Publications by authors named "Heron Werner"

73 Publications

Fetal Cervical Lymphangioma: Magnetic Resonance Imaging and Three-Dimensional Reconstruction Modelling.

J Obstet Gynaecol Can 2020 Dec 7. Epub 2020 Dec 7.

Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil; Medical course, Municipal University of São Caetano do Sul (USCS), Bela Vista Campus, São Paulo-SP, Brazil. Electronic address:

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http://dx.doi.org/10.1016/j.jogc.2020.08.022DOI Listing
December 2020

Omphalopagus in a Dichorionic Diamniotic Triplet Pregnancy: Prenatal and Postnatal 3D Models and Virtual Reality.

J Obstet Gynaecol Can 2021 Feb 10. Epub 2021 Feb 10.

Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil. Electronic address:

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http://dx.doi.org/10.1016/j.jogc.2020.11.022DOI Listing
February 2021

Pre and postnatal diagnosis of a third branchial cleft cyst by sonography and magnetic resonance imaging with three-dimensional virtual reconstruction.

J Clin Ultrasound 2021 Jun 4. Epub 2021 Jun 4.

Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil.

Branchial cleft cysts (BCCs) are common causes of cervical tumors in children and adulthood; however, prenatal diagnosis of BCC is rare. In neonates, these cysts can suddenly increase in size, causing airway obstruction and becoming a life-threatening condition. In this case report, we describe the prenatal diagnosis of a third BCC at the 25th week of pregnancy using ultrasound, magnetic resonance imaging, and three-dimensional virtual models, as well as the perinatal outcomes of this rare condition.
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http://dx.doi.org/10.1002/jcu.23025DOI Listing
June 2021

Three-dimensional virtual reconstruction of a patch after fetal endoscopic surgery for myelomeningocele.

Childs Nerv Syst 2021 Jul 17;37(7):2131-2132. Epub 2021 May 17.

Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil.

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http://dx.doi.org/10.1007/s00381-021-05211-xDOI Listing
July 2021

Excessive Prenatal Supplementation of Iodine and Fetal Goiter: Report of Two Cases Using Three-dimensional Ultrasound and Magnetic Resonance Imaging.

Rev Bras Ginecol Obstet 2021 Apr 12;43(4):317-322. Epub 2021 May 12.

Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

Fetal thyroid complications in pregnancy are uncommon, and are commonly related to the passage of substances through the placenta. The excessive iodine intake during the pregnancy is a well-known mechanism of fetal thyroid enlargement or goiter, and invasive procedures have been proposed for the treatment of fetal thyroid pathologies. In the present report, we demonstrate two cases from different centers of prenatal diagnosis of fetal thyroid enlargement and/or goiter in three fetuses (one pair of twins, wherein both fetuses were affected, and one singleton pregnancy). The anamnesis revealed the ingestion of iodine by the patients, prescribed from inadequate vitamin supplementation. In both cases, the cessation of iodine supplement intake resulted in a marked reduction of the volume of the fetal thyroid glands, demonstrating that conservative treatment may be an option in those cases. Also, clinicians must be aware that patients may be exposed to harmful dosages or substances during pregnancy.
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http://dx.doi.org/10.1055/s-0041-1729143DOI Listing
April 2021

Craniopagus twin: pre- and post-natal 3-dimensional virtual and physical models and virtual navigation created with free or open source software-an option for low-resource centers.

Childs Nerv Syst 2021 Apr 30. Epub 2021 Apr 30.

Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, CEP, São Paulo, SP, 05089-030, Brazil.

Background: Craniopagus twins represent a rare and complex congenital malformation characterized by conjoined twins fused at the cranium. Craniopagus is challenging for patients' families and surgeons, and accurate confirmation of the extent of cranial fusion is a complex process. Most information regarding the surgical anatomy of this rare condition is obtained through analysis of ultrasonographic, magnetic resonance, or computed tomographic images. A multidisciplinary team plays a key role in obtaining such information and in parental counseling and coordination of various complex processes for optimal postnatal care of these twins. The extent of fusion is usually determined based on conventional clinical methods, such as imaging studies.

