Você pesquisou por y - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 2003;25(8):545-552
DOI 10.1590/S0100-72032003000800002
ABSTRACT PURPOSE: to evaluate the changes in the cell phenotype determined by primary chemotherapy. METHODS: we evaluated the expression of proliferating cells of nuclear antigen (PCNA) and the estrogen (RE) and progesterone (RP) receptors in 17 stage II breast cancer patients before and after chemotherapy by immunohistochemistry. The values were compared with menopausal status, tumoral clinical response and with axillary lymph node status. RESULTS: there was a significant decrease in the average index of anti-PCNA-stained cells before (time A) and after (time B) chemotherapy (p=0.041). Responder patients displayed a significant decrease in PCNA levels [time A=53.1 and time B= 30.7 (p=0.011)]. A similar trend was observed in patients with histologic grade GII/GIII [time A=63.1 and time B=38.7 (p=0.049)]. There was no significant difference in PCNA expression regarding menopause status and axillary lymph node involvement. There was a significant decrease in RE after chemotherapy in the premenopausal patients [time A=60.3 and time B=24.1 (p=0.027)] and in those who showed a therapeutic response [time A=59.1 and time B=37.9 (p=0.030)]. We observed a significant increase in RP after chemotherapy in the postmenopausal patients [time A=35.3 and time B=58.3 (p=0.023)]. There was no relationship between hormone receptors and axillary lymph nodes. CONCLUSIONS: the decrease in PCNA levels in patients with high histologic grade, in RE in premenopausal patients, and both, PCNA and RE, in the tumors with clinical response after chemotherapy shows that the drugs acted on proliferating cells, and therefore PCNA can be used as a parameter of treatment response.
Summary
Rev Bras Ginecol Obstet. 2003;25(8):545-552
DOI 10.1590/S0100-72032003000800002
ABSTRACT PURPOSE: to evaluate the changes in the cell phenotype determined by primary chemotherapy. METHODS: we evaluated the expression of proliferating cells of nuclear antigen (PCNA) and the estrogen (RE) and progesterone (RP) receptors in 17 stage II breast cancer patients before and after chemotherapy by immunohistochemistry. The values were compared with menopausal status, tumoral clinical response and with axillary lymph node status. RESULTS: there was a significant decrease in the average index of anti-PCNA-stained cells before (time A) and after (time B) chemotherapy (p=0.041). Responder patients displayed a significant decrease in PCNA levels [time A=53.1 and time B= 30.7 (p=0.011)]. A similar trend was observed in patients with histologic grade GII/GIII [time A=63.1 and time B=38.7 (p=0.049)]. There was no significant difference in PCNA expression regarding menopause status and axillary lymph node involvement. There was a significant decrease in RE after chemotherapy in the premenopausal patients [time A=60.3 and time B=24.1 (p=0.027)] and in those who showed a therapeutic response [time A=59.1 and time B=37.9 (p=0.030)]. We observed a significant increase in RP after chemotherapy in the postmenopausal patients [time A=35.3 and time B=58.3 (p=0.023)]. There was no relationship between hormone receptors and axillary lymph nodes. CONCLUSIONS: the decrease in PCNA levels in patients with high histologic grade, in RE in premenopausal patients, and both, PCNA and RE, in the tumors with clinical response after chemotherapy shows that the drugs acted on proliferating cells, and therefore PCNA can be used as a parameter of treatment response.
Summary
Rev Bras Ginecol Obstet. 2003;25(8):553-559
DOI 10.1590/S0100-72032003000800003
PURPOSE: to verify vitrification techniques using 6 M DMSO to cryopreserve in vitro matured bovine oocytes, and to assess the effects of the time of exposure to vitrification solutions (VS). METHODS: dilutions of VS were prepared from the stock VS (VS 100%) consisting of 6 M DMSO to give 25 and 65% DMSO solutions. Bovine oocytes were in vitro matured for 18-22 h. Matured oocytes were placed first into 25% VS, at room temperature for 5 min, then transferred to 65% VS, before being pipetted into the 100% VS in plastic straws. Three experimental groups were formed: in the first group, time of pipetting through 65% VS and loading the straw took up to 60 s, in the second group it did not exceed 30 s. For thawing, straws were held in air for 10 s and then in a water bath for 10 s. The contents of each straw were expelled in sucrose solution and held for 5 min. In the third experimental group, oocytes went through all VS, but were not vitrified. All retrieved oocytes were inseminated. For control, fresh, in vitro matured oocytes were inseminated. RESULTS: after vitrification, 69.1 and 59.8% of the oocytes were retrieved from the 30 s and 60 s groups, respectively, and 93 and 89% of these oocytes appeared morphologically normal 24 h after insemination, respectively. In the group of oocytes exposed without vitrification, 75.6% were retrieved and 84.7% were morphologically viable, 24 h after insemination. No fertilization was observed in the experimental groups. Among controls, 65.4% were fertilized. CONCLUSIONS: the vitrification technique using 6 M DMSO is not a feasible approach to cryopreserve in vitro matured bovine oocytes. Decreasing the time of exposure to VS did not overcome deleterious effects of the procedure on the fertilizability of oocytes. Improvements in the technique are needed to protect the zona pellucida and oolemma.
