Association between first-trimester uterine artery Doppler and crown-rump length with growth discordance: does it make a difference.

OBJECTIVES: The purpose of this study was to investigate the association between first-trimester uterine artery pulsatility index (UtA-PI) and crown-rump length discordance (CRLD) with growth discordance (GD) in twins and analyze the influence of chorionicity in these parameters. METHODS: This retrospective analysis integrated data from the twin pregnancy database of Centro Hospitalar São João (2019-2023), including 184 fetuses, with 19 monochorionic and 73 dichorionic gestations. To determine the association between UtA-PI and CRLD with GD, correlation analyses were computed and linear regression models were carried out. Separate analyses were conducted for each type of placentation. Logistic regression analysis was carried out to determine the association of mean UtA-PI and CRLD with severe GD, defined as discordance ≥25 %. RESULTS: GD≥25 % was detected in 9.80 % of pregnancies. A statistically significant difference between monochorionic and dichorionic gestations was found in crown-rump length (p=0.009), CRLD (p<0.001) and birth weight (p=0.025), but not in mean UtA-PI (p=0.853) or GD (p=0.556). Mean UtA-PI was significantly higher in discordant than in concordant pairs (p<0.001), but that association was not seen in CRLD (p=0.931). Mean UtA-PI and GD were correlated by the regression line "GD=3.844 × UtA-PI + 6.638", with R2 0.027. CRLD and GD were correlated by the regression line "GD=0.280 × CRLD + 10.79", with R2 0.010. Mean UtA-PI, but not CRLD, was significantly associated with severe GD (odds ratio, 22.753; p=0.002). CONCLUSIONS: Mean UtA-PI, but not CRLD, is associated with GD. The prevalence of severe GD increases significantly with increasing mean UtA-PI.

Adrenal Vein Sampling in the Management of Primary Aldosteronism: The Added Value of Intraprocedural Cortisol Assessment.

Introduction: Primary aldosteronism is the most common cause of secondary hypertension. Adrenal vein sampling is the gold standard for subtyping primary aldosteronism. However, this procedure is technically challenging and often has a low success rate. Our center is one of the very few performing this technique in our country with an increasing experience. Objective: The aim of this study was to evaluate the role of the cortisol intraprocedural assay in improving the performance of adrenal vein sampling. Design: We enrolled all of the patients with primary aldosteronism that underwent adrenal vein sampling from February 2016 to April 2023. The cortisol intraprocedural assay was introduced in October 2021. Methods: We enrolled a total of 50 adrenal vein samplings performed on 43 patients with the diagnosis of primary aldosteronism. In this sample, 19 patients and 24 patients underwent adrenal vein sampling before and after intraprocedural cortisol measurement, respectively. The procedure was repeated in seven patients (one before and six after intraprocedural cortisol measurement), given the unsuccess of the first exam. Selectivity of the adrenal vein sampling was assumed if the serum cortisol concentration from the adrenal vein was at least five times higher than that of the inferior vena cava. Lateralization was assumed if the aldosterone to cortisol ratio of one adrenal vein was at least four times the aldosterone to cortisol ratio of the contralateral side. Results: The mean age of the patients that underwent adrenal vein sampling (N = 43) was 55.2 ± 8.9 years, and 53.5% (n = 23) were female. The mean interval between the diagnosis of hypertension and the diagnosis of primary aldosteronism was 9.8 years (±9.9). At diagnosis, 62.8% of the patients (n = 27) had hypokalemia (mean value of 3 mmol/L (±0.34)), 88.4% (n = 38) had adrenal abnormalities on preprocedural CT scan, and 67.4% (n = 29) described as unilateral nodules. There were no statistically significant differences in the patients' baseline characteristics between the two groups (before and after intraprocedural cortisol measurement). Before intraprocedural cortisol measurement, adrenal vein sampling selectivity was achieved in 35% (n = 7) patients. Selectivity increased to 100% (30/30) after intraprocedural cortisol measurement (p < 0.001). With the exception of one patient who refused it, all patients with lateralized disease underwent unilateral adrenalectomy with normalization of the aldosterone to renin ratio postoperatively. Conclusions: The lack of effective alternatives in subtyping primary aldosteronism highlights the need to improve the success rate of adrenal vein sampling. In this study, intraprocedural cortisol measurement allowed a selectivity of 100%. Its addition to this procedure protocol should be considered, especially in centers with a low success rate.

