Karina Bilda de Castro Rezende (original) (raw)

Papers by Karina Bilda de Castro Rezende

Pregnancy Hypertension, Sep 1, 2023

Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health, 2016

Preeclampsia (PE) 1 prevalence studies in Brazil are both scarce and not divided in accordance wi... more Preeclampsia (PE) 1 prevalence studies in Brazil are both scarce and not divided in accordance with gestational age at delivery. We accessed PE prevalence according to delivery before 34, 37 and 42 weeks in a cross-sectional study including 4464 single deliveries. PE was diagnosed in 301 cases (6.64%); Prevalence of PE was 0,78%; 1,92% and 6,74% according to deliveries before 34, 37 and 42 weeks. PE was associated with fetal death, prematurity and small for gestational age newborns.

Peer Review

O monitoramento da mortalidade perinatal depende da qualidade dos dados dos sistemas de informaçã... more O monitoramento da mortalidade perinatal depende da qualidade dos dados dos sistemas de informação, das fichas de investigação e, principalmente, das declarações de óbito (DO). O objetivo foi discriminar as principais inconformidades no preenchimento das Declarações de Óbitos perinatais, na Maternidade Escola da Universidade Federal do Rio de Janeiro. Trata-se estudo observacional, transversal, quantitativo e documental. Foram analisadas as DOs, os prontuários e fichas de investigação dos óbitos perinatais ocorridos na instituição nos anos de 2015 e 2016. A principal inadequação identificada esteve no campo “causa básica do óbito”, com taxa de 94,8% de erro, o que evidencia a necessidade de se trabalhar a temática não só nas estratégias de educação permanente em saúde, como também na inclusão da temática nas diretrizes curriculares do curso de graduação em medicina, fortalecendo as estratégias de evitabilidade da mortalidade infantil por causas evitáveis.

Aim: The aim of this study was to discuss associations between stress and anxiety and their relat... more Aim: The aim of this study was to discuss associations between stress and anxiety and their relation with mental health during pregnancy based on data from pregnant women who participated in a program for screenning maternal-fetal risks in order to implement a follow up service of maternal mental health. Study design: A cohort of 90 pregnant women at 1st trimester of pregnancy was investigated using the Beck Anxiety Inventory (BAI) to evaluate symptoms of general anxiety and the Lipp Stress Symptoms Inventory for Adults, a Brazilian scale which evaluates stress symptoms. The participants were recruited during eight months and evaluated while they were waiting for exams to identify maternalfetal risks at the Screening Program of Maternidade Escola da Universidade Federal do Rio de Janeiro (ME-UFRJ). This is a public hospital that receives patients on demand. All adult pregnant women at the begining of pregnancy who came to the prenatal care at the MEUFRJ were included. Results: Mild ...

A prematuridade e problema de Saude Publica, pois representa a principal causa de baixo peso ao n... more A prematuridade e problema de Saude Publica, pois representa a principal causa de baixo peso ao nascer, morte neonatal precoce e tardia, alem de associar-se com danos no neurodesenvolvimento e sequelas respiratorias. A busca por estrategias que visem reduzir sua prevalencia ou retardar sua ocorrencia, e relevante. Alem disso, a reducao das complicacoes associadas, ameniza os custos financeiros e sociais. A medida do colo uterino, pela via transvaginal, no primeiro trimestre da gestacao foi incorporada a rotina das pacientes assistidas durante o pre-natal na Maternidade Escola da UFRJ, a partir de janeiro de 2013. Faz parte do programa de rastreio de risco gestacional ,realizado no primeiro trimestre na instituicao em todas as gestantes, que iniciam o pre-natal tempestivamente. Desta maneira, e imperativo avaliar a mensuracao do colo uterino e as condutas pre- natais subsequentes ao exame, como a administracao de progesterona por via vaginal ou a realizacao de cerclagem cervical. Tem...

