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.

Fetal gastroschisis: antepartum fetal heart rate analysis by computerized cardiotocography.

OBJECTIVES: To describe the antenatal fetal heart rate (FHR) parameters analyzed by computerizedcardiotocography (cCTG) in fetuses with gastroschisis and compare the FHR parameters with ultrasound gastrointestinal markers. METHODS: A retrospective analysis of antepartum cCTG records were conducted in 87 pregnant cases with fetal gastroschisis between 28and 36 weeks (plus 6 days). A comparative analysis of the median distribution of the following FHR parameters was performed: basal FHR, short-term variation (STV), FHR accelerations and decelerations, episodes of high and low variations, and variations in low and high episodes. FHR parameters and ultrasound gastrointestinal markers were also compared. RESULTS: The majority of FHR parameters did not present significant changes throughout gestation. An increased number of records with episodes of low variation (p = 0.019) and an increased number of accelerations >15 bpm (p = 0.001) were the only observed changes throughout gestation. Stomach herniation was significantly associated with a lower STV (p = 0.018) and a higher frequency of records with low episodes (p = 0.049). CONCLUSIONS: The cCTG analysis indicated that the FHR parameters in fetuses with gastroschisis presented different patterns from those observed in normal fetuses. Stomach herniation was associated with altered FHR patterns.

Reduced placental volume and flow in severe growth restricted fetuses.

OBJECTIVES: To evaluate placental volume and vascular indices in pregnancies with severe fetal growth restriction and determine their correlations to normal reference ranges and Doppler velocimetry results of uterine and umbilical arteries. METHODS: Twenty-seven fetuses with estimated weights below the 3rd percentile for gestational age were evaluated. Placental volume and vascular indices, including vascularization, flow, and vascularization flow indices, were measured by three-dimensional ultrasound using a rotational technique and compared to a previously described nomogram. The observed-to-expected placental volume ratio for gestational age and observed-to-expected placental volume ratio for fetal weight were calculated. Placental parameters correlated with the Doppler velocimetry results of uterine and umbilical arteries. RESULTS: The mean uterine artery pulsatility index was negatively correlated with the observed-to-expected placental volume ratio for gestational age, vascularization index and vascularization flow index. The observed-to-expected placental volume ratio for gestational age and observed-to-expected placental volume ratio for fetal weight and vascularization index were significantly lower in the group with a bilateral protodiastolic notch. No placental parameter correlated with the umbilical artery pulsatility index. CONCLUSIONS: Pregnancies complicated by severe fetal growth restriction are associated with reduced placental volume and vascularization. These findings are related to changes in uterine artery Doppler velocimetry. Future studies on managing severe fetal growth restriction should focus on combined results of placental three-dimensional ultrasound and Doppler studies of uterine arteries.

Reduced placental volume and flow in severe growth restricted fetuses

OBJECTIVES: To evaluate placental volume and vascular indices in pregnancies with severe fetal growth restriction and determine their correlations to normal reference ranges and Doppler velocimetry results of uterine and umbilical arteries. METHODS: Twenty-seven fetuses with estimated weights below the 3rd percentile for gestational age were evaluated. Placental volume and vascular indices, including vascularization, flow, and vascularization flow indices, were measured by three-dimensional ultrasound using a rotational technique and compared to a previously described nomogram. The observed-to-expected placental volume ratio for gestational age and observed-to-expected placental volume ratio for fetal weight were calculated. Placental parameters correlated with the Doppler velocimetry results of uterine and umbilical arteries. RESULTS: The mean uterine artery pulsatility index was negatively correlated with the observed-to-expected placental volume ratio for gestational age, vascularization index and vascularization flow index. The observed-to-expected placental volume ratio for gestational age and observed-to-expected placental volume ratio for fetal weight and vascularization index were significantly lower in the group with a bilateral protodiastolic notch. No placental parameter correlated with the umbilical artery pulsatility index. CONCLUSIONS: Pregnancies complicated by severe fetal growth restriction are associated with reduced placental volume and vascularization. These findings are related to changes in uterine artery Doppler velocimetry. Future studies on managing severe fetal growth restriction should focus on combined results of placental three-dimensional ultrasound and Doppler studies of uterine arteries.

Intrauterine growth restriction in monochorionic-diamniotic twins / Restrição de crescimento intrauterino em gêmeos monocoriônicos diamnióticos.

