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Review Article10-23-2020
Practical Recommendations for the Management of Benign Adnexal Masses
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(9):569-576
Abstract
Review ArticlePractical Recommendations for the Management of Benign Adnexal Masses
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(9):569-576
Views234Abstract
Objective
To performa comprehensive review to provide practical recommendations regarding the diagnosis and treatment of benign adnexal masses, as well as information for appropriate consent, regarding possible loss of the ovarian reserve.
Methods
A comprehensive review of the literature was performed to identify the most relevant data about this subject.
Results
In total, 48 studies addressed the necessary aspects of the review, and we described their epidemiology, diagnoses, treatment options with detailed techniques, and perspectives regarding future fertility.
Conclusions
Adnexal masses are extremely common. The application of diagnosis algorithms is mandatory to exclude malignancy. A great number of cases can bemanaged with surveillance. Surgery, when necessary, should be performed with adequate techniques. However, even in the hands of experienced surgeons, there is a significant decrease in ovarian reserves, especially in cases of endometriomas. There is an evident necessity of studies that focus on the long-term impact on fertility.
Key-words Adnexal massesFertility preservationInfertilityOvarian cystsOvarian reserveOvarian surgerySee moreViews234
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Review ArticlePractical Recommendations for the Management of Benign Adnexal Masses
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(9):569-576
Views234Abstract
Objective
To performa comprehensive review to provide practical recommendations regarding the diagnosis and treatment of benign adnexal masses, as well as information for appropriate consent, regarding possible loss of the ovarian reserve.
Methods
A comprehensive review of the literature was performed to identify the most relevant data about this subject.
Results
In total, 48 studies addressed the necessary aspects of the review, and we described their epidemiology, diagnoses, treatment options with detailed techniques, and perspectives regarding future fertility.
Conclusions
Adnexal masses are extremely common. The application of diagnosis algorithms is mandatory to exclude malignancy. A great number of cases can bemanaged with surveillance. Surgery, when necessary, should be performed with adequate techniques. However, even in the hands of experienced surgeons, there is a significant decrease in ovarian reserves, especially in cases of endometriomas. There is an evident necessity of studies that focus on the long-term impact on fertility.
Key-words Adnexal massesFertility preservationInfertilityOvarian cystsOvarian reserveOvarian surgerySee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Review Article10-23-2020
Characterization of Placental Infection by Zika Virus in Humans: A Review of the Literature
- Emanuella Meneses Venceslau
, - José Paulo Guida ,
- Eliana Amaral ,
- José Luis Proença Modena ,
- Maria Laura Costa
Abstract
Review ArticleCharacterization of Placental Infection by Zika Virus in Humans: A Review of the Literature
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(9):577-585
- Emanuella Meneses Venceslau ,
- José Paulo Guida ,
- Eliana Amaral ,
- José Luis Proença Modena ,
- Maria Laura Costa
Views228See moreAbstract
Objective
The aim of the current review is to present a systematic evaluation of reported human placental findings in cases of zika virus (ZIKV) infection.
Data
sources We reviewed the EMBASE, PUBMED, and SCIELO databases until June 2019, without language restrictions. Selection of studies The search terms placenta AND zika virus were used. The inclusion criteria of the studies were studies that reported placental findings in humans. Experimental studies, reviews, notes or editorials were excluded. A total of 436 studies were retrieved; after duplicate exclusion, 243 articles had their titles screened, and 128 had their abstract read; of those, 32 were included in the final analysis (18 case reports, 10 case series, and 4 cohorts)
Data collection
We collected data concerning the author, year of publication, study design, number of participants, number of placental samples, onset of symptoms, perinatal outcomes, and main findings on histological analysis.
Data synthesis
The placental pathologic findings were described as mild and nonspecific, similar to those of other placental infections, including chronic placentitis, chronic villitis, increased Hofbauer cells, irregular fibrin deposits, increased mononuclear cells in the villus stroma, villous immaturity, edema, hypervascularization, stromal fibrosis, calcification, and focal necrosis of syncytiotrophoblasts.
