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1.
J Cell Sci ; 135(5)2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33414166

RESUMO

Ferroptosis is a regulated, non-apoptotic form of cell death, characterized by hydroxy-peroxidation of discrete phospholipid hydroperoxides, particularly hydroperoxyl (Hp) forms of arachidonoyl- and adrenoyl-phosphatidylethanolamine, with a downstream cascade of oxidative damage to membrane lipids, proteins and DNA, culminating in cell death. We recently showed that human trophoblasts are particularly sensitive to ferroptosis caused by depletion or inhibition of glutathione peroxidase 4 (GPX4) or the lipase PLA2G6. Here, we show that trophoblastic ferroptosis is accompanied by a dramatic change in the trophoblast plasma membrane, with macro-blebbing and vesiculation. Immunofluorescence revealed that ferroptotic cell-derived blebs stained positive for F-actin, but negative for cytoplasmic organelle markers. Transfer of conditioned medium that contained detached macrovesicles or co-culture of wild-type target cells with blebbing cells did not stimulate ferroptosis in target cells. Molecular modeling showed that the presence of Hp-phosphatidylethanolamine in the cell membrane promoted its cell ability to be stretched. Together, our data establish that membrane macro-blebbing is characteristic of trophoblast ferroptosis and can serve as a useful marker of this process. Whether or not these blebs are physiologically functional remains to be established.


Assuntos
Ferroptose , Feminino , Humanos , Peroxidação de Lipídeos , Fosfolipídeo Hidroperóxido Glutationa Peroxidase , Placenta , Gravidez , Trofoblastos
2.
Rev. enferm. UERJ ; 29: e56037, jan.-dez. 2021.
Artigo em Inglês, Português | LILACS | ID: biblio-1151921

RESUMO

Objetivo: mapear as evidências disponíveis na literatura acerca dos manejos e desfechos da infecção pelo novo coronavírus no puerpério. Método: revisão de escopo conforme o Institute Joanna Briggs, desenvolvida em quatro fontes de dados eletrônicas. A extração, análise e síntese dos dados foi realizada por quatro pesquisadores independentes. Resultados: Nove publicações foram revisadas de 188 localizadas. Seis foram os países produtores das evidências, todas obtidas e publicadas em 2020. Vinte e um casos de COVID-19 no puerpério estiveram tratados nestas publicações, sendo 15 (71,4%) relativos a evoluções graves/exacerbação da doença e seis (28,6%) diagnosticados após a alta hospitalar. Conclusão: O mapeamento aponta para a ocorrência da infecção ou seu agravamento no período pós-parto, com indicativas ao monitoramento de sinais e sintomas, exploração diagnóstica e tratamento acurado e necessidade de acompanhamento próximo das mulheres diagnosticadas com COVID-19, sintomáticas ou não, no período pós-parto.


Objective: to map the evidence available in the literature about management and outcomes of postpartum infection by the new coronavirus. Method: scoping review conducted in four electronic sources, following Joanna Briggs Institute guidelines. Data were extracted, analyzed and summarized by four researchers independently. Results: nine of the 188 publications located were reviewed. The evidence, all obtained and published in 2020, was produced in six countries. These publications considered 21 cases of postpartum COVID-19, 15 (71.4%) of which related to severe developments / exacerbation of the disease and six (28.6%) diagnosed after hospital discharge. Conclusion: the mapping points to the occurrence of infection or worsening of the disease in the postpartum period, indicating the need for monitoring of signs and symptoms, diagnostic exploration and accurate treatment and the need for close monitoring of postpartum women diagnosed with COVID-19, whether symptomatic or not.


Objetivo: mapear las evidencias disponibles en la literatura sobre el manejo y los resultados de la infección por el nuevo coronavirus en el período posparto. Método: revisión del alcance según el Instituto Joanna Briggs, desarrollada en cuatro fuentes de datos electrónicas. La extracción, el análisis y la síntesis de los datos fueron realizados por cuatro investigadores independientes. Resultados: se revisaron nueve publicaciones de 188 encontradas. Fueron seis los países que produjeron las evidencias, obtenidas y publicadas en 2020. En estas publicaciones se trataron 21 casos de COVID-19 en el período posparto, 15 (71,4%) de los cuales estaban relacionados con evoluciones graves/exacerbación de la enfermedad y seis (28,6%) diagnosticados tras el alta hospitalaria. Conclusión: el mapeo apunta hacia la ocurrencia de la infección o su agravamiento en el posparto, con indicaciones de seguimiento de indicios y síntomas, exploración diagnóstica, tratamiento preciso y la necesidad de un seguimiento cercano a las mujeres diagnosticadas con COVID-19, sintomáticas o no, en el período posparto.


