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Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(7):341-348
DOI 10.1590/S0100-72032008000700004
PURPOSE: to verify the correlation between ultrasonography heart measures and hemoglobin deficit in fetuses of alloimmunized pregnant women. METHODS: a transversal study, including 60 fetuses, with 21 to 35 weeks of gestational age, from 56 isoimmunized pregnant women. A number of 139 procedures were performed. Before cordocentesis for the collection of fetal blood, cardiac measures and femur length (FL) were assessed by ultrasonography. The external biventricular diameter (EBVD) was obtained by measuring the distance between the epicardic external parts at the end of the diastole, with the M-mode cursor perpendicular to the interventricular septum, in the atrioventricular valves. The measure of the atrioventricular diameter (AVD) was obtained by positioning the same cursor along the interventricular septum, evaluating the distance between the heart basis and apex. The FL was determined from the trochanter major to the distal metaphysis. The cardiac circumference (CC) was also calculated. To adjust the cardiac measure to the gestational age, each of these measures were divided by the FL measure. Hemoglobin concentration has been determined by spectrophotometry with the Hemocue® system. Hemoglobin deficit calculation was based in the Nicolaides's normality curve. RESULTS: direct and significant correlations were observed between the cardiac measures evaluated and the hemoglobin deficit. To predict moderate and severe anemia, the sensitivity and specificity found were 71.7 and 66.3% for EBVD and FL, 65.8 and 62.4% for AVD and FL, and 73.7 and 60.4% for CC and FL, respectively. CONCLUSIONS: ultrasonography cardiac measures assessed from fetuses of isoimmunized pregnant women correlate directly with hemoglobin deficit.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(7):341-348
DOI 10.1590/S0100-72032008000700004
PURPOSE: to verify the correlation between ultrasonography heart measures and hemoglobin deficit in fetuses of alloimmunized pregnant women. METHODS: a transversal study, including 60 fetuses, with 21 to 35 weeks of gestational age, from 56 isoimmunized pregnant women. A number of 139 procedures were performed. Before cordocentesis for the collection of fetal blood, cardiac measures and femur length (FL) were assessed by ultrasonography. The external biventricular diameter (EBVD) was obtained by measuring the distance between the epicardic external parts at the end of the diastole, with the M-mode cursor perpendicular to the interventricular septum, in the atrioventricular valves. The measure of the atrioventricular diameter (AVD) was obtained by positioning the same cursor along the interventricular septum, evaluating the distance between the heart basis and apex. The FL was determined from the trochanter major to the distal metaphysis. The cardiac circumference (CC) was also calculated. To adjust the cardiac measure to the gestational age, each of these measures were divided by the FL measure. Hemoglobin concentration has been determined by spectrophotometry with the Hemocue® system. Hemoglobin deficit calculation was based in the Nicolaides's normality curve. RESULTS: direct and significant correlations were observed between the cardiac measures evaluated and the hemoglobin deficit. To predict moderate and severe anemia, the sensitivity and specificity found were 71.7 and 66.3% for EBVD and FL, 65.8 and 62.4% for AVD and FL, and 73.7 and 60.4% for CC and FL, respectively. CONCLUSIONS: ultrasonography cardiac measures assessed from fetuses of isoimmunized pregnant women correlate directly with hemoglobin deficit.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(3):149-154
DOI 10.1590/S0100-72032005000300009
PURPOSE: to analyze the efficacy, safety and real advantage of vesicoamniotic shunt catheter in the intrauterine treatment of obstructive uropathy. METHODS: a retrospective and descriptive study, in which the evolution of 35 fetuses with obstructive uropathy, submitted to vesicoamniotic shunt from 1990 to 2004 in a Fetal Medical Center was evaluated. All these fetuses fitted the selection criteria defined by a protocol of this service, and had the parents' consent for the procedure. The Pediatric Nephrology Sector of the Hospital das Clínicas of UFMG assessed all of them after delivery to confirm the prenatal diagnosis and outcome. The dead neonates were studied by the Pathological Anatomy Sector of UFMG. Descriptive analysis of the following parameters was performed: prenatal diagnosis of the uropathy, gestational age at shunt insertion, time of catheter utilization, post-surgery complications, perinatal mortality and neonatal survival. RESULTS: posterior urethral valve was the most common uropathy (62.8%). The mean gestational age at the vesicoamniotic shunt placement was 26.1weeks and the mean time of its presence was 46 days (1-119 days). There were four intrauterine fetal deaths and 17 in the neonatal period (60% perinatal mortality). The main cause of death was pulmonary hypoplasia. Olygohidramnios was present in 33/35 fetuses (94.3%) and it was reversed in 23 of them (70%); fourteen