Fetal growth retardation Archives - Revista Brasileira de Ginecologia e Obstetrícia

  • Original Articles

    Reference range of uterine artery Doppler parameters between the 11th and 14th pregnancy weeks in a population sample from Northeast Brazil

    Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(8):357-362

    Summary

    Original Articles

    Reference range of uterine artery Doppler parameters between the 11th and 14th pregnancy weeks in a population sample from Northeast Brazil

    Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(8):357-362

    DOI 10.1590/S0100-72032013000800004

    Views9

    PURPOSE: To establish reference values for the first trimester uterine artery resistance index (UtA-RI) and pulsatility index (UtA-PI) in healthy singleton pregnant women from Northeast Brazil. METHODS: A prospective observational cohort study including 409 consecutive singleton pregnancies undergoing routine early ultrasound screening at 11 - 14 weeks of gestation was performed. The patients responded to a questionnaire to assess maternal epidemiological characteristics. The left and right UtA-PI and UtA-RI were examined by color and pulsed Doppler by transabdominal technique and the mean UtA-PI, mean UtA-RI and the presence of bilateral protodiastolic notching were recorded. Quartile regression was used to estimate reference values. RESULTS: The mean±standard deviation UtA-RI and UtA-PI were 0.7±0.1 and 1.5±0.5, respectively. When segregated for gestation age, mean UtA-PI was 1.6±0.5 at 11 weeks, 1.5±0.6 at 12 weeks, 1.4±0.4 at 13 weeks and 1.3±0.4 at 14 weeks' gestation and mean UtA-RI was 0.7±0.1 at 11 weeks, 0.7±0.1 at 12 weeks, 0.6±0.1 at 13 weeks and 0.6±0.1 at 14 weeks' gestation. Uterine artery bilateral notch was present in 261 (63.8%) patients. We observed that the 5th and 95th percentiles of the UtA-PI and UtA-RI uterine arteries were 0.7 and 2.3 and, 0.5 and 0.8, respectively. CONCLUSION: Normal reference range of uterine artery Doppler in healthy singleton pregnancies from Northeast Brazil was established. The 95th percentile of UtA-PI and UtA-RI values may serve as a cut-off for future prediction of pregnancy complications studies (i.e., pre-eclampsia) in Northeast Brazil.

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  • Artigos Originais

    Validity of classical fetal weight charts in the Portuguese population

    Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(4):164-169

    Summary

    Artigos Originais

    Validity of classical fetal weight charts in the Portuguese population

    Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(4):164-169

    DOI 10.1590/S0100-72032011000400003

    Views5

    PURPOSE: to assess the validity of several fetal weight charts, commonly used in Portugal, to classify its population. METHODS: observational retrospective study. Singleton birth data was analyzed, from a two- year period (May 2008 to April 2010), from pregnancies with an ultrasound in the same institution, between the 8th and 14th gestational week. Upon data validation, percentiles for each completed gestational week were created, smoothed by a quadratic function, analyzed and compared to the tables more commonly utilized, in the institution and country, by using Z-scores, percentile comparison, sample 10th percentile detection sensibility and birthweight means comparison. RESULTS: a total of 5,378 newborns (NB) were born in the period; 2,195 (42%) NB were included, born from the 24th to 42nd gestational week, allowing statistical analysis from the 34th to the 41st week. There were differences in the mean birthweight for each gestational age, between references and with the sample, as well as between sexes. The 10th percentile from some references has shown differences ranging from -288g at 37 weeks (-11% in Lubchenco et al. data), with and +133g at 34 weeks (+7,6% with Carrascosa et al. data) compared to the values found with the sample. Differences were also found concerning the sensitivity of the identification of a sample birthweight below the 10th percentile, which was between 14.1 and 100%, depending on the reference used. DISCUSSION: the limitation of these kinds of reference values must be remembered and minimized, with the adoption of regionally or nationally produced references, contemplating other variables, such as sex, with precisely known gestation duration and with validation of the utilized references in loco.

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    Validity of classical fetal weight charts in the Portuguese population
  • Artigos Originais

    Early-onset preeclampsia: is it a better classification for maternal and perinatal outcomes?

    Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(12):584-590

    Summary

    Artigos Originais

    Early-onset preeclampsia: is it a better classification for maternal and perinatal outcomes?

    Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(12):584-590

    DOI 10.1590/S0100-72032010001200004

    Views6

    PURPOSE: to evaluate the differences between the maternal and perinatal outcomes of pregnancies complicated by preeclampsia, according to the classification as the severe/mild form, and the early/late onset form. METHODS: a retrospective study with 211 pregnancies complicated by preeclampsia, assessed at a university reference center from 2000 to 2010. The diagnosis and disease severity were based on the values of blood pressure, proteinuria, and clinical and laboratory findings. The pregnant's age, skin color, parity, blood pressure, urine protein semiquantitative values, presence of bilateral notch in the uterine artery dopplervelocimetry and birth conditions were compared between patients with mild and severe disease, as well as between those of early/late onset. The disease was considered to be of early onset when diagnosed at less than 34 weeks of gestational age. RESULTS: most patients had the severe form of preeclampsia (82.8%), and the onset of the condition was early in 50.7%. Blood pressure values (133.6±14.8 versus 115.4 mmHg, p=0.0004 and 132.2±16.5 versus 125.7 mmHg, p=0.0004) and semiquantitative proteinuria (p=0.0003 and p=0.0005) were higher in the early and severe forms compared to mild and late forms. Infant birth weight (1,435.4±521.6 versus 2,710±605.0 g, 1,923.7±807.9 versus 2,415.0±925.0 g, p<0.0001 for both) and Apgar score (p=0.01 for both) were smaller for severe and early preeclampsia compared to mild and late preeclampsia. On the other hand, the presence of a bilateral notch in the uterine arteries was linked to the forms of early onset (69.2 versus 47.9%, p=0.02), whereas fetal growth restriction was more frequent in the severe forms of preeclampsia (30 versus 4.4%, p=0.008). CONCLUSION: the preeclampsia classification based on maternal clinical parameters better reflected the conditions of fetal nutrition, while the early onset of the condition was associated with placental vasculopathy detected by dopplervelocimetry.

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  • Artigos Originais

    Predictor parameters of neonatal death in gestations with absent or reverse end-diastolic flow in the umbilical artery doppler velocimetry

    Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(7):352-358

    Summary

    Artigos Originais

    Predictor parameters of neonatal death in gestations with absent or reverse end-diastolic flow in the umbilical artery doppler velocimetry

    Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(7):352-358

    DOI 10.1590/S0100-72032010000700008

    Views9

    PURPOSE: to evaluate the antenatal and postnatal risk factors of neonatal death in pregnancies with absent (DZ) or reverse (DR) end-diastolic flow in the umbilical artery. METHODS: a cross-sectional retrospective study based on data from 48 medical records of singleton pregnancies with DZ or DR, and gestational age of 24 to 34 weeks, at a maternity in the Brazilian Northeast. Mean age was 27.3 (SD: 7.9) years. Twenty (41.7%) patients were primiparas. Hypertensive disorders were found in 44 (91.7%) cases. Thirty-five women (72.9%) had DZ and 13 (27.1%) had DR. Univariate analysis was firstly done (Student's t-test and Fisher's exact test) correlating the parameters with the assessed outcome (neonatal death). Variables that showed significant association were included in the logistic regression model (Wald statistics). The level of significance was set at 5%. RESULTS: The perinatal mortality rate was 64.6% (31/48). There were five stillbirths and 26 neonatal deaths. The mean gestational age at diagnosis was 27.9 (SD: 2.8) weeks. Deliveries before 24 hours after diagnosis occurred in 52.1% of the cases. Cesarean section was performed in 85.4% of the sample. The newborns weighed 975.9 g on average (SD: 457.5). Twenty-four (57.1%) presented Apgar scores below 7 in the first minute and 21.4% in the fifth minute. Gestational age at diagnosis, birth weight and Apgar of the first minute proved to be variables significantly related to neonatal death (p values were: 0.008, 0.004, and 0.020, respectively). The Odds Ratio was 6.6, 25.3 and 13.8 for neonatal death, when the diagnosis was established at the 28th week, weight was <1000 g and first minute Apgar score was <7, respectively. CONCLUSIONS: gestational age at diagnosis, birth weight and Apgar score at the first minute were factors that could predict neonatal death in pregnancies with DV or DR determined by umbilical artery Doppler velocimetry.