Velamentous cord insertion in monochorionic twin pregnancies: a step forward in screening for twin to twin transfusion syndrome and birthweight discordance?

OBJECTIVES: Two major complications of monochorionic diamniotic (MCDA) twin pregnancies are twin to twin transfusion syndrome (TTTS) and birthweight discordance. The current screening ultrasound test for these pathologies combines the detection of nuchal translucency discrepancy and abnormal ductus venosus in at least one twin, in the first trimester. We aim to determine whether combining the presence of velamentous cord insertion in at least one twin increases screening efficiency. METHODS: This was a retrospective cohort with a sample of 136 MCDA twin pregnancies followed at Centro Hospitalar Universitário São João, during a 16-year period. RESULTS: The combination of abnormal ductus venosus in at least one twin and nuchal translucency discrepancy is associated with the development of TTTS with an OR of 10.455, but not with birthweight discordance. The combination of these first trimester markers with velamentous cord insertion is not associated with the development of either outcome. CONCLUSIONS: The presence of velamentous cord insertion in MCDA pregnancies is not associated to TTTS development. Therefore, the addition of this marker to the first trimester screening would not effectively predict the development of birthweight discordance or TTTS. However, a positive currently used screening test increases the risk of developing TTTS by about ten times.

Pregnancy and working conditions in the hospital sector: a scoping review.

The different areas and work environments in the hospital sector have a complex set of occupational risk factors that can negatively impact the health of pregnant workers. Illness among this workforce results in sick leave due to work-related diseases and pregnancy, with high absenteeism. The main objective of this study was to review the available literature on the gestational and occupational risks to which pregnant health workers are exposed, causes of absenteeism, and issues related to maternity protection and work in the hospital sector. The authors used online databases to identify papers published in English from 2015 to 2020, based on the PRISMA Extension for Scoping Reviews and three steps of Snowballing. The study reviewed 18 peer-reviewed scientific articles that address pregnancy, work, absenteeism, and maternity protection. Most studies used a quantitative approach (12) and cohort studies in particular (6). The distribution of articles by themes was as follows: pregnancy, health and safety at work (11); pregnancy, health conditions, and absenteeism (13); and work and maternity protection (10). Some inferences were possible from the themes raised. However, the results revealed a gap and the need for specific studies for healthcare workers in the hospital sector, focusing on maternity. This review contributes to more in-depth studies on developing programs, actions, and legislation to protect maternity in hospital working environments.

As diferentes áreas e ambientes de trabalho do setor hospitalar apresentam uma complexidade de fatores de risco que podem impactar negativamente a saúde das trabalhadoras grávidas. O adoecimento dessa força de trabalho resulta em afastamentos por doenças relacionadas ao trabalho e à gravidez, com alto absenteísmo. O objetivo principal deste estudo foi revisar a literatura disponível sobre os riscos gestacionais e ocupacionais a que estão expostas as trabalhadoras de saúde grávidas, causas de absenteísmo e questões relacionadas à proteção da maternidade e do trabalho no setor hospitalar. Bases de dados online foram usadas para identificar artigos em inglês publicados de 2015 a 2020, com base no PRISMA Extension for Scoping Reviews e três etapas de snowballing. Este estudo incluiu 18 artigos científicos revisados por pares que abordam questões relativas à gravidez, absenteísmo e proteção à maternidade no trabalho. A maioria dos estudos utilizou abordagem quantitativa (12), com ênfase nos estudos de coorte (6). Distribuição dos artigos por temas: gravidez, saúde e segurança no trabalho (11); gravidez, intercorrências e absenteísmo (13); e proteção ao trabalho e maternidade (10). Algumas inferências foram possíveis a partir dos temas levantados. No entanto, os resultados evidenciaram a lacuna e a necessidade de estudos específicos para trabalhadores de saúde do setor hospitalar, com enfoque na maternidade. Esta revisão pode contribuir para estudos mais aprofundados sobre o desenvolvimento de programas, ações e legislações de proteção à maternidade no ambiente de trabalho do setor hospitalar.

Absolute Hyperglycemia versus Stress Hyperglycemia Ratio for the Prognosis of Hospitalized Patients with COVID-19 in the First Months of the Pandemic: A Retrospective Study.