Methods: Imaging software is being used in recent times to create three-dimensional reconstruction images and for virtual navigation to investigate the skulls and brains of craniopagus twins. However, the acquisition and maintenance costs of such sophisticated medical software may be unaffordable for medical centers in developing countries. To overcome this limitation, we investigated the role of open or free source software for accurate determination of complex malformations of the skull and brain of craniopagus twins.
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http://dx.doi.org/10.1007/s00381-021-05160-5DOI Listing
April 2021

Virtual hysterosalpingography: A new non-invasive tool for the assessment of uterine cavity and fallopian tubes.

Eur J Radiol 2021 Jun 2;139:109688. Epub 2021 Apr 2.

Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil; Medical Course, Municipal University of São Caetano do Sul(USCS), Bela Vista Campus, São Paulo, SP, Brazil. Electronic address:

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http://dx.doi.org/10.1016/j.ejrad.2021.109688DOI Listing
June 2021

Cutting-edge application of ultrasound elastography and superb microvascular imaging in radiofrequency ablation of uterine fibroids.

J Ultrason 2021 8;21(84):80-81. Epub 2021 Mar 8.

Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil.

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http://dx.doi.org/10.15557/JoU.2021.0014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008196PMC
March 2021

Intrauterine Zika virus infection: review of the current findings with emphasis in the prenatal and postnatal brain imaging diagnostic methods.

J Matern Fetal Neonatal Med 2021 Mar 29:1-7. Epub 2021 Mar 29.

Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil.

Zika virus (ZIKV) is a widespread flavivirus transmitted to humans through the bite of mosquitoes. The number of ZIKV cases increased significantly between 2015 and 2016, and Brazil was the first to report autochthonous transmission of infection. The main neurological disorder related to ZIKV infection is microcephaly. Fetal magnetic resonance imaging (MRI) is the gold standard examination for the analysis of fetal brain infection, followed by obstetric ultrasonography. Cerebral atrophy, intracranial calcifications, ventriculomegaly, cerebellar, and brain gyrus abnormalities are some of the most common findings. Postnatal MRI shows high sensitivity and specificity. Corpus callosum abnormalities, cerebellar hypoplasia, and choroid plexus dilation can be also observed. We present a review of congenital ZIKV infection with emphasis on pre and postnatal brain findings using ultrasonography, MRI, computed tomography, and three-dimensional reconstruction models.
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http://dx.doi.org/10.1080/14767058.2021.1904874DOI Listing
March 2021

Venolymphatic malformations: prenatal diagnosis using magnetic resonance imaging, perinatal outcomes and long-term follow-up.

Pediatr Radiol 2021 Jun 29;51(7):1243-1252. Epub 2021 Jan 29.

Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, CEP 05089-030, Brazil.

Background: Venolymphatic malformations are benign. Fetal MRI can more precisely demonstrate an infiltrative pattern of malformations than US.

Objective: To evaluate perinatal outcomes and long-term follow-up of fetal venolymphatic malformations treated in different medical facilities using fetal MRI.

Materials And Methods: This retrospective cohort study evaluated 20 pregnant women between 22 weeks and 37 weeks of gestation who were referred from different institutions. They presented with fetuses with various diagnoses of cystic masses on routine US. The cases were studied using MRI. We analyzed prenatal data, perinatal outcomes and long-term follow-up.

Results: We reviewed the MRI scans of 20 patients with venolymphatic malformation. Referral diagnosis was changed in 40% (8/20) of cases, with postnatal concordance of 100% (20/20). Moreover, 65% (13/20) presented with venolymphatic malformation in more than one body segment. The neck was affected in 70% (14/20) of fetuses, while the head and thorax were affected in 30% (6/20) and 45% (9/20), respectively. There were intrathoracic lesions in 35% (7/20), lesions in the abdomen in 30% (6/20), and lesions in the perineum and extremities in 10% (2/20) each. Tracheal displacement, neck deflection and anatomical displacement caused by tumoral compression were present in 15% (3/20) of cases. Moreover, 25% (5/20) of newborns required neonatal intensive care unit admission, and all presented with cervical or thoracic venolymphatic malformation. Furthermore, 50% (10/20) of cases presented with complete resolution after medical therapy. The intrathoracic and cervical residuals (35%, 7/20) were monitored and treated.

Conclusion: MRI showed good correlation with postnatal examination of venolymphatic malformation, was useful in the differential diagnosis of fetal cysts on US, and presented a significant postnatal correlation with thoracic infiltration. The outcomes of prenatally diagnosed venolymphatic malformations are good despite the varying protocols among medical facilities.
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http://dx.doi.org/10.1007/s00247-020-04939-zDOI Listing
June 2021

Congenital High Airway Obstruction Syndrome (CHAOS): Virtual Navigation in the Fetal Airways After Intrauterine Endoscopic Treatment.

