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Provinciatto H, Moreira MVB, Neves GR, De Freitas LR, Mitsui HC, Zhang JMF, Araujo Júnior E. Levothyroxine for subclinical hypothyroidism during pregnancy: an updated systematic review and meta-analysis of randomized controlled trials. Arch Gynecol Obstet 2024:10.1007/s00404-024-07512-3. [PMID: 38676741 DOI: 10.1007/s00404-024-07512-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/07/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE We aimed to perform a systematic review and meta-analysis addressing the efficacy of levothyroxine therapy in pregnant women with subclinical hypothyroidism considering most recent evidence and subgroups of interest for clinical practice. METHODS PubMed, Embase, and Cochrane Central were searched from inception for randomized controlled trials (RCTs) comparing levothyroxine with placebo or no intervention in pregnant women with subclinical hypothyroidism. We used a random-effects model and conducted subgroup analyses based on thyroid peroxidase antibody status, thyroid stimulating hormone levels, fertility treatment, and recurrent miscarriage. RESULTS We included 11 RCTs comprising 2,749 pregnant women with subclinical hypothyroidism. Patients treated with levothyroxine (1,439; 52.3%) had significantly lower risk of pregnancy loss (risk ratio 0.69; 95% confidence interval 0.52-0.91; p < 0.01; 6 studies). However, there was no significant association between levothyroxine and live birth (risk ratio 1.01; 95% confidence interval 0.99-1.03; p = 0.29; 8 studies). No statistically significant interaction was observed across subgroups (p > 0.05). CONCLUSION Levothyroxine replacement therapy for subclinical hypothyroidism during pregnancy may decrease pregnancy loss when early prescribed. Nevertheless, further investigation is needed in patients with thyroid stimulating hormone above four milliunits per liter, especially when associated with recurrent miscarriage or infertility.
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Affiliation(s)
| | | | | | | | - Henrique Costa Mitsui
- Department of Medicine, Federal University of Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil
| | - Julio Min Fei Zhang
- Department of Medicine, University of São Paulo Medical School (USP), São Paulo, SP, Brazil
| | - Edward Araujo Júnior
- 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, 05089-030, Brazil.
- Discipline of Woman Health, Municipal University of São Caetano do Sul (USCS), São Caetano do Sul, SP, Brazil.
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Nieblas CDO, Bravo-Valenzuela NJ, Araujo Júnior E, Werner H. Fetal transposition of the great arteries: 3D virtual and physical models from ultrasound datasets. Int J Cardiovasc Imaging 2024:10.1007/s10554-024-03106-x. [PMID: 38652393 DOI: 10.1007/s10554-024-03106-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Abstract
Transposition of the great arteries (TGA) is a cyanotic congenital heart disease characterized by ventriculoarterial discordance and atrioventricular concordance with the great arteries in a parallel relationship. Prenatal diagnosis of TGA has implications for postnatal outcomes, allowing for planned delivery and perinatal management. Three-dimensional virtual or physical models of fetal TGA allow better understanding of fetal cardiac anomalies by parents and interactive discussion among the multidisciplinary team (obstetricians, pediatricians, maternal-fetal specialists, pediatric cardiologists, and cardiovascular surgeons), as well as continuing medical education.
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Affiliation(s)
| | | | - Edward Araujo Júnior
- Discipline of Woman Health, Municipal University of São Caetano do Sul (USCS), São Caetano do Sul-SP, Brazil.
- 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.
| | - Heron Werner
- Department of Fetal Medicine, Biodesign Laboratory DASA / PUC, Rio de Janeiro-RJ, Brazil
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Alfaro HGDC, Gomes Junior SC, Sá RAMD, Araujo Júnior E. Analysis of Down syndrome newborn outcomes in three neonatal intensive care units in Rio de Janeiro, Brazil. Rev Assoc Med Bras (1992) 2024; 70:e20231186. [PMID: 38656004 DOI: 10.1590/1806-9282.20231186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 09/24/2023] [Indexed: 04/26/2024]
Abstract
OBJECTIVE The aim of this study was to analyze the outcomes of newborns with Down syndrome admitted to three neonatal intensive care units in the city of Rio de Janeiro, Brazil. METHODS A retrospective cohort study was conducted by analyzing the medical records between 2014 and 2018 of newborns with Down syndrome admitted to three neonatal intensive care units. The following variables were analyzed: maternal and perinatal data, neonatal malformations, neonatal intensive care unit intercurrences, and outcomes. RESULTS A total of 119 newborns with Down syndrome were recruited, and 112 were selected for analysis. The most common maternal age group was >35 years (72.07%), the most common type of delivery was cesarean section (83.93%), and the majority of cases were male (53.57%). The most common reasons for neonatal intensive care unit hospitalization were congenital heart disease (57.66%) and prematurity (23.21%). The most common form of feeding was a combination of human milk and formula (83.93%). The second most common malformation was duodenal atresia (9.82%). The most common complications during neonatal intensive care unit hospitalization were transient tachypnea of the newborn (63.39%), hypoglycemia (18.75%), pulmonary hypertension (7.14%), and sepsis (7.14%). The mean length of stay in the neonatal intensive care unit was 27 days. The most common outcome was discharge (82.14%). Furthermore, 12.50% of newborns were transferred to an external neonatal intensive care unit, and 6% died. CONCLUSION Newborns with Down syndrome are more likely to be admitted to the neonatal intensive care unit, and the length of hospital stay is longer due to complications related to congenital malformations common to this syndrome and prematurity.
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Affiliation(s)
- Hanna Gabriela da Cruz Alfaro
- Fernandes Figueira Institute, Oswaldo Cruz Foundation, Department of Obstetrics and Fetal Medicine - Rio de Janeiro (RJ), Brazil
| | - Saint Clair Gomes Junior
- Fernandes Figueira Institute, Oswaldo Cruz Foundation, Department of Obstetrics and Fetal Medicine - Rio de Janeiro (RJ), Brazil
| | - Renato Augusto Moreira de Sá
- Fernandes Figueira Institute, Oswaldo Cruz Foundation, Department of Obstetrics and Fetal Medicine - Rio de Janeiro (RJ), Brazil
- Universidade Federal Fluminense, Department of Obstetrics - Niterói (RJ), Brazil
| | - Edward Araujo Júnior
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Obstetrics - São Paulo (SP), Brazil
- Universidade Municipal de São Caetano do Sul, Discipline of Woman Health - São Paulo (SP), Brazil
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Nieblas CDO, Bravo-Valenzuela NJ, Araujo Júnior E, Castro PT, Werner H. Fetal tetralogy of Fallot: Three-dimensional virtual and physical models from ultrasound scan data findings. J Clin Ultrasound 2024. [PMID: 38619183 DOI: 10.1002/jcu.23696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/16/2024]
Abstract
Three-dimensional reconstructions provide a spatial view of the congenital heart disease with a better understanding of the pathology for parents and allow interactive discussion among the medical team (maternal-fetal medicine specialist, neonatology, pediatric cardiology, and cardiovascular surgeon) and improve both objective knowledge and learner satisfaction for medical students.
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Affiliation(s)
| | | | - Edward Araujo Júnior
- Discipline of Woman Health, Municipal University of São Caetano do Sul (USCS), São Caetano do Sul, SP, Brazil
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Pedro Teixeira Castro
- Department of Fetal Medicine, Biodesign Laboratory DASA/PUC, Rio de Janeiro, RJ, Brazil
| | - Heron Werner
- Department of Fetal Medicine, Biodesign Laboratory DASA/PUC, Rio de Janeiro, RJ, Brazil
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Santos LG, de Sá RAM, Baião AER, Portari EA, de Avila Frayha A, Gomes Junior SC, Araujo Júnior E. Fetal hemodynamics and placental histopathology in Down syndrome. J Clin Ultrasound 2024. [PMID: 38587238 DOI: 10.1002/jcu.23686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/26/2024] [Accepted: 04/01/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To evaluate the association between Doppler patterns in fetuses with Down syndrome (DS) and their placental histopathologic findings. METHODS A retrospective cross-sectional study was performed by collecting data from medical records of singleton pregnancies between January 2014 and January 2022, whose fetuses had a confirmed diagnosis of DS either prenatally or postnatally. Placental histopathology, maternal characteristics, and prenatal ultrasound (biometric parameters and umbilical artery [UA] Doppler) were evaluated. RESULTS Of 69 eligible pregnant women, 61 met the inclusion and exclusion criteria. In the sample, 15 fetuses had an estimated fetal weight < 10th percentile for gestational age (GA) and were considered small for gestational age (SGA). Thirty-eight fetuses had increased resistance on the UA Doppler. Histologic changes were detected in 100% of the placentas, the most common being delayed villous maturation, alterations associated with poor fetal vascular perfusion, and villous dysmorphism. More than 50% of the placentas showed alterations related to placental insufficiency. We did not observe a statistically significant association between UA Doppler examination and placental alterations. All placentas analyzed in the SGA subgroup showed findings compatible with placental insufficiency. CONCLUSION We found no statistically significant association between placental histopathologic findings and UA Doppler abnormalities in fetuses with DS. The placental alterations identified were delayed villous maturation, alterations associated with poor fetal vascular perfusion, and villous dysmorphism.
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Affiliation(s)
- Luisa Guimarães Santos
- Fetal Medicine Service, National Institute of Women, Children and Adolescents Health Fernandes Figueira/Oswaldo Cruz Foundation (IFF/FIOCRUZ), Rio de Janeiro, Brazil
| | - Renato Augusto Moreira de Sá
- Fetal Medicine Service, National Institute of Women, Children and Adolescents Health Fernandes Figueira/Oswaldo Cruz Foundation (IFF/FIOCRUZ), Rio de Janeiro, Brazil
- Department of Obstetrics, Fluminense Federal University (UFF), Niteroi, Brazil
| | - Ana Elisa Rodrigues Baião
- Fetal Medicine Service, National Institute of Women, Children and Adolescents Health Fernandes Figueira/Oswaldo Cruz Foundation (IFF/FIOCRUZ), Rio de Janeiro, Brazil
| | - Elyzabeth Avvad Portari
- Pathology Service, National Institute of Women, Children and Adolescents Health Fernandes Figueira/Oswaldo Cruz Foundation (IFF/FIOCRUZ), Rio de Janeiro, Brazil
| | - Alexia de Avila Frayha
- Fetal Medicine Service, National Institute of Women, Children and Adolescents Health Fernandes Figueira/Oswaldo Cruz Foundation (IFF/FIOCRUZ), Rio de Janeiro, Brazil
| | - Saint Clair Gomes Junior
- Biostatistics Sector, National Institute of Women, Children and Adolescents Health Fernandes Figueira/Oswaldo Cruz Foundation (IFF/FIOCRUZ), Rio de Janeiro, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
- Discipline of Woman Health, Municipal University of São Caetano do Sul (USCS), São Caetano do Sul, Brazil
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Pires GDV, Nieblas CDO, Bravo-Valenzuela NJ, Araujo Júnior E, Castro PT, Werner H. Ebstein anomaly: 3D virtual and physical models from obstetrical ultrasound data. Echocardiography 2024; 41:e15806. [PMID: 38549419 DOI: 10.1111/echo.15806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 04/02/2024] Open
Abstract
3D virtual and physical models from ultrasound scan data allow a 3D spatial view of congenital heart anomalies, interactive discussion among a multidisciplinary team, and improved parental counseling. To the best of our knowledge, this is the first description of 3D physical and virtual models of a fetal Ebstein anomaly.
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Affiliation(s)
- Graziele do Vale Pires
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, São Paulo, Brazil
| | - Caroline de Oliveira Nieblas
- Discipline of Woman Health, Municipal University of São Caetano do Sul (USCS), São Caetano do Sul, São Paulo, Brazil
| | - Nathalie Jeanne Bravo-Valenzuela
- Department of Pediatrics, Pediatric Cardiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, São Paulo, Brazil
- Discipline of Woman Health, Municipal University of São Caetano do Sul (USCS), São Caetano do Sul, São Paulo, Brazil
| | - Pedro Teixeira Castro
- Department of Fetal Medicine, Biodesign Laboratory DASA/PUC, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Heron Werner
- Department of Fetal Medicine, Biodesign Laboratory DASA/PUC, Rio de Janeiro, Rio de Janeiro, Brazil
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Porto ME, Moura AL, Carvalho TR, Gonçalves CC, Freitas NP, Araujo Júnior E, Cavalcante MB. Fertility preservation: knowledge, awareness, and attitude of university students and professors. Minerva Obstet Gynecol 2024; 76:142-150. [PMID: 36222787 DOI: 10.23736/s2724-606x.22.05187-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Delayed pregnancy is a worldwide trend, especially in Western countries. University students and professors are at high risk of presenting age-related reproductive difficulties due to this new reproductive profile. Thus, through this study, we aimed at exploring the knowledge, awareness, and attitude of university students and professors related to fertility and fertility preservation (FP). METHODS We adopted a prospective cross-sectional study design and included students and professors from private university located in the Northeast of Brazil. Eligible participants (male and female) were invited through an online message. The participants accessed the online questionnaire through a link. RESULTS We performed 256 surveys (100 students and 156 professors). The overall mean age of participants was 35.8±13.1 years (from 18 to 67 years). Fertility was considered relevant by all participants, being very important among a greater number of students compared to professors, 61% versus 30.1%, P<0.001, respectively. The main reasons why participants could have postponed parenthood were reach financial stability (62.1%), career building (51.2%), health issues (37.9%), and not having a partner (33.9%). Students demonstrated a better understanding of FP and highlighted the importance of the age of females at the time of the oocyte cryopreservation. Very few students and professors already discussed reproductive planning with a health professional. CONCLUSIONS We observed a deficiency in the knowledge of Brazilian university students and professors about female fertility and FP options. Thus, exposing the population to information related to FP should be hyped in the university environment.