Diabetes is a risk factor for greater severity of coronavirus disease 2019 (COVID-19). The stress hyperglycemia ratio (SHR) is an independent predictor of critical illness, and it is reported to have a stronger association than absolute hyperglycemia. The aim of this study was to assess the relationship of absolute hyperglycemia and SHR with the severity of COVID-19, since there are no studies investigating SHR in patients with COVID-19. We conducted a retrospective observational study on hospitalized patients with COVID-19 in the first months of the pandemic, regarding absolute hyperglycemia, SHR, and severity outcomes. Of the 374 patients, 28.1% had a previous diagnosis of type 2 diabetes. Absolute hyperglycemia (64.8% versus 22.7%; p < 0.01) and SHR [1.1 (IQR 0.9-1.3) versus 1.0 (IQR 0.9-1.2); p < 0.001] showed a statistically significant association with previous diabetes. Absolute hyperglycemia showed a significant association with clinical severity of COVID-19 (79.0% versus 62.7%; p < 0.001), need for oxygen therapy (74.8% versus 54.4%; p < 0.001), invasive mechanical ventilation (28.6% versus 11.6%; p < 0.001), and intensive care unit (30.3% versus 14.9%; p = 0.002), but not with mortality; by contrast, there was no statistically significant association between SHR and all these parameters. Our results are in agreement with the literature regarding the impact of absolute hyperglycemia on COVID-19 severity outcomes, while SHR was not a significant marker. We therefore suggest that SHR should not be evaluated in all patients admitted in the hospital for COVID-19, and we encourage the standard measures at admission of blood glucose and HbA1c levels.

Pituitary metastasis as the first manifestation of lung carcinoma.

Pituitary metastases are rare. Clinical presentation could range from asymptomatic to panhypopituitarism or local symptoms. We present a case report of a 43-year-old male patient with a new onset headache, visual disturbances, and panhypopituitarism. The investigation led to the diagnosis of pituitary metastasis as the first manifestation of underlying lung cancer.

Does the Hyperglycemia Impact on COVID-19 Outcomes Depend upon the Presence of Diabetes?-An Observational Study.

Diabetes mellitus (DM) has emerged as a major risk factor for COVID-19 severity and SARS-CoV-2 infection can worsen glycemic control and may precipitate new-onset diabetes. At-admission hyperglycemia (AH) is a known predictor for worse outcomes in many diseases and seems to have a similar effect in COVID-19 patients. In this study, we aimed to assess the impact of AH regardless of pre-existing diabetes mellitus and new-onset diabetes diagnosis in the clinical severity of COVID-19 inpatients in the first months of the pandemic. A retrospective monocentric study on 374 COVID-19 inpatients (209 males) was developed to assess associations between AH (blood glucose levels in the Emergency Department or the first 24 h of hospitalization greater than 140 mg/dL) and severity outcomes (disease severity, respiratory support, admission to Intensive Care Unit (ICU) and mortality) in patients with and without diabetes. Considering diabetic patients with AH (N = 68;18.1%) there was a correlation with COVID-19 severity (p = 0.03), invasive mechanical ventilation (p = 0.008), and ICU admission (p = 0.026). No correlation was present with any severity outcomes in diabetic patients without AH (N = 33; 8.8%). All of the New-onset Diabetes patients (N = 15; 4%) had AH, and 12 had severe COVID-19; additionally, five patients were admitted to the ICU and three patients died. However, severity outcomes did not reach statistical correlation significance in this group. In nondiabetic patients with AH (N = 51; 13.6%), there was a statistically significant association with the need for oxygen therapy (p = 0.001), invasive mechanical ventilation (p = 0.01), and ICU admission (p = 0.03). Our results support data regarding the impact of AH on severity outcomes. It also suggests an effect of AH on the prognosis of COVID-19 inpatients, regardless of the presence of pre-existing diabetes or new-onset diabetes. We reinforce the importance to assess at admission glycemia in all patients admitted with COVID-19.