Objective: to evaluate neonatal morbidity and mortality in monochorionic- -diamniotic (MCDA) twin pregnancies complicated by selective intrauterine growth restriction (sIUGR) and non-selective intrauterine growth resctriction (nsIUGR). Methods: neonatal morbidity parameters and mortality were analyzed in 34 twins with IUGR (< 10th percentile on twins’ growth charts): 18 with sIUGR and 16 with nsIUGR. The sIUGR group was made up of 18 pregnancies in which growth was restricted in only one fetus (n = 18). The nsIUGR group was composed of 8 pregnancies in which both fetuses presented restricted growth (n = 16). Cases of twin-to-twin transfusion syndrome and fetal malformation were not included in the study. Results: the MCDA twin pregnancies with sIUGR had a higher rate of orotracheal intubation (p = 0.001) and mechanical ventilation (p = 0.0006), as well as longer than average fasting time (p = 0.014) compared to those in which the fetuses had nsIUGR. A higher incidence was also observed of types II and III umbilical artery Doppler velocimetry patterns in the sIUGR cases (p = 0.002). There was no significant difference between the two groups as to mortality during pregnancy and the neonatal period (p = 0.09). Conclusion: in MCDA twin pregnancies, sIUGR presents more severe umbilical artery Doppler velocimetry abnormalities and worse morbidity than nsIUGR. .

Objetivo: avaliar a morbidade e mortalidade neonatal em gestações monocoriônicas e diamnióticas (MCDA) acometidas pela restrição de crescimento fetal seletiva (RCFS) e não seletiva (RCFNS). Métodos: os parâmetros de morbidade e mortalidade neonatais foram avaliados em 34 gêmeos com RCF (abaixo do percentil 10 de uma curva de crescimento para gêgêmeos): 18 com RCFS e 16 com RCFNS. O grupo com RCFS teve origem em 18 gestações, em que somente um feto apresentava RCF. O grupo com RCFNS teve origem em 8 gestações em que ambos os fetos apresentavam RCF. Foram excluídos deste estudo casos da síndrome da transfusão feto-fetal e malformações fetais. Resultados: os gêmeos de gestações MCDA com RCFS apresentaram maior frequência de entubação orotraqueal (p=0,001), ventilação mecânica (p=0,0006) e maior tempo em jejum durante internação (p=0,014), quando comparados aos gêmeos de gestações MCDA com RCFNS. No grupo com RCFS, também foram observados maior frequência de tipos II e III de dopplervelocimetria de artéria umbilical (p=0,002). Não houve diferença significativa entre os grupos quanto à mortalidade neonatal (p=0,09). Conclusão: em gestações gemelares MCDA, a RCFS representa maior frequência de alterações severas na velocimetria Doppler da artéria umbilical e piores resultados na morbidade neonatal. .

Transient accelerations of fetal heart rate analyzed by computerized cardiotocography in the third trimester of pregnancy.

OBJECTIVE: The aim of this study was to investigate the patterns of transient FHR accelerations (10 bpm and 15 bpm) in the third trimester of pregnancy, comparing the occurrence of this event before and after the 32nd gestational week. METHODS: This is a prospective study comparing the results of the computerized cardiotocography of 46 low-risk women with singleton pregnancies, maternal age between 18 and 40 years, gestational age between 28 and 40 weeks, absence of maternal morbidity and adequate fetal growth according to ultrasound. Computed Cardiotocography (8002 Sonicaid System and Fetal Care System) was performed for 30 minutes to analyze the variables of FHR. RESULTS: Twenty-three pregnant women underwent cardiotocography before 32 weeks (mean = 29.9 weeks, SD = 1.4 weeks) and were compared with 23 pregnant women who were examined after 32 weeks (mean = 36.3 weeks, SD = 2.5 weeks). Regarding the characteristics of FHR, fetuses evaluated between 32 1/7 weeks and 40 weeks showed a significantly greater number of accelerations above 15 bpm (median = 5, variation 0-18) than the group of pregnant women from 28 to 32 weeks (median = 4, variation 0 to 10; P = 0.048). There was a significant positive correlation between the number of accelerations above 15 bpm and the gestational age at examination (rho = 0.33; P = 0.026). CONCLUSION: Computerized cardiotocography showed an association regarding the number of transient accelerations greater than 15 bpm in the assessment of both periods before and after 32 weeks of gestational age, suggesting the influence of the maturation of the fetal autonomic nervous system with pregnancy progression.

Transient accelerations of fetal heart rate analyzed by computerized cardiotocography in the third trimester of pregnancy / Acelerações transitórias da frequência cardíaca fetal analisada pela cardiotocografia computadorizada no terceiro trimestre da gestação