J Obstet Gynaecol Can 2021 Jul 7;43(7):879-883. Epub 2020 Dec 7.

Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil. Electronic address:

Background: Congenital high airway obstruction syndrome (CHAOS) involves the partial or complete obstruction of the fetal upper airways, usually caused by atresia or stenosis of the larynx or trachea. The obstruction of bronchial tree leads to lung distension, diaphragmatic eversion, and cardiac dysfunction, which can result in fetal death.

Case: A primigravid 19-year-old was diagnosed with CHAOS at 19 weeks gestation. Virtual navigation using magnetic resonance imaging (MRI) data was used to visualize the fetal airways after intrauterine endoscopic laser decompression. A perforation in the fetal larynx/trachea was identified and the diagnosis was modified to tracheal stenosis. Cesarean delivery occurred at 31 weeks using an ex utero intrapartum treatment (EXIT) procedure. The neonatology team were unable to perform intubation, suggesting a final diagnosis of tracheal atresia. The male newborn weighed 1920 g and died 1 hour later.

Conclusion: 3D virtual bronchoscopy is a non-invasive approach to visualizing the fetal upper airways and can be used to diagnose and manage CHAOS.
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http://dx.doi.org/10.1016/j.jogc.2020.10.017DOI Listing
July 2021

Intrahepatic bile ductal ectasia in autosomal recessive polycystic kidney disease evaluated by fetal magnetic resonance imaging: a more frequent complication.

J Matern Fetal Neonatal Med 2020 Nov 18:1-6. Epub 2020 Nov 18.

Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil.

Objective: This study aimed to evaluate liver malformations and intrahepatic bile ductal ectasia and dilatation (IBDED) in cases of prenatal diagnosis of autosomal recessive polycystic kidney disease (ARPKD) using magnetic resonance imaging (MRI).

Methods: This retrospective study involved 209 cases referred for fetal MRI studies (f-MRI) from March 2004 and December 2019, suspicious of congenital renal disease. Fetuses that met the criteria for ARPKD were selected.

Results: Six cases were diagnosed as ARPKD (2.8%). The median gestational age at MRI examination was 28 weeks (24-36 weeks). IBDED was observed in 84% of cases. Moreover, 66% presented multilobar liver lesions, and 33% exhibited monolobar lesions. The "central dot sign" (CDS) was found in half of the cases.

Conclusion: In this case series of prenatal diagnosis of ARPKD using f-MRI, IBDED was present in the majority of the cases, and the CDS was noted in half of the cases.
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http://dx.doi.org/10.1080/14767058.2020.1850681DOI Listing
November 2020

Maternal-fetal physical model: image fusion obtained by white light scanner and magnetic resonance imaging.

J Matern Fetal Neonatal Med 2020 Nov 18:1-5. Epub 2020 Nov 18.

Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil.

Background: Physical fetal models developed from three-dimensional (3D) ultrasound or magnetic resonance imaging (MRI) scan data may be used for medical education purposes, for parental counseling/multidisciplinary team management and to improve the maternal-fetal attachment (MFA) in blind pregnant women.

Purpose: We proposed a new technique to create a maternal-fetal physical model by using MRI scan data to improve the MFA.

Methods: For the construction of the maternal-fetal physical model, two different processes were used. For the internal part of the maternal-fetal physical model, we used the segmentation and the 3D reconstruction made from the MRI scan data, and for the outside, we performed 3D scanning by using a white light scanner. After obtaining the 3D models, we used a registration tool to position them in alignment.

Conclusion: Maternal-fetal physical models improve the MFA by using both tactile and visual sensations of the pregnant woman and her fetus.
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http://dx.doi.org/10.1080/14767058.2020.1850682DOI Listing
November 2020

Virtual navigation for the improvement of parents counseling and the planning of fetal endoscopic myelomeningocele repair.

Childs Nerv Syst 2021 03 4;37(3):969-972. Epub 2020 Nov 4.

Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, Brazil.

Background: Myelomeningocele (MMC) is the most severe form of spina bifida with intrauterine repairs becoming more prevalent. The development of three-dimensional ultrasound (3DUS) and magnetic resonance imaging (MRI) has drastically improved the visualization of fetal anatomy.

