Publications by authors named "Renato Augusto Moreira de Sá"

32 Publications

Maternal and perinatal outcomes in high vs low risk-pregnancies affected by SARS-COV-2 infection (Phase-2): The WAPM (World Association of Perinatal Medicine) working group on COVID-19.

Authors:
Francesco D'Antonio Cihat Sen Daniele DI Mascio Alberto Galindo Cecilia Villalain Ignacio Herraiz Resul Arısoy Ali Ovayolu Hasan Eroğlu Manuel Guerra Canales Subhashini Ladella Liviu Cojocaru Ozhan Turan Sifa Turan Eran Hadar Noa A Brzezinski-Sinai Sarah Dollinger Ozlem Uyaniklar Sakine Rahimli Ocakouglu Zeliha Atak Tanja Premru-Srsen Lilijana Kornhauser-Cerar Mirjam Druškovič Liana Ples Reyhan Gündüz Elif Ağaçayak Javier Alfonso Schvartzman Mercedes Negri Malbran Marco Liberati Francesca Di Sebastiano Ludovica Oronzi Chiara Cerra Danilo Buca Angelo Cagnacci Arianna Ramone Fabio Barra Andrea Carosso Chiara Benedetto Stefano Cosma Axelle Pintiaux Caroline Daelemans Elena Costa Ayşegül Özel Murat Muhçu Jesús S Jimenez Lopez Clara Alvarado Anna Luengo Piqueras Dolores Esteban Oliva Giovanni Battista Luca Schera Nicola Volpe Tiziana Frusca Igor Samardjiski Slagjana Simeonova Irena Aleksioska Papestiev Javier Hojman Ilgin Turkcuoglu Antonella Cromi Antonio Simone Laganà Fabio Ghezzi Angelo Sirico Alessandra Familiari Giovanni Scambia Zulfiya Khodjaeva Gennady T Sukhikh Ksenia A Gorina Renato Augusto Moreira de Sa Mariana Vaz Otto Henrique May Feuerschuette Anna Nunzia Della Gatta Aly Youssef Gaetana Di Donna Alicia Martinez-Varea Gabriela Loscalzo José Morales Roselló Vedran Stefanovic Irmeli Nupponen Kaisa Nelskylä Rodrigo Ayala Rebeca Garrote Molpeceres Asunción Pino Vázquez Fabrizio Sandri Ilaria Cataneo Marinella Lenzi Esra Tustas Haberal Erasmo Huertas Amadeo Sanchez Pedro Arango Amanda Bermejo María Monica Gonzalez Alcantara Gökhan Göynümer Erhan Okuyan Ciuhodaru Madalina Ana Concheiro Guisan Alejandra Martínez Schulte Valentina Esposito Valentina De Robertis Snezana Zdjelar Milan Lackovic Sladjana Mihajlovic Nelly Jekova Gabriele Saccone Mehmet Musa Aslan Maria Carmela Di Dedda Maisuri Chalid Jose Enrique Moros Canache George Daskalakis Panos Antsaklis Enrique Criado Vega Elisa Cueto Chiara Taccaliti Alicia Yeliz Aykanat Şerife Özlem Genç Bernd Froessler Petya Angelova Radulova Danila Morano Beatrice Bianchi Maria Giulia Lombana Marino Gabriella Meccariello Bindu Rohatgi Antonio Schiattarella Maddalena Morlando Nicola Colacurci Andrea Villasco Nicoletta Biglia Ana Luiza Santos Marques Alessandra Gatti Daniela Luvero Roberto Angioli Alejandro Pittaro Albert Lila Blanka Zlatohlávková

Am J Obstet Gynecol MFM 2021 Feb 20:100329. Epub 2021 Feb 20.

Department of Obstetrics and Gynecology, Division of Neonatology, General Hospital in Prague and First Faculty of Medicine, Charles University, Prague, Czech Republic.

Objectives: To evaluate maternal and perinatal outcomes in high compared to low-risk pregnancies complicated by SARS-COV-2 infection.

Methods: This was a multinational retrospective cohort study including women with laboratory-confirmed SARS-COV-2 from 76 centers from 25 different countries in Europe, United States, South America, Asia and Australia from 04 April 2020 till 28 October 2020. The primary outcome was a composite measure of maternal mortality and morbidity including admission to intensive care unit (ICU), use of mechanical ventilation, or death. Secondary outcome was a composite measure of adverse perinatal outcome, including miscarriage, fetal loss, neonatal (NND) and perinatal (PND) death, and admission to neonatal intensive care unit. All these outcomes were assessed in high-risk compared to low-risk pregnancies. Pregnancies were considered as high risk in case of either pre-existing chronic medical conditions pre-existing pregnancy or obstetric disorders occurring in pregnancy. Fisher-test and logistic regression analysis were used to analyze the data.

Results: 887 singleton pregnancies tested positive to SARS-COV-2 at RT-PCR nasal and pharyngeal swab were included in the study. The risk of composite adverse maternal outcome was higher in high compared to low risk-pregnancies with an OR of 1.52 (95% CU 1.03-2.24; p= 0.035). Likewise, women carrying a high risk-pregnancies were also at higher risk of hospital admission (OR: 1.48, 95% CI 1.07-2.04; p= 0.002), presence of severe respiratory symptoms (OR: 2.13, 95% CI .41-3.21; p= 0.001), admission to ICU (OR: 2.63, 95% CI 1.42-4.88) and invasive mechanical ventilation (OR: 2.65, 95% CI 1.19- 5.94; p= .002). When exploring perinatal outcomes, high-risk pregnancies were also at high risk of adverse perinatal outcome with an OR 0f 1.78 (95% CI .15-2.72; p= 0.009). However, such association was mainly due to the higher incidence of miscarriage in high risk compared to low risk pregnancies (5.3% vs 1.6%, p= 0.008), while there was no difference as regard as the other explored outcomes between the two study groups. At logistic regression analysis, maternal age (OR: 1.12, 95% CI 1.02-1.22, p= 0.023) and the presence of a high-risk pregnancies (OR: 4.21, 95% CI 3.90-5.11, p<0.001) were independently associated with adverse maternal outcome.

Conclusions: High-risk pregnancies complicated by SARS-COV-2 infection are at higher risk of adverse maternal outcome compared to low-risk gestations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajogmf.2021.100329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7896113PMC
February 2021

Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19.