Objective: the aim of this study was to investigate the patterns of transient FHR accelerations (10 bpm and 15 bpm) in the third trimester of pregnancy, comparing the occurrence of this event before and after the 32nd gestational week. Methods: This is a prospective study comparing the results of the computerized cardiotocography of 46 low-risk women with singleton pregnancies, maternal age between 18 and 40 years, gestational age between 28 and 40 weeks, absence of maternal morbidity and adequate fetal growth according to ultrasound. Computed Cardiotocography (8002 Sonicaid System and Fetal Care System) was performed for 30 minutes to analyze the variables of FHR. Results: twenty-three pregnant women underwent cardiotocography before 32 weeks (mean = 29.9 weeks, SD = 1.4 weeks) and were compared with 23 pregnant women who were examined after 32 weeks (mean = 36.3 weeks, SD = 2.5 weeks). Regarding the characteristics of FHR, fetuses evaluated between 32 1/7 weeks and 40 weeks showed a significantly greater number of accelerations above 15 bpm (median = 5, variation 0-18) than the group of pregnant women from 28 to 32 weeks (median = 4, variation 0 to 10; P = 0.048). There was a significant positive correlation between the number of accelerations above 15 bpm and the gestational age at examination (rho = 0.33; P = 0.026). Conclusion: computerized cardiotocography showed an association regarding the number of transient accelerations greater than 15 bpm in the assessment of both periods before and after 32 weeks of gestational age, suggesting the influence of the maturation of the fetal autonomic nervous system with pregnancy progression. .

Objetivo: o objetivo deste estudo foi investigar os padrões das acelerações transitórias da FCF (de 10 e 15 bpm) no terceiro trimestre da gestação, comparando a ocorrência desse evento antes e após a 32ª semana gestacional. Métodos: trata-se de estudo prospectivo comparando os resultados do exame de cardiotocografia computadorizada de 46 gestantes de baixo risco, com feto único, idade materna entre 18 e 40 anos, idade gestacional entre 28 e 40 semanas, ausência de morbidades maternas e crescimento fetal adequado pela ultrassonografia. Foi realizada a cardiotocografia computadorizada (Sonicaid System 8002 e Fetal Care System) por 30 minutos para análise das variáveis da FCF. Resultados: vinte e três gestantes que realizaram a cardiotocografia antes da 32ª semana (média = 29,9 semanas, DP = 1,4 semanas) foram comparadas com 23 que realizaram o exame após a 32ª semana (média = 36,3 semanas, DP = 2,5 semanas). Quanto às características da FCF, os fetos avaliados entre 32 1/7 semanas e 40 semanas apresentaram número significativamente maior de acelerações acima de 15 bpm (mediana = 5, variação 0 a 18) que o grupo de gestantes de 28 a 32 semanas (mediana = 4, variação 0 a 10; P = 0,048). Houve correlação significativa e positiva entre o número de acelerações transitórias acima de 15 bpm e a idade gestacional no momento do exame (rho = 0,33; P = 0,026). Conclusão: a cardiotocografia computadorizada revelou associação entre o número de acelerações transitórias acima de 15 bpm quando avaliados os períodos antes e após 32 semanas de idade gestacional, sugerindo influência da maturação do sistema nervoso autônomo fetal com a progressão da gestação. .

Arrependimento da realização da esterilização tubária em gestação de alto risco / Repentance of the realization of tubal sterilization in high-risk pregnancies

Objetivos: Identificar o índice de arrependimento relacionado à realização da cirurgia de esterilização tubária, descrever os aspectos associados ao arrependimento e investigar as alterações que as mulheres acreditam ter ocorrido na vida delas decorrente da realização da cirurgia. Métodos: Estudo prospectivo transversal. Foram convocadas a participar do estudo todas as mulheres que apresentaram gestação de alto risco e que realizaram a cirurgia de esterilização tubária na Clínica de Obstetrícia de hospital universitário entre os anos de 2005 e 2007. Foram convocadas 316 mulheres e 216 pacientes foram incluídas no estudo. Resultados: Das mulheres entrevistadas, 2,8% se arrependeram de ter realizado a cirurgia de esterilização tubária. Constatou-se significância estatística no que diz respeito à dúvida em realizar o procedimento (p<0,01); aos sentimentos despertados a partir da constatação da impossibilidade de gerar (p<0,01) e a média de relacionamento estável (p<0,01). Conclusões: A população pesquisada apresentou graves problemas de saúde, o que explica a taxa de arrependimento inferior à observada na literatura. Para minimizar o arrependimento, sugere-se o trabalho multidisciplinar oferecendo acesso a planejamento familiar, reflexão e questionamentos acerca da escolha realizada(AU)

Objective: Identify the index of repentance related to surgery of tubal sterilization, describe aspects related to repentance and to investigate the changes that women believe they have been occurred because of the surgery. Methods: Prospective cross study. High risk pregnant women who underwent tubal sterilization surgery in the Obstetrics clinic in a University Hospital between 2005 and 2007. A total of 316 women were included for a scheduled interview and 216 women answered the interview. Results: Of the women interviewed, 2.8% regretted having the tubal sterilization surgery. Statistical significance was found in doubt to doing the procedure (p<0.01), in the feelings awaken with the inability to reproduce (p<0.01) and stable relationship average (p<0.01). Conclusions: The population studied had severe health problems which explains the lower rate of regret found in the literature. To minimize the regret, we suggest that multidisciplinary work providing access to family planning, reflection and debate about their current choice(AU)

Intrauterine growth restriction in monochorionic-diamniotic twins.

