Uterine tamponade in postpartum hemorrhage with handmade balloons: Comparison of manufacturing, infusion, and total times.

OBJECTIVE: To compare the manufacturing, infusion, and total times of handmade balloons for uterine tamponade using the El Hennawy and Alves techniques, given the failure of initial measures and uterotonic therapy to control postpartum hemorrhage. METHODS: An open clinical trial (clinical article) was conducted among 30 physicians, residents, and assistants in an Obstetrics Department. Each participant manufactured and infused one of two different balloons compared in the study, in a randomly predefined sequence. The manufacturing and infusion times were timed by the researchers and their medians were compared using the t test or Mann-Whitney U test. RESULTS: The manufacturing time of the El Hennawy balloon was 72 s lower in relation to the Alves balloon (P < 0.010). Regarding the infusion time, the Alves balloon was filled faster than the El Hennawy balloon (P < 0.010). The total time (manufacturing and infusion) of Alves balloon was also lower than the El Hennawy device (P < 0.010). CONCLUSIONS: Although the El Hennawy balloon was manufactured more quickly, the total time of manufacturing and infusing the Alves balloon was much faster, which makes it the most suitable device to be used in critical situations of postpartum hemorrhage.

Kidney impairment in fetal growth restriction: three-dimensional evaluation of volume and vascularization.

OBJECTIVES: Renal development is impaired in fetal growth restriction (FGR). Renal size can be considered a surrogate of renal function in childhood, and could be impaired in that condition. Our aim was to evaluate the ratio of total renal volume, measured by three-dimensional ultrasound, to estimated fetal weight (TRV/EFW) among fetuses with and without growth restriction. Furthermore, we correlated TRV/EFW with fetal Doppler velocimetry and renal vascularization indexes and evaluated the association of renal volume and vascular parameters with adverse neonatal events in growth-restricted fetuses. METHODS: In a retrospective cohort, TRV and renal vascularization of growth-restricted and normal fetuses were evaluated by three-dimensional ultrasonography and VOCAL technique. Independent samples t-tests and Mann-Whitney test were used for comparisons between groups. Logistic regression model was applied to evaluate the association between renal characteristics and adverse neonatal events. RESULTS: Seventy-one growth-restricted fetuses were compared to 194 controls. The TRV/EFW was lower in the growth-restricted group (P < .001). In our sample, this ratio did not correlate with Doppler velocimetry parameters, renal vascular indexes or any adverse neonatal events. CONCLUSION: The TRV/EFW ratio is decreased in FGR. Further studies are needed to investigate the association of this ratio with long-term renal outcomes.

An unfavorable intrauterine environment may determine renal functional capacity in adulthood: a meta-analysis.

Since studies show that an unfavorable environment during intrauterine development predisposes individuals to several diseases in adulthood, our objective is to assess the relation between fetal growth restriction and chronic renal disease in adults. We searched four different electronic databases through November 2017: CENTRAL, EMBASE, LILACS and MEDLINE. We selected studies with longitudinal or transversal designs associating kidney function in adulthood with low birth weight. Two reviewers evaluated the inclusion criteria and the risk of bias and extracted data from the included papers. Thirteen studies were selected for the systematic review and meta-analysis. We observed increased risks of presenting end-stage renal disease (risk ratio 1.31, 95% confidence interval: 1.17, 1.47), a lower glomerular filtration rate (ml/min) (mean difference 7.14; 95% confidence interval: -12.12, -2.16), microalbuminuria (risk ratio 1.40; 95% confidence interval: 1.28, 1.52) and a small increase in the albumin/creatinine ratio (mean difference 0.46; 95% confidence interval: 0.03, 0.90) in the low birth weight patients, compared with control group. These findings suggest that low birth weight is associated with renal dysfunction in adults.

An unfavorable intrauterine environment may determine renal functional capacity in adulthood: a meta-analysis

Since studies show that an unfavorable environment during intrauterine development predisposes individuals to several diseases in adulthood, our objective is to assess the relation between fetal growth restriction and chronic renal disease in adults. We searched four different electronic databases through November 2017: CENTRAL, EMBASE, LILACS and MEDLINE. We selected studies with longitudinal or transversal designs associating kidney function in adulthood with low birth weight. Two reviewers evaluated the inclusion criteria and the risk of bias and extracted data from the included papers. Thirteen studies were selected for the systematic review and meta-analysis. We observed increased risks of presenting end-stage renal disease (risk ratio 1.31, 95% confidence interval: 1.17, 1.47), a lower glomerular filtration rate (ml/min) (mean difference 7.14; 95% confidence interval: -12.12, -2.16), microalbuminuria (risk ratio 1.40; 95% confidence interval: 1.28, 1.52) and a small increase in the albumin/creatinine ratio (mean difference 0.46; 95% confidence interval: 0.03, 0.90) in the low birth weight patients, compared with control group. These findings suggest that low birth weight is associated with renal dysfunction in adults.

