Accuracy of the mid-trimester ultrasound scan in the detection of fetal congenital anomalies in a reference center in Northeastern Brazil.

OBJECTIVE: To assess the performance of a basic mid-trimester fetal ultrasound scan protocol for the diagnosis of congenital anomalies by calculating its accuracy, sensitivity, and specificity. METHODS: This longitudinal cohort study involved singleton pregnant women recruited at the mid-trimester fetal ultrasound scan through the postnatal evaluation of congenital anomalies. Pregnant women who underwent a routine mid-trimester ultrasound scan for fetal abnormalities at 20-24 weeks of gestation were enrolled in this study. After childbirth, we searched their medical records on gestational outcomes and neonatal examination records, as well as complementary medical examinations, to assess the ultrasound performance in diagnosing congenital malformations. RESULTS: We included 967 pregnant women in the study population, and prenatal ultrasound scans detected congenital abnormalities in 67 fetuses (6.9%). Among newborns, 54 (5.6%) were postnatally diagnosed with malformations. The overall sensitivity and specificity of the mid-trimester ultrasound scan for congenital malformation detection were 61.1% and 96.3%, respectively, with an accuracy of 94.3% (p < .05). CONCLUSION: The mid-trimester ultrasound scan had good accuracy in the detection of congenital malformations, although the overall sensitivity does not support it as the only screening test for anomalies throughout pregnancy.

Acute renal failure after coronary artery bypass surgery with extracorporeal circulation -- incidence, risk factors, and mortality.

OBJECTIVE: To identify the incidence, risk factors, and mortality of acute renal failure (ARF) in patients undergoing myocardial coronary artery bypass surgery with extracorporeal circulation. METHODS: All patients undergoing myocardial coronary artery bypass surgery were prospectively studied, and their clinical and laboratory variables were assessed using uni- and multivariate analysis (logistic regression). RESULTS: Acute renal failure occurred in 16.1% of the 223 patients studied; 4.9% of patients required dialysis. Risk factors associated with ARF in the univariate analysis were age > 63 years, OR 3.6 (95% CI=1.6 to 8.3); preoperative serum creatinine > 1.2 mg/dL, OR 5.9 (95% CI=2.4 to 14.6); duration of extracorporeal circulation > 90 min, OR 2.1 (95% CI=1.0 to 4.4); use of intraaortic balloon, OR 2.6 (95% CI=1.2 to 5.5); need for inotropic drugs, OR 4.4 (95% CI=1.9 to 10.2). In the multivariate analysis, independent factors associated with ARF were: age > 63 years, OR 3.0 (95% CI=1.3 to 7.2); preoperative serum creatinine > 1.2 mg/dL, OR 4.3 (95% CI=1.6 to 11.4); need for inotropic drugs, OR 3.2 (95% CI=1.3 to 8.0). Mortality in the patients with ARF was 25.0% compared with 1.1% in those without ARF and 63.6% in those who required dialysis. CONCLUSION: Acute renal failure after myocardial coronary artery bypass surgery is a frequent complication associated with a high mortality rate. The independent risk factors are age, previous renal failure, and the need for inotropic drugs.

Insuficiência renal aguda após cirurgia de revascularização miocárdica com circulação extracorpórea: incidência, fatores de risco e mortalidade / Acute renal failure after coronary artery bypass surgery with extracorporeal circulation: incidence, risk factors, and mortality

OBJETIVO: Identificar a incidência, fatores de risco e mortalidade de insuficiência renal aguda (IRA), em pacientes submetidos à cirurgia para revascularização miocárdica com circulação extracorpórea. MÉTODOS: Estudados prospectivamente todos os pacientes submetidos a cirurgia de revascularização miocárdica e as variáveis clínicas e laboratoriais analisadas através de métodos uni e multivariado (regressão logística). RESULTADOS: Insuficiência renal aguda ocorreu em 16,1 por cento dos 223 pacientes estudados, diálise foi necessária em 4,9 por cento dos pacientes. Os fatores de risco associados à IRA na análise univariada foram: idade > 63 anos OR 3,6 (95 por cento IC=1,6 a 8,3), creatinina sérica pré-operatória > 1,2 mg/dl OR 5,9 (95 por cento IC=2,4 a 14,6), duração da circulação extracorpórea > 90 min OR 2,1 (95 por cento IC=1,0 a 4,4), uso de balão intra-aórtico OR 2,6 (95 por cento IC=1,2 a 5,5); necessidade de drogas inotrópicas OR 4,4 (95 por cento IC=1,9 a 10,2) e, na análise multivariada, foram fatores independentes associados à IRA idade > 63 anos OR 3,0 (95 por cento IC=1,3 a 7,2), creatinina sérica pré-operatória > 1,2 mg/dl OR 4,3 (95 por cento IC=1,6 a 11,4), necessidade de drogas inotrópicas OR 3,2 (95 por cento IC=1,3 a 8,0). A mortalidade nos pacientes com IRA foi de 25,0 por cento em comparação com 1,1 por cento entre os sem IRA e 63,6 por cento entre os que necessitaram de diálise. CONCLUSAO: Insuficiência renal aguda em cirurgia de revascularização miocárdica é uma complicação freqüente e está associada à alta mortalidade. Sendo fatores de risco independentes: idade, insuficiência renal prévia e necessidade de drogas inotrópicas.