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- ItemSomente MetadadadosDoença de chagas e gravidez: análise da morbidade materna e fetal(Universidade Federal de São Paulo (UNIFESP), 2013-09-25) Lucena, Alexandre Jorge Gomes de [UNIFESP]; Carvalho, Antonio Carlos de Camargo Carvalho [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)FUNDAMENTO: Pacientes portadoras de doença de Chagas (DC) podem desenvolver formas graves de cardiopatia durante a idade reprodutiva, e com isso maior risco de complicações maternas e fetais durante a gravidez. Objetivo: avaliar a influencia da doença de Chagas sobre a evolução materna e fetal durante a gestação e puerpério. METODOS: Analise retrospectiva de 164 gestações, em150 pacientes, através da analise do banco de dados do setor de cardiopatia e gravidez da UNIFESP. Avaliados três grupos de acordo com a forma de apresentação da DC (cardiomiopatia chagásica, com marcapasso cardíaco, e sem cardiopatia aparente) em relação a variáveis maternas e fetais. Resultados: Os grupos foram assim distribuídos: Cardiomiopatia chagásica com 77 (47%) das gestantes, BAV com marcapasso 35 (21,3%) e sem cardiopatia aparente 52 (31,7%). O grupo de gestantes com cardiomiopatia chagásica associou-se estatisticamente ao baixo peso ao nascer com incidência de 20 (26,7%) casos (P = 0,011; OR - 3,364; IC de 95% 1,380 - 8,200), com o maior uso de medicações cardiológicas maternas com incidência de 32 (41,6%) casos (P = 0,041; OR - 2,101; IC de 95% 1,083 - 4,076), e com maior número de complicações cardiológicas maternas com incidência de 32 (41,6%) casos (p = 0,001; OR - 3,708; IC de 95% 1,787 - 7,692), enquanto na prematuridade e nos fetos pequenos para idade gestacional não houve associação estatística. Já as gestantes com sorologia positiva para DC mas sem cardiopatia aparente e as portadoras de marcapasso definitivo não tiveram aumento significante da morbidade materno e fetal para nenhuma das variáveis analisadas. As gestantes com classe funcional (CF) III e IV no 3º trimestre, independente da forma de apresentação da DC, tiveram maior numero de complicações maternas com incidência de 10 (90,9%) casos (p = 0,000; RR - 15 ), prematuridade com incidência de 9 (42,9%) casos (p = 0,000; RR - 4,57), e de baixo peso ao nascer com incidência de 8 (38,1%) casos (p = 0,012; RR - 2,98). Conclusão: As gestantes com cardiomiopatia chagásica, principalmente as com classe funcional III e IV, tiveram aumento da morbidade materno-fetal, enquanto que as gestantes sem cardiopatia aparente e as portadoras de marcapasso definitivo não tiveram aumento de morbidade durante a gestação.
- ItemAcesso aberto (Open Access)Eletromiografia de superfície para avaliação dos músculos do assoalho pélvico feminino: revisão de literatura(Universidade de São Paulo, 2011-09-01) Resende, Ana Paula Magalhães; Nakamura, Mary Uchiyama [UNIFESP]; Ferreira, Elizabeth Alves Gonçalves [UNIFESP]; Petricelli, Carla Dellabarba [UNIFESP]; Alexandre, Sandra Maria [UNIFESP]; Zanetti, Míriam Raquel Diniz [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Uni Anchieta; Universitário FIEOSurface electromyography has clinical and research importance for the physiotherapist. Although capturing electrical activity promoted by recruitment of motor units, there is a good correlation between the number of activated units and muscle strength. This is one of the methods of higher specificity in pelvic floor evaluation, although the lack of consensus regarding its application. The aim of this literature review was to cluster information regarding to the use of surface electromyography in the evaluation of pelvic floor. Papers were searched in Medline, Pubmed Lilacs, SciELO and Cochrane Library. Were selected papers which methods used surface electromyography to evaluate the pelvic floor. Although its methodology still lacks standardization, is an instrument that should be considered in scientific research in our country because it seems to have good reproducibility and reliability. Women with pelvic floor disorders have changes in the activation time of the pelvic floor muscles (PFM) and abdominal muscles. With respect to pregnancy and postpartum, there is a lack of evidence on possible changes in electrical activation of PFM in these periods.
