Felipe Campanharo | Universidade Federal de São Paulo (UNIFESP) (original) (raw)

Papers by Felipe Campanharo

Revista Brasileira de Ginecologia e Obstetrícia, 2023

Objective Systemic lupus erythematosus (SLE) may cause irreversible organ damage. Pregnancy with ... more Objective Systemic lupus erythematosus (SLE) may cause irreversible organ damage. Pregnancy with SLE may have severe life-threatening risks. The present study aimed to determine the prevalence of severe maternal morbidity (SMM) in patients with SLE and analyze the parameters that contributed to cases of greater severity. Methods This is a cross-sectional retrospective study from analysis of data retrieved from medical records of pregnant women with SLE treated at a University Hospital in Brazil. The pregnant women were divided in a control group without complications, a group with potentially life-threatening conditions (PLTC), and a group with maternal near miss (MNM). Results The maternal near miss rate was 112.9 per 1,000 live births. The majority of PLTC (83.9%) and MNM (92.9%) cases had preterm deliveries with statistically significant increased risk compared with the control group (p ¼ 0.0042; odds ratio [OR]: 12.05; 95% confidence interval [CI]: 1.5-96.6 for the MNM group and p ¼ 0.0001; OR: 4.84; 95%CI: 2.2-10.8 for the PLTC group). Severe maternal morbidity increases the risk of longer hospitalization (p < 0.0001; OR: 18.8; 95%CI: 7.0-50.6 and p < 0.0001; OR: 158.17; 95%CI: 17.6-1424,2 for the PLTC and MNM groups, respectively), newborns with low birthweight (p ¼ 0.0006; OR: 3.67; 95%CI: 1.7-7.9 and p ¼ 0.0009; OR: 17.68; 95%CI: 2-153.6) for the PLTC and MNM groups, respectively] as well as renal diseases (PLTC [8.9%; 33/56; p ¼ 0.0069] and MNM [78.6%; 11/14; p ¼ 0.0026]). Maternal near miss cases presented increased risk for neonatal death (p ¼ 0.0128; OR: 38.4; 95%CI: 3.3-440.3]), and stillbirth and miscarriage (p ¼ 0.0011; OR: 7.68; 95%CI: 2.2-26.3]). Conclusion Systemic lupus erythematosus was significantly associated with severe maternal morbidity, longer hospitalizations, and increased risk of poor obstetric and neonatal outcomes.

Clinical obstetrics, gynecology and reproductive medicine, 2017

A 37-year-old patient with Complex Regional Pain Syndrome(CRPS) and continuous intrathecal morphi... more A 37-year-old patient with Complex Regional Pain Syndrome(CRPS) and continuous intrathecal morphine administration presents to prenatal care pregnant with 16 weeks' gestation. Besides CRPS, she has other medical conditions like obesity, migraine and angina, using topiramate and diltiazem. The discussion goes through an overview of CRPS and chronic pain management in pregnancy. In the end, we include a summary and recommendations based on a brief review of the literature.

Copyright © 2014 Stephanno Gomes Pereira Sarmento et al.This is an open access article distribute... more Copyright © 2014 Stephanno Gomes Pereira Sarmento et al.This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. HELLP syndrome is a complication of severe forms of preeclampsia and occurs mainly in the third trimester of pregnancy. In extreme cases, it may evolve unfavorably and substantially increase maternal mortality. We present the case of an 18-year-old pregnant woman who was admitted to our emergency service in her 31st week, presenting with headache, visual disturbances, and epigastralgia, with progression to a severe condition of HELLP syndrome followed by posterior reversible encephalopathy syndrome (PRES) and hepatic infarction.We highlight the approach taken towards this patient and the casemanagement, in which, in addition to the imaging examinations routinely available, we also used the sidestream dark field (SDF)...

Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology, 2016

Case report Sigmoid volvulus is a rare surgical complication that may occur in pregnancy and duri... more Case report Sigmoid volvulus is a rare surgical complication that may occur in pregnancy and during the puerperium. Th e incidence of intestinal obstruction during gestation ranges from 1 in 1,500 to 1 in 66,431 births (Perdue et al. 1992). In a literature review analysing 66 cases, intestinal obstruction occurred in 53 patients during pregnancy and in 13 patients during the puerperium, with 44 patients presenting specifi c symptoms such as abdominal pain (98%), vomiting (82%) and constipation (30%). In the same study, the leading cause of intestinal obstruction complicating pregnancy and the puerperium was adhesions (59%), followed by volvulus (23%) and intussusception (5%); the most frequent location of the volvulus was the sigmoid colon. Other causes included hernia (3%), carcinoma (1%), appendicitis (1%) and idiopathic cases, accounting for 8% (Perdue et al. 1992). Endoscopy is used for diagnostic as well as therapeutic purposes; fi ndings include obstruction, usually 20 – 30 cm from the anal verge; and the mucosae may be healthy or show signs of ischaemia, with congestion and violaceous colouration. Th e presence of dark spots may suggest necrosis (Lal et al. 2006). Clinical treatment consists of volaemic and electrolyte replacement and antibiotic prophylaxis (Perdue et al. 1992). A 24-year-old patient, 4 gravida, 4 para (4 c-sections) presented the following symptoms on the third postpartum day: pain and abdominal distension, nausea, vomiting and no elimination of gas and faeces for 3 days. On physical examination, the patient was dehydrated and haemodynamically stable but had tachycardia. Th e abdomen was distended, diff usely painful on palpation and exhibited diff use tympanism to percussion, with increased hydro-aerial sounds, no signs of peritonitis and with surgical incision in good condition; rectal examination showed rectal ampulla to be empty. Laboratory examinations showed discrete leucocytosis (15,100 cells/mm 2 ) and increased evidence of infl ammation (C-reactive protein: 102 mg/dL). Th e results of the other laboratory examinations were the following: haemoglobin – 11.2 g/dL, haematocrit – 31.5%, platelets – 272,000/mm 2 , pH – 7,37, arterial lactate – 11 mg/dL and normal renal function. Abdominal radiography exhibited signifi cant colonic distension compatible with the ‘ inverted U shape ’ or the ‘ coff ee bean sign ’ (Figure 1). A computed tomography (CT) scan of the abdomen and pelvis was performed and showed accentuated distention of the colon segment in a closed loop, with apparent twisting of the sigmoid mesocolon, inferring a sigmoid volvulus without signs of perforation or vascular complications. Th e treatment chosen was supported with rehydration and antibiotics, followed by rigid rectosigmoidoscopy with number 30 rectal probe allocated 10 cm from the anal verge. Th e patient exhibited clinical improvement and returned to eliminating fl atus and bowel movements and lower abdominal distension decreased. An abdominal X-ray performed as a control showed decreased colonic distention. Rigid rectosigmoidoscopy, aft er the procedure, showed slightly hyperaemic mucosa, with no signs of necrosis, and the probe was removed. Th e patient progressed well and was discharged on 3rd postoperative day. Postpartum diagnosis of the reason for acute abdominal pain is diffi cult, considering the increased abdominal circumference and diffi culty in elucidating abdominal signs due to the loss of tonus in the abdominal wall, which may mask the signs of peritonitis (Sascha Dua et al. 2007; Kolusari et al. 2009). However, sigmoid volvulus is also the most common cause of intestinal obstruction during pregnancy, accounting for 25% – 44% of the cases because the enlarging uterus can cause a redundant or abnormally long sigmoid colon to rotate around its point of fi xation on the sigmoid mesocolon or the pelvic side wall and should always be considered as one of the causes of acute intestinal obstruction during pregnancy (Kumar et al. 2014). In simple abdominal radiography, characteristic fi ndings are disproportionate enlargement of the sigmoid colon as well as twisting of the sigmoid colon around itself, leading to gas build-up in the colon, which extends from the pelvis to the upper right quadrant of the abdomen, next to the diaphragm, known as the ‘ inverted U ’ or the ‘ coff ee bean sign ’ (Lal et al. 2006). CT of the abdomen and pelvis can be helpful in identifying the cause and location of obstructions, resulting from other diseases and also in assessing consequent ischaemia due to strangulation of bowel loops. During the pregnancy, magnetic resonance imaging has demonstrated the same potential of X-ray to identify the ‘ coff ee bean sign ’ (Palmucci et al. 2014). In this case, the sigmoid volvulus may have occurred due to mobility of the colon combined with a distortion of the sigmoid, associ© 2015 Taylor & Francis Group, LLC ISSN 0144-3615 print/ISSN 1364-6893 online DOI:…

Case Reports in Oncology, 2012

This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCo... more This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 License (www.karger.com/OA-license), applicable to the online version of the article only. Distribution for non-commercial purposes only.