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  • Artigos Originais

    Experimental rat model for fetal growth restriction: effects on liver glycogen and intestinal and renal morphometry

    Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(4):163-168

    Summary

    Artigos Originais

    Experimental rat model for fetal growth restriction: effects on liver glycogen and intestinal and renal morphometry

    Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(4):163-168

    DOI 10.1590/S0100-72032010000400003

    Views10

    PURPOSE: to evaluate the effectiveness of the IUGR model by uterine artery ligation mimicking placental insufficiency in rats. METHODS: sprague-Dawley rat fetuses were divided into three groups: IUGR (intrauterine growth restriction), with fetuses in the right horn of pregnant rats subjected to right uterine artery ligation at 18.5 days of gestation (term = 22 days); C-IUGR (control of restriction), with control fetuses in the left horn, and EC (external control), with fetuses of intact rats. Animals were harvested by cesarean section at day 21.5 days of gestation. Fetuses were weighed and then sacrificed. The intestine, liver, kidney and placenta were weighed and dissected for morphometric and histological analysis. RESULTS: the morphometric data showed decreased body weight (BW), liver weight (LW) and intestinal weight (IW) of fetuses with IUGR compared to C-IUGR and EC (p<0.001). The placental weight (PW), renal weight (RW) and LW/BW, IW/BW, and RW/BW ratios did not change. IUGR fetuses had decreased kidney thickness (p<0.001) and decreased thickness of the intestinal mucosa and submucosa (p<0.05). Histological evaluation showed reduction of liver glycogen storage in fetuses with IUGR compared to C-IUGR and CE. CONCLUSIONS: the model described was efficient and caused symmetric fetal IUGR with decreased size of most organs, especially the liver, and changes in glycogen stores.

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    Experimental rat model for fetal growth restriction: effects on liver glycogen and intestinal and renal morphometry
  • Artigos Originais

    Correlation between estimated fetal weight by ultrasound and neonatal weight

    Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(1):4-10

    Summary

    Artigos Originais

    Correlation between estimated fetal weight by ultrasound and neonatal weight

    Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(1):4-10

    DOI 10.1590/S0100-72032010000100002

    Views5

    PURPOSE: to evaluate the correlation between the estimated fetal weight (EFW) by ultrasonography and the neonatal weight (NW), as well as the EFW's capacity to predict changes in NW among pregnant women in João Pessoa, Paraíba, Brazil. METHODS: a diagnostic validation study, including 122 pregnant women who have had the EFW calculated by ultrasonography up to seven days before delivery and the NW established immediately after birth, with a specific newborn's scale. The correlation between EFW and NW measurements was assessed by Pearson's correlation coefficient and by the mean difference between them. EFW and NW were classified as: low for the gestational age (LGA), adequate for the gestational age (AGA) and high for the gestational age (HGA), according to the percentiles 10 and 90 of the respective reference curves. The diagnosis of EFW deviation has been validated using the values of the Alexander's NW reference curve as gold-standard, by estimating the sensitivity, specificity, and positive and negative predictive values. RESULTS: there has been a high linear correlation between the EFW and NW (R=0.96), and the difference between them has varied from -474 g to +480 g, with an average of +3 g. Most of the highest percent weight estimate variations were between 10 and 15%. EFW has had 85.7% of sensitivity and 100% of specificity for the detection of LGA, and 100 and 77.2%, respectively, for the detection of HGA. CONCLUSIONS: EFW is able to predict NW adequately, and the reference EFW tested has had a good performance in the screening of fetal growth deviation, in the population studied.