Authors:
Daniele Di Mascio Cihat Sen Gabriele Saccone Alberto Galindo Amos Grünebaum Jun Yoshimatsu Milan Stanojevic Asım Kurjak Frank Chervenak María José Rodríguez Suárez Zita Maria Gambacorti-Passerini María de Los Angeles Anaya Baz Esther Vanessa Aguilar Galán Yolanda Cuñarro López Juan Antonio De León Luis Ignacio Cueto Hernández Ignacio Herraiz Cecilia Villalain Roberta Venturella Giuseppe Rizzo Ilenia Mappa Giovanni Gerosolima Lars Hellmeyer Josefine Königbauer Giada Ameli Tiziana Frusca Nicola Volpe Giovanni Battista Luca Schera Stefania Fieni Eutalia Esposito Giuliana Simonazzi Gaetana Di Donna Aly Youssef Anna Nunzia Della Gatta Mariano Catello Di Donna Vito Chiantera Natalina Buono Giulio Sozzi Pantaleo Greco Danila Morano Beatrice Bianchi Maria Giulia Lombana Marino Federica Laraud Arianna Ramone Angelo Cagnacci Fabio Barra Claudio Gustavino Simone Ferrero Fabio Ghezzi Antonella Cromi Antonio Simone Laganà Valentina Laurita Longo Francesca Stollagli Angelo Sirico Antonio Lanzone Lorenza Driul Fabiana Cecchini D Serena Xodo Brian Rodriguez Felipe Mercado-Olivares Deena Elkafrawi Giovanni Sisti Rosanna Esposito Antonio Coviello Marco Cerbone Maddalena Morlando Antonio Schiattarella Nicola Colacurci Pasquale De Franciscis Ilaria Cataneo Marinella Lenzi Fabrizio Sandri Riccardo Buscemi Giorgia Gattei Francesca Della Sala Eleonora Valori Maria Cristina Rovellotti Elisa Done Gilles Faron Leonardo Gucciardo Valentina Esposito Flaminia Vena Antonella Giancotti Roberto Brunelli Ludovico Muzii Luigi Nappi Felice Sorrentino Lorenzo Vasciaveo Marco Liberati Danilo Buca Martina Leombroni Francesca Di Sebastiano Luciano Di Tizio Diego Gazzolo Massimo Franchi Quintino Cesare Ianniciello Simone Garzon Giuliano Petriglia Leonardo Borrello Albaro Josè Nieto-Calvache Juan Manuel Burgos-Luna Caroline Kadji Andrew Carlin Elisa Bevilacqua Marina Moucho Pedro Viana Pinto Rita Figueiredo José Morales Roselló Gabriela Loscalzo Alicia Martinez-Varea Vincente Diago Jesús S Jimenez Lopez Alicia Yeliz Aykanat Stefano Cosma Andrea Carosso Chiara Benedetto Amanda Bermejo Otto Henrique May Feuerschuette Ozlem Uyaniklar Sakine Rahimli Ocakouglu Zeliha Atak Reyhan Gündüz Esra Tustas Haberal Bernd Froessler Anupam Parange Peter Palm Igor Samardjiski Chiara Taccaliti Erhan Okuyan George Daskalakis Renato Augusto Moreira de Sa Alejandro Pittaro Maria Luisa Gonzalez-Duran Ana Concheiro Guisan Şerife Özlem Genç Blanka Zlatohlávková Anna Luengo Piqueras Dolores Esteban Oliva Aylin Pelin Cil Olus Api Panos Antsaklis Liana Ples Ioannis Kyvernitakis Holger Maul Marcel Malan Albert Lila Roberta Granese Alfredo Ercoli Giuseppe Zoccali Andrea Villasco Nicoletta Biglia Ciuhodaru Madalina Elena Costa Caroline Daelemans Axelle Pintiaux Elisa Cueto Eran Hadar Sarah Dollinger Noa A Brzezinski Sinai Erasmo Huertas Pedro Arango Amadeo Sanchez Javier Alfonso Schvartzman Liviu Cojocaru Sifa Turan Ozhan Turan Maria Carmela Di Dedda Rebeca Garrote Molpeceres Snezana Zdjelar Tanja Premru-Srsen Lilijana Kornhauser Cerar Mirjam Druškovič Valentina De Robertis Vedran Stefanovic Irmeli Nupponen Kaisa Nelskylä Zulfiya Khodjaeva Ksenia A Gorina Gennady T Sukhikh Giuseppe Maria Maruotti Silvia Visentin Erich Cosmi Jacopo Ferrari Alessandra Gatti Daniela Luvero Roberto Angioli Ludovica Puri Marco Palumbo Giusella D'Urso Francesco Colaleo Agnese Maria Chiara Rapisarda Ilma Floriana Carbone Antonio Mollo Giovanni Nazzaro Mariavittoria Locci Maurizio Guida Attilio Di Spiezio Sardo Pierluigi Benedetti Panici Vincenzo Berghella Maria Elena Flacco Lamberto Manzoli Giuseppe Bifulco Giovanni Scambia Fulvio Zullo Francesco D'Antonio

J Perinat Med 2020 11;48(9):950-958

Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Department of Obstetrics and Gynaecology, Chieti, Italy.

Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09-1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3-7.9; p=0.001) were independently associated with composite adverse fetal outcome. Conclusions Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1515/jpm-2020-0355DOI Listing
November 2020

Abdominal wall endometriosis: experience of the General Surgery Service of the Antônio Pedro University Hospital of the Universidade Federal Fluminense.

Rev Col Bras Cir 2020 18;47:e20202544. Epub 2020 Sep 18.

- Universidade Federal Fluminense, Faculdade de Medicina, Departamento Materno Infantil - Niterói - RJ - Brasil.

Objective: to study the characteristics of women undergoing abdominal surgery with suspected abdominal wall endometriosis or abdominal wall tumor, and to assess the association with age, race and previous cesarean delivery.

Method: retrospective and analytical study carried out from January 2000 to December 2019, at the General Surgery Service of Hospital Universitário Antônio Pedro (HUAP) at Universidade Federal Fluminense (UFF). Medical records of 100 patients with abdominal wall endometriosis and other types of abdominal wall tumors were analyzed. Age, color, previous history of cesarean section or abdominal surgery and histopathological data were verified. The patients were classified as young adults (aged between 18 and 28 years and 11 months) and adults. The SPSS program was used for data analysis, Fisher's test with a significance level of 0.05.

Results: abdominal wall endometriosis with histopathological confirmation was found in 22%, the mean age was 52.28 ± 18.66 which was lower when compared to other diagnoses. There was an association between previous cesarean section and abdominal wall endometriosis (p <0.005).

Conclusion: the women with a diagnosis of abdominal wall endometriosis had undergone previous cesareans (the majority) and were in an active reproductive age. Although the brown skin women were the most frequent, there was no statistical difference.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1590/0100-6991e-20202544DOI Listing
September 2020

An association between successful engraftment of osteosarcoma patient-derived xenografts and clinicopathological findings.

Histol Histopathol 2020 Nov 23;35(11):1295-1307. Epub 2020 Sep 23.

Research Division, National Institute of Orthopedics and Traumatology (INTO), Rio de Janeiro, RJ, Brazil.

