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Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(2):66-71
DOI 10.1590/S0100-72032010000200003
PURPOSE: to evaluate the importance of maternal plasma concentration of fructosamine as an indicator of fetal congenital cardiopathies in pregnancies complicated by diabetes mellitus. METHODS: this was a retrospective study conducted on 91 pregnant women with diabetes mellitus who underwent routine fetal echocardiography at a university reference center in fetal medicine. Sixty-five patientes who presented pre-gestational diabetes mellitus and plasma fructosamine level were registered in the medical records prior to the ultrasound exam. The first measurement recorded was compared with the result of routine fetal echocardiography, carried out by a specialist physician of the service. The presence or absence of echocardiographic findings of congenital cardiopathies (EFCC) was related to plasma levels of fructosamine by the mean t-test and its accuracy for EFCC was verified by the ROC curve. Plsama fructosamine concentrations of 2.68, 2.9 and 2.23 mmol/L, which are, respectively, the local reference laboratory values, the value of the kit employed for measurement and the one of highest overall accuracy, were discussed as the cut-off values. RESULTS: EFCC was found in 52.3% of the fetuses. The first measurement of fructosamine, during the prenatal care period, was performed, on average, at 20.4±8.0 weeks of pregnancy. The maternal concentration ability of the fructosamine to identify fetuses with EFCC was significant (p<0.0001) and had an area under the ROC curve of 0.78 (95%CI=0.66-0.89). The 2.9 mmol/L plasma concentration of fructosamine revealed EFCC with better specificity, but with a higher percentage of false-negative results (96.8 and 55.9%). Values above 2.68 mmol/L were associated with a probability of 4.6 to identify fetuses with EFCC compared with lower values, with 58.8% of sensitivity and 87.1%, specificity. The value of 2.23 mmol/L proved to be the most overall accurate of the three values suggested, with a sensitivity of 88.2% in the identification of fetuses with echocardiographic abnormalities. CONCLUSIONS: it is possible to use a second trimester plasma fructosamine level to refer high risk pregnant women to a reference center of fetal echocardiography. These findings are important for the management of women with diabetes mellitus who initiate late prenatal care.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(2):66-71
DOI 10.1590/S0100-72032010000200003
PURPOSE: to evaluate the importance of maternal plasma concentration of fructosamine as an indicator of fetal congenital cardiopathies in pregnancies complicated by diabetes mellitus. METHODS: this was a retrospective study conducted on 91 pregnant women with diabetes mellitus who underwent routine fetal echocardiography at a university reference center in fetal medicine. Sixty-five patientes who presented pre-gestational diabetes mellitus and plasma fructosamine level were registered in the medical records prior to the ultrasound exam. The first measurement recorded was compared with the result of routine fetal echocardiography, carried out by a specialist physician of the service. The presence or absence of echocardiographic findings of congenital cardiopathies (EFCC) was related to plasma levels of fructosamine by the mean t-test and its accuracy for EFCC was verified by the ROC curve. Plsama fructosamine concentrations of 2.68, 2.9 and 2.23 mmol/L, which are, respectively, the local reference laboratory values, the value of the kit employed for measurement and the one of highest overall accuracy, were discussed as the cut-off values. RESULTS: EFCC was found in 52.3% of the fetuses. The first measurement of fructosamine, during the prenatal care period, was performed, on average, at 20.4±8.0 weeks of pregnancy. The maternal concentration ability of the fructosamine to identify fetuses with EFCC was significant (p<0.0001) and had an area under the ROC curve of 0.78 (95%CI=0.66-0.89). The 2.9 mmol/L plasma concentration of fructosamine revealed EFCC with better specificity, but with a higher percentage of false-negative results (96.8 and 55.9%). Values above 2.68 mmol/L were associated with a probability of 4.6 to identify fetuses with EFCC compared with lower values, with 58.8% of sensitivity and 87.1%, specificity. The value of 2.23 mmol/L proved to be the most overall accurate of the three values suggested, with a sensitivity of 88.2% in the identification of fetuses with echocardiographic abnormalities. CONCLUSIONS: it is possible to use a second trimester plasma fructosamine level to refer high risk pregnant women to a reference center of fetal echocardiography. These findings are important for the management of women with diabetes mellitus who initiate late prenatal care.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(8):649-653
DOI 10.1590/S0100-72032004000800009
PURPOSE: to assess the correlation between middle cerebral artery peak systolic velocity and umbilical cord blood hemoglobin concentration and to determine its diagnostic value. PATIENTS AND METHODS: a cross-sectional prospective study was performed from January 2000 to May 2003. Forty-four isoimmunized pregnant women underwent a protocol for the identification of fetal hemolysis. When intrauterine transfusions were indicated, the umbilical cord blood hemoglobin concentration was measured at the beginning of the procedure. Each intrauterine transfusion preceded by Doppler velocimetry of the middle cerebral artery was regarded as one case, summing up eighty-three procedures. In all cases, the middle cerebral artery Doppler examinations were performed within the three hours preceding fetal blood sample collection. The systolic velocity peak was recorded and considered abnormal when its value was above 1.5 times the median for the corresponding gestational age. Hemocue® (B-Hemoglobin Photometer Hemocue AB; Angelholm, Sweden) was the device used to measure fetal hemoglobin concentration. The relationship between middle cerebral artery peak systolic velocity and cord blood hemoglobin was obtained by the chi2 test, considered significant at p<0.05. RESULTS: in thirty-three cases the cord blood hemoglobin concentration was below 10.0 g/dL. There was a strong correlation between the two measured variables (p<0.001). The middle cerebral artery peak systolic velocity with values above 1.5 times the median was associated with cord blood hemoglobin concentration below 10 g/mL (p<0,001). The sensitivity of an increased middle cerebral artery peak systolic velocity was 75.8% for the detection of a cord blood hemoglobin level of 10 g/dL or lower. CONCLUSION: the middle cerebral artery peak systolic velocity can be used as a noninvasive method for the diagnosis of fetal anemia.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(8):649-653