A predicao da pre-eclâmpsia(PE) de forma eficaz e efetiva e meta de muitos pesquisadores em todo... more A predicao da pre-eclâmpsia(PE) de forma eficaz e efetiva e meta de muitos pesquisadores em todo o mundo. Existem evidencias de que a identificacao de gestantes de risco, no 1 o trimestre da gestacao e subsequente implementacao de aspirina em doses diarias de 150 mg, diminui a ocorrencia das formas precoces de PE. A Fundacao de Medicina Fetal desenvolveu modelo preditivo apresentado como algoritmo a partir de caracteristicas fisicas e da historia materna e de marcadores biofisicos , que passou a ser utilizado na rotina asistencial. Os objetivos desse estudo sao: (1) descrever a distribuicao dos escores de risco, para desenvolvimento da PE; (2) comparar a importância dos fatores de risco e dos marcadores biofisicos entre a populacao submetida ao rastreio e a populacao de referencia e (3) avaliar o desempenho do teste de rastreio para PE realizado no 1 o trimestre da gestacao, a partir de fatores maternos e marcadores biofisicos. O estudo foi transversal e observacional com incl...

A pre-eclâmpsia (PE) esta relacionada a altos indices de morbidade e mortalidade ao redor do mund... more A pre-eclâmpsia (PE) esta relacionada a altos indices de morbidade e mortalidade ao redor do mundo. Tem uma prevalencia estimada em torno de 2-8% e esta correlacionada com muitos casos de partos pre-termo e crescimento intrauterino restrito (CIR). Multiplos fatores de risco podem estar presentes, sendo a historia obstetrica pregressa de PE considerada um fator de alto risco, dentre outros. A fisiopatologia da PE nao e totalmente compreendida e algumas teorias tentam justificar a sua ocorrencia. A invasao trofoblastica anormal dos vasos uterinos, a intolerância imunologica entre os tecidos maternos e feto-placentario, a ma-adaptacao as alteracoes cardiovasculares ou inflamatorias da gravidez e anormalidades geneticas estao entre as possiveis hipoteses. Em funcao da morbidade causada pela PE severa diversas estrategias de prevencao sao estudadas. Baixas doses de aspirina promovem reducao do risco de PE em mulheres de alto risco. Se administrada precocemente, pode diminuir os casos de ...

Pregnancy Hypertension, 2021

OBJECTIVE To validate a combined algorithm for early prediction of pre-eclampsia (PE) in the Braz... more OBJECTIVE To validate a combined algorithm for early prediction of pre-eclampsia (PE) in the Brazilian population. STUDY DESIGN This is an unplanned secondary analysis of a cohort study. Consecutive singleton pregnancies undergoing first-trimester screening for PE involving examination of maternal characteristics, medical history, and biophysical markers were considered eligible. Women were classified as low-or high-risk using a cutoff of 1/200, but the individual risk was not used to dictate management, as aspirin prophylaxis was given to women based solely on clinical risk factors. Receiver-operating characteristics (ROC) curves for PE, preterm PE(PE < 37) and early 34(PE < 34) were constructed and detection rates(DR) and false-positive rates(FPR) were calculated, adjusting for the effect of aspirin. Propensity score analysis was utilized to account for possible confounding by indication. MAIN OUTCOME MEASURES Screening performance and PE rates. RESULTS Among 1695 women, 323(19.1%) were classified as high-risk for PE and 1372(80.9%) were considered low-risk. Aspirin use was registered in 62(3.7%) in the high-risk group and 33(1.9%) in the low-risk group. There were 164(9.7%) women who developed PE, including 41(2.4%) with PE < 37 and 18(1.1%) PE < 34.Subgroups with aspirin had higher incidence of PE, suggest confounding by indication. The algorithm had an AUC of 0.87, DR of 72% for PE < 34; an AUC of 0.8, DR of 59% for PE < 37, both with FPR of 18%. Accounting for effect of aspirin, we observed an improvement in DR of PE < 37 to 67%. CONCLUSION Using combined predictive algorithm for preterm PE prediction is feasible in clinical practice in low/middle-income countries. Aspirin use needs to be accounted for when evaluating the performance of screening.