OBJECTIVE: to evaluate neonatal morbidity and mortality in monochorionic-diamniotic (MCDA) twin pregnancies complicated by selective intrauterine growth restriction (sIUGR) and non-selective intrauterine growth resctriction (nsIUGR). METHODS: neonatal morbidity parameters and mortality were analyzed in 34 twins with IUGR (< 10th percentile on twins' growth charts): 18 with sIUGR and 16 with nsIUGR. The sIUGR group was made up of 18 pregnancies in which growth was restricted in only one fetus (n = 18). The nsIUGR group was composed of 8 pregnancies in which both fetuses presented restricted growth (n = 16). Cases of twin-to-twin transfusion syndrome and fetal malformation were not included in the study. RESULTS: the MCDA twin pregnancies with sIUGR had a higher rate of orotracheal intubation (p = 0.001) and mechanical ventilation (p = 0.0006), as well as longer than average fasting time (p = 0.014) compared to those in which the fetuses had nsIUGR. A higher incidence was also observed of types II and III umbilical artery Doppler velocimetry patterns in the sIUGR cases (p = 0.002). There was no significant difference between the two groups as to mortality during pregnancy and the neonatal period (p = 0.09). CONCLUSION: in MCDA twin pregnancies, sIUGR presents more severe umbilical artery Doppler velocimetry abnormalities and worse morbidity than nsIUGR.

Cord blood B-type natriuretic peptide levels in placental insufficiency: correlation with fetal Doppler and pH at birth.

OBJECTIVE: To examine the correlation of cardiac B-type natriuretic peptide (BNP) concentrations in umbilical cord blood at birth with fetal Doppler parameters and pH at birth. STUDY DESIGN: Prospective cross-sectional study with the following inclusion criteria: women with a singleton pregnancy, placental insufficiency characterized by increased pulsatility index (PI) of the umbilical artery (UA), intact membranes, and absence of fetal abnormalities. The exclusion criteria kept out cases of newborns with postnatal diagnosis of abnormality and cases in which the blood analysis was not performed. The Doppler parameters used were the UA PI, middle cerebral artery (MCA) PI, cerebroplacental ratio (CPR), and ductus venosus (DV) PI for veins (PIV), all converted into zeta scores. Blood samples were obtained from the umbilical cord immediately after delivery to measure the pH of the UA and the BNP. RESULTS: Thirty-two pregnancies with placental insufficiency were included, 21 (65%) with positive diastolic flow and 11 (35%) with absent or reversed end diastolic flow in the UA. The concentration of BNP correlated significantly with the UA PI z-score (rho=0.43, P=0.016), the CPR z-score (rho=-0.35, P=0.048), the DV PIV z-score (rho=0.61, P<0.001), pH at birth (rho=-0.39, P=0.031), and gestational age (rho=-0.51, P=0.003). In the multiple regression analysis, antenatal parameters were included; the DV PIV z-score (P=0.008) was found to be an independent parameter correlating with BNP at birth. Correlation between BNP and the DV PIV z-score was borne out by the regression equation Log[BNP]=2.34+0.13*DV (F=18.8, P<0.001). Correlation between BNP and pH at birth was confirmed by the regression equation Log[BNP]=21.36-2.62*pH (F=7.69, P=0.01). CONCLUSION: The results suggest that fetal cardiac dysfunction identified by BNP concentrations at birth correlated independently with changes in DV PIV and correlated negatively with pH values at birth.

Fetal venous Doppler in pregnancies with placental dysfunction and correlation with pH at birth.

OBJECTIVES: To determine the correlation between ph at birth and venous Doppler parameters in pregnancies with placental dysfunction. METHODS: This was a prospective cohort study of 58 pregnancies with the diagnosis of placental dysfunction between 26 and 34 weeks of gestation. Inclusion criteria were singleton pregnancies, abnormal umbilical artery (UA) Doppler, fetal growth restriction diagnosed by estimated fetal weight <10th centile for gestational age, intact membranes, and absence of fetal congenital abnormalities. The Doppler measurements were the following: UA pulsatility index (PI), ductus venosus (DV) pulsatility index for veins (PIV), intra-abdominal umbilical vein (UV) time-averaged maximum velocity (TAMxV) and blood flow and left portal vein (LPV) time-averaged maximum velocity (TAMxV) and blood flow. All Doppler parameters were transformed into z-scores (SD values from the mean) according to normative references. RESULTS: The UA pH at birth showed a negative significant correlation with the DV-PIV (p = 0.004) and the DV-PIV z-score (p = 0.004), while LPV TAMxV (p = 0.004), LPV TAMxV z-score (p = 0.002), LPV blood flow (p = 0.01), LPV blood flow normalized (p = 0.04) and UV blood flow (p = 0.04) positively correlated with pH at birth. Multiple regression analysis was performed and the DV-PIV z-score was the variable that independently correlated with pH at birth (p = 0.002). CONCLUSIONS: the present results suggest that changes in fetal venous blood flow, mainly DV and LPV are useful in the management of cases with early onset placental insufficiency and that venous Doppler parameters correlate with pH at birth.

