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BACKGROUND: The correction of tuberous breast deformity with fat grafting has gained popularity in recent years, but it remains unclear whether this new technique can produce patient satisfaction levels comparable to those achieved with implant-based correction. METHODS: This study aimed to compare patients' satisfaction and quality of life using the BREAST-Q questionnaire after correction of tuberous breast deformity with fat grafting and implants. Twenty-four patients (36 breasts) were included in our study. Thirteen patients (15 breasts) had a correction with lipofilling (mean 2.67 interventions) and 11 patients (21 breasts) had an implant-based correction (mean 1 intervention). RESULTS: Both fat and implant treatments showed statistically significant improvements in breast satisfaction (p value=0.001, 0.002, respectively), psychosocial (p value=0.003, 0.003, respectively), and sexual satisfaction (p value=0.008, 0.002, respectively) between the pre-treatment and post-treatment stages. However, the only statistically significant differences between the treatments were observed in the physical condition pre-treatment (p value=0.008) and sexual condition post-treatment (p value=0.030). The outcome of both treatments was not statistically different. Furthermore, the outcome exhibited a statistically significant positive linear relationship with breast satisfaction for both treatments. CONCLUSIONS: This study suggests that lipofilling can achieve breast and outcome satisfaction comparable to that of implants, although this parity in results comes at the cost of more interventions. These preliminary results lend support to the notion that, as surgeons have access to two equally effective techniques, it is crucial to provide appropriate guidance to patients to ensure their satisfaction. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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STUDY OBJECTIVE: To estimate the diagnostic accuracy of three-dimensional ultrasonography (3D US) compared to hysteroscopy/laparoscopy, in the investigation of uterine congenital anomalies using the ESHRE/ESGE classification of female genital tract congenital anomalies. DESIGN: Prospective blind, comparative, cohort study. SETTING: University Tertiary Hospital and affiliated private Hospital. PATIENTS AND METHODS: Sixty-two women consecutively referred with a suspected diagnosis of uterine congenital anomalies. The ESHRE/ESGE classification of congenital anomalies of the female genital tract was used for the description of abnormal findings. INTERVENTIONS: All patients underwent (1) 3D US and (2) hysteroscopy with laparoscopy to establish the final diagnosis. RESULTS: Concordance between 3D US and hysteroscopy with laparoscopy about the type and the classification of uterine anomaly was verified in 61 cases, including all those with septate uterus, dysmorphic uterus, bicorporeal, hemi-uterus or unicorporeal, and aplastic uterus and one out of two with normal uterus. For the diagnosis of septate uteri, which was the most common anomaly, the sensitivity of 3D US was 100%, the specificity was 92.3%, the PPV was 98% and the NPV was 100%, with kappa index 0.950. For bicorporeal, dysmorphic uterus, hemi-uteri or unicorporeal and aplastic uterus the sensitivity, specificity, PPV and NPV were all 100% with K = 1.00. Overall, 3D US showed perfect diagnostic accuracy (Kappa index = 0.945) in the detection of congenital uterine anomalies. CONCLUSION: 3D US appears to be a very accurate method for the diagnosis of congenital uterine anomalies.
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Ultrassonografia/métodos , Anormalidades Urogenitais/classificação , Anormalidades Urogenitais/diagnóstico por imagem , Útero/anormalidades , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Gravidez , Estudos Prospectivos , Método Simples-Cego , Útero/diagnóstico por imagem , Adulto JovemRESUMO
PURPOSE: This study aimed to explore the feasibility of implementation of the ISUOG 2013 guidelines on routine second-trimester examination of the fetal heart. MATERIALS AND METHODS: This was a prospective study in 357 women with singleton pregnancy undergoing their routine second-trimester scan. The fetal heart was examined using B-mode in different planes according to the guidelines. Potential maternal and fetal factors that can affect the rates of diagnostic-quality imaging for each of the recommended views were tested, using regression analysis. The intra- and interobserver agreement was analyzed in stored video loops. RESULTS: Most cardiac structures could be successfully examined with rates at or close to 100â%. Structures with a successful examination rate of ≤â85â% included the ventricular wall fine details (55.2â%), tricuspid valve insertion (82.6â%), aortic root with clear walls (77.9â%), pulmonary artery walls (65.8â%) and clear view of the great artery walls (66.7â%). Common factors affecting the likelihood of successful examination of these structures included maternal BMI, skin-to-crux distance and the orientation of the cardiac axis. A post-hoc analysis indicated that a lack of pre-defined criteria for diagnostic quality was a constant reason for the interobserver variation. CONCLUSION: Most of the cardiac views can be consistently and reliably obtained, with maternal habitus being the primary factor limiting the quality of visualization. As offline interpretation may be subjective, using pre-defined quality criteria for the assessment of the images might improve interrater agreement.