Methods: Virtual Navigation (VN) results from a technology that uses software generated realistic images to replicate the immersive feeling of a real environment.

Conclusion: This report aims to demonstrate VN in a Chiari II malformation case, obtained from 3DUS and MRI files, comparing this with the fetal endoscopic surgery for MMC.
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http://dx.doi.org/10.1007/s00381-020-04961-4DOI Listing
March 2021

Treatment of Acute Toxoplasmosis in Pregnancy: Influence in the Mother-to-Child Transmission.

J Obstet Gynaecol Can 2020 Dec 20;42(12):1505-1510. Epub 2020 Jun 20.

Department of Obstetrics, Paulista School of Medicine-Federal University of São Paulo, São Paulo, Brazil; Municipal University of São Caetano do Sul, Campus Bela Vista, São Paulo, Brazil. Electronic address:

Objective: To evaluate the association between treatment and mother-to-child transmission of acute Toxoplasma gondii infection in pregnancy.

Methods: This was a concurrent cohort study of 26 pregnant women diagnosed with acute toxoplasmosis. Transmission of T. gondii to the fetus was characterized by detection of the parasite in the amniotic fluid by polymerase chain reaction (PCR). Congenital toxoplasmosis was diagnosed by a positive serological test for IgM, intracranial calcification, chorioretinitis, hydrocephalus, and/or microcephaly in the newborn.

Results: There was direct correlation between acute toxoplasmosis and low socioeconomic status and inadequate hygienic/health conditions. The MCT rate in adequately and inadequately treated patients was 17.4% and 33.3%, respectively. PCR analysis of the amniotic fluid was performed for 15 women, with 1 positive result; the pregnant woman was adequately treated, and her infant had no complications. Congenital infection occurred in 4 newborns, who had hydrocephalus, intracranial calcifications, and chorioretinitis. Cerebrospinal fluid alteration was found in 3 of the 16 infants tested. Transmission was more frequent in the third quarter of pregnancy (P = 0.04).

Conclusion: The rate of mother-to-child transmission of T. gondii is higher in untreated pregnant women and those who acquired the infection later in pregnancy.
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http://dx.doi.org/10.1016/j.jogc.2020.04.021DOI Listing
December 2020

Fetal ultrasound estimated weight and correlation to Brazilian newborn weight.

J Ultrason 2020 15;20(81):e106-e110. Epub 2020 Jun 15.

Department of Pediatrics, Federal University of Santa Catarina (UFSC) Florianopolis-SC , Brazil.

To compare the best fetal weight formula with different biometric tables on the weight of Brazilian newborns. This observational study has tested the performance of different common fetal weight formulas and biometric tables. Weight estimates were performed by the methods of Warsof . (1977), Shepard . (1982), Hadlock . (1985), Furlan . (2012) and Stirnemann . (2017). The biometric tables selected were the following: Snijders and Nicolaides (1994), Hadlock . (1984), Papageorghiou . (2014) and Kiserud . (2016) and correlated to Pedreira . (2011) database, which was considered the gold standard. Statistical analyses were performed using the mean relative error, average absolute error and the Pearson correlation coefficient (r). The best r was found when using the Snijders and Nicolaides (1994) biometric table with weight formula by Stirnemann . (2017). The average relative error was lower when using weight formula by Shepard . (1982) with biometric tables by Snijders and Nicolaides (1994), Papageorghiou . (2014) or Kiserud . (2016). On average, absolute error, the lowest r was obtained for the Furlan . (2012) weight formula and the Papageorghiou . (2014) biometric table. The best correlation was found for biometric table by Snijders and Nicolaides (1994) and fetal weight formula calculation for the estimation of Brazilian newborn weight by Stirnemann . (2017).

To compare the best fetal weight formula with different biometric tables on the weight of Brazilian newborns. This observational study has tested the performance of different common fetal weight formulas and biometric tables. Weight estimates were performed by the methods of Warsof . (1977), Shepard . (1982), Hadlock . (1985), Furlan . (2012) and Stirnemann . (2017). The biometric tables selected were the following: Snijders and Nicolaides (1994), Hadlock . (1984), Papageorghiou . (2014) and Kiserud . (2016) and correlated to Pedreira . (2011) database, which was considered the gold standard. Statistical analyses were performed using the mean relative error, average absolute error and the Pearson correlation coefficient (r). The best r was found when using the Snijders and Nicolaides (1994) biometric table with weight formula by Stirnemann . (2017). The average relative error was lower when using weight formula by Shepard . (1982) with biometric tables by Snijders and Nicolaides (1994), Papageorghiou . (2014) or Kiserud . (2016). On average, absolute error, the lowest r was obtained for the Furlan . (2012) weight formula and the Papageorghiou . (2014) biometric table. The best correlation was found for biometric table by Snijders and Nicolaides (1994) and fetal weight formula calculation for the estimation of Brazilian newborn weight by Stirnemann . (2017).
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http://dx.doi.org/10.15557/JoU.2020.0017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7409559PMC
June 2020