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Affiliation(s)
- Maria E Porto
- Department of Medicine, University of Fortaleza (UNIFOR), Fortaleza, Brazil
| | - Ana L Moura
- Department of Medicine, University of Fortaleza (UNIFOR), Fortaleza, Brazil
| | - Thiago R Carvalho
- Department of Medicine, University of Fortaleza (UNIFOR), Fortaleza, Brazil
| | | | - Natércia P Freitas
- Department of Medical Sciences, University of Fortaleza (UNIFOR), Fortaleza, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil -
- Department of Medicine, Municipal University of São Caetano do Sul (USCS), Bela Vista Campus, São Paulo, Brazil
| | - Marcelo B Cavalcante
- Department of Medicine, University of Fortaleza (UNIFOR), Fortaleza, Brazil
- Department of Medical Sciences, University of Fortaleza (UNIFOR), Fortaleza, Brazil
- Human Reproduction Sector, CONCEPTUS - Reproductive Medicine, Fortaleza, Brazil
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Castro PT, Matos APP, Coutinho CM, Ribeiro G, Araujo Júnior E, Werner H. Is there a role for magnetic resonance imaging in cesarean scar pregnancy after the first trimester? J Clin Ultrasound 2024. [PMID: 38471962 DOI: 10.1002/jcu.23670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 03/05/2024] [Indexed: 03/14/2024]
Abstract
Magnetic resonance imaging (MRI) can provide additional information in cases of cesarean scar pregnancy beyond the first trimester. MRI and 3D reconstructions can demonstrate the relationships between the uterus, cervix, bladder, and placenta, improving the spatial perspective of the pelvic anatomy in cases requiring surgical management. MRI and 3D reconstructions can also provide more comprehensive images for parental counseling, virtual and face-to-face multidisciplinary team discussion, and medical record storage.
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Affiliation(s)
| | - Ana Paula Pinho Matos
- Department of Radiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Conrado Milani Coutinho
- Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of São Paulo (FMRP-USP), Ribeirão Preto, Brazil
| | - Gerson Ribeiro
- Department of Fetal Medicine, Biodesign Laboratory DASA/PUC, Rio de Janeiro, Brazil
- Department of Radiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
- Discipline of Woman Health, Municipal University of São Caetano do Sul (USCS), São Caetano do Sul, Brazil
| | - Heron Werner
- Department of Fetal Medicine, Biodesign Laboratory DASA/PUC, Rio de Janeiro, Brazil
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Araujo Júnior E, Caldas JVJ, Sun SY, Castro PT, Passos JP, Werner H. Placenta acrreta spectrum-first trimester, 2D and 3D ultrasound, and magnetic resonance imaging findings. J Clin Ultrasound 2024; 52:321-330. [PMID: 38126224 DOI: 10.1002/jcu.23627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/23/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The term placenta accreta spectrum (PAS) is commonly used to describe abnormal trophoblastic invasion of the myometrium, serosa, or organs adjacent to the uterus. It is of great obstetric importance because of its high morbidity, risk of hemorrhage, admission to the intensive care unit, risk of hysterectomy, and high risk of iatrogenic pelvic lesions and even death. These risks are minimized when prenatal diagnosis is performed. Prenatal diagnosis of PAS is based on imaging findings suggestive of abnormal and pathologically adherent placentation, including placental lacunae (intraplacental sonolucent spaces), disruption of the bladder-uterine serosa interface, turbulent flow on color Doppler, and bridging vessels. OBJECTIVE In this article, we review the major prenatal imaging features of PAS using diagnostic modalities (first trimester, two-dimensional ultrasound, three-dimensional ultrasound, and magnetic resonance imaging) for the diagnosis of PAS.
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Affiliation(s)
- Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
- Discipline of Woman Health, Municipal University of São Caetano do Sul (USCS), São Caetano do Sul, SP, Brazil
| | - João Victor Jacomele Caldas
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Sue Yasaki Sun
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Pedro Teixeira Castro
- Department of Fetal Medicine, Biodesign Laboratory DASA/PUC, Rio de Janeiro-RJ, Brazil
| | - Jurandir Piassi Passos
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Heron Werner
- Department of Fetal Medicine, Biodesign Laboratory DASA/PUC, Rio de Janeiro-RJ, Brazil
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Pares DBDS, Pacheco GHAS, Lobo GAR, Araujo Júnior E. Intrauterine Transfusion for Rhesus Alloimmunization: A Historical Retrospective Cohort from A Single Reference Center in Brazil. J Clin Med 2024; 13:1362. [PMID: 38592667 PMCID: PMC10931764 DOI: 10.3390/jcm13051362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 02/21/2024] [Accepted: 02/25/2024] [Indexed: 04/10/2024] Open
Abstract
Objective: This study aimed to describe the historical experience of a single reference center in Brazil with intrauterine transfusion (IUT) for Rhesus (Rh) alloimmunization, evaluating the major complications and the perinatal outcomes of this procedure. Methods: This retrospective cohort study evaluated data from medical records of pregnant women between 20 and 34 weeks of gestation whose fetuses underwent IUT by cordocentesis between January 1991 and June 2021. The same experienced examiner performed all procedures. Univariate and multivariate logistic regression was used to assess the effect of fetal hydrops, duration of IUT, post-transfusion cord bleeding time, and bradycardia on death (fetal or neonatal). Results: We analyzed data from 388 IUTs in 169 fetuses of alloimmunized pregnant women with a mean age of 29.3 ± 5.1 years. Death and fetal hydrops were significantly associated at first IUT (p < 0.001). We had two cases of emergency cesarean section (mean of 0.51% per IUT) and three cases of premature rupture of the ovular membranes (mean of 0.77% per procedure). Thirty-six deaths were recorded, including 14 intrauterine and 22 neonatal. A higher percentage of neonatal deaths was observed in the group with post-transfusion cord bleeding time > 120 s (45.8%). The odds of neonatal death were 17.6 and 12.9 times higher in cases with hydrops and bradycardia than in cases without hydrops and bradycardia, respectively. The odds of death (fetal and neonatal) were 79.9 and 92.3 times higher in cases with hydrops and bradycardia than in cases without hydrops and bradycardia, respectively. Conclusions: The most common complications of IUT for Rh alloimmunization were post-transfusion cord bleeding, fetal bradycardia, premature rupture of ovular membranes, and emergency cesarean section. The IUT complication most associated with death (fetal and neonatal) was bradycardia, and the perinatal outcomes were worse in fetuses with hydrops.
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Affiliation(s)
| | | | | | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo 04023-062, SP, Brazil; (D.B.d.S.P.); (G.H.A.S.P.); (G.A.R.L.)
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Bravo-Valenzuela NJ, Beleza MCL, Rezende GB, Trajano Filho E, Kirschner G, Paiva LC, Araujo Júnior E, Nieblas CDO, Castro PT, Werner H. Prenatal diagnosis of fetal left ventricular diverticulum: 3D virtual and physical reconstruction models. J Clin Ultrasound 2024. [PMID: 38366846 DOI: 10.1002/jcu.23650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
Congenital diverticulum is a very rare congenital heart disease. 3D virtual and physical models from ultrasound scan data provide a spatial visualization and better understanding of congenital heart disease to the parents and support possible surgical procedures.
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Affiliation(s)
| | | | | | | | - Gabriela Kirschner
- Service of Gynecology and Obstetrics, Brasília Maternity, Brasília, Brazil
| | | | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
- Discipline of Woman Health, Municipal University of São Caetano do Sul (USCS), São Caetano do Sul, Brazil
| | | | | | - Heron Werner
- Department of Fetal Medicine, Biodesign Laboratory DASA/PUC, Rio de Janeiro, Brazil
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12
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Peixoto AB, Bravo-Valenzuela NJ, Martins WP, Tonni G, Moron AF, Mattar R, Ruano R, Rolo LC, Araujo Júnior E. Impact of overweight and obesity in the fetal cardiac function parameters in the second and third trimesters of pregnancy. Cardiol Young 2024; 34:319-324. [PMID: 37408451 DOI: 10.1017/s1047951123001609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
OBJECTIVE To assess the impact of overweight and obesity in the second and third trimesters of pregnancy on fetal cardiac function parameters. METHODS We performed a prospective cohort study of 374 singleton pregnant women between 20w0d and 36w6d divided into three groups: 154 controls (body mass index - BMI < 25 kg/m2), 140 overweight (BMI 25-30 kg/m2) and 80 obese (BMI ≥ 30 kg/m2). Fetal left ventricular (LV) modified myocardial performance index (Mod-MPI) was calculated according to the following formula: (isovolumetric contraction time + isovolumetric relaxation time)/ejection time. Spectral tissue Doppler was used to determine LV and right ventricular (RV) myocardial performance index (MPI'), peak myocardial velocity during systole (S'), early diastole (E'), and late diastole (A'). RESULTS We found significant differences between the groups in maternal age (p < 0.001), maternal weight (p < 0.001), BMI (p < 0.001), number of pregnancies (p < 0.001), parity (p < 0.001), gestational age (p = 0.013), and estimated fetal weight (p = 0.003). Overweight pregnant women had higher LV Mod-MPI (0.046 versus 0.044 seconds, p = 0.009) and LV MPI' (0.50 versus 0.47 seconds, p < 0.001) than the control group. Obese pregnant women had higher RV E' than control (6.82 versus 6.33 cm/sec, p = 0.008) and overweight (6.82 versus 6.46 cm/sec, p = 0.047) groups. There were no differences in 5-min APGAR score < 7, neonatal intensive care unit admission, hypoglycemia and hyperglobulinemia between the groups. CONCLUSIONS We observed fetal myocardial dysfunction in overweight and obese pregnant women with higher LV Mod-MPI, LV MPI' and RV E' compared to fetuses from normal weight pregnant women.
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Affiliation(s)
- Alberto Borges Peixoto
- Gynecology and Obstetrics Service, Mário Palmério University Hospital, University of Uberaba (UNIUBE), Uberaba-MG, Brazil
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba-MG, Brazil
| | - Nathalie Jeanne Bravo-Valenzuela
- Department of Pediatrics, Pediatric Cardiology, School of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro-RJ, Brazil
| | | | - Gabriele Tonni
- Department of Obstetrics and Neonatology, Prenatal Diagnostic Centre, Istituto di Cura e Ricovero a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Italy
| | - Antonio Fernandes Moron
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Rosiane Mattar
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Rodrigo Ruano
- Department of Maternal and Fetal Medicine, Fetal Surgery Service, Obstetrics and GynecologyUniversity of Miami, Miller School of Medicine, Miami, Fl, USA
| | - Liliam Cristine Rolo
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
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Dittmer FP, Guimarães CDM, Peixoto AB, Pontes KFM, Bonasoni MP, Tonni G, Araujo Júnior E. Parvovirus B19 Infection and Pregnancy: Review of the Current Knowledge. J Pers Med 2024; 14:139. [PMID: 38392573 PMCID: PMC10890458 DOI: 10.3390/jpm14020139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
Parvovirus B19, a member of the Parvoviridae family, is a human pathogenic virus. It can be transmitted by respiratory secretions, hand-to-mouth contact, blood transfusion, or transplacental transmission. Most patients are asymptomatic or present with mild symptoms such as erythema infectiosum, especially in children. In rare cases, moderate-to-severe symptoms may occur, affecting blood cells and other systems, resulting in anemia, thrombocytopenia, and neutropenia. Non-immune pregnant women are at risk for fetal infection by parvovirus B19, with greater complications if transmission occurs in the first or second trimester. Infected fetuses may not show any abnormalities in most cases, but in more severe cases, there may be severe fetal anemia, hydrops, and even pregnancy loss. Maternal diagnosis of intrauterine parvovirus B19 infection includes IgG and IgM antibody testing. For fetal diagnosis, PCR is performed through amniocentesis. In addition to diagnosing the infection, it is important to monitor the peak of systolic velocity of the middle cerebral artery (PVS-MCA) Doppler to assess the presence of fetal anemia. There is no vaccine for parvovirus B19, and fetal management focuses on detecting moderate/severe anemia by fetal PVS-MCA Doppler, which, if diagnosed, should be treated with intrauterine transfusion by cordocentesis. Prevention focuses on reducing exposure in high-risk populations, particularly pregnant women.
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Affiliation(s)
- Fernanda Parciasepe Dittmer
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo 04023-062, SP, Brazil
| | - Clara de Moura Guimarães
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo 04023-062, SP, Brazil
| | - Alberto Borges Peixoto
- Gynecology and Obstetrics Service, Mário Palmério University Hospital, University of Uberaba (UNIUBE), Uberaba 38050-501, MG, Brazil
- Department of Gynecology and Obstetrics, Federal University of Triângulo Mineiro (UFTM), Uberaba 38025-440, MG, Brazil
| | - Karina Felippe Monezi Pontes
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo 04023-062, SP, Brazil
- Service of Gynecology and Obstetrics, Ipiranga Hospital, São Paulo 04262-000, SP, Brazil
| | - Maria Paola Bonasoni
- Department of Pathology, Santa Maria Nuova Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, 50122 Reggio Emilia, Italy
| | - Gabriele Tonni
- Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo 04023-062, SP, Brazil
- Discipline of Woman Health, Municipal University of São Caetano do Sul (USCS), São Caetano do Sul 09521-160, SP, Brazil
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Pontes KFM, Nardozza LMM, Peixoto AB, Werner H, Tonni G, Granese R, Araujo Júnior E. Cytomegalovirus and Pregnancy: A Narrative Review. J Clin Med 2024; 13:640. [PMID: 38276146 PMCID: PMC10816506 DOI: 10.3390/jcm13020640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/14/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
Cytomegalovirus (CMV) infection is the most common congenital infection worldwide, affecting between 0.7% and 1% of all live births. Approximately 11% of infected newborns are symptomatic at birth, and between 30% and 40% of these are at risk of developing long-term neurological sequelae. Until recently, the lack of an effective treatment did not justify universal testing of pregnant women. In recent years, however, valacyclovir at a dose of 8 g/day has been shown to be effective in preventing vertical transmission, and ganciclovir has been shown to be effective in preventing long-term sequelae in the treatment of symptomatic neonates. The aim of this article is to review congenital CMV infection, from its epidemiology to its treatment, using the most recent studies in the literature, and to help in the decision to modify protocols for universal testing of pregnant women according to the possibilities of each locality.
