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You searched for:"Francisco Mauad Filho"
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Rev Bras Ginecol Obstet. 2008;30(3):142-148
DOI 10.1590/S0100-72032008005000004
PURPOSE: to compare the intra and interobserver reproducibility of the total thickness measurement of the inferior uterine segment (IUS), through the abdominal route, and of the muscle layer measurement, through the vaginal route, using bi and tridimensional ultrasonography. METHODS: the IUS thickness measurement of 30 women, between the 36th and 39th weeks of gestation with previous caesarean section, done by two observers, was studied. Abdominal ultrasonography with the patient in both supine and lithotomy position was performed. In the sagittal section, the IUS was identified and four bidimensional images and two tridimensional blocks of the total thickness were collected through the abdominal route, and the same for the muscle layer, through the vaginal route. Tridimensional acquisitions were manipulated in the multiplanar mode. The time was measured with a chronometer. Reproducibility was evaluated by the computation of the absolute difference between measurements, the ratio of differences smaller than 1 mm, the intraclass coefficient (ICC), and the Bland and Altman's concordance limits. RESULTS: the average bidimensional measurement of IUS thickness was 7.4 mm through the abdominal and 2.7 mm through the vaginal route, and the tridimensional measurement was 6.9 mm through the abdominal and 5.1 mm through the vaginal route. Intra- and interobserver reproducibility of vaginal versus abdominal route: smaller absolute difference (0.2-0.4 mm versus 0.8-1.5 mm), greater ratio of differences (85.8-97.8% versus 48.7-72,8%), with p<0,0001, higher ICC (0.8-0.9 versus 0.6-0.8) and lower concordance limits (-0.9 to 1.5 versus -3.8 to 4 mm) for the vaginal route. Tri versus bidimensional ultrasonography: lower absolute difference (0.2-1.4 versus 0.4-1.5 mm), higher ratio of differences (57.7-97.8% versus 48.7-91.7%) with p>0.05[A1] and similar lower concordance limits (-38 to 3.4 versus -3.6 to 4 mm) for tridimensional ultrasonography and ICC (0.6-0.9 versus 0.7-0.9). CONCLUSIONS: from the above, we came to the conclusion that the measurement of the IUS muscle layer, through the vaginal route using tridimensional ultrasonography is more reproducible. Nevertheless, our results do not indicate that this measurement shows any clinical evidence to predict uterine tear, as that was not the aim of this study. The only work that has correlated the UIS thickness with risk of uterine tear, without interfering in the obstetrician behavior or anticipating delivery, was done by bidimensional abdominal measurements of the total thickness.
Summary
Rev Bras Ginecol Obstet. 2008;30(3):142-148
DOI 10.1590/S0100-72032008005000004
PURPOSE: to compare the intra and interobserver reproducibility of the total thickness measurement of the inferior uterine segment (IUS), through the abdominal route, and of the muscle layer measurement, through the vaginal route, using bi and tridimensional ultrasonography. METHODS: the IUS thickness measurement of 30 women, between the 36th and 39th weeks of gestation with previous caesarean section, done by two observers, was studied. Abdominal ultrasonography with the patient in both supine and lithotomy position was performed. In the sagittal section, the IUS was identified and four bidimensional images and two tridimensional blocks of the total thickness were collected through the abdominal route, and the same for the muscle layer, through the vaginal route. Tridimensional acquisitions were manipulated in the multiplanar mode. The time was measured with a chronometer. Reproducibility was evaluated by the computation of the absolute difference between measurements, the ratio of differences smaller than 1 mm, the intraclass coefficient (ICC), and the Bland and Altman's concordance limits. RESULTS: the average bidimensional measurement of IUS thickness was 7.4 mm through the abdominal and 2.7 mm through the vaginal route, and the tridimensional measurement was 6.9 mm through the abdominal and 5.1 mm through the vaginal route. Intra- and interobserver reproducibility of vaginal versus abdominal route: smaller absolute difference (0.2-0.4 mm versus 0.8-1.5 mm), greater ratio of differences (85.8-97.8% versus 48.7-72,8%), with p<0,0001, higher ICC (0.8-0.9 versus 0.6-0.8) and lower concordance limits (-0.9 to 1.5 versus -3.8 to 4 mm) for the vaginal route. Tri versus bidimensional ultrasonography: lower absolute difference (0.2-1.4 versus 0.4-1.5 mm), higher ratio of differences (57.7-97.8% versus 48.7-91.7%) with p>0.05[A1] and similar lower concordance limits (-38 to 3.4 versus -3.6 to 4 mm) for tridimensional ultrasonography and ICC (0.6-0.9 versus 0.7-0.9). CONCLUSIONS: from the above, we came to the conclusion that the measurement of the IUS muscle layer, through the vaginal route using tridimensional ultrasonography is more reproducible. Nevertheless, our results do not indicate that this measurement shows any clinical evidence to predict uterine tear, as that was not the aim of this study. The only work that has correlated the UIS thickness with risk of uterine tear, without interfering in the obstetrician behavior or anticipating delivery, was done by bidimensional abdominal measurements of the total thickness.