Proportional vascularization along the fallopian tubes and ovarian fimbria: assessment by confocal microtomography.

Radiol Bras 2020 May-Jun;53(3):161-166

Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.

Objective: To evaluate and reconstruct three-dimensional images of vascularization along the fallopian tube (FT), as well as to determine its relationship with the ovary and ovarian fimbria, and to quantify the blood vessels along the FT according to its anatomical segments, using confocal microtomography (micro-CT).

Materials And Methods: Nine specimens (six FTs and three FTs with ovaries) were fixed in a solution of 10% formalin for > 24 h at room temperature. Iodine staining was performed by soaking the specimens in 10% Lugol's solution for 24 h. All specimens were evaluated using micro-CT. A morphometric analysis was performed on the reconstructed images to quantify the vascular distribution along the FT.

Results: In the FTs evaluated, the density of blood vessels was significantly greater in the fimbrial segments than in the isthmic segments ( < 0.05). The ovarian fimbria was clearly identified, demonstrating the important relationship between these vessels and the FT fimbriae.

Conclusion: We believe that the vascularization in the fimbriae is greater than and disproportional that in the other segments of FT, and that the ovarian fimbria plays an important role in the development of that difference.
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http://dx.doi.org/10.1590/0100-3984.2019.0080DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7302899PMC
June 2020

Pregnant, uninfected, stressed, and confined in the COVID-19 period: what can we expect in the near future?

Rev Assoc Med Bras (1992) 2020 04;66(4):386-387

. Departamento de Obstetrícia, Escola Paulista de Medicina - Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, SP, Brasil.

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http://dx.doi.org/10.1590/1806-9282.66.4.386DOI Listing
April 2020

Covid-19 and Pregnancy: An Overview.

Rev Bras Ginecol Obstet 2020 Jul 19;42(7):420-426. Epub 2020 Jun 19.

Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

Since the World Health Organization (WHO) declared coronavirus infection (COVID-19) a Public Health Emergency of International Concern in January 2020, there have been many concerns about pregnant women and the possible effects of this emergency with catastrophic outcomes in many countries. Information on COVID-19 and pregnancy are scarce and spread throughout a few case series, with no more than 50 cases in total. The present review provides a brief analysis of COVID-19, pregnancy in the COVID-19 era, and the effects of COVID-19 on pregnancy.
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http://dx.doi.org/10.1055/s-0040-1713408DOI Listing
July 2020

Coronavirus and pregnancy: How can three-dimensional printing laboratories help?

J Matern Fetal Neonatal Med 2020 May 19:1-2. Epub 2020 May 19.

Medical course, Municipal University of São Caetano do Sul (USCS), São Paulo-SP, Brazil.

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http://dx.doi.org/10.1080/14767058.2020.1763950DOI Listing
May 2020

Fetal skeletal dysplasias: a new way to look at them.

Radiol Bras 2020 Mar-Apr;53(2):112-113

Department of Obstetrics, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.

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http://dx.doi.org/10.1590/0100-3984.2018.0140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170586PMC
April 2020

Fallopian tube vascularization observed by microfocus computed tomography.

Radiol Bras 2020 Jan-Feb;53(1):36-37

Department of Obstetrics, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.

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http://dx.doi.org/10.1590/0100-3984.2018.0120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7159048PMC
April 2020

Zika virus infection.

Authors:
Heron Werner

Radiol Bras 2019 Nov-Dec;52(6):IX-X

Fetal Medicine Specialist - Clínica Alta Excelência Diagnóstica/DASA, Rio de Janeiro, RJ, Brazil. E-mail:

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http://dx.doi.org/10.1590/0100-3984.2019.52.6e3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7007063PMC
February 2020

Zika Virus and Pregnancy: Association between Acute Infection and Microcephaly in Newborns in the State of Rio de Janeiro, Brazil.

