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.
As Boas Práticas de Atenção ao Parto e ao Nascimento são práticas recomendadas pela Organização Mundial da Saúde (OMS) que visam garantir um cuidado humanizado às mulheres durante o período de pré-natal, parto e puerpério. O presente estudo objetivou analisar a adoção das boas práticas de atenção ao parto e ao nascimento em um Centro Obstétrico no norte de SC. Tratou-se de uma pesquisa mista, de estratégia exploratória sequencial. As participantes da pesquisa foram puérperas, no segundo dia de pós-parto, que realizaram parto normal em uma maternidade pública no norte de Santa Catarina. O estudo contou com 64 participantes, com idade média de 26,5 anos, predominantemente brancas, com ensino médio completo, solteiras e com renda familiar entre 1 a 2 salários mínimos. A categoria de práticas “A” foi a de maior prevalência, o que evidencia a importância dada pela instituição e pelos profissionais que nela atuam no que tange à humanização da assistência ao parto e ao bem-estar do binômio mãe-bebê. Pode-se considerar que a instituição adere às Boas Práticas de Atenção ao Parto e ao Nascimento recomendadas pela OMS em sua assistência e a percepção das gestantes em relação a isso torna-se explícita em seus relatos preenchidos de satisfação e compreensão do processo que vivenciaram. Compreende-se ainda que a adesão por completo requer educação continuada dos profissionais que atuam neste cenário, assim como o empoderamento das mulheres sobre seus processos por meio de informação de qualidade.
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