Twin pregnancies, crown-rump length and birthweight discordancy: the influence of chorionicity / Gestações gemelares, comprimento craniocaudal e discordância de peso ao nascimento: a influência da corionicidade

Abstract Objective The purpose of the present study was to analyze the influence of chorionicity in the biometric parameters crown-rump length (CRL), birthweight (BW), crown-rump length discordancy (CRLD) and birthweight discordancy (BWD), determine the correlation between these latter two in cases of intertwin discordancy, and to analyze the influence of chronicity in the presence of these discordancies with clinical relevance (> 10% and > 15%, respectively). Methods The present study was a retrospective study based on the twin pregnancy database of the Centro Hospitalar S. João (2010-2015), including 486 fetuses among 66 monochorionic (MC) and 177 dichorionic gestations (DC). The inclusion criteria were multiple pregnancies with 2 fetuses and healthy twin gestations. The exclusion criteria were trichorionic gestations and pregnancies with inconclusive chorionicity, multiple pregnancy with ≥ 3 fetuses and pathological twin gestations. Results No statistically significant difference was found in BW (p = 0.09) and in its discordancy (p = 0.06) nor in CRL (p = 0.48) and its discordancy (p = 0.74) between MCs and DCs. Crown-rump length discordancy and birthweight discordancy were correlated by the regression line "BWD = 0.8864 x CRLD + 0.0743," with r2 = 0.1599. Crown-rump length discordancy > 10% was found in 7.58% of monochorionic and in 13.56% of dichorionic twins. Birthweight discordancy > 15% was detected in 16.67% of monochorionic and in 31.64% of dichorionic twins. Conclusion No statistically significant influence of chorionicity was identified in both birthweight and birthweight discordancy, as in crown-rump length and crown-rump length discordancy. Birthweight discordancy was correlated to crown-rump length discordancy in 20% of cases.

Resumo Objetivo O objetivo do presente estudo foi analisar a influência da corionicidade nos parâmetros biométricos comprimento craniocaudal, peso ao nascimento, discordância de comprimento craniocaudal e discordância de peso ao nascimento, determinar a correlação entre estes dois últimos caso haja discordância intergemelar e analisar a influência da corionicidade na presença destas discordâncias com relevância clínica (> 10% e > 15%, respectivamente). Métodos O presente estudo foi um estudo retrospectivo baseado na base de dados de gestações gemelares do Centro Hospitalar S. João (2010-2015), incluindo 486 fetos de 66 gestações monocoriônicas e 177 dicoriônicas. Os critérios de inclusão foram gestações múltiplas de 2 fetos e gestações gemelares saudáveis. Os critérios de exclusão foram gestações tricoriônicas ou de corionicidade inconclusiva, gestações múltiplas com ≥ 3 fetos e gestações gemelares patológicas. Resultados Não se encontrou diferença estatisticamente significativa no peso ao nascimento (p =0,09) e sua discordância (p = 0,06) nem no comprimento craniocaudal (p = 0,48) e sua discordância (p = 0,74) entre gestações monocoriônicas e dicoriônicas. Considerando todas as gestações, as discordâncias de comprimento craniocaudal e peso ao nascimento foram correlacionadas pela reta de regressão "discordância de peso ao nascimento = 0.8864 x discordância de comprimento craniocaudal + 0.0743," com r2 = 0,1599. A discordância de comprimento craniocaudal > 10% descobriu-se em 7.58% das gestações monocoriônicas e em 13.56% das dicoriônicas. A discordância de peso ao nascimento > 15% detectou-se em 16.67% das gestações monocoriônicas e em 31.64% das dicoriônicas. Conclusão Não se identificou influência estatisticamente significativa no peso ao nascimento e sua discordância, bem como no comprimento craniocaudal e sua discordância. A discordância de peso ao nascimento correlacionou-se com a discordância de comprimento craniocaudal em 20% dos casos.

Twin Pregnancies, Crown-rump Length and Birthweight Discordancy: The Influence of Chorionicity.