Esterilização tubária e representação do feminino: aspectos anteriores à realização da cirurgia / Tubal sterilization and representation of feminine: aspects prior to surgery

As alterações no discurso sobre a sexualidade possibilitaram às mulheres escolher a maternidade ao invés de tê-la como papel obrigatório. Objetivo: identificar a representação do feminino, verificando as expectativas conscientes e inconscientes de alteração de vida após a cirurgia de laqueadura. Sujeitos: 20 gestantes e 16 homens. Instrumentos: entrevista semidirigida e teste Desenho-Estória com Tema. Observou-se que 20% das mulheres e 19% dos homens acreditavam existir uma mudança corporal; 30% das mulheres e 38% dos homens afirmaram que as mulheres que não podem ter filhos são marginalizadas pela sociedade. O teste projetivo revelou que a representação inconsciente do feminino está diretamente associada à reprodução(AU)

The changes in the speech about sexuality allowed women to choose maternity instead of having it as an obligation. Objective: identify the representation of the feminine, verifying the conscious and unconscious expectations of alterations of life after surgical tubal sterilization. Sample: 20 pregnant women and 16 men. One semi-conducted interview and a test of thematic story-drawings were carried out. The interviews showed that 20% of the women and 19% of the men believed that there would be a body change; 30% of the women and 38% of the men reported believing that women who cannot have kids are marginalized by society. The projective test revealed that, in most individuals, the unconscious representation of the feminine is directly associated with reproduction(AU)

Predicting pH at birth in pregnancies with abnormal pulsatility index and positive end-diastolic velocity in the umbilical artery.

OBJECTIVES: To identify potential associations between fetal surveillance tests and acidosis at birth in pregnancies with abnormal but positive end-diastolic velocity in the umbilical artery. METHODS: A prospective case-control study [group 1: pH < 7.2; group 2: pH ≥ 7.2] including 46 fetuses with abnormal but positive end-diastolic velocity in the umbilical artery was conducted between February 2007 and March 2009. Outcome variables were evaluated by univariate analysis and compared between the two groups. Clinically relevant and statistically significant variables were analyzed by logistic regression. RESULTS: Abnormal nonstress test, presence of deceleration, and absent fetal breathing movements were statistically significant. Logistic regression analysis revealed that fetal heart rate (FHR) deceleration in the nonstress test is the only predictor of fetal acidosis at birth (p = 0.024; OR = 8.2; 95%CI: 1.2-52). CONCLUSIONS: In fetuses with positive end-diastolic flow velocity, acute variables of the antenatal surveillance tests are correlated with acidosis at birth and FHR deceleration in the nonstress test is the only predictor of fetal acidosis.

Avaliação da vitalidade fetal em gestações complicadas pela plaquetopenia materna moderada ou grave / Assessment of fetal well-being in pregnancies complicated by maternal moderate to severe thrombocytopenia

OBJETIVO: Analisar os resultados da avaliação da vitalidade fetal em gestações complicadas por plaquetopenia materna moderada ou grave. MÉTODOS: No período de abril de 2001 a julho de 2011, foram analisados, retrospectivamente, os dados de prontuários de 96 gestantes com diagnóstico de plaquetopenia na gestação. Foram analisados os seguintes exames de avaliação da vitalidade fetal realizados no período anteparto: cardiotocografia, perfil biofísico fetal, índice de líquido amniótico e doplervelocimetria das artérias umbilicais. RESULTADOS: Foram analisadas 96 gestações com os seguintes diagnósticos: plaquetopenia gestacional (n=37, 38,5 por cento), hiperesplenismo (n=32, 33,3 por cento), púrpura trombocitopenica imune (PTI, n=14, 14,6 por cento), plaquetopenia imune secundária (n=6, 6,3 por cento), aplasia medular (n=3, 3,1 por cento) e outros (n=4, 4,1 por cento). A cardiotocografia apresentou resultado normal em 94 por cento dos casos, o perfil biofísico fetal com índice 8 ou 10 em 96,9 por cento e o índice de líquido amniótico >5,0 cm em 89,6 por cento. A doplervelocimetria da artéria umbilical apresentou resultado normal em 96,9 por cento. Na análise dos principais grupos de plaquetopenia, constatou-se que o diagnóstico de oligohidrâmnio foi significativamente mais frequente no grupo com PTI (28,6 por cento) quando comparado aos demais (gestacional: 5,4 por cento e hiperesplenismo: 9,4 por cento, p=0,04). CONCLUSÕES: O presente estudo permitiu concluir que, nas gestações complicadas pela plaquetopenia materna moderada ou grave, apesar do bem-estar fetal manter-se preservado na grande maioria dos casos, em gestantes com PTI é importante o seguimento da vitalidade fetal com ênfase na avaliação do volume de líquido amniótico, devido à sua associação com a oligohidramnia.