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Affiliation(s)
- Karina Felippe Monezi Pontes
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo 04023-900, SP, Brazil; (K.F.M.P.); (L.M.M.N.); (E.A.J.)
- Service of Gynecology and Obstetrics, Ipiranga Hospital, São Paulo 04262-000, SP, Brazil
| | - Luciano Marcondes Machado Nardozza
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo 04023-900, SP, Brazil; (K.F.M.P.); (L.M.M.N.); (E.A.J.)
| | - Alberto Borges Peixoto
- Gynecology and Obstetrics Service, Mário Palmério University Hospital, University of Uberaba (UNIUBE), Uberaba 38050-501, MG, Brazil;
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba 38025-180, MG, Brazil
| | - Heron Werner
- Department of Fetal Medicine, Biodesign Laboratory DASA/PUC, Rio de Janeiro 21941-901, SP, Brazil;
| | - Gabriele Tonni
- Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, 242100 Reggio Emilia, Italy
| | - Roberta Granese
- Obstetrics and Gynecology Unit, Department of Human Pathology of Adult and Childhood “G. Barresi”, University Hospital “G. Martino”, 98124 Messina, Italy;
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo 04023-900, SP, Brazil; (K.F.M.P.); (L.M.M.N.); (E.A.J.)
- Discipline of Woman Health, Municipal University of São Caetano do Sul (USCS), Campus Center, São Caetano do Sul 09521-160, SP, Brazil
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Peixoto AB, Araujo Júnior E. Fetal frontal lobe and gestational diabetes mellitus: Can maternal inflammation affect fetal brain development? J Clin Ultrasound 2024; 52:37-38. [PMID: 38006290 DOI: 10.1002/jcu.23611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 11/27/2023]
Affiliation(s)
- Alberto Borges Peixoto
- Gynecology and Obstetrics Service, Mário Palmério University Hospital, University of Uberaba (UNIUBE), Uberaba, MG, Brazil
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
- Discipline of Woman Health, Municipal University of São Caetano do Sul (USCS), São Paulo, SP, Brazil
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Paiva TM, Santana EF, Casati MF, Araujo Júnior E. Neurological morbidity in monochorionic twins with selective fetal growth restriction. Minerva Obstet Gynecol 2023; 75:565-572. [PMID: 35758094 DOI: 10.23736/s2724-606x.22.05068-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The increased risks of various obstetric, maternal and fetal comorbidities of monochorionic twin pregnancies are widely known. However, despite its high prevalence and significance, the assessment of neurological morbidity as more commonly in selective fetal growth restriction (sFGR) is concerned with more health care. This literature review aims to provide more information about such an assessment. To this end, retrospective cases of sFGR were studied in monochorionic twins, already diagnosed, classified and who had the recommended management, published between 2001 and 2018 in 17 scientific articles. In the assessment of fetal mortality, the highest risk of death of the restricted fetus was found in type 3 of sFGR, while type 2 sFGR was responsible for the highest death rates of both fetuses and also the lowest mean gestational age at delivery, 30.9 weeks. Regarding neurological morbidity, however, studies have shown a higher risk of brain damage in the habitually growing twin compared to the restricted one in the case of sFGR. This may be due to prematurity or intermittent diastolic flow on Doppler in type 2 and 3 of sFGR, however, statements about its pathophysiology still lack further studies.
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Affiliation(s)
| | - Eduardo F Santana
- Albert Einstein Medical School, São Paulo, Brazil
- Unit of Fetal Medicine, Albert Einstein Hospital, São Paulo, Brazil
| | - Murilo F Casati
- Department of Obstetrics and Gynecology, ABC Medical School (FMABC), Santo André, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil -
- Municipal University of São Caetano do Sul (USCS), Bela Vista Campus, São Paulo, Brazil
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17
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Silva PHAD, Romão LGDM, Freitas NPAD, Carvalho TR, Porto MEMP, Araujo Júnior E, Cavalcante MB. Kisspeptin as a predictor of miscarriage: a systematic review. J Matern Fetal Neonatal Med 2023; 36:2197097. [PMID: 37015836 DOI: 10.1080/14767058.2023.2197097] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
OBJECTIVE A highly accurate serum marker for predicting viable pregnancy needs to be developed. Recent studies have demonstrated that kisspeptin is a potential biomarker for this purpose. METHODS This systematic review evaluated the available data in the literature on the role of kisspeptin as a miscarriage biomarker. A literature search was conducted in the PubMed/Medline, Embase, Web of Science, and Scopus databases using the following keywords: (kisspeptin) AND (miscarriage OR pregnancy loss OR spontaneous abortion OR reproductive failure). RESULTS Seven case-control studies were selected for the systematic review. The included papers described the potential role of kisspeptin as a putative biomarker of pregnancy loss. Furthermore, two studies reported that changes in kisspeptin levels may be associated with unexplained infertility and low rates of embryo implantation in women undergoing assisted reproductive technology. CONCLUSION Kisspeptin might be used as a potential biomarker of pregnancy viability in the near future. However, studies with better evidence are needed to establish the applicability of kisspeptin as a diagnostic and prognostic tool.
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Affiliation(s)
- Pedro Henrique Alcântara da Silva
- Reproductive Medicine Sector, CONCEPTUS, Fortaleza, CE, Brazil
- Ana Bezerra University Hospital - Federal University of Rio Grande do Norte (UFRN), Santa Cruz, RN, Brazil
| | | | | | | | | | - Edward Araujo Júnior
- 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
| | - Marcelo Borges Cavalcante
- Reproductive Medicine Sector, CONCEPTUS, Fortaleza, CE, Brazil
- Postgraduate Program in Medical Sciences, University of Fortaleza (UNIFOR), Fortaleza, CE, Brazil
- Medical Course, University of Fortaleza (UNIFOR), Fortaleza, CE, Brazil
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Andrade JA, Viana Junior AB, Holanda Moura SB, Gurgel Alves JA, Araujo Júnior E, Carvalho FH. Using the algorithm of the Fetal Medicine Foundation to determine the cutoff point for prediction of pre-eclampsia in a Brazilian population. Minerva Obstet Gynecol 2023; 75:503-511. [PMID: 35758093 DOI: 10.23736/s2724-606x.22.05061-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND To use the algorithm of the Fetal Medicine Foundation (FMF) to determine the cutoff point for prediction of preeclampsia (PE) in a Brazilian population. METHODS Randomized clinical trial with 274 nulliparous patients at gestational age between 11 and 13 weeks and 6 days. To calculate the risk of PE, the algorithm available at the website of the FMF (http://fetalmedicine.org/research/assess/preeclampsia/first-trimester) was used. Among the patients, 138 did not use preventive measures (100 mg/day aspirin [ASA]). Youden's criteria were used to calculate the cutoff point. To test the effectiveness of 100 mg/day ASA in preventing PE, the patients were divided into two groups - at risk above and below the cutoff point. RESULTS In the group comprising the 135 patients that did not take ASA, the median age was 22 years, the Body Mass Index (BMI) was 59.3 kg/m2, the mean arterial pressure (MAP) was 73.3 mmHg, and the mean pulsatility index of uterine artery Doppler was 1.71. The median gestational age at delivery was 39.3 (38.1-40.3) weeks. The prevalence of PE was 11.1%. In our sample, the use of 100 mg/day ASA reduced total PE by 36.3% (prevalence of PE in the group above the cutoff point was 19% and 12.1% when ASA and placebo were used, respectively). CONCLUSIONS The cutoff point defined for prediction of PE was 1:155 with sensitivity of 80%, specificity of 57.5%, positive predictive value of 19.1%, and negative predictive value of 95%, which should help to select patients that will benefit from prophylactic ASA.
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Affiliation(s)
- Joana A Andrade
- Department of Women's, Child and Adolescent Health, Assis Chateaubriand Maternity School, Federal University of Ceará (UFC), Fortaleza, Brazil
| | - Antonio B Viana Junior
- Department of Women's, Child and Adolescent Health, Assis Chateaubriand Maternity School, Federal University of Ceará (UFC), Fortaleza, Brazil
| | | | - Julio A Gurgel Alves
- Department of Women's, Child and Adolescent Health, Assis Chateaubriand Maternity School, Federal University of Ceará (UFC), Fortaleza, Brazil
- University of Fortaleza (UNIFOR), Fortaleza, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil -
- Municipal University of São Caetano do Sul (USCS), Bela Vista Campus, São Paulo, Brazil
| | - Francisco H Carvalho
- Department of Women's, Child and Adolescent Health, Assis Chateaubriand Maternity School, Federal University of Ceará (UFC), Fortaleza, Brazil
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Araujo Júnior E, Coutinho LG, Bravo-Valenzuela NJ, Aquino P, Rocha LAD, Rizzo G, Tonni G, Respondek-Liberska M, Slodki M, Wolter A, Axt-Fliedner R. Ectopia cordis: prenatal diagnosis, perinatal outcomes, and postnatal follow-up of an international multicenter cohort case series. J Matern Fetal Neonatal Med 2023; 36:2203791. [PMID: 37080921 DOI: 10.1080/14767058.2023.2203791] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
OBJECTIVE This study aimed to analyze prenatal diagnosis, perinatal outcomes, and postnatal follow-up in fetuses with ectopia cordis (EC). METHODS This retrospective analysis accessed 31 patients with EC who were either diagnosed or referred to a tertiary Fetal Medicine centers for EC diagnosis in Brazil, Germany, Italy, and Poland. We analyzed prenatal diagnosis, perinatal outcomes, and follow-up in these patients. RESULTS Our study included a cohort of 31 fetuses with EC, 4 and 27 of whom had partial and complete protrusion of the heart through a ventral defect in the thoracoabdominal wall, respectively. EC was diagnosed by fetal echocardiography at a mean gestational age of 20.3 ± 8.6 weeks (range, 8-35 weeks). Of the four cases, in which the karyotype was performed, all of them had a normal result (1 - 46,XX and 3 - 46,XY). Five patients showed conotruncal abnormalities and six ventricular septal defects. Termination of pregnancy (TOP) was performed in 15 cases (48%) and seven pregnant women had spontaneous fetal demise (22.5%). Of the seven fetuses that were born alive, four of them died, and three infants underwent surgery. Among these three infants, all of them survived, one was 5 months, 13 years old and 29 years old at the time of study completion. CONCLUSIONS Ectopia cordis is associated with high mortality rates and intracardiac/extra-cardiac defects. Ventricular septal defects and conotruncal anomalies were the more common intracardiac defects associated with EC. However, in this cohort of fetuses with EC the incidence of PC was lower than reported in the literature.
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Affiliation(s)
- Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
- The International Prenatal Cardiology Collaboration Group, Lodz, Poland
| | - Luiza Graça Coutinho
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Nathalie Jeanne Bravo-Valenzuela
- Department of Pediatrics, Pediatric Cardiology, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Postgraduate Program in Health Sciences (Fetal Medicine), Itinerant Continuing Medical Education, Rio de Janeiro, Brazil
| | - Patrícia Aquino
- Postgraduate Program in Health Sciences (Fetal Medicine), Itinerant Continuing Medical Education, Rio de Janeiro, Brazil
| | - Luciane Alves da Rocha
- Postgraduate Program in Health Sciences, Medical School, Federal University of Amazonas (UFAM), Manaus, Brazil
| | - Giuseppe Rizzo
- The International Prenatal Cardiology Collaboration Group, Lodz, Poland
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Gabriele Tonni
- Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL di Reggio Emilia, Reggio Emilia, Italy
| | - Maria Respondek-Liberska
- The International Prenatal Cardiology Collaboration Group, Lodz, Poland
- Prenatal Cardiology Department, Research Institute Polish Mother's Memorial Hospital, Lodz, Poland
| | - Maciej Slodki
- The International Prenatal Cardiology Collaboration Group, Lodz, Poland
- Prenatal Cardiology Department, Research Institute Polish Mother's Memorial Hospital, Lodz, Poland
- Faculty of Health Sciences, The Masovian State University, Plock, Poland
| | - Aline Wolter
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University-Hospitals Giessen and Marburg Campus, Giessen, Germany
| | - Roland Axt-Fliedner
- The International Prenatal Cardiology Collaboration Group, Lodz, Poland
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University-Hospitals Giessen and Marburg Campus, Giessen, Germany
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Andrade Júnior VLD, França MS, Santos RAF, Hatanaka AR, Cruz JDJ, Hamamoto TEK, Traina E, Sarmento SGP, Elito Júnior J, Pares DBDS, Mattar R, Araujo Júnior E, Moron AF. A new model based on artificial intelligence to screening preterm birth. J Matern Fetal Neonatal Med 2023; 36:2241100. [PMID: 37518185 DOI: 10.1080/14767058.2023.2241100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE The objective of this study is to create a new screening for spontaneous preterm birth (sPTB) based on artificial intelligence (AI). METHODS This study included 524 singleton pregnancies from 18th to 24th-week gestation after transvaginal ultrasound cervical length (CL) analyzes for screening sPTB < 35 weeks. AI model was created based on the stacking-based ensemble learning method (SBELM) by the neural network, gathering CL < 25 mm, multivariate unadjusted logistic regression (LR), and the best AI algorithm. Receiver Operating Characteristics (ROC) curve to predict sPTB < 35 weeks and area under the curve (AUC), sensitivity, specificity, accuracy, predictive positive and negative values were performed to evaluate CL < 25 mm, LR, the best algorithms of AI and SBELM. RESULTS The most relevant variables presented by LR were cervical funneling, index straight CL/internal angle inside the cervix (≤ 0.200), previous PTB < 37 weeks, previous curettage, no antibiotic treatment during pregnancy, and weight (≤ 58 kg), no smoking, and CL < 30.9 mm. Fixing 10% of false positive rate, CL < 25 mm and SBELM present, respectively: AUC of 0.318 and 0.808; sensitivity of 33.3% and 47,3%; specificity of 91.8 and 92.8%; positive predictive value of 23.1 and 32.7%; negative predictive value of 94.9 and 96.0%. This machine learning presented high statistical significance when compared to CL < 25 mm after T-test (p < .00001). CONCLUSION AI applied to clinical and ultrasonographic variables could be a viable option for screening of sPTB < 35 weeks, improving the performance of short cervix, with a low false-positive rate.