Assuntos
Humanos , Feminino , Gravidez , Saúde da Mulher , Período Pós-Parto , COVID-19 , COVID-19/terapia , COVID-19/epidemiologia , Revisão , Infecções por Coronavirus , Período Pós-Parto/sangue , COVID-19/diagnóstico
3.
Rev. enferm. UERJ ; 29: e56113, jan.-dez. 2021.
Artigo em Inglês, Português | LILACS | ID: biblio-1224567

RESUMO

Objetivo: descrever a escolha do parto domiciliar planejado acompanhado por enfermeira obstétrica em um centro urbano de grande porte, na perspectiva de mulheres brasileiras. Métodos: estudo qualitativo guiado pela Grounded Theory. Foram entrevistadas dez mulheres com idade entre 20 e 41 anos que tiveram parto domiciliar planejado acompanhadas por enfermeiras obstétricas. As participantes foram recrutadas por meio de rede social, acessando um grupo de mulheres que escreveram sobre seu parto domiciliar. Resultados: Emergiram duas categorias: Não vendo possibilidade de parir naturalmente no ambiente hospitalar e Pensando na segurança do parto domiciliar planejado. O hospital representou vários aspectos desfavoráveis como intervenções desnecessárias e solidão. As mulheres consideravam o lar um lugar seguro para parir, conectado aos cuidados de enfermeiras obstétricas. Conclusão: há mulheres que não desejam parir no hospital, preferindo parir em casa e do ponto de vista dos direitos humanos e dos cuidados desmedicalizados, as enfermeiras obstétricas devem apoiar as mulheres nessa sua decisão.


Objective: to describe the choice of planned homebirth attended by a nurse midwife in a large urban centre, from the perspective of Brazilian women. Methods: in this Grounded Theory study, ten women aged 20 to 41 years, who had a planned homebirth accompanied by a nurse midwife, were interviewed. Participants were recruited through a social network by accessing a group of women who wrote about their homebirth. Results: two categories emerged: seeing no possibility of giving birth naturally in the hospital environment; and thinking about the safety of a planned homebirth. Hospital represented several unfavourable aspects, such as unnecessary interventions and loneliness. Women thought of home as a safe place to give birth, connected with nurse midwife care. Conclusion: there are women who do not wish to give birth in hospital, but prefer to give birth at home and, from the point of view of human rights and de-medicalized care, nurse midwives should support women in their decision.


Objetivo: describir la elección del parto domiciliario planificado con enfermera obstétrica en un gran centro urbano, desde la perspectiva de mujeres brasileñas. Métodos: estudio cualitativo guiado por la Grounded Theory. Se entrevistó a diez mujeres entre 20 y 41 años que tuvieron parto domiciliario planificado, siendo acompañadas de enfermeras obstétricas. Las participantes fueron reclutadas a través de red social, accediendo a un grupo de mujeres que escribieron sobre su parto en domicilio. Resultados: surgieron dos categorías: las que no veían posibilidad de dar a luz naturalmente en el hospital y las que pensaron en la seguridad del parto domiciliario planificado. El hospital representó varios aspectos desfavorables como intervenciones innecesarias y soledad. Las mujeres consideraban que el hogar era un ambiente seguro para dar a luz, vinculado al cuidado de enfermeras obstétricas. Conclusión: hay mujeres que no desean dar a luz en el hospital, prefieren hacerlo en casa y, desde el punto de vista de los derechos humanos y de los cuidados sin la intervención de un médico, las enfermeras obstétricas deben apoyarlas en esa decisión.


Assuntos
Humanos , Feminino , Gravidez , Adulto , Parto Domiciliar/enfermagem , Parto Normal/enfermagem , Enfermeiras Obstétricas , Gestantes/psicologia , Segurança do Paciente , Parto Domiciliar/psicologia , Parto Normal/psicologia
4.
Porto Alegre; CEVS/RS; out. 2021. 1-15 p. ilus., graf., tab., mapas.
Não convencional em Português | Coleciona SUS (Brasil), CONASS, SES-RS | ID: biblio-1292931

RESUMO

Neste boletim são apresentados: situação mundial, ocorrência de hospitalizações confirmadas para sars-cov-2, perfil das pessoas, distribuição espacial, Síndrome Inflamatória Multissistêmica Pediátrica (SIM-P), povos indígenas, descrição de surtos, trabalhadores da saúde, Vigilância sentinela de síndrome gripal e tabelas de descrição do surto. (AU)


Assuntos
Humanos , Masculino , Feminino , Gravidez , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Perfil de Saúde , Mortalidade Hospitalar/etnologia , Grupos Populacionais/estatística & dados numéricos , COVID-19/epidemiologia , Surtos de Doenças/estatística & dados numéricos , COVID-19/complicações , COVID-19/mortalidade
5.
J Med Case Rep ; 15(1): 492, 2021 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-34615533

RESUMO

BACKGROUND: Subdural hematoma is a rare, potentially devastating, yet curable complication of spinal anesthesia. Differentiation between post-dural puncture headache and subdural hematoma can be difficult, resulting in a delay in diagnosis. CASE PRESENTATION: We present a 28-year-old Ethiopian female patient who underwent elective cesarean section under spinal anesthesia and returned to the emergency department after 1 month with a worsening headache. Brain computed tomography revealed a chronic subdural hematoma with a significant midline shift. The patient recovered completely after surgical evacuation. CONCLUSIONS: A high index of suspicion and close attention to the pattern and characteristics of the headache, coupled with a meticulous neurologic examination and neuroimaging, can help to achieve timely diagnosis of this serious entity. Investigation with head computed tomography or magnetic resonance imaging is vital.