fetuses survived the neonatal period. At present, there are 4 children followed up by the Pediatric Sector of Nephrology of Hospital das Clínicas. Two of them have been treated with peritoneal dialysis, awaiting renal transplantation. The other two have normal renal function. Their age varies from 2 months to 4 years. CONCLUSION: the vesicoamniotic shunt may be a viable intrauterine treatment for severe obstructive uropathy, with 40% of survival rate of fetuses that might have progressed to death. However, the procedure's success was directly related to the adequate selection, and to the early intervention in the uterus, performed before 32 weeks of gestation in fetuses with bilateral obstruction, without any associated malformation and with still preserved renal function. Olygohidramnios reversion did not guarantee a good prognosis. It remains controversial if the vesicoamniotic shunt can really ensure long-term renal function.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(3):149-154
DOI 10.1590/S0100-72032005000300009
PURPOSE: to analyze the efficacy, safety and real advantage of vesicoamniotic shunt catheter in the intrauterine treatment of obstructive uropathy. METHODS: a retrospective and descriptive study, in which the evolution of 35 fetuses with obstructive uropathy, submitted to vesicoamniotic shunt from 1990 to 2004 in a Fetal Medical Center was evaluated. All these fetuses fitted the selection criteria defined by a protocol of this service, and had the parents' consent for the procedure. The Pediatric Nephrology Sector of the Hospital das Clínicas of UFMG assessed all of them after delivery to confirm the prenatal diagnosis and outcome. The dead neonates were studied by the Pathological Anatomy Sector of UFMG. Descriptive analysis of the following parameters was performed: prenatal diagnosis of the uropathy, gestational age at shunt insertion, time of catheter utilization, post-surgery complications, perinatal mortality and neonatal survival. RESULTS: posterior urethral valve was the most common uropathy (62.8%). The mean gestational age at the vesicoamniotic shunt placement was 26.1weeks and the mean time of its presence was 46 days (1-119 days). There were four intrauterine fetal deaths and 17 in the neonatal period (60% perinatal mortality). The main cause of death was pulmonary hypoplasia. Olygohidramnios was present in 33/35 fetuses (94.3%) and it was reversed in 23 of them (70%); fourteen fetuses survived the neonatal period. At present, there are 4 children followed up by the Pediatric Sector of Nephrology of Hospital das Clínicas. Two of them have been treated with peritoneal dialysis, awaiting renal transplantation. The other two have normal renal function. Their age varies from 2 months to 4 years. CONCLUSION: the vesicoamniotic shunt may be a viable intrauterine treatment for severe obstructive uropathy, with 40% of survival rate of fetuses that might have progressed to death. However, the procedure's success was directly related to the adequate selection, and to the early intervention in the uterus, performed before 32 weeks of gestation in fetuses with bilateral obstruction, without any associated malformation and with still preserved renal function. Olygohidramnios reversion did not guarantee a good prognosis. It remains controversial if the vesicoamniotic shunt can really ensure long-term renal function.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(9):691-695
DOI 10.1590/S0100-72032004000900003
PURPOSE: to evaluate the importance of circulating maternal and fetal leptin in the healthy gestation, using its association with maternal, placental and fetal anthropometric variables, obtained at birth, and the relationship between the evaluated compartments. METHODS: in a transversal study a population of 33 single, healthy and term gestations was studied. The evaluated variables were maternal age, maternal weight, body mass index (BMF), weight of the newborn, placental weight, and placental index. Samples of maternal blood were immediately obtained before birth and from fetal umbilical cord blood at birth. Determination of serum leptin was performed using conventional radioimmunoassay. The relationships between serum leptin concentrations in maternal blood, umbilical artery and vein and the studied variables were assessed through linear regression. RESULTS: leptin levels were detected in the blood of all 33 pregnant women and their respective newborns, with maternal blood concentration (17.1±1.77 ng/mL) higher than that of umbilical vessels (vein: 9.0±1.16 ng/mL; artery: 8.23±1.02 ng/mL), p<0.0001. Leptin concentrations in the maternal blood were correlated with leptin concentrations in fetal blood (artery: coef. 0.63, p=0.037; vein: coef. 0.72, p=0.006). Regarding the anthropometric variables, leptin measured in the maternal blood was associated with initial and final maternal BMF (coef. 1.13; p=0.002; coef. 1,18, p=0.001) and cord leptin levels were correlated with the fetal weight at birth (vein: coef. 0.007, p=0.02; artery: coef. 0.006, p=0.02). CONCLUSION: there was a correlation between maternal and fetal leptin production and probably by the action of similar stimuli during gestation. Serum leptin was associated with the weight of the compartment where it circulates.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(9):691-695
