sammya moura - Academia.edu (original) (raw)

Papers by sammya moura

Research paper thumbnail of Prenatal Diagnosis of Arthrogryposis multiplex congenita with Increased Nuchal Translucency but without Any Underlying Fetal Neurogenic or Myogenic Pathology

Fetal Diagnosis and Therapy, 2002

Arthrogryposis multiplex congenita is a general term for congenital multiple joint contractures, ... more Arthrogryposis multiplex congenita is a general term for congenital multiple joint contractures, the aetiology of which is variable. Prenatal diagnosis is usually based on the detection of diminished fetal movements and joint contractures on ultrasound. There are also reports of early diagnosis of arthrogryposis in the first and early second trimester by detection of subcutaneous oedema. We report another case of arthrogryposis multiplex congenita with increased nuchal translucency and scoliosis diagnosed by ultrasonography at 15 weeks of gestation. The pregnancy was terminated at the request of the parents. Post-mortem examination revealed that it was not associated with fetal myopathy or neuropathy. Multiple joint contractures with increased nuchal translucency without any underlying fetal neurogenic and myogenic pathology may be a distinct form of arthrogryposis multiplex congenita.

Research paper thumbnail of Estimativa pré-operatória do tamanho do câncer mamário : correlação entre exame clínico, mamografia, ultra-sonografia e histopatológico

Objetivo: estabelecer a correlacao entre o exame clinico, mamografia e ultra-sonografia a fim de ... more Objetivo: estabelecer a correlacao entre o exame clinico, mamografia e ultra-sonografia a fim de avaliar o metodo mais acurado na estimativa pre-operatoria do tamanho do câncer de mama. Pacientes e metodos: estudo de validacao de tecnicas diagnosticas. Foram selecionadas prospectivamente 29 mulheres apresentando tumores mamarios suspeitos e palpaveis no Servico de Mastologia da UFC no periodo de janeiro a agosto de 2007. Foram incluidos os cânceres de mama palpaveis confirmados e indicados para cirurgia como tratamento inicial. Excluiram-se os cânceres multicentricos, os indicados para quimioterapia neo-adjuvante e os nao identificados pela mamografia e/ou ultra-sonografia, totalizando 20 casos. Os tumores foram medidos por exame clinico (Tc), ultra-sonografia (Ts) e mamografia (Tm) por dois profissionais distintos. Registrou-se a maior medida encontrada em cada metodo e comparou-se com a medida da peca cirurgica (Tp). Observou-se ainda a variacao interobservador para cada metodo. R...

Research paper thumbnail of Contents Vol. 40, 2016

Fetal Diagnosis and Therapy, 2016

Access to full text and tables of contents, including tentative ones for forthcoming issues: www.... more Access to full text and tables of contents, including tentative ones for forthcoming issues: www.karger.com/fdt_issues

Research paper thumbnail of D1. Renal interlobar vein impedance index (RIVI) as a first trimester marker for prediction of hypertensive disorders of pregnancy

The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 2016

To examine whether the maternal renal interlobar vein impedance index (RIVI) as assessed by first... more To examine whether the maternal renal interlobar vein impedance index (RIVI) as assessed by first trimester ultrasonography is able to predict the later development of hypertensive disorders of pregnancy. Venous Doppler parameters of both maternal kidneys were studied in 214 pregnant women at 11 + 0 to 13 + 6 weeks' gestation. Subjects were classified according to the outcomes related to hypertensive disorders. Detection rates and areas under receiver operating characteristic (ROC) curves were determined for the maternal RIVI impedance as a first trimester predictor for preeclampsia (PE) and gestational hypertension (GH). Among the 214 patients, 22 developed PE (10.3%), 10 developed GH (4.7%), and 182 were unaffected by hypertensive disorders (controls) (85%). In the overall study population, there was no difference in the RIVI between the right (0.44; 0.35-0.50) and left side (0.43; 0.35-0.53), p¼0.86. The average RIVI did not differ among women destined to develop PE (0.46; 0....