PURPOSE: To analyze the results of assessment of fetal well-being in pregnancies complicated by moderate or severe maternal thrombocytopenia. METHODS: Data from April 2001 to July 2011 of 96 women with a diagnosis of thrombocytopenia in pregnancy were retrospectively analyzed. We analyzed the following tests performed during the antepartum period for fetal assessment: cardiotocography, fetal biophysical profile, amniotic fluid index and umbilical artery Doppler velocimetry. RESULTS: A total of 96 pregnancies with the following diagnoses were analyzed: gestational thrombocytopenia (n=37, 38.5 percent) hypersplenism (n=32, 33.3 percent), immune thrombocytopenic purpura (ITP, n=14, 14.6 percent), secondary immune thrombocytopenia (n=6, 6.3 percent), bone marrow aplasia (n=3, 3.1 percent), and others (n=4, 4.1 percent). Cardiotocography showed normal results in 94 percent of cases, a fetal biophysical profile with an index of 8 or 10 in 96.9 percent and an amniotic fluid index >5.0 cm in 89.6 percent. Doppler umbilical artery velocimetry showed normal results in 96.9 percent of cases. In the analysis of the major groups of thrombocytopenia, the diagnosis of oligohydramnios was found to be significantly more frequent in the group with ITP (28.6 percent) compared to the other groups (gestational thrombocytopenia: 5.4 percent and hypersplenism: 9.4 percent, p=0.04). CONCLUSIONS: This study indicates that in pregnancies complicated by moderate or severe maternal thrombocytopenia, even though the fetal well-being remains preserved in most cases, fetal surveillance is important in pregnant women with ITP, with emphasis on amniotic fluid volume evaluation due to its association with oligohydramnios.

[Assessment of fetal well-being in pregnancies complicated by maternal moderate to severe thrombocytopenia]. / Avaliação da vitalidade fetal em gestações complicadas pela plaquetopenia materna moderada ou grave.

PURPOSE: To analyze the results of assessment of fetal well-being in pregnancies complicated by moderate or severe maternal thrombocytopenia. METHODS: Data from April 2001 to July 2011 of 96 women with a diagnosis of thrombocytopenia in pregnancy were retrospectively analyzed. We analyzed the following tests performed during the antepartum period for fetal assessment: cardiotocography, fetal biophysical profile, amniotic fluid index and umbilical artery Doppler velocimetry. RESULTS: A total of 96 pregnancies with the following diagnoses were analyzed: gestational thrombocytopenia (n=37, 38.5%) hypersplenism (n=32, 33.3%), immune thrombocytopenic purpura (ITP, n=14, 14.6%), secondary immune thrombocytopenia (n=6, 6.3%), bone marrow aplasia (n=3, 3.1%), and others (n=4, 4.1%). Cardiotocography showed normal results in 94% of cases, a fetal biophysical profile with an index of 8 or 10 in 96.9% and an amniotic fluid index >5.0 cm in 89.6%. Doppler umbilical artery velocimetry showed normal results in 96.9% of cases. In the analysis of the major groups of thrombocytopenia, the diagnosis of oligohydramnios was found to be significantly more frequent in the group with ITP (28.6%) compared to the other groups (gestational thrombocytopenia: 5.4% and hypersplenism: 9.4%, p=0.04). CONCLUSIONS: This study indicates that in pregnancies complicated by moderate or severe maternal thrombocytopenia, even though the fetal well-being remains preserved in most cases, fetal surveillance is important in pregnant women with ITP, with emphasis on amniotic fluid volume evaluation due to its association with oligohydramnios.

Relação cerebroplacentária e acidemia ao nascimento em gestações com insuficiência placentária detectada antes da 34ª semana de gestação / Cerebroplacental ratio and acidemia to the birth in placental insufficiency detected before 34th week's gestation