DOI 10.1590/S0100-72032004000900003
PURPOSE: to evaluate the importance of circulating maternal and fetal leptin in the healthy gestation, using its association with maternal, placental and fetal anthropometric variables, obtained at birth, and the relationship between the evaluated compartments. METHODS: in a transversal study a population of 33 single, healthy and term gestations was studied. The evaluated variables were maternal age, maternal weight, body mass index (BMF), weight of the newborn, placental weight, and placental index. Samples of maternal blood were immediately obtained before birth and from fetal umbilical cord blood at birth. Determination of serum leptin was performed using conventional radioimmunoassay. The relationships between serum leptin concentrations in maternal blood, umbilical artery and vein and the studied variables were assessed through linear regression. RESULTS: leptin levels were detected in the blood of all 33 pregnant women and their respective newborns, with maternal blood concentration (17.1±1.77 ng/mL) higher than that of umbilical vessels (vein: 9.0±1.16 ng/mL; artery: 8.23±1.02 ng/mL), p<0.0001. Leptin concentrations in the maternal blood were correlated with leptin concentrations in fetal blood (artery: coef. 0.63, p=0.037; vein: coef. 0.72, p=0.006). Regarding the anthropometric variables, leptin measured in the maternal blood was associated with initial and final maternal BMF (coef. 1.13; p=0.002; coef. 1,18, p=0.001) and cord leptin levels were correlated with the fetal weight at birth (vein: coef. 0.007, p=0.02; artery: coef. 0.006, p=0.02). CONCLUSION: there was a correlation between maternal and fetal leptin production and probably by the action of similar stimuli during gestation. Serum leptin was associated with the weight of the compartment where it circulates.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(6):365-371
DOI 10.1590/S0100-72032000000600007
Purpose: to evaluate the accuracy of prenatal ultrasound in the diagnosis of nephrouropathies. Methods: the authors followed-up 127 pregnancies referred to the Fetal Medicine Center of UFMG with suspicion of these anomalies. Fetal biometry, growth, vitality, and associated malformations were evaluated. Finally, a detailed description of the renal system was made to define the prenatal morphologic diagnosis of the malformations to be compared with the postnatal diagnosis. Results: based on the kappa index (statistical method that measures the concordance between different measurements, methods or measurement instruments: below 0.40, poor agreement; between 0.40 and 0.75, good agreement; above 0.75, excellent ageement), the authors found an excellent concordance (kappa index 0.95). Among the 127 cases, there were only 9 misdiagnoses, all of them of obstructive uropathies: 6 cases showed different obstruction levels after delivery and in three cases there were confounding diagnosis with multicystic kidney. Conclusions: the detailed ultrasonographic description of the renal system is a good method for prenatal diagnosis of the fetal nephropathies, allowing some options to modify the outcome of these fetuses, like to send them to specialized centers, to anticipate delivery and even to apply intrauterine therapy, in order to preserve the renal function. Serial echography and amnioinfusion can be used to improve the precision of prenatal diagnosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(6):365-371
DOI 10.1590/S0100-72032000000600007
Purpose: to evaluate the accuracy of prenatal ultrasound in the diagnosis of nephrouropathies. Methods: the authors followed-up 127 pregnancies referred to the Fetal Medicine Center of UFMG with suspicion of these anomalies. Fetal biometry, growth, vitality, and associated malformations were evaluated. Finally, a detailed description of the renal system was made to define the prenatal morphologic diagnosis of the malformations to be compared with the postnatal diagnosis. Results: based on the kappa index (statistical method that measures the concordance between different measurements, methods or measurement instruments: below 0.40, poor agreement; between 0.40 and 0.75, good agreement; above 0.75, excellent ageement), the authors found an excellent concordance (kappa index 0.95). Among the 127 cases, there were only 9 misdiagnoses, all of them of obstructive uropathies: 6 cases showed different obstruction levels after delivery and in three cases there were confounding diagnosis with multicystic kidney. Conclusions: the detailed ultrasonographic description of the renal system is a good method for prenatal diagnosis of the fetal nephropathies, allowing some options to modify the outcome of these fetuses, like to send them to specialized centers, to anticipate delivery and even to apply intrauterine therapy, in order to preserve the renal function. Serial echography and amnioinfusion can be used to improve the precision of prenatal diagnosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(4):243-246
DOI 10.1590/S0100-72032001000400007