OBJECTIVE: The purpose of the present study was to analyze the influence of chorionicity in the biometric parameters crown-rump length (CRL), birthweight (BW), crown-rump length discordancy (CRLD) and birthweight discordancy (BWD), determine the correlation between these latter two in cases of intertwin discordancy, and to analyze the influence of chronicity in the presence of these discordancies with clinical relevance (> 10% and > 15%, respectively). METHODS: The present study was a retrospective study based on the twin pregnancy database of the Centro Hospitalar S. João (2010-2015), including 486 fetuses among 66 monochorionic (MC) and 177 dichorionic gestations (DC). The inclusion criteria were multiple pregnancies with 2 fetuses and healthy twin gestations. The exclusion criteria were trichorionic gestations and pregnancies with inconclusive chorionicity, multiple pregnancy with ≥ 3 fetuses and pathological twin gestations. RESULTS: No statistically significant difference was found in BW (p = 0.09) and in its discordancy (p = 0.06) nor in CRL (p = 0.48) and its discordancy (p = 0.74) between MCs and DCs. Crown-rump length discordancy and birthweight discordancy were correlated by the regression line "BWD = 0.8864 x CRLD + 0.0743," with r2 = 0.1599. Crown-rump length discordancy > 10% was found in 7.58% of monochorionic and in 13.56% of dichorionic twins. Birthweight discordancy > 15% was detected in 16.67% of monochorionic and in 31.64% of dichorionic twins. CONCLUSION: No statistically significant influence of chorionicity was identified in both birthweight and birthweight discordancy, as in crown-rump length and crown-rump length discordancy. Birthweight discordancy was correlated to crown-rump length discordancy in 20% of cases.

OBJETIVO: O objetivo do presente estudo foi analisar a influência da corionicidade nos parâmetros biométricos comprimento craniocaudal, peso ao nascimento, discordância de comprimento craniocaudal e discordância de peso ao nascimento, determinar a correlação entre estes dois últimos caso haja discordância intergemelar e analisar a influência da corionicidade na presença destas discordâncias com relevância clínica (> 10% e > 15%, respectivamente). MéTODOS: O presente estudo foi um estudo retrospectivo baseado na base de dados de gestações gemelares do Centro Hospitalar S. João (2010­2015), incluindo 486 fetos de 66 gestações monocoriônicas e 177 dicoriônicas. Os critérios de inclusão foram gestações múltiplas de 2 fetos e gestações gemelares saudáveis. Os critérios de exclusão foram gestações tricoriônicas ou de corionicidade inconclusiva, gestações múltiplas com ≥ 3 fetos e gestações gemelares patológicas. RESULTADOS: Não se encontrou diferença estatisticamente significativa no peso ao nascimento (p = 0,09) e sua discordância (p = 0,06) nem no comprimento craniocaudal (p = 0,48) e sua discordância (p = 0,74) entre gestações monocoriônicas e dicoriônicas. Considerando todas as gestações, as discordâncias de comprimento craniocaudal e peso ao nascimento foram correlacionadas pela reta de regressão "discordância de peso ao nascimento = 0.8864 x discordância de comprimento craniocaudal + 0.0743," com r2 = 0,1599. A discordância de comprimento craniocaudal > 10% descobriu-se em 7.58% das gestações monocoriônicas e em 13.56% das dicoriônicas. A discordância de peso ao nascimento > 15% detectou-se em 16.67% das gestações monocoriônicas e em 31.64% das dicoriônicas. CONCLUSãO: Não se identificou influência estatisticamente significativa no peso ao nascimento e sua discordância, bem como no comprimento craniocaudal e sua discordância. A discordância de peso ao nascimento correlacionou-se com a discordância de comprimento craniocaudal em 20% dos casos.

Formação do enfermeiro para os cuidados de pacientes críticos na Unidade de Terapia Intensiva / Critical care nurses training for patients in the Intensive Care Unit

Objetiva-se analisar e discutir o perfil da formação pré e pós-admissional dos enfermeiros de uma UTI. Estudo descritivo com 20 enfermeiros de uma UTI num hospital de ensino no Rio de Janeiro. Foi realizada uma entrevista contendo variáveis sociais e formação pré e pós-admissional. Os dados foram analisados por estatística descritiva. A média de idade dos enfermeiros foi de 39,4 anos e 12 (60%) foram admitidos na UTI com algum tipo de especialização médico-cirúrgica. No que tange à formação em stricto sensu, somente (3) 15% tinham essa formação pré-admissão, sendo que houve aumento de 8 (40%) na formação pós-admissional, distribuídos entre lato e stricto sensu. Conclui-se que há o domínio da formação lato sensu, reflexo de uma formação voltada para a prática, porém já é possível observar a presença de mestres profissionais e doutorandos demonstrando a preocupação com sua autonomia e aprimoramento permanente de alto nível.(AU)