Research paper thumbnail of Renal Interlobar Vein Impedance Index as a First-Trimester Marker Does Not Predict Hypertensive Disorders of Pregnancy

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, Dec 1, 2016

The purpose of this study was to examine whether the maternal renal interlobar vein impedance ind... more The purpose of this study was to examine whether the maternal renal interlobar vein impedance index as assessed by first-trimester sonography is able to predict the later development of hypertensive disorders of pregnancy. Venous Doppler parameters of both maternal kidneys were studied in 214 pregnant women at gestational ages of 11 weeks to 13 weeks 6 days. Patients were classified according to outcomes related to hypertensive disorders. Detection rates and areas under receiver operating characteristic curves were determined for the maternal renal interlobar vein impedance index as a first-trimester predictor of preeclampsia and gestational hypertension. Among the 214 patients, 22 (10.3%) developed preeclampsia; 10 (4.7%) developed gestational hypertension; and 182 were unaffected by hypertensive disorders (controls; 85.0%). In the overall study population, there was no difference in the impedance index between the right (0.44; 95% confidence interval, 0.35-0.50) and left (0.43; 95...

Research paper thumbnail of Reference range of uterine artery Doppler parameters between the 11th and 14th pregnancy weeks in a population sample from Northeast Brazil

Revista Brasileira de Ginecologia e Obstetrícia, 2013

Valores de referência para parâmetros doplervelocimétricos das artérias uterinas entre a 11 a e 1... more Valores de referência para parâmetros doplervelocimétricos das artérias uterinas entre a 11 a e 14 a semanas de gestação em uma amostra populacional do Nordeste do Brasil

Research paper thumbnail of Evaluation of ultrasound measurements of abdominal fat for the prediction of gestational diabetes in the first and second trimesters of pregnancy

The Journal of Maternal-Fetal & Neonatal Medicine

OBJECTIVE To evaluate whether ultrasound abdominal fat measurements in the first and second trime... more OBJECTIVE To evaluate whether ultrasound abdominal fat measurements in the first and second trimesters can predict adverse gestational outcomes, particularly gestational diabetes mellitus (GDM), and identify early patients at higher risk for complications. METHODS A prospective cohort study of 126 pregnant women at 11-14 and 20-24 weeks of gestation with normal fasting glucose levels during early pregnancy. From 126 participants with complete data, 13.5% were diagnosed with GDM, based on the cutoffs established for the peripherical blood glucose. Subcutaneous, visceral, and maximum preperitoneal abdominal fat were measured using ultrasound techniques. GDM status was determined by oral glucose tolerance test (OGTT) with 75 g glucose overload, and the following values were considered abnormal: fasting glucose ≥92 mg/dl and/or 1 h after overload ≥180 mg/dl and/or 2 h after overload ≥153 mg/dl. The receiver operator characteristic (ROC) curve was used to determine the optimal threshold to predict GDM. RESULTS Maximum preperitoneal fat measurement was predictive of GDM, and subcutaneous and visceral abdominal fat measurements did not show significant differences in the prediction of GDM. According to the ROC curve, a threshold of 45.25 mm of preperitoneal fat was identified as the optimal cutoff point, with 87% sensitivity and 41% specificity to predict GDM. The raw and adjusted odds ratios for age and pre-pregnancy body mass index were 0.730 (95% confidence interval [CI], 0.561-0.900) and 0.777 (95% CI, 0.623-0.931), respectively. CONCLUSION The use of a 45.25 mm threshold for maximum preperitoneal fat, measured by ultrasound to predict the risk of GDM, appears to be a feasible, inexpensive, and practical alternative to incorporate into clinical practice during the first trimester of pregnancy.

