Adverse perinatal outcomes in fetuses with severe late-onset fetal growth restriction.

OBJECTIVE: To evaluate perinatal outcomes in fetuses with severe late-onset fetal growth restriction. METHODS: This was a retrospective and observational cohort study in which pregnant women diagnosed with late-onset fetal growth restriction assisted at perinatal maternity birth from 2010 to 2017 were included. The outcomes were intensive care unit (ICU) admission and perinatal complications, such as neonatal death, intraventricular hemorrhage, periventricular leukomalacia, hypoxic-ischemic encephalopathy, necrotizing enterocolitis, bronchopulmonary dysplasia, and sepsis. RESULTS: We selected 277 pregnant women, of whom 124 newborns (44.76%) went to the ICU. The chance of a newborn needing ICU decreases by 62, 7, and 9% according to an increase of one gestational week, 1 cm of the abdominal circumference, or 1 cm of the amniotic fluid index, respectively. Oligohydramnios increases the risk of going to the ICU by 2.13 times. The increase in the umbilical artery pulsatility index (PI) Doppler increases the chance of ICU admission by 7.9 times. The normal middle cerebral artery PI Doppler and the normal cerebroplacental ratio reduce the risk of ICU admission. CONCLUSION: The estimated fetal weight, abdominal circumference, and amniotic fluid index diagnosed severe late-onset fetal growth restriction. With the decrease in middle cerebral artery PI Doppler, there is a greater probability of admission to the ICU, with the most common complications being intraventricular hemorrhage and necrotizing enterocolitis.

Ultrasonographic Evaluation of Uterine Involution in the Early Puerperium.

Purpose Our aim was to describe the changes observed by ultrasonography in uterine dimensions during the early puerperium among women who experienced an uncomplicated puerperium. Additionally, the influence of parity, mode of delivery, breastfeeding and birth weight on uterine involution was evaluated. Methods Ninety-one patients underwent an ultrasound examination on days 1 (D1), 2 (D2) and 7 (D7) of the postpartum period. The longitudinal, anteroposterior and transverse uterine diameters were measured, and the uterine volume was calculated by the formula: longitudinal diameter (LD) X anteroposterior diameter (APD) X transverse diameter (TD) X 0.45. The thickness and length of the uterine cavity were also measured. Results The uterine volume and the LD, APD and TD decreased by 44.8%, 20.9%, 11.8% and 20.0% respectively. The uterine cavity thickness was reduced by 23%, and the length of the cavity was reduced by 27.2% on D7. Uterine involution was correlated inversely with parity when the day of the postpartum period was not taken into account (p = 0.01). However, when the uterine involution was correlated to parity separately, with D1, D2 or D3, no correlations were found. A significant difference occurred at D2, when it was found that the uterus had a smaller volume following cesarean section compared with vaginal delivery (p = 0.04). The high birth weight and breastfeeding were significantly related to uterine involution (p ≤ 0.01 and p = 0.04). Conclusion The sonographic evaluation of the uterus in the early puerperium should consider birth weight, breastfeeding and parity, as well as the delivery route on D2, to identify abnormalities related to uterine involution.

Ultrasonographic Evaluation of Uterine Involution in the Early Puerperium / Avaliação ultrassonográfica da involução uterina no puerpério precoce