The aim of this study is to analyze and discuss the profile of pre and post admission training of nurses at an ICU. A descriptive study with 20 nurses from an ICU in a teaching hospital in Rio de Janeiro. An interview was conducted containing social variables and pre and post admission training. Data were analyzed by descriptive statistics. The mean age of the nurses was 39.4 years and 12 (60%) were admitted to the ICU with medical-surgical specialization. Concerning training in stricto sensu, only (3) 15% had this pre-admission training, and there was an increase of 8 (40%) in post-admission training, distributed between lato and stricto sensu. It is concluded that there is mastery of the lato sensu training, reflecting a practical formation, but it is already possible to observe the presence of professional masters and doctoral students demonstrating the concern with their autonomy and permanent improvement of high level.(AU)

Se pretende analizar y discutir el perfil de la formación pre y post-admisional de los enfermeros de una UTI. Estudio descriptivo con 20 enfermeros de una UTI en un hospital de enseñanza en Río de Janeiro. Se realizó una entrevista que contenía variables sociales y formación pre y post-admisional. Los datos fueron analizados por estadística descriptiva. La media de edad de los enfermeros fue de 39,4 años y 12 (60%) fueron admitidos en la UTI con algún tipo de especialización médico-quirúrgica. En lo que se refiere a la formación en stricto sensu, solamente (3) 15% tenían esa formación pre-admisión, siendo que hubo aumento de 8 (40%) en la formación post-admisional, distribuidos entre lato y stricto sensu. Se concluye que existe el dominio de la formación lato sensu, reflejo de una formación orientada a la práctica, pero ya es posible observar la presencia de maestros profesionales y doctorandos demostrando la preocupación por su autonomía y perfeccionamiento permanente de alto nivel.(AU)

Ductus venosus agenesis and fetal malformations: what can we expect? - a systematic review of the literature.

Background The ductus venosus agenesis (DVA) is a rare condition with a variable prognosis that relies partly on the presence of associated conditions. The purpose of our study was to analyze the literature regarding the post-natal outcome of fetuses with DVA associated with fetal malformations, in order to discuss the best management options for couples. Methods We performed a systematic review of the literature of MEDLINE and SCOPUS electronic databases in a 25-year period from 1992 to September 2017. Methods We found 340 cases of DVA associated with fetal abnormalities. The most common chromosomal abnormalities were: monosomy X (12/48, 25%), trisomy 21 (11/48, 22.9%) and trisomy 18 (6/48, 12.5%). From the 340 cases with DVA, in 31 cases the umbilical venous shunt type was not reported. Of the fetuses, 60.8% (188/309) had an extrahepatic umbilical venous drainage while 39.2% (121/309) presented an intrahepatic connection. The DVA was associated in 71 cases (23.0%) with cardiac abnormalities, in 82 cases (26.5%) with extracardiac abnormalities and in 85 cases (27.5%) with both cardiac and extracardiac abnormalities. Conclusion DVA associated with both cardiac and extracardiac malformations may confer a poorer fetal outcome, a clinically relevant fact that should clarify what can be expected from this entity and help prenatal counseling.

First trimester ß-hCG and estradiol levels in singleton and twin pregnancies after assisted reproduction.

Objective To compare levels of ß-hCG and estradiol collected during the first trimester in singleton and twin pregnancies following assisted reproduction technologies (ART). Methods We prospectively evaluated 50 singleton and 47 dichorionic twin pregnancies that eventually ended in live births. Patients were recruited from a single ART center with standard treatment protocols followed by fresh embryo transfers. Hormone measurements were performed within a narrow gestational age range and analyzed in a single laboratory thus minimizing inter- and intra-assay variability. We measured serum ß-hCG at 13 days after embryo transfer as well as samples of ß-hCG and estradiol at 8-9 weeks+6 days. Results No significant differences existed between singletons and twins in respect to demographic and cycle characteristics. ß-hCG and estradiol were all significantly higher in twins (P<0.05). Conclusion The data confirms the higher levels of ß-hCG and estradiol in twins, pointing to the potential role of these placental hormones in early support of a twin pregnancy.

Can early ß-human chorionic gonadotropin predict birth of singletons and twins after in vitro fertilization?