Conclusion
Zika infection presents unspecific placental findings, similar to other infections in the toxoplasmosis, other agents, rubella, cytomegalovirus, and herpes (TORCH)group. Characterizing and standardizing placental findings after zika virus infection is key to understanding the mechanisms of congenital diseases.
Views228This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Review ArticleCharacterization of Placental Infection by Zika Virus in Humans: A Review of the Literature
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(9):577-585
- Emanuella Meneses Venceslau ,
- José Paulo Guida ,
- Eliana Amaral ,
- José Luis Proença Modena ,
- Maria Laura Costa
Views228See moreAbstract
Objective
The aim of the current review is to present a systematic evaluation of reported human placental findings in cases of zika virus (ZIKV) infection.
Data
sources We reviewed the EMBASE, PUBMED, and SCIELO databases until June 2019, without language restrictions. Selection of studies The search terms placenta AND zika virus were used. The inclusion criteria of the studies were studies that reported placental findings in humans. Experimental studies, reviews, notes or editorials were excluded. A total of 436 studies were retrieved; after duplicate exclusion, 243 articles had their titles screened, and 128 had their abstract read; of those, 32 were included in the final analysis (18 case reports, 10 case series, and 4 cohorts)
Data collection
We collected data concerning the author, year of publication, study design, number of participants, number of placental samples, onset of symptoms, perinatal outcomes, and main findings on histological analysis.
Data synthesis
The placental pathologic findings were described as mild and nonspecific, similar to those of other placental infections, including chronic placentitis, chronic villitis, increased Hofbauer cells, irregular fibrin deposits, increased mononuclear cells in the villus stroma, villous immaturity, edema, hypervascularization, stromal fibrosis, calcification, and focal necrosis of syncytiotrophoblasts.
Conclusion
Zika infection presents unspecific placental findings, similar to other infections in the toxoplasmosis, other agents, rubella, cytomegalovirus, and herpes (TORCH)group. Characterizing and standardizing placental findings after zika virus infection is key to understanding the mechanisms of congenital diseases.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Emanuella Meneses Venceslau
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Review Article09-25-2020
Primary Dysmenorrhea: Assessment and Treatment
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(8):501-507
Abstract
Review ArticlePrimary Dysmenorrhea: Assessment and Treatment
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(8):501-507
Views587See moreAbstract
Primary dysmenorrhea is defined asmenstrual pain in the absence of pelvic disease. It is characterized by overproduction of prostaglandins by the endometrium, causing uterine hypercontractility that results in uterine muscle ischemia, hypoxia, and, subsequently, pain. It is the most common gynecological illness in women in their reproductive years and one of the most frequent causes of pelvic pain; however, it is underdiagnosed, undertreated, and even undervalued by women themselves, who accept it as part of themenstrual cycle. It hasmajor implications for quality of life, such as limitation of daily activities and psychological stress, being one of themain causes of school and work absenteeism. Its diagnosis is essentially clinical, based on the clinical history and normal physical examination. It is important to exclude secondary causes of dysmenorrhea. The treatment may have different approaches (pharmacological, nonpharmacological and surgical), but the first line of treatment is the use of nonsteroidal anti-inflammatory drugs (NSAIDs), and, in cases of women who want contraception, the use of hormonal contraceptives. Alternative treatments, such as topical heat, lifestyle modification, transcutaneous electrical nerve stimulation, dietary supplements, acupuncture, and acupressure, may be an option in cases of conventional treatments’ contraindication. Surgical treatment is only indicated in rare cases of women with severe dysmenorrhea refractory to treatment.
