LAUDELINO M LOPES - Profile on Academia.edu (original) (raw)

Papers by LAUDELINO M LOPES

Research paper thumbnail of Thrombophilia testing in pregnancy: should we agree to disagree?

Journal of perinatal medicine, 2015

The value of testing for inherited thrombophilia in pregnancy has been debated in literature with... more The value of testing for inherited thrombophilia in pregnancy has been debated in literature with regard to its utility in preventing adverse obstetrical outcomes or identifying women at risk for it. In this commentary, an evidence based approach is used to investigate the strength of association between thrombophilias and recurrent pregnancy loss and stillbirth. Several studies and meta-analyses have shown that there is only a weak association with recurrent pregnancy loss. However, many of these studies were underpowered, and there was significant heterogeneity-issues that are addressed in this paper. The evidence for association with stillbirth is lacking, but the few studies that are available seem to suggest a stronger correlation than for recurrent pregnancy loss. Further, the benefit of treating thrombophilias with anticoagulation in order to prevent these outcomes is discussed. While there is a lack of evidence looking at whether anticoagulation prevents stillbirth, there is...

Research paper thumbnail of P11.02: First-trimester combined screening for aneuploidy in a Brazilian population from a private center in Rio de Janeiro: a preliminary study

Ultrasound in Obstetrics and Gynecology, 2009

were rated to enable highly diagnostic confidence (82.9%), and produce better image quality for t... more were rated to enable highly diagnostic confidence (82.9%), and produce better image quality for the near field image (94.3%), the far field image (88.6%), and overall (94.3%). Conclusions: The current study described an objective method of comparing image quality acquired using different sonographic technologies. Ultrasound transducer incorporated with PureWave Crystal technology produces significantly better image quality for diagnostic purpose.

Research paper thumbnail of Estudo do sonograma do ducto venoso em fetos com centralização hemodinâmica: avaliação de repercussões perinatais

Objetivo: avaliar a associação da relação sístole ventricular/atrial (S/A) do ducto venoso (DV) c... more Objetivo: avaliar a associação da relação sístole ventricular/atrial (S/A) do ducto venoso (DV) com resultados perinatais em fetos prematuros com centralização de fluxo à dopplervelocimetria. Métodos: o estudo foi delineado como um estudo observacional, transversal, com os dados colhidos de forma prospectiva. A relação S/A do DV foi estudada em 41 fetos centralizados com idade gestacional (IG) entre 25 e 33ª semana completa, no período de novembro de 2002 a julho de 2005. Os recém-nascidos foram acompanhados até o 28º dia pós-parto na UTI da Clínica Perinatal Laranjeiras, buscando-se complicações neonatais. A população de estudo foi dividida em dois grupos a partir do resultado do DV. Foram incluídos no grupo normal os fetos com relação S/A menor ou igual a 3,6 e no grupo alterado aqueles com valores de S/A maiores que 3,6. A comparação entre os grupos foi realizada com os testes estatísticos de Mann-Whitney, χ2 e exato de Fisher. Todos os resultados foram considerados estatisticamente significativos se p<0,05. Foram avaliados a IG ao nascimento, peso ao nascer e índice de Apgar menor que 7 no 5º minuto. Os parâmetros perinatais avaliados foram: natimortalidade, neomortalidade, convulsão, hemorragia intraventricular, necessidade de surfactante, uso de respirador, disfunção miocárdica, enterocolite necrotizante e permanência na UTI após o período neonatal. Resultados: dos 41 fetos incluídos, 26 (63,4%) não apresentaram alteração da relação S/A do DV, ao passo que 15 (36,6%) fetos cursaram com a relação S/A do DV alteradas (>3,6). Não houve diferença significativa entre os grupos quanto à IG ao nascimento e Apgar <7. Encontrou-se associação significante entre o grupo com DV alterado e mortalidade neonatal (p=0,049; teste exato de Fisher). Quanto às demais variáveis estudadas não foi observada diferença entre os dois grupos. Conclusão: os nossos resultados sugerem que a anormalidade do fluxo no DV detectada pela dopplervelocimetria não está associada a resultados perinatais adversos, além da mortalidade neonatal. Esta associação pode ser considerada estatisticamente significante, porém com valor próximo ao limite (p=0,049). Quando excluídos os fetos com peso de nascimento inferior a 400 gramas, não é mais observada a associação entre o DV e neomortalidade (p=0,37). A alteração da relação S/A do DV não apresentou, em nossa amostra, associação com mortalidade perinatal em fetos prematuros viáveis.

Research paper thumbnail of Prevention of Preeclampsia

Journal of Pregnancy, 2012

Preeclampsia (PE) affects around 2-5% of pregnant women. It is a major cause of maternal and peri... more Preeclampsia (PE) affects around 2-5% of pregnant women. It is a major cause of maternal and perinatal morbidity and mortality. In an attempt to prevent preeclampsia, many strategies based on antenatal care, change in lifestyle, nutritional supplementation, and drugs have been studied. The aim of this paper is to review recent evidence about primary and secondary prevention of preeclampsia.

Research paper thumbnail of Magnesium sulphate for fetal neuroprotection

Revista brasileira de ginecologia e obstetrícia : revista da Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2011

Research paper thumbnail of Dopplerfluxometria de ducto venoso: identificação não invasiva da acidemia em fetos prematuros centralizados