Although osteosarcoma is a rare disease, with a global incidence rate estimated at 5.0/million/year, it is the most frequent primary bone sarcoma in children and adolescents. In translational research, the patient-derived xenograft (PDX) model is considered an authentic in vivo model for several types of cancer, as tumorgrafts faithfully retain the biological characteristics of the primary tumors. Our goal was to investigate the association between PDX formation and clinical findings of osteosarcoma patients and the ability of the model to preserve in immunocompromized mice the characteristics of the parental tumor. A fresh sample of the patient tumor obtained from a representative biopsy or from surgical resection was implanted into nude mice. When tumor outgrowths reached ~1,500mm³, fresh PDX fragments were re-transplanted into new hosts. Engraftment in mice was obtained after a latency period of 19-225 days (median 92 days) in 40.54% of the implanted samples. We confirmed the histopathological fidelity between the patient tumor and their respective established PDXs, including the expression of biomarkers. PDX take rate was higher in surgical resection samples, in post-chemotherapy surgical samples and in samples from patients with metastatic disease at presentation. In conclusion, we have shown that the osteosarcoma PDX model reliably recapitulates the morphological aspects of the human disease after serial passage in mice. The observation that more aggressive forms of osteosarcoma, including those with metastatic disease at presentation, have a higher efficiency to generate PDXs provides a promising scenario to address several unanswered issues in clinical oncology.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.14670/HH-18-256DOI Listing
November 2020

Doppler Velocimetry of the Ophthalmic Artery Behavior in Twin Pregnancy.

Ultrasound Q 2020 Sep;36(3):263-267

Pós-Graduação em Ciências Médicas, Fluminense Federal University, Rio de Janeiro, Brazil.

Our main objective was to evaluate the ophthalmic artery Doppler behavior in twin pregnancies and compare with singleton pregnancies. We studied 64 healthy twin pregnant women between 12 to 38 weeks of gestation. Resistance index (RI), pulsatility index (PI), and peak ratio (PR) were determined. The control group consisted of 289 singletons. Linear regression analysis was performed to evaluate the association between gestational age and the ophthalmic indexes. Student t test was used to compare the means and standard deviation of the Doppler indexes. There was a decrease in RI and PI and an increase in PR with advancing gestational age (ρ < 0.0001, 0.0052, and 0.0033). The means ± SDs for RI, PI, and PR were 0.77 ± 0.07, 1.79 ± 0.46, and 0.53 ± 0.12, in women with twin pregnancies and 0.75 ± 0.05, 1.88 ± 0.43, and 0.52 ± 0.10 in singletons. No significant difference was found between the PI and PR values, but significant difference was found in the RI values between the groups (P = 0.0332). We concluded that there are no significant differences in ophthalmic artery behavior in twins and the same reference values established in singleton pregnancies can be applied for PI and PR indexes in the evaluation of twin pregnancies. These indexes were the best to evaluate twin pregnancies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/RUQ.0000000000000480DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7495985PMC
September 2020

Assessment of Fetal Lung Maturity Using Quantitative Ultrasound Analysis in Patients with Prelabor Rupture of Membranes.

Fetal Diagn Ther 2020 10;47(8):636-641. Epub 2020 Jul 10.

Medical Sciences Post Graduation, Universidade Federal Fluminense, Niterói, Brazil,

Introduction: Prelabor rupture of membranes (PROM) is a frequent clinical situation, and the decision about the best time for delivery remains controversial, mainly due to the risk of neonatal respiratory morbidity (NRM). Assessment of fetal lung maturity using ultrasound, a safe method and widely used in current obstetrical practice, could change this scenario. This study was designed to evaluate the ability of quantitative ultrasound method QuantusFLM® to predict NRM in patients with PROM and whether maternal BMI, gestational age, occurrence of the disease, and presence of oligohydramnios influenced the performance.

Methods: Patients with singleton gestations, diagnosis of PROM, and gestational age between 24 and 38 weeks and 6 days were included. Fetal lung image was acquired by ultrasound within 48 h prior to delivery and analyzed by QuantusFLM®. The results were then paired with neonatal outcomes to assess the program's ability to predict the NRM in this specific group. A logistic regression model was created to analyze factors that could affect the test results.

Results: Fifty-four patients were included. Mean maternal BMI was 28.99 kg/m2, and in 25 patients (46.2%), oligohydramnios was observed at the time of examination. Mean gestational age at delivery was 35 weeks and 4 days, and the NRM prevalence was of 18.5%. QuantusFLM® predicted NRM with a 60% sensitivity, 79.5% specificity, 40% positive predictive value, 89.7% negative predictive value, and 75.6% accuracy. Maternal BMI, disease occurrence, presence of oligohydramnios, and gestational age did not interfere with the evaluation.

Conclusion: This study demonstrates a good accuracy of QuantusFLM® as a NRM predictor in patients with PROM, with particular reliability in identifying that pulmonary maturity has already occurred.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000507550DOI Listing
July 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).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.15557/JoU.2020.0017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7409559PMC
June 2020

Aortic Isthmus Doppler Velocimetry in Fetuses with Intrauterine Growth Restriction: A Literature Review.

Rev Bras Ginecol Obstet 2020 May 29;42(5):289-296. Epub 2020 May 29.

Fetal Medicine Department, Instituto Fernandes Figueira, Rio de Janeiro, RJ, Brazil.

Intrauterine growth restriction (IUGR) is associated with poor perinatal prognosis and a higher risk of stillbirth, neonatal death, and cerebral palsy. Its detection and the evaluation of its severity by new Doppler velocimetric parameters, such as aortic isthmus (AoI), are of great relevance for obstetrical practice. The AoI is a vascular segment that represents a point of communication between the right and left fetal circulations. It is considered to be a functional arterial shunt that reflects the relationship between the systemic and cerebral impedances, and has recently been proposed as a tool to detect the status of hemodynamic balance and prognosis of IUGR in fetuses. In the present review, we noticed that in healthy fetuses, the AoI net flow is always antegrade, but in fetuses with IUGR the deterioration of placental function leads to progressive reduction in its flow until it becomes mostly retrograde; this point is associated with a drastic reduction in oxygen delivery to the brain. The more impaired the AoI flow is, the greater is the risk of impairment in the Doppler velocimetry of other vessels; and the alterations of the AoI Doppler seem to precede other indicators of severe hypoxemia. Although there seems to be an association between the presence of retrograde flow in the AoI and the risk of long-term neurologic disability, its role in the prediction of perinatal morbi-mortality remains unclear. The AoI Doppler seems to be a promising tool in the management of fetuses with IUGR, but more studies are needed to investigate its employment in clinical practice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0040-1710301DOI Listing
May 2020

Maternal obesity influences the endocrine cord blood profile of their offspring.