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Affiliation(s)
| | - Marcelo Santucci França
- Screening and Prevention of Preterm Birth Sector, Discipline of Fetal Medicine, Department of Obstetrics, Paulista School of Medicine - Federal University of Sao Paulo (EPM-UNIFESP), São Paulo, Brazil
| | | | - Alan Roberto Hatanaka
- Screening and Prevention of Preterm Birth Sector, Discipline of Fetal Medicine, Department of Obstetrics, Paulista School of Medicine - Federal University of Sao Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Jader de Jesus Cruz
- Fetal Medicine Unit, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Tatiana Emy Kawanami Hamamoto
- Screening and Prevention of Preterm Birth Sector, Discipline of Fetal Medicine, Department of Obstetrics, Paulista School of Medicine - Federal University of Sao Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Evelyn Traina
- Screening and Prevention of Preterm Birth Sector, Discipline of Fetal Medicine, Department of Obstetrics, Paulista School of Medicine - Federal University of Sao Paulo (EPM-UNIFESP), São Paulo, Brazil
| | | | - Júlio Elito Júnior
- Screening and Prevention of Preterm Birth Sector, Discipline of Fetal Medicine, Department of Obstetrics, Paulista School of Medicine - Federal University of Sao Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - David Baptista da Silva Pares
- Screening and Prevention of Preterm Birth Sector, Discipline of Fetal Medicine, Department of Obstetrics, Paulista School of Medicine - Federal University of Sao Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Rosiane Mattar
- Screening and Prevention of Preterm Birth Sector, Discipline of Fetal Medicine, Department of Obstetrics, Paulista School of Medicine - Federal University of Sao Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Edward Araujo Júnior
- Screening and Prevention of Preterm Birth Sector, Discipline of Fetal Medicine, Department of Obstetrics, Paulista School of Medicine - Federal University of Sao Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Antonio Fernandes Moron
- Screening and Prevention of Preterm Birth Sector, Discipline of Fetal Medicine, Department of Obstetrics, Paulista School of Medicine - Federal University of Sao Paulo (EPM-UNIFESP), São Paulo, Brazil
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21
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do Amaral CC, Castro PT, Frota R, de Freitas Lima LAC, Sobreira I, Araujo Júnior E, Werner H. Vaginal leiomyoma: Advantages of clinical sonovaginography and ultrasound dynamic evaluation of uterine cervix-related lesions. J Clin Ultrasound 2023; 51:1509-1511. [PMID: 37800472 DOI: 10.1002/jcu.23580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/07/2023] [Accepted: 09/26/2023] [Indexed: 10/07/2023]
Abstract
Evaluation of vaginal leiomyoma by dynamic transvaginal ultrasound improves the diagnosis, with the impact on surgical planning, and surgical outcomes. Sonovaginography using three-dimensional ultrasound allows the assessment of spatial relationship between the cervix and the tumor.
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Affiliation(s)
- Cristiana Coutinho do Amaral
- Department of Fetal Medicine, Biodesign Laboratory DASA/PUC, Rio de Janeiro, Brazil
- Department of Radiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Pedro Teixeira Castro
- Department of Fetal Medicine, Biodesign Laboratory DASA/PUC, Rio de Janeiro, Brazil
- Department of Obstetrics, Vassouras University, Vassouras, Brazil
| | - Rachel Frota
- Department of Fetal Medicine, Biodesign Laboratory DASA/PUC, Rio de Janeiro, Brazil
| | - Luiz Alberto Coutinho de Freitas Lima
- Department of Fetal Medicine, Biodesign Laboratory DASA/PUC, Rio de Janeiro, Brazil
- Department of Radiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Iris Sobreira
- Department of Fetal Medicine, Biodesign Laboratory DASA/PUC, Rio de Janeiro, Brazil
- Department of Radiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Edward Araujo Júnior
- 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), São Paulo, Brazil
| | - Heron Werner
- Department of Fetal Medicine, Biodesign Laboratory DASA/PUC, Rio de Janeiro, Brazil
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Almeida SLDM, Tuda LTS, Dias MB, de Carvalho LIA, Estevam TLL, Novelleto ALMT, Araujo Júnior E, da Rocha Amorim LA. Family Counseling after the Diagnosis of Congenital Heart Disease in the Fetus: Scoping Review. Healthcare (Basel) 2023; 11:2826. [PMID: 37957971 PMCID: PMC10647570 DOI: 10.3390/healthcare11212826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/15/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Congenital heart disease (CHD) is the leading cause of death from malformations in the first year of life and carries a significant burden to the family when the diagnosis is made in the prenatal period. We recognize the significance of family counseling following a fetal CHD diagnosis. However, we have observed that most research focuses on assessing the emotional state of family members rather than examining the counseling process itself. The objective of this study was to identify and summarize the findings in the literature on family counseling in cases of diagnosis of CHD during pregnancy, demonstrating gaps and suggesting future research on this topic. Eight databases were searched to review the literature on family counseling in cases of CHD diagnosis during pregnancy. A systematic search was conducted from September to October 2022. The descriptors were "congenital heart disease", "fetal heart", and "family counseling". The inclusion criteria were studies on counseling family members who received a diagnosis of CHD in the fetus (family counseling was defined as any health professional who advises mothers and fathers on the diagnosis of CHD during the gestational period), how the news is expressed to family members (including an explanation of CHD and questions about management and prognosis), empirical and qualitative studies, quantitative studies, no publication deadline, and any language. Out of the initial search of 3719 reports, 21 articles were included. Most were cross-sectional (11) and qualitative (9) studies, and all were from developed countries. The findings in the literature address the difficulties in effectively conducting family counseling, the strengths of family counseling to be effective, opportunities to generate effective counseling, and the main challenges in family counseling.
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Affiliation(s)
- Sophia Livas de Morais Almeida
- Postgraduate Program in Health Sciences, Medical School, Federal University of Amazonas (UFAM), Manaus 69067-005, AM, Brazil
| | | | | | | | - Thayla Lais Lima Estevam
- Postgraduate Program in Health Sciences, Medical School, Federal University of Amazonas (UFAM), Manaus 69067-005, AM, Brazil
| | | | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo 04023-062, SP, Brazil
- Medical School, Municipal University of São Caetano do Sul (USCS), São Caetano do Sul 09521-160, SP, Brazil
| | - Luciane Alves da Rocha Amorim
- Postgraduate Program in Health Sciences, Medical School, Federal University of Amazonas (UFAM), Manaus 69067-005, AM, Brazil
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Scappa JPC, Peixoto AB, Bravo-Valenzuela NJ, Tonni G, Mattar R, Araujo Júnior E. Area of the Fetal Ascending and Descending Aorta by Spatiotemporal Image Correlation in the Rendering Mode: Reproducibility and Comparison with Pregestational Diabetic Mothers. J Med Ultrasound 2023; 31:298-304. [PMID: 38264598 PMCID: PMC10802868 DOI: 10.4103/jmu.jmu_102_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/14/2022] [Accepted: 03/21/2023] [Indexed: 01/25/2024] Open
Abstract
Background The objective of this study was to assess the ascending and descending aorta area measurements by three-dimensional (3D) ultrasound using spatiotemporal image correlation (STIC) in the rendering mode comparing these measurements with pregestational diabetic mothers and assessing the reproducibility of the method. Methods We carried out a retrospective cross-sectional study with 58 normal and nine fetuses from pregestational diabetic mothers between 20 and 33 + 6 weeks of gestation. Fetal heart volumes were acquired at the level of four-chamber view to obtain the reconstructed planes for the ascending and descending aorta areas in the rendering mode. Linear regression was performed to assess the correlation between the fetal aorta areas and gestational age (GA). To assess the intra- and interobserver reproducibility, we used the concordance correlation coefficient (CCC). Results The mean ascending and descending aorta areas were 0.12 (0.02-0.48) and 0.11 (0.04-0.39) cm2 in normal fetuses, respectively. There was a moderate positive correlation between GA and ascending aorta area measurements (0.005676*GA - 0.01283; r = 0.53, P < 0.0001) and strong positive correlation between GA and descending aorta area (0.01095*GA - 0.1581; r = 0.68, P < 0.0001). We observed a weak intra- and interobserver reproducibility with CCC ranging from 0.05 to 0.91. The mean difference in the ascending and descending aorta area measurements of normal and fetuses of pregestational diabetic mothers was -0.03 cm2 (P = 0.276) and -0.03 cm2 (P = 0.231), respectively. Conclusion The fetal ascending and descending aorta area measurements obtained by 3D ultrasound using STIC in the rendering mode increased with GA in normal fetuses. The method showed weak intra- and interobserver reproducibility.
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Affiliation(s)
- João Pedro Cassin Scappa
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Alberto Borges Peixoto
- Gynecology and Obstetrics Service, Mario Palmério University Hospital – University of Uberaba (UNIUBE), Uberaba, Minas Gerais, Brazil
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Nathalie Jeanne Bravo-Valenzuela
- Department of Pediatrics, Pediatric Cardiology, School of Medicine, Federal University of Rio De Janeiro, Rio De Janeiro, Brazil
| | - Gabriele Tonni
- Department of Obstetrics and Neonatology, Istituto Di Ricovero E Cura A Carattere Scientifico, Ausl Di Reggio Emilia, Reggio Emilia, Italy
| | - Rosiane Mattar
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
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Castro PT, Matos APP, Macedo N, Ribeiro G, Lopes J, Dittmer FP, Araujo Júnior E, Werner H. Prenatal diagnosis of closed gastroschisis: What to expect in the most severe form of gastroschisis? Case report and literature review. J Clin Ultrasound 2023; 51:1356-1363. [PMID: 37596943 DOI: 10.1002/jcu.23543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 07/24/2023] [Accepted: 08/07/2023] [Indexed: 08/21/2023]
Abstract
Closed gastroschisis (CG) and vanishing gastroschisis (VG) are the most severe forms of evolution of the malformation. In this case, a fetus presented with gastroschisis at 13 weeks, and the gastroschisis was not visualized at 22 weeks of gestation. Distal ileum, cecum, and ascending colon atresia were diagnosed at surgery, and the child is fully enteral-fed at 5 months of age. In a literature review of 43 cases of prenatal diagnosis of CS-VG, intrauterine death occurred in 4.5% of cases. 79.6% of the cases underwent surgical treatment. Of these cases, 20% of cases died due to complications of treatment, 26% were still under treatment and 54% are alive with enteral feeding. In 77% of the cases, the closure of the umbilical ring occurred after 26 weeks of gestation and the absence of prenatal diagnosis of CG-VG during pregnancy has a risk of 71% of death.
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Affiliation(s)
- Pedro Teixeira Castro
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI - DASA), Rio de Janeiro, Brazil
| | - Ana Paula Pinho Matos
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI - DASA), Rio de Janeiro, Brazil
| | - Nicanor Macedo
- Department of Surgery, Gaffrè and Guinle University Hospital, Rio de Janeiro, Brazil
| | | | - Jorge Lopes
- Biodesign Laboratory DASA / PUC, Rio de Janeiro, Brazil
| | - Fernanda Parciasepe Dittmer
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Edward Araujo Júnior
- 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, Brazil
| | - Heron Werner
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI - DASA), Rio de Janeiro, Brazil
- Biodesign Laboratory DASA / PUC, Rio de Janeiro, Brazil
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Rossi I, Peixoto AB, de Souza MAR, Araujo Júnior E, Paschoini MC. Intrauterine Diagnosis of Portosystemic Shunt Associated with Trisomy 21. J Obstet Gynaecol Can 2023; 45:101784. [PMID: 34303009 DOI: 10.1016/j.jogc.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Isabela Rossi
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba-MG, Brazil
| | - Alberto Borges Peixoto
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba-MG, Brazil; Sabin Diagnostic Medicine, Uberaba-MG, Brazil; Mário Palmério University Hospital, University of Uberaba (UNIUBE), Uberaba-MG, Brazil
| | | | - Edward Araujo Júnior
- 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), São Paulo-SP, Brazil.
| | - Marina Carvalho Paschoini
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba-MG, Brazil
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Rabachini Caetano AC, Machado Nardozza LM, Perez Zamarian AC, Silva Drumond LG, Chiaratti de Oliveira A, Dualib PM, Araujo Júnior E, Mattar R. Prediction of lung maturity through quantitative ultrasound analysis of fetal lung texture in women with diabetes during pregnancy. J Perinat Med 2023; 51:913-919. [PMID: 37097317 DOI: 10.1515/jpm-2023-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/01/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVES The present study aimed to evaluate the performance of QuantusFLM® software, which performs quantitative ultrasound analysis of fetal lung texture, in predicting lung maturity in fetuses of diabetic mothers. METHODS The patients included in this study were between 34 and 38 weeks and 6 days gestation and were divided into two groups: (1) patients with diabetes on medication and (2) control. The ultrasound images were performed up to 48 h prior to delivery and analyzed using QuantusFLM® software, which classified each fetus as high or low risk for neonatal respiratory morbidity based on lung maturity or immaturity. RESULTS A total of 111 patients were included in the study, being 55 in diabetes and 56 in control group. The pregnant women with diabetes had significantly higher body mass index (27.8 kg/m2 vs. 25.9 kg/m2, respectively, p=0.02), increased birth weight (3,135 g vs. 2,887 g, respectively, p=0.002), and a higher rate of labor induction (63.6 vs. 30.4 %, respectively, p<0.001) compared to the control group. QuantusFLM® software was able to predict lung maturity in diabetes group with 96.4 % accuracy, 96.4 % sensitivity and 100 % positive predictive value. Considering the total number of patients, the software demonstrated accuracy, sensitivity, specificity, positive predictive value and negative predictive value of 95.5 , 97.2, 33.3, 98.1 and 25 %, respectively. CONCLUSIONS QuantusFLM® was an accurate method for predicting lung maturity in normal and DM singleton pregnancies and has the potential to aid in deciding the timing of delivery for pregnant women with DM.