OBJECTIVE: To assess the predictive value for clinical pregnancy outcome of ß-hCG level at 13 d after embryo transfer. METHODS: Retrospective study of IVF clinical pregnancies diagnosed at 6 weeks. We calculated the value of ß-hCG level at 13 d after embryo transfer to predict live births. RESULTS: We analyzed 177 IVF cycles between 2009 and 2014 (50 singleton births, 50 twin births, 27 sets with a vanishing twin, 43 first trimester singleton pregnancy loss and seven first trimester total twin pregnancy loss). Singleton pregnancies with a ß-hCG concentration <85 mIU/mL had an 89% risk of having a first trimester loss whereas a concentration >386 mU/mL had a 91% chance of a live birth. Twin pregnancies with a concentration <207 mIU/mL had only a 33% chance of delivering twins and a 55% risk of having a vanishing twin; whereas a level >768 mIU/mL was associated with a 81% chance of live twin birth and a low risk (19%) of having a vanishing twin. Age, type and duration of infertility, body mass index (BMI) and number of fertilized oocytes did not affect these calculations. CONCLUSIONS: ß-hCG level at 13 d after embryo transfer might predict outcomes in clinical singleton and twin pregnancies following IVF.

Prenatal ultrasound diagnosis of Tessier number 7 cleft: Case report and review of the literature.

Lateral or transverse facial clefts are the most frequent of the atypical facial clefts, classified by Tessier as no. 7 clefts. Most of the cases are diagnosed at birth, while few cases are diagnosed prenatally. We report a case of prenatal ultrasound detection and three-dimensional characterisation of a lateral facial cleft at 21 weeks of gestation, which was terminated at 22 weeks. It was a transverse cleft, running through the left cheek towards the ear, along with micrognathia and mild polyhydramnios. We also present a review on classification, anatomical features and prenatal diagnosis of Tessier no. 7 cleft.

Cervical pessary for the prevention of preterm birth: is it of any use?

Preterm birth (PTB) represents a heavy burden in modern obstetrics as it is a major cause of perinatal morbidity and mortality. After the introduction of transvaginal sonography (TVS) screening, secondary prevention of PTB has been re-evaluated on the basis of pre-existing cervical length (CL) and meanwhile the cervical pessary has become an object of increasing interest. This device consists of a silicone cone acting mechanically, that can be easily placed or removed, but whose efficacy is still controversial. Therefore, this study aims to review the most recent evidence regarding its efficacy for prevention of PTB, together with the correct position, the evidence regarding the mechanism of action, the exclusion criteria for pessary placement and the reasons for precocious removal. Overall, it is well tolerated and there are no reports on severe associated side effects. Finally, we discuss published data regarding cervical pessary efficacy. Although results are still conflicting, it seems however to be an effective method for preventing PTB, both in singleton and multiple pregnancies, but further evidence is needed.

Late pregnancy - a clue to prolonging life?

The relation between fertility and longevity has always been a subject of study and controversy. Indeed, life expectancy extension is found to be tied to late births. This conclusion can be drawn from social-observational studies like the Long Life Family Study in New England and the New England Centenarian Study on which was found that women whose last birth was after 40 years of age are more likely to live longer. Recently, a group in Israel published a review on animal and human studies that shed some understanding on the cellular mechanisms behind the association between pregnancy and tissue regeneration and repair. These studies shed some understanding to draw biological plausibility on the association between late pregnancy and life expectancy.

Absence of an anatomical origin for altered ductus venosus flow velocity waveforms in first-trimester human fetuses with increased nuchal translucency.

OBJECTIVE: To perform a morphological evaluation of the ductus venosus, heart and jugular lymphatic sac (JLS) in first-trimester human fetuses with normal and abnormal ductus venosus flow velocity waveforms (DV-FVWs) and normal and increased nuchal translucency (NT). METHOD: Postmortem examination was performed on fetuses with increased NT or structural malformations with previous NT and DV-FVW measurements. Ductus venosus morphology was examined using markers for endothelium, smooth muscle actin (SMA), nerves and elastic fibers. Fetal hearts were studied by microscopy. The nuchal region was analyzed using markers for lymphatic vessels, endothelium, SMA and nerves. RESULTS: Two trisomy 21 and two trisomy 18 fetuses with increased NT and abnormal DV-FVWs were analyzed. As a control, one euploid anencephalic fetus with normal NT, cardiac anatomy and DV-FVWs was examined. Similar endothelial and SMA expression was observed in the ductus venosus in all fetuses. Nerve and elastic fiber expression were not detected. Three trisomic fetuses showed cardiac defects, one trisomic fetus demonstrated normal cardiac anatomy. The JLS was abnormally enlarged or contained red blood cells in all trisomic fetuses. The control fetus showed a normal JLS. CONCLUSION: Abnormal DV-FVWs are not justified by alterations in ductus venosus morphology. DV-FVWs most probably reflect intracardiac pressure. © 2016 John Wiley & Sons, Ltd.

