ABSTRACT
Objetivos: determinar el desempeño predictivo de la definición de retardo de crecimiento fetal (RCF) de ultrasonografía de la Sociedad de Medicina Materno Fetal (SMMF), consenso Delphi (CD) y Medicina Fetal de Barcelona (MFB) respecto a resultados adversos perinatales en cada una, e identificar si hay asociación entre diagnóstico de RCF y resultados adversos perinatales. Materiales y métodos: se realizó un estudio de cohorte retrospectiva. Se incluyeron gestantes con embarazo único de 24 a 36 semanas con 6 días, quienes fueron atendidas en la unidad de medicina materna fetal con evaluación ecográfica de crecimiento fetal y atención de parto en una institución hospitalaria pública de referencia ubicada en Popayán, Colombia. Se excluyeron embarazos con hallazgos ecográficos de anomalías congénitas. Muestreo por conveniencia. Se midieron variables sociodemográficas y clínicas de las gestantes al ingreso, la edad gestacional, el diagnóstico de RCF y el resultado adverso perinatal compuesto. Se analizó la capacidad predictiva de tres criterios diagnósticos de restricción de crecimiento fetal para malos resultados perinatales y la asociación entre el diagnóstico de RCF y mal resultado periantal. Resultados: se incluyeron 228 gestantes, cuya edad media fue de 26,8 años, la prevalencia de RCF según los tres criterios fue de 3,95 %, 16,6 % y 21,9 % para CD, MFB y SMMF respectivamente. Ningún criterio aportó área bajo la curva aceptable para predicción de resultado neonatal adverso compuesto, el diagnóstico de RCF por CD y SMMF se asoció a resultados adversos perinatales con RR de 2,6 (IC 95 %: 1,5-4,3) y 1,57 (IC 95 %: 1,01-2,44), respectivamente. No se encontró asociación por MFB RR: 1,32 (IC 95 %: 0,8-2,1). Conclusiones: ante un resultado positivo para RCF, el método Delphi se asocia de manera más importante a los resultados perinatales adversos.Los tres métodos tienen una muy alta proporción de falsos negativos en la predicción de mal resultado perinatal. Se requieren estudios prospectivos que reduzcan los sesgos de medición y datos ausentes.
Objectives: To determine the predictive performance of fetal growth restriction by Maternal Fetal Medicine Society (MFMS) definition of ultrasound, the Delphi consensus (DC) and the Barcelona Fetal Medicine (BFM) criteria for adverse perinatal outcomes, and to identify whether there is an association between the diagnosis of fetal growth restriction (FGR) and adverse perinatal outcomes. Material and methods: A retrospective cohort study was conducted including women with singleton pregnancies between 24 and 36 weeks of gestation seen at the maternal fetal medicine unit for ultrasound assessment of fetal growth and delivery care in a public referral hospital in Popayán, Colombia. Pregnancies with ultrasound findings of congenital abnormalities were excluded. Convenience sampling was used. Sociodemographic and clinical variables were measured on admission; additional variables were gestational age, FGR diagnosis and adverse composite perinatal outcome. The predictive ability of three fetal growth restriction diagnostic criteria for poor perinatal outcomes was analyzed and asociation between FGR and adverse perinatlal outcomes. Results: Overall, 228 pregnant women with a mean age of 26.8 years were included; FGR prevalence according to the three criteria was 3.95 %, 16.6 % and 21.9 % for DC, BFM and MFMS, respectively. None of the criteria resulted in an acceptable area under the curve for the prediction of the composite adverse neonatal outcome; FGR diagnosis by DC and MFMS were associated with adverse perinatal outcomes with a RR of 2.6 (95 % CI: 1.5-4.3) and 1.57 (95 % CI: 1.01-2.44) respectively. No association was found for BFM RR: 1.32 (95 % CI: 0.8-2.1). Conclusions: Given a positive result for FGR, the Delphi method is significantly associated with adverse perinatal outcomes. The proportion of false negative results for a poor perinatal outcome is high for the three methods. Prospective studies that reduce measurement and attrition bias are required.
Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Adult , Fetal Growth Retardation , Forecasting , Negative Results , Ultrasonography , Practice Guidelines as Topic , Pregnant Women , Fetal Development , Perinatal DeathABSTRACT
OBJETIVO: Avaliar a prevalência de estenose hemodinamicamente significativa na revascularização infrainguinal realizada com a veia safena magna reversa. MÉTODOS: No período compreendido entre março de 2008 e março de 2009, foram realizadas 56 revascularizações infrainguinais com a veia safena magna reversa em 56 pacientes, dos quais 32 foram avaliados com ultrassonografia vascular no 30º dia de pós- operatório. Foi analisada a prevalência de estenoses significativas nos enxertos e sua relação com as características clínico-cirúrgicas dos pacientes. Os parâmetros avaliados foram a localização das estenoses ao longo do enxerto, fatores de risco associados e a relação existente entre a ultrassonografia vascular e o índice tornozelo-braço no diagnóstico de estenoses. RESULTADOS: Houve prevalência de 48,4 por cento de estenoses significativas nos enxertos avaliados, com 19,4 por cento de estenoses graves e 29 por cento de estenoses leve a moderada. Não foram encontradas associações significativas entre sexo, diabetes mellitus, hipertensão arterial, hipercolesterolemia, diâmetro do enxerto, localização da anastomose distal, composição do enxerto e a constatação de estenoses significativas. Observou-se fraca correlação entre os métodos no diagnóstico das estenoses em geral (K = 0,30; IC95 por cento 0,232-0,473; p = 0,018), mas razoável concordância no diagnóstico das estenoses graves (K = 0,75; IC95 por cento 0,655-0,811; p = 0,0001). CONCLUSÃO: Este estudo demonstrou elevada prevalência de estenoses no 30º dia do pós-operatório, com localização predominante na metade proximal do enxerto. O índice tornozelo-braço e a ultrassonografia vascular apresentaram concordância, sobretudo no diagnóstico das estenoses graves, mas o índice tornozelo-braço, isoladamente, mostrou-se insuficiente na vigilância dos enxertos de veia safena magna reversa.
