Variation of the Oxidative Profile in Pregnant Women With and Without Gestational Complications.

INTRODUCTION: Oxidative stress is closely related to the pathophysiology of gestation, where the placenta is susceptible to oxidative damage, contributing to the onset of gestational complications. Currently, few studies evaluate the use of oxidative markers for prediction of risk of gestational complications. However, there are some reports that suggest these biomarkers as potential prognostic biomarkers. Therefore, the objective of this study was to compare the biomarkers of oxidative stress from gestations with and without complications, and also evaluate the delta of variation in these markers from the first gestational trimester. MATERIAL AND METHODS: A total of 45 pregnant women were evaluated during the three gestational trimesters, of whom 15 developed gestational complications by the end of gestation. The evaluated oxidative damage markers were thiobarbituric acid reactive substances and nitric oxide dosage. Evaluation of the antioxidant system was performed by the quantification of vitamin C, sulfhydryl groups, total antioxidant capacity, plasmatic iron reduction ability, the evaluation of catalase and delta-aminolevulinate dehydratase enzymatic activity. RESULTS: According to the results, the markers of oxidative damage are increased, and the antioxidant profile decreased, in the third trimester of complicated pregnancies as compared to uncomplicated pregnancies. Moreover, the delta of variation in both oxidative damage markers and antioxidants was higher in complicated gestations as compared to uncomplicated gestations, thus suggesting a higher oxidative stress in pregnancies with complications. CONCLUSIONS: Oxidative stress parameters appear altered in pregnant women with gestational complications. The markers to oxidative stress can be possible biomarkers, helping in understanding mechanisms underlying the associations between complications during pregnancy and various health outcomes.

Activity of the enzyme delta-aminolevulinate dehydratase and parameters of oxidative stress in different modes of delivery.

AIMS: The objective of this study was to investigate the effect of the type of delivery (vaginal and cesarean) on the activity of the enzyme delta-aminolevulinate dehydratase (δ-ALA-D), which as yet has not been studied, and the markers of oxidative stress. METHODS: Seventy-six mothers and their newborns were divided into two groups: normal birth (VD) and elective cesarean section (ECS). Samples of maternal and umbilical cord blood were collected up to 5 min after birth. Thiobarbituric acid reactive substances (TBARS), advanced oxidation protein products (AOPP), protein thiol (P-SH), nonprotein (NP-SH), the ferric reducing ability of plasma (FRAP), total antioxidant capacity (TAC), catalase, and δ-ALA-D enzyme activity were tested. RESULTS: TBARS and AOPP were significantly higher in mothers of the VD group, while P-SH, NP-SH, FRAP and TAC were reduced. In newborns, TBARS and AOPP did not differ between the groups; however, in the VD group, there was a decrease in P-SH, NP-SH, FRAP, TAC, and catalase. The activity of the δ-ALA-D enzyme was decreased in mothers and neonates born by VD. CONCLUSIONS: Mothers undergoing VD had higher levels of free radicals and lower antioxidant defenses, while their newborns decreased antioxidant defenses likely to contain the oxidative imbalance. The inhibition of the δ-ALA-D enzyme in this scenario allows its use as a useful marker of oxidative stress in different obstetric settings.

Influence of maternal labor time on delta-aminolevulinate dehydratase enzyme activity and markers of oxidative stress in newborns.

The purpose is to determine markers of oxidative stress related to the longer and shorter duration of labor (DOL) of pregnant women in the umbilical cord blood of neonates, not yet studied. Blood samples from the umbilical cord were collected from pregnant women with normal delivery and classified according to DOL in two groups: a group with DOL less than 310 min (n = 33) and a group with DOL greater than or equal to 310 min (n = 35). The oxidative stress parameters were analyzed by the quantification of thiobarbituric acid reactive substances (TBARS), nitrate/nitrite (NOx), protein thiol groups (P-SH) and non-protein (NP-SH), vitamin C and plasma iron reduction capacity (FRAP), in addition to the activity of the enzyme delta-aminolevulinate dehydratase (δ-ALA-D). The activity of the δ-ALA-D enzyme was shown to be decreased in longer DOL, however, the oxidant parameters and antioxidants were higher in the longer DOL, with the exception of NP-SH that was lower. The longer maternal DOL time is related to the alteration of δ-ALA-D enzyme activity and other parameters in neonates, suggesting an increase in the passage of maternal oxidative markers by umbilical cord blood.