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Affiliation(s)
- Ana Carolina Rabachini Caetano
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
- Fetal Medicine Unit, Department of Perinatology, Albert Einstein Hospital, São Paulo, SP, Brazil
| | | | - Ana Cristina Perez Zamarian
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Luiza Grosso Silva Drumond
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Allan Chiaratti de Oliveira
- Department of Pediatrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Patricia Medici Dualib
- Department of Medical Clinic, Discipline of Endocrinology, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Rosiane Mattar
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
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Bravo-Valenzuela NJ, Araujo Júnior E. Prenatal diagnosis of hypoplastic left heart syndrome: current knowledge. Radiol Bras 2023; 56:282-286. [PMID: 38204904 PMCID: PMC10775813 DOI: 10.1590/0100-3984.2023.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/17/2023] [Accepted: 09/05/2023] [Indexed: 01/12/2024] Open
Abstract
Hypoplastic left heart syndrome (HLHS) is characterized by underdevelopment of the left-sided heart structures. The prenatal diagnosis of this congenital heart disease is crucial because a newborn with undiagnosed HLHS often presents with clinical signs of low cardiac output once the ductus arteriosus begins to close. With that in mind, the aim of this article was to perform a non-systematic review focusing on the key ultrasound features that can be used in the prenatal diagnosis of HLHS. Severe forms of HLHS are characterized by a markedly abnormal four-chamber view of the fetal heart (small left atrium, hypoplastic left ventricle, or abnormal mitral valve). The left ventricular outflow tract view allows the degree of hypoplasia in the tract to be evaluated and the diameter of the ascending aorta to be measured. The Z-scores are intended to aid in the diagnosis and follow-up of HLHS. In mild forms of HLHS, a right ventricle/left ventricle length ratio > 1.28 was the strongest predictor of a univentricular outcome.
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Affiliation(s)
- Nathalie Jeanne Bravo-Valenzuela
- Department of Pediatrics, Pediatric Cardiology, School of Medicine,
Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Escola Paulista de Medicina da
Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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28
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Tonni G, Koçak Ç, Grisolia G, Rizzo G, Araujo Júnior E, Werner H, Ruano R, Sepulveda W, Bonasoni MP, Lituania M. Clinical Presentations and Diagnostic Imaging of VACTERL Association. Fetal Pediatr Pathol 2023; 42:651-674. [PMID: 37195727 DOI: 10.1080/15513815.2023.2206905] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 05/18/2023]
Abstract
Background: VACTERL association consists of Vertebral, Anorectal, Cardiac, Tracheo-Esophageal, Renal, and Limb defects. The diagnosis depends on the presence of at least three of these structural abnormalities. Methods: The clinical presentation and diagnostic prenatal imaging of VACTERL association are comprehensively reviewed. Results: The most common feature is a vertebral anomaly, found in 60-80% of cases. Tracheo-esophageal fistula is seen in 50-80% of cases and renal malformations in 30% of patients. Limb defects including thumb aplasia/hypoplasia, polydactyly, and radial agenesis/hypoplasia are present in 40-50% of cases. Anorectal defects, like imperforate anus/anal atresia, are challenging to detect prenatally. Conclusion: The diagnosis of VACTERL association mostly relies on imaging techniques such as ultrasound, computed tomography, and magnetic resonance. Differential diagnosis should exclude similar diseases such as CHARGE and Townes-Brocks syndromes and Fanconi anemia. New insights into genetic etiology have led to recommendations of chromosomal breakage investigation for optimal diagnosis and counseling.
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Affiliation(s)
- Gabriele Tonni
- Department of Obstetrics and Neonatology and Researcher, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Çağla Koçak
- Faculty of Medicine, Düzce Medical School, Duzce, Turkey
| | - Gianpaolo Grisolia
- Prenatal Diagnostic Centre, Department of Obstetrics and Neonatology, Carlo Poma Hospital, Mantua, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Policlinic Hospital, University of Tor Vergata, Rome, Italy
| | - Edward Araujo Júnior
- Department of Obstetrics and Gynecology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Heron Werner
- Laboratorio de Biodesign (Dasa/PUC-Rio), Alta Excelência Diagnostica, Rio de Janeiro, RJ, Brazil
| | - Rodrigo Ruano
- Fetal Surgery, Department of Maternal and Fetal Medicine, Obstetrics and Gynecology, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Waldo Sepulveda
- FETALMED, Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
| | - Maria Paola Bonasoni
- Pathology Unit, Santa Maria Nuova Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Mario Lituania
- Preconceptional and Prenatal Physiopathology, Department of Maternal & Neonatology, E.O. Ospedali Galliera, Genoa, Italy
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Cavalcante ANM, Almeida RLFD, Oliveira DN, Lima DM, Cavalcante CTDMB, Tavares LVDS, Almeida RP, Machado RPG, Araujo Júnior E, Cavalcante MB. Screening for coronavirus disease 2019 in pregnant women admitted for delivery: an observational study. Rev Assoc Med Bras (1992) 2023; 69:e20230084. [PMID: 37466595 DOI: 10.1590/1806-9282.20230084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE The aim of this study was to examine the impact of symptom-based screening on the prevalence and outcomes of neonatal coronavirus disease 2019 in pregnant women admitted for delivery. METHODS A retrospective observational study was conducted from June to August 2020 at Gonzaga Mota of Messejana Hospital, Fortaleza, CE, Brazil. All pregnant women were screened for coronavirus disease 2019 based on symptoms. Reverse transcription-polymerase chain reaction or immunology assays for severe acute respiratory syndrome coronavirus 2 were performed when a patient reported a symptom. All newborns of symptomatic patients were submitted for Reverse transcription-polymerase chain reaction. Newborns were divided into groups according to the Reverse transcription-polymerase chain reaction results to identify the relationship between maternal symptoms and neonatal coronavirus disease 2019. RESULTS A total of 55 (55/1,026, 5.4%) and 50 (50/1,026, 4.8%) pregnant women reported symptoms and had a positive confirmatory test, respectively. The most common symptom of coronavirus disease 2019 among the pregnant women with positive confirmatory test was cough (n=23, 46%). Seven newborns (7/50, 14%) of symptomatic mothers had positive Reverse transcription-polymerase chain reaction. Upon birth, no newborn had serious complications. CONCLUSION Universal screening of pregnant women admitted for delivery can reduce the perinatal transmission of coronavirus disease 2019. Symptom-based screening can be an alternative for regions with a low prevalence of the disease where a better allocation of financial resources is necessary.
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Affiliation(s)
- Ana Nery Melo Cavalcante
- Gonzaga Mota of Messejana Hospital, Department of Obstetrics and Neonatology - Fortaleza (CE), Brazil
- Universidade de Fortaleza, Public Health Postgraduate Program - Fortaleza (CE), Brazil
- Universidade de Fortaleza, Medical Course - Fortaleza (CE), Brazil
| | | | | | - Danielle Malta Lima
- Universidade de Fortaleza, Medical Course - Fortaleza (CE), Brazil
- Universidade de Fortaleza, Medical Sciences Postgraduate Program - Fortaleza (CE) Brazil
| | - Candice Torres de Melo Bezerra Cavalcante
- Gonzaga Mota of Messejana Hospital, Department of Obstetrics and Neonatology - Fortaleza (CE), Brazil
- Universidade de Fortaleza, Medical Course - Fortaleza (CE), Brazil
| | | | | | - Rosângela Pinheiro Gonçalves Machado
- Gonzaga Mota of Messejana Hospital, Department of Obstetrics and Neonatology - Fortaleza (CE), Brazil
- Universidade de Fortaleza, Medical Course - Fortaleza (CE), Brazil
| | - Edward Araujo Júnior
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Obstetrics - São Paulo (SP), Brazil
- Universidade Municipal de São Caetano do Sul, Medical Course - São Paulo (SP), Brazil
| | - Marcelo Borges Cavalcante
- Gonzaga Mota of Messejana Hospital, Department of Obstetrics and Neonatology - Fortaleza (CE), Brazil
- Universidade de Fortaleza, Medical Course - Fortaleza (CE), Brazil
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30
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Guesine GD, Paschoini MC, Melo GA, Araujo Júnior E, Peixoto AB. Labor analgesia and its impact on the maternal and perinatal outcomes. Rev Assoc Med Bras (1992) 2023; 69:e20230500. [PMID: 37466614 DOI: 10.1590/1806-9282.20230500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE This study aimed to assess adverse maternal and perinatal outcomes in parturients undergoing labor analgesia. METHODS This was a retrospective cohort study in parturients who underwent labor analgesia. Parturients were categorized into three groups: Group 1 (n=83)-analgesia performed with cervical dilatation ≤4.0 cm; Group 2 (n=82)-analgesia performed with cervical dilatation between 5.0 and 8.0 cm; and Group 3 (n=83)-analgesia performed with cervical dilatation ≥9.0 cm. RESULTS Analgesia in parturients with cervical dilatation ≥9.0 cm showed a higher prevalence and a 3.86-fold increase (OR 3.86; 95%CI 1.50-9.87; p=0.009) in the risk of forceps delivery. Analgesia in parturients with cervical dilatation ≤4.0 cm showed a higher prevalence and a 3.31-fold increase (OR 3.31; 95%CI 1.62-6.77; p=0.0016) in the risk of cesarean section. Analgesia in parturients with cervical dilatation ≥9.0 cm was associated with a higher prevalence of fetal bradycardia (20.7%), a need for neonatal oxygen therapy (6.1%), and a need for admission to a neonatal intensive care unit (4.9%). Analgesia in parturients with cervical dilatation ≤4 cm was associated with a higher prevalence of Apgar score <7 at 1st minute (44.6%). CONCLUSION Performing labor analgesia in parturients with cervical dilatation ≤4.0 or ≥9.0 cm was associated with a higher prevalence of adverse maternal and perinatal outcomes.
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Affiliation(s)
- Georgeana Debs Guesine
- Universidade de Uberaba, Mário Palmério University Hospital, Gynecology and Obstetrics Service - Uberaba (MG), Brazil
| | - Marina Carvalho Paschoini
- Universidade Federal do Triângulo Mineiro, Department of Obstetrics and Gynecology - Uberaba (MG), Brazil
| | - Giselle Agreli Melo
- Universidade de Uberaba, Mário Palmério University Hospital, Gynecology and Obstetrics Service - Uberaba (MG), Brazil
| | - Edward Araujo Júnior
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Obstetrics - São Paulo (SP), Brazil
- Universidade Municipal de São Caetano do Sul, Medical Course - São Paulo (SP), Brazil
| | - Alberto Borges Peixoto
- Universidade de Uberaba, Mário Palmério University Hospital, Gynecology and Obstetrics Service - Uberaba (MG), Brazil
- Universidade Federal do Triângulo Mineiro, Department of Obstetrics and Gynecology - Uberaba (MG), Brazil
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Trevizo JP, Araujo Júnior E, Elito Júnior J. In vitro Fertilization: An Alert for the Association of Placenta Previa and Vasa Previa - Ultrasound and Magnetic Resonance Imaging Findings. J Med Ultrasound 2023; 31:248-251. [PMID: 38025015 PMCID: PMC10668897 DOI: 10.4103/jmu.jmu_16_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/16/2022] [Accepted: 05/23/2022] [Indexed: 12/01/2023] Open
Abstract
A 33-year-old woman, gravida 2 para 0, with a history of two previous miscarriages, underwent an investigation for recurrent miscarriage. After genetic counseling, the couple were submitted to the karyotype, which resulted in 45, X/46, XX mosaicism (mosaic Turner syndrome) in the wife result, while the husband chromosomal resulted in 46, XY (normal). After evaluating the options, the couple opted for in vitro fertilization. During prenatal follow-up, placenta and vasa previa were identified, considerably increasing the maternal-fetal mortality rate in this case. However, despite being a delicate and challenging case, the early diagnose was possible due to transvaginal ultrasound using color Doppler. Due to good care in obstetric follow-up, involving a multidisciplinary team, a therapeutic program and a successful outcome were possible. The patient underwent a cesarean section at 35 weeks of pregnancy, without complications, with a newborn in good general condition, despite the prematurity.