J Perinat Med 2020 Mar;48(3):242-248

Medical School Universities of Zagreb and Sarajevo, Zagreb, Croatia.

Objective To compare the endocrine cord blood characteristics of offspring from obese mothers with those of offspring from healthy controls. Methods Cross-sectional case control study.

Setting: University medical centers.

Patient(s): Offspring from obese mothers (n = 41) and healthy controls (n = 31).

Intervention(s): Cord blood withdrawal from neonates.

Main Outcome Measure(s): Cord blood total cholesterol (TC), triglycerides (TGs), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), blood glucose (GL) and insulin (Ins). Result(s) Fetal GL and TGs were reduced in the offspring of obese women when compared to those in the offspring of the controls. The mean cord blood GL level was 47.8 mg/dL standard deviation (SD 33.1) in the offspring of the obese group vs. 57.9 mg/dL (SD 12.5) in the offspring of the control group, and the mean cord blood TG level was 26.5 (SD 33.6) in the offspring of the obese group vs. 34.6 (SD 12.3) in the offspring of the control group. Maternal obesity was also associated with reduced levels of TC and HDL-C in the pregnant women. Conclusion The observed results suggest that GL and TGs in the cord blood of the offspring of obese mothers were significantly lower than those in the offspring of the control group.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1515/jpm-2019-0387DOI Listing
March 2020

Behavior of fetal longitudinal myocardial fibers assessed by speckle tracking to obtain strain and strain rate values for low-risk pregnancies.

J Perinat Med 2020 Feb;48(2):144-152

Fernandes Figueira Institute - FIOCRUZ, Av. Rui Barbosa, 716 - Flamengo, Rio de Janeiro, RJ 20021-140, Brazil.

Objective To analyze the behavior of fetal longitudinal myocardial fibers assessed by speckle tracking (STE) after fetal viability. Methods A cross-sectional study was performed in 156 women with normal singleton pregnancies from 22 to 31 weeks of gestation. Strain (S) and strain rate (SR) values were measured in both ventricles during the fetal cardiac cycle. The population was divided into five gestational age groups based on 2-week intervals. The correlations of maternal variables with the S and SR variables and intra-observer analysis were performed. Results There was a significant difference in the S and SR values of the left ventricle (LV) among the gestational age groups (P = 0.007). Significantly higher S and SR values were observed in early age groups demonstrating reductions in LV S and SR values at 26 weeks, followed by stabilization. For the right ventricle (RV), there was no significant difference between gestational age groups. Significant intra-observer agreement was observed for S values of the RV (P = 0.008) and LV (P = 0.0004) and SR values of the RV (P = 0.0001) and LV (P = 0.015). Conclusion Decreases in the S and SR values of the LV occurred after 26 weeks, followed by stabilization. No significant difference was observed in the S or SR value of the RV among the gestational age groups, and no significant association of any maternal variable evaluated with S and SR values was observed. Significant intra-observer agreement was obtained among the results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1515/jpm-2019-0342DOI Listing
February 2020

Predictors of perinatal outcome in early-onset fetal growth restriction: A study from an emerging economy country.

Prenat Diagn 2020 02 3;40(3):373-379. Epub 2020 Jan 3.

Clinical Research Department, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira-Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.

Objective: To identify antenatal predictors of adverse perinatal outcomes in a population of preterm fetuses with early placental insufficiency diagnosed by Doppler abnormalities.

Method: In this cross-sectional study of a cohort of singleton pregnant women diagnosed with early placental insufficiency, relationships between perinatal variables (arterial and venous Doppler, gestational age, birth weight, oligohydramnios, estimated fetal weight, and fetal weight z-scores) and major neonatal complications were analyzed by logistic regression.

Results: Two hundred sixty-five women were delivered, between 24 and 33 weeks gestation. The overall frequency of intact survival was 57.9% (n = 154). Gestational age thresholds for best prediction of survival was 27 + 6 weeks and for intact survival was 29 + 0 weeks gestation. Fetal weight and absent/reversed ductus venosus a-wave were the main predictors of survival in the regression model. When fetal weight was substituted for fetal weight z-score, ductus venosus abnormal Doppler predicted mortality and absent or reversed umbilical artery diastolic velocities predicted intact survival.

Conclusions: This study illustrates the impact of gestational age and fetal weight on perinatal outcomes in early placental insufficiency, with well-defined thresholds. Gestational age and fetal weight, or a combination of fetal weight z-scores and fetal Doppler parameters, were the best predictors of intact survival in our sample.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/pd.5596DOI Listing
February 2020

Heterotopic cervical pregnancy after in-vitro fertilization - case report and literature review.

JBRA Assist Reprod 2019 08 22;23(3):290-296. Epub 2019 Aug 22.

Universidade Federal do Estado do Rio de Janeiro (UNIRIO) - Rio de Janeiro - RJ - Brazil.

Heterotopic cervical pregnancy is an uncommon condition, with a rising incidence due to the increasing number of pregnancies resulting from in-vitro fertilization (IVF). Although it is associated with maternal-fetal complications, there is no consensus in the literature about the best approach for this condition. This study aims to report a case of cervical heterotopic gestation after IVF in which the intrauterine pregnancy was preserved, with spontaneous elimination of the cervical gestational sac after patient sedation and introduction of the vaginal speculum. In addition, we reviewed the literature on the subject, which demonstrated that most cases have a favorable outcome, especially after treatment with surgical excision of the cervical pregnancy. The growing body of evidence is still scarce to define the best treatment for this condition.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5935/1518-0557.20190017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6724399PMC
August 2019

First-trimester Combined Screening Test for Aneuploidies in Brazilian Unselected Pregnancies: Diagnostic Performance of Fetal Medicine Foundation Algorithm.

Rev Bras Ginecol Obstet 2018 Jul 16;40(7):384-389. Epub 2018 Jul 16.

Department of Woman and Child Health, Universidade Federal Fluminense, Niterói, RJ, Brazil.

Objective:  The main objective of this study was to examine the diagnostic performance of the first-trimester combined test for aneuploidies in unselected pregnancies from Rio de Janeiro and compare it with the examples available in the literature.

Methods:  We investigated 3,639 patients submitted to aneuploidy screening from February 2009 to September 2015. The examination is composed of the Fetal Medicine Foundation risk evaluation based on nuchal translucency evaluation, mother's age, presence of risk factors, presence of the nasal bone and Doppler of the ductus venous in addition to biochemical analysis of pregnancy-associated plasma protein A (PAPP-A) and beta-human chorionic gonadotropin (β-hCG) markers. The cut-off point for high risk for aneuploidies was defined as greater than 1:100, with intermediate risk defined between 1:100 and 1:1,000, and low risk defined as less than 1:1,000. The variable aneuploidy was considered as a result not only of trisomy of chromosome 21 but also trisomy of chromosomes 13 and 18.