Geburtshilfe Frauenheilkd 2020 Jan 13;80(1):60-65. Epub 2020 Jan 13.

Perinatal Unit, State University of Rio de Janeiro (UERJ), Rio de Janeiro-RJ, Brazil.

Aim of the study was to evaluate the association between microcephaly and acute infection with Zika virus (ZIKV) in pregnant women in the state of Rio de Janeiro, Brazil. Infection was confirmed by laboratory testing. A cross-sectional retrospective study of pregnant women with symptoms occurring between 2015 and 2016 suggestive of acute ZIKV infection was carried out, with confirmation of infection done by blood or urine RT-PCR. The relative proportions of categorical variables were calculated for two distinct groups: pregnant women whose newborns had microcephaly and pregnant women who gave birth to infants without microcephaly. Confidence intervals with a 95% level of agreement were estimated for the relative ratios. A total of 1609 pregnant women with a mean age of 26.4 ± 6.5 years were evaluated. As regards the time of acute infection, 19.6% (316) of cases occurred in the first trimester of pregnancy. Nineteen (76%) of the 25 cases with microcephaly (1.5%) were associated with an infection contracted in the first trimester of pregnancy (p < 0.001, OR = 13.7, 95% CI: 5.6 - 37.7). 48% (12/25) of the newborns with microcephaly had a birth weight of < 2500 grams, while only 7% (116/1597) of the group of newborns without microcephaly had a similarly low birth weight (p < 0.001, OR = 11.7, 95% CI: 5.2 - 26.2). Logistic regression showed that a birth weight of < 2500 g (OR = 12.54) and ZIKV infection in the first trimester of pregnancy (OR = 14.05) were associated with microcephaly (area under ROC curve = 0.86). Acute ZIKV infection in the first trimester of pregnancy and low birth weight are associated with microcephaly.
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http://dx.doi.org/10.1055/a-0972-2052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6957353PMC
January 2020

Congenital Duodenal Stenosis: Prenatal Evaluation by Three-dimensional Ultrasound HDlive Silhouette Mode, Magnetic Resonance Imaging, and Postnatal Outcomes.

J Med Ultrasound 2019 Jul-Sep;27(3):151-153. Epub 2019 May 17.

Department of Obstetrics, Federal University of São Paulo (EPM-UNIFESP), Paulista School of Medicine, São Paulo-SP, Brazil.

The "double bubble" sign is a common sign of congenital duodenal obstruction (CDO), which has been detected during prenatal diagnosis for over 40 years. CDO is strongly associated with chromosomal and structural abnormalities and encompasses a wide spectrum of diagnoses. Here, we describe a case of duodenal stenosis, a rare cause of duodenal obstruction, which was suspected using conventional two-dimensional ultrasound and three-dimensional reconstruction with the HDlive silhouette mode at the 28 prenatal week. The suspicion was further supported by magnetic resonance imaging performed at the 32 prenatal week and confirmed by postnatal surgery.
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http://dx.doi.org/10.4103/JMU.JMU_14_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6905263PMC
May 2019

Perinatal outcomes of fetal intra-abdominal umbilical vein varix: a multicenter cohort study.

J Matern Fetal Neonatal Med 2019 Nov 17:1-4. Epub 2019 Nov 17.

Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA.

To investigate the perinatal outcomes of fetuses with antenatal diagnoses of intra-abdominal umbilical vein varix (UVV). A multicenter retrospective study was conducted in four countries on fetuses diagnosed with intra-abdominal UVV between 2012 and 2019. Collected data included gestational age (GA), UVV maximum diameter at diagnosis and delivery, associated anatomical and chromosomal anomalies, birth weight, and neonatal outcomes. Twenty fetuses were identified, of which 20% had associated chromosomal and/or anatomical abnormalities, most resulting in poor outcomes (either intrauterine fetal death or pregnancy termination). Mean maternal age was 34.1 ± 7.0 years, UVV was diagnosed at 26.5 ± 4.5 weeks of GA on average with a maximum diameter of 12.0 ± 4.0 mm. Mean GA at delivery was 35.4 ± 5.6 weeks. Survival rate was 85%. Our study shows a satisfactory outcome when intra-abdominal UVV is an isolated finding, with minimal obstetrical and perinatal consequences. The prognosis is worse when UVV is associated with other anomalies.
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http://dx.doi.org/10.1080/14767058.2019.1685969DOI Listing
November 2019

The human endosalpinx: anatomical three-dimensional study and reconstruction using confocal microtomography.