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Coração Fetal , Ultrassonografia Pré-Natal , Estudos de Viabilidade , Feminino , Coração Fetal/diagnóstico por imagem , Humanos , Gravidez , Segundo Trimestre da Gravidez , Estudos ProspectivosRESUMO
OBJECTIVE: To compare normal ranges of ultrasonographically measured fetal nasal bone length in the second trimester between different ethnic groups. METHOD: A prospective, non-interventional study in order to establish normal ranges of fetal nasal bone length in the second trimester in a Greek population was conducted in 1220 singleton fetuses between 18 completed weeks and 23 weeks and 6 days of gestation. A literature search followed in order to identify similar studies in different population groups. Fetal nasal bone length mean values and percentiles from different population groups were compared. RESULTS: Analysis of measurements in the Greek population showed a linear association, i.e., increasing nasal bone length with increasing gestational age from 5.73 mm at 18 weeks to 7.63 mm at 23 weeks. Eleven studies establishing normal ranges of fetal nasal bone length in the second trimester were identified. Comparison of fetal nasal bone length mean values between the 12 population groups showed statistically significant differences (P<0.0001). CONCLUSION: Normal ranges of fetal nasal bone length in the second trimester vary significantly between different ethnic groups. Hence, distinct ethnic nomograms of fetal nasal bone length in the second trimester should be used in a given population rather than an international model.
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Etnicidade , Osso Nasal/diagnóstico por imagem , Feminino , Idade Gestacional , Grécia , Humanos , Gravidez , Segundo Trimestre da Gravidez , Estudos Prospectivos , Grupos Raciais , Valores de Referência , Ultrassonografia Pré-NatalRESUMO
This study aimed to characterize dietary protein patterns (DPPs) in a sample pool of 298 well-nourished pregnant women and explore potential associations between DPPs and neonatal anthropometrics. Maternal dietary data were collected using a validated food frequency questionnaire. Neonatal anthropometrics were abstracted from health booklets. A hierarchical cluster analysis identified three DPPs: "Dairy-focused", "Med-fusion", and "Traditional-inspired". The "Dairy-focused" DPP exhibited the highest protein intake (p < 0.001), predominantly animal protein (p < 0.001), while the "Traditional-inspired" DPP presented higher plant protein (p < 0.001) and fiber intakes (p < 0.001), and, therefore, a reduced carbohydrate-to-fiber quotient (p < 0.001). The "Med-fusion" DPP had the lowest protein-to-fat ratio (p < 0.001). Infants of women following the "Dairy-focused" DPP had the highest birth height centiles (p = 0.007) and the lowest ponderal index (p = 0.003). The NMR-metabolomics approach was implemented on a subset of women that provided amniotic fluid (AF) specimens (n = 62) to elucidate distinct metabolic signatures associated with DPPs. PCA and OPLS-DA models verified the adherence to three DPPs, revealing that the levels of several amino acids (AAs) were the highest in "Dairy-focused", reflecting its protein-rich nature. The "Traditional-inspired" DPP showed decreased AAs and glucose levels. This knowledge may contribute to optimizing maternal dietary recommendations. Further research is needed to validate these findings and better understand the relationships between maternal diet, AF metabolic signature, and neonatal anthropometrics.
