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You searched for:"Emílio Francisco Marussi"
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Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(1):33-38
DOI 10.1590/S0100-72032013000100007
PURPOSE: To create longitudinal reference intervals for pulsatility index (PI) of the umbilical (UA), middle cerebral (MCA), uterine (UtA) arteries and ductus venosus (DV) in a Brazilian cohort. METHODS: A longitudinal observational study performed from February 2010 to May 2012. Low risk pregnancies were scanned fortnightly from 18 to 40 weeks for the measurements of PI of the UA, MCA, DV and UtA. Linear mixed models were used for the elaboration of longitudinal reference intervals (5th, 50th and 95th percentiles) of these measurements. PI obtained for the placental and abdominal portions of the umbilical artery were compared by the t-test for independent samples. Two-sided p values of less than 0.05 were considered statistically significant. RESULTS: A total of 164 patients underwent 1,242 scans. There was significant decrease in PI values of all vessels studied with gestational age (GA). From the 18th to the 40th week of pregnancy, the median PI values of UA (abdominal and placental ends of the cord), MCA, DV and the mean PI of the UtA ranged from 1.19 to 0.74, 1.33 to 0.78, 1.56 to 1.39, 0.58 to 0.41, and 0.98 to 0.66, respectively. The following equations were obtained for the prediction of the medians: PI-UA=1.5602786 - (0.020623 x GA); Logarithm of the PI-MCA=0.8149111 - (0.004168 x GA) - [0.02543 x (GA - 28.7756)²]; Logarithm of the PI-DV=-0.26691- (0.015414 x GA); PI-UtA = 1.2362403 - (0.014392 x GA). There was a significant difference between the PI-UA obtained at the abdominal and placental ends of the umbilical cord (p<0.001). CONCLUSIONS: Longitudinal reference intervals for the main gestational Doppler parameters were obtained in a Brazilian cohort. These intervals could be more adequate for the follow-up of maternal-fetal hemodynamic modifications in normal and abnormal pregnancies, a fact that still requires further validation.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(1):33-38
DOI 10.1590/S0100-72032013000100007
PURPOSE: To create longitudinal reference intervals for pulsatility index (PI) of the umbilical (UA), middle cerebral (MCA), uterine (UtA) arteries and ductus venosus (DV) in a Brazilian cohort. METHODS: A longitudinal observational study performed from February 2010 to May 2012. Low risk pregnancies were scanned fortnightly from 18 to 40 weeks for the measurements of PI of the UA, MCA, DV and UtA. Linear mixed models were used for the elaboration of longitudinal reference intervals (5th, 50th and 95th percentiles) of these measurements. PI obtained for the placental and abdominal portions of the umbilical artery were compared by the t-test for independent samples. Two-sided p values of less than 0.05 were considered statistically significant. RESULTS: A total of 164 patients underwent 1,242 scans. There was significant decrease in PI values of all vessels studied with gestational age (GA). From the 18th to the 40th week of pregnancy, the median PI values of UA (abdominal and placental ends of the cord), MCA, DV and the mean PI of the UtA ranged from 1.19 to 0.74, 1.33 to 0.78, 1.56 to 1.39, 0.58 to 0.41, and 0.98 to 0.66, respectively. The following equations were obtained for the prediction of the medians: PI-UA=1.5602786 - (0.020623 x GA); Logarithm of the PI-MCA=0.8149111 - (0.004168 x GA) - [0.02543 x (GA - 28.7756)²]; Logarithm of the PI-DV=-0.26691- (0.015414 x GA); PI-UtA = 1.2362403 - (0.014392 x GA). There was a significant difference between the PI-UA obtained at the abdominal and placental ends of the umbilical cord (p<0.001). CONCLUSIONS: Longitudinal reference intervals for the main gestational Doppler parameters were obtained in a Brazilian cohort. These intervals could be more adequate for the follow-up of maternal-fetal hemodynamic modifications in normal and abnormal pregnancies, a fact that still requires further validation.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(10):466-472
DOI 10.1590/S0100-72032012001000006