Research paper thumbnail of Using the algorithm of the fetal medicine foundation to determine the cutoff point for prediction of pre-eclampsia in a Brazilian population

Minerva Obstetrics and Gynecology

Research paper thumbnail of Comparison of three algorithms for prediction preeclampsia in the first trimester of pregnancy

Pregnancy Hypertension, 2017

Research paper thumbnail of Simple approach based on maternal characteristics and mean arterial pressure for the prediction of preeclampsia in the first trimester of pregnancy

Journal of perinatal medicine, Jan 6, 2017

To propose a simple model for predicting preeclampsia (PE) in the 1st trimester of pregnancy on t... more To propose a simple model for predicting preeclampsia (PE) in the 1st trimester of pregnancy on the basis of maternal characteristics (MC) and mean arterial pressure (MAP). A prospective cohort was performed to predict PE between 11 and 13+6 weeks of gestation. The MC evaluated were maternal age, skin color, parity, previous PE, smoking, family history of PE, hypertension, diabetes mellitus and body mass index (BMI). Mean arterial blood pressure (MAP) was measured at the time of the 1st trimester ultrasound. The outcome measures were the incidences of total PE, preterm PE (delivery <37 weeks) and term PE (delivery ≥37 weeks). We performed logistic regression analysis to determine which factors made significant contributions for the prediction of the three outcomes. We analyzed 733 pregnant women; 55 developed PE, 21 of those developed preterm PE and 34 term PE. For total PE, the best model was MC+MAP, which had an area under the receiver operating characteristic curve (AUC ROC) o...

Research paper thumbnail of Pre-Implantation Genetic Screening Techniques: Implications for Clinical Prenatal Diagnosis

Fetal Diagnosis and Therapy, 2016

Chromosomal aneuploidy is responsible for a significant proportion of pregnancy failures, whether... more Chromosomal aneuploidy is responsible for a significant proportion of pregnancy failures, whether conceived naturally or through in vitro fertilization (IVF). In an effort to improve the success rate of IVF, screening embryos for aneuploidy - or pre-implantation genetic screening (PGS) - has been proposed as a means of ensuring only euploid embryos are selected for transfer. Early PGS approaches were based on fluorescence in situ hybridization testing, and have been shown not to improve live birth rates. Recent developments in genetic testing technologies - such as next-generation sequencing and quantitative polymerase chain reaction, coupled with embryo biopsy at the blastocyst stage - have shown promise in improving IVF outcomes, but they remain to be validated in adequately powered, prospective randomized trials. The extent to which IVF with PGS lowers the a priori risk of aneuploidy in ongoing pregnancies so conceived has been poorly described, rendering it difficult to incorpor...

Research paper thumbnail of 105 Body mass index and mean arterial pressure are increased in nulliparous with late preeclampsia

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

Research paper thumbnail of Second Trimester Screening of Preeclampsia Using Maternal Characteristics and Uterine and Ophthalmic Artery Doppler

Ultraschall in der Medizin - European Journal of Ultrasound, 2016

Purpose To establish the performance of a multi-parametric test including maternal risk factors a... more Purpose To establish the performance of a multi-parametric test including maternal risk factors and maternal uterine and ophthalmic artery Doppler in the second trimester of pregnancy for the prediction of preeclampsia (PE). Materials and Methods We performed a prospective observational cohort study with pregnant women who underwent a second trimester morphology scan. Maternal uterine and ophthalmic artery Doppler examinations were performed in 415 singleton pregnancies between 18 and 23 weeks of gestation. Additional history was obtained through participant questionnaires, and follow-up occurred to the time of discharge post-delivery. The control and PE groups were compared to continuous variables using the Kruskal-Wallis test and to categorical variables using the Chi-square and Fisher exact tests. Univariate and multivariate logistic regression analyses were performed to determine the best model for the prediction of PE. Results 40 (9.6 %) pregnant women developed PE. We observed...

