with shame, guilt and risk of stigmatization of HIV-positive person. For pregnant women in Burundi, the situation is even more worrying. Socio-cultural barriers cause avoidance of HIV testing, while the screening is a gateway to care for the prevention of HIV transmission from mother to child.

The objective of this thesis was to understand the psychological state of pregnant women in HIV testing services in the Prevention of Mother to Child Transmission (PMTCT) of HIV in Bujumbura. This understanding would maximize the psychological care of pregnant women at the time of HIV testing and to develop psychosocial support in their living environment. Specifically, this work aimed to: (1) analyzing the verbal content of counseling interviews pre and post-test as they are made in PMTCT services, and compare them with the proposed standards in this area by WHO, (2) assess anxiety in pregnant women at different stages of HIV testing, (3) analyze the reasons for refusal of screening and seeking care for pregnant HIV-positive.

The research was conducted mainly among pregnant women encountered in antenatal clinics in Bujumbura, Burundi's capital. Tools for data collection were interviews between counselors and pregnant women during routine screening, rating scales of anxiety (HADS and STAI), questionnaires of retention / impact of information, focus groups and a life story. These tools have allowed us to collect data that we have treated qualitatively by content analysis and quantitatively by statistical analysis using SPSS.

The results are presented in five studies. Our first study showed that local adaptation of the scheme proposed by the WHO for counseling pre and post-test in antenatal HIV testing is a necessity. This would allow counselors to better communicate with pregnant women. The other three studies of anxiety assessment showed that the psychological needs of pregnant women in HIV testing should be recognized and taken into account. Anxiety screening should be systematic to begin psychological support early in the process of HIV testing. The fifth and final study showed that stigma and its consequences would be the causes for refusal of HIV testing and treatment in HIV positive cases. Therefore, medical care should be combined with psychological support to achieve an optimal management of pregnant women in PMTCT services. In continuity with this support in the structures of health, psychosocial support strategies should be planned at the community level. In addition, we recommend studies related to psychological and social issues of HIV / AIDS among pregnant women in Burundi.

Doctorat en Sciences Psychologiques et de l'éducation
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Fernandes, Alessandra Fernandez. "Valvopatia mitral em gestantes: repercusões maternas e perinatais." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/5/5139/tde-27052010-164816/.

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Os objetivos deste estudo foram correlacionar o tipo de lesão valvar mitral com eventos maternos e neonatais. É um estudo retrospectivo, observacional, realizado na Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina de São Paulo. Foram coletados dados de 117 gestações em 111 mulheres com valvopatia mitral e 117 recém-nascidos resultantes destas gestações. No grupo estudado, foram observados 71 casos de gestantes portadoras de insuficiência mitral e 46 casos de gestantes portadoras de estenose mitral e seus 117 recém-natos. O tipo de lesão valvar, a estenose mitral, esteve significantemente relacionado piores classes funcionais (com predominância de CF III/IV), a maior necessidade de uso de medicamentos cardiovasculares, à maior freqüência de internação para compensação do quadro cardíaco, a maiores índices de parto cesárea, a menor média ponderal ao nascimento e a maior incidência de RNs pequenos para idade gestacional. Entretanto, a lesão valvar predominante não influiu com relevância estatística quanto à presença de complicações obstétricas, presença de co-morbidades clínicas, a complicações fetais, índice de Apgar < 7, e necessidade de UTI neonatal. A presença de valvopatia mitral na gravidez, principalmente a estenose mitral, acompanha-se de riscos maternos e perinatais
PURPOSE: To evaluate the maternal (clinical e obstetrical) and perinatal events related to the predominant valvar lesion in pregnant women with mitral valve disease. This is a Observational and retrospective study of 117 pregnancies in 111 patients with mitral disease, followed in a single tertiary center from January 2004 until August 2008. Clinical and obstetrical data were reviewed and analyzed according to the main type of valvar lesion (stenosis or insufficiency). The statistical analysis of the results was performed by chi-square test, Fishers exact test, and Mann-Whitney test. Among the 117 pregnancies (and neonates), there were 71 cases of predominant mitral regurgitation (MR group) and 46 with predominant mitral stenosis. The MS group presented more severe heart failure symptoms (functional class III and IV) during pregnancy, received more cardiovascular drugs and needed more hospital admissions due to cardiac reasons . Concerning perinatal events, MS presented higher rates of cesarean sections, smaller birthweight and higher incidence of SGA (small for gestational age, babies. Nevertheless, the predominant valvar lesion was not significantly related to other clinical co-morbidities, obstetrical or perinatal complications. Mitral valve disease in pregnancy is related to clinical and perinatal events, especially in patients with predominant mitral stenosis

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50

Santana, Nádia Barboza. "Perfil de saúde de gestantes brasileiras: uma análise do Vigitel, 2009-2013." Universidade Federal de Juiz de Fora (UFJF), 2016. https://repositorio.ufjf.br/jspui/handle/ufjf/5473.

