Experiência da gravidez após os 35 anos de mulheres com baixa renda

Objetivou-se apreender as representações sociais sobre gravidez após os 35 anos a partir de mulheres com baixa renda que vivenciaram essa experiência. A abordagem qualitativa foi empregada com base na Teoria das Representações Sociais. Foram realizadas entrevistas semiestruturadas com 25 gestantes usuárias de um serviço público de referência do interior paulista. Os dados foram sistematizados pela técnica do Discurso do Sujeito Coletivo. Verificou-se que a opção pela gravidez tardia se atrela ao desejo da mulher de consolidar suas relações em novas uniões conjugais, à estabilidade financeira e à maturidade do casal. As mulheres representam esta experiência como positiva, se houver planejamento prévio, envolvimento do companheiro e se for bem aceita pela família, após sua constatação. Sem a satisfação destas condições, as representações revestem-se de sentimentos negativos ligados a dor, sofrimento e morte. As conclusões deste estudo enfatizam a importância de os serviços públicos de saúde considerarem estes aspectos.

Utilização das recomendações de nutrientes para estimar prevalência de consumo insuficiente das vitaminas C e E em gestantes

Na gestação ocorrem adaptações que conduzem a um aumento da taxa metabólica basal, caracterizando um estado de alto nível de estresse oxidativo, tornando relevante a avaliação do consumo de nutrientes antioxidantes por mulheres grávidas. Este estudo teve como objetivo estimar a prevalência de consumo insuficiente das vitaminas C e E em gestantes assistidas em serviços públicos de saúde. Estudou-se amostra (n=107) representativa das mulheres no segundo trimestre gestacional atendidas durante o pré-natal nas unidades de atenção básica do município de Botucatu/SP. O consumo foi investigado mediante dois inquéritos recordatórios de 24 horas. Para estimar a prevalência de inadequação de consumo na população, foi utilizado o método EAR como ponto de corte. Diferenças de consumo (em tercis) em relação a fatores socioeconômicos, obstétricos e hábitos de vida foram pesquisadas mediante análise estratificada, adotando-se p<0.05 como nível de significância. As prevalências estimadas de consumo insuficiente das vitaminas C e E foram 60% e 91,5%, respectivamente. Houve associação inversa entre o consumo de vitamina E com paridade e o consumo de vitamina C foi menor nas adolescentes em relação às adultas. Estes resultados indicam a necessidade de intervenções individuais e coletivas de promoção e apoio ao consumo de alimentação saudável por mulheres em idade fértil. Conclui-se que a prevalência de inadequação do consumo das vitaminas C e E é elevada e sem contrastes socioeconômicos.

Studies of natural-killer-cells in pregnancy-induced hypertension

The number and activity of natural killer (NK) cells were studied in 20 patients with pregnancy-induced hypertension (PIH), 15 uncomplicated pregnant women and 16 healthy non-pregnant women, All the pregnant women were primigravidae and were evaluated during the third trimester of gestation. Peripheral blood NK cells were detected with monoclonal antibodies by indirect immunofluorescence and cytotoxic activity was measured using a single-cell assay against K562 target cells. Hypertensive pregnant women had an increased number of circulating NK cells associated with a significant decrease of NK activity, the cytotoxic activity was significantly lower in normal pregnant and PIH women when compared with non-pregnant controls. The onset of immature NK cells in peripheral blood and the impairment of their cytotoxic activity in PIH patients may be associated with hormones and immunosuppressive substances produced by tissues occurring at the maternal-fetal interface.

Effectiveness and safety of a new vaginal misoprostol product specifically labeled for cervical ripening and labor induction

Objective. The purpose of this study was to evaluate the effectiveness and safety of misoprostol in two different formulations: vaginal tablets of 25 mu g and one-eighth of a 200-mu g oral tablet, also administered intravaginally, for cervical ripening and labor induction of term pregnancies with an indication for that. Methods. A single-blind, randomized, controlled clinical trial was carried out in 120 pregnant women who randomly received one of the two formulations. The main dependent variables were mode of delivery, need for additional oxytocin, time between beginning of induction and delivery, perinatal results, complications, and maternal side effects. Student's t, Mann-Whitney, chi(2), Fisher's Exact, Wilcoxon and Kolmogorov-Smirnoff tests, as well as survival analysis, were used in the data analysis. Results. There were no significant differences between the groups in terms of general characteristics, uterine contractility, and fetal well-being during labor, cesarean section rates, perinatal outcomes, or maternal adverse events. The mean time between the beginning of cervical ripening and delivery was 31.3 h in the vaginal tablet group and 30.1 h in the oral tablet group, a difference that was not statistically significant. Conclusion. The results showed that the 25-mu g vaginal tablets of misoprostol were as effective and safe for cervical ripening and labor induction as the dose-equivalent fraction of 200-mu g oral tablets.