- ItemAcesso aberto (Open Access)Estudo sobre níveis de ansiedade em gestantes cardiopatas(Universidade Federal de São Paulo (UNIFESP), 2015-12-18) Oliveira, Ariana Queiroz de [UNIFESP]; Carvalho, Antonio Carlos de Camargo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)In this work, levels of anxiety were studied in three groups of pregnant women (thirty subjects each one), who had acquired cardiopathy, hypertension and healthy. Beck Scales, anxiety and depression subscales, and semi-structured interview were used. The analysis of the variance (ANOVA) indicated difference in the anxiety variable (p-value=0.021). The Tukey test was applied in the significant differences. Women with hypertension showed medium average level of anxiety meaningfully higher than the low risk ones. The majority of the pregnancies was not planned. In general, the women with heart disease cardiopathy didn´t refer to fear, and the ones who did it, mentioned fear of delivery, complications and C-section. In this group, the medical follow up clarified questions and also helped to reduce the anxiety. We pointed out the possibility to associate psychological counseling with prenatal and family planning in order to face pregnancy anxiety and avoid life-threatening situations.
- ItemAcesso aberto (Open Access)Fatores de risco para o baixo peso ao nascer em gestantes de baixa renda(Pontifícia Universidade Católica de Campinas, 2003-06-01) Franceschini, Sylvia do Carmo Castro [UNIFESP]; Priore, Silvia Eloiza [UNIFESP]; Pequeno, Nila Patrícia Freire [UNIFESP]; Silva, Danielle Goes da [UNIFESP]; Sigulem, Dirce Maria [UNIFESP]; Universidade Federal de Viçosa Departamento de Nutrição e Saúde; Universidade Federal de São Paulo (UNIFESP)This paper assessed 77 pregnant women undergoing the last three months of gestation, in order to analyze their exposure to risk factors for low birth weight. They lived in slums in the region of Vila Mariana, a district in the city of São Paulo, and were followed up by the Projeto Favela, developed by the Federal University of São Paulo/School of Medicine. The maternal variables which most influenced birth weight were the mother's number of pregnancies and height. Primiparous women gave birth to newborns with lower birthweight, presenting an average difference of -264g when compared with infants born to multiparous mothers. Women whose height did not exceed 150cm also delivered infants with lower birth weight, demonstrating an average difference of -287g when compared with neonates born to taller mothers. Only 2.6% of the infants presented low birth weight, despite the high exposure of the studied population to risk factors.
- ItemAcesso aberto (Open Access)Gravidez, puerpério e doença vascular cerebral(Academia Brasileira de Neurologia - ABNEURO, 1996-06-01) Fukujima, Marcia Maiumi [UNIFESP]; Oliveira, Roberto De Magalhães Carneiro de [UNIFESP]; Shimazaki, Jean Carlos [UNIFESP]; Lima, José Geraldo de Camargo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Six patients who presented cerebrovascular disease during puerperium or pregnancy were studied. One of them presented hemorrhagic stroke caused by intracerebral bleeding due to pre-eclampsia. Three patients presented ischemic stroke, they all had positive serologic reactions for Chagas' disease, but only two of them had clinical cardiopathy; one of these patients had anticardiolipin antibody. The other two patients presented cerebral venous thrombosis of sagittal sinus. Both were smokers and one of them used oral contraceptive. We emphasize the importance of clinical investigation to seek for the common causes of cerebrovascular disease in young people, with special attention to Chagas disease in Brazil.
- ItemAcesso aberto (Open Access)Maternal high-fat diet during pregnancy or lactation changes the somatic and neurological development of the offspring(Academia Brasileira de Neurologia - ABNEURO, 2014-02-01) Mendes-da-Silva, Cristiano [UNIFESP]; Giriko, Catherine Ássuka; Mennitti, Laís Vales; Hosoume, Lilian Fazion; Souto, Tayane dos Santos; Silva, Alexandre Valotta da [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hospital Israelita Albert Einstein Instituto do CérebroThe maternal exposure to high fat diet (HFD) during pregnancy and breastfeeding have been considered an important inducer of alterations in offspring normal programming, both in animals and humans, and may disturb brain development. In the present study we investigated the somatic and sensory-motor development of the offspring from rat dams fed a HFD, compared with dams fed a control diet, during pregnancy or lactation. Indicators of the body growth, physical maturation, and reflex ontogeny were evaluated. Offspring of dams fed a HFD showed reduced weight and body growth, delayed physical maturation, and delayed maturation of the physiological reflexes, such as vibrissa placing, auditory startle response, and free-fall righting. Our findings suggest that maternal HFD during pregnancy or lactation modifies somatic and neurological development of the offspring, possibly increasing the risk of neuroendocrine and neuropsychiatric disorders later in life.