PURPOSES: To elaborate models for the estimation of fetal weight and longitudinal reference intervals of estimated fetal weight (EFW) using a sample of the Brazilian population. METHODS: Prospective observational study. Two groups of patients were evaluated: Group EFW (estimation of fetal weight): to elaborate (EFW-El) and validate (EFW-Val) a model for the prediction of fetal weight; Group LRI (longitudinal reference intervals): To elaborate (LRI-El) and validate (LRF-Val) conditional (longitudinal) percentiles of EFW. Polynomial regression analysis was applied to the data from subgroup EFW-El to elaborate a model for the estimation of fetal weight. The performance of this model was compared to those of previously published formulas. Linear mixed models were used for the elaboration of longitudinal reference intervals of EFW using data from subgroup LRI-El. Data obtained from subgroup LRI-Val were used to validate these intervals. RESULTS: Group EFW consisted of 458 patients (EFW-El: 367; EFW-Val: 91) and Group LRI consisted of 315 patients (LRI-El: 265; LRI-Val: 50). The model obtained for EFW was: EFW=-8.277+2.146xBPDxACxFL-2.449xFLxBPD². The performances of other models were significantly worse than those obtained with our formula. Equations for the prediction of conditional percentiles of EFW were derived from the longitudinal observation of patients of subgroup LRI-El and validated with data from subgroup LRI-Val. CONCLUSIONS: We described a method for customization of longitudinal reference intervals of EFW obtained using formulas generated from a sample of the Brazilian population.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(10):466-472
DOI 10.1590/S0100-72032012001000006
PURPOSES: To elaborate models for the estimation of fetal weight and longitudinal reference intervals of estimated fetal weight (EFW) using a sample of the Brazilian population. METHODS: Prospective observational study. Two groups of patients were evaluated: Group EFW (estimation of fetal weight): to elaborate (EFW-El) and validate (EFW-Val) a model for the prediction of fetal weight; Group LRI (longitudinal reference intervals): To elaborate (LRI-El) and validate (LRF-Val) conditional (longitudinal) percentiles of EFW. Polynomial regression analysis was applied to the data from subgroup EFW-El to elaborate a model for the estimation of fetal weight. The performance of this model was compared to those of previously published formulas. Linear mixed models were used for the elaboration of longitudinal reference intervals of EFW using data from subgroup LRI-El. Data obtained from subgroup LRI-Val were used to validate these intervals. RESULTS: Group EFW consisted of 458 patients (EFW-El: 367; EFW-Val: 91) and Group LRI consisted of 315 patients (LRI-El: 265; LRI-Val: 50). The model obtained for EFW was: EFW=-8.277+2.146xBPDxACxFL-2.449xFLxBPD². The performances of other models were significantly worse than those obtained with our formula. Equations for the prediction of conditional percentiles of EFW were derived from the longitudinal observation of patients of subgroup LRI-El and validated with data from subgroup LRI-Val. CONCLUSIONS: We described a method for customization of longitudinal reference intervals of EFW obtained using formulas generated from a sample of the Brazilian population.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(2):94-98
DOI 10.1590/S0100-72032010000200008
Monoamniotic twin pregnancies are very rare, but they are associated with high fetal morbidity and mortality. There is much controversy regarding the follow-up and obstetric procedures towards prenatal diagnosis of intertwined umbilical cords. In this article, we describe a case of monoamniotic pregnancy with diagnosis of intertwined umbilical cords, and we discuss aspects related to the follow-up and obstetric procedures through a brief literature review.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(2):94-98
DOI 10.1590/S0100-72032010000200008
Monoamniotic twin pregnancies are very rare, but they are associated with high fetal morbidity and mortality. There is much controversy regarding the follow-up and obstetric procedures towards prenatal diagnosis of intertwined umbilical cords. In this article, we describe a case of monoamniotic pregnancy with diagnosis of intertwined umbilical cords, and we discuss aspects related to the follow-up and obstetric procedures through a brief literature review.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(11):540-546
DOI 10.1590/S0100-72032009001100003