OBJECTIVE: The aim of this study was to evaluate the prevalence of hemodynamically significant infrainguinal bypasses stenosis using reverse great saphenous vein graft. METHODS: From March of 2008 to March of 2009, 56 infrainguinal bypasses were performed with reverse great saphenous vein graft in 56 patients. On the 30th post-operative day, 32 out of 56 patients were submitted to vascular ultrasonography. The prevalence of significant graft stenosis was determined. In addition, the diagnosis of stenosis was related to the clinical and surgical characteristics of the patients. The variables analyzed at the moment of diagnosis were the localization of the graft stenosis, the risk factors associated with stenosis and the association of vascular ultrasonography findings with ankle brachial pressure index (ABI). RESULTS: The overall prevalence of significant graft stenosis was 48.4 percent. Out of the total number of observed stenosis, 19.4 percent were considered severe, and 29 percent mild or moderate. There was no significant association between the presence of significant stenosis and the following variables: gender, diabetes, hypertension, smoking, hipercholesterolemia, graft diameter, site of the distal anastomosis, and graft composition. There was a weak agreement between ABI and vascular ultrasonography in detecting stenosis in general (K = 0.30; CL95 percent 0.232 - 0.473; p = 0.018). However, there was a substantial agreement in detecting severe stenosis (K = 0.75; CL95 percent 0.655 - 0.811; p = 0.0001). CONCLUSION: There was a high prevalence of stenosis on the 30th post-operative day, mostly localized in the proximal half of the vein graft. There was no significant association of stenosis with clinical and surgical factors analyzed. ABI and vascular ultrasonography had weak agreement with the diagnosis of stenosis in general and an important agreement for the diagnosis of severe stenosis.
Subject(s)
Female , Humans , Male , Constriction, Pathologic/etiology , Graft Occlusion, Vascular/epidemiology , Saphenous Vein/transplantation , Ankle Brachial Index , Arteries , Constriction, Pathologic/epidemiology , Constriction, Pathologic , Graft Occlusion, Vascular/etiology , Graft Occlusion, Vascular , Prevalence , Risk Factors , Saphenous Vein , Ultrasonography, Doppler, DuplexABSTRACT
The purpose of this study was to verify whether small intestinal peristalsis could be observed and quantitatively assessed using pulsed-Doppler ultrasound. Pulsed-Doppler ultrasound was used to evaluate small intestinal peristalsis after a meal in ten normal dogs and ten sedated dogs. The small intestinal peristalses were measured 0, 1, 3, 6, 9, 12, and 24 hours after a 24-hour fast and after feeding. The number of small intestinal peristalsis were 0.133/min, 0.100/min, 0.033/min, 0.167/min, 0.070/min, 0.067/min, and 0.100/min in the fasted dogs, and 1.667/ min, 0.933/min, 1.133/min, 1.234/min, 1.933/min, 1.533/ min, and 0.533/min in fed dogs, respectively. In the dogs sedated with xylazine HCl, the number of small intestinal peristalsis was significantly reduced (p<0.01). However, in the dogs treated with ketamine HCl and acepromazine, the number of small intestinal peristalsis remained unchanged. Therefore, it can be concluded that pulsed-Doppler ultrasound allows graphic visualization of the intestinal movements, which can be subjected to qualitative and quantitative analysis, and may be suitable for a non-invasive study of small intestinal motility.
Subject(s)
Animals , Dogs , Acepromazine/pharmacology , Dopamine Antagonists/pharmacology , Excitatory Amino Acid Antagonists/pharmacology , Gastrointestinal Motility/drug effects , Intestine, Small/drug effects , Ketamine/pharmacology , Peristalsis/drug effects , Ultrasonography, Doppler, Pulsed/methodsABSTRACT
OBJECTIVE: The aim was to assess the value of resistance index(RI) and pulsatility index(PI) to differentiate between benign and malignant ovarian tumors by color and pulsed Doppler ultrasound. METHODS: 129 ovarian tumors identified with ultrasound were referred for color and pulsed Doppler ultrasound evaluation to calculate the lowest RI and PI, and the corresponding histopathologic diagnosis was recorded. RESULTS: The intratumor artery waveforms were obtained in 37.1%(36 of 97) of benign tumors and in 91.0%(29 of 32) of the malignant group. RI and PI were lower in malignant tumors than in benign tumors(p<0.01). Also, there was a significant incremental decrease in both indices value from the benign tumor toward borderline malignancy(p<0.05) and to invasive ovarian cancer(p<0.01). But, there was no significant difference in both indices value according to the FIGO stage of ovarian malignancy. For RI cut-off value of 0.6, sensitivity and specificity were 89.7% and 91.7%; for PI cut-off value of 1.1, 86.2% and 91.7%. Therefore, the most accurate cut-off values of RI and PI were 0.6 and 1.1, respectively. CONCLUSION: RI and PI calculated by color and pulsed Doppler ultrasound can help in the diagnosis and selection of treatment plan of ovarian tumors, especially when the morphological finding of ovarian tumor is equivocal. And during the follow up of benign tumors, both indicies can give us the clue of malignant potential of benign tumors.