Summary
Rev Bras Ginecol Obstet. 2004;26(2):147-151
DOI 10.1590/S0100-72032004000200010
PURPOSE: to assess the length of the uterine cervix by transvaginal ultrasonography in pregnant women with preterm premature rupture of membranes. METHODS: the study group (Ge) consisted of 26 pregnant women with gestational age between 24 and 36 weeks and the control group (Gc) of 49 clinically normal patients at the same gestational age. The patients were evaluated between the 24th to 28th, 28th to 32th and 32th to 36th weeks. The groups were divided into subgroups Ge24-28, Ge28-32, Ge32-36 and Gc24-28, Gc28-32, Gc32-36, according to the study or control group. The cervix length was measured by transvaginal ultrasonography as the linear distance between the internal and external cervical os. RESULTS: we observed significant differences in cervix length between Ge24-28 and Gc24-28 groups whose values were, respectively, 24.3 and 33.0 mm (p=0.04), and between Ge32-36 and Gc32-36, 20.1 and 28.0 mm, respectively (p=0.005). The latency periods of Ge24-28, Ge28-32 and Ge32-36 were, respectively, seven, five and three days, showing a positive correlation with cervix length (r=0.66) and a negative correlation with gestational age (r=-0.27). CONCLUSIONS: the length of the uterine cervix varied with the gestational age when premature preterm rupture of the membranes was detected, with the length being shorter in the study group than in the control group betweeen the 24th and 28th and 32th and 36th weeks. In addition, it was demonstrated that, the shorter the cervix length, the shorter the latency time, with a reduction in the latency period with increasing gestational age at the time of rupture.
Summary
Rev Bras Ginecol Obstet. 2004;26(2):147-151
DOI 10.1590/S0100-72032004000200010
PURPOSE: to assess the length of the uterine cervix by transvaginal ultrasonography in pregnant women with preterm premature rupture of membranes. METHODS: the study group (Ge) consisted of 26 pregnant women with gestational age between 24 and 36 weeks and the control group (Gc) of 49 clinically normal patients at the same gestational age. The patients were evaluated between the 24th to 28th, 28th to 32th and 32th to 36th weeks. The groups were divided into subgroups Ge24-28, Ge28-32, Ge32-36 and Gc24-28, Gc28-32, Gc32-36, according to the study or control group. The cervix length was measured by transvaginal ultrasonography as the linear distance between the internal and external cervical os. RESULTS: we observed significant differences in cervix length between Ge24-28 and Gc24-28 groups whose values were, respectively, 24.3 and 33.0 mm (p=0.04), and between Ge32-36 and Gc32-36, 20.1 and 28.0 mm, respectively (p=0.005). The latency periods of Ge24-28, Ge28-32 and Ge32-36 were, respectively, seven, five and three days, showing a positive correlation with cervix length (r=0.66) and a negative correlation with gestational age (r=-0.27). CONCLUSIONS: the length of the uterine cervix varied with the gestational age when premature preterm rupture of the membranes was detected, with the length being shorter in the study group than in the control group betweeen the 24th and 28th and 32th and 36th weeks. In addition, it was demonstrated that, the shorter the cervix length, the shorter the latency time, with a reduction in the latency period with increasing gestational age at the time of rupture.
Summary
Rev Bras Ginecol Obstet. 1999;21(3):147-152
DOI 10.1590/S0100-72031999000300005
Purpose: to determine the possible occurrence of hemodynamic changes in the middle cerebral artery of the fetus (MCA) using color doppler after vibro-acoustic stimulation. Methods: thirty fetuses from pregnant women considered to be clinically normal, with a gestational age of 28 weeks or more were submitted to vibro-acoustic stimulation. We examined the changes in blood flow rate in the middle cerebral artery of the fetus on the basis of resistance index (RI) and fetal heart rate (FHR) by color doppler before and after the sound stimulus. Results: mean FHR before vibro-acoustic stimulation was 142.41 beats per minute (bpm) with a standard deviation of 9.01 and a range of 122 to 162 bpm. After stimulation, mean FHR was 159.44 bpm with a standard deviation of 15.49 and a range of 130 to 187 bpm (p<0.01). Mean RI in the MCA of the fetuses was 75.89% (range: 64 to 91%) before the experiment. After the vibro-acoustic stimulation, mean RI was 66.93% (range: 47 to 83%; p < 0.01). Conclusions: we observed that a sound stimulus provokes the well-known immediate and significant elevation of FHR and a decrease in cerebral vascular resistance when evaluated by the RI of the fetal middle cerebral artery.