BACKGROUND There is a pioneer algorithm developed by Fetal Medicine Foundation (FMF) to predict p... more BACKGROUND There is a pioneer algorithm developed by Fetal Medicine Foundation (FMF) to predict preeclampsia based on maternal characteristics combined with biophysical and/or biochemical markers. The Afro-Caribbean ethnicity is the second risk factor, in magnitude, found in populations tested by FMF, which was not confirmed in a Brazilian scenario. OBJECTIVE This study aimed to analyze the performance of preeclampsia (PE) prediction software by customization of maternal ethnicity. METHODS It was an observational, cross-sectional study, with secondary evaluation of data from FMF first trimester screening tests of singleton pregnancies. Risk scores were calculated from maternal characteristics and biophysical markers and were presented as the risk for PE development before 34 and 37 weeks. The following steps were followed: (1)identification of women characterized as black ethnicity; (2)calculation of early and preterm PE risk, reclassifying them as white, which generated a new score...

The Journal of Maternal-Fetal & Neonatal Medicine, 2017

Abstract Objective To evaluate the impacts of maternal risk factors described by the Fetal Medici... more Abstract Objective To evaluate the impacts of maternal risk factors described by the Fetal Medicine Foundation’s 2012 algorithm (FMF2012) in a Brazilian population. Methods All singleton pregnancies submitted to first-trimester preeclampsia (PE) screening using the FMF2012 algorithm were considered for study inclusion. Maternal factors, recorded via a patient questionnaire, were described and compared between PE outcome groups. A Gaussian regression model was derived to measure the effects of maternal factors, and to identify factors that contributed significantly (p < .05) to the alteration of gestational age at delivery, in pregnancies with PE. Results Of the 1934 cases considered for study inclusion, the final sample consisted of 1531 cases. The sample included 120 (7.8%) cases of PE, of which 26 (1.7%) were preterm PE (PE < 37 weeks) and 11 (0.72%) were early PE (PE < 34 weeks). The PE rate did not differ according to ethnicity, smoking, family history of PE, or use of assisted reproductive technology. Significant differences (p < .05) between the normal and PE groups in maternal age, maternal weight, previous history of PE, chronic hypertension, and types 1 and 2 diabetes were detected. Conclusions The significance and magnitude of associations of maternal factors in our sample differed from those incorporated in the FMF2012 model, implying the need to derive a fitted model for our population.

Ultrasound in Obstetrics and Gynecology, 2010

Objectives: To estimate the transvaginal ultrasound value in surgical correction of SI. Methods: ... more Objectives: To estimate the transvaginal ultrasound value in surgical correction of SI. Methods: 61 patients with SI were examined to derminate the type of SI and its severity. The echography of UVS was performed in all observed women using transvaginal probe of Voluson-730 expert (GE) before and after surgical correction. The measurements of basic angles (α and β) were performed in patients in supine position at rest and on valsalva. The ultrasound signs of urethra hypermobility were found (SI, type II) when the angle α rotation was more than 20◦. Also the cystocele presence was noted. The ratio of urethra transversal section square and urethral sphincter width was calculated by means of 3D. The signs of urethral sphincter insufficiency (SI, type III) seems to be when the ratio of urethra transversal section square and urethral sphincter width exceeded 0.74. Results: All patients were divided in 5 groups: 10 patients (16.4%) did not have any US signs of SI; 28 women (46%) had signs of urethra hypermobility; urethral sphincter insufficiency were revealed in 9 patients (14.7%); 9 women (14.7%) had the combination type of stress incontinence; only cystocele were found in 5 patients (8.2%). At rest the mean values of α and β angles in the 1st group were 27.1◦ + 2.7◦ and 115.4◦ + 14◦; in the 2nd group – 34.7◦ + 9.2◦ and 120.7◦ + 10.4◦; in the 3rd group – 31◦ + 5.4◦ and 126.1◦ + 19.1◦; in the 4th group – 32◦ + 8.4◦ and 124.6◦ + 18.5◦ respectively. All patients were operated with TVT-O only or combined with other additional surgery. All patients were underwent the postoperative dynamic follow-up and did not demonstrate neither clinical nor functional signs of SI. The positive dynamic were registrated in all operated patients. Conclusions: Transvaginal echography of urethrovesical segment can be used as a method of efficiency evaluation in surgical correction of SI.