Longitudinal Study of Delta-Aminolevulinate Dehydratase Activity and Oxidative Profile in Healthy Pregnant Women.

Pregnancy is characterized by changes in various organs, triggering changes in the use of energy substrates and increased oxygen consumption. In addition, gestation is an oxidative event that can be assessed by the relationship between free radicals and antioxidants produced by the body. Excessive production of free radicals has detrimental effects such as damage to enzymes, carbohydrates, and DNA. Thus, the objective of this study was to evaluate the oxidative status and antioxidant responses throughout pregnancy through a longitudinal study. Reactive oxygen species were analyzed by means of thiobarbituric acid reactive substances and nitric oxide, the antioxidant system through vitamin C, sulfhydryl groups, total antioxidant capacity, and ferric reducing ability of plasma as well as enzymes such as catalase and delta-aminolevulinate-dehydratase in pregnant women in the three gestational trimesters (n = 30). According to the results, the markers of oxidative damage showed significant differences in the different gestational trimesters where they were increased in the second trimester when compared to the first trimester. The antioxidant defenses responded differently in each gestational trimester, suggesting a response pattern to try to combat the damage caused by free radicals, in order to stabilize the increase of oxidative stress caused in the second gestational trimester.

Perinatal outcome of hypertensive pregnant women is related to the severity of preeclampsia

Introduction: Hypertension in pregnancy plays a key role in perinatal morbidity and mortality. This study aims to analyze maternal and perinatal outcomes associated with hypertension in pregnant women. Methods: A prospective longitudinal study was conducted at the University Hospital of Santa Maria, RS, Brazil, involving hypertensive pregnant women admitted for delivery. The results were analyzed using the chi-square test and the Mann-Whitney test. Results: Of the 162 hypertensive pregnant women studied, 61.1% were diagnosed with preeclampsia. Cesarean section was the most frequent mode of delivery (79.6%). Overall, 46.2% of newborns were premature; of these, 23.4% required intensive neonatal care. Preeclampsia and severe preeclampsia were associated with prematurity in 56.2% of cases (p = 0.011) and 75.7% of cases (p = 0.004), respectively. Severe preeclampsia was associated with neonatal complications (45.9%), and no neonatal complications were associated with mild preeclampsia in 78% (p = 0.014) and gestational hypertension in 96% (p = 0.001). Neonatal deaths occurred in 11.1% of cases admitted to the neonatal intensive care unit, corresponding to a neonatal mortality rate of 24 per 1,000 live births. Conclusions: The association of severe preeclampsia with prematurity and adverse perinatal outcomes corroborates the need . (AU)

Pregnancy in Non-Communicating Unicornuate Uterus: Diagnosis Difficulty and Outcomes - a Case Report / Gestação em útero unicorno não comunicante: dificuldade diagnóstica e desfechos - relato de caso

Abstract Approximately 1 in every 76,000 pregnancies develops within a unicornuate uterus with a rudimentary horn.Müllerian uterus anomalies are often asymptomatic, thus, the diagnosis is a challenge, and it is usually made during the gestation or due to its complications, such as uterine rupture, pregnancy-induced hypertension, antepartum, postpartum bleeding and intrauterine growth restriction (IUGR). In order to avoid unnecessary cesarean sections and the risks they involve, the physicians should consider the several approaches and for how long it is feasible to perform labor induction in suspected cases of pregnancy in a unicornuate uterus with a rudimentary horn, despite the rarity of the anomaly. This report describes a case of a unicornuate uterus in which a pregnancy developed in the non-communicating rudimentary horn and the consequences of the delayed diagnosis.