Research paper thumbnail of Brachial artery flow mediated dilation and pulsatility index change as independent predictors for hypertensive disorders in the second trimester of pregnancy

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2016

Research paper thumbnail of OP09.04: Maternal ophthalmic artery Doppler: novel parameter to predict early-onset pre-eclampsia in the first trimester of pregnancy

Ultrasound in Obstetrics & Gynecology, 2011

Research paper thumbnail of OP08.05: Brachial artery flow‐mediated dilatation as a predictor of pre‐eclampsia in the second trimester of pregnancy

Ultrasound in Obstetrics & Gynecology, 2013

Research paper thumbnail of P12.04: Normal reference range of maternal ophthalmic artery Doppler during the first trimester (11–14 weeks) of pregnancy

Ultrasound in Obstetrics & Gynecology, 2011

Research paper thumbnail of OP19.07: Maternal renal interlobar vein Doppler is not a first trimester predictor of pre‐eclampsia: preliminary data

Ultrasound in Obstetrics & Gynecology, 2013

Research paper thumbnail of Predicting small for gestational age in the first trimester of pregnancy using maternal ophthalmic artery Doppler indices

The Journal of Maternal-Fetal & Neonatal Medicine, 2015

To assess the capacity of maternal ophthalmic Doppler indices for predicting small for gestationa... more To assess the capacity of maternal ophthalmic Doppler indices for predicting small for gestational age (SGA) newborns in the first trimester of pregnancy. We performed a prospective observational cohort study involving 499 singleton pregnancies during the first trimester scan (11-14 weeks). The following maternal ophthalmic Doppler indices were assessed: pulsatility index (PI), first diastolic peak velocity (PD1) and peak ratio (PR) = PD1/peak systolic velocity. We considered SGA all newborns with weight below 10th percentile. We used chi-square test (χ(2)) to compare the groups. We used area under receiver operating characteristics (ROC) curves with 95% confidence intervals (CI) and detection rate of 5% of false positive of each maternal ophthalmic Doppler index and the mean uterine artery PI for prediction SGA. 27 (5.4%) patients delivered SGA newborns, 12 (2.4%) patients developed preeclampsia (PE) and delivered SGA newborns, and 460 had uneventful pregnancies (controls). We observed significant difference of PI and PR between SGA (SGA and SGA+PE) and control groups, p = 0.043 and p = 0.014, respectively. To 5% of false positive, the detection rate of SGA (SGA and SGA+PE groups) using PI, PD1 and PR were 14.8, 3.7, 14.8, 16.7, 16.7 and 16.7%, respectively. Mean uterine PI was significantly higher in the SGA+PE group (p = 0.003). The isolated use of maternal ophthalmic Doppler indices or in combination with uterine artery Doppler, in the first trimester of pregnancy, was not efficient to predict SGA newborns.

Research paper thumbnail of The 4G/4G polymorphism of the plasminogen activator inhibitor-1 (PAI-1) gene as an independent risk factor for placental insufficiency, which triggers fetal hemodynamic centralization

Ceska gynekologie / Ceska lekarska spolecnost J. Ev. Purkyne, 2015

Objective: To describe a case report of 4G/4G polymorphism of the plasminogen activator inhibitor... more Objective: To describe a case report of 4G/4G polymorphism of the plasminogen activator inhibitor-1 (PAI-1) gene as an independent risk factor for placental insufficiency.Design: Case report.Setting: Department of Public Health, State University of Ceará (UECE), Fortaleza-CE, Brazil.Case report: Hereditary hypofibrinolysis, which is mediated by 4G/4G homozygosity for the PAI-1 gene, is an independent risk factor for pregnancy complications, probably acting through thrombotic induction of placental insufficiency. We report a case of a low risk pregnancy, which separately presented placental insufficiency and fetal centralization at the beginning of the third trimester, without any other clinical manifestations during pregnancy. However, immediately after childbirth, the patient had a deep vein thrombosis of a lower limb. The anatomopathological examination of the placenta showed old and recent placental infarcts. Homozygosity for the 4G allele of PAI-1 gene was subsequently diagnosed...