Purpose: to evaluate the possibility and accuracy of fetal karyotyping in pleural effusions. Methods: we studied fifteen fetuses with unilateral or bilateral pleural effusions. All of these fetuses underwent intrauterine thoracocentesis guided by ultrasound examinations. The gestational age varied from 19 to 34 weeks. A morphogenetic ultrasound examination was performed in each case by the authors in order to identify associated structural anomalies. When the cellular cultures of pleural effusion samples were negative, an alternative karyotype was obtained by cordocentesis. A fetal lymphocyte culture was made of pleural effusion samples for karyotype in a similar technique as for fetal blood. Results: the fetal karyotype was successful in 12 cases. There were 4 abnormal results, all of them were Down syndromes, and in the other 8 cases the chromosomal analyses were normal. The fetal karyotype was confirmed and compared by newborn blood chromosomal analysis, genetic evaluation or necropsy. There were no maternal or fetal side effects related to the procedure. Conclusions: the fetal karyotyping performed in pleural effusions obtained by intrauterine thoracocentesis proved to be highly efficient and safe. It must be the method of choice for rapid karyotyping in fetuses with pleural edema.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(4):243-246
DOI 10.1590/S0100-72032001000400007
Purpose: to evaluate the possibility and accuracy of fetal karyotyping in pleural effusions. Methods: we studied fifteen fetuses with unilateral or bilateral pleural effusions. All of these fetuses underwent intrauterine thoracocentesis guided by ultrasound examinations. The gestational age varied from 19 to 34 weeks. A morphogenetic ultrasound examination was performed in each case by the authors in order to identify associated structural anomalies. When the cellular cultures of pleural effusion samples were negative, an alternative karyotype was obtained by cordocentesis. A fetal lymphocyte culture was made of pleural effusion samples for karyotype in a similar technique as for fetal blood. Results: the fetal karyotype was successful in 12 cases. There were 4 abnormal results, all of them were Down syndromes, and in the other 8 cases the chromosomal analyses were normal. The fetal karyotype was confirmed and compared by newborn blood chromosomal analysis, genetic evaluation or necropsy. There were no maternal or fetal side effects related to the procedure. Conclusions: the fetal karyotyping performed in pleural effusions obtained by intrauterine thoracocentesis proved to be highly efficient and safe. It must be the method of choice for rapid karyotyping in fetuses with pleural edema.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(5):299-303
DOI 10.1590/S0100-72032001000500005
Purpose: to evaluate the intrauterine treatment of anemic fetuses that underwent intrauterine transfusions due to rhesus isoimmunization. Methods: the authors studied sixty-one fetuses undergoing intrauterine transfusions by the intravascular, intraperitoneal or both routes. The hydropic fetuses (19.7%) received only intravascular intrauterine transfusions. There was an overall number of 163 intrauterine transfusions with a mean of 2.7 procedures for each case. The indications for intrauterine transfusions were high values of bilirubin in amniotic fluid analyses by the Liley method or a hemoglobin concentration of cord blood below 10.0 g/mL. Results: the overall perinatal survival rate was 46% for hydropic fetuses and 84% for the nonhydropic ones. There were no maternal side effects related to the procedures. Half of the intrauterine transfusions were performed by the intravascular route. The mean gestational age at the delivery was 34.8 weeks. Conclusions: despite better perinatal results with intrauterine transfusions guided by ultrasound, especially using intravascular procedures, rhesus isoimmunization remains as an important cause of high rates of perinatal morbidity and mortality.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(5):299-303
DOI 10.1590/S0100-72032001000500005
Purpose: to evaluate the intrauterine treatment of anemic fetuses that underwent intrauterine transfusions due to rhesus isoimmunization. Methods: the authors studied sixty-one fetuses undergoing intrauterine transfusions by the intravascular, intraperitoneal or both routes. The hydropic fetuses (19.7%) received only intravascular intrauterine transfusions. There was an overall number of 163 intrauterine transfusions with a mean of 2.7 procedures for each case. The indications for intrauterine transfusions were high values of bilirubin in amniotic fluid analyses by the Liley method or a hemoglobin concentration of cord blood below 10.0 g/mL. Results: the overall perinatal survival rate was 46% for hydropic fetuses and 84% for the nonhydropic ones. There were no maternal side effects related to the procedures. Half of the intrauterine transfusions were performed by the intravascular route. The mean gestational age at the delivery was 34.8 weeks. Conclusions: despite better perinatal results with intrauterine transfusions guided by ultrasound, especially using intravascular procedures, rhesus isoimmunization remains as an important cause of high rates of perinatal morbidity and mortality.