Resumo Aproximadamente 1 em cada 76 mil gestações se desenvolvememútero unicorno sem comunicação com o colo uterino. Anomalias müllerianas uterinas são, na maioria das vezes, assintomáticas, tornando difícil o diagnóstico, que geralmente é esclarecido durante a gestação ou por conta das complicações gestacionais, como ruptura uterina, hipertensão gestacional, parto pré-termo, hemorragias pós-parto e crescimento intrauterino restrito (CIUR). Com o intuito de evitar cesáreas desnecessárias e os riscos que esse procedimento envolve, considerações devem ser feitas quanto aos diferentes métodos utilizados, e por quanto tempo é viável induzir o parto na possibilidade de útero não comunicante, mesmo sendo uma anomalia rara. Este relato descreve um caso de uma gestação que se desenvolveu em um útero unicorno não comunicante com o colo uterino e as consequências do diagnóstico tardio.

Pregnancy in Non-Communicating Unicornuate Uterus: Diagnosis Difficulty and Outcomes - a Case Report.

Approximately 1 in every 76,000 pregnancies develops within a unicornuate uterus with a rudimentary horn. Müllerian uterus anomalies are often asymptomatic, thus, the diagnosis is a challenge, and it is usually made during the gestation or due to its complications, such as uterine rupture, pregnancy-induced hypertension, antepartum, postpartum bleeding and intrauterine growth restriction (IUGR). In order to avoid unnecessary cesarean sections and the risks they involve, the physicians should consider the several approaches and for how long it is feasible to perform labor induction in suspected cases of pregnancy in a unicornuate uterus with a rudimentary horn, despite the rarity of the anomaly. This report describes a case of a unicornuate uterus in which a pregnancy developed in the non-communicating rudimentary horn and the consequences of the delayed diagnosis.

Aproximadamente 1 em cada 76 mil gestações se desenvolvem em útero unicorno sem comunicação com o colo uterino. Anomalias müllerianas uterinas são, na maioria das vezes, assintomáticas, tornando difícil o diagnóstico, que geralmente é esclarecido durante a gestação ou por conta das complicações gestacionais, como ruptura uterina, hipertensão gestacional, parto pré-termo, hemorragias pós-parto e crescimento intrauterino restrito (CIUR). Com o intuito de evitar cesáreas desnecessárias e os riscos que esse procedimento envolve, considerações devem ser feitas quanto aos diferentes métodos utilizados, e por quanto tempo é viável induzir o parto na possibilidade de útero não comunicante, mesmo sendo uma anomalia rara. Este relato descreve um caso de uma gestação que se desenvolveu em um útero unicorno não comunicante com o colo uterino e as consequências do diagnóstico tardio.

Levantamento epidemiológico de fetos malformados em serviço de medicina fetal / Epidemiological survey of malformed fetuses in a maternal-fetal medicine unit

Objetivo: determinar as malformações fetais prevalentes em um serviço de medicina fetal e seus fatores de risco. Método: pesquisa em fontes de dados secundários, a ser realizada com fetos malformados de gestantes atendidas no Hospital Universitário de da Universidade Federal de Santa Maria, RS, Brasil, no período de 2010a 2013. A coleta de dados acontecerá por meio de uma busca nos laudos de ultrassonografia no Serviço de Medicina Fetal e nos prontuários das gestantes e dos recém-nascidos diagnosticados com malformações. O estudo teve o projeto aprovado pelo Comitê de Ética e Pesquisa da Universidade Federal de Santa Maria, sob o número CAAE 7862314.5.0000.5346. Resultados esperados: possibilitar a identificação da prevalência de malformações fetais em um serviço de pré-natal de alto risco, assim como os principais fatores de risco.

Effect of maternal exercises on biophysical fetal and maternal parameters: a transversal study / Efeito do exercício materno em parâmetros biofísicos maternofetais: um estudo transversal

ABSTRACT Objective To evaluate the acute effects of maternal and fetal hemodynamic responses in pregnant women submitted to fetal Doppler and an aerobic physical exercise test according to the degree of effort during the activity and the impact on the well-being. Methods Transversal study with low risk pregnant women, obtained by convenience sample with gestational age between 26 to 34 weeks. The participants carry out a progressive exercise test. Results After the exercise session, reduced resistance (p=0.02) and pulsatility indices (p=0.01) were identified in the umbilical artery; however, other Doppler parameters analyzed, in addition to cardiotocography and fetal biophysical profile did not achieve significant change. Maternal parameters obtained linear growth with activity, but it was not possible to establish a standard with the Borg scale, and oxygen saturation remained stable. Conclusion A short submaximal exercise had little effect on placental blood flow after exercise in pregnancies without complications, corroborating that healthy fetus maintains homeostasis even in situations that alter maternal hemodynamics.