Views587This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Review ArticlePrimary Dysmenorrhea: Assessment and Treatment
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(8):501-507
Views587See moreAbstract
Primary dysmenorrhea is defined asmenstrual pain in the absence of pelvic disease. It is characterized by overproduction of prostaglandins by the endometrium, causing uterine hypercontractility that results in uterine muscle ischemia, hypoxia, and, subsequently, pain. It is the most common gynecological illness in women in their reproductive years and one of the most frequent causes of pelvic pain; however, it is underdiagnosed, undertreated, and even undervalued by women themselves, who accept it as part of themenstrual cycle. It hasmajor implications for quality of life, such as limitation of daily activities and psychological stress, being one of themain causes of school and work absenteeism. Its diagnosis is essentially clinical, based on the clinical history and normal physical examination. It is important to exclude secondary causes of dysmenorrhea. The treatment may have different approaches (pharmacological, nonpharmacological and surgical), but the first line of treatment is the use of nonsteroidal anti-inflammatory drugs (NSAIDs), and, in cases of women who want contraception, the use of hormonal contraceptives. Alternative treatments, such as topical heat, lifestyle modification, transcutaneous electrical nerve stimulation, dietary supplements, acupuncture, and acupressure, may be an option in cases of conventional treatments’ contraindication. Surgical treatment is only indicated in rare cases of women with severe dysmenorrhea refractory to treatment.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Review Article08-26-2020
Gynecological Surgery and COVID-19: What is the Impact and How Should I Manage it?
- Julio Cesar Rosa-e-Silva ,
- Paulo Ayroza Ribeiro ,
- Luiz Gustavo Oliveira Brito ,
- Mariano Tamura Vieira Gomes ,
- Sergio Podgaec , [ ... ],
- Agnaldo Lopes da Silva Filho
Abstract
Review ArticleGynecological Surgery and COVID-19: What is the Impact and How Should I Manage it?
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(7):415-419
- Julio Cesar Rosa-e-Silva ,
- Paulo Ayroza Ribeiro ,
- Luiz Gustavo Oliveira Brito ,
- Mariano Tamura Vieira Gomes ,
- Sergio Podgaec ,
- Helizabet Salomão Abdalla Ayroza Ribeiro ,
- Carlos Augusto Pires Costa Lino ,
- Ricardo Quintairos ,
- Walquiria Quida Salles Pereira Primo ,
- Agnaldo Lopes da Silva Filho
Views237See moreAbstract
It is estimated that around 28 million surgeries will be postponed or canceled worldwide as a result of this pandemic, causing a delay in the diagnosis and treatment of more than 2 million cancer cases. In Brazil, both the National Health Agency (ANS) and National Health Surveillance Agency (ANVISA) advised the postponement of elective and non-essential surgeries, causing a considerable impact on the number of surgical procedures that decreased by 33.4% in this period. However, some women need treatment for various gynecological diseases that cannot be postponed. The purpose of this article is to present recommendations on surgical treatment during the COVID-19 pandemic.
Views237This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Review ArticleGynecological Surgery and COVID-19: What is the Impact and How Should I Manage it?
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(7):415-419
- Julio Cesar Rosa-e-Silva ,
- Paulo Ayroza Ribeiro ,
- Luiz Gustavo Oliveira Brito ,
- Mariano Tamura Vieira Gomes ,
- Sergio Podgaec ,
- Helizabet Salomão Abdalla Ayroza Ribeiro ,
- Carlos Augusto Pires Costa Lino ,
- Ricardo Quintairos ,
- Walquiria Quida Salles Pereira Primo ,
- Agnaldo Lopes da Silva Filho
Views237See moreAbstract
It is estimated that around 28 million surgeries will be postponed or canceled worldwide as a result of this pandemic, causing a delay in the diagnosis and treatment of more than 2 million cancer cases. In Brazil, both the National Health Agency (ANS) and National Health Surveillance Agency (ANVISA) advised the postponement of elective and non-essential surgeries, causing a considerable impact on the number of surgical procedures that decreased by 33.4% in this period. However, some women need treatment for various gynecological diseases that cannot be postponed. The purpose of this article is to present recommendations on surgical treatment during the COVID-19 pandemic.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Julio Cesar Rosa-e-Silva
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Review Article08-26-2020
Covid-19 and Pregnancy: An Overview
- Pedro Castro ,
- Ana Paula Matos ,
- Heron Werner ,
- Flávia Paiva Lopes ,
- Gabriele Tonni , [ ... ],
- Edward Araujo Júnior
Abstract
Review ArticleCovid-19 and Pregnancy: An Overview
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(7):420-426
- Pedro Castro ,
- Ana Paula Matos ,
- Heron Werner ,
- Flávia Paiva Lopes ,
- Gabriele Tonni ,
- Edward Araujo Júnior
Views288See moreAbstract
Since the World Health Organization (WHO) declared coronavirus infection (COVID-19) a Public Health Emergency of International Concern in January 2020, there have been many concerns about pregnant women and the possible effects of this emergency with catastrophic outcomes inmany countries. Information on COVID-19 and pregnancy are scarce and spread throughout a fewcase series, with no more than 50 cases in total. The present review provides a brief analysis of COVID-19, pregnancy in the COVID-19 era, and the effects of COVID-19 on pregnancy.