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This study aimed to explore the nutritional profile of 608 women during the second trimester of pregnancy, in terms of nutrient patterns, dietary quality and nutritional adequacy. Dietary data were collected using a validated Mediterranean-oriented, culture-specific FFQ. Principal component analysis was performed on 18 energy-adjusted nutrients. Two main nutrient patterns, "plant-origin" (PLO) and "animal-origin" (ANO), were extracted. Six homogenous clusters (C) relative to nutrient patterns were obtained and analyzed through a multidimensional methodological approach. C1, C5 and C6 scored positively on PLO, while C1, C2 and C3 scored positively on ANO. When dietary quality was mapped on food choices and dietary indexes, C6 unveiled a group with a distinct image resembling the Mediterranean-type diet (MedDiet Score = 33.8). Although C1-C5 shared common dietary characteristics, their diet quality differed as reflected in the HEI-2010 (C1:79.7; C2:73.3; C3:70.9; C4:63.2; C5:76.6). The appraisal of nutritional adequacy mirrored a "nutritional-quality gradient". A total of 50% of participants in C6 had almost 100% adequate magnesium intake, while 50% of participants in C4 had a probability of adequacy of ≤10%. Our methodological framework is efficient for assessing the link between a posteriori dietary patterns and nutritional adequacy during pregnancy. Given that macro- and micronutrient distributions may induce metabolic modifications of potential relevance to offspring's health, public health strategies should be implemented.
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Ectopic kidney is a rare congenital malformation, caused by renal malpositioning during embryogenesis. We report a rare case of ectopic kidney located in the left hemithorax of a male fetus. The unique features in this case were early sonographic prenatal diagnosis of thoracic kidney at 22 weeks' gestation, which was confirmed by fetal MRI, and delayed sonographic manifestation of the associated congenital diaphragmatic hernia at 27 weeks.
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Coristoma/diagnóstico por imagem , Hérnia Diafragmática/diagnóstico por imagem , Hérnias Diafragmáticas Congênitas , Rim , Doenças Torácicas/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Adulto , Coristoma/cirurgia , Feminino , Hérnia Diafragmática/cirurgia , Humanos , Recém-Nascido , Imageamento por Ressonância Magnética , Masculino , Gravidez , Resultado da Gravidez , Segundo Trimestre da Gravidez , Doenças Torácicas/cirurgiaRESUMO
The aim of this study was to unravel the methodological challenges when exploring nutritional inadequacy, involving 608 healthy pregnant women. The usual intake of twenty-one nutrients was recorded by employing a validated FFQ. Simulated datasets of usual intake were generated, with randomly imposed uncertainty. The comparison between the usual intake and the EAR was accomplished with the probability approach and the EAR cut-point method. Point estimates were accompanied by bootstrap confidence intervals. Bootstrap intervals applied on the risk of inadequacy for raw and simulated data tended in most cases to overlap. A detailed statistical analysis, aiming to predict the level of inadequacy, as well as the application of the EAR cut-point method, along with bootstrap intervals, could effectively be used to assess nutrient inadequacy. However, the final decision for the method used depends on the distribution of nutrient-intake under evaluation. Irrespective of the applied methodology, moderate to high levels of inadequacy, calculated from FFQ were identified for certain nutrients (e.g., vitamins C, B6, magnesium, vitamin A), while the highest were recorded for folate and iron. Considering that micronutrient-poor, obesogenic diets are becoming more common, the underlying rationale may help towards unraveling the complexity characterizing nutritional inadequacies, especially in vulnerable populations.