Pol J Radiol 2019 17;84:e281-e288. Epub 2019 Jun 17.

Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil.

Purpose: To evaluate in three dimensions (3D) the human endosalpinx and reconstruct its surface along its different anatomical segments, without the injection or insertion of luminal contrasts, using confocal microtomography (micro-CT).

Material And Methods: 15 fallopian tubes (FT) from 14 women in reproductive age from procedures for benign disease or sterilization were selected. The specimens were fixed in formalin and stained with Lugol solution. Micro-CT studies were conducted on the specimens using protocols adapted from biological studies, to acquire images to reconstruct in 3D the endosalpinx surface.

Results: From these specimens, 6 presented the intra-mural segment, 14 presented the isthmus and 15 presented the ampulla and fimbria segment of the FT. The specimen presented tissue definition, and contrast sufficient for FT endosalpinx morphological analysis and lumen definition. The intramural portion presented initially a mucosal projection toward the lumen, bending on its own axis, and increased numbers of projections towards the isthmic portion, where the projections become longer more numerous. The endosalpinx becomes more tortuous, the lumen diameter increases and the mucosal projections become more bulky in the ampullary portion, with the projections less present on the antimesenteric side. The infundibular portion is marked with the organized and predictable endosalpinx, the abdominal ostium is cleared demonstrated, with the reduction of the endosalpinx volume. The fimbria demonstrated a small relation between fringes and intratubal endosalpinx.

Conclusions: Microscopic anatomy of different segments of the human FT mucosa can be analyzed and reconstructed in 3D with histological correlation using micro-CT.
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http://dx.doi.org/10.5114/pjr.2019.86824DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6717942PMC
June 2019

Symmetric and ventrally conjoined twins: prenatal evaluation by ultrasound and magnetic resonance imaging and postnatal outcomes.

J Matern Fetal Neonatal Med 2021 Jun 12;34(12):1955-1962. Epub 2019 Aug 12.

Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil.

Objective: To review the perinatal and long-term outcomes of symmetric and ventrally conjoined twins evaluated prenatally by ultrasound and fetal magnetic resonance imaging (MRI).

Methods: From March 2010 to January 2019, cases of symmetric and ventrally conjoined twins, who were prenatally diagnosed and referred to the Clínica Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil, for prenatal evaluation by ultrasound and MRI were selected. The postnatal information was collected from hospitals where the twins were born and/or treated and from parents' verbal and written information.

Results: Four cases of symmetrical and ventrally conjoined twins were selected. Of these, two were omphalopagi and two thoracopagi. One pair of thoracomphalopagus died early and the other died 6 days after birth. The outcome of the two omphalopagus pairs were separation in emergency surgeries after birth, with neonatal demise of one of the twins due to congenital malformations. In cases of omphalopagi, fetal MRI presented important information of the twins' anatomy before emergency separation of both pairs.

Conclusion: Despite the apparently similar conditions of twins with ventral fusion, ventrally attached twins have very different outcomes, most adverse for thoracomphalopagus and related to the singular anatomy of the pair, associated malformations and the extension of the adhesion, requiring individual evaluation of the cases. Fetal MRI is as an important tool for the postnatal surgery management of twin neonates, providing crucial information in cases where urgent separation is required.
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http://dx.doi.org/10.1080/14767058.2019.1651282DOI Listing
June 2021

Prenatal Diagnosis of Jejunal Atresia by 3-D Ultrasonography and MRI.

J Obstet Gynaecol Can 2019 Nov 14;41(11):1529-1530. Epub 2019 Feb 14.

Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil; Medicine Course, Municipal University of São Caetano do Sul (USCS), São Paulo, Brazil. Electronic address:

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http://dx.doi.org/10.1016/j.jogc.2018.06.022DOI Listing
November 2019

Diagnostic prénatal de l'atrésie jéjunale par échographie 3D et IRM.

J Obstet Gynaecol Can 2019 Nov 14;41(11):1531-1532. Epub 2019 Feb 14.

Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil; Medicine Course, Municipal University of São Caetano do Sul (USCS), São Paulo, Brazil.

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http://dx.doi.org/10.1016/j.jogc.2018.12.008DOI Listing
November 2019
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