Views288This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Review ArticleCovid-19 and Pregnancy: An Overview
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(7):420-426
- Pedro Castro ,
- Ana Paula Matos ,
- Heron Werner ,
- Flávia Paiva Lopes ,
- Gabriele Tonni ,
- Edward Araujo Júnior
Views288See moreAbstract
Since the World Health Organization (WHO) declared coronavirus infection (COVID-19) a Public Health Emergency of International Concern in January 2020, there have been many concerns about pregnant women and the possible effects of this emergency with catastrophic outcomes inmany countries. Information on COVID-19 and pregnancy are scarce and spread throughout a fewcase series, with no more than 50 cases in total. The present review provides a brief analysis of COVID-19, pregnancy in the COVID-19 era, and the effects of COVID-19 on pregnancy.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Pedro Castro
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Review Article08-26-2020
Tribulus Terrestris for Female Sexual Dysfunction: A Systematic Review
- Ana Luiza Cabrera Martimbianco ,
- Rafael Leite Pacheco ,
- Fábia Lima Vilarino ,
- Carolina de Oliveira Cruz Latorraca ,
- Maria Regina Torloni , [ ... ],
- Rachel Riera
Abstract
Review ArticleTribulus Terrestris for Female Sexual Dysfunction: A Systematic Review
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(7):427-435
- Ana Luiza Cabrera Martimbianco ,
- Rafael Leite Pacheco ,
- Fábia Lima Vilarino ,
- Carolina de Oliveira Cruz Latorraca ,
- Maria Regina Torloni ,
- Rachel Riera
Views428See moreAbstract
Objective
We performed a systematic review to assess the effectiveness and safety of Tribulus terrestris to treat female sexual dysfunction (FSD).
Data sources
We performed unrestricted electronic searches in the MEDLINE, CENTRAL, EMBASE, LILACS, CINAHL, PsycINFO,WHO-ICTR, Clinicaltrials.gov and OpenGrey databases. Selection of studies We included any randomized controlled trials (RCTs) that compared T. terrestris versus inactive/active interventions. After the selection process, conducted by two reviewers, 5 RCTs (n = 279 participants) were included.
Data collection
Data extraction was performed by two reviewers with a preestablished data collection formulary.
Data synthesis
Due to lack of data and clinical heterogeneity, we could not perform meta-analyses. The risk of bias was assessed by the Cochrane Risk of Bias (RoB) tool, and the certainty of evidence was assessed with Grading of Recommendations, Assessment, Development and Evaluations (GRADE).
Results
After 1 to 3 months of treatment, premenopausal and postmenopausal women randomized to T. terrestris had a significant increase in sexual function scores. Three months of treatment with T. terrestris showed a significant increase in the serum testosterone levels of premenopausal women. There was no report of serious adverse events, and none of the studies assessed health-related quality of life. The certainty of the evidence was very low, whichmeans that we have very little confidence in the effect estimates, and future studies are likely to change these estimates.
Conclusion
MoreRCTs are needed to supportor refute the use of T. terrestris. The decision to use this intervention should be shared with the patients, and the uncertainties around its effects should be discussed in the clinical decision-making process. Number of Protocol registration in PROSPERO database: CRD42019121130
Views428This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Review ArticleTribulus Terrestris for Female Sexual Dysfunction: A Systematic Review
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(7):427-435
- Ana Luiza Cabrera Martimbianco ,
- Rafael Leite Pacheco ,
- Fábia Lima Vilarino ,
- Carolina de Oliveira Cruz Latorraca ,
- Maria Regina Torloni ,
- Rachel Riera
Views428See moreAbstract
Objective
We performed a systematic review to assess the effectiveness and safety of Tribulus terrestris to treat female sexual dysfunction (FSD).