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Necessidades Nutricionais , Adulto , Registros de Dieta , Ingestão de Alimentos , Ingestão de Energia , Feminino , Humanos , Estilo de Vida , Micronutrientes , Modelos Teóricos , Gravidez , Recomendações NutricionaisRESUMO
OBJECTIVE: To compare short-term complications of amniocentesis using 20G versus 22G needle. METHODS: A total of 200 women referred for mid-trimester amniocentesis were randomized to a 20G (Group I, n = 100) or 22G amniocentesis needle (Group II, n = 100). The primary outcome was intrauterine bleeding at needle insertion. The operator reported technical aspects and patient's reactions immediately after the procedure. Women's perception of discomfort 30 min after the procedure and complications after 2 weeks were recorded. RESULTS: Intrauterine bleeding at needle insertion was similar between groups (4/100 vs 8/100). When only transplacental taps were analyzed, bleeding was significantly lower in Group I (4/20 vs 8/14, p = 0.035). Fluid retrieval was faster in Group I (9.6 vs 26.8 sec, p < 0.001). In all, 65% of women in Group I versus 30% in Group II reported discomfort during the procedure, although discomfort 30 min after the procedure and complications within 2 weeks after the procedure were similar in the two groups. CONCLUSION: Amniocentesis with 20G needle is associated with lower risk of intrauterine bleeding in case of transplacental needle insertion and allows for faster fluid retrieval, as compared with 22G needle. Nevertheless, 20G needle is associated with more immediate discomfort during the procedure.
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Amniocentese/instrumentação , Complicações Intraoperatórias , Agulhas/efeitos adversos , Segundo Trimestre da Gravidez , Hemorragia Uterina/etiologia , Adulto , Feminino , Idade Gestacional , Humanos , Placenta/lesões , Gravidez , Método Simples-CegoRESUMO
OBJECTIVE: The aims of this study were: (1) to explore pregnant women's background knowledge and expectations of 2nd trimester ultrasound screening, and (2) to investigate women's intentions to proceed to pregnancy termination if fetal anomaly is detected at the 2nd trimester ultrasound screening. METHODS: A prospective, cross-sectional, questionnaire-based study. 300 consecutive pregnant women served as a convenience sample for this study. All the women had had a detailed, 2nd trimester, fetal anomaly scan. The questionnaire was a standardized but not validated, purpose-built structure consisting of five parts: (a) demographics, (b) anamnesis and obstetric history, (c) perceived aim of the scan, (d) expectations from the scan, and (e) intention to terminate pregnancy in case of fetal malformation diagnosis. Statistical analysis was performed with the SPSS 12.0 for Windows. RESULTS: The participants' mean age was 31.3 (21-45) years. 89.3% of the women filled in the questionnaire. The main reasons for the scan, according to the women, were to exclude fetal abnormalities and to assess the fetal karyotype. The main maternal expectations from the scan were to reduce maternal anxiety and to identify fetal malformations. 75.3% of the women were willing to terminate their pregnancy if fetal abnormalities were detected. Older women more commonly opted for pregnancy termination. CONCLUSION: The majority of participants have a correct notion about the aim of the ultrasound scan, their expectation is mainly anxiety reduction and a high percentage would proceed to pregnancy termination in the event of the detection of a fetal abnormality.
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Aborto Eugênico/psicologia , Doenças Fetais/diagnóstico por imagem , Intenção , Segundo Trimestre da Gravidez , Ultrassonografia Pré-Natal/psicologia , Mulheres/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Gravidez , Estudos ProspectivosRESUMO
Maternal diet may influence offspring's health, even within well-nourished populations. Amniotic fluid (AF) provides a rational compartment for studies on fetal metabolism. Evidence in animal models indicates that maternal diet affects AF metabolic profile; however, data from human studies are scarce. Therefore, we have explored whether AF content may be influenced by maternal diet, using a validated food-frequency questionnaire and implementing NMR-based metabolomics. Sixty-five AF specimens, from women undergoing second-trimester amniocentesis for prenatal diagnosis, were analysed. Complementary, maternal serum and urine samples were profiled. Hierarchical cluster analysis identified 2 dietary patterns, cluster 1 (C1, n = 33) and cluster 2 (C2, n = 32). C1 was characterized by significantly higher percentages of energy derived from refined cereals, yellow cheese, red meat, poultry, and "ready-to-eat" foods, while C2 by higher (P < 0.05) whole cereals, vegetables, fruits, legumes, and nuts. 1H NMR spectra allowed the identification of metabolites associated with these dietary patterns; glucose, alanine, tyrosine, valine, citrate, cis-acotinate, and formate were the key discriminatory metabolites elevated in C1 AF specimens. This is the first evidence to suggest that the composition of AF is influenced by maternal habitual dietary patterns. Our results highlight the need to broaden the knowledge on the importance of maternal nutrition during pregnancy.