Revista Brasileira de Ginecologia e Obstetrícia, 2004

Rua das Laranjeiras 445, sub-solo -Laranjeiras 22240-002 -Rio de Janeiro -RJ RESUMO Objetivo: est... more Rua das Laranjeiras 445, sub-solo -Laranjeiras 22240-002 -Rio de Janeiro -RJ RESUMO Objetivo: estabelecer o ponto de corte a partir do qual seja possível identificar fetos prematuros com centralização do fluxo sangüíneo que apresentem gasometria anormal. Métodos: foi realizado estudo observacional transversal, cuja população consistia de 60 gestantes com fetos centralizados (relação umbílico-cerebral maior que 1), com idade gestacional entre 25 e 33 semanas. O ducto venoso foi identificado com auxílio da dopplerfluxometria colorida e obtida a relação S/A a partir do sonograma (relação entre a velocidade de pico da sístole ventricular e a velocidade de pico da sístole atrial). Imediatamente após a cesariana foi colhida amostra de sangue da veia umbilical para gasometria. Os conceptos foram classificados de acordo com a análise gasométrica e considerados anormais quando pH <7,20 e BE < -6 mmol/L. Após o cálculo da sensibilidade e especificidade para cada ponto de corte foi construída a curva ROC (receiver operator characteristic). Resultados: foram selecionadas 60 gestantes no período de janeiro de 1998 a janeiro de 2003. No momento do estudo a idade gestacional variou entre 25 e 33 semanas, média de 29,7 semanas (±1,8 semanas). Todos os fetos apresentavam-se centralizados; dentre eles 14 apresentavam gasometria anormal ao nascimento e 46 apresentavam gasometria normal. A prevalência de resultados de fetos com gasometria anormal no material estudado foi de 23,33%. Observou-se associação significativa entre o resultado anormal do ducto venoso e gasometria anormal ao nascimento (χ 2 = 784,44, p < 0,00001). O ponto de corte da relação S/A (onde a curva ROC "muda de tendência") foi 3,4. Conclusão: a análise da relação S/A do ducto venoso se mostra adequada para a predição não invasiva de gasometria anormal em fetos prematuros, centralizados, quando os valores são superiores a 3,4. PALAVRAS-CHAVE: Dopplervelocimetria. Gasometria. Circulação fetoplacentária. Dopplerfluxometria. Introdução A evolução tecnológica observada em décadas recentes, possibilitando o desenvolvimento de métodos que facilitam a observação e o estudo do feto, tem permitido extraordinário avanço no en-tendimento da fisiologia e da fisiopatologia do paciente intra-uterino. Esta evolução na propedêutica fetal, além de tornar possível melhor conhecimento da doença, fornece subsídios para que o tratamento do paciente ainda não nascido possa ser instituído. As gestações com evolução desfavorável para o concepto chamam-se genericamente gestações de alto risco e se associam, no mais das vezes, ao sofrimento fetal crônico. Vários fatores complicam a gestação, determinando alterações na placenta, pelo geral secundárias ao comprometimento da vascularização uterina, Trabalhos Originais 26 (5): 355-361, 2004 RBGO

Research paper thumbnail of Dopplerfluxometria do ducto venoso: relação com a gasometria em fetos prematuros com centralização de fluxo sangüíneo

Revista Brasileira de Ginecologia e Obstetrícia, 2003

Correspondência: Renato Augusto Moreira de Sá Rua das Laranjeiras 445, sub-solo -Laranjeiras 2224... more Correspondência: Renato Augusto Moreira de Sá Rua das Laranjeiras 445, sub-solo -Laranjeiras 22240-002 -Rio de Janeiro -RJ Introdução A expectativa para a sobrevivência neonatal é influenciada pela maturidade e pela idade gestacional. A imprecisão desta última dificulta a avaliação do potencial de sobrevida. Assim sendo, RESUMO Objetivo: avaliar o desempenho da dopplerfluxometria do ducto venoso (DV) na detecção da acidemia em fetos prematuros apresentando centralização de fluxo sangüíneo. Métodos: estudo observacional transversal. A população em estudo consistiu de 48 gestantes entre a 25 a e a 33 a semana de gestação, que apresentavam centralização de fluxo sangüíneo fetal (relação umbílico/cerebral >1). O tempo decorrido entre o diagnóstico de centralização fetal e o nascimento (cesariana sob anestesia peridural) foi de até cinco horas. Os seguintes parâmetros foram estudados: relação sístole ventricular atrial (S/A) do ducto venoso, pH e base excess (BE) de amostra de sangue da veia umbilical colhida imediatamente após o nascimento. A relação S/A do DV foi considerada anormal quando maior que 3,6. Os conceptos foram classificados quanto ao resultado da gasometria, sendo considerada gasometria anormal quando pH <7,26 e BE <6 mmol/L. O estudo estatístico utilizado foi o teste de Fisher, considerado significativo quando p < 0,05. Resultados: a correlação entre a gasometria do cordão umbilical de fetos prematuros centralizados e a relação S/A do DV foi significativa (p=0,0000082; teste de Fisher). A dopplervelocimetria do DV foi capaz de identificar 10 dos 14 fetos com gasometria anormal. Por outro lado, 32 dos 34 fetos com gasometria normal foram corretamente identificados. A sensibilidade da dopplerfluxometria do DV para o diagnóstico de acidemia fetal ao nascimento foi de 71%, a especificidade foi de 94%, a taxa de falso-negativo de 8%, a taxa de falsopositivo de 4%, o valor preditivo positivo de 83% e o valor preditivo negativo de 89%. A probabilidade pré-teste para um feto centralizado de apresentar acidemia ao nascimento foi de 31%. Já a probabilidade de acidemia após resultado do DV anormal (probabilidade após teste anormal) foi de 84%, ao passo que a probabilidade de acidemia fetal com o DV normal (probabilidade após-teste normal) foi de apenas 10%. Conclusão: a análise da relação S/A do ducto venoso se mostra adequada para o diagnóstico de gasometria anormal em fetos prematuros, centralizados. PALAVRAS-CHAVE: Dopplervelocimetria. Gasometria, Sofrimento fetal. a maioria dos dados neonatais se baseia no peso ao nascimento 1 .

Research paper thumbnail of Doppler velocimetry of ductus venous in preterm fetuses with brain sparing effect: neonatal outcome

Journal of prenatal medicine, 2012

to evaluate the relationship between ductus venous (DV) and Doppler velocimetry in neonatal outco... more to evaluate the relationship between ductus venous (DV) and Doppler velocimetry in neonatal outcome in severe compromised preterm fetuses. the study was designed as an observational and cross-sectional study with 52 premature neonates with brain sparing effect. The criteria of neonatal severe morbidity were: severe intraventricular hemorrhage (grades 3 or 4), retinopathy of prematurity (grade 3 or 4), cystic periventricular leukomalatia, bronchopneumo dysplasia and neonatal mortality. The fetuses were divided in two groups: group 0 - all the fetuses with ventricular systole/atrial contraction (S/A) in DV ratio values less them 3.4; group 1 - fetuses with values of S/A ratio greater than 3.4. 42% of fetuses showed abnormal S/A ratio in DV and 48% showed birth weight below percentile 3 for gestational age. There was no statistical significance comparing the 02 groups according to bronchopneumo dysplasia, retinopathy of prematurity (grade 3 or 4) and intraventricular hemorrhage (grade ...