Summary
Rev Bras Ginecol Obstet. 1999;21(3):147-152
DOI 10.1590/S0100-72031999000300005
Purpose: to determine the possible occurrence of hemodynamic changes in the middle cerebral artery of the fetus (MCA) using color doppler after vibro-acoustic stimulation. Methods: thirty fetuses from pregnant women considered to be clinically normal, with a gestational age of 28 weeks or more were submitted to vibro-acoustic stimulation. We examined the changes in blood flow rate in the middle cerebral artery of the fetus on the basis of resistance index (RI) and fetal heart rate (FHR) by color doppler before and after the sound stimulus. Results: mean FHR before vibro-acoustic stimulation was 142.41 beats per minute (bpm) with a standard deviation of 9.01 and a range of 122 to 162 bpm. After stimulation, mean FHR was 159.44 bpm with a standard deviation of 15.49 and a range of 130 to 187 bpm (p<0.01). Mean RI in the MCA of the fetuses was 75.89% (range: 64 to 91%) before the experiment. After the vibro-acoustic stimulation, mean RI was 66.93% (range: 47 to 83%; p < 0.01). Conclusions: we observed that a sound stimulus provokes the well-known immediate and significant elevation of FHR and a decrease in cerebral vascular resistance when evaluated by the RI of the fetal middle cerebral artery.
Summary
Rev Bras Ginecol Obstet. 2001;23(3):175-179
DOI 10.1590/S0100-72032001000300007
Purpose: to determine the accuracy of transabdominal ultrasound (TAUS) in revealing physiological and pathological changes in uterine volume, and to compare uterine volume detected by TAUS and by transvaginal ultrasound (TVUS) in an attempt to determine the relationship between the two methods. Methods: a total of 1,186 pelvic echographic examinations (TAUS and TVUS) were first reviewed retrospectively in terms of the major diseases and indications for the examinations. A total of 480 TAUS examinations without uterine disease were then selected and uterine volume was correlated with age and parity. Finally, a retrospective study was conducted to compare the uterine volume of 50 women obtained by TAUS and TVUS. Data were analyzed statistically by Student's t-test and Spearman and Pearson correlation. Results: correlating with parity, volume was 44.4 cm³ for P = 0 (n = 99), 58.5 cm³ for P = 1 (n = 72), 75.8 cm³ for P = 2-3 (n = 137), 88cm³ for P = 4-5 (n = 56), and 105cm³ for P = 6 or more (n = 26), showing a positive correlation between parity and uterine volume. Calculation of Spearman's correlation coefficient yielded r = 0.59 and p = 0.001 and calculation of Pearson's correlation coefficient yielded r = 0.55 and the same p value. There were no significant differences between the uterine volumes detected by TAUS and TVUS. Conclusions: the volume increases with parity and changes with age, and these modifications are detected by TAUS. The two methods (TAUS and TVUS) are equivalent in determining the uterine volume; however, when TAUS is used, bladder filling allows a better evaluation of the uterine length.
Summary
Rev Bras Ginecol Obstet. 2001;23(3):175-179
DOI 10.1590/S0100-72032001000300007
Purpose: to determine the accuracy of transabdominal ultrasound (TAUS) in revealing physiological and pathological changes in uterine volume, and to compare uterine volume detected by TAUS and by transvaginal ultrasound (TVUS) in an attempt to determine the relationship between the two methods. Methods: a total of 1,186 pelvic echographic examinations (TAUS and TVUS) were first reviewed retrospectively in terms of the major diseases and indications for the examinations. A total of 480 TAUS examinations without uterine disease were then selected and uterine volume was correlated with age and parity. Finally, a retrospective study was conducted to compare the uterine volume of 50 women obtained by TAUS and TVUS. Data were analyzed statistically by Student's t-test and Spearman and Pearson correlation. Results: correlating with parity, volume was 44.4 cm³ for P = 0 (n = 99), 58.5 cm³ for P = 1 (n = 72), 75.8 cm³ for P = 2-3 (n = 137), 88cm³ for P = 4-5 (n = 56), and 105cm³ for P = 6 or more (n = 26), showing a positive correlation between parity and uterine volume. Calculation of Spearman's correlation coefficient yielded r = 0.59 and p = 0.001 and calculation of Pearson's correlation coefficient yielded r = 0.55 and the same p value. There were no significant differences between the uterine volumes detected by TAUS and TVUS. Conclusions: the volume increases with parity and changes with age, and these modifications are detected by TAUS. The two methods (TAUS and TVUS) are equivalent in determining the uterine volume; however, when TAUS is used, bladder filling allows a better evaluation of the uterine length.