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Líquido Amniótico/química , Fatores Biológicos/análise , Comportamento Alimentar , Metaboloma , Feminino , Grécia , Humanos , GravidezRESUMO
OBJECTIVE: The precise etiopathogenesis of preeclampsia (PE) still remains enigmatic. In recent published work, there is a scientific trend aiming to unveil early biomarkers of PE based on amniotic fluid compositional changes before the development of clinical symptoms. CASE REPORT: We describe a case of an apparently clinically healthy woman, whose amniotic fluid, retrieved after amniocentesis at 222/7 gestational week, had elevated uric acid and potassium concentration, as well as cysteine to methionine ratio. At the time of amniocentesis, conventional clinical signs of PE were absent. The woman developed severe PE and intrauterine growth restriction, at the 280/7 week of gestation. CONCLUSION: Although the limitation of such studies lies in the fact that amniocentesis is an invasive procedure, and thus employed only under specific indications, our scientific observations might be useful for future research towards unraveling the causes of PE.
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Líquido Amniótico/química , Pré-Eclâmpsia/etiologia , Adulto , Amniocentese , Biomarcadores/análise , Cisteína/análise , Feminino , Retardo do Crescimento Fetal/etiologia , Humanos , Metionina/análise , Potássio/análise , Gravidez , Segundo Trimestre da Gravidez , Ultrassonografia Pré-Natal , Ácido Úrico/análiseRESUMO
OBJECTIVE: To evaluate different methods of defining fetal nasal bone hypoplasia in the second trimester for the detection of trisomy 21. METHODS: Prospective study in Greek women undergoing anomaly scan between 18 + 0 and 23 + 6 weeks. The following methods of defining nasal bone hypoplasia were evaluated, either as a single marker or in combination with others: (1) BPD to nasal bone length (NBL) ratio; (2) multiples of the median (MoM) of NBL, according to normal curves from a Greek population; (3-4) NBL < 2.5 percentile according to normal curves (3) commonly used internationally curves and (4) curves from a Greek population. RESULTS: In total, 1301 singleton fetuses were evaluated - 10 with trisomy 21. The best detection rate of trisomy 21 was achieved when the applied method was nasal bone percentiles adjusted to maternal ethnicity, in combination with other markers (<2.5 percentile according to normal curves from a Greek population; p < 0.001; sensitivity 50%; specificity 94.8%; false-positive rate 5.2%; positive likelihood ratio 9.6). CONCLUSION: Screening performance of fetal nasal bone hypoplasia in detecting trisomy 21 varies according to the method applied. The best screening performance is achieved by using percentiles adjusted to maternal ethnicity in combination with other markers of aneuploidy.
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Síndrome de Down/diagnóstico por imagem , Osso Nasal/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Feminino , Humanos , Programas de Rastreamento , Gravidez , Segundo Trimestre da Gravidez , Estudos ProspectivosRESUMO
The objectives were to develop a Mediterranean oriented semi-quantitative food frequency questionnaire (FFQ) and evaluate its validity in measuring energy and nutrient intakes. For FFQ development, the main challenge was to merge food items and practices reflecting cultural Mediterranean preferences with other food choices ensuing from diet transition to more westernized dietary patterns. FFQ validity was evaluated by comparing nutrient intakes against the average of two 24-h dietary recalls for 179 pregnant women. Although the mean intake values for most nutrients and energy tended to be higher when determined by the FFQ, the Cohen's d was below 0.3. Bland-Altman plots confirmed the agreement between the two methods. Positive significant correlations ranged from 0.35 to 0.77. The proportion of women classified correctly was between 73.2% and 92.2%, whereas gross misclassification was low. Weighted kappa values were between 0.31 and 0.78, while intraclass correlation coefficients were between 0.49 and 0.89. Our methodological approach for the development and validation of this FFQ provides reliable measurements of energy, macro- and micronutrient intakes. Overall, our culture-specific FFQ could serve as a useful assessment tool in studies aiming at monitoring dietary intakes, especially in the Mediterranean region, where countries share common cultural dietary habits.