Research paper thumbnail of P34.06: Predicting adverse neonatal outcome in severe fetal compromise: a pivotal role for estimated fetal weight Z-score

Ultrasound in Obstetrics and Gynecology, 2007

weight for adverse perinatal outcome in a group of small-forgestational age (SGA) fetuses. Method... more weight for adverse perinatal outcome in a group of small-forgestational age (SGA) fetuses. Methods: Data were collected from 105 singleton and nonmalformed fetuses suspected of being SGA during the third trimester and with a confirmed birth weight below the 10 th centile. At diagnosis, estimated fetal weight was customized according to maternal and fetal characteristics and middle cerebral artery pulsatility index and umbilical artery pulsatility index were recorded, and tranformed to Z-values. Adverse perinatal outcome was defined as umbilical artery pH at delivery ≤ 7.15, 5-minutes Apgar score ≤ 7, significant neonatal morbidity (seizures, respiratory distress syndrome, necrotising enterocolitis, grade II-III intraventricular hemorrhage, hypoxic-ischemic encephalopathy), need of intubation, neonatal intensive care unit admission or neonatal mortality. Results: The prevalence of adverse perinatal outcome in our group of SGA fetuses was 50.5%. While the area under the curve (AUC) for Z-customized estimated fetal weight was 0.7 (95% CI, 0.59-0.81), for Z-umbilical artery Doppler was 0.5 (95% CI, 0.39-0.63) and for Z-middle cerebral artery was 0.55 (95% CI, 0.44-0.68). Paired analysis between parameters demonstrated that customized standards UAC was significantly larger than for both Doppler indices. Overall, the sensitivity and specificity for 10th centile cut-off of customized estimated fetal weight was 67.4% and 64%, respectively. Conclusion: In SGA fetuses, customized standards are a better predictor for adverse perinatal outcome than middle cerebral artery or umbilical artery Doppler indices.

Research paper thumbnail of OC35: Three-dimensional ultrasound hourly fetal urine production rate (HFUPR): reliability of rotational (VOCAL) technique using different steps of rotation

Ultrasound in Obstetrics and Gynecology, 2007

OC34: Table NT 5.0-5.9 mm % NT 6.0-6.9 mm % NT 7.0-7.9 mm % NT > 8.0 mm %

Research paper thumbnail of P11.16: Median levels of free beta-hCG and PAPP-A in the first trimester screening for Down syndrome in a Brazilian population from a private center in Rio de Janeiro

Ultrasound in Obstetrics and Gynecology, 2009

To assess whether there is a need to correct first-trimester biochemical markers (free beta-hCG a... more To assess whether there is a need to correct first-trimester biochemical markers (free beta-hCG and PAPP-A) in a Brazilian population from a private center in Rio de Janeiro (Perinatal Group -Laranjeiras) while screening for Down syndrome using the Fetal Medicine Foundation (FMF) algorithm. Methods: The data from 546 women undergoing first trimester combined screening for fetal Down syndrome were analyzed to derive our center population-specific medians. The observed medians were compared to those based on the original algorithm of the Fetal Medicine Foundation (FMF) in Caucasians. Results: The median maternal serum levels of free beta-hCG and PAPP-A were similar between the target population and average Caucasians. There was no need to correct the original FMF algorithm for the Brazilian population analyzed in this study. Conclusion: There is no need to adjust the biochemical markers in the Brazilian population from our center in Rio de Janeiro in a first trimester screening program.

Research paper thumbnail of OC37.03: Routine use of ultrasound guided curettage for incomplete abortion or missed abortion-five years experience

Ultrasound in Obstetrics and Gynecology, 2005

Research paper thumbnail of P10.10: First trimester screening for chromosomal anomalies II—nasal bone and ductus venosus(pilot study)

Ultrasound in Obstetrics and Gynecology, 2004

We started this research line since October 2002 with nuchal translucency. We initiated the inves... more We started this research line since October 2002 with nuchal translucency. We initiated the investigation with nasal bone and ductus venosus in a first trimester screening in September 2003. These studies examines: 1) the association between absent nasal bone (NB) at the 11-14 weeks scan and chromosomal anomalies in Brazilian pregnant women sample. 2) The association between ductus venosus abnormal wave form at the 11-14 weeks Doppler and chromosomal anomalies in Brazilian pregnant women sample Methods: Since September 2003, 35 patients have been included in this study. Ultrasound and Doppler examination of fetal profile was carried out between 11 and 14 weeks of gestation. All data was obtained with a Voluson 730 GE and Toshiba SSH 140 A. All patients referred to our department have accepted fetal karyotyping. Results: A total of 35 fetuses were included in this study. When we analyzed the NB, the sensitivity was 50%, specificity was 96.8%, positive predictive value (PPV) was 50% and negative predictive value (NPV) was 96.8%. The association was not statistically significant (P = 0.11 -Fisher). When we analyzed the ductus venosus, the sensitivity was 50%, specificity was 100%, positive predictive value (PPV) was 100% and negative predictive value (NPV) was 97.1%. The association was statistically significant (P = 0.05 -Fisher). Conclusions: This is only a first view of our research (previous note).

Research paper thumbnail of P11.09: Antenatal diagnosis of limb-body wall complex with ultrasound and magnetic resonance imaging—case report

P11.09: Antenatal diagnosis of limb-body wall complex with ultrasound and magnetic resonance imaging—case report

Ultrasound in Obstetrics and Gynecology, 2004

Research paper thumbnail of Cantrell's Pentalogy in Twins: Prenatal Diagnosis

Cantrell's Pentalogy in Twins: Prenatal Diagnosis

Twin Research and Human Genetics, 2006

The combination of an onphalocele, an anterior thoracic wall defect and an anterior diaphragmatic... more The combination of an onphalocele, an anterior thoracic wall defect and an anterior diaphragmatic defect constitutes classical Cantrell&amp;amp;amp;amp;#39;s pentalogy. We present a case of Cantrell&amp;amp;amp;amp;#39;s pentalogy diagnosed prenataly in twins with conventional and three-dimensional sonography.