Assuntos
Raquianestesia , Hematoma Subdural Crônico , Hematoma Subdural Intracraniano , Adulto , Raquianestesia/efeitos adversos , Cesárea/efeitos adversos , Feminino , Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/etiologia , Hematoma Subdural Crônico/cirurgia , Hematoma Subdural Intracraniano/diagnóstico por imagem , Hematoma Subdural Intracraniano/etiologia , Hematoma Subdural Intracraniano/cirurgia , Humanos , Gravidez
6.
BMC Pregnancy Childbirth ; 21(1): 667, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34598709

RESUMO

BACKGROUND: Women across the world value choice and control throughout their maternity care experiences. In response to this health policy and frameworks are adapting and developing. The concepts of choice and control are extrinsically complex and open to interpretation by healthcare professionals and service users, with the two not necessarily aligning. Depending on a number of factors, women's experiences of choice and control within the same maternity care system may be very different. This study aimed to investigate the factors influencing women's perceptions of choice and control during pregnancy and birth in Ireland. METHODS: We conducted a cross-sectional study using an adapted version of the UK national maternity experience survey (National Perinatal Epidemiology Unit). During March - July 2017, a sample of 1277 women were recruited from the postnatal wards of three maternity units and a tertiary maternity hospital. Poisson regression was used to assess the association between twelve factors and a series of measures of the women's perception of choice and control. RESULTS: Most women reported not having choice in the model or location of their maternity care but most reported being involved enough in decision-making, especially during birth. Women who availed of private maternity care reported higher levels of choice and control than those who availed of public maternity care. This factor was the most influential factor on almost all choice and control measures. CONCLUSION: Most women experiencing maternity care in Ireland report not having choice in the model and location of care. These are core elements of the Irish maternity strategy and significant investment will be required if improved choice is to be provided. Availing of private maternity care has the strongest influence on a woman's perceived choice and control but many women cannot afford this type of care, nor may they want this model of care.


Assuntos
Tomada de Decisões , Maternidades , Serviços de Saúde Materna , Cuidado Pós-Natal/psicologia , Gestantes/psicologia , Cuidado Pré-Natal/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Irlanda , Gravidez
7.
BMC Genomics ; 22(1): 713, 2021 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-34600470

RESUMO

BACKGROUND: Abortion in horses leads to economic and welfare losses to the equine industry. Most cases of equine abortions are sporadic, and the cause is often unknown. This study aimed to detect potential abortigenic pathogens in equine abortion cases in Australia using metagenomic deep sequencing methods. RESULTS: After sequencing and analysis, a total of 68 and 86 phyla were detected in the material originating from 49 equine abortion samples and 8 samples from normal deliveries, respectively. Most phyla were present in both groups, with the exception of Chlamydiae that were only present in abortion samples. Around 2886 genera were present in the abortion samples and samples from normal deliveries at a cut off value of 0.001% of relative abundance. Significant differences in species diversity between aborted and normal tissues was observed. Several potential abortigenic pathogens were identified at a high level of relative abundance in a number of the abortion cases, including Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, Streptococcus equi subspecies zooepidemicus, Pantoea agglomerans, Acinetobacter lwoffii, Acinetobacter calcoaceticus and Chlamydia psittaci. CONCLUSIONS: This work revealed the presence of several potentially abortigenic pathogens in aborted specimens. No novel potential abortigenic agents were detected. The ability to screen samples for multiple pathogens that may not have been specifically targeted broadens the frontiers of diagnostic potential. The future use of metagenomic approaches for diagnostic purposes is likely to be facilitated by further improvements in deep sequencing technologies.


Assuntos
Doenças dos Cavalos , Metagenômica , Acinetobacter , Animais , Austrália , Feminino , Feto , Cavalos , Metagenoma , Gravidez
8.
BMC Pregnancy Childbirth ; 21(1): 668, 2021 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-34600512