DOI 10.1590/S0100-72032004000800009
PURPOSE: to assess the correlation between middle cerebral artery peak systolic velocity and umbilical cord blood hemoglobin concentration and to determine its diagnostic value. PATIENTS AND METHODS: a cross-sectional prospective study was performed from January 2000 to May 2003. Forty-four isoimmunized pregnant women underwent a protocol for the identification of fetal hemolysis. When intrauterine transfusions were indicated, the umbilical cord blood hemoglobin concentration was measured at the beginning of the procedure. Each intrauterine transfusion preceded by Doppler velocimetry of the middle cerebral artery was regarded as one case, summing up eighty-three procedures. In all cases, the middle cerebral artery Doppler examinations were performed within the three hours preceding fetal blood sample collection. The systolic velocity peak was recorded and considered abnormal when its value was above 1.5 times the median for the corresponding gestational age. Hemocue® (B-Hemoglobin Photometer Hemocue AB; Angelholm, Sweden) was the device used to measure fetal hemoglobin concentration. The relationship between middle cerebral artery peak systolic velocity and cord blood hemoglobin was obtained by the chi2 test, considered significant at p<0.05. RESULTS: in thirty-three cases the cord blood hemoglobin concentration was below 10.0 g/dL. There was a strong correlation between the two measured variables (p<0.001). The middle cerebral artery peak systolic velocity with values above 1.5 times the median was associated with cord blood hemoglobin concentration below 10 g/mL (p<0,001). The sensitivity of an increased middle cerebral artery peak systolic velocity was 75.8% for the detection of a cord blood hemoglobin level of 10 g/dL or lower. CONCLUSION: the middle cerebral artery peak systolic velocity can be used as a noninvasive method for the diagnosis of fetal anemia.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(10):653-657
DOI 10.1590/S0100-72032001001000007
Purpose: to verify if there is an association between the mean blood velocity in the descending thoracic aorta and fetal anemia diagnosis. Methods: this is a prospective, cross-sectional study in which the mean blood velocities in the fetal aorta, in 66 fetuses at risk for severe anemia due to severe Rh immunization, and cord blood hemoglobin levels were analyzed comparatively. The hemoglobin level was obtained by cordocentesis if an intravascular transfusion was performed for severe anemia, however, if the fetus received an intrauterine transfusion by the intraperitoneal route or if the fetus did not receive a transfusion at all, hemoglobin level was measured at the time of pregnancy termination by umbilical cord puncture. The authors made a statistical association between the mean blood velocity in fetal descending thoracic aorta and the diagnosis of fetal anemia. The c² test was used for statistical analysis and a p value <0,05 was used to indicate significance. Results: there was a significant and indirect association between the mean blood velocity in the descending thoracic aorta and the detection of fetal anemia. The mean blood velocity in fetal thoracic aorta had a sensitivity of 47.4% for the diagnosis of moderate fetal anemia (Hg<10.0 g/dL), with a p value <0.01 by the Fisher exact test, and a sensitivity of 54.5% for severe Rh isoimmunization (Hg<7.0 g/dL), with a p value =0.01. Conclusion: this study revealed a significant indirect correlation between mean blood velocity in the descending thoracic aorta and the detection of fetal anemia due to Rh isoimmunization.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(10):653-657
DOI 10.1590/S0100-72032001001000007
Purpose: to verify if there is an association between the mean blood velocity in the descending thoracic aorta and fetal anemia diagnosis. Methods: this is a prospective, cross-sectional study in which the mean blood velocities in the fetal aorta, in 66 fetuses at risk for severe anemia due to severe Rh immunization, and cord blood hemoglobin levels were analyzed comparatively. The hemoglobin level was obtained by cordocentesis if an intravascular transfusion was performed for severe anemia, however, if the fetus received an intrauterine transfusion by the intraperitoneal route or if the fetus did not receive a transfusion at all, hemoglobin level was measured at the time of pregnancy termination by umbilical cord puncture. The authors made a statistical association between the mean blood velocity in fetal descending thoracic aorta and the diagnosis of fetal anemia. The c² test was used for statistical analysis and a p value <0,05 was used to indicate significance. Results: there was a significant and indirect association between the mean blood velocity in the descending thoracic aorta and the detection of fetal anemia. The mean blood velocity in fetal thoracic aorta had a sensitivity of 47.4% for the diagnosis of moderate fetal anemia (Hg<10.0 g/dL), with a p value <0.01 by the Fisher exact test, and a sensitivity of 54.5% for severe Rh isoimmunization (Hg<7.0 g/dL), with a p value =0.01. Conclusion: this study revealed a significant indirect correlation between mean blood velocity in the descending thoracic aorta and the detection of fetal anemia due to Rh isoimmunization.