The Journal of Maternal-Fetal & Neonatal Medicine, 2019

Objectives: To examine the performance of the Fetal Medicine Foundation (FMF) 2012 predictive mod... more Objectives: To examine the performance of the Fetal Medicine Foundation (FMF) 2012 predictive model and of isolated biophysical markers (uterine artery pulsatility index and mean arterial pressure) for small-for-gestational-age (SGA), in patients from Rio de Janeiro, Brazil. Methods: For this cross-sectional study, SGA was diagnosed when a newborn presented birth weight below the 5th percentile for gestational age. FMF2012 algorithm sensitivity and specificity, positive (PPV) and negative (NPV) predictive value, positive likelihood ratio (LR +) and area under the ROC curve (AUC) were calculated to predict total and preterm SGA (SGA <37). The performance of isolated biophysical markers-mean arterial pressure (MAP) and mean uterine artery pulsatility index (UtA-PI) were studied. Results: The final sample consisted of 1480 cases: 69 (4.6%) developed SGA, including 12 patients (0.8%) who were SGA<37. The AUC showed that the performances of the FMF2012 combined model for SGA prediction was 0.687 and for preterm SGA was

Ultrasound in Obstetrics and Gynecology, 2010

Objectives: Analyze the interference of ultrasound estimation of fetal weight in perinatal outcom... more Objectives: Analyze the interference of ultrasound estimation of fetal weight in perinatal outcome in newborns with birth weight greater than 3500 g. Methods: It is a single center retrospective study. 118 newborns with birth weight greater than 3500 g were included. The cases were divided in two groups: 1) infants who have ultrasound estimation of fetal weight within 14 days of delivery and 2) infants who didn’t have it. Fetal weight estimation (FWE) was performed by Hadlock formula. Perinatal outcome was analyzed by cesarean section rate, 5 minutes Apgar score < 7, meconium stained newborns, shoulder dystocia occurrence and intensive care unit (ICU) admission. Statistical analysis was done by the chi square test with significant association when P < 0.05. Results: Table 1. Conclusions: Our results suggest that ultrasound FWE increases Cesarean section rate without significant improve in perinatal outcome. More studies are needed to increase the sample size and analyze ultrasound accuracy.

Projeto de Mestrado profissional – Maternidade Escola, Universidade Federal do Rio de janeiro, ri... more Projeto de Mestrado profissional – Maternidade Escola, Universidade Federal do Rio de janeiro, rio de Janeiro. O exame ultrassonografico de rastreio do primeiro trimestre de gestacao realizado entre 11 e 13 semanas e 6 dias, foi desenvolvido para o rastreio de cromossomopatias e atualmente tambem se presta para o rastreio de outras situacoes adversas como a restricao de crescimento fetal, do parto prematuro e da pre-eclâmpsia. O ducto venoso (DV) e um pequeno vaso da circulacao fetal, que aparece no embriao humano em torno do 30° dia de vida, quando o mesmo tem aproximadamente 6,5 mm de comprimento cabeca nadega. Sua funcao na vida intra-uterina e transportar sangue oxigenado da veia umbilical ate o atrio direito do feto. E o DV um importante marcador a ser avaliado no primeiro trimestre. A alteracao qualitativa ou quantitativa do DV contribui para identificar gestacoes com prognostico adverso, como a presenca de anomalias estruturais, sindromes geneticas e maior risco de obito feta...

Revista Paulista de Pediatria

Objective: To estimate the rate of the use of antenatal corticosteroids (ANC) among pregnant wome... more Objective: To estimate the rate of the use of antenatal corticosteroids (ANC) among pregnant women and to identify the conditions associated with their non-use in Brazil. Methods: Secondary data analysis from “Birth in Brazil”, a national hospital-based survey carried out in 2011–2012 on childbirth and birth. The sample was characterized regarding maternal age, marital status and maternal education, parity, mode of delivery and place of residence. The association of ANC use with gestational age and type of delivery was analyzed. The studied maternal complications were the presence of hypertension, pre-eclampsia/eclampsia, and pyelonephritis, infection by the HIV virus or acquired immune deficiency syndrome. Results: 2,623 pregnant women with less than 37 weeks of gestational age were identified, and, of these, 835 (31.8%) received ANC. The frequency of ANC use was higher among women with gestational ages between 26–34 weeks (481 cases; 48.73%). In pregnancies with less than 37 weeks...