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    Correlation between estimated fetal weight by ultrasound and neonatal weight
  • Artigos Originais

    Distribution of uterine height during pregnancy in a Brazilian cohort: comparison with the reference curve of the Centro Latino-Americano de Perinatologia

    Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(9):513-522

    Summary

    Artigos Originais

    Distribution of uterine height during pregnancy in a Brazilian cohort: comparison with the reference curve of the Centro Latino-Americano de Perinatologia

    Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(9):513-522

    DOI 10.1590/S0100-72032006000900003

    Views10

    PURPOSE: to describe, in participants of the Brazilian Study of Gestational Diabetes (EBDG), the percentile distribution of uterine height by gestational age and to validate the use of percentiles of the chart derived by the "Centro Latino-Americano de Perinatologia" (CLAP), used as reference in predicting abnormal fetal growth. METHODS: the EBDG is a cohort study of 5564 pregnant women older than 19 years, followed through and after delivery. Interviews and standardized anthropometry were performed at baseline between 20-28 weeks. Medical records covering prenatal and delivery periods were then reviewed following a standardized approach. Analyses pertain to 3539 women with gestational age confirmed by ultrasound. Diagnostic properties of the 10th and the 90th percentiles of both charts (EBDG and CLAP) as predictors of abnormal neonatal weight were determined. RESULTS: uterine height was higher in EBDG than in the CLAP chart at every gestational week, being 1-4 and 2-6 cm greater, at the 10th and 90th percentiles respectively. The CLAP 10th percentile classified as small the uterine heights of only 0.3 to 1.7% of Brazilian women, while the 90th percentile classified as large the uterine heights of 42 to 57% of the sample. The sensitivity of CLAP percentile 10 in the prediction of small for gestational age varied from 0.8 to 6% and the specificity of CLAP percentile 90 in the prediction of large for gestational age, from 46 to 61%. CONCLUSIONS: the CLAP uterine height reference chart does not reflect the current uterine growth pattern of pregnant Brazilians, limiting its clinical applicability in the detection of abnormal fetal growth, especially intrauterine growth restriction.

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    Distribution of uterine height during pregnancy in a Brazilian cohort: comparison with the reference curve of the Centro Latino-Americano de Perinatologia
  • Artigos Originais

    Influence of side stream cigarette smoke exposure on body weight gain and food consumption of pregnant rats: analysis of weight and length at birth

    Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(3):143-150

    Summary

    Artigos Originais

    Influence of side stream cigarette smoke exposure on body weight gain and food consumption of pregnant rats: analysis of weight and length at birth

    Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(3):143-150

    DOI 10.1590/S0100-72032006000300002

    Views3

    PURPOSE: to analyze the effect of cigarette smoke on weight gain and food consumption of female pregnant rats, as well as of their offspring's weight and length at birth METHODS: Wistar rats were studied from the second day until the end of pregnancy. Fifty-one female rats were divided into three groups: Group F: 15 rats exposed to tobacco smoke (2 cigarettes/animal/day) plus air flush (10 L/min); Group Air: 18 rats exposed to air flush only (10 L/min); Group C: 18 non-exposed, non-manipulated controls. Body weight was measured every 5 days and food consumption every seven days (expressed as medium consumption per day). Offspring weight and length were measured on the first day of life. The Lavene test was used to verify the behavior of numeric variable distribution and for parametric one-way ANOVA analysis and Student's t test were used, according to the case. Results with p<0.05 were considered to be statistically significant. RESULTS: the rats of Group F consumed less food per day [Group F=18.9 g (±1.2) vs Group Air=21.7 g (±1,6) vs Group C=24.2g (±1,7); (p<0,05)], gained less weight during pregnancy than the animals of the air flush group and the control group: Group F=338.9 g (±13.7) vs Group Air=352.3g (±15,9) vs Group C=366.3 g (±13.1) (p<0.05). Pups birth weight and length were significantly smaller in the smoking group when compared to controls and to the air flush group, while these last two groups did not differ: Group F=5.5 g (±0.3) vs Group Air=5.9 g (±0,5) vs Group C=5.9 g (±0.4) - (p<0,01); Group F=6.8 cm (±0.2) vs Group Air=6.9 cm (±0,2) vs Group C=6.9 cm (±0.1) - (p<0.05), respectively. CONCLUSIONS: tobacco smoke exposure reduced the weight gain and food consumption during pregnancy and reduced the offspring weight and length evaluated at birth.

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    Influence of side stream cigarette smoke exposure on body weight gain and food consumption of pregnant rats: analysis of weight and length at birth

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