Research paper thumbnail of Human Cord Blood Transplantation in a Neonatal Rat Model of Hypoxic–Ischemic Brain Damage: Functional Outcome Related to Neuroprotection in the Striatum

Human Cord Blood Transplantation in a Neonatal Rat Model of Hypoxic–Ischemic Brain Damage: Functional Outcome Related to Neuroprotection in the Striatum

Stem Cells and Development, 2010

Human umbilical cord blood mononuclear cells (HUCB) have been shown to have a therapeutic role in... more Human umbilical cord blood mononuclear cells (HUCB) have been shown to have a therapeutic role in different models of central nervous system (CNS) damage, including stroke. We evaluated the possible therapeutic potential of HUCB in P7 rats submitted to the Rice-Vannucci model of neonatal hypoxic-ischemic (HI) brain damage. Our results demonstrated that intraperitoneal transplantation of HUCB, 3 h after the HI insult, resulted in better performance in two developmental sensorimotor reflexes, in the first week after the injury. We also showed a neuroprotective effect in the striatum, and a decrease in the number of activated microglial cells in the cerebral cortex of treated animals. We suggest that HUCB transplantation might rescue striatal neurons from cell death after a neonatal HI injury resulting in better functional recovery.

Research paper thumbnail of Predicting adverse neonatal outcome in severe fetal compromise: A pivotal role for estimated fetal weight Z scores

Predicting adverse neonatal outcome in severe fetal compromise: A pivotal role for estimated fetal weight Z scores

Prenatal Diagnosis, 2007

To identify significant predictors for adverse neonatal outcome in severe by compromised fetuses.... more To identify significant predictors for adverse neonatal outcome in severe by compromised fetuses. Consecutive premature fetuses at between 25 and 32 weeks&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; with severe placental insufficiency were examined prospectively. Inclusion criteria were: singletons; normal anatomy; abnormal umbilical artery Doppler pulsatility index; abnormal cerebroplacental ratio; middle cerebral artery pulsatility index (PI) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;or=2 standard deviations. We considered as independent potential predicting variables: absent or reversed end diastolic flow in umbilical artery, abnormal ductus venosus S/A ratio, absent or reversed flow during atrial contraction in the ductus venosus, and estimated fetal weight (EFW) Z score. Outcome parameters were: neonatal mortality and severe neonatal morbidity (Periventricular-Intraventricular Hemorrhage grade 03 or 04, Retinopathy of Prematurity stage 3 or 4, Periventricular Leukomalacia or Broncopulmonary Dysplasia). Univariate analysis for all potential predicting variables was performed. EFW Z score index showed the strongest association with mortality and there was no fetal death or Retinopathy of Prematurity in the group with EFW Z-score index below lower limit. There was no case of Cystic Periventricular Leukomalatia in these analyses. The area under receiver-operator characteristic curve was significant for EFW Z-score index. Our study suggests that EFW Z score is the strongest predictor of adverse neonatal outcome in severely compromised fetuses.

Research paper thumbnail of SNAPPE-II application in newborns with very low birth weight: evaluation of adverse outcomes in severe placental dysfunction

SNAPPE-II application in newborns with very low birth weight: evaluation of adverse outcomes in severe placental dysfunction

Journal of Perinatal Medicine, 2000

The aim of this study was to evaluate the ability of the admission Score for Neonatal Acute Physi... more The aim of this study was to evaluate the ability of the admission Score for Neonatal Acute Physiology - Perinatal Extension-II (SNAPPE-II) to predict adverse outcome among premature very low birth weight (BW) infants with abnormal Doppler blood flow in the uterus secondary to severe placental insufficiency of early onset. A total of 86 neonates, weighing between 360 and 1498 g, were studied. Descriptive statistics of the population were reported. The areas under the receiver operating characteristics curves for the SNAPPE-II were calculated. The calibration of the model was assessed using the technique of Hosmer-Lemeshow. Adverse outcome was defined as mortality or the development of the following diagnoses: (1) periventricular-intraventricular hemorrhage (PIH); (2) retinopathy of prematurity stage 3 or 4; (3) periventricular leukomalacia; (4) bronchopulmonary dysplasia; (5) necrotizing enterocolitis (NEC). The SNAPPE-II area under curve was 0.86 (95% CI: 0.78-0.94) for mortality and 0.76 (95% CI: 0.65-0.86) for the prediction of adverse outcomes. Analyzing each morbidity variable, the SNAPPE-II AUC varied between 0.51 for NEC and 0.72 for PIH. SNAPPE-II shows accuracy in the prediction of adverse outcome for this highly selective group of very low BW infants compromised by severe placental insufficiency.

Research paper thumbnail of P492 Minimally invasive fetal surgery for TTTS – Brazilian perinatal center experience

International Journal of Gynecology & Obstetrics, 2009

cases were planned laparoscopic bilateral oophorectomy (BSO). Of these 4 (20%) were converted in ... more cases were planned laparoscopic bilateral oophorectomy (BSO). Of these 4 (20%) were converted in open surgery. In one (0.5%) case malignancy was confirmed on histology. 16 (14.5%) cases were scheduled for laparoscopic hysterectomy-BSO. Of these 9 (56.6%)cases were converted into open procedures. Malignancy was confirmed in 3 (18.7%) cases. One case of bowel perforation was reported. Overall 7 (6.36%) cases of malignancy were identified on histology and 24 (21%) procedures were converted into open surgery. Conclusion: 79% of adnexal masses greater than 7 cm was successfully managed by laparoscopy. 21% of cases were converted into open surgery because of suspected malignancy and/or because of limited access. One case was converted to open surgery because of small bowel perforation. Management of large adnexal masses by laparoscopic surgery is safe and feasible.