Results:  Excluding the losses, the results of 2,748 patients were analyzed. The first-trimester combined test achieved 71.4% sensitivity with a 7.4% false-positive (FP) rate, specificity of 92.6%, positive predictive value (PPV) of 6.91% and negative predictive value (NPV) of 99.76%, when the cut-off point considered was greater than 1:1,000. Through a receiving operating characteristics (ROC) curve, the cut-off point that maximized the sensitivity and specificity for the diagnosis of aneuploidies was defined as 1:1,860. When we adjusted the false-positive (FP) rate to 5%, the detection rate for this analysis is 72.7%, with a cut-off point of 1:610.

Conclusion:  The combined test of aneuploidy screening showed a detection rate inferior to those described in the literature for a higher FP rate.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0038-1666996DOI Listing
July 2018

Magnesium sulfate and ophthalmic artery Doppler velocimetry in patients with severe preeclampsia: a case series.

J Med Case Rep 2017 Nov 20;11(1):326. Epub 2017 Nov 20.

Grupo Perinatal, Rio de Janeiro, RJ, Brazil.

Background: In the present study, we used Doppler velocimetry in the ophthalmic artery to evaluate the hemodynamic status of the intracranial vasculature. This is the first time in the literature that indices of ophthalmic artery Doppler sonography of women with preeclampsia were evaluated before and after the use of magnesium sulfate to prevent eclampsia.

Case Presentation: Indices of ophthalmic artery Doppler sonography of six women with severe preeclampsia at 27 to 33 weeks of gestational age were evaluated before and after the use of magnesium sulfate (10 minutes, 30 minutes, and 60 minutes after the magnesium sulfate loading dosage. The patients' ages were 26 years (patient 01), 29 years (patient 02), 20 years (patient 03), 21 years (patient 04), 20 years (patient 05), and 19 years (patient 06). The ethnic group of patients 01 and 04 was white and the ethnic group of patients 02, 03, 05 and 06 was mulatto.

Conclusions: The apparent increase in resistance index and pulsatility index values, although there is no statistical significance in this series of cases, and the decrease in peak ratio values after the administration of magnesium sulfate reflect an increase in the impedance to flow in the ophthalmic artery and consequently a reduction in cerebral perfusion after the use of magnesium sulfate. This may explain how magnesium sulfate protects women with severe preeclampsia against cerebral damage and prevents acute convulsions in these patients. We believe that this case series report may have a broader clinical impact across medicine because the mechanism of how magnesium sulfate can protect patients and prevent acute convulsions is controversial.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13256-017-1490-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5694913PMC
November 2017

3-D Virtual Reconstruction of a Large Amniocele With Protrusion of Legs and Umbilical Cord Following Asymptomatic Uterine Rupture.

J Obstet Gynaecol Can 2018 Jan 29;40(1):75-77. Epub 2017 Jul 29.

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

Background: Complete uterine rupture is a rare and severe intrapartum complication with high rates of maternal and fetal mortality. Asymptomatic uterine rupture is a very rare condition with one unique previous case described in the literature. Three-dimensional virtual models allow an immersive virtual reality of maternal-fetal structures with better understanding by the parents and the medical team.

Case: We demonstrate a case of asymptomatic rupture uterine with a large amniocele and protruded legs and umbilical cord at 28 weeks of gestation by using a 3-D virtual model from ultrasound scan data.

Conclusion: 3-D virtual models may be applied to the assessment of obstetric complications, thereby allowing a novel 3-D spatial view of maternal-fetal structures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jogc.2017.05.025DOI Listing
January 2018

Zika Virus Infection in Pregnant Women and Microcephaly.

Rev Bras Ginecol Obstet 2017 05 2;39(5):235-248. Epub 2017 Jun 2.

Universidade de São Paulo, São Paulo, SP, Brazil.

From the discovery of the Zika virus (ZIKV) in 1947 in Uganda (Africa), until its arrival in South America, it was not known that it would affect human reproductive life so severely. Today, damage to the central nervous system is known to be multiple, and microcephaly is considered the tip of the iceberg. Microcephaly actually represents the epilogue of this infection's devastating process on the central nervous system of embryos and fetuses. As a result of central nervous system aggression by the ZIKV, this infection brings the possibility of arthrogryposis, dysphagia, deafness and visual impairment. All of these changes of varying severity directly or indirectly compromise the future life of these children, and are already considered a congenital syndrome linked to the ZIKV. Diagnosis is one of the main difficulties in the approach of this infection. Considering the clinical part, it has manifestations common to infections by the dengue virus and the chikungunya fever, varying only in subjective intensities. The most frequent clinical variables are rash, febrile state, non-purulent conjunctivitis and arthralgia, among others. In terms of laboratory resources, there are also limitations to the subsidiary diagnosis. Molecular biology tests are based on polymerase chain reaction (PCR) with reverse transcriptase (RT) action, since the ZIKV is a ribonucleic acid (RNA) virus. The RT-PCR shows serum or plasma positivity for a short period of time, no more than five days after the onset of the signs and symptoms. The ZIKV urine test is positive for a longer period, up to 14 days. There are still no reliable techniques for the serological diagnosis of this infection. If there are no complications (meningoencephalitis or Guillain-Barré syndrome), further examination is unnecessary to assess systemic impairment. However, evidence is needed to rule out other infections that also cause rashes, such as dengue, chikungunya, syphilis, toxoplasmosis, cytomegalovirus, rubella, and herpes. There is no specific antiviral therapy against ZIKV, and the therapeutic approach to infected pregnant women is limited to the use of antipyretics and analgesics. Anti-inflammatory drugs should be avoided until the diagnosis of dengue is discarded. There is no need to modify the schedule of prenatal visits for pregnant women infected by ZIKV, but it is necessary to guarantee three ultrasound examinations during pregnancy for low-risk pregnancies, and monthly for pregnant women with confirmed ZIKV infection. Vaginal delivery and natural breastfeeding are advised.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0037-1603450DOI Listing
May 2017

Ultrasonographic Evaluation of Uterine Involution in the Early Puerperium.

Rev Bras Ginecol Obstet 2017 Apr 3;39(4):149-154. Epub 2017 Apr 3.

Medical Sciences Post Graduation, Universidade Federal Fluminense, Niterói, RJ, Brazil.