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Affiliation(s)
- Juliana Pagotto Trevizo
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Julio Elito Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
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Fracalozzi JDL, Okido MM, Crott GC, Duarte G, Cavalli RDC, Araujo Júnior E, Peixoto AB, Marcolin AC. Maternal, obstetric, and fetal Doppler characteristics in a high-risk population: prediction of adverse perinatal outcomes and of cesarean section due to intrapartum fetal compromise. Radiol Bras 2023; 56:179-186. [PMID: 37829588 PMCID: PMC10567096 DOI: 10.1590/0100-3984.2022.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/28/2022] [Accepted: 12/01/2022] [Indexed: 10/14/2023] Open
Abstract
Objective To evaluate the capacity of fetal Doppler, maternal, and obstetric characteristics for the prediction of cesarean section due to intrapartum fetal compromise (IFC), a 5-min Apgar score < 7, and an adverse perinatal outcome (APO), in a high-risk population. Materials and Methods This was a prospective cohort study involving 613 singleton pregnant women, admitted for labor induction or at the beginning of spontaneous labor, who underwent Doppler ultrasound within the last 72 h before delivery. The outcome measures were cesarean section due to IFC, a 5-min Apgar score < 7, and any APO. Results We found that maternal characteristics were neither associated with nor predictors of an APO. Abnormal umbilical artery (UA) resistance index (RI) and the need for intrauterine resuscitation were found to be significant risk factors for cesarean section due to IFC (p = 0.03 and p < 0.0001, respectively). A UA RI > the 95th percentile and a cerebroplacental ratio (CPR) < 0.98 were also found to be predictors of cesarean section due to IFC. Gestational age and a UA RI > 0.84 were found to be predictors of a 5-min Apgar score < 7 for newborns at < 29 and ≥ 29 weeks, respectively. The UA RI and CPR presented moderate accuracy in predicting an APO, with areas under the ROC curve of 0.76 and 0.72, respectively. Conclusion A high UA RI appears to be a significant predictor of an APO. The CPR seems to be predictive of cesarean section due to IFC and of an APO in late preterm and term newborns.
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Affiliation(s)
- Jonas de Lara Fracalozzi
- Department of Gynecology and Obstetrics, Faculdade de Medicina de
Ribeirão Preto da Universidade de São Paulo (FMRP-USP),
Ribeirão Preto, SP, Brazil
| | - Marcos Masaru Okido
- Department of Gynecology and Obstetrics, Faculdade de Medicina de
Ribeirão Preto da Universidade de São Paulo (FMRP-USP),
Ribeirão Preto, SP, Brazil
| | - Gerson Cláudio Crott
- Department of Gynecology and Obstetrics, Faculdade de Medicina de
Ribeirão Preto da Universidade de São Paulo (FMRP-USP),
Ribeirão Preto, SP, Brazil
| | - Geraldo Duarte
- Department of Gynecology and Obstetrics, Faculdade de Medicina de
Ribeirão Preto da Universidade de São Paulo (FMRP-USP),
Ribeirão Preto, SP, Brazil
| | - Ricardo de Carvalho Cavalli
- Department of Gynecology and Obstetrics, Faculdade de Medicina de
Ribeirão Preto da Universidade de São Paulo (FMRP-USP),
Ribeirão Preto, SP, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Escola Paulista de Medicina da
Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
- Medical Course, Universidade Municipal de São Caetano do Sul
(USCS), Campus Bela Vista, São Paulo, SP, Brazil
| | - Alberto Borges Peixoto
- Department of Obstetrics and Gynecology, Universidade Federal do
Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
- Gynecology and Obstetrics Service, Hospital Universitário
Mário Palmério, Universidade de Uberaba (Uniube), Uberaba, MG, Brazil
| | - Alessandra Cristina Marcolin
- Department of Gynecology and Obstetrics, Faculdade de Medicina de
Ribeirão Preto da Universidade de São Paulo (FMRP-USP),
Ribeirão Preto, SP, Brazil
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Cavalcante MB, Zanforlin Filho SM, Chagouri Ocké WBN, Pessoas Caldas MM, da Silva PHA, Ferraz AA, Pires CR, Júnior EA. Self-made transvaginal ultrasound simulator: new training equipment in ultrasound evaluation of controlled ovarian stimulation and oocyte retrieval. J Ultrason 2023; 23:e73-e79. [PMID: 37520745 PMCID: PMC10379845 DOI: 10.15557/jou.2023.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/22/2023] [Indexed: 08/01/2023] Open
Abstract
Aim We sought to create and describe a self-made simulator designed and created for teaching purposes: a high-fidelity ultrasound phantom for demonstrating antral follicle count, ultrasound supervision of controlled of ovarian stimulation, and ultrasound-guided oocyte retrieval. Materials and methods The uterus and ovaries of the ultrasound phantom were made from beef tongue, a male condom, latex gloves, cotton suture threads, bi-distilled water, and ultrasound gel. The components were placed in a pelvis created using three-dimensional (3D) printing. The phantom was presented to and evaluated by a group of 14 physicians pursuing a postgraduate course in reproductive medicine. Two training stations were structured: one to simulate antral follicle count and controlled ovarian stimulation and the other to simulate ultrasound-guided oocyte retrieval. Future specialists were requested to complete a feedback questionnaire evaluating the self-made simulator and the two practice stations. Results The transvaginal ultrasound phantom was successfully created, making it possible to simulate antral follicle count, ultrasound control of ovarian hyperstimulation, and oocyte retrieval, and to capture ultrasound images. A review of the answers provided in the feedback questionnaire showed that the phantom had a good appearance and design, was realistic, helped to improve motor coordination, and could be a useful tool in the training of specialists in assisted reproduction. Conclusion This phantom was designed to enable instruction and practice in the evaluation of ovarian follicles and ultrasound-guided oocyte retrieval in a supervised training environment. This self-made simulator is proposed as a training tool that could be included in the curricular structure of residency and postgraduate programs in reproductive medicine.
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Affiliation(s)
- Marcelo Borges Cavalcante
- Postgraduate Program in Medical Sciences, University of Fortaleza (UNIFOR), Fortaleza-CE, Brazil
- Center for Teaching and Training in Ultrasound (CETRUS), Recife-PE, Brazil
- Reproductive Medicine, GEARE, Recife-PE, Brazil
| | | | | | - Maria Madalena Pessoas Caldas
- Center for Teaching and Training in Ultrasound (CETRUS), Recife-PE, Brazil
- Reproductive Medicine, GEARE, Recife-PE, Brazil
| | | | | | | | - Edward Araujo Júnior
- 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
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Carneiro DN, Rossi I, Oliveira NT, de Moraes Oliveira L, Rodrigues M, Araujo Júnior E, Ruano R, Peixoto AB, Paschoini MC. Congenital intra-hepatic porto-systemic shunts diagnosed during intrauterine life: Systematic review. J Clin Ultrasound 2023; 51:803-811. [PMID: 36152014 DOI: 10.1002/jcu.23341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/27/2022] [Accepted: 09/03/2022] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To describe the ultrasonographic characteristics of congenital porto-systemic venous shunts (CPSS) diagnosed during pregnancy, their outcomes, and their evolution. METHODS Two independent researchers selected 493 review articles and case reports through the analysis of titles, abstracts, and full text. The PubMed and LILACS databases were searched. Through the application of filters according to the PRISMA protocol, only six articles were used in the research. The following information was collected, when available: gestational age at diagnosis, gender, birth weight, type of shunt, associated anomalies/complications and treatment/progression. RESULTS The data were obtained from 27 cases, with 22 (82%) fetuses diagnosed with intra-hepatic CPSS and 5 (18%) with extra-hepatic CPSS. The median time of intrauterine diagnosis was 33 weeks. In 12 (57.1%) of the 21 pregnancies evaluated, delivery was preterm. The estimated fetal weight ranged from 1150 to 3760 g, with 4 (25%) cases at <3rd, 3 (18.75%) cases at <10th, 8 (50%) cases at <50th, and 1 (6.25%) case at >97th percentile for gestational age. The most frequent obstetric complication was fetal growth restriction, which occurred in nine (60%) cases. As for postnatal treatment, 19 (70.4%) cases were conservatively treated, and 8 (29.6%) cases required surgical intervention. CONCLUSION The diagnosis of CPSS still represents a challenge during prenatal care. Its early identification aims to provide guidance to pregnant women and their families, as well as follow-up and anticipation of possible complications, in addition to the evaluation of the mode of delivery and postnatal follow-up, directing the short- and long-term prognosis.
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Affiliation(s)
- Darlei Neves Carneiro
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Isabela Rossi
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Nagibe Tayfour Oliveira
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Lorena de Moraes Oliveira
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Mariana Rodrigues
- Department of Radiology and Imaging Diagnostic, Faculty of Medicine of Ribeirão Preto - University of São Paulo (FMRP-USP), Ribeirão Preto, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Alberto Borges Peixoto
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
- Gynecology and Obstetrics Service, Mário Palmério University Hospital, University of Uberaba (UNIUBE), Uberaba, Brazil
| | - Marina Carvalho Paschoini
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
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Dias MB, Tuda LTS, Carvalho LIAD, Estevam TL, Mori B, Novelleto ALMT, Araujo Júnior E, Amorim LADR. What is important in family counseling in cases of fetuses with congenital heart disease? Rev Assoc Med Bras (1992) 2023; 69:e20230161. [PMID: 37255086 DOI: 10.1590/1806-9282.20230161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 02/23/2023] [Indexed: 06/01/2023]
Affiliation(s)
- Marcela Bezerra Dias
- Universidade Federal do Amazonas, Medical School, Postgraduate Program in Health Sciences - Manaus (AM), Brazil
| | | | | | - Thayla Lais Estevam
- Universidade Federal do Amazonas, Medical School, Postgraduate Program in Health Sciences - Manaus (AM), Brazil
| | - Bruno Mori
- Universidade Federal do Amazonas, Institute of Health and Biotechnology - Manaus (AM), Brazil
| | | | - Edward Araujo Júnior
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Obstetrics - São Paulo (SP), Brazil
- Universidade Municipal de São Caetano do Sul, Medical Course - São Caetano do Sul (SP), Brazil
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Castro PT, Ribeiro G, Fazecas T, Peixoto-Filho FM, Araujo Júnior E, Werner H. Fetal giant liver hemangioma: Ultrasound, magnetic resonance imaging, three-dimensional reconstruction findings and perinatal outcomes of two cases. J Clin Ultrasound 2023; 51:652-655. [PMID: 36367358 DOI: 10.1002/jcu.23391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 05/03/2023]
Abstract
In this case report, we present two cases of fetal liver giant hemangioma assessed using ultrasound, magnetic resonance imaging and three-dimensional reconstructions with their respective postnatal outcomes.
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Affiliation(s)
- Pedro Teixeira Castro
- Department of Fetal Medicine, Biodesign Laboratory DASA/PUC, Rio de Janeiro, RJ, Brazil
| | - Gerson Ribeiro
- Department of Fetal Medicine, Biodesign Laboratory DASA/PUC, Rio de Janeiro, RJ, Brazil
| | - Tatiana Fazecas
- Department of Fetal Medicine, Biodesign Laboratory DASA/PUC, Rio de Janeiro, RJ, Brazil
| | | | - Edward Araujo Júnior
- 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
| | - Heron Werner
- Department of Fetal Medicine, Biodesign Laboratory DASA/PUC, Rio de Janeiro, RJ, Brazil
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Castro PT, Lopes J, Ribeiro G, Peixoto-Filho FM, Araujo Júnior E, Werner H. Prenatal diagnosis of Pallister-Hall syndrome: ultrasound, magnetic resonance imaging, and three-dimensional reconstructions of phenotypical findings. J Ultrasound 2023:10.1007/s40477-023-00782-8. [PMID: 37067730 DOI: 10.1007/s40477-023-00782-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/27/2023] [Indexed: 04/18/2023] Open
Abstract
Pallister - Hall syndrome is a rare malformation that involves the presence of a suprasellar hamartoma and associated malformations. Prenatal diagnosis is also rare, and few cases have been reported using magnetic resonance imaging (MRI). A 35-year-old G5P2A2 woman at the 35th week of gestation was referred to our service. Fetal MRI showed an isointense image in the suprasellar region, pushing the brainstem up and backward, and compressing the vermis and cerebellum on T2-weighted images. On T1-weighted images, the hypointense signal of the tumor was similar to that of the brain parenchyma. Ultrasound images showed a suprasellar mass, which was more echogenic than the normal cerebral parenchyma, posteriorly pushing the brain stem, with involvement of the vermis of the tumor and compression of the posterior fossa. Three-dimensional reconstruction using MRI scan data showed a space view of the tumor and its relationships with the other brain tissues allowing better understanding by parents and multidisciplinary team.
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Affiliation(s)
- Pedro Teixeira Castro
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI - DASA), Rio de Janeiro, RJ, Brazil
| | - Jorge Lopes
- Biodesign Laboratory DASA/PUC, Rio de Janeiro, RJ, Brazil
| | - Gerson Ribeiro
- Biodesign Laboratory DASA/PUC, Rio de Janeiro, RJ, Brazil
| | | | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil, Rua Belchior de Azevedo, 156 apto. 111 Torre Vitória, 05089-030.
- Medical Course, Municipal University of São Caetano do Sul (USCS), Bela Vista Campus, São Paulo, SP, Brazil.
| | - Heron Werner
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI - DASA), Rio de Janeiro, RJ, Brazil
- Biodesign Laboratory DASA/PUC, Rio de Janeiro, RJ, Brazil
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Castro PT, Werner H, Araujo Júnior E, Bonasoni MP, Tonni G. Prenatal and Postnatal Zika Intrauterine Infection: Diagnostic Imaging Techniques and Placental Pathology. Fetal Pediatr Pathol 2023; 42:207-215. [PMID: 36125260 DOI: 10.1080/15513815.2022.2118559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction: Zika virus (ZIKV) is an arbovirus (arthropod-borne virus) in the genus Flavivirus and Flaviviridae family. In November 2015, several cases of microcephaly in Northeastern of Brazil suggested ZIKV involvement. Case Report: A 33-year-old primigravida developed fever and cutaneous rash at 7th week of gestation (WGA). The ultrasound and MRI examination showed head circumference < 5th centile and enlargement of lateral ventricles. The infant was delivered at 39th WGA with microcephaly. Microscopy of the placenta showed chronic villitis and intervillitis, nodular stromal fibrosis in the stem villi, and vascular thickening. Postnatal CT showed collapsed cranium due to growth impairment of the suprathalamic brain, multiple cerebral calcifications, parenchymal atrophy, and ventricular dilatation. Now, at 6 years old, the child suffers from severe neurologic symptoms, including seizures. Conclusion: This case gathers images of prenatal and postnatal period, and placental histopathology. The long-term follow-up highlights the dramatic neurological sequelae induced by ZIKV.