Summary
Rev Bras Ginecol Obstet. 2003;25(8):553-559
DOI 10.1590/S0100-72032003000800003
PURPOSE: to verify vitrification techniques using 6 M DMSO to cryopreserve in vitro matured bovine oocytes, and to assess the effects of the time of exposure to vitrification solutions (VS). METHODS: dilutions of VS were prepared from the stock VS (VS 100%) consisting of 6 M DMSO to give 25 and 65% DMSO solutions. Bovine oocytes were in vitro matured for 18-22 h. Matured oocytes were placed first into 25% VS, at room temperature for 5 min, then transferred to 65% VS, before being pipetted into the 100% VS in plastic straws. Three experimental groups were formed: in the first group, time of pipetting through 65% VS and loading the straw took up to 60 s, in the second group it did not exceed 30 s. For thawing, straws were held in air for 10 s and then in a water bath for 10 s. The contents of each straw were expelled in sucrose solution and held for 5 min. In the third experimental group, oocytes went through all VS, but were not vitrified. All retrieved oocytes were inseminated. For control, fresh, in vitro matured oocytes were inseminated. RESULTS: after vitrification, 69.1 and 59.8% of the oocytes were retrieved from the 30 s and 60 s groups, respectively, and 93 and 89% of these oocytes appeared morphologically normal 24 h after insemination, respectively. In the group of oocytes exposed without vitrification, 75.6% were retrieved and 84.7% were morphologically viable, 24 h after insemination. No fertilization was observed in the experimental groups. Among controls, 65.4% were fertilized. CONCLUSIONS: the vitrification technique using 6 M DMSO is not a feasible approach to cryopreserve in vitro matured bovine oocytes. Decreasing the time of exposure to VS did not overcome deleterious effects of the procedure on the fertilizability of oocytes. Improvements in the technique are needed to protect the zona pellucida and oolemma.
Summary
Rev Bras Ginecol Obstet. 2003;25(8):563-569
DOI 10.1590/S0100-72032003000800004
PURPOSE: to verify the efficacy of a single subcutaneous dose of cetrorelix acetate to avoid premature ovulation in assisted fertilization cycles. METHODS: this is a prospective, controlled and randomized study, with 20 women undergoing ovarian stimulation for assisted fertilization, 10 of whom were submitted to classical GnRH agonist protocol (control group) while 10 utilized a 3-mg subcutaneous dose of the GnRH antagonist on the 7th day of ovarian stimulation (cetrorelix group). Serum FSH, LH, estradiol and progesterone concentrations were assessed on the first, seventh, HCG administration and oocyte retrieval days. Both groups were compared for pituitary suppression (progesterone concentration on HCG day) and assisted fertilization cycle performance (gonadotropin ampoules utilized, follicles over 18 mm, retrieved oocytes, fertilization, implantation and pregnancy rates), utilizing Mann-Whitney and Fisher exact tests. RESULTS: no significant difference was observed between control and cetrorelix groups, respectively, for medians of age (31.5 and 34 years), body mass index (24 and 22), gonadotropin ampoles utilized (34 and 32), follicles over 18 mm (3.5 and 3.3), retrieved oocytes (11 and 5), obtained embryos (4 and 3), fertilization (93,7 and 60%, p=0.07) and pregnancy rates (50 and 60%, p=0.07). Efficient pituitary blockade through the ovarian stimulation period was observed for both groups. CONCLUSIONS: these results confirm the efficacy of a 3-mg dose of cetrorelix acetate to prevent premature ovulation in patients undergoing assisted fertilization and suggest a tendency towards a smaller number of embryos and fertilization rates in the cetrorelix group than in the control group. Implantation and pregnancy rates were similar between groups. Other prospective studies with a greater number of patients should be performed to confirm these results.