 Our aim was to describe the changes observed by ultrasonography in uterine dimensions during the early puerperium among women who experienced an uncomplicated puerperium. Additionally, the influence of parity, mode of delivery, breastfeeding and birth weight on uterine involution was evaluated.  Ninety-one patients underwent an ultrasound examination on days 1 (D1), 2 (D2) and 7 (D7) of the postpartum period. The longitudinal, anteroposterior and transverse uterine diameters were measured, and the uterine volume was calculated by the formula: longitudinal diameter (LD) X anteroposterior diameter (APD) X transverse diameter (TD) X 0.45. The thickness and length of the uterine cavity were also measured.  The uterine volume and the LD, APD and TD decreased by 44.8%, 20.9%, 11.8% and 20.0% respectively. The uterine cavity thickness was reduced by 23%, and the length of the cavity was reduced by 27.2% on D7. Uterine involution was correlated inversely with parity when the day of the postpartum period was not taken into account ( = 0.01). However, when the uterine involution was correlated to parity separately, with D1, D2 or D3, no correlations were found. A significant difference occurred at D2, when it was found that the uterus had a smaller volume following cesarean section compared with vaginal delivery ( = 0.04). The high birth weight and breastfeeding were significantly related to uterine involution (p ≤ 0.01 and  = 0.04).  The sonographic evaluation of the uterus in the early puerperium should consider birth weight, breastfeeding and parity, as well as the delivery route on D2, to identify abnormalities related to uterine involution.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0037-1601418DOI Listing
April 2017

Fetal magnetic resonance imaging and ultrasound.

J Perinat Med 2016 Jul;44(5):533-42

Magnetic resonance imaging (MRI) has been increasingly adopted in obstetrics practice in the past three decades. MRI aids prenatal ultrasound and improves diagnostic accuracy for selected maternal and fetal conditions. However, it should be considered only when high-quality ultrasound cannot provide certain information that affects the counseling, prenatal intervention, pregnancy course, and delivery plan. Major indications of fetal MRI include, but are not restricted to, morbidly adherent placenta, selected cases of fetal brain anomalies, thoracic lesions (especially in severe congenital diaphragmatic hernia), and soft tissue tumors at head and neck regions of the fetus. For fetal anatomy assessment, a 1.5-Tesla machine with a fast T2-weighted single-shot technique is recommended for image requisition of common fetal abnormalities. Individual judgment needs to be applied when considering usage of a 3-Tesla machine. Gadolinium MRI contrast is not recommended during pregnancy. MRI should be avoided in the first half of pregnancy due to small fetal structures and motion artifacts. Assessment of fetal cerebral cortex can be achieved with MRI in the third trimester. MRI is a viable research tool for noninvasive interrogation of the fetus and the placenta.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1515/jpm-2015-0226DOI Listing
July 2016

Controversial ultrasound findings in mid trimester pregnancy. Evidence based approach.

J Perinat Med 2016 Mar;44(2):131-7

Mid trimester fetal anatomy scan is a fundamental part of routine antenatal care. Some U/S soft markers or controversial U/S signs are seen during the scan and create some confusion regarding their relation to fetal chromosomal abnormalities. Example of these signs: echogenic focus in the heart, echogenic bowel, renal pyelectasis, ventriculomegaly, polydactely, club foot, choroid plexus cyst, single umbilical artery. We are presenting an evidence based approach from the literature for management of these controversial U/S signs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1515/jpm-2015-0223DOI Listing
March 2016

Ultrasound in Africa: what can really be done?

J Perinat Med 2016 Mar;44(2):119-23

Today we are living in a globalized world in which information on what is happening in one part of the world is easily communicated to other parts of the world. This happens thanks to advancement in science and technology. One area where technology has made the greatest impact is heath care provision. Ultrasound technology is now playing a critical role in health care provision particularly in Obstetrics and Gynaecology. This has significantly assisted in provision of quality health care to pregnant women and their unborn infants and in reducing maternal and neonatal morbidity and mortality in the developed world. Africa the continent with greatest health care challenges and with the highest maternal and neonatal mortalities is yet to fully utilize this important technology. The need for this technology is great as the conditions requiring its application abound. The effective application of Ultrasound however faces serious challenges in Africa. To successfully entrench Ultrasound in quality Obstetrics and Gynaecology care various approaches must be adopted to overcome the challenges. The aim of this paper is to identify the benefits and the challenges inimical to the application Ultrasound in Obstetrics and Gynecology in Africa. It also examines what needs to be done to achieve better application of Ultrasound in Obstetrics and Gynecology.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1515/jpm-2015-0224DOI Listing
March 2016

3D/4D sonography - any safety problem.

J Perinat Med 2016 Mar;44(2):125-9

Gray-scale image data are processed in 3D ultrasound by repeated scans of multiple planes within a few seconds to achieve one surface rendering image and three perpendicular plane images. The 4D image is achieved by repeating 3D images in short intervals, i.e. 3D and 4D ultrasound are based on simple B-mode images. During 3D/4D acquisition, a fetus in utero is exposed by ultrasound beam for only a few seconds, and it is as short as real-time B-mode scanning. Therefore, simple 3D imaging is as safe as a simple B-mode scan. The 4D ultrasound is also as safe as a simple B-mode scan, but the ultrasound exposure should be shorter than 30 min. The thermal index (TI) and mechanical index (MI) should both be lower than 1.0, and the ultrasound study is regulated by the Doppler ultrasound if it is combined with simple 3D or 4D ultrasound. Recently, some articles have reported the functional changes of animal fetal brain neuronal cells and liver cell apoptosis with Doppler ultrasound. We discuss cell apoptosis by ultrasound in this report. Diagnostic ultrasound safety is achieved by controlling the output pulse and continuous ultrasound waves using thermal and mechanical indices, which should be <1.0 in abdominal and transvaginal scan, pulsed Doppler, as well as 3D and 4D ultrasound. The lowest spatial peak temporal average (SPTA) intensity of the ultrasound to suppress cultured cell growth is 240 mW/cm2, below which no ultrasound effect has been reported. An ultrasound user must be trained to recognize the ultrasound bioeffects; thermal and mechanical indices, and how to reduce these when they are higher than 1.0 on the monitor display; and guide the proper use of the ultrasound under the ALARA principle, because the user is responsible for ensuring ultrasound safety.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1515/jpm-2015-0225DOI Listing
March 2016

Neonatal outcome in women with preterm premature rupture of membranes (PPROM) between 18 and 26 weeks.

J Matern Fetal Neonatal Med 2016 3;29(7):1108-12. Epub 2015 Jul 3.

c Universidade Federal Fluminense , Niterói , RJ , Brazil , and.

Objective: The aim of this study was to identify adverse neonatal outcomes and identifies the predictors of adverse neonatal outcomes in premature rupture of membranes before 26 weeks.

Methods: Data were collected between January 2005 and December 2011 from all pregnant women who presented preterm premature rupture of membranes (PPROM) between 18 and 26 complete weeks of gestation and were admitted to one of three Brazilian institutes. The adverse outcomes included mortality or the development of a severe morbidity during the length of stay in the neonatal intensive care unit (NICU). The descriptive statistics of the population were reported. A multiple logistic regression was performed for each predictor of neonatal adverse outcomes. The area under the receiver operating characteristics curves for the birth weight was calculated.