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Affiliation(s)
- Pedro Teixeira Castro
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, RJ, Brazil
| | - Heron Werner
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, RJ, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | | | - Gabriele Tonni
- Department of Obstetrics and Neonatology and Researcher, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Grohmann RM, Marçal VMG, Corazza IC, Peixoto AB, Júnior EA, Nardozza LMM. Maternal Blood Fatty Acid Levels in Fetal Growth Restriction. Rev Bras Ginecol Obstet 2023; 45:127-133. [PMID: 37105196 PMCID: PMC10139773 DOI: 10.1055/s-0043-1768455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVE To assess the maternal blood levels of fatty acids (FAs) in pregnancies with fetal growth restriction (FGR). METHODS This prospective cross-sectional study included pregnant women with gestational age between 26 and 37 + 6 weeks with FGR and appropriate for gestational age (AGA) fetuses. The levels of saturated, trans, monounsaturated, and polyunsaturated FAs were measured using centrifugation and liquid chromatography. The Student's t-test, Mann-Whitney test, and general linear model, with gestational age and maternal weight as covariants, were used to compare FA levels and the FGR and AGA groups. The Chi-square was used to evaluate the association between groups and studied variables. RESULTS Maternal blood sample was collected from 64 pregnant women, being 24 FGR and 40 AGA. A weak positive correlation was found between the palmitoleic acid level and maternal weight (r = 0.285, p = 0.036). A weak negative correlation was found between the gamma-linoleic acid level and gestational age (r = - 0.277, p = 0.026). The median of the elaidic acid level (2.3 vs. 4.7 ng/ml, p = 0.045) and gamma-linoleic acid (6.3 vs. 6.6 ng/ml, p = 0.024) was significantly lower in the FGR than the AGA group. The palmitoleic acid level was significantly higher in the FGR than AGA group (50.5 vs. 47.6 ng/ml, p = 0.033). CONCLUSION Pregnant women with FGR had lower elaidic acid and gamma-linoleic acid levels and higher palmitoleic acid levels than AGA fetuses.
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Affiliation(s)
- Raquel Margiotte Grohmann
- Department of Obstetrics, Paulista School of Medicine-Federal University of São Paulo, São Paulo, SP, Brazil
| | - Vivian Macedo Gomes Marçal
- Department of Obstetrics, Paulista School of Medicine-Federal University of São Paulo, São Paulo, SP, Brazil
- Department of Obstetrics and Gynecology, Medical Science College of Santos, Santos, SP, Brazil
| | - Isabela César Corazza
- Department of Obstetrics, Paulista School of Medicine-Federal University of São Paulo, São Paulo, SP, Brazil
| | - Alberto Borges Peixoto
- Department of Gynecology and Obstetrics, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
- Gynecology and Obstetrics Service, Mário Palmério University Hospital, University of Uberaba, Uberaba, MG, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine-Federal University of São Paulo, São Paulo, SP, Brazil
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Milani HJF, Barreto EQDS, Araujo Júnior E, Cavalheiro S, Barbosa MM, Peixoto AB, Moron AF. Assessment of lower limb trophism in fetuses with open spina bifida using fractional thigh volume of three-dimensional ultrasound. J Clin Ultrasound 2023; 51:409-414. [PMID: 36223260 DOI: 10.1002/jcu.23364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/12/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To assess the trophism of the lower limbs of fetuses with open spina bifida using fractional thigh volume (TVOL) of three-dimensional (3D) ultrasound. METHODS A prospective cross-sectional study was carried out with normal fetuses and with open spina bifida (myelomeningocele and rachischisis) at 26 weeks' gestation. The TVOL (delimitation of five cross-sectional areas of the middle portion of the limb) was evaluated, as well as the subjective assessment of hypotrophy and lower limb movement. RESULTS Thirty-one fetuses with open spina bifida, 21 with myelomeningocele and 10 with rachischisis, and 51 normal fetuses were included. There were no significant differences in the TVOL between normal and spina bifida fetuses (p = 0.623), as well as between normal fetuses, with myelomeningocele and with rachischisis (p = 0.148). There was no significant difference in the TVOL of fetuses with spina bifida with or without lower limb hypotrophy (p = 0.148). Fetuses with spina bifida and with lower limb movement had higher TVOL values than fetuses without lower limb movement (p = 0.002). CONCLUSION There were no significant differences in the TVOL measurement of normal and spina bifida fetuses (rachischisis and myelomeningocele). Fetuses with spina bifida without spontaneous movement of the lower limbs had lower TVOL values.
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Affiliation(s)
- Hérbene José Figuinha Milani
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
- Department of Fetal Medicine, Hospital e Maternidade Santa Joana, São Paulo, SP, Brazil
| | | | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Sérgio Cavalheiro
- Department of Neurology and Neurosurgery, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
- Department of Fetal Neurosurgery, Hospital e Maternidade Santa Joana, São Paulo, SP, Brazil
| | - Maurício Mendes Barbosa
- Department of Fetal Medicine, Hospital e Maternidade Santa Joana, São Paulo, SP, Brazil
- Service of Gynecology and Obstetrics, Israeli Faculty of Health Sciences Albert Einstein, São Paulo, SP, Brazil
| | - Alberto Borges Peixoto
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
- Gynecology and Obstetrics Service, Mário Palmério University Hospital, University of Uberaba (UNIUBE), Uberaba, MG, Brazil
| | - Antonio Fernandes Moron
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
- Department of Fetal Medicine, Hospital e Maternidade Santa Joana, São Paulo, SP, Brazil
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Sasaoka AKS, Moron AF, Araujo Júnior E, Sañudo A, Barbosa MM, Milani HJF, Sarmento SGP, Cavalheiro S. Ultrasound evaluation of uterine scar thickness after open fetal surgery for myelomeningocele. Childs Nerv Syst 2023; 39:655-661. [PMID: 35939128 DOI: 10.1007/s00381-022-05642-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to analyse the evolution of uterine scar thickness after open fetal surgery for myelomeningocele (MMC) by ultrasonography, and to establish a cut-off point for uterine scar thickness associated with high-risk of uterine rupture. METHODS A prospective longitudinal study was conducted with 77 pregnant women who underwent open fetal surgery for MMC between 24 and 27 weeks of gestation. After fetal surgery, ultrasound follow-up was performed once a week, and the scar on the uterine wall was evaluated and its thickness was measured by transabdominal ultrasound. At least five measurements of the uterine scar thickness were performed during pregnancy. A receiver operating characteristics (ROC) curve was constructed to obtain a cut-off point for the thickness of the scar capable of detecting the absence of thinning. Kaplan-Meier curves were constructed to evaluate the probability of thinning during pregnancy follow-up. RESULTS The mean ± standard deviation of maternal age (years), gestational age at surgery (weeks), gestational age at delivery (weeks), and birth weight (g) were 30.6 ± 4.5, 26.1 ± 0.8, 34.3 ± 1.2 and 2287.4 ± 334.4, respectively. Thinning was observed in 23 patients (29.9%). Pregnant women with no thinning had an average of 17.1 ± 5.2 min longer surgery time than pregnant women with thinning. A decrease of 1.0 mm in the thickness of the uterine scar was associated with an increased likelihood of thinning by 1.81-fold (95% confidence interval [CI]: 1.32-2.47; p < 0.001). The area below the ROC curve was 0.899 (95% CI: 0.806-0.954; p < 0.001), and the cut-off point was ≤ 3.0 mm, which simultaneously presented greater sensitivity and specificity. After 63 days of surgery, the probability of uterine scarring was 50% (95% CI: 58-69). CONCLUSION A cut-off point of ≤ 3.0 mm in the thickness of the uterine scar after open fetal surgery for MMC may be used during ultrasonography monitoring for decision-making regarding the risk of uterine rupture and indication of caesarean section.
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Affiliation(s)
- Alexandre Kim Sangalan Sasaoka
- Department of Obstetrics, Paulista School of Medicina - Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, 05089-030, Brazil
| | - Antonio Fernandes Moron
- Department of Obstetrics, Paulista School of Medicina - Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, 05089-030, Brazil
- Paulista Center of Fetal Medicine, São Paulo, SP, Brazil
- Santa Joana Maternity and Hospital, São Paulo, SP, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicina - Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, 05089-030, Brazil.
| | - Adriana Sañudo
- Department of Preventive Medicine, Paulista School of Medicina - Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Mauricio Mendes Barbosa
- Paulista Center of Fetal Medicine, São Paulo, SP, Brazil
- Santa Joana Maternity and Hospital, São Paulo, SP, Brazil
| | - Herbene José Figuinha Milani
- Department of Obstetrics, Paulista School of Medicina - Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, 05089-030, Brazil
- Paulista Center of Fetal Medicine, São Paulo, SP, Brazil
- Santa Joana Maternity and Hospital, São Paulo, SP, Brazil
| | | | - Sergio Cavalheiro
- Paulista Center of Fetal Medicine, São Paulo, SP, Brazil
- Santa Joana Maternity and Hospital, São Paulo, SP, Brazil
- Department of Neurology and Neurosurgery, Paulista School of Medicina - Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
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Pontes ALS, Chagas CC, Bravo-Valenzuela NJ, Peixoto AB, Mappa I, Rizzo G, Tonni G, Araujo Júnior E. Fetal heart foramen ovale area by three-dimensional ultrasound using stic in the rendering mode: reference range and applicability in congenital heart diseases. Int J Cardiovasc Imaging 2023; 39:531-539. [PMID: 36334212 DOI: 10.1007/s10554-022-02752-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/23/2022] [Indexed: 11/09/2022]
Abstract
To determine reference values for the foramen ovale (FO) area of fetal hearts by three-dimensional (3D) ultrasound using spatio-temporal image correlation (STIC) method in the rendering mode, as well as applicability in fetuses with congenital heart disease (CHD). A retrospective and prospective study was performed of 242 normal fetuses and 36 fetuses with CHD between 20 and 33 + 6 weeks of gestation. The FO area was determined in the four-chamber view with manual delineation. To determine the reference curve of the FO area as a function of gestational age (GA), a linear regression model was utilized with an adjusted coefficient of determination (R2). For intra- and interobserver reproducibility calculations, the concordance correlation coefficient (CCC) was used. The mean ± standard deviation (SD) of the FO measurement area was 21.2 ± 1.8 and 48.1 ± 1.9 mm2 at 20 and 33 weeks' gestation, respectively. A linear correlation was observed between the FO area and GA (1.924*GA - 17.95; R2 = 0.91). Good intra- (CCC = 0.97) and interobserver (CCC = 0.94) agreement was observed for the FO area measurement. The mean difference in FO area between normal and CHD fetuses was - 14.4 mm2 (p < 0.001). Reference values for the FO area of fetal hearts were determined by 3D ultrasound using STIC in the rendering mode. This method showed good intra- and interobserver reproducibility and could be used to assess different CHD types.
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Affiliation(s)
- Ana Letícia Siqueira Pontes
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM- UNIFESP), São Paulo, SP, Brazil
| | - Caroline Cervantes Chagas
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM- UNIFESP), São Paulo, SP, Brazil
| | - Nathalie Jeanne Bravo-Valenzuela
- Department of Pediatrics, Pediatric Cardiology, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro-RJ, Brazil
| | - Alberto Borges Peixoto
- Gynecology and Obstetrics Service, Mario Palmério University Hospital - University of Uberaba (UNIUBE), Uberaba, MG, Brazil
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Ilenia Mappa
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Gabriele Tonni
- Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL di Reggio Emilia, Reggio Emilia, Italy
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM- UNIFESP), São Paulo, SP, Brazil.
- , Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, Vila Leopoldina, Sao Paulo, SP, CEP 05089-030, Brazil.
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Tonni G, Grisolia G, Bonasoni MP, Rizzo G, Werner H, Sepulveda W, Ruano R, Araujo Júnior E. Fetal Hands: A Comprehensive Review of Prenatal Assessment and Diagnosis Over the Past 40 Years. Ultrasound Med Biol 2023; 49:657-676. [PMID: 36526543 DOI: 10.1016/j.ultrasmedbio.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/16/2022] [Accepted: 09/30/2022] [Indexed: 06/17/2023]
Abstract
Fetal skeletal dysplasias involving limbs and hands are rare congenital malformations. Prenatal two-dimensional ultrasound diagnosis of fetal limb defects has a sensitivity of about 30%; however, an increased detection rate may be obtained using three-dimensional (3-D) ultrasound in the rendering mode. 3-D ultrasound may be used as a complementary method providing additional information. Currently, magnetic resonance imaging (MRI), with the emergence of ultrafast imaging techniques and new sequences, allows for better diagnosis of several fetal skeletal dysplasias such as limb reduction defects and neuromuscular disorders. 3-D volumetric images from ultrasound or MRI scan data allow 3-D ultrasound reconstructions of virtual/physical models, and virtual reality can help researchers to improve our understanding of both normal and abnormal fetal limb/hand anatomy. In this article, we review the embryological development of fetal hands and their main anomalies including prenatal diagnostic methods, genetic counseling, the role of orthopedic and plastic surgery reconstruction, and new perspectives in fetal surgery.