PURPOSE: to verify the association between ultrasonographic signs during gestation and post-delivery evolution in fetuses with bilateral obstructive uropathies, followed up in an expectant way. METHODS: fetuses with bilateral obstructive uropathies presenting severe oligoamnios and narrow thorax have been compared with fetuses with bilateral obstructive uropathies without those alterations, concerning the presence or absence of cysts in both kidneys, and the presence or absence of parenchymal hyperechogenicity in both kidneys. Cases of neonatal death were compared with cases of neonatal discharge from the nursery, regarding the same renal echographic aspects mentioned above, the presence of severe oligoamnios and narrow thorax. The sensitivity, specificity, positive and negative predictive value of the presence of bilateral renal cysts, bilateral renal hyperechogenicity, severe oligoamnios and narrow fetal thorax for the neonatal death were calculated. RESULTS: severe oligoamnios and narrow thorax were more frequent (p=0.03; p<0.001) in fetuses with bilateral renal cysts, as compared to those with echographically normal renal parenchyma. Neonatal death was more frequent among cases with severe oligoamnios (p<0.001), narrow thorax (p<0.001) and bilateral renal cysts (p<0.002), when respectively compared with cases without those alterations. The best values of sensitivity, specificity, positive and negative predictive value for the death of neonatal/breastfeeding infants were obtained using the echographic aspect of narrow thorax, and were 81.8, 100, 100 and 79.3%, respectively. CONCLUSIONS: in cases of fetuses with bilateral obstructive uropathies followed up in an expectant way, the ultrasonographic signs more associated to bad prognosis are severe oligoamnios, narrow fetal thorax and presence of bilateral renal cysts.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(11):540-546
DOI 10.1590/S0100-72032009001100003
PURPOSE: to verify the association between ultrasonographic signs during gestation and post-delivery evolution in fetuses with bilateral obstructive uropathies, followed up in an expectant way. METHODS: fetuses with bilateral obstructive uropathies presenting severe oligoamnios and narrow thorax have been compared with fetuses with bilateral obstructive uropathies without those alterations, concerning the presence or absence of cysts in both kidneys, and the presence or absence of parenchymal hyperechogenicity in both kidneys. Cases of neonatal death were compared with cases of neonatal discharge from the nursery, regarding the same renal echographic aspects mentioned above, the presence of severe oligoamnios and narrow thorax. The sensitivity, specificity, positive and negative predictive value of the presence of bilateral renal cysts, bilateral renal hyperechogenicity, severe oligoamnios and narrow fetal thorax for the neonatal death were calculated. RESULTS: severe oligoamnios and narrow thorax were more frequent (p=0.03; p<0.001) in fetuses with bilateral renal cysts, as compared to those with echographically normal renal parenchyma. Neonatal death was more frequent among cases with severe oligoamnios (p<0.001), narrow thorax (p<0.001) and bilateral renal cysts (p<0.002), when respectively compared with cases without those alterations. The best values of sensitivity, specificity, positive and negative predictive value for the death of neonatal/breastfeeding infants were obtained using the echographic aspect of narrow thorax, and were 81.8, 100, 100 and 79.3%, respectively. CONCLUSIONS: in cases of fetuses with bilateral obstructive uropathies followed up in an expectant way, the ultrasonographic signs more associated to bad prognosis are severe oligoamnios, narrow fetal thorax and presence of bilateral renal cysts.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(9):534-540
DOI 10.1590/S0100-72032005000900006