Prenatal testosterone supplementation alters puberty onset, aggressive behavior, and partner preference in adult male rats

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Bupivacaína, Ropivacaína e Levobupivacaína em Analgesia e Anestesia de Parto. Repercussões Materno-Fetais

Background and Objectives - Bupivacaine has been a very useful local anesthetic in Obstetrics in spite of its potential cardiotoxicity. In obstetric analgesia, ropivacaine is preferred to bupivacaine, and levobupivacaine is less cardiotoxic than the racemic mixture. The aim of this study was to compare the maternal-fetal effects of bupivacaine, ropivacaine and levobupivacaine in obstetric analgesia and anesthesia. Methods - Participated in this study 33 term pregnant women, physical status ASA I and II submitted to epidural anesthesia who received 18.75 mg (in 15 ml completed with 9% saline) of: GI - bupivacaine, GII - ropivacaine, and GIII - levobupivacaine. Pain intensity, sensory block level, onset time, quality of analgesia, motor block intensity, analgesia duration and time for labor resolution were evaluated. For vaginal delivery, 40 mg (in 8 ml of saline) of the same local anesthetic were used; for cesarean delivery, the dose has been mg in 20 ml solution. Newborns of these mothers were evaluated through the Apgar score in minutes 1, 5 and 10, and through the Amiel-Tison method (neurologic and adaptative capacity score - NACS) at 30 min, 2 h, and 24 h. Results - There were no significant statistical differences among groups as to sensory block level, onset time, quality of analgesia, labor analgesia duration, time for labor resolution, and Apgar scores at minute 1. Ast to motor block, GIII > GII and GI was intermediary. In relation to pain intensity, there was a trend for GI > GIII. For Apgar scores in minute 5, GII > (GI = GIII), and in minute 10 (GI = GII) < GIII. NACS at 2 h showed, GII > GI > GIII, and at 24 h, GII > GIII > GI. Conclusions - Ropivacaine has relieved maternal pain with less motor block. Newborns of GII mothers (ropivacaine) showed the best Apgar and NACS scores.

Prevenção de hemoglobinopatias a partir do estudo em gestantes

The Brazilian population, presents genes for abnormal hemoglobins with variable frequencies, which are influenced by the founding racial groups. Thus, the detection of carriers of the genetic alterations is important for public health, since they represent sources of new beterozygotes and possible homozygotes. The control of the hemoglobin pathologies has been possible by means of genetic counseling and early diagnosis. The clinical follow-up of the homozygotes and the orientation of the beterozygotes and especially the couples at risk represent a more effective mode of acting to avoid the birth of children who are carriers of a genetic disease, that is frequently lethal. For these reasons this work had as its objectives: to evaluate the importance of testing in pregnant women for the detection of hemoglobin pathologies with the purpose of investigating the prevalence, attaining prevention, a familial study and awareness; for the positive cases such as couples at risk, orient as to appropriate medical attendance; and to evaluate the response to the program. Of the total of 696 pregnant women analysed, 10.7% revealed hemoglobin pathologies with the following rates: alpha Thalassemia 6.75%; Hb AS 2.01%; beta minor Thalassemia 1.29%; Hb AC 0.28%; Hb AJ 0.14%; Hb AS/Alpha Thalassemia 0.14% and P.H.H.F. 0.14%. The high rates of hemoglobin pathologies encountered in the population of pregnant women studied shows the necessity of the implantation of tests for these abnormalities in the pre-natal routine, since in this period the mothers are more apt to be preoccupied with their own health and that of their babies and, however earlier diagnosed the alterations in the hemoglobins, better and more adequate will be the orientations given the couple.

