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      Modificações no índice de líquido amniótico estimado pela ultra-sonografia em gestantes submetidas a imersão subtotal em água Translated title: Changes in amniotic fluid index estimated by ultrasonography in pregnant patients submitted to subtotal immersion in water

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          Abstract

          Objetivo: estudar as modificações do índice de líquido amniótico (ILA), mensuradas pela ultra-sonografia, da pressão arterial média (PAM) e do pulso em gestantes normais quando submetidas a imersão corporal subtotal em água, por diferentes intervalos de tempo, e padronização da técnica. Métodos: foram estudados os valores do ILA, como descrito por Phelan et al.¹, de um grupo de 52 gestantes, com idade gestacional igual ou superior a 28 semanas, consideradas clinicamente normais, antes e após a sua imersão subtotal em um tanque com água aquecida entre 32ºC e 34ºC, por 30, 45 e 60 minutos. Resultados: as médias da PAM, antes e depois da imersão, mostraram diferenças estatisticamente significantes: 87,8 e 87,1 no grupo de 30 minutos, 76,7 e 66,6 no grupo de 45 minutos e 77,4 e 60,7 no grupo de 60 minutos. As médias de pulso também foram diferentes, com valores 74,9 e 78,7 no grupo de 30 minutos, 83,6 e 85,2 no grupo de 45 minutos e 84,9 e 90,6 no grupo de 60 minutos. Quanto ao grupo que foi submetido a imersão por 30 minutos, o valor médio do ILA foi de 11,7 cm antes e de 16,8 cm após imersão. No grupo de 45 minutos, o valor médio do ILA foi de 9,7 cm antes e de 13,8 cm após a imersão. No grupo de 60 minutos, o valor médio do ILA foi de 9,5 cm antes e de 13,6 cm após a imersão. O tempo de imersão de 30 minutos é tão eficaz e suficiente quanto 45 e 60 minutos. Conclusões: a imersão subtotal de gestantes em água é segura, prática e capaz de imobilizar os fluidos durante a gestação, aumentando o volume de líquido amniótico.

          Translated abstract

          Purpose: to study the changes in amniotic fluid index (AFI) measured by ultrasonography, mean arterial pressure (MAP) and pulse rate in normal pregnant women submitted to subtotal body immersion in water for different periods of time, and to standardize the technique. Methods: AFI values were studied as recommended by Phelan et al.¹ in a group of 52 pregnant women with gestational age of 28 weeks or more considered to be clinically normal, before and after exposure to subtotal immersion in water heated to 32 to 34ºC for 30, 45 and 60 min. The patients were seen at the Ultrasonography and Medical Updating School of Ribeirão Preto and in the Department of Gynecology and Obstetrics of the Faculty of Medicine of Ribeirão Preto, University of São Paulo. Results: before and after immersion, the average of MAP was 87.8 and 87.1 in the group of 30 min, 76.7 and 66.6 in the group of 45 min and 77.4 and 60.7 in the group of 60 min, with statistical significance. Before and after immersion, the means of pulse rates were 74.9 and 78.7 in the group of 30 min, 83.6 and 85.2 in the group of 45 min and 84.9 and 90.6 in the group of 60 min, with statistical significance. The mean of AFI also showed statistical significance. When submitted to 30-min immersion the means of AFI were 11.7 cm before and 16.8 cm after. In the group of 45 min, the averages were 9.7 cm before and 13.8 cm after immersion. In the group of 60 min, the averages were 9.5 cm before and 13.6 cm after immersion. The time of immersion of 30-min was as effective and ample as 45 or 60 min. Conclusions: subtotal immersion in water is a safe and practical procedure that can mobilize fluids during pregnancy, increasing amniotic fluid volume.

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          Most cited references 20

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          Physiological responses to prolonged bed rest and fluid immersion in humans.

          Rest in bed and immersion in water have been used for centuries by physicians and healers in treating injury and disease. The qualitative similarity of acute and chronic responses to bed rest, immersion, and weightlessness has sparked renewed interest in and a resultant greater understanding of the mechanisms of disuse deconditioning. Some combination of changes in hydrostatic pressure, reduced total metabolism (exercise), compression force on weight-bearing bones, as well as psychological factors associated with prolonged confinement in a new environment probably comprise the major input stimuli for the adaptive responses. Virtually every physiological system is affected. Early responses involve the fluid, electrolyte, and blood pressure control systems with significant muscular atrophy and decreases in bone density occurring over weeks and months. Much effort has been expended to describe the various responses to bed rest and immersion with understandably less effort devoted to research during weightlessness. Future research should be directed mainly toward an understanding of the mechanisms of these adaptive responses. Additional work is especially needed to elucidate the effects of deconditioning on drug metabolism, functioning of the immune system, carbohydrate metabolism, protein and peptide metabolism in muscle, and calcium metabolism as it affects integrity of bone.
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            Hypervolemia and plasma vasopressin response during water immersion in men.

            To investigate changes in plasma volume (PV) and osmolality as stimuli for plasma vasopressin (PVP) suppression and diuresis, seven normal healthy men (22-48 yr) were immersed to the neck for 4 h in a sitting position in tap water (34.5 degrees C) after overnight food and fluid restriction. Mean +/- SE urine volume was 823 +/- 123 ml/4 h; fluid intake was 400 ml/4 h, and mean negative water balance was 944 ml/4 h. Urinary sodium excretion increased from 0.77 to 1.25 mosmol/min (P less than 0.05) and UNaV from 0.14 to 0.37 meq/min (P less than 0.05). During immersion, PV (T-1824) increased by 8.8% (P less than 0.05) during the first 30 min and declined linearly thereafter. Mean +/- SD serum osmolality (294 +/- 1.2 mosmol/kg H2O) and sodium (143.2 +/- 0.4 meq/l) were constant throughout immersion; PVP (2.3 +/- 0.5 pg/ml) and plasma renin activity [0.3 +/- 0.2 ng ANG I/(ml X h]) were not significantly changed. Thus, the composition of the fluid entering the vascular space maintained constant serum osmolality and PVP throughout immersion. These findings do not support the hypothesis that acute expansion of central volume and PV cause suppression of PVP. The results suggest a mechanism other than or in addition to PVP suppression as a contributory cause of the immersion diuresis.
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              Water immersion-induced endocrine alterations in women with EPH gestosis

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rbgo
                Revista Brasileira de Ginecologia e Obstetrícia
                Rev. Bras. Ginecol. Obstet.
                Federação Brasileira das Sociedades de Ginecologia e Obstetrícia (Rio de Janeiro )
                1806-9339
                March 2001
                : 23
                : 2
                : 101-105
                Affiliations
                [1 ] Universidade de São Paulo Brazil
                Article
                S0100-72032001000200007
                10.1590/S0100-72032001000200007
                Product
                Product Information: website
                Categories
                OBSTETRICS & GYNECOLOGY

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