Results: Composite adverse outcomes during the NICU stay occurred in 82.1% (n = 23) of the cases and included 33 (54%) neonatal deaths, 19 (67.8%) cases of retinopathy of prematurity (ROP), 13 (46.4%) cases of pulmonary hypoplasia (BPD), 8 (28.5%) cases of periventricular-intraventricular hemorrhage (PIH) and 3 (10.7%) cases of periventricular leukomalacia (PVL). Only 17.8% (n = 5) of the neonates survived without morbidity. The area under the curve for the birth weight was 0.90 (95% IC: 0.81-0.98) for the prediction of mortality.

Conclusions: PPROM before 26 weeks has a high morbidity and mortality, and the significant predictors of neonatal mortality and adverse outcomes were antibiotic prophylaxis, latency period, GA at birth and birth weight. Nevertheless, the only independent significant predictor of survival rate was birth weight.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/14767058.2015.1035643DOI Listing
December 2016

Is intrauterine surgery justified? Report from the working group on ultrasound in obstetrics of the World Association of Perinatal Medicine (WAPM).

J Perinat Med 2016 Oct;44(7):737-743

Fetal surgery involves a large number of heterogeneous interventions that vary from simple and settled procedures to very sophisticated or still-in-development approaches. The overarching goal of fetal interventions is clear: to improve the health of children by intervening before birth to correct or treat prenatally diagnosed abnormalities. This article provides an overview of fetal interventions, ethical approaches in fetal surgery, and benefits obtained from antenatal surgeries.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1515/jpm-2015-0132DOI Listing
October 2016

3D ultrasonography to evaluate fetal urinary production rates in twin gestation: construction of a normal value curve.

Twin Res Hum Genet 2014 Feb 13;17(1):45-50. Epub 2013 Dec 13.

Department of Obstetrics and Maternal-Fetal Medicine, Université Paris Descartes, Paris, France.

Objective: The aim of this study was to assess fetal urinary production rates (FUPR) in twin gestations using 3D ultrasonography with VOCAL® (virtual organ computer-aided analysis) and to develop a curve of normal values for the target population.

Methods: A cross-sectional study was performed in 30 normal twin pregnancies with gestational ages ranging from 20 to 34 weeks. FUPR was measured using a three-dimensional ultrasound (3D US) virtual organ computer-aided analysis (VOCAL) system. FUPR (ml/hour) was calculated during the filling phase using the equation UPR = (VFB(2) - VFB(1))/time. The values for UPR were plotted as a function of fetal biometry (biparietal diameter) to generate a nomogram.

Results: A total of 41 normal twin fetuses with gestational ages between 20 and 34 weeks were investigated. Eleven were excluded because of inadequate bladder contour image quality and/or the observation of micturition in one or both fetuses. Linear regression analysis of FUPR as a function of biparietal diameter (BPD) shows the normal range for UPR by fetal biometry and is expressed by the following equation: Ln(UPR) = -5.0121 + 0.0548 BPD (R(2) 0.3386, p value <.001). There was no statistically significant difference when the UPR was stratified by chorionicity.

Conclusions: The use of biometric parameters to predict fetal FUPR seems to be useful. In twin pregnancies, BPD is the variable that is most closely related to FUPR. For each 1 mm increase in BPD, there is a 5% increase in FUPR. Chorionicity did not affect FUPR.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/thg.2013.82DOI Listing
February 2014

Changes in ophthalmic artery Doppler indices in hypertensive disorders during pregnancy.

J Ultrasound Med 2013 Apr;32(4):609-16

Universidade Federal Fluminense, Rio de Janeiro, Brazil.

Objectives: To compare the ophthalmic artery Doppler indices observed in women with singleton pregnancies complicated by hypertension and to correlate the indices observed in hypertensive pregnant women with those observed in healthy pregnant women.

Methods: Ophthalmic artery Doppler indices were compared between 30 women with mild preeclampsia, 30 women with severe preeclampsia, and 30 women with chronic hypertension at 20 to 40 weeks' gestation. The control group consisted of 289 normotensive pregnant women. The resistive index, pulsatility index, and peak ratio were measured in the right eye. The mean and standard deviation were calculated for each group. Analysis of variance and the Tukey method were used to compare the means of the Doppler indices between groups. Receiver operating characteristic curves were used to determine the predictive power of the Doppler indices for identification of women with severe preeclampsia. P < .05 was considered statistically significant.

Results: Significant differences were found between the resistive index, pulsatility index, and peak ratio in women with severe preeclampsia compared to the other groups. The means ± SDs for the resistive index, pulsatility index, and pulse ratio in women with severe preeclampsia were 0.63 ± 0.09, 1.13 ± 0.31, and 0.89 ± 0.12, respectively. The optimal cutoff values for the resistive index, pulsatility index and the peak ratio for identification of women with severe preeclampsia were determined by the receiver operating characteristic curves to be 0.657, 1.318, and 0.784.

Conclusions: Doppler imaging of the ophthalmic artery showed central overperfusion among pregnant women with severe preeclampsia. The peak ratio was the best index for discriminating between severe and mild preeclampsia or chronic hypertension.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7863/jum.2013.32.4.609DOI Listing
April 2013

Doppler velocimetry of ductus venous in preterm fetuses with brain sparing effect: neonatal outcome.

J Prenat Med 2012 Jul;6(3):40-6

Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil ; Perinatal Clinic of Laranjeiras, Rio de Janeiro, Brasil.

Objective: to evaluate the relationship between ductus venous (DV) and Doppler velocimetry in neonatal outcome in severe compromised preterm fetuses.

Methods: the study was designed as an observational and cross-sectional study with 52 premature neonates with brain sparing effect. The criteria of neonatal severe morbidity were: severe intraventricular hemorrhage (grades 3 or 4), retinopathy of prematurity (grade 3 or 4), cystic periventricular leukomalatia, bronchopneumo dysplasia and neonatal mortality. The fetuses were divided in two groups: group 0 - all the fetuses with ventricular systole/atrial contraction (S/A) in DV ratio values less them 3.4; group 1 - fetuses with values of S/A ratio greater than 3.4.

Results: 42% of fetuses showed abnormal S/A ratio in DV and 48% showed birth weight below percentile 3 for gestational age. There was no statistical significance comparing the 02 groups according to bronchopneumo dysplasia, retinopathy of prematurity (grade 3 or 4) and intraventricular hemorrhage (grade 3 or 4). Only one fetus presented cystic periventricular leukomalatia. We found statistically significant association between abnormal DV S/A ratio and neonatal mortality (CI 95%, 1.28 -38.22, p< 0.002).