Research paper thumbnail of Pregnancy complicated by spontaneous rupture of uterus and endometrioses and ovarian endometrioma

International Journal of Gynecology & Obstetrics, 2000

WEDNESDAY, SEPTEMBER 6

Research paper thumbnail of Thrombophilia testing in pregnancy: should we agree to disagree?

Journal of perinatal medicine, 2015

The value of testing for inherited thrombophilia in pregnancy has been debated in literature with... more The value of testing for inherited thrombophilia in pregnancy has been debated in literature with regard to its utility in preventing adverse obstetrical outcomes or identifying women at risk for it. In this commentary, an evidence based approach is used to investigate the strength of association between thrombophilias and recurrent pregnancy loss and stillbirth. Several studies and meta-analyses have shown that there is only a weak association with recurrent pregnancy loss. However, many of these studies were underpowered, and there was significant heterogeneity-issues that are addressed in this paper. The evidence for association with stillbirth is lacking, but the few studies that are available seem to suggest a stronger correlation than for recurrent pregnancy loss. Further, the benefit of treating thrombophilias with anticoagulation in order to prevent these outcomes is discussed. While there is a lack of evidence looking at whether anticoagulation prevents stillbirth, there is...

Research paper thumbnail of P11.02: First-trimester combined screening for aneuploidy in a Brazilian population from a private center in Rio de Janeiro: a preliminary study

Ultrasound in Obstetrics and Gynecology, 2009

were rated to enable highly diagnostic confidence (82.9%), and produce better image quality for t... more were rated to enable highly diagnostic confidence (82.9%), and produce better image quality for the near field image (94.3%), the far field image (88.6%), and overall (94.3%). Conclusions: The current study described an objective method of comparing image quality acquired using different sonographic technologies. Ultrasound transducer incorporated with PureWave Crystal technology produces significantly better image quality for diagnostic purpose.

Research paper thumbnail of Estudo do sonograma do ducto venoso em fetos com centralização hemodinâmica: avaliação de repercussões perinatais

Objetivo: avaliar a associação da relação sístole ventricular/atrial (S/A) do ducto venoso (DV) c... more Objetivo: avaliar a associação da relação sístole ventricular/atrial (S/A) do ducto venoso (DV) com resultados perinatais em fetos prematuros com centralização de fluxo à dopplervelocimetria. Métodos: o estudo foi delineado como um estudo observacional, transversal, com os dados colhidos de forma prospectiva. A relação S/A do DV foi estudada em 41 fetos centralizados com idade gestacional (IG) entre 25 e 33ª semana completa, no período de novembro de 2002 a julho de 2005. Os recém-nascidos foram acompanhados até o 28º dia pós-parto na UTI da Clínica Perinatal Laranjeiras, buscando-se complicações neonatais. A população de estudo foi dividida em dois grupos a partir do resultado do DV. Foram incluídos no grupo normal os fetos com relação S/A menor ou igual a 3,6 e no grupo alterado aqueles com valores de S/A maiores que 3,6. A comparação entre os grupos foi realizada com os testes estatísticos de Mann-Whitney, χ2 e exato de Fisher. Todos os resultados foram considerados estatisticamente significativos se p<0,05. Foram avaliados a IG ao nascimento, peso ao nascer e índice de Apgar menor que 7 no 5º minuto. Os parâmetros perinatais avaliados foram: natimortalidade, neomortalidade, convulsão, hemorragia intraventricular, necessidade de surfactante, uso de respirador, disfunção miocárdica, enterocolite necrotizante e permanência na UTI após o período neonatal. Resultados: dos 41 fetos incluídos, 26 (63,4%) não apresentaram alteração da relação S/A do DV, ao passo que 15 (36,6%) fetos cursaram com a relação S/A do DV alteradas (>3,6). Não houve diferença significativa entre os grupos quanto à IG ao nascimento e Apgar <7. Encontrou-se associação significante entre o grupo com DV alterado e mortalidade neonatal (p=0,049; teste exato de Fisher). Quanto às demais variáveis estudadas não foi observada diferença entre os dois grupos. Conclusão: os nossos resultados sugerem que a anormalidade do fluxo no DV detectada pela dopplervelocimetria não está associada a resultados perinatais adversos, além da mortalidade neonatal. Esta associação pode ser considerada estatisticamente significante, porém com valor próximo ao limite (p=0,049). Quando excluídos os fetos com peso de nascimento inferior a 400 gramas, não é mais observada a associação entre o DV e neomortalidade (p=0,37). A alteração da relação S/A do DV não apresentou, em nossa amostra, associação com mortalidade perinatal em fetos prematuros viáveis.

Research paper thumbnail of Prevention of Preeclampsia

Journal of Pregnancy, 2012

Preeclampsia (PE) affects around 2-5% of pregnant women. It is a major cause of maternal and peri... more Preeclampsia (PE) affects around 2-5% of pregnant women. It is a major cause of maternal and perinatal morbidity and mortality. In an attempt to prevent preeclampsia, many strategies based on antenatal care, change in lifestyle, nutritional supplementation, and drugs have been studied. The aim of this paper is to review recent evidence about primary and secondary prevention of preeclampsia.

Research paper thumbnail of Magnesium sulphate for fetal neuroprotection

Revista brasileira de ginecologia e obstetrícia : revista da Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2011

Research paper thumbnail of Dopplerfluxometria de ducto venoso: identificação não invasiva da acidemia em fetos prematuros centralizados