RESUMO

BACKGROUND: Triage, identifying patients with critical and time-sensitive disorders, is an integrated process in general emergency medicine. Obstetric triage is more specialised, requiring assessment of both woman, fetus and labour status. Failure to identify severely ill obstetric patients has repeatedly led to maternal morbidity and mortality. Reliable triage systems, adapted to obstetric patients as well as local conditions, are thus essential. The study aims to assess the interrater reliability (IRR) of the Gothenburg Obstetric Triage System (GOTS). METHODS: Midwives (n = 6) and registered nurses with no experience in managing obstetric patients (n = 7), assessed 30 paper cases based on actual real-life cases, using the GOTS. Furthermore, a reference group consisting of two midwives and two obstetricians, with extensive experience in obstetric care, determined the correct triage level in order to enable analysis of over- and undertriage. IRR was assessed, both with percentage of absolute agreement and with intra-class correlation coefficients (ICC) with 95% confidence intervals (CI). RESULTS: A total of 388 assessments were performed, comprising all five levels of acuity in the GOTS. Absolute agreement was found in 69.6% of the assessments. The overall IRR was good, with a Kappa value of 0.78 (0.69-0.87, 95% CI) for final triage level. Comparison with reference group assessments established that over- and undertriage had occurred in 9% and 21% of the cases, respectively. The main reasons for undertriage were "not acknowledging abnormal vital sign parameters" and "limitations in study design". CONCLUSION: The GOTS is a reliable tool for triaging obstetric patients. It enables a standardized triage process unrelated to the assessors' level of experience in assessing and managing obstetric patients and is applicable for triaging obstetric patients presenting for emergency care at obstetric or emergency units.


Assuntos
Serviços Médicos de Emergência , Trabalho de Parto , Triagem/métodos , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Tocologia , Enfermeiras e Enfermeiros , Gravidez , Reprodutibilidade dos Testes , Projetos de Pesquisa , Suécia
9.
BMC Pregnancy Childbirth ; 21(1): 671, 2021 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-34602049

RESUMO

BACKGROUND: The aims of this study were to evaluate the time intervals of flow velocity waveforms (FVW) of ductus venosus (DV) and cardiac cycles, as well as the pulsatility index of DV-FVW (DV-PI), in correlation with umbilical artery (UA) pH at birth in fetal growth restriction (FGR) complicated with placental insufficiency. METHODS: Data were retrospectively retrieved from pregnancies complicated by FGR. FGR was defined as an estimated fetal weight below - 2.0 S.D. with an elevated UA-PI. Time interval assessments of DV-FVW were as follows: the duration of systolic wave was divided by the duration of diastolic wave and defined as DV-S/D. We also measured the following time intervals of ventricular inflow through tricuspid valve (TV) and mitral valve (MV): (iii), from the second peak of ventricular inflow caused by atrial contraction (A-wave) to the opening of atrio-ventricular valves and: (iv), from the opening of atrio-ventricular valves to the peak of A-wave. (iii)/(iv) was expressed as TV-S/D and MV-S/D, for TV and MV, respectively. The time interval data were transformed into z-scores. RESULTS: Thirty-one FGR fetuses were included in this study. Both DV-PI and DV-S/D showed significant correlation with UA-pH (r = - 0.677, p = < 0.001 and r = 0.489, p = 0.005 for DV-PI and z-score of DV-S/D, respectively) and more significances were observed in FGR ≤ 28 + 6 gestational weeks (r = - 0.819, p < 0.001 and r = 0.726, p = 0.005, for DV-PI and z-score of DV-S/D, respectively) than in FGR > 28 + 6 gestational weeks (r = - 0.634, p = 0.007 and r = 0.635, p = 0.020, for DV-PI and z-score of DV-S/D, respectively). On the other hand, TV-S/D and MV-S/D showed no significant correlation with UA-pH, although these z-scores indicated significant decreases compared with normal references. CONCLUSIONS: Time interval analysis of DV-FVW might be a valuable parameter, as well as DV-PI, for the antenatal prediction of fetal acidemia in the management of FGR fetuses.


Assuntos
Velocidade do Fluxo Sanguíneo , Retardo do Crescimento Fetal/fisiopatologia , Coração Fetal/diagnóstico por imagem , Insuficiência Placentária/fisiopatologia , Complicações na Gravidez/fisiopatologia , Artérias Umbilicais , Feminino , Idade Gestacional , Humanos , Concentração de Íons de Hidrogênio , Recém-Nascido , Japão/epidemiologia , Gravidez , Estudos Retrospectivos , Ultrassonografia Doppler
10.
BMC Pregnancy Childbirth ; 21(1): 672, 2021 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-34602052