Summary
Rev Bras Ginecol Obstet. 1998;20(4):193-198
DOI 10.1590/S0100-72031998000400004
The patients who do not adjust to the metabolic changes of pregnancy and those with previous alterations in carbohydrate metabolism show a significant increase in perinatal morbidity and mortality. In order to contribute to a better prenatal management of diabetic patients, the authors reviewed 60 cases of diabetes during pregnancy, assisted at the Department of Obstetrics and Gynecology, Faculty of Medicine of Ribeirão Preto, University of São Paulo. The sample was divided into two groups: one with prenatal care according to the Department protocol, and referred to this center for pregnancy resolution, and the other without appropriate prenatal care. In the group with prenatal care according to the Department protocol the complications observed were related to prematurity. The group without appropriate care showed 3 cases of congenital malformations, 3 cases of prematurity, 1 case of severe neonatal hypoglycemia, 1 case of macrossomia, 1 case of intrauterine growth retardation and 1 neonatal death. Comparing the groups, it became clear that the appropriate prenatal care is essential for the diabetic pregnant patient, but also that a reference center, such as this Obstetrical and Gynecological Department, must be fully integrated with the regional health centers, in order to offer assistance before and during gestation to the diabetic patients.
Summary
Rev Bras Ginecol Obstet. 1998;20(4):193-198
DOI 10.1590/S0100-72031998000400004
The patients who do not adjust to the metabolic changes of pregnancy and those with previous alterations in carbohydrate metabolism show a significant increase in perinatal morbidity and mortality. In order to contribute to a better prenatal management of diabetic patients, the authors reviewed 60 cases of diabetes during pregnancy, assisted at the Department of Obstetrics and Gynecology, Faculty of Medicine of Ribeirão Preto, University of São Paulo. The sample was divided into two groups: one with prenatal care according to the Department protocol, and referred to this center for pregnancy resolution, and the other without appropriate prenatal care. In the group with prenatal care according to the Department protocol the complications observed were related to prematurity. The group without appropriate care showed 3 cases of congenital malformations, 3 cases of prematurity, 1 case of severe neonatal hypoglycemia, 1 case of macrossomia, 1 case of intrauterine growth retardation and 1 neonatal death. Comparing the groups, it became clear that the appropriate prenatal care is essential for the diabetic pregnant patient, but also that a reference center, such as this Obstetrical and Gynecological Department, must be fully integrated with the regional health centers, in order to offer assistance before and during gestation to the diabetic patients.
Summary
Rev Bras Ginecol Obstet. 2006;28(1):38-43
DOI 10.1590/S0100-72032006000100007
PURPOSE: to determine the intraobserver and interobserver reproducibility of endometrial volume measurements using the VOCAL®-imaging program (Virtual Organ Computer-aided AnaLysis). METHODS: one three-dimensional (3-D) ultrasound dataset of the endometrium was obtained from each of five infertile women with different endometrial volumes. For each 3-D dataset, the endometrial volume was calculated by two different observers using the manual mode in four different rotational steps (30º, 15º, 9º and 6º). Ten measurements were obtained with each method and observer from each 3-D dataset. We have used one-way ANOVA and the Tukey post-test to verify the differences among means and the intraclass correlation coefficient to test reliability. RESULTS: rotational methods employing a rotation step of 30º were associated with lower endometrial volume readings in 3 of the 5 patients. There were no significant differences between the means obtained by the 15º, 9º or 6º step rotation. No significant difference was found between the means obtained by the two different observers. The intraclass correlation coefficients were significantly lower with 30º (all under 0.984) than with the other step rotations (all above 0.996). CONCLUSIONS: the use of a rotational step of 15º or less provides reliable readings of endometrial volume: there were no significant differences between the means calculated by the two observers, associated with highintraclass correlation coefficient (>0.996). We recommend the 15º step rotation because it is quicker to be performed than 6º and 9º.