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CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
A gravidez constitui-se como um processo natural da mulher. Nesse período é possível o aperfeiçoamento no manejo dessas mulheres no pré-natal, no sentido de que a gestante adquira hábitos de vida mais saudáveis, que irão evitar doenças e complicações indesejáveis. O objetivo deste estudo foi identificar e avaliar o perfil de saúde das gestantes brasileiras com enfoque nas DCNT e nos comportamentos em saúde, segundo características sociodemográficas. Avaliou-se 1.855 gestantes que responderam ao Inquérito Telefônico de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas no período 2009-2013. Analisou-se o perfil sóciodemográfico das gestantes, bem como a prevalência dos comportamentos e doenças crônicas não transmissíveis: tabagismo, consumo de álcool, consumo regular de frutas e hortaliças, consumo de refrigerantes, consumo de leite, consumo de carne com gordura aparente, atividade física, hipertensão e diabetes. Avaliou-se, também, a autoclassificação do estado de saúde e o rastreamento de câncer cérvico-uterino. As análises dos dados foram realizadas por meio do programa estatístico Statistical Software for Professional (Stata), versão 14.0 e os comandos do módulo Survey, levando em consideração os pesos e, por conseguinte, a representatividade da amostra. Para analisar as diferenças das prevalências segundo idade, escolaridade e região, foram estimadas as razões de prevalências ajustadas e os seus respectivos IC95% por meio de modelo de Regressão de Poisson com variância robusta justificando uso pela sua utilização em eventos mais frequentes. A maior proporção de gestantes tinha entre 26 e 34 anos de idade (48,0%), eram brancas (39,2%), tinham companheiro (61,2%), trabalhavam (60,7%) e possuíam de 9 a 11 anos de escolaridade (50,4%). A prevalência de gestantes foi maior nas regiões Sudeste (41,7%) e Nordeste (26,6%). As prevalências de consumo de álcool (13,5%, < 4 doses nos últimos 30 dias) e tabagismo (6,1%) foram baixas, mas não ideais. Por outro lado, detectou-se alta prevalência do consumo inadequado de frutas e hortaliças (62,9%) e de inatividade física (87,2%). O consumo excessivo de refrigerantes (5 ou mais dias/semana), bem como o consumo de carne com gordura aparente, foi observado em cerca de 30% das gestantes. Aproximadamente 96% delas apresentaram pelo menos um comportamento negativo. Os resultados encontrados apontam uma má qualidade da alimentação e sedentarismo das gestantes, em sua maioria, ressaltando a importância de estratégias e intervenções no âmbito de saúde pública para a melhoria da alimentação, comportamentos mais saudáveis e prevenção de doenças crônicas não transmissíveis nesse grupo populacional, o que poderia beneficiar desfechos positivos na saúde materna e fetal, propiciar qualidade de vida para o binômio e, consequentemente, reduzir a morbimortalidade materna e perinatal.
Pregnancy is constituted as a natural process of women. During this period the improvement is possible in the management of these women in prenatal care, in the sense that pregnant women get healthier lifestyle that will prevent disease and unwanted complications. The aim of this study was to identify and assess the health profile of Brazilian women with a focus on NCDs and health behaviors, according to sociodemographic characteristics. We evaluated 1,855 pregnant women who responded to the survey Risk Factors Surveillance and Protection for Chronic Diseases Telephone Survey in 2009-2013. Analyzed the sociodemographic profile of pregnant women, and the prevalence of behaviors and chronic diseases: tobacco use, alcohol consumption, regular consumption of fruits and vegetables, consumption of soft drinks, milk consumption, consumption of meat with visible fat, activity physical, hypertension and diabetes. It evaluated also the self-classification of health status and tracking of cervical cancer. Data analyzes were performed using the statistical program Statistical Software for Professional (Stata) version 14.0 and Survey module commands, taking into account the weight and therefore the representativeness of the sample. To analyze the differences in prevalence by age, education and region, the adjusted prevalence ratios and their respective 95% CI were estimated using Poisson regression model with robust variance justifying use by its use in more frequent events. The highest proportion of pregnant women were between 26 and 34 years of age (48.0%) were white (39.2%) had a partner (61.2%), working (60.7%) and had from 9 to 11 years of education (50.4%). The prevalence of pregnant women was higher in the Southeast (41.7%) and Northeast (26.6%). The prevalence of alcohol consumption (13.5% <4 doses in the last 30 days) and tobacco (6.1%) were low, but not ideal. On the other hand, found a high prevalence of inadequate intake of fruits and vegetables (62.9%) and physical inactivity (87.2%). Excessive consumption of soft drinks (5 or more days / week) as well as the consumption of meat with visible fat, was observed in about 30% of pregnant women. Approximately 96% of them had at least one negative behavior. The results show a poor quality of food and sedentary lifestyle of pregnant women, mostly emphasizing the importance of strategies and interventions in the public health system to better nutrition, healthier behavior and prevention of chronic diseases in this population, which could benefit from positive outcomes in maternal and fetal health, provide quality of life for the binomial and thus reduce maternal and perinatal morbidity and mortality.

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