Abstract Purpose Our aim was to describe the changes observed by ultrasonography in uterine dimensions during the early puerperium among women who experienced an uncomplicated puerperium. Additionally, the influence of parity, mode of delivery, breastfeeding and birth weight on uterine involution was evaluated. Methods Ninety-one patients underwent an ultrasound examination on days 1 (D1), 2 (D2) and 7 (D7) of the postpartum period. The longitudinal, anteroposterior and transverse uterine diameters were measured, and the uterine volume was calculated by the formula: longitudinal diameter (LD) X anteroposterior diameter (APD) X transverse diameter (TD) X 0.45. The thickness and length of the uterine cavity were also measured. Results The uterine volume and the LD, APD and TD decreased by 44.8%, 20.9%, 11.8% and 20.0% respectively. The uterine cavity thickness was reduced by 23%, and the length of the cavity was reduced by 27.2% on D7. Uterine involution was correlated inversely with parity when the day of the postpartum period was not taken into account (p= 0.01). However, when the uterine involution was correlated to parity separately, with D1, D2 or D3, no correlations were found. A significant difference occurred at D2, when it was found that the uterus had a smaller volume following cesarean section compared with vaginal delivery (p= 0.04). The high birth weight and breastfeeding were significantly related to uterine involution (p ≤ 0.01 and p= 0.04). Conclusion The sonographic evaluation of the uterus in the early puerperium should consider birth weight, breastfeeding and parity, as well as the delivery route on D2, to identify abnormalities related to uterine involution.

Resumo Objetivo Descrever as alterações observadas pela ultrassonografia nas dimensões uterinas durante o puerpério precoce em mulheres com evolução puerperal não complicada, considerando a influência da paridade, tipo de parto, amamentação e peso ao nascer sobre a involução uterina. Métodos Noventa e uma pacientes foram submetidas a exame ultrassonográfico nos dias 1 (D1), 2 (D2) e 7 (D7) do puerpério. Os diâmetros uterinos longitudinal, anteroposterior e transversal foram medidos, e o volume uterino foi calculado pela fórmula: diâmetro longitudinal (DL) X diâmetro anteroposterior (DAP) X diâmetro transverso (DT) X 0,45. A espessura e comprimento da cavidade uterina também foram medidos. Resultados O volume uterino e o DL, DAP e DT diminuíram 44,8%, 20,9%, 11.8% e 20,0% respectivamente no D7. A espessura da cavidade uterina reduziu em 23%, e o comprimento da cavidade foi reduzido em 27,2% no D7. A involução uterina se correlacionou inversamente com a paridade quando o dia do puerpério não foi levado em conta (p= 0,01). Uma diferença significativa foi encontrada em D2, quando se verificou que o útero tinha um volume menor no grupo submetido a cesariana em comparação com o parto vaginal (p= 0,04). O peso ao nascer elevado e amamentação apresentaram relação estatisticamente significativa com a involução uterina (p ≤ 0,01 e p= 0,04). Conclusão A avaliação ultrassonográfica do útero no puerpério precoce deve considerar o peso ao nascer, a amamentação e a paridade, assim como a via de parto no D2, para a identificação de anormalidades relacionadas à involução uterina.

O papel do DOPPLER da artéria cerebral média nos fetos com Crescimento Restrito Tardio / The role of middle cerebral artery Doppler in late onset fetal growth restriction

Ocrescimento intrauterino restrito (CIUR) é uma inibição patológica do crescimento fetal, acometendo 5-10% das gestações e está associado ao aumento da morbimortalidade perinatal. Este estudo tem como objetivo realizar uma revisão não sistemática sobre os eventos adversos perinatais dos fetos com CIUR tardio e alteração seletiva do Doppler da artéria cerebral média (ACM). A pesquisa bibliográfica foi realizada através da base de dados do PubMed, obtendo um total de 25 referências, que serviram de base para o presente artigo. Conclui-se que a artéria cerebral média possui valor particular na identificação e predição de resultados adversos nestes fetos, os quais possuem risco aumentado de desenvolvimento neurológico anormal ao nascimento e aos dois anos de idade.(AU)

Intrauterine growth restriction (IUGR) is a pathological inhibition of the fetal growth that affects 5-10% of pregnancies and it is associated with an increase of perinatal morbidity and mortality. This study aims to conduct a non-systematic review of perinatal adverse events of fetuses with late-onset IUGR and selective changes in middle cerebral artery (MCA) Doppler. A literature search was performed using the PubMed database. A total of 25 references, which were the basis for this article was obtained. It concludes the middle cerebral artery has a particular value in the identification and prediction of adverse outcomes in these fetuses, which has an increased risk of abnormal neurological performance at birth and at two years of age.(AU)