Ultrasound in Obstetrics & Gynecology, 2014

Journal of Obstetrics & Gynaecology, 2014

Descemet ’ s tear and hyphaema (Jain et al. 1980; Bergen and Margolis 1976). Th e described poste... more Descemet ’ s tear and hyphaema (Jain et al. 1980; Bergen and Margolis 1976). Th e described posterior segment complications are retinal haemorrhages, Purtscher retinopathy, macular hole, choroidal rupture and traumatic optic neuropathy (Jain et al. 1980; Casillas et al. 2010; Osmundson and Giangiacomo 1999). Retinal haemorrhage is the most common injury associated with birth trauma (Jain et al. 1980). With the decrease in incidence of instrumental vaginal deliveries, these forceps-related ocular complications are less frequently reported now (Dupuis et al. 2003). There are few complications which can be managed conservatively, but severe ocular injuries need specialist care and surgical intervention (Holden et al. 1992). A GRT is defi ned as a full-thickness retinal break involving more than 3 clock hours (90 ° ) of the retina associated with posterior vitreous detachment. Giant tears result from sudden transverse distension of the globe as it is compressed anteroposteriorly during trauma (Duguid and Leaver 2000). The same mechanism might have caused GRT in the present case. Retinal reattachment surgeries in these cases with silicone oil tamponade needs post-operative prone positioning for 14 – 16 h a day for 3 weeks, which is difficult for children to maintain. The integrity of these eyes can be achieved anatomically; however, functional outcome is difficult to obtain especially following severe trauma and in eyes which require repeated surgeries. These eyes are prone to develop phthisis bulbi despite best efforts and amblyopia is of major concern for visual improvement in these children even if the injured eye has been salvaged anatomically (Meier 2010). Sympathetic ophthalmia, an autoimmune variety of panuveitis, characterised by inflammation of the uveal tract of the contralateral uninjured eye may occur later in this child because of the insult to the uveal tissue of the injured eye. The onset may be delayed for years necessitating lifelong management for these children (Chu and Chan 2013). A thorough English language literature search did not reveal any report of a case with GRT and corneal tear following obstetric forceps delivery. Th is report highlights hitherto unreported severe ocular complication of forceps injury which has a long-term bearing on the visual status of the aff ected eye. Th e obstetricians should be very careful while performing instrument-assisted deliveries to avoid such devastating visual complications.

ARQUIVOS BRASILEIROS CARDIOLOGIA, 2020

ABCS Health Sciences, Dec 15, 2016

Introduction: Systemic lupus erythematosus (SLE) may cause irreversible organ damage. Pregnancy w... more Introduction: Systemic lupus erythematosus (SLE) may cause irreversible organ damage. Pregnancy with coexisting SLE may have severe life-threatening risks. Severe maternal morbidities (SMM) include maternal death, maternal near miss (MNM), and potentially life-threatening conditions (PLTC). This study aimed to determine the prevalence of SMM in patients with SLE and analyze the parameters that contributed to cases of greater severity. Methods: This is a cross-sectional retrospective study from analysis of data retrieved from medical records of pregnant women with SLE treated at São Paulo Hospital , Brazil, from 2005 to 2015. The pregnant women were divided in control group without complications, group with PLTC, and group with MNM. Results: Out of 149 pregnancies, there were 14 cases of MNM (9.4%), 56 cases of PLTC (37.6%), and no maternal death. The maternal near miss rate was 112.9 per 1,000 live births. The majority of PLTC (83.9%) and MNM (92.9%) cases had preterm deliveries wit...

which permits unrestricted use, distribution, and reproduction in any medium, provided the origin... more which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Heterotopic pregnancy is a condition characterized by implantation of one or more viable embryos into the uterine cavity while another one is implanted ectopically, particularly into the uterine tube. Its occurrence has increased drastically over the last few years due to assisted reproduction procedures. In general, the diagnosis is made during the first trimester by using endovaginal two-dimensional ultrasound (2DUS), through observing a complex para- or retrouterine mass in association with a viable uterine pregnancy. However, under some conditions such as atypical ultrasonographic presentations, 2DUS does not clarify the situation whereas magnetic resonance imaging (MRI) of the pelvis is able to do so. We present the case of a pregnant woman in her fifth pregnancy, with a clinical condition of lower abdominal pain and pallor. Endovaginal 2DUS showed a compl...