Revista Brasileira de Ginecologia e Obstetrícia, 2004

Rua das Laranjeiras 445, sub-solo -Laranjeiras 22240-002 -Rio de Janeiro -RJ RESUMO Objetivo: est... more Rua das Laranjeiras 445, sub-solo -Laranjeiras 22240-002 -Rio de Janeiro -RJ RESUMO Objetivo: estabelecer o ponto de corte a partir do qual seja possível identificar fetos prematuros com centralização do fluxo sangüíneo que apresentem gasometria anormal. Métodos: foi realizado estudo observacional transversal, cuja população consistia de 60 gestantes com fetos centralizados (relação umbílico-cerebral maior que 1), com idade gestacional entre 25 e 33 semanas. O ducto venoso foi identificado com auxílio da dopplerfluxometria colorida e obtida a relação S/A a partir do sonograma (relação entre a velocidade de pico da sístole ventricular e a velocidade de pico da sístole atrial). Imediatamente após a cesariana foi colhida amostra de sangue da veia umbilical para gasometria. Os conceptos foram classificados de acordo com a análise gasométrica e considerados anormais quando pH <7,20 e BE < -6 mmol/L. Após o cálculo da sensibilidade e especificidade para cada ponto de corte foi construída a curva ROC (receiver operator characteristic). Resultados: foram selecionadas 60 gestantes no período de janeiro de 1998 a janeiro de 2003. No momento do estudo a idade gestacional variou entre 25 e 33 semanas, média de 29,7 semanas (±1,8 semanas). Todos os fetos apresentavam-se centralizados; dentre eles 14 apresentavam gasometria anormal ao nascimento e 46 apresentavam gasometria normal. A prevalência de resultados de fetos com gasometria anormal no material estudado foi de 23,33%. Observou-se associação significativa entre o resultado anormal do ducto venoso e gasometria anormal ao nascimento (χ 2 = 784,44, p < 0,00001). O ponto de corte da relação S/A (onde a curva ROC "muda de tendência") foi 3,4. Conclusão: a análise da relação S/A do ducto venoso se mostra adequada para a predição não invasiva de gasometria anormal em fetos prematuros, centralizados, quando os valores são superiores a 3,4. PALAVRAS-CHAVE: Dopplervelocimetria. Gasometria. Circulação fetoplacentária. Dopplerfluxometria. Introdução A evolução tecnológica observada em décadas recentes, possibilitando o desenvolvimento de métodos que facilitam a observação e o estudo do feto, tem permitido extraordinário avanço no en-tendimento da fisiologia e da fisiopatologia do paciente intra-uterino. Esta evolução na propedêutica fetal, além de tornar possível melhor conhecimento da doença, fornece subsídios para que o tratamento do paciente ainda não nascido possa ser instituído. As gestações com evolução desfavorável para o concepto chamam-se genericamente gestações de alto risco e se associam, no mais das vezes, ao sofrimento fetal crônico. Vários fatores complicam a gestação, determinando alterações na placenta, pelo geral secundárias ao comprometimento da vascularização uterina, Trabalhos Originais 26 (5): 355-361, 2004 RBGO

Research paper thumbnail of Dopplerfluxometria do ducto venoso: relação com a gasometria em fetos prematuros com centralização de fluxo sangüíneo

Revista Brasileira de Ginecologia e Obstetrícia, 2003

Correspondência: Renato Augusto Moreira de Sá Rua das Laranjeiras 445, sub-solo -Laranjeiras 2224... more Correspondência: Renato Augusto Moreira de Sá Rua das Laranjeiras 445, sub-solo -Laranjeiras 22240-002 -Rio de Janeiro -RJ Introdução A expectativa para a sobrevivência neonatal é influenciada pela maturidade e pela idade gestacional. A imprecisão desta última dificulta a avaliação do potencial de sobrevida. Assim sendo, RESUMO Objetivo: avaliar o desempenho da dopplerfluxometria do ducto venoso (DV) na detecção da acidemia em fetos prematuros apresentando centralização de fluxo sangüíneo. Métodos: estudo observacional transversal. A população em estudo consistiu de 48 gestantes entre a 25 a e a 33 a semana de gestação, que apresentavam centralização de fluxo sangüíneo fetal (relação umbílico/cerebral >1). O tempo decorrido entre o diagnóstico de centralização fetal e o nascimento (cesariana sob anestesia peridural) foi de até cinco horas. Os seguintes parâmetros foram estudados: relação sístole ventricular atrial (S/A) do ducto venoso, pH e base excess (BE) de amostra de sangue da veia umbilical colhida imediatamente após o nascimento. A relação S/A do DV foi considerada anormal quando maior que 3,6. Os conceptos foram classificados quanto ao resultado da gasometria, sendo considerada gasometria anormal quando pH <7,26 e BE <6 mmol/L. O estudo estatístico utilizado foi o teste de Fisher, considerado significativo quando p < 0,05. Resultados: a correlação entre a gasometria do cordão umbilical de fetos prematuros centralizados e a relação S/A do DV foi significativa (p=0,0000082; teste de Fisher). A dopplervelocimetria do DV foi capaz de identificar 10 dos 14 fetos com gasometria anormal. Por outro lado, 32 dos 34 fetos com gasometria normal foram corretamente identificados. A sensibilidade da dopplerfluxometria do DV para o diagnóstico de acidemia fetal ao nascimento foi de 71%, a especificidade foi de 94%, a taxa de falso-negativo de 8%, a taxa de falsopositivo de 4%, o valor preditivo positivo de 83% e o valor preditivo negativo de 89%. A probabilidade pré-teste para um feto centralizado de apresentar acidemia ao nascimento foi de 31%. Já a probabilidade de acidemia após resultado do DV anormal (probabilidade após teste anormal) foi de 84%, ao passo que a probabilidade de acidemia fetal com o DV normal (probabilidade após-teste normal) foi de apenas 10%. Conclusão: a análise da relação S/A do ducto venoso se mostra adequada para o diagnóstico de gasometria anormal em fetos prematuros, centralizados. PALAVRAS-CHAVE: Dopplervelocimetria. Gasometria, Sofrimento fetal. a maioria dos dados neonatais se baseia no peso ao nascimento 1 .

Research paper thumbnail of Doppler velocimetry of ductus venous in preterm fetuses with brain sparing effect: neonatal outcome

Journal of prenatal medicine, 2012

to evaluate the relationship between ductus venous (DV) and Doppler velocimetry in neonatal outco... more to evaluate the relationship between ductus venous (DV) and Doppler velocimetry in neonatal outcome in severe compromised preterm fetuses. the study was designed as an observational and cross-sectional study with 52 premature neonates with brain sparing effect. The criteria of neonatal severe morbidity were: severe intraventricular hemorrhage (grades 3 or 4), retinopathy of prematurity (grade 3 or 4), cystic periventricular leukomalatia, bronchopneumo dysplasia and neonatal mortality. The fetuses were divided in two groups: group 0 - all the fetuses with ventricular systole/atrial contraction (S/A) in DV ratio values less them 3.4; group 1 - fetuses with values of S/A ratio greater than 3.4. 42% of fetuses showed abnormal S/A ratio in DV and 48% showed birth weight below percentile 3 for gestational age. There was no statistical significance comparing the 02 groups according to bronchopneumo dysplasia, retinopathy of prematurity (grade 3 or 4) and intraventricular hemorrhage (grade ...