PURPOSE: to evaluate the role of morphological (12) and Doppler velocimetry (17) ultrasonographic features, in the detection of lymph node metastases in breast cancer patients. METHODS: 179 women (181 axillary cavities) were included in the study from January to December 2004. The ultrasonographic examinations were performed with a real-time linear probe (Toshiba-Power Vision-6000 (model SSA-370A)). The morphological parameters were studied with a frequency of 7.5-12 MHz. A frequency of 5 MHz was used for the Doppler velocimetry parameters. Subsequently, the women were submitted to level I, II and III axillary dissection (158), or to the sentinel lymph node technique (23). Sensitivity, specificity, and positive and negative predictive values were calculated for each parameter. The decision tree test was used for parameter association. The cutoff points were established by the ROC curve. RESULTS: at least one lymph node was detected in 173 (96%) of the women by the ultrasonographic examinations. Histological examination detected lymph node metastases in 87 women (48%). The best sensitivity among the morphological paramenters was found with the volume (62%), the antero-posterior diameter (62%) and the fatty hilum placement (56%). Though the specificity of the extracapsular invasion (100%), border regularity (92%) and cortex echogenicity (99%) were high, the sensitivity of these features was too low. None of the Doppler velocimetry parameters reached 50% sensitivity. The decision tree test selected the ultrasonographic parametners: fatty hilum placement, border regularity and cortex echogenicity, as the best parameter association. CONCLUSION: the detection of axillary cavity lymph node stage by a noninvasive method still remains an unfulfilled goal in the treatment of patients with breast cancer.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(9):534-540
DOI 10.1590/S0100-72032005000900006
PURPOSE: to evaluate the role of morphological (12) and Doppler velocimetry (17) ultrasonographic features, in the detection of lymph node metastases in breast cancer patients. METHODS: 179 women (181 axillary cavities) were included in the study from January to December 2004. The ultrasonographic examinations were performed with a real-time linear probe (Toshiba-Power Vision-6000 (model SSA-370A)). The morphological parameters were studied with a frequency of 7.5-12 MHz. A frequency of 5 MHz was used for the Doppler velocimetry parameters. Subsequently, the women were submitted to level I, II and III axillary dissection (158), or to the sentinel lymph node technique (23). Sensitivity, specificity, and positive and negative predictive values were calculated for each parameter. The decision tree test was used for parameter association. The cutoff points were established by the ROC curve. RESULTS: at least one lymph node was detected in 173 (96%) of the women by the ultrasonographic examinations. Histological examination detected lymph node metastases in 87 women (48%). The best sensitivity among the morphological paramenters was found with the volume (62%), the antero-posterior diameter (62%) and the fatty hilum placement (56%). Though the specificity of the extracapsular invasion (100%), border regularity (92%) and cortex echogenicity (99%) were high, the sensitivity of these features was too low. None of the Doppler velocimetry parameters reached 50% sensitivity. The decision tree test selected the ultrasonographic parametners: fatty hilum placement, border regularity and cortex echogenicity, as the best parameter association. CONCLUSION: the detection of axillary cavity lymph node stage by a noninvasive method still remains an unfulfilled goal in the treatment of patients with breast cancer.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(9):639-646
DOI 10.1590/S0100-72032003000900004
PURPOSE: to evaluate the association between the variability of amniotic fluid index (AFI) values with gestational age and some sociodemographic and obstetric variables among low-risk pregnant women. METHOD: a comparative study was carried out including 2868 low-risk pregnant women who had routine obstetric ultrasound examination, including fetal biometry and the measurement of AFI, from 20 to 42 weeks of gestation. The data were analyzed using Student's t test, analysis of variance of mean AFI values along gestational ages, according to other control variables, and also by multiple linear regression analysis. RESULTS: there was no significant variation of mean AFI values during the time of pregnancy neither when separately evaluating its association with maternal age, color, education, smoking habit, parity, and the presence of previous cesarean section scars, nor when the evaluation was performed through multivariate analysis. In this situation only the increase in gestational age showed to be associated with the decrease of AFI. Generally speaking, the mean AFI values fluctuated between 140 and 180 mm between the 20th and the 36th week, then showing values below 140 mm in a progressive decrease after this limit of gestational age. CONCLUSIONS: AFI values do not show a significant variation during pregnancy regarding the studied sociodemographic and obstetric variables.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(9):639-646