Research paper thumbnail of Prenatal Diagnosis of Arthrogryposis multiplex congenita with Increased Nuchal Translucency but without Any Underlying Fetal Neurogenic or Myogenic Pathology

Fetal Diagnosis and Therapy, 2002

Arthrogryposis multiplex congenita is a general term for congenital multiple joint contractures, ... more Arthrogryposis multiplex congenita is a general term for congenital multiple joint contractures, the aetiology of which is variable. Prenatal diagnosis is usually based on the detection of diminished fetal movements and joint contractures on ultrasound. There are also reports of early diagnosis of arthrogryposis in the first and early second trimester by detection of subcutaneous oedema. We report another case of arthrogryposis multiplex congenita with increased nuchal translucency and scoliosis diagnosed by ultrasonography at 15 weeks of gestation. The pregnancy was terminated at the request of the parents. Post-mortem examination revealed that it was not associated with fetal myopathy or neuropathy. Multiple joint contractures with increased nuchal translucency without any underlying fetal neurogenic and myogenic pathology may be a distinct form of arthrogryposis multiplex congenita.

Research paper thumbnail of Estimativa pré-operatória do tamanho do câncer mamário : correlação entre exame clínico, mamografia, ultra-sonografia e histopatológico

Objetivo: estabelecer a correlacao entre o exame clinico, mamografia e ultra-sonografia a fim de ... more Objetivo: estabelecer a correlacao entre o exame clinico, mamografia e ultra-sonografia a fim de avaliar o metodo mais acurado na estimativa pre-operatoria do tamanho do câncer de mama. Pacientes e metodos: estudo de validacao de tecnicas diagnosticas. Foram selecionadas prospectivamente 29 mulheres apresentando tumores mamarios suspeitos e palpaveis no Servico de Mastologia da UFC no periodo de janeiro a agosto de 2007. Foram incluidos os cânceres de mama palpaveis confirmados e indicados para cirurgia como tratamento inicial. Excluiram-se os cânceres multicentricos, os indicados para quimioterapia neo-adjuvante e os nao identificados pela mamografia e/ou ultra-sonografia, totalizando 20 casos. Os tumores foram medidos por exame clinico (Tc), ultra-sonografia (Ts) e mamografia (Tm) por dois profissionais distintos. Registrou-se a maior medida encontrada em cada metodo e comparou-se com a medida da peca cirurgica (Tp). Observou-se ainda a variacao interobservador para cada metodo. R...

Research paper thumbnail of Contents Vol. 40, 2016

Fetal Diagnosis and Therapy, 2016

Access to full text and tables of contents, including tentative ones for forthcoming issues: www.... more Access to full text and tables of contents, including tentative ones for forthcoming issues: www.karger.com/fdt_issues

Research paper thumbnail of D1. Renal interlobar vein impedance index (RIVI) as a first trimester marker for prediction of hypertensive disorders of pregnancy

The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 2016

To examine whether the maternal renal interlobar vein impedance index (RIVI) as assessed by first... more To examine whether the maternal renal interlobar vein impedance index (RIVI) as assessed by first trimester ultrasonography is able to predict the later development of hypertensive disorders of pregnancy. Venous Doppler parameters of both maternal kidneys were studied in 214 pregnant women at 11 + 0 to 13 + 6 weeks' gestation. Subjects were classified according to the outcomes related to hypertensive disorders. Detection rates and areas under receiver operating characteristic (ROC) curves were determined for the maternal RIVI impedance as a first trimester predictor for preeclampsia (PE) and gestational hypertension (GH). Among the 214 patients, 22 developed PE (10.3%), 10 developed GH (4.7%), and 182 were unaffected by hypertensive disorders (controls) (85%). In the overall study population, there was no difference in the RIVI between the right (0.44; 0.35-0.50) and left side (0.43; 0.35-0.53), p¼0.86. The average RIVI did not differ among women destined to develop PE (0.46; 0....