Data sources
We performed unrestricted electronic searches in the MEDLINE, CENTRAL, EMBASE, LILACS, CINAHL, PsycINFO,WHO-ICTR, Clinicaltrials.gov and OpenGrey databases. Selection of studies We included any randomized controlled trials (RCTs) that compared T. terrestris versus inactive/active interventions. After the selection process, conducted by two reviewers, 5 RCTs (n = 279 participants) were included.
Data collection
Data extraction was performed by two reviewers with a preestablished data collection formulary.
Data synthesis
Due to lack of data and clinical heterogeneity, we could not perform meta-analyses. The risk of bias was assessed by the Cochrane Risk of Bias (RoB) tool, and the certainty of evidence was assessed with Grading of Recommendations, Assessment, Development and Evaluations (GRADE).
Results
After 1 to 3 months of treatment, premenopausal and postmenopausal women randomized to T. terrestris had a significant increase in sexual function scores. Three months of treatment with T. terrestris showed a significant increase in the serum testosterone levels of premenopausal women. There was no report of serious adverse events, and none of the studies assessed health-related quality of life. The certainty of the evidence was very low, whichmeans that we have very little confidence in the effect estimates, and future studies are likely to change these estimates.
Conclusion
MoreRCTs are needed to supportor refute the use of T. terrestris. The decision to use this intervention should be shared with the patients, and the uncertainties around its effects should be discussed in the clinical decision-making process. Number of Protocol registration in PROSPERO database: CRD42019121130
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Ana Luiza Cabrera Martimbianco
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Review Article07-17-2020
Progress in Local Treatment of Breast Cancer: A Narrative Review
- Francisco Pimentel Cavalcante ,
- Eduardo Camargo Millen ,
- Felipe Pereira Zerwes ,
- Guilherme Garcia Novita
Abstract
Review ArticleProgress in Local Treatment of Breast Cancer: A Narrative Review
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(6):356-364
- Francisco Pimentel Cavalcante ,
- Eduardo Camargo Millen ,
- Felipe Pereira Zerwes ,
- Guilherme Garcia Novita
Views187Abstract
The present paper reports on the local treatment of breast cancer from a historical perspective. A search for articles written in English was made in the Medline and EMBASE databases, and 40 papers were selected. Over the past 10 years, various randomized, controlled clinical trials on the local treatment of breast cancer indicated that patients with the samemolecular subtypemay receive different individualized surgical treatments aimed atoptimizing systemic adjuvant therapy. With a view to retaining the gainsmade in diseasefree and overall survival, surgical techniques have advanced from radical surgery to conservative mastectomies, thus reducing sequelae, while adjuvant and neoadjuvant therapies have contributed toward controlling the disease, both distant metastases and local recurrence. Current studies evaluate whether future breast cancer therapy may even succeed in eliminating surgery to the breast and axilla altogether.
Key-words Breast cancer/therapybreast-conserving therapyMastectomyneoadjuvant and adjuvant therapysentinel node biopsySee moreViews187This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Review ArticleProgress in Local Treatment of Breast Cancer: A Narrative Review
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(6):356-364
- Francisco Pimentel Cavalcante ,
- Eduardo Camargo Millen ,
- Felipe Pereira Zerwes ,
- Guilherme Garcia Novita
Views187Abstract
The present paper reports on the local treatment of breast cancer from a historical perspective. A search for articles written in English was made in the Medline and EMBASE databases, and 40 papers were selected. Over the past 10 years, various randomized, controlled clinical trials on the local treatment of breast cancer indicated that patients with the samemolecular subtypemay receive different individualized surgical treatments aimed atoptimizing systemic adjuvant therapy. With a view to retaining the gainsmade in diseasefree and overall survival, surgical techniques have advanced from radical surgery to conservative mastectomies, thus reducing sequelae, while adjuvant and neoadjuvant therapies have contributed toward controlling the disease, both distant metastases and local recurrence. Current studies evaluate whether future breast cancer therapy may even succeed in eliminating surgery to the breast and axilla altogether.