Copyright © 2012 Felipe Favorette Campanharo et al. This is an open access article distributed un... more Copyright © 2012 Felipe Favorette Campanharo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Guillain-Barre ́ syndrome is a rare neurological disease of progressive installation, usually following a previous acute infectious state, has a rare incidence, especially in pregnancy, and can induce major complications and high mortality risk. Its occurrence, after immunization to influenza during the last trimester pregnancy, has not been reported before. We presented a case of a 36-year-old pregnant woman that was immunized to H1N1 in the last trimester; 10 days later she developed shoulder and lumbar spine’s pain, limbs weakness and facial paralysis with unfavorable clinical evolution and was submitted to intensive therapy care. We described clinical and obstetrical approach, pointing out peculiarities involved in t...

HELLP syndrome is a complication of severe forms of preeclampsia and occurs mainly in the third t... more HELLP syndrome is a complication of severe forms of preeclampsia and occurs mainly in the third trimester of pregnancy. In extreme cases, it may evolve unfavorably and substantially increase maternal mortality. We present the case of an 18-year-old pregnant woman who was admitted to our emergency service in her 31st week, presenting with headache, visual disturbances, and epigastralgia, with progression to a severe condition of HELLP syndrome followed by posterior reversible encephalopathy syndrome (PRES) and hepatic infarction. We highlight the approach taken towards this patient and the case management, in which, in addition to the imaging examinations routinely available, we also used the sidestream dark field (SDF) technique to evaluate the systemic microcirculation.

International Journal of Cardiovascular Sciences, 2021

Background: Maternal mortality rates in Brazil remain above the goals established by the United N... more Background: Maternal mortality rates in Brazil remain above the goals established by the United Nations Sustainable Development Goals. Heart disease is estimated to affect 4% of all pregnancies and remains by itself the main indirect obstetric cause of maternal death. In the last decades, a significant improvement in the prognosis of heart diseases has made pregnancy possible in women with heart disease and provided better maternal and fetal outcomes. Objective: To establish a multicenter Brazilian Registry of pregnant women with heart disease; to study the causes of immediate and late maternal mortality; and to assess the prevalence of heart disease in the country’s macro-regions. Method: This is an observational study, with retrospective and prospective stages, of the clinical and obstetric progression of pregnant women with heart disease. These women consecutively received care during pregnancy and will be followed up for up to a year after delivery at public and private hospital...

Case Reports in Radiology, 2012

Heterotopic pregnancy is a condition characterized by implantation of one or more viable embryos ... more Heterotopic pregnancy is a condition characterized by implantation of one or more viable embryos into the uterine cavity while another one is implanted ectopically, particularly into the uterine tube. Its occurrence has increased drastically over the last few years due to assisted reproduction procedures. In general, the diagnosis is made during the first trimester by using endovaginal two-dimensional ultrasound (2DUS), through observing a complex para- or retrouterine mass in association with a viable uterine pregnancy. However, under some conditions such as atypical ultrasonographic presentations, 2DUS does not clarify the situation whereas magnetic resonance imaging (MRI) of the pelvis is able to do so. We present the case of a pregnant woman in her fifth pregnancy, with a clinical condition of lower abdominal pain and pallor. Endovaginal 2DUS showed a complex voluminous mass in the left pelvic region in association with a viable intrauterine pregnancy. 2DUS in power Doppler mode...

Case Reports in Emergency Medicine, 2014

PLoS ONE, 2012

Objectives: To validate the WHO maternal near-miss criteria and develop a benchmark tool for seve... more Objectives: To validate the WHO maternal near-miss criteria and develop a benchmark tool for severe maternal morbidity assessments. Methods: In a multicenter cross-sectional study implemented in 27 referral maternity hospitals in Brazil, a one-year prospective surveillance on severe maternal morbidity and data collection was carried out. Diagnostic accuracy tests were used to assess the validity of the WHO maternal near-miss criteria. Binary logistic regression was used to model the death probability among women with severe maternal complications and benchmark the management of severe maternal morbidity. Results: Of the 82,388 women having deliveries in the participating health facilities, 9,555 women presented pregnancyrelated complications, including 140 maternal deaths and 770 maternal near misses. The WHO maternal near-miss criteria were found to be accurate and highly associated with maternal deaths (Positive likelihood ratio 106.8 (95% CI 99.56-114.6)). The maternal severity index (MSI) model was developed and found to able to describe the relationship between lifethreatening conditions and mortality (Area under the ROC curve: 0.951 (95% CI 0.909-0.993)). Conclusion: The identification of maternal near-miss cases using the WHO list of pregnancy-related life-threatening conditions was validated. The MSI model can be used as a tool for benchmarking the performance of health services managing women with severe maternal complications and provide case-mix adjustment.

Hematology, Transfusion and Cell Therapy, 2020