RESUMEN
Hypertensive disorders of pregnancy are closely associated with prematurity, stillbirth, and maternal morbidity and mortality. The onset of hypertensive disorders of pregnancy (HDP) is generally noticed after the 20th week of gestation, limiting earlier intervention. The placenta is directly responsible for modulating local and systemic physiology by communicating using mechanisms such as the release of extracellular vesicles, especially exosomes. In this study, we postulated that an analysis of exosome-enriched maternal plasma could provide a more focused and applicable approach for diagnosing HDP earlier in pregnancy. Therefore, the peripheral blood plasma of 24 pregnant women (11 controls, 13 HDP) was collected between 20th and 24th gestational weeks and centrifuged for exosome enrichment. Exosome-enriched plasma samples were analyzed by Raman spectroscopy and by proton nuclear magnetic resonance metabolomics (1H NMR). Principal component analysis (PCA) and orthogonal partial least squares discriminant analysis (OPLS-DA) were used to analyze the Raman data, from the spectral region of 600-1,800 cm-1, to determine its potential to discriminate between groups. Using principal component analysis, we were able to differentiate the two groups, with 89% of all variances found in the first three principal components. In patients with HDP, most significant differences in Raman bands intensity were found for sphingomyelin, acetyl CoA, methionine, DNA, RNA, phenylalanine, tryptophan, carotenoids, tyrosine, arginine, leucine, amide I and III, and phospholipids. The 1H NMR analysis showed reduced levels of D-glucose, L-proline, L-tyrosine, glycine, and anserine in HDP, while levels of 2-hydroxyvalerate, polyunsaturated fatty acids, and very-low-density lipoprotein (VLDL) were increased. 1H NMR results were able to assign an unknown sample to either the control or HDP groups at a precision of 88.3% using orthogonal partial least squares discriminant analysis and 87% using logistic regression analysis. Our results suggested that an analysis of exosome-enriched plasma could provide an initial assessment of placental function at the maternal-fetal interface and aid HDP diagnosis, prognosis, and treatment, as well as to detect novel, early biomarkers for HDP.
RESUMEN
Objetivou-se conhecer a compreensão do termo violência obstétrica em um grupo de enfermeiros, de uma maternidade pública de SC. Trata-se de uma pesquisa exploratória com abordagem qualitativa e quantitativa. Para o seu desenvolvimento, foi aplicado questionário semi estruturado com perguntas abertas e fechadas a dezenove enfermeiros, no período de maio a outubro de 2015. Com o intuito de analisar e caracterizar a amostra investigada foi aplicada a análise descritiva a todos os dados, correlacionando com a literatura atual. Os resultados encontrados evidenciam que os enfermeiros possuem plena compressão do termo violência obstétrica, e seus conceitos estão em acordo com literatura atual, o que contrapõem a hipótese inicial de que o desconhecimento deste termo pudesse levar a uma assistência socialmente aceita. Concluiu-se, por meio das falas dos entrevistados que a violência ainda permeia a assistência prestada, por razões passíveis de mudança, e a enfermagem obstétrica pode atuar para a mobilização e a mudança deste atual modelo obstétrico, e a capacitação profissional surge como preceito base à esta mudança.