Pregnancy Hypertension, Sep 1, 2023

Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health, 2016

Preeclampsia (PE) 1 prevalence studies in Brazil are both scarce and not divided in accordance wi... more Preeclampsia (PE) 1 prevalence studies in Brazil are both scarce and not divided in accordance with gestational age at delivery. We accessed PE prevalence according to delivery before 34, 37 and 42 weeks in a cross-sectional study including 4464 single deliveries. PE was diagnosed in 301 cases (6.64%); Prevalence of PE was 0,78%; 1,92% and 6,74% according to deliveries before 34, 37 and 42 weeks. PE was associated with fetal death, prematurity and small for gestational age newborns.

Peer Review

O monitoramento da mortalidade perinatal depende da qualidade dos dados dos sistemas de informaçã... more O monitoramento da mortalidade perinatal depende da qualidade dos dados dos sistemas de informação, das fichas de investigação e, principalmente, das declarações de óbito (DO). O objetivo foi discriminar as principais inconformidades no preenchimento das Declarações de Óbitos perinatais, na Maternidade Escola da Universidade Federal do Rio de Janeiro. Trata-se estudo observacional, transversal, quantitativo e documental. Foram analisadas as DOs, os prontuários e fichas de investigação dos óbitos perinatais ocorridos na instituição nos anos de 2015 e 2016. A principal inadequação identificada esteve no campo “causa básica do óbito”, com taxa de 94,8% de erro, o que evidencia a necessidade de se trabalhar a temática não só nas estratégias de educação permanente em saúde, como também na inclusão da temática nas diretrizes curriculares do curso de graduação em medicina, fortalecendo as estratégias de evitabilidade da mortalidade infantil por causas evitáveis.

Aim: The aim of this study was to discuss associations between stress and anxiety and their relat... more Aim: The aim of this study was to discuss associations between stress and anxiety and their relation with mental health during pregnancy based on data from pregnant women who participated in a program for screenning maternal-fetal risks in order to implement a follow up service of maternal mental health. Study design: A cohort of 90 pregnant women at 1st trimester of pregnancy was investigated using the Beck Anxiety Inventory (BAI) to evaluate symptoms of general anxiety and the Lipp Stress Symptoms Inventory for Adults, a Brazilian scale which evaluates stress symptoms. The participants were recruited during eight months and evaluated while they were waiting for exams to identify maternalfetal risks at the Screening Program of Maternidade Escola da Universidade Federal do Rio de Janeiro (ME-UFRJ). This is a public hospital that receives patients on demand. All adult pregnant women at the begining of pregnancy who came to the prenatal care at the MEUFRJ were included. Results: Mild ...

A prematuridade e problema de Saude Publica, pois representa a principal causa de baixo peso ao n... more A prematuridade e problema de Saude Publica, pois representa a principal causa de baixo peso ao nascer, morte neonatal precoce e tardia, alem de associar-se com danos no neurodesenvolvimento e sequelas respiratorias. A busca por estrategias que visem reduzir sua prevalencia ou retardar sua ocorrencia, e relevante. Alem disso, a reducao das complicacoes associadas, ameniza os custos financeiros e sociais. A medida do colo uterino, pela via transvaginal, no primeiro trimestre da gestacao foi incorporada a rotina das pacientes assistidas durante o pre-natal na Maternidade Escola da UFRJ, a partir de janeiro de 2013. Faz parte do programa de rastreio de risco gestacional ,realizado no primeiro trimestre na instituicao em todas as gestantes, que iniciam o pre-natal tempestivamente. Desta maneira, e imperativo avaliar a mensuracao do colo uterino e as condutas pre- natais subsequentes ao exame, como a administracao de progesterona por via vaginal ou a realizacao de cerclagem cervical. Tem...