RESUMO

BACKGROUND: Various manoeuvres such as McRoberts position, suprapubic pressure, rotational methods, posterior arm extraction and all-four position (HELPERR) have been proposed for relieving shoulder dystocia with variable success. Posterior axillary sling method using a rubber catheter was proposed in 2009 but has not been widely used. We modified this method using ribbon gauzes and a long right-angle forceps and report a successful case. CASE PRESENTATION: A 44 years old parity one Chinese woman with a history of a caesarean delivery and poorly controlled type 2 diabetes mellitus was admitted to the Accident and Emergency Department for advanced stage of labour at term. Upon arrival, intrauterine fetal demise was diagnosed with severe asynclitism causing obstruction at the perineum. Episiotomy resulted in birth of the fetal head. The fetal posterior right shoulder, however, remained very high up in the pelvis and HELPERR methods failed to extract the shoulders. We then tied two long ribbon gauzes together, and guided its knot to the anterior aspect of the posterior axilla. By using a long right-angle forceps (24 cm long) to grasp the knot on the posterior side of the axilla and pulling it through, a sling was formed. Traction was then applied through the sling to simultaneously pull and rotate the posterior shoulder. A stillbirth of 3488 g was finally extracted. CONCLUSIONS: We modified the sling method by using two ribbon gauzes, tied together and a right-angle forceps with several advantages. Compared to a rubber catheter, ribbon gauze with a knot can be easily held between the fingers for easy guidance past the fetal axilla. It is also thin, non-elastic and stiff enough to ensure a good grip for traction. The long and slim design of the right-angle forceps makes it easy to pass through a narrow space and reach the axilla high up in the pelvis. We emphasize simultaneous traction and rotation, so that the shoulders are delivered through the wider oblique pelvic outlet dimension.


Assuntos
Parto Obstétrico/métodos , Morte Fetal , Apresentação no Trabalho de Parto , Complicações do Trabalho de Parto , Distocia do Ombro , Adulto , Feminino , Hong Kong , Humanos , Gravidez
11.
BMC Pregnancy Childbirth ; 21(1): 669, 2021 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-34602066

RESUMO

BACKGROUND: The neuroimaging manifestations of eclampsia and preeclampsia often overlap, mainly presenting as posterior reversible encephalopathy syndrome (PRES). The purpose of this retrospective study was to compare the extent and nature of brain edema in eclampsia and preeclampsia patients with PRES based on MRI characteristics. METHODS: One hundred fifty women diagnosed with preeclampsia-eclampsia and undergoing cranial MRI were enrolled; 24 of these were diagnosed as having eclampsia. According to clinicoradiologic diagnosis of PRES, eligible patients were classified as having eclampsia with PRES (group E-PRES) and preeclampsia with PRES (group P-PRES). A scale on T2W FLAIR-SPIR images was established to evaluate the extent of brain edema, and the score of brain edema (SBE) of both groups was compared. In patients of the two groups who also underwent DWI sequence, the presence or absence of hyperintensity on DWI and hypointensity on ADC maps were determined to compare the nature of brain edema. Furthermore, clinical and biochemical data of the two groups were compared. RESULTS: The incidence of PRES in eclampsia patients was significantly higher than that in preeclampsia patients (87.50% vs. 46.03%, P<0.001). The SBE of all regions and typical regions in group E-PRES patients were significantly higher than those in group P-PRES patients (15.88±8.72 vs. 10.90±10.21, P=0.021; 8.52±3.87 vs. 5.01±4.19, P=0.002; respectively). The presence of hyperintensity on DWI was determined more frequently in group E-PRES patients than group P-PRES patients (71.43% vs. 32.00%, P=0.024). Age, systolic blood pressure, white blood cell count, neutrophil count and percentage of neutrophils were significantly different between the two groups (P<0.05). CONCLUSIONS: Certain MRI characteristics that reflect the extent and nature of brain edema were different between eclampsia and preeclampsia patients with PRES. Additional prospective studies are still required to explore whether these MRI characteristics of brain edema may further become a potential predictor for eclamptic seizures in preeclampsia patients with PRES.


Assuntos
Edema Encefálico/diagnóstico por imagem , Eclampsia/diagnóstico por imagem , Imageamento por Ressonância Magnética , Neuroimagem , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Pré-Eclâmpsia/diagnóstico por imagem , Complicações na Gravidez/diagnóstico por imagem , Adulto , Eclampsia/epidemiologia , Feminino , Humanos , Síndrome da Leucoencefalopatia Posterior/complicações , Síndrome da Leucoencefalopatia Posterior/epidemiologia , Pré-Eclâmpsia/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Estudos Retrospectivos
12.
Gen Physiol Biophys ; 40(5): 351-363, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34602449

RESUMO

Successful implantation requires endometrial receptivity. To investigate the mechanisms of miR-494-3p on endometrial receptivity, GnRHa's superovulation scheme was designed to reduce endometrial receptivity, and the pregnant mice were injected with miR-494-3p antagomir. The regulatory role of miR-494-3p was identified by RT-qPCR, uterine blastocyst count, scanning electron microscopy, hematoxylin-eosin (HE) staining, and Western blot. Results indicated that miR-494-3p antagomir increased uterine blastocysts numbers, promoted the pinocytosis expressions, and increased endometrial thickness. Besides, miR-494-3p antagomir significantly increased leukemia inhibitory factor (LIF), Ang-2 and VEGF protein expressions, and up-regulated p-AKT/AKT and p-mTOR/mTOR protein ratios in endometrium. Luciferase assay confirmed that LIF was a potential target of miR-494-3p. Subsequently, human endometrial epithelial cells (hEECs) were transfected with miR-494-3p inhibitor and PI3K inhibitor (LY294002). The role of miR-494-3p was identified by RT-qPCR, CCK-8 assay, transwell assay and flow cytometry. Results indicated that miR-494-3p inhibitor significantly increased proliferation and invasion, and significantly inhibited apoptosis in hEECs, while LY294002 reversed its biological function. Overall, these results suggested that miR-494-3p is the key regulator of endometrial receptivity in mice, regulating this complex process through the PI3K/AKT/mTOR pathway. Understanding the role of miR-494-3p in endometrial receptivity is of great significance for exploring new targets for the diagnosis and treatment of early pregnancy failure, and improving the success rates of artificial reproduction.