Research paper thumbnail of P34.06: Predicting adverse neonatal outcome in severe fetal compromise: a pivotal role for estimated fetal weight Z-score

Ultrasound in Obstetrics and Gynecology, 2007

weight for adverse perinatal outcome in a group of small-forgestational age (SGA) fetuses. Method... more weight for adverse perinatal outcome in a group of small-forgestational age (SGA) fetuses. Methods: Data were collected from 105 singleton and nonmalformed fetuses suspected of being SGA during the third trimester and with a confirmed birth weight below the 10 th centile. At diagnosis, estimated fetal weight was customized according to maternal and fetal characteristics and middle cerebral artery pulsatility index and umbilical artery pulsatility index were recorded, and tranformed to Z-values. Adverse perinatal outcome was defined as umbilical artery pH at delivery ≤ 7.15, 5-minutes Apgar score ≤ 7, significant neonatal morbidity (seizures, respiratory distress syndrome, necrotising enterocolitis, grade II-III intraventricular hemorrhage, hypoxic-ischemic encephalopathy), need of intubation, neonatal intensive care unit admission or neonatal mortality. Results: The prevalence of adverse perinatal outcome in our group of SGA fetuses was 50.5%. While the area under the curve (AUC) for Z-customized estimated fetal weight was 0.7 (95% CI, 0.59-0.81), for Z-umbilical artery Doppler was 0.5 (95% CI, 0.39-0.63) and for Z-middle cerebral artery was 0.55 (95% CI, 0.44-0.68). Paired analysis between parameters demonstrated that customized standards UAC was significantly larger than for both Doppler indices. Overall, the sensitivity and specificity for 10th centile cut-off of customized estimated fetal weight was 67.4% and 64%, respectively. Conclusion: In SGA fetuses, customized standards are a better predictor for adverse perinatal outcome than middle cerebral artery or umbilical artery Doppler indices.

Research paper thumbnail of OC35: Three-dimensional ultrasound hourly fetal urine production rate (HFUPR): reliability of rotational (VOCAL) technique using different steps of rotation

Ultrasound in Obstetrics and Gynecology, 2007

OC34: Table NT 5.0-5.9 mm % NT 6.0-6.9 mm % NT 7.0-7.9 mm % NT > 8.0 mm %

Research paper thumbnail of P11.16: Median levels of free beta-hCG and PAPP-A in the first trimester screening for Down syndrome in a Brazilian population from a private center in Rio de Janeiro

Ultrasound in Obstetrics and Gynecology, 2009

To assess whether there is a need to correct first-trimester biochemical markers (free beta-hCG a... more To assess whether there is a need to correct first-trimester biochemical markers (free beta-hCG and PAPP-A) in a Brazilian population from a private center in Rio de Janeiro (Perinatal Group -Laranjeiras) while screening for Down syndrome using the Fetal Medicine Foundation (FMF) algorithm. Methods: The data from 546 women undergoing first trimester combined screening for fetal Down syndrome were analyzed to derive our center population-specific medians. The observed medians were compared to those based on the original algorithm of the Fetal Medicine Foundation (FMF) in Caucasians. Results: The median maternal serum levels of free beta-hCG and PAPP-A were similar between the target population and average Caucasians. There was no need to correct the original FMF algorithm for the Brazilian population analyzed in this study. Conclusion: There is no need to adjust the biochemical markers in the Brazilian population from our center in Rio de Janeiro in a first trimester screening program.

Research paper thumbnail of OC37.03: Routine use of ultrasound guided curettage for incomplete abortion or missed abortion-five years experience

Ultrasound in Obstetrics and Gynecology, 2005

Research paper thumbnail of P10.10: First trimester screening for chromosomal anomalies II—nasal bone and ductus venosus(pilot study)

Ultrasound in Obstetrics and Gynecology, 2004

We started this research line since October 2002 with nuchal translucency. We initiated the inves... more We started this research line since October 2002 with nuchal translucency. We initiated the investigation with nasal bone and ductus venosus in a first trimester screening in September 2003. These studies examines: 1) the association between absent nasal bone (NB) at the 11-14 weeks scan and chromosomal anomalies in Brazilian pregnant women sample. 2) The association between ductus venosus abnormal wave form at the 11-14 weeks Doppler and chromosomal anomalies in Brazilian pregnant women sample Methods: Since September 2003, 35 patients have been included in this study. Ultrasound and Doppler examination of fetal profile was carried out between 11 and 14 weeks of gestation. All data was obtained with a Voluson 730 GE and Toshiba SSH 140 A. All patients referred to our department have accepted fetal karyotyping. Results: A total of 35 fetuses were included in this study. When we analyzed the NB, the sensitivity was 50%, specificity was 96.8%, positive predictive value (PPV) was 50% and negative predictive value (NPV) was 96.8%. The association was not statistically significant (P = 0.11 -Fisher). When we analyzed the ductus venosus, the sensitivity was 50%, specificity was 100%, positive predictive value (PPV) was 100% and negative predictive value (NPV) was 97.1%. The association was statistically significant (P = 0.05 -Fisher). Conclusions: This is only a first view of our research (previous note).

Research paper thumbnail of P11.09: Antenatal diagnosis of limb-body wall complex with ultrasound and magnetic resonance imaging—case report

P11.09: Antenatal diagnosis of limb-body wall complex with ultrasound and magnetic resonance imaging—case report

Ultrasound in Obstetrics and Gynecology, 2004

Research paper thumbnail of Cantrell's Pentalogy in Twins: Prenatal Diagnosis

Cantrell's Pentalogy in Twins: Prenatal Diagnosis

Twin Research and Human Genetics, 2006

The combination of an onphalocele, an anterior thoracic wall defect and an anterior diaphragmatic... more The combination of an onphalocele, an anterior thoracic wall defect and an anterior diaphragmatic defect constitutes classical Cantrell&amp;amp;amp;amp;#39;s pentalogy. We present a case of Cantrell&amp;amp;amp;amp;#39;s pentalogy diagnosed prenataly in twins with conventional and three-dimensional sonography.