Summary
Rev Bras Ginecol Obstet. 2006;28(1):38-43
DOI 10.1590/S0100-72032006000100007
PURPOSE: to determine the intraobserver and interobserver reproducibility of endometrial volume measurements using the VOCAL®-imaging program (Virtual Organ Computer-aided AnaLysis). METHODS: one three-dimensional (3-D) ultrasound dataset of the endometrium was obtained from each of five infertile women with different endometrial volumes. For each 3-D dataset, the endometrial volume was calculated by two different observers using the manual mode in four different rotational steps (30º, 15º, 9º and 6º). Ten measurements were obtained with each method and observer from each 3-D dataset. We have used one-way ANOVA and the Tukey post-test to verify the differences among means and the intraclass correlation coefficient to test reliability. RESULTS: rotational methods employing a rotation step of 30º were associated with lower endometrial volume readings in 3 of the 5 patients. There were no significant differences between the means obtained by the 15º, 9º or 6º step rotation. No significant difference was found between the means obtained by the two different observers. The intraclass correlation coefficients were significantly lower with 30º (all under 0.984) than with the other step rotations (all above 0.996). CONCLUSIONS: the use of a rotational step of 15º or less provides reliable readings of endometrial volume: there were no significant differences between the means calculated by the two observers, associated with highintraclass correlation coefficient (>0.996). We recommend the 15º step rotation because it is quicker to be performed than 6º and 9º.
Summary
Rev Bras Ginecol Obstet. 2005;27(7):387-392
DOI 10.1590/S0100-72032005000700004
PURPOSE: to assess peak systolic velocity (PSV) and the resistance index (RI) in the middle cerebral artery (MCA), suprarenal aorta (SRA) and infrarenal aorta (IRA) of the fetus and in the umbilical artery (UA) between the 22nd and 38th week of gestation. METHODS: a prospective study which evaluated the parameters of 33 normal fetuses in the 22nd, 26th, 30th, and 38th week of gestation. Pregnant women with a singleton fetus with no diseases or complications and who agreed to participate were included in the study. Exclusion criteria were fetal malformations, discontinuation of prenatal care visits and mothers who smoked, used alcohol or illicit drugs. Ultrasound examinations were performed by a single observer. For the acquisition of the Doppler velocimetry tracing in the MCA, SRA, IRA and UA, the sample volume was 1 to 2 mm, placed in the center of the arteries. The insonation angle was 5º to 19º in the MCA, below 45º in the SRA and IRA, and less than 60º in the UA. We used a wall filter of 50-100 Hz. The parameters were calculated automatically with the frozen image, three measurements being made. The final result was obtained by the arithmetic mean of the three values. Data were analyzed by analysis of variance (ANOVA), post hoc Bonferroni test, Pearson's correlation, and regression analysis. The level of significance was set at p<0.05 in all analyses. RESULTS: PSV increased from 26.3 to 57.7 cm/s in the MCA between the 22nd and the 38th week of gestation (p<0.05). In the SRA and in the IRA, PSV increased between the 22nd and 34th week of gestation, from 74.6 and 59.0 cm/s to 106.0 and 86.6 cm/s, respectively (p<0.05). In the UA, PSV increased between the 22nd and the 34th week of gestation, but decreased from 55.5 to 46.2 cm/s between the 34th and the 38th week of gestation. In the MCA, the RI was lower in the 22nd (0.81) and 38th week of gestation (0.75) and higher (0.85) in the 26th week (p<0.05). In the SRA, the RI values were stable in all weeks and in the IRA they were stable in most weeks (p>0.05). In the UA, RI decreased from 0.69 to 0.56 between the 22nd and 38th week of gestation (p<0.05). CONCLUSION: in normal fetuses, in the second half of gestation PSV increased in the MCA, SRA and IRA, decreasing in the UA between the 34th and 38th week of gestation. RI was lower in the 22nd and 38th weeks of gestation in the MCA, decreased between the 22nd and the 38th week in the UA, and was constant in most of the gestational weeks in the SRA and IRA.