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Affiliation(s)
- Gabriele Tonni
- Prenatal Diagnostic Centre, Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Italy.
| | - Gianpaolo Grisolia
- Prenatal Diagnostic Centre, Department of Obstetrics and Neonatology, Carlo Poma Hospital, Mantua, Italy
| | - Maria Paola Bonasoni
- Human Pathology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Tor Vergata, Rome, Italy
| | - Heron Werner
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI-DASA), Rio de Janeiro, Brazil
| | - Waldo Sepulveda
- FETALMED-Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
| | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
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Ximenes RS, Bravo-Valenzuela NJ, Pares DBS, Araujo Júnior E. The use of cardiac ultrasound imaging in first-trimester prenatal diagnosis of congenital heart diseases. J Clin Ultrasound 2023; 51:225-239. [PMID: 36468264 DOI: 10.1002/jcu.23330] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/08/2022] [Indexed: 06/17/2023]
Abstract
This study aims to explore ultrasound (US) cardiac and echocardiographic features that may enable the early diagnosis of various major congenital heart diseases (CHDs). Focusing on providing useful US tools for this assessment, high resolution of US cardiac images of various CHDs, such as hypoplastic left heart syndrome, conotruncal anomalies, and univentricular heart, were evaluated. Results show that early US detection of most major CHDs is feasible during first-trimester ultrasonography cardiac evaluation. Concerns about safety issues, findings on early fetal cardiovascular hemodynamics, and cardiac lesions that can progress during the course of pregnancy were also discussed.
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Affiliation(s)
| | - Nathalie Jeanne Bravo-Valenzuela
- Discipline of Pediatrics, Department of Internal Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - David Baptista Silva Pares
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Edward Araujo Júnior
- 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), São Paulo, SP, Brazil
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45
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Tonni G, Peixoto AB, Werner H, Grisolia G, Ruano R, Sepulveda F, Sepulveda W, Araujo Júnior E. Ultrasound and fetal magnetic resonance imaging: Clinical performance in the prenatal diagnosis of orofacial clefts and mandibular abnormalities. J Clin Ultrasound 2023; 51:346-361. [PMID: 36785498 DOI: 10.1002/jcu.23403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 06/18/2023]
Abstract
Cleft lip, with or without cleft palate, is the most common congenital craniofacial anomaly and the second most common birth defect worldwide. Micrognathia is a rare facial malformation characterized by small, underdeveloped mandible and frequently associated with retrognathia. Second- and third-trimester prenatal ultrasound is the standard modality for screening and identification of fetal orofacial abnormalities, with a detection rate in the low-risk population ranging from 0% to 73% for all types of cleft. The prenatal ultrasonography detection can also be performed during the first trimester of pregnancy. Given the potential limitations of obstetric ultrasound for examining the fetal face, such as suboptimal fetal position, shadowing from the surrounding bones, reduce amniotic fluid around the face, interposition of fetal limbs, umbilical cord and placenta, and maternal habitus/abdominal scars, the use of adjunct imaging modalities can enhance prenatal diagnosis of craniofacial anomalies in at-risk pregnancies. Fetal magnetic resonance imaging (MRI) is a potentially useful second-line investigation for the prenatal diagnosis of orofacial malformations with a pooled sensitivity of 97%. In this review, we discuss the role of ultrasound and fetal MRI in the prenatal assessment of abnormalities of the upper lip, palate, and mandible.
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Affiliation(s)
- Gabriele Tonni
- Prenatal Diagnostic Centre, Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Alberto Borges Peixoto
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Heron Werner
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI - DASA), Rio de Janeiro, Brazil
| | - Gianpaolo Grisolia
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, ASST Mantova, Mantova, Italy
| | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, UH Jackson Fetal Care, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Francisco Sepulveda
- FETALMED-Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
| | - Waldo Sepulveda
- FETALMED-Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
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Bravo-Valenzuela NJ, Peixoto AB, Araujo Júnior E. Second Trimester Fetal Cardiac Screening - Current Opinion. Rev Bras Ginecol Obstet 2023; 45:55-58. [PMID: 36977401 PMCID: PMC10078885 DOI: 10.1055/s-0043-1764492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Affiliation(s)
| | - Alberto Borges Peixoto
- Gynecology and Obstetrics Service, Mário Palmério University Hospital, University of Uberaba, Uberaba, MG, Brazil
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo, São Paulo, SP, Brazil
- Medical course, Municipal University of São Caetano do Sul, São Caetano, SP, Brazil
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Chagas CC, Siqueira Pontes AL, Bravo-Valenzuela NJ, Peixoto AB, Mappa I, Viscardi C, Rizzo G, Araujo Júnior E. Assessment of fetal heart aortic and pulmonary valve annulus area by three-dimensional ultrasonography: reference curves and applicability in congenital heart diseases. J Perinat Med 2023:jpm-2022-0532. [PMID: 36584322 DOI: 10.1515/jpm-2022-0532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/14/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To determine reference curves for fetal aortic and pulmonary valve annulus area by three-dimensional ultrasonography using the spatio-temporal image correlation (STIC) in the rendering mode, and to ascertain its applicability in congenital heart disease (CHD). METHODS We performed a retrospective cross-sectional study of 328 normal fetuses and 42 fetuses with CHD between 20 and 33 weeks 6 days of gestation. The outflow plane view of the great vessels was used to measure the areas of the valvar annuli, and the measurements were performed in systole. A linear regression model adjusted according to the determination coefficient (R2) was utilized to construct the reference intervals. The concordance correlation coefficient (CCC) was used to calculate the reproducibility of the mitral and tricuspid valve areas. RESULTS The mean ± standard deviation (SD) of the aortic and pulmonary valve annulus areas ranged from 6.6 ± 1.2 to 32.9 ± 1.1 mm2 and 10.7 ± 1.3 to 40.3 ± 1.2 mm2, respectively. We observed a linear relationship and strong positive correlation between the area of the aortic and pulmonary valve annuli with r=0.97 and 0.96, respectively. Good intra (CCC=0.99) and interobserver agreement (CCC=0.98) was observed for the measurement of the aortic valve annulus area. A good intra (CCC=0.99) and interobserver (CCC=0.97) agreement was also observed for the measurement of the pulmonary valve annulus area. The mean ± SD of the difference of the areas of the aortic and pulmonary valve annuli between the normal fetuses and those with CHD were -1.801 ± 1.429 mm2 (p=0.208) and -1.033 ± 1.467 mm2 (p<0.0001), respectively. CONCLUSIONS The reference curves for the areas of the aortic and pulmonary valve annuli of fetal hearts were determined, and showed good inter and intraobserver reproducibility. The constructed reference curves showed applicability in different types of CHD.
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Affiliation(s)
- Caroline Cervante Chagas
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Ana Letícia Siqueira Pontes
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Nathalie Jeanne Bravo-Valenzuela
- Department of Pediatrics, Pediatric Cardiology, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Alberto Borges Peixoto
- Gynecology and Obstetrics Service, Mario Palmério University Hospital - University of Uberaba (UNIUBE), Uberaba, MG, Brazil
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Ilenia Mappa
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Clementina Viscardi
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
- Department of Obstetrics and Gynecology, Università di Bari, Bari, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
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Tomich MF, Leoni RS, Meireles PT, Petrini CG, Araujo Júnior E, Peixoto AB. Accuracy of intrapartum cardiotocography in identifying fetal acidemia by umbilical cord blood analysis in low-risk pregnancies. Rev Assoc Med Bras (1992) 2023; 69:e20221182. [PMID: 37194903 DOI: 10.1590/1806-9282.20221182] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the accuracy of intrapartum cardiotocography in identifying fetal acidemia by umbilical cord blood analysis in low-risk pregnancies. METHODS This is a retrospective cohort study of low-risk singleton pregnancies in labor after performing intrapartum cardiotocography categories I, II, and III. The presence of fetal acidemia at birth was identified by analyzing the pH of umbilical cord arterial blood (pH<7.1). RESULTS No significant effect of the cardiotocography category on the arterial (p=0.543) and venous (p=0.770) pH of umbilical cord blood was observed. No significant association was observed between the cardiotocography category and the presence of fetal acidemia (p=0.706), 1-min Apgar score <7 (p=0.260), hospitalization in the neonatal intensive care unit (p=0.605), newborn death within the first 48 h, need for neonatal resuscitation (p=0.637), and adverse perinatal outcomes (p=0.373). Sensitivities of 62, 31, and 6.0%; positive predictive values of 11.0, 16.0, and 10.0%; and negative predictive values of 85, 89.0, and 87.0% were observed for cardiotocography categories I, II, and III, respectively. CONCLUSION The three categories of intrapartum cardiotocography presented low sensitivities and high negative predictive values to identify fetal acidemia at birth in low-risk pregnancies.
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Affiliation(s)
- Michaela Franco Tomich
- Universidade de Uberaba, Mário Palmério University Hospital, Gynecology and Obstetrics Service - Uberaba (MG), Brazil
| | - Renato Silva Leoni
- Universidade de Uberaba, Mário Palmério University Hospital, Gynecology and Obstetrics Service - Uberaba (MG), Brazil
| | - Pedro Teixeira Meireles
- Universidade de Uberaba, Mário Palmério University Hospital, Gynecology and Obstetrics Service - Uberaba (MG), Brazil
| | - Caetano Galvão Petrini
- Universidade de Uberaba, Mário Palmério University Hospital, Gynecology and Obstetrics Service - Uberaba (MG), Brazil
- Universidade Federal do Triângulo Mineiro, Department of Gynecology and Obstetrics - Uberaba (MG), Brazil
| | - Edward Araujo Júnior
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Obstetrics - São Paulo (SP), Brazil
- Universidade Municipal de São Caetano do Sul, Medical Course - São Paulo (SP), Brazil
| | - Alberto Borges Peixoto
- Universidade de Uberaba, Mário Palmério University Hospital, Gynecology and Obstetrics Service - Uberaba (MG), Brazil
- Universidade Federal do Triângulo Mineiro, Department of Gynecology and Obstetrics - Uberaba (MG), Brazil
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Hamamoto TENK, Hatanaka AR, França MS, Sarmento SGP, Helfer TM, Nomura RMY, Araujo Júnior E, Moron AF. An enlarged fetal thymus may be the initial response to intrauterine inflammation in pregnant women at risk for preterm birth. Rev Assoc Med Bras (1992) 2023; 69:e20221678. [PMID: 37075382 PMCID: PMC10176657 DOI: 10.1590/1806-9282.20221678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 01/02/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE Fetal thymus involvement in prematurity has been studied, and this study aimed to evaluate its relationship with short cervix and amniotic fluid sludge in the second trimester of pregnancy. METHODS In this prospective cross-sectional study, 79 pregnant women (19+0 to 24+6 weeks) were included, and cervical length and the presence or absence of amniotic fluid sludge were evaluated. In the three-vessel view of the fetal thorax, the thymus was identified, and its perimeter and transverse diameter were measured and transformed to a zeta score based on gestational age. RESULTS Data from 22 women with short cervix (<25 mm) and 57 patients with normal cervix (≥25 mm) were analyzed. The transverse diameter of the fetal thymus was significantly greater in the short cervix group compared to that of the normal cervix group (z-score 2.708 vs. -0.043, p=0.003). There were no significant differences in the perimeter (z-score -0.039 vs. -0.071, p=0.890) or the transverse diameter (z-score 1.297 vs. -0.004, p=0.091) of the fetal thymus associated with the presence (n=21) or absence of sludge (n=58). CONCLUSION A short cervix is associated with an increased transverse diameter of the fetal thymus during the second trimester of gestation.
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Affiliation(s)
| | - Alan Roberto Hatanaka
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Obstetrics - São Paulo (SP), Brazil
| | - Marcelo Santucci França
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Obstetrics - São Paulo (SP), Brazil
| | | | - Talita Micheletti Helfer
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Obstetrics - São Paulo (SP), Brazil
| | - Roseli Mieko Yamamoto Nomura
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Obstetrics - São Paulo (SP), Brazil
| | - Edward Araujo Júnior
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Obstetrics - São Paulo (SP), Brazil
| | - Antonio Fernandes Moron
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Obstetrics - São Paulo (SP), Brazil
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50
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Silva CBDO, Rodrigues KMD, Zoldan C, Nomura RMY, Araujo Júnior E, Peixoto AB. Nonpharmacological Methods to Reduce Pain During Active Labor in A Real-life Setting. Rev Bras Ginecol Obstet 2023; 45:3-10. [PMID: 36878247 PMCID: PMC10021005 DOI: 10.1055/s-0042-1759629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVE To evaluate the association between pain intensity in the active phase of the first stage of labor with the use or not of nonpharmacological methods for pain relief in a real-life scenario. METHODS This was an observational cross-sectional study. The variables analyzed were obtained by a questionnaire with the mothers (up to 48 hours postpartum) to investigate the intensity of pain during labor using the visual analog scale (VAS). The nonpharmacological pain relief methods routinely used in obstetric practice were evaluated by consulting medical records. The patients were separated into two groups: Group I - patients who did not use nonpharmacological methods for pain relief and Group II -patients who used these methods. RESULTS A total of 439 women who underwent vaginal delivery were included; 386 (87.9%) used at least 1 nonpharmacological method and 53 (12.1%) did not. The women who did not use nonpharmacological methods had significantly lower gestational age (37.2 versus 39.6 weeks, p < 0.001) and shorter duration of labor (24 versus 114 min, p < 0.001) than those who used the methods. There was no statistically significant difference in the pain scale score using the VAS between the group that used nonpharmacological methods and the group that did not (median 10 [minimum 2-maximum 10] versus 10 [minimum 6-maximum 10] p = 0.334). CONCLUSION In a real-life setting, there was no difference in labor pain intensity between the patients who used nonpharmacological methods and those who did not use them during the active phase of labor.
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Affiliation(s)
| | | | - Camila Zoldan
- Gynecology and Obstetrics Service, Hospital Universitário Mario Palmério, Universidade de Uberaba, Uberaba, MG, Brazil
| | | | - Edward Araujo Júnior
- Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Alberto Borges Peixoto
- Gynecology and Obstetrics Service, Hospital Universitário Mario Palmério, Universidade de Uberaba, Uberaba, MG, Brazil.,Department of Obstetrics and Gynecology, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil
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