Summary
Rev Bras Ginecol Obstet. 2003;25(8):563-569
DOI 10.1590/S0100-72032003000800004
PURPOSE: to verify the efficacy of a single subcutaneous dose of cetrorelix acetate to avoid premature ovulation in assisted fertilization cycles. METHODS: this is a prospective, controlled and randomized study, with 20 women undergoing ovarian stimulation for assisted fertilization, 10 of whom were submitted to classical GnRH agonist protocol (control group) while 10 utilized a 3-mg subcutaneous dose of the GnRH antagonist on the 7th day of ovarian stimulation (cetrorelix group). Serum FSH, LH, estradiol and progesterone concentrations were assessed on the first, seventh, HCG administration and oocyte retrieval days. Both groups were compared for pituitary suppression (progesterone concentration on HCG day) and assisted fertilization cycle performance (gonadotropin ampoules utilized, follicles over 18 mm, retrieved oocytes, fertilization, implantation and pregnancy rates), utilizing Mann-Whitney and Fisher exact tests. RESULTS: no significant difference was observed between control and cetrorelix groups, respectively, for medians of age (31.5 and 34 years), body mass index (24 and 22), gonadotropin ampoles utilized (34 and 32), follicles over 18 mm (3.5 and 3.3), retrieved oocytes (11 and 5), obtained embryos (4 and 3), fertilization (93,7 and 60%, p=0.07) and pregnancy rates (50 and 60%, p=0.07). Efficient pituitary blockade through the ovarian stimulation period was observed for both groups. CONCLUSIONS: these results confirm the efficacy of a 3-mg dose of cetrorelix acetate to prevent premature ovulation in patients undergoing assisted fertilization and suggest a tendency towards a smaller number of embryos and fertilization rates in the cetrorelix group than in the control group. Implantation and pregnancy rates were similar between groups. Other prospective studies with a greater number of patients should be performed to confirm these results.
Summary
Rev Bras Ginecol Obstet. 2003;25(8):571-576
DOI 10.1590/S0100-72032003000800005
PURPOSE: to estimate the prevalence of the hepatitis B surface antigen (HBsAg) in parturients admitted to the "Instituto Materno-Infantil de Pernambuco (IMIP)", Recife-PE, and to determine the serologic profile of the positive ones. METHODS: this is a prospective cross-sectional study where the VIDAS and VIDAS HBs systems were used for detection and confirmation of HBsAg, respectively. The parturients were randomly selected. In HBsAg+ patients, the other serologic markers were tested by the use of the AxSYM automated system. The newborn babies of HBsAg+ mothers were vaccinated with the Engerix B vaccine. RESULTS: among 1584 parturients, there were 9 (0.6%) HBsAg positive. None of them had anti-HBc IgM, thus they were all prevalent cases. In 1/9 (11.1%) of the HBsAg+ mothers, HBeAg was isolated and in 4/9 (44.4%), this antigen circulated along with its antibody, hence the importance of establishing the different magnitudes of risk of vertical transmission. Except for two newborn babies from a twin pregnancy (one with low birth weight), all presented seroconversion to anti-HBs with 3 doses of the vaccine. The premature twin babies showed seroconvertion only after the fourth dose of the vaccine. CONCLUSIONS: the prevalence of hepatitis B among parturients at IMIP is relatively low and all patients diagnosed had the chronic form of the infection.
Summary
Rev Bras Ginecol Obstet. 2003;25(8):571-576
DOI 10.1590/S0100-72032003000800005
PURPOSE: to estimate the prevalence of the hepatitis B surface antigen (HBsAg) in parturients admitted to the "Instituto Materno-Infantil de Pernambuco (IMIP)", Recife-PE, and to determine the serologic profile of the positive ones. METHODS: this is a prospective cross-sectional study where the VIDAS and VIDAS HBs systems were used for detection and confirmation of HBsAg, respectively. The parturients were randomly selected. In HBsAg+ patients, the other serologic markers were tested by the use of the AxSYM automated system. The newborn babies of HBsAg+ mothers were vaccinated with the Engerix B vaccine. RESULTS: among 1584 parturients, there were 9 (0.6%) HBsAg positive. None of them had anti-HBc IgM, thus they were all prevalent cases. In 1/9 (11.1%) of the HBsAg+ mothers, HBeAg was isolated and in 4/9 (44.4%), this antigen circulated along with its antibody, hence the importance of establishing the different magnitudes of risk of vertical transmission. Except for two newborn babies from a twin pregnancy (one with low birth weight), all presented seroconversion to anti-HBs with 3 doses of the vaccine. The premature twin babies showed seroconvertion only after the fourth dose of the vaccine. CONCLUSIONS: the prevalence of hepatitis B among parturients at IMIP is relatively low and all patients diagnosed had the chronic form of the infection.