Research paper thumbnail of Renal Interlobar Vein Impedance Index as a First-Trimester Marker Does Not Predict Hypertensive Disorders of Pregnancy

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, Dec 1, 2016

The purpose of this study was to examine whether the maternal renal interlobar vein impedance ind... more The purpose of this study was to examine whether the maternal renal interlobar vein impedance index as assessed by first-trimester sonography is able to predict the later development of hypertensive disorders of pregnancy. Venous Doppler parameters of both maternal kidneys were studied in 214 pregnant women at gestational ages of 11 weeks to 13 weeks 6 days. Patients were classified according to outcomes related to hypertensive disorders. Detection rates and areas under receiver operating characteristic curves were determined for the maternal renal interlobar vein impedance index as a first-trimester predictor of preeclampsia and gestational hypertension. Among the 214 patients, 22 (10.3%) developed preeclampsia; 10 (4.7%) developed gestational hypertension; and 182 were unaffected by hypertensive disorders (controls; 85.0%). In the overall study population, there was no difference in the impedance index between the right (0.44; 95% confidence interval, 0.35-0.50) and left (0.43; 95...

Research paper thumbnail of Reference range of uterine artery Doppler parameters between the 11th and 14th pregnancy weeks in a population sample from Northeast Brazil

Revista Brasileira de Ginecologia e Obstetrícia, 2013

Valores de referência para parâmetros doplervelocimétricos das artérias uterinas entre a 11 a e 1... more Valores de referência para parâmetros doplervelocimétricos das artérias uterinas entre a 11 a e 14 a semanas de gestação em uma amostra populacional do Nordeste do Brasil

Research paper thumbnail of Evaluation of ultrasound measurements of abdominal fat for the prediction of gestational diabetes in the first and second trimesters of pregnancy

The Journal of Maternal-Fetal & Neonatal Medicine

OBJECTIVE To evaluate whether ultrasound abdominal fat measurements in the first and second trime... more OBJECTIVE To evaluate whether ultrasound abdominal fat measurements in the first and second trimesters can predict adverse gestational outcomes, particularly gestational diabetes mellitus (GDM), and identify early patients at higher risk for complications. METHODS A prospective cohort study of 126 pregnant women at 11-14 and 20-24 weeks of gestation with normal fasting glucose levels during early pregnancy. From 126 participants with complete data, 13.5% were diagnosed with GDM, based on the cutoffs established for the peripherical blood glucose. Subcutaneous, visceral, and maximum preperitoneal abdominal fat were measured using ultrasound techniques. GDM status was determined by oral glucose tolerance test (OGTT) with 75 g glucose overload, and the following values were considered abnormal: fasting glucose ≥92 mg/dl and/or 1 h after overload ≥180 mg/dl and/or 2 h after overload ≥153 mg/dl. The receiver operator characteristic (ROC) curve was used to determine the optimal threshold to predict GDM. RESULTS Maximum preperitoneal fat measurement was predictive of GDM, and subcutaneous and visceral abdominal fat measurements did not show significant differences in the prediction of GDM. According to the ROC curve, a threshold of 45.25 mm of preperitoneal fat was identified as the optimal cutoff point, with 87% sensitivity and 41% specificity to predict GDM. The raw and adjusted odds ratios for age and pre-pregnancy body mass index were 0.730 (95% confidence interval [CI], 0.561-0.900) and 0.777 (95% CI, 0.623-0.931), respectively. CONCLUSION The use of a 45.25 mm threshold for maximum preperitoneal fat, measured by ultrasound to predict the risk of GDM, appears to be a feasible, inexpensive, and practical alternative to incorporate into clinical practice during the first trimester of pregnancy.