Estudo do extrato de Ginkgo biloba na prevenção de malformações em recémnascidos de ratas diabéticas

The pregnant women presenting Diabetes mellitus develop metabolic alterations, that may cause damage to the fetal well-being and provoke anomalies and/or malformations. The antioxidant treatment has improved the embryonic development from streptozotocin diabetic rats. Several studies have shown that a Gingko biloba extract presents antioxidant effects and, in the present study, one of the G. biloba extract formulations was used (EGb761) - Tebonin (200 mg/Kg/day), given to the diabetic pregnant female rats. The aim was to evaluate the effect of the EGb761 treatment on the of anomalies and/ or malformations incidence of the offspring. Diabetes was induced in female rats using streptozotocin in a dose of 40 mg/kg. The rats were mated, and the pregnant animals were divided in two groups: Control (water) and experimental (G. biloba). At day 21 of pregnancy, the rats were killed, and their fetuses were analyzed and processed for anomalies and/or malformations incidence. The results demonstrated that control and experimental groups presented no external anomalies and malformations; increased incidence of skeletal anomalies and of visceral malformations, and lower rate of visceral anomalies and skeletal malformations. These data confirm no statistical difference and, therefore, EGb761 treatment did not cause changes. Thus, a dose of 200 mg/Kg/day of a Gingko biloba extract given during the pregnancy rat was ineffective in the prevention of the anomalies and/or malformations related to the diabetes.

Compreendendo o significado da gestação para grávidas diabéticas.

This qualitative study intends to understand the meaning of pregnancy for diabetic women. Semi-structured interviews were carried out and data were analyzed by means of the Collective Subject Discourse, identifying the following central ideas: happiness about a desired pregnancy, preoccupation with pregnancy and renouncement, my pregnancy was planned, I had other plans, I feel what pregnant women feel, I had many problems during pregnancy, a child was everything that he wanted, he didn't feel the same emotions as a woman, I am controlling, doing everything the doctor says, I am trying to follow a diet, but it is hard. These central ideas demonstrate that, among the diabetic pregnant women, planning and wanting the pregnancy and counting on the support of the family and/or companion were also essential for the treatment to be faced naturally and for the pregnancy to be experienced in a pleasant way.

Intervenções benéficas no pré-natal para prevenção da mortalidade materna

Maternal mortality rate (MM) is a health quality indicator that is directly influenced by the economic, cultural and technological level of a country. Official data of MM in Brazil, although underestimated, point to the lack of quality in pregnancy, childbirth and puerperium care services. This characteristic is common in developing countries, where poorer pregnant women as well as those facing greater difficulty to quality care access are found. Prenatal care cannot prevent major childbirth complications, which are important causes of MM; however, some interventions during the prenatal period can favor maternal prognosis and prevent MM. In this setting, this study brings a scientifically based update concerning effective interventions for maternal mortality prevention during the prenatal period. The most important strategies consist of a tripod with specific interventions related to maternal health promotion, risk prevention and assurance of nutritional support during gestation, in addition to criteria to investigate gestational risk and inclusion of the pregnant woman in the basic component of the prenatal care model. It ends with the definition of priorities in the prevention of MM related to eclampsia/preeclampsia and reinforces the importance of normalization of reference systems for obstetric emergency cases.

Determinação precoce do sexo fetal pela análise do DNA no plasma materno

Purpose: to verify the viability of early diagnosis of fetal gender in maternal plasma by the real-time polymerase chain reaction (real-time PCR) starting at the 5th week of pregnancy. Methods: peripheral blood was collected from pregnant women with single fetus starting at the 5th week of gestation. After centrifugation, 0.4 mL plasma was separated for fetal DNA extraction. The DNA was analyzed in duplicate by real-time PCR for two genomic regions, one of the Y chromosome and the other common to both sexes, through the TaqMan® method, which uses a pair of primers and a fluorescent probe. Patients who aborted were excluded. Results: a total of 79 determinations of fetal DNA in maternal plasma were performed in 52 pregnant women. The results of the determinations were compared to fetal gender after delivery. Accuracy according to gestational age was 92.6% (25 of 27 cases) at 5 weeks with 87% sensitivity, and 95.6% (22 of 23 cases) at 6 weeks with 92% sensitivity. Starting at the 7th week of pregnancy, accuracy was 100% (29 of 29 cases). Specificity was 100% regardless of gestational age. Conclusion: real-time PCR for the detection of fetal gender in maternal plasma starting at the 5th week of gestation has good sensitivity and excellent specificity. There was agreement of the results in 100% of the cases in which male gender was diagnosed, regardless of gestational age, and from the 7th week of gestation for female gender diagnosis.