Summary
Rev Bras Ginecol Obstet. 2003;25(8):577-583
DOI 10.1590/S0100-72032003000800006
PURPOSE: to determine the relationship between the Doppler indices of inferior vena cava and ductus venosus and the fetal hemoglobin concentration. METHODS: a cross-sectional prospective study was performed at the "Centro de Medicina Fetal HC UFMG" from January 1998 to July 2001. Thirty-one pregnant women with isoimmunization, detected by an indirect Coombs test >1:8, underwent a protocol for the identification of fetal hemolysis. When intrauterine transfusions were indicated, the umbilical cord hemoglobin concentration was measured at the begining of the procedure. In the other cases, it was measured at delivery. Every single intrauterine transfusion preceded by Doppler flow velocity waveforms from inferior vena cava and ductus venosus was defined as one case. Hemocue® (B-Hemoglobin Photometer Hemocue AB; Angelholm, Sweden) was used to measure the fetal hemoglobin concentration. In all cases, inferior vena cava and ductus venosus Doppler examinations were performed before the collection of fetal blood samples. For the inferior vena cava Doppler, the studied indices were pulsatility index for veins (PVI), peak velocity index for veins (PVIV) and atrial/systole ratio (CA/SV ratio or preload index); for ductus venosus, PVI, PVIV and systole/atrial ratio (SV/CA ratio). The relationship between inferior vena cava and ductus venosus Doppler indices and cord blood hemoglobin concentration was obtained by simple linear regression analysis. Moreover, an association between those indices and the finding of fetal hemoglobin <10 g/dL was shown by the c² test, significant at p<0.05. RESULTS: seventy-four procedures were studied. In twenty-three cases fetal hemoglobin was below 7 g/dL. A significant negative correlation between all studied Doppler indices and fetal concentration of hemoglobin was observed (p<0.05). The highest Doppler index values were observed in severe anemic fetuses. Fetuses with cord blood hemoglobin below 10 g/dL presented inferior vena cava and ductus venosus Doppler indices over the 95 percentile for gestational age. CONCLUSIONS: Doppler flow velocity waveforms from inferior vena cava and ductus venosus may be used as a noninvasive marker of severe fetal anemia.
Summary
Rev Bras Ginecol Obstet. 2003;25(8):577-583
DOI 10.1590/S0100-72032003000800006
PURPOSE: to determine the relationship between the Doppler indices of inferior vena cava and ductus venosus and the fetal hemoglobin concentration. METHODS: a cross-sectional prospective study was performed at the "Centro de Medicina Fetal HC UFMG" from January 1998 to July 2001. Thirty-one pregnant women with isoimmunization, detected by an indirect Coombs test >1:8, underwent a protocol for the identification of fetal hemolysis. When intrauterine transfusions were indicated, the umbilical cord hemoglobin concentration was measured at the begining of the procedure. In the other cases, it was measured at delivery. Every single intrauterine transfusion preceded by Doppler flow velocity waveforms from inferior vena cava and ductus venosus was defined as one case. Hemocue® (B-Hemoglobin Photometer Hemocue AB; Angelholm, Sweden) was used to measure the fetal hemoglobin concentration. In all cases, inferior vena cava and ductus venosus Doppler examinations were performed before the collection of fetal blood samples. For the inferior vena cava Doppler, the studied indices were pulsatility index for veins (PVI), peak velocity index for veins (PVIV) and atrial/systole ratio (CA/SV ratio or preload index); for ductus venosus, PVI, PVIV and systole/atrial ratio (SV/CA ratio). The relationship between inferior vena cava and ductus venosus Doppler indices and cord blood hemoglobin concentration was obtained by simple linear regression analysis. Moreover, an association between those indices and the finding of fetal hemoglobin <10 g/dL was shown by the c² test, significant at p<0.05. RESULTS: seventy-four procedures were studied. In twenty-three cases fetal hemoglobin was below 7 g/dL. A significant negative correlation between all studied Doppler indices and fetal concentration of hemoglobin was observed (p<0.05). The highest Doppler index values were observed in severe anemic fetuses. Fetuses with cord blood hemoglobin below 10 g/dL presented inferior vena cava and ductus venosus Doppler indices over the 95 percentile for gestational age. CONCLUSIONS: Doppler flow velocity waveforms from inferior vena cava and ductus venosus may be used as a noninvasive marker of severe fetal anemia.
