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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

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

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

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

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

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

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

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

Research paper thumbnail of 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

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's pentalogy. We present a case of Cantrell'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

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

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' 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) <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

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 P42. 10: Videohysteroscopy resection of myoma: the importance of ultrasound in the per‐operatory

… in Obstetrics & …, 2007

17th World Congress on Ultrasound in Obstetrics and Gynecology ... P42.10 Videohysteroscopy resec... more 17th World Congress on Ultrasound in Obstetrics and Gynecology ... P42.10 Videohysteroscopy resection of myoma: the importance of ultrasound in the per-operatory ER Valle1, R. Araujo1, S. Conde1, RA Moreira de Sa2, LM Lopes2 1CPDT MIGS – Laranjeiras Clinica ...

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

International Journal of Gynecology & Obstetrics, 2009

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

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

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

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

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

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

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

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

Research paper thumbnail of 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

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's pentalogy. We present a case of Cantrell'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

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

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' 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) <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

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 P42. 10: Videohysteroscopy resection of myoma: the importance of ultrasound in the per‐operatory

… in Obstetrics & …, 2007

17th World Congress on Ultrasound in Obstetrics and Gynecology ... P42.10 Videohysteroscopy resec... more 17th World Congress on Ultrasound in Obstetrics and Gynecology ... P42.10 Videohysteroscopy resection of myoma: the importance of ultrasound in the per-operatory ER Valle1, R. Araujo1, S. Conde1, RA Moreira de Sa2, LM Lopes2 1CPDT MIGS – Laranjeiras Clinica ...

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

International Journal of Gynecology & Obstetrics, 2009