- ItemAcesso aberto (Open Access)Mindfulness e gravidez: uma revisão integrativa dos efeitos da prática de mindfulness no processo de vínculo mãe/bebê na gestação(Universidade Federal de São Paulo (UNIFESP), 2020) Ferreira, Cristiane Linhares [UNIFESP]; Cicuto, Karen Messas [UNIFESP]; http://lattes.cnpq.br/9905267940193868; Universidade Federal de São Paulo (UNIFESP)Objective: to verify if practices of mindfulness based on compassion in pregnant women with psychic disorders, reduces anxiety, stress and depression, favoring the mother / baby bonding process during pregnancy. Method: it is an integrative review based on the PUbMed research database, where the following descriptors were used: pregnancy, mindfulness, compassion and depression. In the screening, 7 articles were found and, after reading the title and abstracts, only 6 were selected for conducting studies with pregnant women with mental disorders submitted to mindfulness protocols. Conclusion: all studies showed an improvement in the psychological disorder of pregnant women, especially in the context of anxiety. No study addressed a specific protocol of compassion, but all showed improvement in self-compassion and compassion. There was also no study focused on the observation of the bonding process, however, the results obtained in relation to the improvement of the mental health condition during pregnancy, seem to have signaled an improvement in the fetal maternal attachment and a greater availability of the mother for the needs of the baby in the postpartum period.
- ItemSomente MetadadadosPaternidade e o diagnóstico de anomalia fetal não letal: um estudo qualitativo(Universidade Federal de São Paulo (UNIFESP), 2016-11-28) Oliveira e Silva, Roberta Carvalho de [UNIFESP]; Pares, David Baptista da Silva Pares [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Studies about the paternal attitude towards the diagnosis of fetal anomalies are scarce. The transition to parenthood is a process that involves a number of changes in a man?s life, both individual and in the relationship with his wife/partner and the family as a whole, and that requires several adjustments and shifts. The objective of this paper is to describe the expectations about the paternity, to check the feelings resulting from the diagnosis of nonlethal fetal anomalies, and to identify existing concerns after the diagnosis of nonlethal fetal anomaly and changes in the relationship with the wife/partner after the diagnosis. This is a qualitative study previously approved by the institution?s ethics committee. A total of 20 fathers who were waiting for their prenatal appointment in the Outpatient Clinic of Fetal Medicine of the Department of Obstetrics of Escola Paulista de Medicina-Unifesp were interviewed from August 2014 to July 2015. Data was collected through semi-structured interviews and treated based on a categorical thematic content analysis. The results addressed the following topics: paternity, involvement during pregnancy, communication with the baby, feelings about the diagnosis, problem sharing and conflicts arising from the diagnosis. These cores of meaning gave rise to the following categories: inexperience; paternal reference; learnings after the diagnosis; desire; care; available time; sadness/sense of powerlessness; unfairness; uncertainty; fear of miscarriage; concerns with the wife/partner; search for information; life change; acceptance/hope. Conclusion: Regarding the diagnosis of fetal anomaly, it?s important that the father receives psychological follow-up by the health team so that he can express his feelings and relieve his suffering with a view to facilitating his emotional growth and strengthening the connection of the mother-father-baby triad.