RESUMO Objetivo Avaliar os efeitos agudos de respostas hemodinâmicas maternas e fetais em gestantes submetidas a Doppler fetal e a um teste de exercício físico aeróbio, de acordo com o grau de esforço durante a atividade e o impacto sobre o bem-estar. Métodos Estudo transversal desenvolvido com gestantes de baixo risco, por amostra de conveniência com idade gestacional entre 26 e 34 semanas. As participantes realizam um teste de esforço progressivo. Resultados Na artéria umbilical, após sessão de exercício físico, identificou-se a redução do índice de resistência (p=0,02) e do índice de pulsatilidade (p=0,01), mas os demais parâmetros Doppler analisados, além da cardiotocografia e do perfil biofísico fetal, não obtiveram alteração significativa. Os parâmetros maternos obtiveram crescimento linear com a atividade, mas não foi possível estabelecer padrão com a escala de Borg, e a saturação de oxigênio se manteve estável. Conclusão O esforço submáximo curto teve pouco efeito sobre o fluxo de sangue da placenta após o exercício em gestações sem complicações, corroborando que o feto hígido mantém a homeostase mesmo em situações que alterem a hemodinâmica materna.

Effect of maternal exercises on biophysical fetal and maternal parameters: a transversal study.

OBJECTIVE: To evaluate the acute effects of maternal and fetal hemodynamic responses in pregnant women submitted to fetal Doppler and an aerobic physical exercise test according to the degree of effort during the activity and the impact on the well-being. METHODS: Transversal study with low risk pregnant women, obtained by convenience sample with gestational age between 26 to 34 weeks. The participants carry out a progressive exercise test. RESULTS: After the exercise session, reduced resistance (p=0.02) and pulsatility indices (p=0.01) were identified in the umbilical artery; however, other Doppler parameters analyzed, in addition to cardiotocography and fetal biophysical profile did not achieve significant change. Maternal parameters obtained linear growth with activity, but it was not possible to establish a standard with the Borg scale, and oxygen saturation remained stable. CONCLUSION: A short submaximal exercise had little effect on placental blood flow after exercise in pregnancies without complications, corroborating that healthy fetus maintains homeostasis even in situations that alter maternal hemodynamics. OBJETIVO: Avaliar os efeitos agudos de respostas hemodinâmicas maternas e fetais em gestantes submetidas a Doppler fetal e a um teste de exercício físico aeróbio, de acordo com o grau de esforço durante a atividade e o impacto sobre o bem-estar. MÉTODOS: Estudo transversal desenvolvido com gestantes de baixo risco, por amostra de conveniência com idade gestacional entre 26 e 34 semanas. As participantes realizam um teste de esforço progressivo. RESULTADOS: Na artéria umbilical, após sessão de exercício físico, identificou-se a redução do índice de resistência (p=0,02) e do índice de pulsatilidade (p=0,01), mas os demais parâmetros Doppler analisados, além da cardiotocografia e do perfil biofísico fetal, não obtiveram alteração significativa. Os parâmetros maternos obtiveram crescimento linear com a atividade, mas não foi possível estabelecer padrão com a escala de Borg, e a saturação de oxigênio se manteve estável. CONCLUSÃO: O esforço submáximo curto teve pouco efeito sobre o fluxo de sangue da placenta após o exercício em gestações sem complicações, corroborando que o feto hígido mantém a homeostase mesmo em situações que alterem a hemodinâmica materna.