Research paper thumbnail of Using the algorithm of the fetal medicine foundation to determine the cutoff point for prediction of pre-eclampsia in a Brazilian population

Minerva Obstetrics and Gynecology

Research paper thumbnail of Comparison of three algorithms for prediction preeclampsia in the first trimester of pregnancy

Pregnancy Hypertension, 2017

Research paper thumbnail of Simple approach based on maternal characteristics and mean arterial pressure for the prediction of preeclampsia in the first trimester of pregnancy

Journal of perinatal medicine, Jan 6, 2017

To propose a simple model for predicting preeclampsia (PE) in the 1st trimester of pregnancy on t... more To propose a simple model for predicting preeclampsia (PE) in the 1st trimester of pregnancy on the basis of maternal characteristics (MC) and mean arterial pressure (MAP). A prospective cohort was performed to predict PE between 11 and 13+6 weeks of gestation. The MC evaluated were maternal age, skin color, parity, previous PE, smoking, family history of PE, hypertension, diabetes mellitus and body mass index (BMI). Mean arterial blood pressure (MAP) was measured at the time of the 1st trimester ultrasound. The outcome measures were the incidences of total PE, preterm PE (delivery <37 weeks) and term PE (delivery ≥37 weeks). We performed logistic regression analysis to determine which factors made significant contributions for the prediction of the three outcomes. We analyzed 733 pregnant women; 55 developed PE, 21 of those developed preterm PE and 34 term PE. For total PE, the best model was MC+MAP, which had an area under the receiver operating characteristic curve (AUC ROC) o...

Research paper thumbnail of Pre-Implantation Genetic Screening Techniques: Implications for Clinical Prenatal Diagnosis

Fetal Diagnosis and Therapy, 2016

Chromosomal aneuploidy is responsible for a significant proportion of pregnancy failures, whether... more Chromosomal aneuploidy is responsible for a significant proportion of pregnancy failures, whether conceived naturally or through in vitro fertilization (IVF). In an effort to improve the success rate of IVF, screening embryos for aneuploidy - or pre-implantation genetic screening (PGS) - has been proposed as a means of ensuring only euploid embryos are selected for transfer. Early PGS approaches were based on fluorescence in situ hybridization testing, and have been shown not to improve live birth rates. Recent developments in genetic testing technologies - such as next-generation sequencing and quantitative polymerase chain reaction, coupled with embryo biopsy at the blastocyst stage - have shown promise in improving IVF outcomes, but they remain to be validated in adequately powered, prospective randomized trials. The extent to which IVF with PGS lowers the a priori risk of aneuploidy in ongoing pregnancies so conceived has been poorly described, rendering it difficult to incorpor...

Research paper thumbnail of 105 Body mass index and mean arterial pressure are increased in nulliparous with late preeclampsia

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

Research paper thumbnail of Second Trimester Screening of Preeclampsia Using Maternal Characteristics and Uterine and Ophthalmic Artery Doppler

Ultraschall in der Medizin - European Journal of Ultrasound, 2016

Purpose To establish the performance of a multi-parametric test including maternal risk factors a... more Purpose To establish the performance of a multi-parametric test including maternal risk factors and maternal uterine and ophthalmic artery Doppler in the second trimester of pregnancy for the prediction of preeclampsia (PE). Materials and Methods We performed a prospective observational cohort study with pregnant women who underwent a second trimester morphology scan. Maternal uterine and ophthalmic artery Doppler examinations were performed in 415 singleton pregnancies between 18 and 23 weeks of gestation. Additional history was obtained through participant questionnaires, and follow-up occurred to the time of discharge post-delivery. The control and PE groups were compared to continuous variables using the Kruskal-Wallis test and to categorical variables using the Chi-square and Fisher exact tests. Univariate and multivariate logistic regression analyses were performed to determine the best model for the prediction of PE. Results 40 (9.6 %) pregnant women developed PE. We observed...