Key-words Breast cancer/therapybreast-conserving therapyMastectomyneoadjuvant and adjuvant therapysentinel node biopsySee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Francisco Pimentel Cavalcante
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Review Article06-22-2020
Aortic Isthmus Doppler Velocimetry in Fetuses with Intrauterine Growth Restriction: A Literature Review
- Mariana Martins Ferraz ,
- Flávia do Vale Araújo ,
- Paulo Roberto Nassar de Carvalho ,
- Renato Augusto Moreira de Sá
Abstract
Review ArticleAortic Isthmus Doppler Velocimetry in Fetuses with Intrauterine Growth Restriction: A Literature Review
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(5):289-296
- Mariana Martins Ferraz ,
- Flávia do Vale Araújo ,
- Paulo Roberto Nassar de Carvalho ,
- Renato Augusto Moreira de Sá
Views239Abstract
Intrauterine growth restriction (IUGR) is associated with poor perinatal prognosis and a higher risk of stillbirth, neonatal death, and cerebral palsy. Its detection and the evaluation of its severity by new Doppler velocimetric parameters, such as aortic isthmus (AoI), are of great relevance for obstetrical practice. The AoI is a vascular segment that represents a point of communication between the right and left fetal circulations. It is considered to be a functional arterial shunt that reflects the relationship between the systemic and cerebral impedances, and has recently been proposed as a tool to detect the status of hemodynamic balance and prognosis of IUGR in fetuses. In the present review, we noticed that in healthy fetuses, the AoI net flow is always antegrade, but in fetuses with IUGR the deterioration of placental function leads to progressive reduction in its flow until it becomes mostly retrograde; this point is associated with a drastic reduction in oxygen delivery to the brain. The more impaired the AoI flow is, the greater is the risk of impairment in the Doppler velocimetry of other vessels; and the alterations of the AoI Doppler seem to precede other indicators of severe hypoxemia. Although there seems to be an association between the presence of retrograde flow in the AoI and the risk of long-term neurologic disability, its role in the prediction of perinatal morbi-mortality remains unclear. The AoI Doppler seems to be a promising tool in the management of fetuses with IUGR, but more studies are needed to investigate its employment in clinical practice.
Key-words aortic isthmusDopplerDoppler velocimetryIntrauterine growth restrictionIntrauterine growth retardationplacental insufficiencySee moreViews239This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Review ArticleAortic Isthmus Doppler Velocimetry in Fetuses with Intrauterine Growth Restriction: A Literature Review
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(5):289-296
- Mariana Martins Ferraz ,
- Flávia do Vale Araújo ,
- Paulo Roberto Nassar de Carvalho ,
- Renato Augusto Moreira de Sá
Views239Abstract
Intrauterine growth restriction (IUGR) is associated with poor perinatal prognosis and a higher risk of stillbirth, neonatal death, and cerebral palsy. Its detection and the evaluation of its severity by new Doppler velocimetric parameters, such as aortic isthmus (AoI), are of great relevance for obstetrical practice. The AoI is a vascular segment that represents a point of communication between the right and left fetal circulations. It is considered to be a functional arterial shunt that reflects the relationship between the systemic and cerebral impedances, and has recently been proposed as a tool to detect the status of hemodynamic balance and prognosis of IUGR in fetuses. In the present review, we noticed that in healthy fetuses, the AoI net flow is always antegrade, but in fetuses with IUGR the deterioration of placental function leads to progressive reduction in its flow until it becomes mostly retrograde; this point is associated with a drastic reduction in oxygen delivery to the brain. The more impaired the AoI flow is, the greater is the risk of impairment in the Doppler velocimetry of other vessels; and the alterations of the AoI Doppler seem to precede other indicators of severe hypoxemia. Although there seems to be an association between the presence of retrograde flow in the AoI and the risk of long-term neurologic disability, its role in the prediction of perinatal morbi-mortality remains unclear. The AoI Doppler seems to be a promising tool in the management of fetuses with IUGR, but more studies are needed to investigate its employment in clinical practice.
Key-words aortic isthmusDopplerDoppler velocimetryIntrauterine growth restrictionIntrauterine growth retardationplacental insufficiencySee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Mariana Martins Ferraz
Review Article Archives - Page 7 of 24 - Revista Brasileira de Ginecologia e Obstetrícia