Levantamento epidemiológico de gestantes atendidas em serviço de medicina fetal / Epidemiological study of pregnant women cared for in a maternal-fetal unit / Estudio epidemiológico de mujeres embarazadas atendidas en una unidad de medicina materno-fetal

Objetivo: determinar quais são as patologias prevalentes em um serviço de medicina fetal e seus fatores de risco. Método: pesquisa transversal documental retrospectiva, a qual será realizada com 1.721 gestantes atendidas no Hospital Universitário de Santa Maria, Estado do Rio grande do Sul, Brasil, no período de 2010 a 2013. A coleta de dados será realizada por meio de uma busca nos laudos de ultrassonografia no Serviço de Medicina Fetal e nos prontuários das referidas gestantes. A análise dos dados será realizada utilizando o software Assistat, versão 7.7 beta (cópia distribuída gratuitamente). O estudo teve o projeto de pesquisa aprovado pelo Comitê de Ética em Pesquisa, sob o número CAAE 7862314.5.0000.5346. Resultados esperados: verificar os fatores de risco para as patologias identificadas, possibilitando a alteração na condução clinica para melhor prognostico no binômio mãe/feto.(AU)

Objective: to determine prevalent diseases in a maternal-fetal unit and their risk factors. Method: retrospective, documentary, and cross-sectional study, which will be conducted with 1,721 pregnant women cared for at the Santa Maria University Hospital, State of Rio Grande do Sul, Brazil, from 2010 to 2013. Data collection will be carried out through a search using ultrasonography reports of the Maternal-Fetal Unit and the medical records of those pregnant women. Data analysis will be performed using the Assistat, version 7.7 beta software (free software). The research project was approved by the Research Ethics Committee, under opinion No. CAAE 7862314.5.0000.5346. Expected results: to find the risk factors for diseases identified, enabling changes in the clinical performance in order to obtain better prognosis in the mother-fetus binomial.(AU)

Objetivo: determinar las patologías prevalentes en una unidad de medicina fetal y sus factores de riesgo. Método: estudio retrospectivo documental transversal que se llevará a cabo con 1.721 mujeres embarazadas atendidas en el Hospital Universitario de Santa Maria, Estado de Rio Grande do Sul, Brasil, en el período comprendido entre 2010 y 2013. La recolección de datos se realizará mediante una búsqueda en los informes de ultrasonografía de la Unidad de Medicina Materno-Fetal y en los registros médicos de esas mujeres embarazadas. El análisis de datos se realizará usando el software Assistat, versión 7.7 beta (software libre). El proyecto de investigación fue aprobado por el Comité de Ética en Investigación, N° CAAE 7862314.5.0000.5346. Resultados esperados: comprobar los factores de riesgo de las patologías identificadas, lo que permitirá cambios en el desempeño clínico para obtener mejor pronóstico en el binomio madre-feto.(AU)

Tabagismo e gestação: análise de uma amostra de conveniência de puérperas do Hospital Universitário de Santa Maria / Smoking and pregnancy: analysis of a convenience sample of postpartum women in the University Hospital of Santa Maria

Introdução: Estudar prospectivamente a prevalência do tabagismo na gestação em uma amostra de puérperas, suas principais características epidemiológicas e possíveis complicações neonatais associadas, no Hospital Universitário de Santa Maria. Método: O protocolo foi aplicado às puérperas, no período de novembro de 2012 a julho de 2013. Excluídas gestações gemelares. O protocolo constava de 24 questões de respostas diretas às puérperas e 6 questões relacionadas aos resultados perinatais, que foram revisados em prontuário. Resultados: Foram entrevistadas 817 puérperas, 142 (16,3%) tabagistas. A maior proporção de tabagistas estava na faixa etária de 19-34 anos (75,35%), com menor escolaridade e renda familiar. Não foi encontrada associação significativa entre o tabagismo na gestação e baixo peso ao nascer, prematuridade, escores de apgar no 1° e 5° minutos e outras intercorrências neonatais. Conclusão: Os resultados em relação à escolaridade e renda familiar foram semelhantes aos descritos por outros autores em gestantes tabagistas. No entanto, foram encontradas diferenças em relação à distribuição de idade, seguimento pré-natal e baixo peso ao nascer (AU)