Summary
Rev Bras Ginecol Obstet. 2003;25(8):585-591
DOI 10.1590/S0100-72032003000800007
PURPOSE: to analyze the histopathological patterns of the placental bed arteries in pregnancies complicated by abruptio placentae (AP) and compare them with the normal vascular histology of the placental bed. METHODS: placental bed biopsy was performed in 23 pregnant women with a diagnosis of abruptio placentae associated with high blood pressure (G/HBP) disorders, with gestational age of 28 weeks or more, submitted to cesarean section. The control group (CG) consisted of 30 patients without disease, submitted to cesarean section for obstetric reasons. The selected histological variables were: unaltered pattern, physiological changes, medial layer disorganization, hyperplastic changes, acute necrosis and atherosis. RESULTS: in patients with AP associated with HBP there was a significant predominance of medial layer disorganization and hyperplastic changes, compared to CG, while physiological changes in spiral arteries were statistically more common in CG. Findings of acute necrosis and atherosis were observed in a low number of G/HBP, with no statistical significance. CONCLUSIONS: in pregnant women with AP associated with HBP the predominant vascular histological findings were medial layer disorganization and hyperplastic changes. The presence of histopathological features was significantly higher in G/HBP, with prevalence of medial layer disorganization. Normal histological pattern, i.e., physiological changes, were more prevalent in CG.
Summary
Rev Bras Ginecol Obstet. 2003;25(8):585-591
DOI 10.1590/S0100-72032003000800007
PURPOSE: to analyze the histopathological patterns of the placental bed arteries in pregnancies complicated by abruptio placentae (AP) and compare them with the normal vascular histology of the placental bed. METHODS: placental bed biopsy was performed in 23 pregnant women with a diagnosis of abruptio placentae associated with high blood pressure (G/HBP) disorders, with gestational age of 28 weeks or more, submitted to cesarean section. The control group (CG) consisted of 30 patients without disease, submitted to cesarean section for obstetric reasons. The selected histological variables were: unaltered pattern, physiological changes, medial layer disorganization, hyperplastic changes, acute necrosis and atherosis. RESULTS: in patients with AP associated with HBP there was a significant predominance of medial layer disorganization and hyperplastic changes, compared to CG, while physiological changes in spiral arteries were statistically more common in CG. Findings of acute necrosis and atherosis were observed in a low number of G/HBP, with no statistical significance. CONCLUSIONS: in pregnant women with AP associated with HBP the predominant vascular histological findings were medial layer disorganization and hyperplastic changes. The presence of histopathological features was significantly higher in G/HBP, with prevalence of medial layer disorganization. Normal histological pattern, i.e., physiological changes, were more prevalent in CG.
Summary
Rev Bras Ginecol Obstet. 2003;25(8):593-598
DOI 10.1590/S0100-72032003000800008
PURPOSE: to investigate the effect of antiretroviral drugs on the lipid metabolism in HIV-infected pregnant women. METHODS: a prospective study was conducted on 57 pregnant women. The women were divided into three groups: ZDV group, consisting of 20 HIV-infected women taking ZDV; TT group, consisting of 25 HIV-1-infected women on triple antiretroviral treatment (ZDV + 3TC + NFV), and control group, consisting of 12 pregnant women considered to be normal from a clinical and laboratory viewpoint. Demographic and anthropometric data were homogeneous. Patients with a personal and family history of hyperlipidemia were excluded. Blood samples were obtained for the determination of fasting lipids (total cholesterol, LDL and HDL, and triglycerides) at four periods during pregnancy (1st = 14-20 weeks; 2nd = 21-26 weeks; 3rd = 27-32 weeks and 4th = 33-38 weeks). Data were analyzed statistically using the nonparametric chi², Friedman and Kruskal-Wallis tests . RESULTS: the use of antiretroviral drugs during pregnancy induced no difference in total or HDL cholesterol but caused an increase from 76.5 and 84 mg/dL to 96 and 105 mg/dL in the concentration of the LDL fraction along gestation in ZDV and TT groups, respectively (p<0.01). A positive significant association was observed between triglycerides and viral burden in the ZDV group (r: 0.534; p=0.015). CONCLUSION: Antiretroviral agents during pregnancy increase serum LDL-colesterol levels. The risk of pregnancy regarding potentiation of long-term antiretroviral effects on lipid metabolism, remains to be established.