A predicao da pre-eclâmpsia(PE) de forma eficaz e efetiva e meta de muitos pesquisadores em todo... more A predicao da pre-eclâmpsia(PE) de forma eficaz e efetiva e meta de muitos pesquisadores em todo o mundo. Existem evidencias de que a identificacao de gestantes de risco, no 1 o trimestre da gestacao e subsequente implementacao de aspirina em doses diarias de 150 mg, diminui a ocorrencia das formas precoces de PE. A Fundacao de Medicina Fetal desenvolveu modelo preditivo apresentado como algoritmo a partir de caracteristicas fisicas e da historia materna e de marcadores biofisicos , que passou a ser utilizado na rotina asistencial. Os objetivos desse estudo sao: (1) descrever a distribuicao dos escores de risco, para desenvolvimento da PE; (2) comparar a importância dos fatores de risco e dos marcadores biofisicos entre a populacao submetida ao rastreio e a populacao de referencia e (3) avaliar o desempenho do teste de rastreio para PE realizado no 1 o trimestre da gestacao, a partir de fatores maternos e marcadores biofisicos. O estudo foi transversal e observacional com incl...

A pre-eclâmpsia (PE) esta relacionada a altos indices de morbidade e mortalidade ao redor do mund... more A pre-eclâmpsia (PE) esta relacionada a altos indices de morbidade e mortalidade ao redor do mundo. Tem uma prevalencia estimada em torno de 2-8% e esta correlacionada com muitos casos de partos pre-termo e crescimento intrauterino restrito (CIR). Multiplos fatores de risco podem estar presentes, sendo a historia obstetrica pregressa de PE considerada um fator de alto risco, dentre outros. A fisiopatologia da PE nao e totalmente compreendida e algumas teorias tentam justificar a sua ocorrencia. A invasao trofoblastica anormal dos vasos uterinos, a intolerância imunologica entre os tecidos maternos e feto-placentario, a ma-adaptacao as alteracoes cardiovasculares ou inflamatorias da gravidez e anormalidades geneticas estao entre as possiveis hipoteses. Em funcao da morbidade causada pela PE severa diversas estrategias de prevencao sao estudadas. Baixas doses de aspirina promovem reducao do risco de PE em mulheres de alto risco. Se administrada precocemente, pode diminuir os casos de ...

Pregnancy Hypertension, 2021

OBJECTIVE To validate a combined algorithm for early prediction of pre-eclampsia (PE) in the Braz... more OBJECTIVE To validate a combined algorithm for early prediction of pre-eclampsia (PE) in the Brazilian population. STUDY DESIGN This is an unplanned secondary analysis of a cohort study. Consecutive singleton pregnancies undergoing first-trimester screening for PE involving examination of maternal characteristics, medical history, and biophysical markers were considered eligible. Women were classified as low-or high-risk using a cutoff of 1/200, but the individual risk was not used to dictate management, as aspirin prophylaxis was given to women based solely on clinical risk factors. Receiver-operating characteristics (ROC) curves for PE, preterm PE(PE < 37) and early 34(PE < 34) were constructed and detection rates(DR) and false-positive rates(FPR) were calculated, adjusting for the effect of aspirin. Propensity score analysis was utilized to account for possible confounding by indication. MAIN OUTCOME MEASURES Screening performance and PE rates. RESULTS Among 1695 women, 323(19.1%) were classified as high-risk for PE and 1372(80.9%) were considered low-risk. Aspirin use was registered in 62(3.7%) in the high-risk group and 33(1.9%) in the low-risk group. There were 164(9.7%) women who developed PE, including 41(2.4%) with PE < 37 and 18(1.1%) PE < 34.Subgroups with aspirin had higher incidence of PE, suggest confounding by indication. The algorithm had an AUC of 0.87, DR of 72% for PE < 34; an AUC of 0.8, DR of 59% for PE < 37, both with FPR of 18%. Accounting for effect of aspirin, we observed an improvement in DR of PE < 37 to 67%. CONCLUSION Using combined predictive algorithm for preterm PE prediction is feasible in clinical practice in low/middle-income countries. Aspirin use needs to be accounted for when evaluating the performance of screening.