OBJETIVO: avaliar a hipótese de que a relação cerebroplacentária (RCP) fetal relaciona-se com acidemia no nascimento, em gestações complicadas pela insuficiência placentária detectada antes da 34ª semana de gestação. MÉTODOS: trata-se de coorte prospectiva de 55 pacientes entre a 26ª e a 34ª semanas de gestação, com diagnóstico de insuficiência placentária caracterizada pelo Doppler de artéria umbilical alterado (índice de pulsatilidade >p95). Para cada paciente foi realizada avaliação da vitalidade fetal pela doplervelocimetria de artéria umbilical, artéria cerebral média e ducto venoso, e pelo perfil biofísico fetal. Foi calculada a RCP pela razão entre os valores do índice de pulsatilidade da artéria umbilical e da artéria cerebral média, bem como o cálculo de seu z-score (número de desvios padrão que se afasta da média para a idade gestacional). A acidemia no nascimento foi caracterizada quando pH<7,2. RESULTADOS: das 55 pacientes, 29 (52,7 por cento) apresentaram acidemia no nascimento. O grupo com acidemia, comparado ao grupo com pH>7,2, apresentou associação significativa com os valores da RCP (mediana 0,47 versus 0,58; p=0,009), índice de pulsatilidade da artéria umbilical (mediana 2,45 versus 1,93; p=0,003), índice de pulsatilidade para veias (IPV) do ducto venoso (mediana 1,08 versus 0,85; p=0,034) e perfil biofísico fetal suspeito ou alterado (37 versus 8 por cento; p=0,031). A análise da RCP pelo seu z-score demonstrou tendência de maior afastamento negativo da média, mas sem atingir valor significativo (p=0,08). Foi constatada correlação significativa entre o pH no nascimento e a RCP (r=0,45; p<0,01), o z-score da RCP (r=0,27; p<0,05) e o IPV do ducto venoso (r=-0,35 p<0,01). CONCLUSÃO: A RCP associa-se à presença de acidemia no nascimento nas gestações com insuficiência placentária antes da 34ª semana, e esse parâmetro pode configurar potencial fator para avaliação da gravidade do comprometimento fetal.

PURPOSE: to evaluate the hypothesis that the fetal cerebroplacental ratio (CPR) is related to acidemia at birth in pregnancies complicated by placental insufficiency detected before 34 weeks of gestation. METHODS: this is a prospective cohort study of 55 patients between 26 and 34 weeks of gestation with a diagnosis of placental insufficiency characterized by abnormal umbilical artery Doppler (pulsatility index>95p). Fetal assessment was performed for each patient by dopplervelocimetry of the umbilical artery, middle cerebral artery and ductus venosus, and by the fetal biophysical profile. CPR was calculated using the ratio between middle cerebral artery pulsatility index and umbilical artery pulsatility index, and the z-score was obtained (number of standard deviations of the mean value at each gestational age). Acidemia at birth was characterized when pH<7.2. RESULTS: of 55 patients, 29 (52.7 percent) presented acidemia at birth. In the group of fetal acidemia, when compared with the group with pH>7.2, a significant association was observed with CPR values (median 0.47 versus 0.58; p=0.009), pulsatility index of the umbilical artery (median 2.45 versus 1.93; p=0.003), ductus venosus pulsatility index for veins (PIV) (median 1.08 versus 0.85; p=0.034) and suspected or abnormal fetal biophysical profile (37 versus 8 percent; p=0.031). CPR analysis by z-score showed a negative tendency, but was not statistically significant (p=0.080). Significant correlations were found between pH at birth and CPR (r=0.45; p<0.01), z-score of CPR (r=0.27; p<0.05) and ductus venosus PIV (r=-0.35 p<0.01). CONCLUSION: CPR is associated with the presence of acidemia at birth in pregnancies with placental insufficiency detected before 34 weeks of gestation and this parameter could potentially represent a factor for assessing the severity of fetal involvement.

Comparação dos padrões da frequência cardíaca fetal no segundo e terceiro trimestres da gestação / Comparison of fetal heart rate patterns in the second and third trimesters of pregnancy

OBJETIVO: comparar os padrões da frequência cardíaca fetal (FCF) do segundo e terceiro trimestres da gestação. MÉTODOS: estudo prospectivo, comparativo, realizado no período de Janeiro de 2008 e Julho de 2009 com os seguintes critérios de inclusão: gestação única, feto vivo, ausência de intercorrências clínicas ou obstétricas, ausência de malformação fetal, com idade gestacional entre 24 e 27 semanas (segundo trimestre - 2ºT) ou entre 36 e 40 semanas (terceiro trimestre - 3ºT). Foram realizados os exames de cardiotocografia computadorizada (Sistema 8002 - Sonicaid) por período de 30 minutos e o perfil biofísico fetal. O Sistema 8002 analisa o traçado da FCF em períodos de 3,75 segundos (1/16 de minuto). Em cada período, a duração média dos intervalos de tempo entre sucessivos batimentos cardíacos fetais foi avaliada e mensurada em milisegundos (ms). A FCF média foi calculada em cada período, e também as diferenças entre períodos adjacentes. Os parâmetros incluíram: FCF basal, acelerações transitórias, duração dos episódios de alta variação, duração dos episódios de baixa variação e variação de curto prazo. Os resultados foram analisados pelos testes t de Student, teste do qui-quadrado e teste exato de Fischer. Foi adotado nível de significância de 0,05. RESULTADOS: dezoito gestações de 2ºT foram comparadas com 25 gestações de 3ºT. Houve diferença significativa nos parâmetros da FCF avaliada pela cardiotocografia computadorizada quando comparados os fetos de 2ºT e os de 3ºT em relação aos seguintes resultados: média da FCF basal (143,8 bpm versus 134,0 bpm, p=0,009), média do número de acelerações transitórias >10 bpm (3,7 versus 8,4, p<0,001) e >15 bpm (0,9 bpm versus 5,4 bpm, p<0,001), duração média dos episódios de alta variação (8,4 min x 15,4 min, p=0,008) e média da variação de curto prazo (8,0 ms versus10,9 ms, p=0,01). Em todos os exames o perfil biofísico fetal apresentou resultado normal. CONCLUSÕES: o presente estudo constata diferenças significativas nos padrões avaliados entre gestações de segundo e terceiro trimestres, e indica a influência da maturação do sistema nervoso autonômico na regulação da FCF.

