Aortic isthmus blood flow in fetuses of diabetic mothers.

OBJECTIVE: To test the hypothesis that the aortic isthmus flow index (IFI) is lower in fetuses of diabetic mothers than in fetuses of nondiabetic mothers. STUDY DESIGN: We performed a cross-sectional observational study to assess the IFI in fetuses, with (n = 13) and without (n = 37) myocardial hypertrophy, of mothers with diabetes mellitus and in fetuses of nondiabetic mothers (n = 23). Analysis of variance and Tukey test were used to assess differences among the groups. RESULTS: There were no differences in maternal or gestational age among the groups. In fetuses of diabetic mothers, the mean IFI in fetuses with myocardial hypertrophy was 1.19 ± 0.06, and in fetuses without it was 1.18 ± 0.09. The mean IFI in fetuses of nondiabetic mothers was 1.32 ± 0.07 (P < 0.001). CONCLUSIONS: The IFI in fetuses of diabetic mothers is lower than in fetuses of nondiabetic mothers, possibly as a result of a decreased left ventricular compliance.

Corrigendum to "Behaviour of the Foramen Ovale Flow in Fetuses with Intrauterine Growth Restriction".

[This corrects the article DOI: 10.1155/2018/1496903.].

Behaviour of the Foramen Ovale Flow in Fetuses with Intrauterine Growth Restriction.

Background: Foramen ovale (FO) flow may be altered in IUGR. This study was designed to test this hypothesis. Methods: Forty pregnant women (24-38 weeks) were divided into 3 groups: group I (IUGR), group II (adequate growth and maternal hypertension), and group III (normal controls). Impedance across the FO was assessed by the FO pulsatility index (FOPI): (systolic velocity - presystolic velocity)/mean velocity. Statistical analysis utilized ANOVA, Tukey test, and ROC curves. Results: Mean FOPI in IUGR fetuses (n = 15) was 3.70 ± 0.99 (3.15-4.26); in the group II (n = 12), it was 2.84 ± 0.69 (2.40-3.28), and in the group III (n = 13), it was 2.77 ± 0.44 (2.50-3.04) (p=0.004). FOPI and UtA RI were correlated (r = 0.375, p=0.017), as well as FOPI and UA RI (r = 0.356, p=0.024) and, inversely, FOPI and MCA RI (r = -0.359, p=0.023). Conclusions: The FO flow pulsatility index is increased in fetuses with IUGR, probably as a result of impaired left ventricular diastolic function.

Myocardial velocities, dynamics of the septum primum, and placental dysfunction in fetuses with growth restriction.

INTRODUCTION: Diastolic dysfunction may occur in fetuses with intrauterine growth restriction (IUGR) and may be assessed by myocardial tissue Doppler (MTD). We previously have shown that excursion index of the septum primum (EISP) is reduced in IUGR fetuses over 30 weeks because of a higher left atrial pressure. PATIENTS, SETTING, AND DESIGN: The sample was made up of 14 fetuses with IUGR. MTD examination was carried out with the sample volume placed at the basal lateral wall of the left ventricle (LV), interventricular septum (IVS), and free wall of the right ventricle (RV) to determine E'/A' ratios. EISP was calculated as the ratio between the maximal excursion of the septum primum into the left atrium during diastole and the maximal diastolic diameter of the left atrium. Mitral and tricuspid flows were assessed by the conventional Doppler method. OUTCOME MEASURES: Pearson's correlation test was used to analyze the correlations between the parameters. RESULTS: A positive correlation was observed between UARI and E'/A' ratios for RV (r = 0.63, P = .02), IVS (r = 0.59, P = .03), and LV (r = 0.41, P = .15). There was a negative correlation between EISP and IVS E'/A' ratios (r = -0.58, P = .03), and a positive correlation for LV (r = 0.49, P = .08). At the RV position, a weak negative correlation was observed (r = -0.32, P = .26). CONCLUSIONS: A higher left atrial pressure in fetuses with IUGR, indicated by the lower mobility of the septum primum, is accompanied by higher ratios between early and late diastolic myocardial velocities. Placental dysfunction was correlated to septal E'/A' ratios. Fetal MTD can be a useful method to assess severity of placental dysfunction and fetal distress.

Association between ovarian volume and serum insulin levels in ovulatory patients with idiopathic hirsutism.

We assessed the influence of insulin on ovarian volume in 45 women with regular, ovulatory menstrual cycles, normal androgen levels, and isolated hirsutism (idiopathic hirsutism). Insulin levels, insulin-to-glucose ratio, and homeostasis model assessment (HOMA) were significantly higher in patients with ovarian volume >9 cm3 than in women with smaller ovaries (P<.05), and insulin levels presented a significant positive correlation with ovarian volume (r = 0.37, P=.02), which was independent of body mass index (BMI) or the luteinizing hormone/follicle-stimulating hormone (LH/FSH) ratio.

Comportamento do fluxo pelo forame oval em fetos de mães diabéticas com hipertrofia miocárdica / Bahavior of the foramen ovale flow in fetuses of diabetic mothers and myocardial hypertrophy

Introdução: O forame oval (FO) tem extrema importância na circulação fetal, pois conduz o sangue oxigenado proveniente da placenta diretamente ao átrio esquerdo. Frequentemente fetos de mães diabéticas(FMD) apresentam hipertrofia miocárdica(HM), com alterações na função diastólica ventricular esquerda, podendo acarretar modificações do fluxo pelo FO, com reflexo no índice de pulsatilidade. Objetivo: Testar a hipótese de que o fluxo pelo FO apresenta índice de pulsatilidade maior em FMD com HM do que em fetos sem HM de mães com ou sem diabetes. Métodos: Trata-se de um estudo transversal controlado comparando FMD com HM com FMD sem hipertrofia e fetos controles normais. Pacientes: 16 FMD com HM(grupo I), 36 FMD sem HM(grupo II) e 39 fetos controles normais(grupo III), A ecocardiografia fetal com Doppler foi realizada para obter o índice de pulsatilidade do forame oval(IPFO), através da razão velocidade sistólica-velocidade pré-sistólica/velocidade média. Foram utilizados ANOVA e teste das diferenças mínimas significativas, com alfa crítico de 0,05. Resultados: O IPFO médio foi de 4,07 mais ou menos 1,33 no grupo I, 2,28 mais ou menos 0,58 no grupo II e 2,78 mais ou menos 0,55 no grupo III. Houve diferença estatisticamente significante entre os grupos (p menor 0,001); os valores de IPFO do grupo I foram significativamente maiores dos que o do grupo II e III (p menor 0,001). Os valores do IPFO do grupo II não foram significativamente diferentes em relação ao grupo III (p igual 0,604). Conclusão: Fetos de mães diabéticas com hipertrofia miocárdica têm o índice de pulsatilidade do fluxo do forame oval maior do que os fetos sem hipertrofia miocárdica e fetos controles normais. Sugere-se que sua diferença ocorra por uma complacência diminuída do ventriculo esquerdo secundária à hipertrofia do septo interventricular.

Partograma: uma análise retrospectiva / Partogram: a retrospective analysis

Os autores fazem uma análise retrospectiva do momento do partograma no acompanhamento do trabalho de parto de 500 pacientes, procurando evidenciar se a conduta médica esteve alicerçada no mesmo