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Registros de Dieta , Comportamento Alimentar/etnologia , Adulto , Coleta de Dados , Dieta Mediterrânea/etnologia , Dieta Mediterrânea/estatística & dados numéricos , Ingestão de Energia , Feminino , Humanos , Região do Mediterrâneo , Avaliação Nutricional , Gravidez , Inquéritos e QuestionáriosRESUMO
A case of a nontuplet pregnancy that was successfully reduced to twins resulting in a good neonatal outcome is described. A 37-year-old woman achieved a nontuplet pregnancy after ovarian stimulation with GnRH-analogues and gonadotrophins in the short protocol and artificial insemination. Reduction of the nontuplet pregnancy to twins was successfully performed in three attempts and delivery by caesarian section was followed on the 32nd week of pregnancy. Two alive and healthy neonates with birth weights 1235 g and 1515 g were born. Multifetal pregnancy reduction is medically justified in the very high order pregnancies. The first approach, though, to the problem of multiple gestation should be prevention through carefully monitored infertility treatment, as the elective embryo reduction procedure carries with it medical, ethical and psychological issues for both the parents and the physicians involved.
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Redução de Gravidez Multifetal/ética , Redução de Gravidez Multifetal/métodos , Gravidez Múltipla , Adulto , Cesárea , Feminino , Ruptura Prematura de Membranas Fetais , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Inseminação Artificial , Masculino , Indução da Ovulação , Gravidez , Resultado da Gravidez , GêmeosRESUMO
OBJECTIVE: To study the evolution profile of amniotic fluid (AF) glucose, uric acid, phosphate, potassium, and sodium, in the second trimester of pregnancy, and explore the possible relations between the concentration of these components and maternal, as well as neonatal characteristics. METHODS: AF of 52 pregnant women was analyzed using an automatic multichannel analyzer. Maternal age, pre-pregnancy Body Mass Index (BMI), inter-pregnancy intervals, and smoking status were derived from questionnaires. Information on pregnancy and delivery was collected from medical records. RESULTS: Uric acid increased (r = 0.423, p < 0.01), while phosphate and glucose concentrations decreased during the period of 16-26th week of pregnancy (r = -0.590, p < 0.001 and r = -0.314, p < 0.05, respectively). Maternal pre-pregnancy BMI was significantly correlated with AF uric acid concentration (r = 0.460, p < 0.01) and marginally with AF glucose (r = 0.274, p = 0.052) and sodium (r = 0.254, p = 0.070) levels. Multiple linear regression indicated that mid-trimester AF uric acid and phosphate levels were significantly related to birth weight centiles (R(2)( )= 0.345, p < 0.05). CONCLUSIONS: Our results suggest that: (a) AF phosphate levels reflect gestational age to a satisfactory extent, (b) maternal pre-pregnancy BMI is significantly correlated with AF uric acid concentration, and (c) in appropriate for gestational age infants, AF phosphate and uric acid levels may serve as potential biomarkers of birth weight centiles. Further studies on AF composition may help to unravel the biochemical pathways underlying fetal development and could offer insight on the potential impact of maternal nutritional management on fetal growth regulation.