Introduction: To study the prevalence of smoking during pregnancy in a sample of postpartum women, their main epidemiological characteristics and possible neonatal complications associated, at the University Hospital of Santa Maria. Methods: The protocol was applied to the postpartum women in the period from Nov 2012 to Jul 2013, excluding twin pregnancies. The protocol consisted of 24 direct questions to postpartum women and 6 questions related to perinatal outcomes, which were reviewed from medical records. Results: We interviewed 817 postpartum women, 142 (16.3%) smokers. The proportion of smokers was higher in mothers at the 19-34 years (75.35%) age group, with less education and lower income. No significant association was found between smoking during pregnancy and low birth weight, prematurity, Apgar scores at 1 and 5 minutes, and other neonatal complications. Conclusion: The results concerning education and family income were similar to those described by other authors in pregnant smokers. However, differences in the distribution of age, prenatal care and low birth weight were found (AU)

[Effects of physical exercise on the fetal hemodynamic parameters]. / Efeito do exercício físico sobre os parâmetros hemodinâmicos fetais.

PURPOSE: To assess the effects of aerobic physical exercise on the Doppler velocimetry of fetal vessels in pregnant women with no clinical or obstetrical complications. METHODS: A cross-sectional study was conducted on 10 healthy low-risk pregnant women at 2 different gestational times: between the 26th and 29th week and 6 days, and at the end of pregnancy, between the 30th and 35th week. The patients were submitted to aerobic physical exercise on a treadmill until reaching fatigue. Ultrasonographic data were obtained at rest and after physical exercise (Doppler velocimetry indices for the umbilical artery, middle cerebral artery, ductus venosus, and uterine arteries). Data were analyzed statistically by the paired and independent Student's t-test using the Statistical Package for the Social Sciences (SPSS) package, version 21.0. RESULTS: A change in the pulsatility index was observed, with an indication of vasodilatation, with a median value of 1.1±0.1 before exercise and of 1.0±0.1 after exercise; the median value of the resistance index was 0.7±0.04 before exercise and 0.6±0.07 after exercise. The median systole/diastole ratio of the umbilical artery was 3.1±0.4 before exercise and 2.9±0.2 (p=0.03) after exercise at the beginning of pregnancy. No changes in the Doppler velocimetry parameters were observed for the uterine arteries, the middle cerebral artery or the ductus venosus after physical activity at either testing time. Paired analysis of pre- and post-activity data showed a reduction of resistance from the first to the second period (p<0.04). CONCLUSIONS: Physical exercise does not lead to changes in systemic blood flow or fetal-placental flow in healthy pregnant women, confirming that exercises of mild to moderate intensity can be prescribed.

Efeito do exercício físico sobre os parâmetros hemodinâmicos fetais / Effects of physical exercise on the fetal hemodynamic parameters

OBJETIVO: Avaliar as alterações das repercussões fetais ao estudo da dopplervelocimetria após sessão de exercício físico aeróbico em gestantes sem complicações clínicas ou obstétricas. MÉTODOS: A pesquisa compreendeu um estudo transversal realizado com 10 gestantes hígidas, de baixo risco, em 2 períodos gestacionais distintos (início da gravidez: 26ª à 29ª semana e 6 dias; final da gravidez: 30ª à 35ª semana), que foram submetidas a exercício físico aeróbico em esteira até a fadiga. Foram obtidos os dados ultrassonográficos de repouso e após o exercício (índices da dopplervelocimetria da artéria umbilical, da cerebral média, do ducto venoso e das artérias uterinas). A análise foi efetuada por meio do teste t de Student pareado e independente, com o Statistical Package for the Social Sciences (SPSS) versão 21.0. RESULTADOS: Demonstrou-se vasodilatação do índice de pulsatilidade com valor mediano pré-exercício físico de 1,1±0,1 e pós-exercício de 1,0±0,1, índice de resistência apresentando valor mediano pré-exercício físico de 0,7±0,04 e pós de 0,6±0,07 e da relação sístole/diástole da artéria umbilical com p=0,03 (valor mediano pré-exercício físico de 3,1±0,4 e pós de 2,9±0,2) após a atividade física no início da gravidez. Não foi demonstrada alteração nos parâmetros da dopplervelocimetria das artérias uterinas, da cerebral média e do ducto venoso após a atividade física em nenhum dos períodos estudados. Ao analisarmos de forma pareada pré e pós-atividade física entre os períodos, o estudo hemodinâmico das artérias umbilicais ...