Research paper thumbnail of Human Cord Blood Transplantation in a Neonatal Rat Model of Hypoxic–Ischemic Brain Damage: Functional Outcome Related to Neuroprotection in the Striatum

Human Cord Blood Transplantation in a Neonatal Rat Model of Hypoxic–Ischemic Brain Damage: Functional Outcome Related to Neuroprotection in the Striatum

Stem Cells and Development, 2010

Human umbilical cord blood mononuclear cells (HUCB) have been shown to have a therapeutic role in... more Human umbilical cord blood mononuclear cells (HUCB) have been shown to have a therapeutic role in different models of central nervous system (CNS) damage, including stroke. We evaluated the possible therapeutic potential of HUCB in P7 rats submitted to the Rice-Vannucci model of neonatal hypoxic-ischemic (HI) brain damage. Our results demonstrated that intraperitoneal transplantation of HUCB, 3 h after the HI insult, resulted in better performance in two developmental sensorimotor reflexes, in the first week after the injury. We also showed a neuroprotective effect in the striatum, and a decrease in the number of activated microglial cells in the cerebral cortex of treated animals. We suggest that HUCB transplantation might rescue striatal neurons from cell death after a neonatal HI injury resulting in better functional recovery.

Research paper thumbnail of Predicting adverse neonatal outcome in severe fetal compromise: A pivotal role for estimated fetal weight Z scores

Predicting adverse neonatal outcome in severe fetal compromise: A pivotal role for estimated fetal weight Z scores

Prenatal Diagnosis, 2007

To identify significant predictors for adverse neonatal outcome in severe by compromised fetuses.... more To identify significant predictors for adverse neonatal outcome in severe by compromised fetuses. Consecutive premature fetuses at between 25 and 32 weeks&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; with severe placental insufficiency were examined prospectively. Inclusion criteria were: singletons; normal anatomy; abnormal umbilical artery Doppler pulsatility index; abnormal cerebroplacental ratio; middle cerebral artery pulsatility index (PI) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;or=2 standard deviations. We considered as independent potential predicting variables: absent or reversed end diastolic flow in umbilical artery, abnormal ductus venosus S/A ratio, absent or reversed flow during atrial contraction in the ductus venosus, and estimated fetal weight (EFW) Z score. Outcome parameters were: neonatal mortality and severe neonatal morbidity (Periventricular-Intraventricular Hemorrhage grade 03 or 04, Retinopathy of Prematurity stage 3 or 4, Periventricular Leukomalacia or Broncopulmonary Dysplasia). Univariate analysis for all potential predicting variables was performed. EFW Z score index showed the strongest association with mortality and there was no fetal death or Retinopathy of Prematurity in the group with EFW Z-score index below lower limit. There was no case of Cystic Periventricular Leukomalatia in these analyses. The area under receiver-operator characteristic curve was significant for EFW Z-score index. Our study suggests that EFW Z score is the strongest predictor of adverse neonatal outcome in severely compromised fetuses.

Research paper thumbnail of SNAPPE-II application in newborns with very low birth weight: evaluation of adverse outcomes in severe placental dysfunction

SNAPPE-II application in newborns with very low birth weight: evaluation of adverse outcomes in severe placental dysfunction

Journal of Perinatal Medicine, 2000

The aim of this study was to evaluate the ability of the admission Score for Neonatal Acute Physi... more The aim of this study was to evaluate the ability of the admission Score for Neonatal Acute Physiology - Perinatal Extension-II (SNAPPE-II) to predict adverse outcome among premature very low birth weight (BW) infants with abnormal Doppler blood flow in the uterus secondary to severe placental insufficiency of early onset. A total of 86 neonates, weighing between 360 and 1498 g, were studied. Descriptive statistics of the population were reported. The areas under the receiver operating characteristics curves for the SNAPPE-II were calculated. The calibration of the model was assessed using the technique of Hosmer-Lemeshow. Adverse outcome was defined as mortality or the development of the following diagnoses: (1) periventricular-intraventricular hemorrhage (PIH); (2) retinopathy of prematurity stage 3 or 4; (3) periventricular leukomalacia; (4) bronchopulmonary dysplasia; (5) necrotizing enterocolitis (NEC). The SNAPPE-II area under curve was 0.86 (95% CI: 0.78-0.94) for mortality and 0.76 (95% CI: 0.65-0.86) for the prediction of adverse outcomes. Analyzing each morbidity variable, the SNAPPE-II AUC varied between 0.51 for NEC and 0.72 for PIH. SNAPPE-II shows accuracy in the prediction of adverse outcome for this highly selective group of very low BW infants compromised by severe placental insufficiency.

Research paper thumbnail of P492 Minimally invasive fetal surgery for TTTS – Brazilian perinatal center experience

International Journal of Gynecology & Obstetrics, 2009

cases were planned laparoscopic bilateral oophorectomy (BSO). Of these 4 (20%) were converted in ... more cases were planned laparoscopic bilateral oophorectomy (BSO). Of these 4 (20%) were converted in open surgery. In one (0.5%) case malignancy was confirmed on histology. 16 (14.5%) cases were scheduled for laparoscopic hysterectomy-BSO. Of these 9 (56.6%)cases were converted into open procedures. Malignancy was confirmed in 3 (18.7%) cases. One case of bowel perforation was reported. Overall 7 (6.36%) cases of malignancy were identified on histology and 24 (21%) procedures were converted into open surgery. Conclusion: 79% of adnexal masses greater than 7 cm was successfully managed by laparoscopy. 21% of cases were converted into open surgery because of suspected malignancy and/or because of limited access. One case was converted to open surgery because of small bowel perforation. Management of large adnexal masses by laparoscopic surgery is safe and feasible.

Research paper thumbnail of Pregnancy complicated by spontaneous rupture of uterus and endometrioses and ovarian endometrioma

International Journal of Gynecology & Obstetrics, 2000

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