DOI 10.1590/S0100-72032003000900004
PURPOSE: to evaluate the association between the variability of amniotic fluid index (AFI) values with gestational age and some sociodemographic and obstetric variables among low-risk pregnant women. METHOD: a comparative study was carried out including 2868 low-risk pregnant women who had routine obstetric ultrasound examination, including fetal biometry and the measurement of AFI, from 20 to 42 weeks of gestation. The data were analyzed using Student's t test, analysis of variance of mean AFI values along gestational ages, according to other control variables, and also by multiple linear regression analysis. RESULTS: there was no significant variation of mean AFI values during the time of pregnancy neither when separately evaluating its association with maternal age, color, education, smoking habit, parity, and the presence of previous cesarean section scars, nor when the evaluation was performed through multivariate analysis. In this situation only the increase in gestational age showed to be associated with the decrease of AFI. Generally speaking, the mean AFI values fluctuated between 140 and 180 mm between the 20th and the 36th week, then showing values below 140 mm in a progressive decrease after this limit of gestational age. CONCLUSIONS: AFI values do not show a significant variation during pregnancy regarding the studied sociodemographic and obstetric variables.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(10):659-665
DOI 10.1590/S0100-72032001001000008
Purpose: evaluation of perinatal outcome of brain-sparing effect detected by color Doppler. Methods: brain-sparing effect was detected in 32 fetuses at the Ultrasound Service of the Center for Integral Attention to Women's Health at Campinas State University (UNICAMP). The diagnosis of brain-sparing effect was made when the ratio between middle cerebral artery and umbilical artery pulsatility indexes was below one (IPACM/IPAU <1). The measurement was obtained with color Doppler equipment Toshiba SSH-140A. Results: admission to neonatal intensive care unit (ICU) was necessary in 26 fetuses (89.6%). The number of days in ICU varied from 1 to 83 days, with a mean of 22 days. Fetal mortality rate was 3 in 32 (9.4%) and perinatal mortality was 9 in 29 (31%). Considering the gestational age by the Capurro method, the incidence of birth below 36 weeks was 21 in 32 (65.6%). Intrauterine growth restriction occurred in 71.8% of the cases and hypoglycemia in 44.8%. Conclusions: brain-sparing effect is a condition in which the fetus is at serious risk of adverse perinatal outcome and Doppler studies might be helpful in the obstetric management.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(10):659-665
DOI 10.1590/S0100-72032001001000008
Purpose: evaluation of perinatal outcome of brain-sparing effect detected by color Doppler. Methods: brain-sparing effect was detected in 32 fetuses at the Ultrasound Service of the Center for Integral Attention to Women's Health at Campinas State University (UNICAMP). The diagnosis of brain-sparing effect was made when the ratio between middle cerebral artery and umbilical artery pulsatility indexes was below one (IPACM/IPAU <1). The measurement was obtained with color Doppler equipment Toshiba SSH-140A. Results: admission to neonatal intensive care unit (ICU) was necessary in 26 fetuses (89.6%). The number of days in ICU varied from 1 to 83 days, with a mean of 22 days. Fetal mortality rate was 3 in 32 (9.4%) and perinatal mortality was 9 in 29 (31%). Considering the gestational age by the Capurro method, the incidence of birth below 36 weeks was 21 in 32 (65.6%). Intrauterine growth restriction occurred in 71.8% of the cases and hypoglycemia in 44.8%. Conclusions: brain-sparing effect is a condition in which the fetus is at serious risk of adverse perinatal outcome and Doppler studies might be helpful in the obstetric management.