Assuntos
MicroRNAs/genética , Fosfatidilinositol 3-Quinases , Animais , Endométrio , Feminino , Camundongos , Gravidez , Proteínas Proto-Oncogênicas c-akt , Serina-Treonina Quinases TOR
13.
BMC Health Serv Res ; 21(1): 1029, 2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34592984

RESUMO

BACKGROUND: Family-centred maternity care models include the expectation that fathers prepare for and attend the birth. In Australia over 20% of the population is from a culturally and linguistically diverse background. Public policies espouse culturally competent healthcare. Little is known about the experiences of perinatal health care of men from culturally and linguistically diverse (CALD) communities living in high income countries. The aim was to understand the experiences, attitudes and beliefs about father's inclusion in perinatal healthcare, from the growing, and recently settled community of Ethiopian families living in Australia. METHODS: A qualitative study using semi-structured individual interviews with Ethiopian-Australian men and women who had experienced Australian maternity care and were sampled for diversity of time since migration, and parity. Interviews were in English, audio-recorded, transcribed and then analysed thematically. RESULTS: Participants were seven women and six men all born in Ethiopia, including two couples. Key themes included: the loss of extended family through migration, new roles for both parents and the need to establish 'family-like' relationships with friendship groups in Australia. There was a willingness to involve male partners in the Ethiopian community in Australia, although it was recognised as a cultural change. Experiences of male partner involvement were mixed among healthcare types, with men attending Maternal and Child Health (MCH) appointments less frequently than antenatal (ANC) appointments. CONCLUSIONS: Results suggests men may be missing out on the education provided during antenatal appointments and may benefit from an alternative. There were not universally high levels of cultural competency among healthcare professionals, with further training still required. Commitment to paid employment remains a barrier to men's involvement, suggesting that flexible working conditions and increased paternity leave would support their involvement. Alternatively services could utilise flexible delivery methods such as phone and zoom to include fathers.


Assuntos
Pai , Serviços de Saúde Materna , Austrália , Criança , Atenção à Saúde , Feminino , Humanos , Masculino , Gravidez , Cuidado Pré-Natal , Pesquisa Qualitativa
14.
BMJ Case Rep ; 14(9)2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34593553

RESUMO

A 40-year-old woman presents with recurrent secondary postpartum haemorrhage (PPH) following her third normal vaginal delivery. Histology from subsequent evacuation of the uterus confirmed that she had subinvolution of the placental implantation site. Hysterectomy is the most common method of managing this condition and recurrent PPH, most often due to significant vaginal bleeding. We present a case of subinvolution of the placental implantation site with recurrent PPH managed with medical treatment alone, to offer a fertility-sparing treatment option.


Assuntos
Hemorragia Pós-Parto , Adulto , Parto Obstétrico , Feminino , Humanos , Histerectomia , Placenta , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/cirurgia , Gravidez , Útero
15.
BMC Pregnancy Childbirth ; 21(1): 664, 2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34592953

RESUMO

BACKGROUND: The outbreak of the COVID-19 pandemic caused great uncertainty about causes, treatment and mortality of the new virus. Constant updates of recommendations and restrictions from national authorities may have caused great concern for pregnant women. Reports suggested an increased number of pregnant women choosing to give birth at home, some even unassisted ('freebirth') due to concerns of transmission in hospital or reduction in birthplace options. During April and May 2020, we aimed to investigate i) the level of concern about coronavirus transmission in Danish pregnant women, ii) the level of concern related to changes in maternity services due to the pandemic, and iii) implications for choice of place of birth. METHODS: We conducted a nationwide cross-sectional online survey study, inviting all registered pregnant women in Denmark (n = 30,009) in April and May 2020. RESULTS: The response rate was 60% (n = 17,995). Concerns of transmission during pregnancy and birth were considerable; 63% worried about getting severely ill whilst pregnant, and 55% worried that virus would be transmitted to their child. Thirtyeight percent worried about contracting the virus at the hospital. The most predominant concern related to changes in maternity services during the pandemic was restrictions on partners' attendance at birth (81%). Especially nulliparous women were concerned about whether cancelled antenatal classes or fewer physical midwifery consultations would affect their ability to give birth or care for their child postpartum.. The proportion of women who considered a home birth was equivalent to pre-pandemic home birth rates in Denmark (3%). During the temporary discontinue of public home birth services, 18% of this group considered a home birth assisted by a private midwife (n = 125), and 6% considered a home birth with no midwifery assistance at all (n = 41). CONCLUSION: Danish pregnant womens' concerns about virus transmission to the unborn child and worries about contracting the virus during hospital appointments were considerable during the early pandemic. Home birth rates may not be affected by the pandemic, but restrictions in home birth services may impose decisions to freebirth for a small proportion of the population.