Doppler hepático na pré-eclâmpsia e na síndrome HELLP / Doppler ultrasonography of the liver in pre-eclampsia and HELLP syndrome

O fígado está entre os múltiplos órgãos que podem ser afetados na pré-eclâmpsia, e a função hepática pode ser gravemente prejudicada na síndrome HELLP. A ultrassonografia com Doppler constitui um método não invasivo que pode ser usado para o estudo da circulação hepática durante a gravidez. Com o objetivo de apresentar as evidências científicas disponíveis sobre as alterações do fluxo hepático na gravidez, foi realizada pesquisa da literatura mundial por meio das bases de dados MEDLINE/PubMed e LILACS. Em estudos de Dopplerfluxometria e Dopplervelocimetria, isoladamente ou associados ao eletrocardiograma e cardiografia por impedância, foram observadas alterações na circulação hepática durante a gravidez complicada por pré?eclâmpsia e síndrome HELLP. Entre os desafios para a pesquisa nesse campo destacamos a necessidade de aperfeiçoamento da técnica de exame, o estabelecimento de curvas de normalidade para as gestantes brasileiras, de indicadores de agravamento da pré?eclâmpsia e a aplicação potencial do método para o estudo da hipertensão crônica na gravidez.(AU)

The liver is among multiple organs that may be affected in pre-eclampsia, and liver function can be impaired in HELLP syndrome. Doppler ultrasonography of the liver provides a noninvasive method to study liver circulation during pregnancy. This paper reviews scientific evidence available in MEDLINE/ Pubmed and LILACS databases. Doppler studies on hepatic blood flow, flow velocities and vascular resistance indices, isolated or combined with Doppler?electrocardiography and impedance cardiography, observed changes in pregnancies complicated by pre?eclampsia and HELLP syndrome. Challenges to this research topic include improvements in Doppler examination techniques, establishment of normal values for Brazilian pregnant women, predictors for severe pre?eclampsia and potential use of hepatic Doppler use in chronic hypertension as well.(AU)

Doppler sonography of maternal cerebral arteries in pregnancy: side-to-side differences.

BACKGROUND/AIMS: To study side-to-side differences in blood flow of the common and internal carotid arteries, and the vertebral arteries (VAs) in women with uncomplicated pregnancies as a first step to build a reference values chart. METHODS: A total of 155 healthy pregnant women between 20 and 40 weeks' gestation were included. Doppler sonography of the common and internal carotid arteries and VAs was performed on both sides. Parameters measured included diameter, peak systolic velocity, systolic-diastolic ratio, end-diastolic velocity, pulsatility index and resistance index. Statistical analysis was performed using the S-Plus 8.0 program. Normality was determined using the Kolmogorov-Smirnov test. Differences between sides were tested using Student's paired t test, association using linear correlation, and agreement using the Bland-Altman method. RESULTS: Mean values were equal between sides for all parameters with the exception of the end-diastolic velocity in the VAs. The association and agreement between the measurements taken from the right and left sides were poor. Bland-Altman plots also indicated low agreement between sides. All parameters showed significant right-to-left differences. CONCLUSION: Despite the equality between means, right and left flows through the vessels studied differed as there was poor association and agreement.

Aspectos atuais em cirurgia fetal / Current aspects of fetal surgery

A cirurgia fetal é aceita atualmente como modalidade de tratamento para grande variedade de condições congênitas letais ou não letais, representando uma nova fronteira no desenvolvimento da Medicina nos últimos 25 anos, impulsionada pela impossibilidade de correção e pelos resultados frustantes da terapia após o nascimento de algumas doenças. As intervenções fetais representadas por grande número de estratégias terapêuticas, que variam desde técnicas percutâneas até cirurgias abertas, requerem esforços de cooperação de múltiplas especialidades médicas para assegurar o bem-estar fetal e materno. Os autores fazem uma breve revisão sobre as técnicas cirúrgicas e aspectos éticos da cirurgia fetal.