PURPOSE: To assess the effects of aerobic physical exercise on the Doppler velocimetry of fetal vessels in pregnant women with no clinical or obstetrical complications. METHODS: A cross-sectional study was conducted on 10 healthy low-risk pregnant women at 2 different gestational times: between the 26th and 29th week and 6 days, and at the end of pregnancy, between the 30th and 35th week. The patients were submitted to aerobic physical exercise on a treadmill until reaching fatigue. Ultrasonographic data were obtained at rest and after physical exercise (Doppler velocimetry indices for the umbilical artery, middle cerebral artery, ductus venosus, and uterine arteries). Data were analyzed statistically by the paired and independent Student's t-test using the Statistical Package for the Social Sciences (SPSS) package, version 21.0. RESULTS: A change in the pulsatility index was observed, with an indication of vasodilatation, with a median value of 1.1±0.1 before exercise and of 1.0±0.1 after exercise; the median value of the resistance index was 0.7±0.04 before exercise and 0.6±0.07 after exercise. The median systole/diastole ratio of the umbilical artery was 3.1±0.4 before exercise and 2.9±0.2 (p=0.03) after exercise at the beginning of pregnancy. No changes in the Doppler velocimetry parameters were observed for the uterine arteries, the middle cerebral artery or the ductus venosus after physical activity at either testing time. Paired analysis of pre- and post-activity data showed a reduction of resistance from the first to the second period (p<0.04). CONCLUSIONS: Physical exercise does not lead to changes in systemic blood flow or fetal-placental flow in healthy pregnant women, confirming that exercises of mild to moderate intensity can be prescribed. .

Doenças malignas ovarianas: importância atual da ultrassonografia no rastreamento e manejo terapêutico / Ovarian malignancies diseases: current importance of ultrasonography in screening and therapeutic management

A ultrassonografia transvaginal é um método largamente utilizado na prática ginecológica, associada à história clínica, exame físico e marcadores tumorais, em especial a dosagem de CA-125, na propedêutica ovariana. As neoplasias malignas ovarianas possuem caráter mundial, distribuindo-se em todas as faixas etárias, em especial na pós-menopausa. Têm grande impacto na morbi-mortalidade dessas pacientes, por ser considerada uma patologia silenciosa, de difícil detecção precoce. Há um crescente interesse, nos últimos anos, na tentativa de melhorar o diagnóstico e prognóstico nessa doença. Nesta atualizada revisão de literatura, apresentam-se graus de evidências científicos quanto à importância da ultrassonografia como método de rastreamento, na programação cirúrgica adequada e, o estudo Doppler e tridimensional das massas anexiais.

A transvaginal ultrasound is a method widely used in gynecological practice, associated with the clinical history, physical examination and tumor markers, especially serum CA-125 in ovarian workup. The ovarian malignancies have a global character, distributed in all age groups, especially in postmenopausal women. Have great impact on morbidity and mortality of these patients, because it is considered as a silent disease, difficult to detect early. There is a growing interest in recent years in an attempt to improve the diagnosis and prognosis in this pathology. In this present literature review there are some degrees of scientific evidence about the importance of ultrasound as a screening method in planning adequate surgical and Doppler and three of adnexal masses.

Avaliação da dilatação máxima da artéria braquial em gestantes e não gestantes, fumantes e não fumantes / Maximum dilation of the brachial artery in smoking and nonsmoking pregnant and non-pregnant women