- ItemAcesso aberto (Open Access)Sleep disorders in pregnancy(Academia Brasileira de Neurologia - ABNEURO, 2004-06-01) Lopes, Eliane Aversa [UNIFESP]; Carvalho, Luciane Bizari Coin de [UNIFESP]; Seguro, Priscila Bernal da Costa [UNIFESP]; Mattar, Rosiane [UNIFESP]; Silva, Ademir Baptista [UNIFESP]; Prado, Lucila Bizari Fernandes do [UNIFESP]; Prado, Gilmar Fernandes do [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)CONTEXT: The precise function of sleep in animals and human beings is still unknown, and any sort of physical, social or psychological variation may change the normal sleep-wake cycle. PURPOSE: This research aims is to determine the sleep disorders (SD) for each of the three trimesters of the pregnancy comparing them to the pre-pregnancy state (PG). METHOD: SD were investigated in three hundred pregnant women 11- to 40-years-old through with a brief clinical interview based on directed questions. One hundred pregnant women were considered for each trimester. RESULTS: The rate of pregnant women with insomnia increased by 23% in the 2nd trimester (p< 0.005); the rate for excessive daytime sleepiness (EDS) by 15% in the 1st trimester (p<0.003), 55% in the 2nd trimester (p<0.001) and by 14% in the 3rd trimester (p<0.002); the rate for mild sleepiness increased by 33% in the 2nd trimester (p<0.002) and by 48% in the 3rd trimester (p<0.001); the rate for specific awakenings increased by 63% in the 1st trimester, by 80% in the 2nd trimester and by 84% in the 3rd trimester (p<0.001). CONCLUSION: SD were more frequent during pregnancy comparatively to PG state, mostly at the expenses of EDS and specific awakenings.
- ItemAcesso aberto (Open Access)O transtorno bipolar na mulher(Faculdade de Medicina da Universidade de São Paulo, 2005-01-01) Guerra, Alexandro de Borja Gonçalves [UNIFESP]; Calil, Helena Maria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Gender differences, described in several psychiatric disorders, seem to be also present in bipolar disorder (BD). The prevalence of bipolar I disorder is equally distributed between women and men. Women seem to be at higher risk for rapid cycling and mixed mania, conditions that could make BD a disorder with a more severe course in the female sex. A marked depressive diathesis among women, greatest use of antidepressants and hormonal differences have been mentioned as hypotheses to explain these phenomenological differences. However, women and men seem to respond equally to medication. The indication of anticonvulsivants as first-line treatment in women is controversial, except for the treatment of mixed mania and, probably, rapid cycling.BD treatment during pregnancy must take into account risks related to medication effects as well as to the mother's illness. Prophylaxis in the postpartum is strongly recommended due to a great risk of recurrence in this period. Although psychotropic medication is generally contraindicated during lactation, among mood stabilizers, carbamazepine and valproate seem safer than lithium. Further studies are needed to confirm BD's course differences between women and men and to investigate possible impact on treatment effectiveness.
- ItemAcesso aberto (Open Access)Vacinação em situações especiais(Sociedade Brasileira de Pediatria, 2006-07-01) Succi, Regina Célia de Menezes [UNIFESP]; Farhat, Calil Kairala [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVES: To review the indications, contraindications and efficacy of vaccination in some special situations: immunosuppression, prematurity, pregnancy and post-exposure situations. SOURCES OF DATA: Systematic review of articles published during the two last decades, found in MEDLINE, SciELO and Lilacs databases; guidelines of Programa Nacional de Imunizações (Brazilian National Immunization Program), Brazil, 2001 to 2004, and of Programa Nacional de DST/AIDS (Brazilian National STD/AIDS Program), Brazil, 2004. Abstracts published in national and international pediatric and infectious disease congress annals during the last five years were also consulted. SUMMARY OF THE FINDINGS: Some special situations, such as immunosuppression, prematurity, pregnancy and exposure to infectious diseases increased the risk of diseases or adverse post-vaccination events. In these situations, special vaccines or special vaccination schedules are indicated, or vaccines should be postponed or even forbidden. In general, toxoid or inactivated vaccines can be used, considering the possibility of insufficient immune response. For immunosuppressed patients, in accordance with the type of immunosuppression, live virus or bacterial vaccines should be avoided, because of the risk of vaccine agent spread. Immunization should include not only the patient, but his/her home and day-care contacts as well. CONCLUSIONS: Knowledge about the schedule indicated for each situation improves the chances of better vaccine protection and decreases the risk of adverse events. Immunosuppressed or immunodeficient patients whose post-vaccine antibody titers are not available should be considered susceptible when exposed to infectious disease, and all the available prophylactic measures should be implemented, even when the vaccination schedule is correct.