BACKGROUND There is a pioneer algorithm developed by Fetal Medicine Foundation (FMF) to predict p... more BACKGROUND There is a pioneer algorithm developed by Fetal Medicine Foundation (FMF) to predict preeclampsia based on maternal characteristics combined with biophysical and/or biochemical markers. The Afro-Caribbean ethnicity is the second risk factor, in magnitude, found in populations tested by FMF, which was not confirmed in a Brazilian scenario. OBJECTIVE This study aimed to analyze the performance of preeclampsia (PE) prediction software by customization of maternal ethnicity. METHODS It was an observational, cross-sectional study, with secondary evaluation of data from FMF first trimester screening tests of singleton pregnancies. Risk scores were calculated from maternal characteristics and biophysical markers and were presented as the risk for PE development before 34 and 37 weeks. The following steps were followed: (1)identification of women characterized as black ethnicity; (2)calculation of early and preterm PE risk, reclassifying them as white, which generated a new score...

The Journal of Maternal-Fetal & Neonatal Medicine, 2017

Abstract Objective To evaluate the impacts of maternal risk factors described by the Fetal Medici... more Abstract Objective To evaluate the impacts of maternal risk factors described by the Fetal Medicine Foundation’s 2012 algorithm (FMF2012) in a Brazilian population. Methods All singleton pregnancies submitted to first-trimester preeclampsia (PE) screening using the FMF2012 algorithm were considered for study inclusion. Maternal factors, recorded via a patient questionnaire, were described and compared between PE outcome groups. A Gaussian regression model was derived to measure the effects of maternal factors, and to identify factors that contributed significantly (p < .05) to the alteration of gestational age at delivery, in pregnancies with PE. Results Of the 1934 cases considered for study inclusion, the final sample consisted of 1531 cases. The sample included 120 (7.8%) cases of PE, of which 26 (1.7%) were preterm PE (PE < 37 weeks) and 11 (0.72%) were early PE (PE < 34 weeks). The PE rate did not differ according to ethnicity, smoking, family history of PE, or use of assisted reproductive technology. Significant differences (p < .05) between the normal and PE groups in maternal age, maternal weight, previous history of PE, chronic hypertension, and types 1 and 2 diabetes were detected. Conclusions The significance and magnitude of associations of maternal factors in our sample differed from those incorporated in the FMF2012 model, implying the need to derive a fitted model for our population.

Ultrasound in Obstetrics and Gynecology, 2010

Objectives: To estimate the transvaginal ultrasound value in surgical correction of SI. Methods: ... more Objectives: To estimate the transvaginal ultrasound value in surgical correction of SI. Methods: 61 patients with SI were examined to derminate the type of SI and its severity. The echography of UVS was performed in all observed women using transvaginal probe of Voluson-730 expert (GE) before and after surgical correction. The measurements of basic angles (α and β) were performed in patients in supine position at rest and on valsalva. The ultrasound signs of urethra hypermobility were found (SI, type II) when the angle α rotation was more than 20◦. Also the cystocele presence was noted. The ratio of urethra transversal section square and urethral sphincter width was calculated by means of 3D. The signs of urethral sphincter insufficiency (SI, type III) seems to be when the ratio of urethra transversal section square and urethral sphincter width exceeded 0.74. Results: All patients were divided in 5 groups: 10 patients (16.4%) did not have any US signs of SI; 28 women (46%) had signs of urethra hypermobility; urethral sphincter insufficiency were revealed in 9 patients (14.7%); 9 women (14.7%) had the combination type of stress incontinence; only cystocele were found in 5 patients (8.2%). At rest the mean values of α and β angles in the 1st group were 27.1◦ + 2.7◦ and 115.4◦ + 14◦; in the 2nd group – 34.7◦ + 9.2◦ and 120.7◦ + 10.4◦; in the 3rd group – 31◦ + 5.4◦ and 126.1◦ + 19.1◦; in the 4th group – 32◦ + 8.4◦ and 124.6◦ + 18.5◦ respectively. All patients were operated with TVT-O only or combined with other additional surgery. All patients were underwent the postoperative dynamic follow-up and did not demonstrate neither clinical nor functional signs of SI. The positive dynamic were registrated in all operated patients. Conclusions: Transvaginal echography of urethrovesical segment can be used as a method of efficiency evaluation in surgical correction of SI.