OBJETIVO: Avaliar, por meio da dilatação mediada por fluxo da artéria braquial, em que tempo ocorre a máxima dilatação da artéria braquial e se existe diferença nesta avaliação ao comparar mulheres gestantes e não gestantes, fumantes e não fumantes. MATERIAIS E MÉTODOS: Estudo transversal, no qual o diâmetro da artéria braquial foi avaliado em quatro tempos após estímulo pressórico (30, 60, 90 e 120 segundos) em quatro grupos de mulheres entre 20 e 30 anos de idade assim distribuídos: mulheres gestantes entre 24 e 28 semanas de idade gestacional não fumantes (n = 47) e fumantes (n = 33), e mulheres não gestantes não fumantes (n = 34) e fumantes (n = 19). RESULTADOS: A avaliação da dilatação da artéria braquial nos diferentes tempos após o estímulo pressórico foi máxima para todos os grupos no tempo "60 segundos" após a desinsuflação (p < 0,01). A dilatação mediada por fluxo da artéria braquial foi maior entre as mulheres gestantes não fumantes em comparação às fumantes (p = 0,03), assim como no grupo de mulheres não gestantes não fumantes em comparação às fumantes (p = 0,03). CONCLUSÃO: O hábito de fumar não interferiu no tempo em que ocorre a máxima dilatação da artéria braquial.

OBJECTIVE: To evaluate the time required to achieve maximum brachial artery dilation by means of flow-mediated dilation, as well as the differences in such dilation as four groups of smoking and nonsmoking pregnant and non-pregnant women are compared. MATERIALS AND METHODS: Cross-sectional study where the brachial artery diameter was measured considering four time spans following pressoric stimulus (30, 60, 90 and 120 seconds) in four groups of women in the age range between 20 and 30 years as follows: nonsmoking pregnant women (n = 47) and smoking pregnant women (n = 33) with gestational age between 24 and 28 weeks, nonsmoking (n = 34) and smoking (n = 19) non-pregnant women. RESULTS: The evaluation of dilation of the brachial artery at the different time spans following pressoric stimulus demonstrated maximum dilation for all the groups at "60 seconds" following the cuff deflation (p < 0.01). Brachial artery flow-mediated dilation was greater among nonsmoking pregnant women as compared with smoking ones (p = 0.03), as well as in the group of nonsmoking, non-pregnant women as compared with the smoking ones (p = 0.03). CONCLUSION: The smoking habit does not interfere in the time span required to achieve maximum brachial artery dilation.

Aspectos atuais da oligodramnia avaliada pela ecografia e pelos resultados perinatais / Current aspects of oligohydramnios assessed by ultrasound and perinatal outcomes

O líquido amniótico (LA) é um importante componente do ambiente intrauterino, que apresenta inúmeras funções na manutenção da evolução da gestação, sendo amplamente estudado como componente da avaliação da vitalidade fetal. A avaliação ultrassonográfica do volume de LA tornou-se um componente da propedêutica gestacional, dotado de grande impacto sobre o controle obstétrico subsequente das pacientes que a realizam. Sinalizar a redução do volume de LA, frequentemente, implica em submeter a paciente à intervenções adicionais, a despeito da normalidade dos demais parâmetros de avaliação da vitalidade fetal. Entretanto, as técnicas mais utilizadas (índice de LA e medida de bolsão único) para avaliação da oligodramnia na predição de resultados perinatais apresentam resultados fracos para predizê-los. A utilização da técnica proposta por Phelan leva a um aumento do número de diagnósticos de oligodramnia, quando comparada com a técnica do bolsão único sem, contudo, levar a melhora nos resultados perinatais. Neste estudo revisaremos a literatura atualizada acerca dos resultados do diagnóstico da oligodramnia pelo índice de LA, na predição dos resultados perinatais, bem como a sua comparação com os métodos de medida do bolsão único.

Amniotic fluid (AF) is an important component of the intrauterine environment responsible for many gestational maintaining functions, being widely studied as a marker of fetal vitality. Its ultrasonographic assessment became a component of gestational period follow-up, performing great impact on obstetrics decisions. Signing amniotic fluid volume reduction, frequently imply obstetrics interventions, despite of other fetal vitality normal parameters. However, the most used techniques (as AF index and single deepest vertical pocket measurement) showed poor results to predict perinatal outcomes. The use of Phelan technique (AF index) increases oligohydramnios diagnostic, compared to single deepest vertical pocket measurement without improving perinatal outcomes. In this study, current literature is reviewed surrounding AF index, the oligohydramnios diagnostic in predicting perinatal outcomes and its comparison with single deepest vertical pocket measurement.