A influência da web na tomada de decisão da grávida: rastreio pré-natal e tipo de parto / The influence of the web in the decision process of the pregnant woman: prenatal screening and type of birth / La influencia de la web en la toma de decisiones de la mujer embarazada: detección prenatal y tipo de parto

Este artigo explora a influência que a web tem nos mecanismos de tomada de decisão da grávida, por meio, apenas, da análise dos resultados obtidos pela participação de grávidas e relativamente às opções de“rastreio pré-natal” e de “tipo de parto”. Em termos metodológicos, o estudo baseou-se nos dados recolhidos através de um survey exploratório, com base num inquérito por questionário, em suporte papel, aplicado a grávidas portuguesas. Apesar da importância da pesquisa na internet, é o contacto presencial, sobretudo com o médico, que mais as influencia. Concluiu-se que a revisão da literatura recente e a investigação sobre a utilização da internet por grávidas aponta que, no seu processo de tomada de decisão, a influênciada opinião do médico é maior do que a das pesquisas digitais feitas por elas. Os resultados desse survey deverão ser úteis para pressionar os policy-makers a encontrar respostas eficazes e eficientes nesta matéria...

This article explores the answers given by pregnant women concerning the options “prenatal screening”and “type of delivery”. The influence of the web on the decision-making processes of pregnant womenis analysed, aiming to understand how search practices, peer influence and opinion sharing are carriedout on the web. The results are based on data collected through an exploratory survey conducted with aquestionnaire applied to 178 Portuguese pregnant women. Although research on the internet has greateffect on the respondents, face to face contact is what most influences them, especially with the doctor.Relatives and friends are also relevant. The study pointed to the biggest influence of the doctor’s opinionover the internet in their decision-making process. These results should be useful for pressuring policymakersto find prompter and better quality answers...

El presente artículo analiza la influencia que la web tiene en la toma de decisiones de una mujer embarazada,con objectivo de entender la búsqueda de casos de “detección prenatal” y “tipo de parto” en páginas web, así como el papel de las influencias sociales y opiniones compartidas online. Los resultados están basados en la información recopilada en un estudio que se ha realizado a través de un cuestionario que ha sido llevado a cabo a mujeres portuguesas embarazadas. Los resultados demuestran que si bien la búsqueda en internet tiene un gran impacto, el contacto cara a cara, especialmente con un médico, es lo que tiene una mayor influencia. La opinión de los médicos en la toma de decisiones relacionadas con lo embarazo causa mayor influencia que las consultas efectuadas a través de internet. Los resultados deberían servir para ejercer presión en los que lideran estlas políticas de salud, para que encuentren respuestas más precisas y de mejor calidad...

Risks to the fetus from diagnostic imaging during pregnancy: review and proposal of a clinical protocol.

Every day, medical practitioners face the dilemma of exposing pregnant or possibly pregnant patients to radiation from diagnostic examinations. Both doctors and patients often have questions about the risks of radiation. The most vulnerable period is between the 8th and 15th weeks of gestation. Deterministic effects like pregnancy loss, congenital malformations, growth retardation and neurobehavioral abnormalities have threshold doses above 100-200 mGy. The risk is considered negligible at 50 mGy and in reality no diagnostic examination exceeds this limit. The risk of carcinogenesis is slightly higher than in the general population. Intravenous iodinated contrast is discouraged, except in highly selected patients. Considering all the possible noxious effects of radiation exposure, measures to diminish radiation are essential and affect the fetal outcome. Nonionizing procedures should be considered whenever possible and every radiology center should have its own data analysis on fetal radiation exposure. In this review, we analyze existing literature on fetal risks due to radiation exposure, producing a clinical protocol to guide safe radiation use in a clinical setting.