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Líquido Amniótico/metabolismo , Peso ao Nascer , Índice de Massa Corporal , Segundo Trimestre da Gravidez/metabolismo , Adulto , Biomarcadores/metabolismo , Feminino , Desenvolvimento Fetal/fisiologia , Idade Gestacional , Glucose/metabolismo , Humanos , Recém-Nascido , Modelos Lineares , Masculino , Fosfatos/metabolismo , Potássio/metabolismo , Gravidez , Sódio/metabolismo , Ácido Úrico/metabolismoRESUMO
OBJECTIVE: To assess and compare fetal behavior and neurodevelopment (KANET) between low and high risk pregnancies. METHODS: Prospective, comparative, cohort study. One hundred and fifty-two consecutive pregnant women presenting for routine 2nd trimester and 3rd trimester scan had four dimensional ultrasound examinations (4D US) in order to assess fetal behavior and neurodevelopment. This was achieved by the study of: (1) isolated head movements, (2) isolated hand movements, (3) isolated leg movements, (4) cranial sutures, (5) hand to face/head movements, (6) finger movements, (7) yawning - mouthing, (8) facial expressions, (9) isolated eye blinking, (10) "Gestalt" perception. According to the maternal background risk, the population of the study was classified in low risk pregnancies (n = 78) and high risk pregnancies (n = 74) with IUGR fetuses (n = 12), diabetes mellitus (n = 24), and pre-eclampsia (n = 38). RESULTS: The neurodevelopmental score was statistically significant higher in the low risk group compared to the high risk group (p < 0.0004). The diabetes subgroup score was statistically significantly higher compared to the IUGR and the pre-eclampsia subgroup (p = 0.0001). CONCLUSIONS: The neurodevelopment fetal assessment by 4D ultrasound appears to be a feasible technique in the evaluation of high risk pregnancies. Further studies where any association between KANET score and neurological outcome of the childhood are warranted.
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Desenvolvimento Fetal , Sistema Nervoso/embriologia , Gravidez de Alto Risco , Adulto , Comportamento , Estudos de Coortes , Movimentos Oculares , Expressão Facial , Feminino , Retardo do Crescimento Fetal/fisiopatologia , Movimento Fetal , Idade Gestacional , Humanos , Masculino , Pré-Eclâmpsia/fisiopatologia , Gravidez , Gravidez em Diabéticas/fisiopatologia , Estudos Prospectivos , Ultrassonografia Pré-Natal/métodosRESUMO
OBJECTIVES: Our aim was to identify and quantitate free amino acids in human amniotic fluid (AF) specimens collected during 2nd trimester amniocentesis and determine the correlation between amino acid concentrations, gestational age, and estimated fetal weight. METHODS: Seventy-eight AF samples were retrieved between 18 and 22 weeks of gestation. Fetal weight estimation was based on fetal biometric measurements. RESULTS: Twenty-one amino acids were quantified. The concentration of glutamine exhibited the greatest correlation with gestational age (râ=â0.477, pâ<â0.01). Additionally, significant negative correlations were recorded between gestational age and levels of alanine, proline, lysine, valine, taurine, leucine, glutamic acid, tyrosine, phenylalanine, isoleucine, ornithine, methionine, and tryptophane (pâ<â0.05). After adjusting for maternal age, fetal gender, intervals between consecutive pregnancies, pre-pregnancy body mass index, and smoking during pregnancy the strength of the correlation for proline and lysine decreased. A stepwise multiple linear regression model including gestational age as a first level predictor of fetal weight indicated that lysine and cysteine concentrations were additional predictors. CONCLUSIONS: Our results suggest that AF amino acids are crucial for fetal growth. Our purpose was not to establish an immediate diagnostic application. However, further exploration is likely to be fruitful, especially in high-risk pregnancies.
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Aminoácidos/análise , Líquido Amniótico/química , Peso Fetal , Idade Gestacional , Segundo Trimestre da Gravidez , Adulto , Amniocentese , Cromatografia Líquida de Alta Pressão , Feminino , Humanos , Modelos Lineares , GravidezRESUMO
A unique case of conjoined triplets that was characterized as tricephalus, tetrabrachius, and tetrapus parapagothoracopagus is presented. Antenatal diagnosis of the conjoined triplet was made at 22 weeks of gestation with 2-dimensional ultrasonography and magnetic resonance imaging. Pregnancy was terminated by hysterotomy, and diagnosis of conjoined triplets was confirmed postnatally.