The Journal of Maternal-Fetal & Neonatal Medicine, 2019

Objectives: To examine the performance of the Fetal Medicine Foundation (FMF) 2012 predictive mod... more Objectives: To examine the performance of the Fetal Medicine Foundation (FMF) 2012 predictive model and of isolated biophysical markers (uterine artery pulsatility index and mean arterial pressure) for small-for-gestational-age (SGA), in patients from Rio de Janeiro, Brazil. Methods: For this cross-sectional study, SGA was diagnosed when a newborn presented birth weight below the 5th percentile for gestational age. FMF2012 algorithm sensitivity and specificity, positive (PPV) and negative (NPV) predictive value, positive likelihood ratio (LR +) and area under the ROC curve (AUC) were calculated to predict total and preterm SGA (SGA <37). The performance of isolated biophysical markers-mean arterial pressure (MAP) and mean uterine artery pulsatility index (UtA-PI) were studied. Results: The final sample consisted of 1480 cases: 69 (4.6%) developed SGA, including 12 patients (0.8%) who were SGA<37. The AUC showed that the performances of the FMF2012 combined model for SGA prediction was 0.687 and for preterm SGA was

Ultrasound in Obstetrics and Gynecology, 2010

Objectives: Analyze the interference of ultrasound estimation of fetal weight in perinatal outcom... more Objectives: Analyze the interference of ultrasound estimation of fetal weight in perinatal outcome in newborns with birth weight greater than 3500 g. Methods: It is a single center retrospective study. 118 newborns with birth weight greater than 3500 g were included. The cases were divided in two groups: 1) infants who have ultrasound estimation of fetal weight within 14 days of delivery and 2) infants who didn’t have it. Fetal weight estimation (FWE) was performed by Hadlock formula. Perinatal outcome was analyzed by cesarean section rate, 5 minutes Apgar score < 7, meconium stained newborns, shoulder dystocia occurrence and intensive care unit (ICU) admission. Statistical analysis was done by the chi square test with significant association when P < 0.05. Results: Table 1. Conclusions: Our results suggest that ultrasound FWE increases Cesarean section rate without significant improve in perinatal outcome. More studies are needed to increase the sample size and analyze ultrasound accuracy.

Projeto de Mestrado profissional – Maternidade Escola, Universidade Federal do Rio de janeiro, ri... more Projeto de Mestrado profissional – Maternidade Escola, Universidade Federal do Rio de janeiro, rio de Janeiro. O exame ultrassonografico de rastreio do primeiro trimestre de gestacao realizado entre 11 e 13 semanas e 6 dias, foi desenvolvido para o rastreio de cromossomopatias e atualmente tambem se presta para o rastreio de outras situacoes adversas como a restricao de crescimento fetal, do parto prematuro e da pre-eclâmpsia. O ducto venoso (DV) e um pequeno vaso da circulacao fetal, que aparece no embriao humano em torno do 30° dia de vida, quando o mesmo tem aproximadamente 6,5 mm de comprimento cabeca nadega. Sua funcao na vida intra-uterina e transportar sangue oxigenado da veia umbilical ate o atrio direito do feto. E o DV um importante marcador a ser avaliado no primeiro trimestre. A alteracao qualitativa ou quantitativa do DV contribui para identificar gestacoes com prognostico adverso, como a presenca de anomalias estruturais, sindromes geneticas e maior risco de obito feta...

Revista Paulista de Pediatria

Objective: To estimate the rate of the use of antenatal corticosteroids (ANC) among pregnant wome... more Objective: To estimate the rate of the use of antenatal corticosteroids (ANC) among pregnant women and to identify the conditions associated with their non-use in Brazil. Methods: Secondary data analysis from “Birth in Brazil”, a national hospital-based survey carried out in 2011–2012 on childbirth and birth. The sample was characterized regarding maternal age, marital status and maternal education, parity, mode of delivery and place of residence. The association of ANC use with gestational age and type of delivery was analyzed. The studied maternal complications were the presence of hypertension, pre-eclampsia/eclampsia, and pyelonephritis, infection by the HIV virus or acquired immune deficiency syndrome. Results: 2,623 pregnant women with less than 37 weeks of gestational age were identified, and, of these, 835 (31.8%) received ANC. The frequency of ANC use was higher among women with gestational ages between 26–34 weeks (481 cases; 48.73%). In pregnancies with less than 37 weeks...