Assuntos
Ansiedade/psicologia , Entorno do Parto , COVID-19/psicologia , Serviços de Saúde Materna , Parto/psicologia , Gestantes/psicologia , Adulto , COVID-19/transmissão , Estudos Transversais , Dinamarca/epidemiologia , Feminino , Humanos , Tocologia , Gravidez , SARS-CoV-2 , Cônjuges , Inquéritos e Questionários
16.
Nurs Womens Health ; 25(5): 329-336, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34602165

RESUMO

OBJECTIVE: To solicit advice from members of the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN) on what to include in an update of nurse staffing standards. DESIGN: Online, single-question survey with thematic analysis of responses. SETTING: Electronic survey link sent via e-mail. PARTICIPANTS: AWHONN members who shared their e-mail with the association and who responded to the survey (n = 1,813). MEASURES: Participants were asked to answer this single question: "The AWHONN (2010) Guidelines for Professional Registered Nurse Staffing for Perinatal Units are being updated. During their initial development, feedback from nearly 900 AWHONN members was extremely helpful in providing specific details for the nurse staffing guidelines. We'd really like to hear from you again. Please give the writing team your input. What should AWHONN consider when updating the AWHONN nurse staffing guidelines?" RESULTS: The e-mail was successfully delivered to 20,463 members; 8,050 opened the e-mail, and 3,050 opened the link to the survey. There were 1,892 responses. After removing duplicate and blank responses, 1,813 responses were available for analysis. They represented all hospital practice settings for maternity and newborn care and included nurses from small-volume and rural hospitals. Primary concerns of respondents centered on two aspects of patient acuity-the increasing complexity of clinical cases and the need to link nurse staffing standards to patient acuity. Other themes included maintaining current nurse-to-patient ratios, needing help with implementation in the context of economic challenges, and changing wording from "guidelines" to "standards" to promote widespread adoption. CONCLUSION: In a single-question survey, AWHONN members offered rich, detailed recommendations that were used in the updating of the AWHONN nurse staffing standards.


Assuntos
Guias como Assunto , Enfermeiras e Enfermeiros , Recursos Humanos de Enfermagem no Hospital/normas , Recursos Humanos/normas , Feminino , Humanos , Recém-Nascido , Enfermagem Neonatal , Relações Enfermeiro-Paciente , Parto , Admissão e Escalonamento de Pessoal , Gravidez , Sociedades de Enfermagem
17.
Health Aff (Millwood) ; 40(10): 1566-1574, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34606353

RESUMO

Acute stress during pregnancy can have adverse effects on maternal health and increase the risk for postpartum depression and impaired mother-infant bonding. The COVID-19 pandemic represents an acute environmental stressor during which it is possible to explore risk and resilience factors that contribute to postpartum outcomes. To investigate prenatal risk and resilience factors as predictors of postpartum depression and impaired mother-infant bonding, this study recruited a diverse cohort of 833 pregnant women from an urban medical center in Philadelphia, Pennsylvania, and assessed them once during pregnancy in the early phase of the COVID-19 pandemic (April-July 2020) and again at approximately twelve weeks postpartum. Adverse childhood experiences, prenatal depression and anxiety, and COVID-19-related distress predicted a greater likelihood of postpartum depression. Prenatal depression was the only unique predictor of impaired maternal-infant bonding after postpartum depression was controlled for. Women reporting greater emotion regulation, self-reliance, and nonhostile relationships had healthier postpartum outcomes. Policies to increase the number of nonspecialty providers providing perinatal mental health services as well as reimbursement for integrated care and access to mental health screening and care are needed to improve lifelong outcomes for women and their children.


Assuntos
COVID-19 , Depressão Pós-Parto , Criança , Depressão Pós-Parto/epidemiologia , Feminino , Humanos , Lactente , Mães , Pandemias , Philadelphia/epidemiologia , Gravidez , SARS-CoV-2
18.
BMC Health Serv Res ; 21(1): 1056, 2021 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-34610842