Conclusions: our results suggest that abnormal DV blood flow detected by Doppler examination isn't associated with severe neonatal morbidity but with neonatal mortality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3503520PMC
July 2012

Normal range for fetal urine production rate customized by biometry.

Arch Gynecol Obstet 2013 Jan 17;287(1):31-5. Epub 2012 Aug 17.

Department of Obstetrics, Fernandes Figueira Institute, Oswaldo Cruz Foundation (IFF-FIOCRUZ), Avenida Rui Barbosa 716, 3 degrees Andar, Flamengo, Rio de Janeiro, Brazil.

Objective: The aim of this study was to develop a nomogram for fetal urine production (UPR) using biometric parameters.

Methods: A cross-sectional study was performed in 110 normal singleton fetuses with gestational ages ranging from 20 to 40 weeks. UPR was measured using tridimensional ultrasound (3-DUS) virtual organ computer-aided analysis. UPR (ml/h) was calculated during the filling phase using the equation, UPR = (VFB2-VFB1)/time. The values for UPR were plotted as a function of fetal biometry (femur, humerus, abdominal circumference, and head circumference and biparietal diameter) to obtain a nomogram for each parameter.

Results: A total of 110 normal singleton fetuses with gestational age between 20 and 40 weeks were investigated. Five of them were excluded because the image quality was insufficient for correct visualization of the bladder contour. Linear regression analysis of UPR as a function of femur, humerus, abdominal circumference, and head circumference and biparietal diameter generated curves that represents the normal range for UPR by fetal biometry, and expressed by the following equations: (1) Humerus length (HL): ln (UPR) = -5.9546 + 0.0958 × HL (mm); (R(2) 0.6422); (2) abdominal circumference: ln (UPR) = -1.0981 + 0.158 × AC (mm); (R(2) 0.6328); (3) femur length: ln (UPR) = -1.5133 + 0.0803 × FL (mm); (R(2) 0.6611); (4) biparietal diameter ln (UPR) = -7.8779 + 0.2368 × BPD-0.0012 × DBP(2); (R(2) 0.7066). Although BPD has the highest correlation coefficient (R(2) 0.7066) there was no statistical significant difference between the parameters investigated for UPR prediction.

Conclusion: The use of biometric parameters for prediction of fetal UPR seems to be useful and can avoid the necessity of building local nomograms for different populations. The same strategy should be considered to other fields in fetal medicine.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00404-012-2516-yDOI Listing
January 2013

Doppler velocimetry of the ophthalmic artery: reproducibility of blood flow velocity measurements.

J Ultrasound Med 2012 Jun;31(6):879-84

Universidade Federal Fluminense, Rio de Janeiro, Brazil.

Objectives: The aim of this study was to investigate the interobserver reliability for measuring ophthalmic artery Doppler indices.

Methods: Healthy women (n = 30) were evaluated. The resistive index, pulsatility index, and peak ratio were determined by two independent observers who were blind to each other. A paired t test was used for the comparison of paired samples in the cases of replication between observers. Pearson product-moment correlation was used to study the relationship between the samples. The Bland-Altman graphic approach was used to investigate the agreement between observers.

Results: No significant differences were found between the values obtained by the two independent observers for the resistive index and pulsatility index. The difference observed between the values obtained by the observers for the peak ratio was 0.02.

Conclusions: Doppler velocimetry is a reproducible technique for evaluation of the resistive index and pulsatility index. For analysis of the peak ratio, an interval of ±0.02 should be considered for the measurement.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7863/jum.2012.31.6.879DOI Listing
June 2012

Doppler sonography of maternal cerebral arteries in pregnancy: side-to-side differences.

Gynecol Obstet Invest 2011 15;72(1):25-31. Epub 2010 Dec 15.

Clínica Perinatal, Bonsucesso General Hospital, Fluminense Federal University,Av. Abelardo Bueno 201, Barra, Rio de Janeiro, Brazil.

Background/aims: To study side-to-side differences in blood flow of the common and internal carotid arteries, and the vertebral arteries (VAs) in women with uncomplicated pregnancies as a first step to build a reference values chart.

Methods: A total of 155 healthy pregnant women between 20 and 40 weeks' gestation were included. Doppler sonography of the common and internal carotid arteries and VAs was performed on both sides. Parameters measured included diameter, peak systolic velocity, systolic-diastolic ratio, end-diastolic velocity, pulsatility index and resistance index. Statistical analysis was performed using the S-Plus 8.0 program. Normality was determined using the Kolmogorov-Smirnov test. Differences between sides were tested using Student's paired t test, association using linear correlation, and agreement using the Bland-Altman method.

Results: Mean values were equal between sides for all parameters with the exception of the end-diastolic velocity in the VAs. The association and agreement between the measurements taken from the right and left sides were poor. Bland-Altman plots also indicated low agreement between sides. All parameters showed significant right-to-left differences.

Conclusion: Despite the equality between means, right and left flows through the vessels studied differed as there was poor association and agreement.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000322218DOI Listing
February 2012

Normal range for fetal urine production rate by 3-D ultrasound in Brazilian population.

Arch Gynecol Obstet 2011 Mar 27;283(3):497-500. Epub 2010 Feb 27.

Grupo Perinatal, Rua das Laranjeiras, 445, Rio de Janeiro, RJ, CEP 22240-002, Brazil.

Objective: The aim of the present study was to establish the normal range for fetal UPR in the Brazilian population.

Methods: A cross-sectional study was performed in 167 normal singleton fetuses with gestational ages ranging from 20 to 40 weeks. UPR was measured using 3-D US virtual organ computer-aided analysis (VOCAL). UPR (in ml/h) was calculated during the filling phase by using the equation UPR = (VFB(2) - VFB(1))/time. The values for UPR were plotted as a function of gestational age to obtain a nomogram. Interobserver reliability was also investigated by using Spearman's rank correlation for comparison of paired samples in cases of replication between observers. Bland and Altman's graphical approach was utilized to investigate the agreement between observers.

Results: A total of 167 normal singleton fetuses with gestational age between 20 and 40 weeks were investigated. Nine of them were excluded because the image quality was insufficient for correct visualization of the bladder contour. Linear regression analysis of UPR as a function of gestational age generated a curve that represents the normal range for fetal UPR in the Brazilian population, and is expressed by the equation: Ln (UPR) = -13.7508 + 0.7094 × GA - 0.0092 × GA(2) (R (2) 0.60). A correlation coefficient of 0.9994 (Spearman) was obtained. Bland and Altman's graphic plots confirm the significant agreement between observers.

Conclusion: Small differences were observed between the values for UPR observed in our sample and the normal values described in previous studies. These differences were observed mainly in late third trimester and are probably related to population biometric differences.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00404-010-1397-1DOI Listing
March 2011