Deficiência de ferro: Conseqüências biológicas e propostas de prevenção

Iron deficiency is the commonest nutritional deficiency in the world. Although it affects adults, particularly women of reproductive age and during gestation, the most vulnerable group is children under two years of age. It affects mainly people living in developing countries, who have less access to balanced diets and health services and are exposed to precarious sanitary conditions. Iron deficiency has an impact on the immunity, adult work capacity and the cognitive development of children. Combating and preventing iron deficiency is one of the priorities in promoting public health. The strategies to achieve this end include the evaluation and correction of iron deficiency in pregnant women, the encouragement of breast feeding, oral iron supplementation in premature and newborn babies of low birth-weight, food enrichment and mobilization of the community.

Significado da presença de esquizócitos no sangue periférico de gestantes com pré-eclâmpsia

PURPOSE: to evaluate the significance of schizocytes presence in peripheral blood smear of pregnant women with pre-eclampsia, identifying and correlating them with other markers of hemolysis and of the disease severity. METHODS: Seventh six glass slides of peripheral blood smear of pregnant women with pre-eclampsia have been evaluated. After the smear, the slides have been stained with Leishman's dye and stored till they were examined with a Leica, model DLMB microscope, provided with the Qwin Lite 2.5 software that made it possible to record the images of selected fields in CD-ROM. Ten fields with approximately 100 erythrocytes were counted in each glass slide. Schizocytes (irregular fragment or helmet-shaped, bite-shaped or triangular) were considered as present, when their percentage was equal or higher than 0.2%, their presence being correlated with other hemolysis markers (hemoglobin, total bilirubin, lactic desidrogenasis and reticulocytes), pre-eclampsia markers (proteinuria and platelet number). The Statistical Package in Social Science for Windows (SPSS), 10.0 version has been used for statistical analysis, at p<0.05. RESULTS: schizocytes have been present in 31.6% of the pregnant women with pre-eclampsia. In most (75%) of the blood smears there have been three or four schizocytes. There has been no correlation between schizocyte presence and any other hemolysis marker, any pre-eclampsia marker or disease severity. CONCLUSIONS: schizocytes have been identified in a small number and in less than a third of the pregnant women with pre-eclampsia. There has been no correlation with other hemolysis marker parameters or with the disease severity. This way, the presence of schizocytes is not a marker of the clinical evolution of pre-eclampsia.

A ótica do usuário na avaliação da qualidade do programa de atenção odontológica à gestante

Objective: To evaluate the pregnant women's perception of the FOA-UNESP's Pregnant Women Dental Care Program (Araraquara, SP, Brazil). Method: The sample included 75 pregnant women and used a questionnaire with 16 closed questions, containing variables grouped in the following categories: the didactic-psychological meetings, clinical treatment, professional's profile, clinical facility, fear/confidence in the treatment, and learning. Except for the variables fear/confidence in the treatment and learning, to which 'yes' or 'no' answers were attributed, the remaining variables were attributed answers varying from weak to excellent. The questionnaire pretested in a pilot-study and applied after informed consent was obtained from all pregnant women treated between 2005 and 2006. Results: Most women rated as excellent the information addressed during the didactic-psychological meetings (81.1%), the clinical treatment (90.6%), the professional as to personal appearance, kindness and attention (88.7%, 96.2% and 90.6%, respectively), and the clinical facility as to cleanness, ventilation and comfort (92.5%, 86.8% and 90.6%, respectively). Most of them stated to feel confident (96.2%) and have no fear (86.8%) during the treatment and also affirmed having learned new information in the didactic-psychological meetings of the program (92.5%). Conclusion: The services and actions developed in the program have reached successful outcomes, providing health to the pregnant women and their forthcoming babies.

Sistema de Informação Pré-Natal: análise crítica de registros em um município paulista.

The prenatal assistance is one of the health care pillars. This study aimed to conduct a critical evaluation of the SIS Prenatal in a city of São Paulo State, to compare its data with the local assistance and to verify the registry of pregnant women attended at Health Care Centers. It was analyzed the pregnant women records through consultation at Health Regional Unit and municipal health service. There were inconsistencies between the system and local registry. The failures were related to the inadequate filling of attendance files, besides scarce control of pregnant women files and scheduling on health centers. The results suggest the need for better planning of actions for the improvement of prenatal service quality.