RESUMO

INTRODUCTION: Malaria interventions including use of Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment (IPTp-SP) and distribution of Insecticide Treated Nets (ITNs) have been implemented through ante-natal clinic (ANC) services in Ghana. Yet, the high ANC attendance is not commensurate with the uptake of these interventions, with missed opportunities to deliver the interventions. This study sought to assess the health system factors affecting access and delivery of IPTp-SP and ITN as defined by the Ghana Malaria Policy Guideline to eligible pregnant women attending ANC clinic sessions. METHODS: A quantitative cross-sectional study was conducted in the Volta Region of Ghana, with data collected across three levels of health care delivery facilities, including hospitals, health centres and Community-Based Health Planning Service (CHPS) compounds. Data collection included structured observation checklists to document the communication and interaction between the ANC health staff and pregnant women. Additionally, structured questionnaires were used to elicit information on cadre, trainings attended, knowledge and delivery practices of health workers on IPTp-SP and ITN. Stata 16 was used for data analysis, and a defined delivery algorithm was used to compute appropriate and inappropriate delivery practices, using the Ghana policy directive as a guide. Predictors of appropriate delivery were determined using logistic regression analysis. RESULTS: Approximately 97% of the 680 ANC observations had complete information for analysis. Of these, 78% (511/657) were eligible for IPTp-SP after excluding women who have less than 16 weeks of gestation, G6PD deficient, malaria positive and have taken 5 doses of IPTp-SP prior to day of observation. Appropriate delivery of IPTp-SP was 76% (390/511). Despite the availability of SP, 15% (75/511) of all eligible women were not offered the medication and 37% (44/119) of inappropriate delivery was recorded during periods of stock out. ITNs were appropriately delivered to 59% (139) out of 237 eligible women. Thirty-two percent (77/237) of eligible women, mostly continuing ANC clients, were not given ITN despite stock availability. CONCLUSIONS: IPTp-SP was appropriately delivered to most of the eligible pregnant women compared to ITN. While stock out of both intervention could account for inappropriate delivery, despite stock availability, IPTp-SP and ITN were not delivered to some eligible women.


Assuntos
Antimaláricos , Malária , Antimaláricos/uso terapêutico , Estudos Transversais , Feminino , Gana/epidemiologia , Humanos , Malária/tratamento farmacológico , Malária/epidemiologia , Malária/prevenção & controle , Gravidez , Gestantes , Estados Unidos
19.
Ann Parasitol ; 67(2): 281-286, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34597501

RESUMO

Toxoplasma gondii infections are endemic in Iraq and represent serious problems. Human toxoplasmosis can be associated with serious clinical manifestations, particularly in developing fetus. This study was aimed to determine the distribution of genotypes and alleles, residing within interleukin-6 (IL-6) and interleukin-1 beta (IL-1ß) polymorphisms, among fetuses and neonates, congenitally infected with Toxoplasma gondii, and among uninfected control cases. Blood samples were collected from 125 aborted women with a history of single or recurrent miscarriage, in addition to fifty normal healthy control women. Molecular identification of the parasite was performed by detecting Toxoplasma B1 gene using real-time qPCR technique. IL-6 and IL-1ß gene expression was assayed in each case-study samples by using RT-PCR. T. gondii was detected in recurrent toxoplasmosis aborted women at percent (16%). IL-1ß and IL-6 gene expression was significantly increased in toxoplasmosis women compared with healthy control women. Fold expression of IL-1ß was 9.5 in toxoplasmosis patients compared with one fold in healthy control. IL-1ß and IL-6 over-expression was correlated to the high-risk toxoplasmosis infection and could be a biomarker for prognosis of the disease.


Assuntos
Aborto Espontâneo , Toxoplasma , Toxoplasmose , Aborto Espontâneo/genética , Citocinas/genética , Feminino , Expressão Gênica , Humanos , Recém-Nascido , Gravidez , Toxoplasma/genética
20.
Ann Parasitol ; 67(2): 321-328, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34598404

RESUMO

Epidemiological studies of vaginalis trichomonosis, especially in pregnant women are rare in Africa due to the lack of screening programs. The present study aimed to assess the prevalence of T. vaginalis infection and its associated factors in pregnant women who attended the antenatal care clinics in three primary health centers of Bobo-Dioulasso. We carried out a cross-sectional study for descriptive and analytical purposes from February to April 2015 in pregnant women seen in prenatal consultations. The study took place in 3 primary public health centers: Guimbi (Central Urban), Bolomakoté (Peri-urban) and Yéguérésso (rural). The trophozoites of Trichomonas vaginalis was carried out by microscopy on vaginal swabs and urine samples. Sociodemographic, obstetric and biological variables were also collected. A total of 315 pregnant women were included in the study. The overall prevalence of urogenital trichomonosis was 3.2%. It was 1.9% in Guimbi, 2.9% in Bolomakoté, and 4.7% in Yéguérésso. The prevalence of HIV infection was 2.2%. Married women were less exposed to T. vaginalis infection than single women (p=0.03). The prevalence of urogenital trichomonosis obtained was considered lower compared to the previously reported from Burkina Faso. Thus, it is essential to extend this study to the whole country periodically by integrating other STIs not subject to a surveillance system and by integrating molecular epidemiology tools.


Assuntos
Infecções por HIV , Trichomonas vaginalis , Burkina Faso/epidemiologia , Estudos Transversais , Feminino , Humanos , Gravidez , Gestantes , Prevalência
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