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.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(10):663-668
DOI 10.1590/S0100-72032002001000005
PURPOSE: to evaluate the effect of intravascular transfusion on ductus venosus and inferior vena cava Doppler ultrasound indexes (SV/CA) and to relate it to hemoglobin levels before transfusion. METHODS: this is a transversal prospective study. A total of 62 intravascular transfusions were performed in 27 fetuses from pregnancies with red blood cell isoimmunization. The 62 cases were divided into two groups: (1) fetuses with hemoglobin levels before transfusion £10 g/dL and (2) fetuses with hemoglobin levels before transfusion >10 g/dL. The SV/CA and CA/SV indexes were measured using color Doppler ultrasound 6 h before and 12 h after intravascular transfusion. The index values before and after transfusion in all 62 cases were compared. Thereafter we compared these indexes before and after transfusion regarding each group. The Wilcoxon test was used and the results were considered statiscally significant when p<0.05. RESULTS: when we studied the whole group (62 cases) no significant difference was observed between the CA/SV index before and after transfusion (p=0.775). On the other hand, a significant increase in the SV/CA index was observed after transfusion (p=0.004). No significant differences were observed in both the SV/CA and CA/SV indexes before and after transfusion in the group of fetuses with hemoglobin levels before transfusion £10 g/dL (p=0.061 and p=0.345, respectively). There was a significant increase in the CA/SV index after transfusion in fetuses with hemoglobin levels before transfusion >10 g/dL (p=0.049), but the SV/CA index did not change in this group (p=0.086). CONCLUSION: venous Doppler study may be useful to understand fetal hemodynamic adjustment after intravascular transfusion. An increase in SV/CA without change in CA/SV after transfusion in anemic fetuses may be an important compensatory mechanism to increase intravascular volume. The increase in CA/SV index in fetuses with hemoglobin levels before transfusion <10 g/dL suggests a state of fetal hypervolemia.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(10):663-668
DOI 10.1590/S0100-72032002001000005
PURPOSE: to evaluate the effect of intravascular transfusion on ductus venosus and inferior vena cava Doppler ultrasound indexes (SV/CA) and to relate it to hemoglobin levels before transfusion. METHODS: this is a transversal prospective study. A total of 62 intravascular transfusions were performed in 27 fetuses from pregnancies with red blood cell isoimmunization. The 62 cases were divided into two groups: (1) fetuses with hemoglobin levels before transfusion £10 g/dL and (2) fetuses with hemoglobin levels before transfusion >10 g/dL. The SV/CA and CA/SV indexes were measured using color Doppler ultrasound 6 h before and 12 h after intravascular transfusion. The index values before and after transfusion in all 62 cases were compared. Thereafter we compared these indexes before and after transfusion regarding each group. The Wilcoxon test was used and the results were considered statiscally significant when p<0.05. RESULTS: when we studied the whole group (62 cases) no significant difference was observed between the CA/SV index before and after transfusion (p=0.775). On the other hand, a significant increase in the SV/CA index was observed after transfusion (p=0.004). No significant differences were observed in both the SV/CA and CA/SV indexes before and after transfusion in the group of fetuses with hemoglobin levels before transfusion £10 g/dL (p=0.061 and p=0.345, respectively). There was a significant increase in the CA/SV index after transfusion in fetuses with hemoglobin levels before transfusion >10 g/dL (p=0.049), but the SV/CA index did not change in this group (p=0.086). CONCLUSION: venous Doppler study may be useful to understand fetal hemodynamic adjustment after intravascular transfusion. An increase in SV/CA without change in CA/SV after transfusion in anemic fetuses may be an important compensatory mechanism to increase intravascular volume. The increase in CA/SV index in fetuses with hemoglobin levels before transfusion <10 g/dL suggests a state of fetal hypervolemia.