Research paper thumbnail of Brachial artery flow mediated dilation and pulsatility index change as independent predictors for hypertensive disorders in the second trimester of pregnancy

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2016

Research paper thumbnail of OP09.04: Maternal ophthalmic artery Doppler: novel parameter to predict early-onset pre-eclampsia in the first trimester of pregnancy

Ultrasound in Obstetrics & Gynecology, 2011

Research paper thumbnail of OP08.05: Brachial artery flow‐mediated dilatation as a predictor of pre‐eclampsia in the second trimester of pregnancy

Ultrasound in Obstetrics & Gynecology, 2013

Research paper thumbnail of P12.04: Normal reference range of maternal ophthalmic artery Doppler during the first trimester (11–14 weeks) of pregnancy

Ultrasound in Obstetrics & Gynecology, 2011

Research paper thumbnail of OP19.07: Maternal renal interlobar vein Doppler is not a first trimester predictor of pre‐eclampsia: preliminary data

Ultrasound in Obstetrics & Gynecology, 2013

Research paper thumbnail of Predicting small for gestational age in the first trimester of pregnancy using maternal ophthalmic artery Doppler indices

The Journal of Maternal-Fetal & Neonatal Medicine, 2015

To assess the capacity of maternal ophthalmic Doppler indices for predicting small for gestationa... more To assess the capacity of maternal ophthalmic Doppler indices for predicting small for gestational age (SGA) newborns in the first trimester of pregnancy. We performed a prospective observational cohort study involving 499 singleton pregnancies during the first trimester scan (11-14 weeks). The following maternal ophthalmic Doppler indices were assessed: pulsatility index (PI), first diastolic peak velocity (PD1) and peak ratio (PR) = PD1/peak systolic velocity. We considered SGA all newborns with weight below 10th percentile. We used chi-square test (χ(2)) to compare the groups. We used area under receiver operating characteristics (ROC) curves with 95% confidence intervals (CI) and detection rate of 5% of false positive of each maternal ophthalmic Doppler index and the mean uterine artery PI for prediction SGA. 27 (5.4%) patients delivered SGA newborns, 12 (2.4%) patients developed preeclampsia (PE) and delivered SGA newborns, and 460 had uneventful pregnancies (controls). We observed significant difference of PI and PR between SGA (SGA and SGA+PE) and control groups, p = 0.043 and p = 0.014, respectively. To 5% of false positive, the detection rate of SGA (SGA and SGA+PE groups) using PI, PD1 and PR were 14.8, 3.7, 14.8, 16.7, 16.7 and 16.7%, respectively. Mean uterine PI was significantly higher in the SGA+PE group (p = 0.003). The isolated use of maternal ophthalmic Doppler indices or in combination with uterine artery Doppler, in the first trimester of pregnancy, was not efficient to predict SGA newborns.

Research paper thumbnail of The 4G/4G polymorphism of the plasminogen activator inhibitor-1 (PAI-1) gene as an independent risk factor for placental insufficiency, which triggers fetal hemodynamic centralization

Ceska gynekologie / Ceska lekarska spolecnost J. Ev. Purkyne, 2015

Objective: To describe a case report of 4G/4G polymorphism of the plasminogen activator inhibitor... more Objective: To describe a case report of 4G/4G polymorphism of the plasminogen activator inhibitor-1 (PAI-1) gene as an independent risk factor for placental insufficiency.Design: Case report.Setting: Department of Public Health, State University of Ceará (UECE), Fortaleza-CE, Brazil.Case report: Hereditary hypofibrinolysis, which is mediated by 4G/4G homozygosity for the PAI-1 gene, is an independent risk factor for pregnancy complications, probably acting through thrombotic induction of placental insufficiency. We report a case of a low risk pregnancy, which separately presented placental insufficiency and fetal centralization at the beginning of the third trimester, without any other clinical manifestations during pregnancy. However, immediately after childbirth, the patient had a deep vein thrombosis of a lower limb. The anatomopathological examination of the placenta showed old and recent placental infarcts. Homozygosity for the 4G allele of PAI-1 gene was subsequently diagnosed...