Summary
Rev Bras Ginecol Obstet. 2003;25(8):593-598
DOI 10.1590/S0100-72032003000800008
PURPOSE: to investigate the effect of antiretroviral drugs on the lipid metabolism in HIV-infected pregnant women. METHODS: a prospective study was conducted on 57 pregnant women. The women were divided into three groups: ZDV group, consisting of 20 HIV-infected women taking ZDV; TT group, consisting of 25 HIV-1-infected women on triple antiretroviral treatment (ZDV + 3TC + NFV), and control group, consisting of 12 pregnant women considered to be normal from a clinical and laboratory viewpoint. Demographic and anthropometric data were homogeneous. Patients with a personal and family history of hyperlipidemia were excluded. Blood samples were obtained for the determination of fasting lipids (total cholesterol, LDL and HDL, and triglycerides) at four periods during pregnancy (1st = 14-20 weeks; 2nd = 21-26 weeks; 3rd = 27-32 weeks and 4th = 33-38 weeks). Data were analyzed statistically using the nonparametric chi², Friedman and Kruskal-Wallis tests . RESULTS: the use of antiretroviral drugs during pregnancy induced no difference in total or HDL cholesterol but caused an increase from 76.5 and 84 mg/dL to 96 and 105 mg/dL in the concentration of the LDL fraction along gestation in ZDV and TT groups, respectively (p<0.01). A positive significant association was observed between triglycerides and viral burden in the ZDV group (r: 0.534; p=0.015). CONCLUSION: Antiretroviral agents during pregnancy increase serum LDL-colesterol levels. The risk of pregnancy regarding potentiation of long-term antiretroviral effects on lipid metabolism, remains to be established.
Summary
Rev Bras Ginecol Obstet. 2003;25(8):599-603
DOI 10.1590/S0100-72032003000800009
PURPOSE: the aim was to study Rh-alloimmunized pregnant women and describe the gasometric abnormalities and the fetal acid-base changes before and after intrauterine transfusion. METHODS: between June 2001 and October 2001, before and after intrauterine transfusion in the alloimunized fetuses, gasometric data and acid-base parameters were prospectively studied in the umbilical vein blood. The measurements were performed in 8 samples of 5 fetuses. The fetal blood was obtained by cordocentesis before and after the intrauterine transfusion. The results were compared to the volemic expansion, the gestational age at procedure, the estimated fetal weight and the hemoglobin values (g/dL). RESULTS: all the cases showed pH value reduction, mean of 0.09 (SD=0.02). The fetal hemoglobin value showed a mean improvement of 8.4 g/dL (SD=2.9 g/dL). The pO2 and HCO3- concentrations showed negative variation (mean deltapO2 = -1.28 mmHg, mean deltaHCO3- = -2.25 mEq/L). pCO2 showed improvement (mean deltapCO2 = 3.2 mmHg) and reduced values of base excess occurred (mean = -3.75). CONCLUSION: the gasometric analysis allows to conclude that intrauterine transfusion is followed by pH reduction in the umbilical vein, with relative fetal acidemia after the procedure.
Summary
Rev Bras Ginecol Obstet. 2003;25(8):599-603
DOI 10.1590/S0100-72032003000800009
PURPOSE: the aim was to study Rh-alloimmunized pregnant women and describe the gasometric abnormalities and the fetal acid-base changes before and after intrauterine transfusion. METHODS: between June 2001 and October 2001, before and after intrauterine transfusion in the alloimunized fetuses, gasometric data and acid-base parameters were prospectively studied in the umbilical vein blood. The measurements were performed in 8 samples of 5 fetuses. The fetal blood was obtained by cordocentesis before and after the intrauterine transfusion. The results were compared to the volemic expansion, the gestational age at procedure, the estimated fetal weight and the hemoglobin values (g/dL). RESULTS: all the cases showed pH value reduction, mean of 0.09 (SD=0.02). The fetal hemoglobin value showed a mean improvement of 8.4 g/dL (SD=2.9 g/dL). The pO2 and HCO3- concentrations showed negative variation (mean deltapO2 = -1.28 mmHg, mean deltaHCO3- = -2.25 mEq/L). pCO2 showed improvement (mean deltapCO2 = 3.2 mmHg) and reduced values of base excess occurred (mean = -3.75). CONCLUSION: the gasometric analysis allows to conclude that intrauterine transfusion is followed by pH reduction in the umbilical vein, with relative fetal acidemia after the procedure.