Renal vascularization indexes and fetal hemodynamics in fetuses with growth restriction.

OBJECTIVE: To identify the correlation between the renal vascularization index (VI), the flow index (FI) and the vascularization and flow index (VFI) and placental and fetal hemodynamics in fetuses with growth restriction. METHOD: Bidimensional ultrasound and three-dimensional power Doppler with the VOCAL technique were used to determine the renal vascular indexes and fetal and placental hemodynamics in fetuses below the 10th percentile for fetal weight. Partial correlation analysis (controlled for renal depth and gestational age) was performed. The fetuses were divided into four groups according to their hemodynamic picture, and renal indexes were compared between the groups. RESULTS: Eighty-one fetuses were evaluated. VI, FI and VFI showed negative correlation with the ductus venosus pulsatility index. VI and VFI showed positive correlations with the amniotic fluid index. The group of fetuses with the worst hemodynamic picture (abnormal umbilical artery, middle cerebral artery and ductus venosus pulsatility indexes) showed significantly lower VI and VFI than the group with no changes in these pulsatility indexes. CONCLUSIONS: Renal vascularization indexes were inversely correlated with ductus venosus pulsatility indexes and were diminished in fetuses showing hemodynamic compromise. These changes might be related to postnatal renal impairment. © 2017 John Wiley & Sons, Ltd.

Miocardiopatia periparto / Peripartum cardiomyopathy

A miocardiopatia periparto (MCPP) é doença rara, reconhecida como entidade distinta das cardiomiopatias preexistentes, de ocorrência em mulheres previamente saudáveis, durante o período periparto. É pouco conhecida em relação a sua etiologia, risco e prognóstico. As manifestações clínicas mais comuns são as da insuficiência cardíaca sistólica. Sua terapia farmacológica convencional inclui diuréticos, digoxina, inibidores da enzima conversora de angiotensina, bloqueadores dos receptores de angiotensina e bloqueadores beta-adrenérgicos. Os pacientes refratários à terapia farmacológica convencional requerem o suporte circulatório mecânico e o transplante cardíaco. Não existe consenso sobre os riscos de futuras gravidezes em pacientes com MCPP prévia.

Peripartum cardiomyopathy (PPCM) is a rare disease, recognized as a distinct entity from preexisting cardiomyopathy. It occurs in previously healthy woman, during the peripartum period. PPCM is still a little known disease concerning its etiology, risk and prognosis. The most common clinical manifestations are those of systolic heart dysfunction. The objective of the study is to review the scientific literature about the several aspects of PPCM. A total of 19 publications were evaluated. The conventional therapy for congestive heart failure includes diuretics, digoxin, angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB) and beta-adrenergic blockers. For those patients who are resistant to all conventional pharmacological therapy, the viable options are cardiac transplant and mechanical circulation support. There is no consensus about the recommendations on risk of future pregnancies in these patients. Results demonstrate the need for more studies to the understanding of this disease etiology, epidemiology and prognosis.

Miocardiopatia periparto: aspectos relevantes / Peripartum cardiomyopathy: relevant aspects

A miocardiopatia periparto constitui entidade clínica rara, caracterizada por dilatação cardíaca e manifestações de insuficiência cardíaca grave, capaz de evoluir de forma fatal. Ocorre nos meses finais da gestação ou precocemente no puerpério. Sua etiologia e epidemiologia ainda são pouco conhecidas. Há grande discrepância nos prognósticos observados em relatos de caso, variando desde recuperação completa da função ventricular até fatalidade. Neste artigo é relatada a apresentação da doença de forma típica. O objetivo é enfatizar sua importância para que seja instituída precocemente sua terapêutica, evitando assim sua progressão para formas graves.

Peripartum cardiomyopathy (PPCM) is a rare clinical condition characterized by cardiac dilation and signs of severe heart failure and can be fatal. Its main characteristic is to affect women in the final months of pregnancy or early puerperium. Although the high morbidity and mortality, its etiology and epidemiology are poorly known. However, the outcome reports differ widely from complete recovery to death. The article reports a case to illustrate a typical manifestation of the disease. Our objective is to emphasize the importance of the theme not only to cardiologists but also to obstetricians, as the early therapy is the most important way to prevent the progression to severe conditions. Therefore the diagnosis of PPCM requires a lot of care and attention, and preventive counseling after PPCM is important due the increased risk for recurrence in a subsequent pregnancy.