PURPOSE: to compare the patterns of fetal heart rate (FHR) in the second and third trimesters of pregnancy. METHODS: a prospective and comparative study performed between January 2008 and July 2009. The inclusion criteria were: singleton pregnancy, live fetus, pregnant women without clinical or obstetrical complications, no fetal malformation, gestational age between 24 and 27 weeks (2nd trimester - 2T) or between 36 and 40 weeks (3rd trimester - 3T). Computerized cardiotocography (System 8002 - Sonicaid) was performed for 30 minutes and the fetal biophysical profile was obtained. System 8002 analyzes the FHR tracings for periods of 3.75 seconds (1/16 minutes). During each period, the mean duration of the time intervals between successive fetal heart beats is determined in milliseconds (ms); the mean FHR and also the differences between adjacent periods are calculated for each period. The parameters included: basal FHR, FHR accelerations, duration of high variation episodes, duration of low variation episodes and short-term variation. The dataset was analyzed by the Student t test, chi-square test and Fisher's exact test. Statistical significance was set at p<0.05. RESULTS: eighteen pregnancies on the second trimester were compared to 25 pregnancies on the third trimester. There was a significant difference in the FHR parameters evaluated by computerized cardiotocography between the 2T and 3T groups, regarding the following results: mean basal FHR (mean, 143.8 bpm versus 134.0 bpm, p=0.009), mean number of transitory FHR accelerations > 10 bpm (3.7 bpm versus 8.4 bpm, p <0.001) and >15 bpm (mean, 0.9 bpm versus 5.4 bpm, p <0.001), mean duration of high variation episodes (8.4 min versus 15.4 min, p=0.008) and mean short - term variation (8.0 ms versus 10.9 ms, p=0.01). The fetal biophysical profile showed normal results in all pregnancies. CONCLUSION: the present study shows significant differences in the FHR characteristics when the 2nd and 3rd trimesters of pregnancy are compared and confirms the influence of autonomic nervous system maturation on FHR regulation.

[Assessment of fetal vitality and perinatal results in pregnancies after gastroplasty with Roux-en-Y gastric bypass]. / Avaliação da vitalidade fetal e resultados perinatais em gestações após gastroplastia com derivação em Y de Roux.

OBJECTIVE: To study fetal vitality assessed in pregnancies after gastroplasty with Roux-en-Y gastric bypass and verify maternal complications and perinatal results. METHODS: Hospital charts of all pregnancies after gastroplasty with Roux-en-Y gastric bypass were reviewed retrospectively. All cases followed at the specialized prenatal care that gave birth in this institution, between July 2001 and September 2009, were reviewed. The assessment of fetal vitality (cardiotocography, fetal biophysical profile and umbilical artery Doppler velocimetry) performed in the last week before delivery were analyzed. The maternal variables investigated were: demographic data, maternal complications, mode of delivery, complications during delivery and postpartum, maternal blood exams and perinatal results. RESULTS: During the study period 30 pregnancies after gastroplasty with Roux-en-Y gastric bypass were identified and 24 of them had undergone assessment of fetal vitality. All patients presented normal cardiotocography, normal fetal biophysical profile and normal results at the umbilical artery Doppler velocimetry. One case presented with oligohydramnios. The main complication observed was maternal anemia (Hb < 11.0 g/dL, 86.7%). Cesarean section was performed in 21 pregnancies (70%). Delivery complications included one case of adherences, one hematoma and infection of abdominal wall scar and one postpartum hysterectomy for myoma and uterine atony. The proportion of small infants for gestational age was 23.3%. CONCLUSION: Fetal vitality was not compromised in pregnancies after gastroplasty with Roux-en-Y gastric bypass. The main maternal complication was anemia, therefore these women require specific nutritional counseling and a broad evaluation for micronutrient deficiencies at early pregnancy.