Summary
Rev Bras Ginecol Obstet. 2005;27(7):387-392
DOI 10.1590/S0100-72032005000700004
PURPOSE: to assess peak systolic velocity (PSV) and the resistance index (RI) in the middle cerebral artery (MCA), suprarenal aorta (SRA) and infrarenal aorta (IRA) of the fetus and in the umbilical artery (UA) between the 22nd and 38th week of gestation. METHODS: a prospective study which evaluated the parameters of 33 normal fetuses in the 22nd, 26th, 30th, and 38th week of gestation. Pregnant women with a singleton fetus with no diseases or complications and who agreed to participate were included in the study. Exclusion criteria were fetal malformations, discontinuation of prenatal care visits and mothers who smoked, used alcohol or illicit drugs. Ultrasound examinations were performed by a single observer. For the acquisition of the Doppler velocimetry tracing in the MCA, SRA, IRA and UA, the sample volume was 1 to 2 mm, placed in the center of the arteries. The insonation angle was 5º to 19º in the MCA, below 45º in the SRA and IRA, and less than 60º in the UA. We used a wall filter of 50-100 Hz. The parameters were calculated automatically with the frozen image, three measurements being made. The final result was obtained by the arithmetic mean of the three values. Data were analyzed by analysis of variance (ANOVA), post hoc Bonferroni test, Pearson's correlation, and regression analysis. The level of significance was set at p<0.05 in all analyses. RESULTS: PSV increased from 26.3 to 57.7 cm/s in the MCA between the 22nd and the 38th week of gestation (p<0.05). In the SRA and in the IRA, PSV increased between the 22nd and 34th week of gestation, from 74.6 and 59.0 cm/s to 106.0 and 86.6 cm/s, respectively (p<0.05). In the UA, PSV increased between the 22nd and the 34th week of gestation, but decreased from 55.5 to 46.2 cm/s between the 34th and the 38th week of gestation. In the MCA, the RI was lower in the 22nd (0.81) and 38th week of gestation (0.75) and higher (0.85) in the 26th week (p<0.05). In the SRA, the RI values were stable in all weeks and in the IRA they were stable in most weeks (p>0.05). In the UA, RI decreased from 0.69 to 0.56 between the 22nd and 38th week of gestation (p<0.05). CONCLUSION: in normal fetuses, in the second half of gestation PSV increased in the MCA, SRA and IRA, decreasing in the UA between the 34th and 38th week of gestation. RI was lower in the 22nd and 38th weeks of gestation in the MCA, decreased between the 22nd and the 38th week in the UA, and was constant in most of the gestational weeks in the SRA and IRA.
Summary
Rev Bras Ginecol Obstet. 2003;25(6):437-442
DOI 10.1590/S0100-72032003000600009
PURPOSE: to study the evolution of the resistance and pulsatility indices, maximum velocity, final diastolic velocity and time of acceleration of the middle cerebral artery of fetuses between 22 and 38 weeks of gestation. METHODS: a prospective and longitudinal observational study was conducted on 33 fetuses of normal pregnant women evaluated between 22 and 38 weeks of pregnancy. The gestational age was determined on the basis of the date of the last menstruation and/or by ultrasound examination during the first trimester. Doppler ultrasound examination was performed by a single observer using an Image Point 1800 (Hewlett Packard) apparatus equipped with a multiple frequency transducer. For the acquisition of the Doppler tracing of the middle cerebral artery, the sample indicator was calibrated for a sample volume of 1 mm³ and placed on the anterior middle cerebral artery as close as possible to the skullcap. The insonation angle was kept between 5º and 19º and the filter was adjusted to a frequency of 50-100 Hz. The newborn infants were evaluated in order to confirm that the fetuses were vigorous and adequate for gestational age. RESULTS: the results obtained for the resistance and pulsatility indices revealed a 2nd-degree equation, representing a parabola whose values for the resistance index were 0.81 during the 22nd week and 0.75 during the 38th week. The pulsatility index was 1.59 during the 22nd week and 1.45 during the 38th week. Maximum systolic velocity increased progressively along pregnancy, with values of 26.3 cm/s during the 22nd week and 57.7 cm/s during the 38th week. Final diastolic velocity increased progressively from the 26th week (5.21 cm/s) to term (14.6 cm/s). Acceleration time increased significantly only between 26 and 30 weeks, with values of 0.04 s during the 26th week and 0.05 s during the 30th week. CONCLUSION: it was concluded that the evolution of the resistance and pulsatility indices and of maximum systolic velocity were similar to those of most studies described in the literature. Acceleration time presented few modifications during the evaluated gestational weeks.
Summary
Rev Bras Ginecol Obstet. 2003;25(6):437-442
DOI 10.1590/S0100-72032003000600009
PURPOSE: to study the evolution of the resistance and pulsatility indices, maximum velocity, final diastolic velocity and time of acceleration of the middle cerebral artery of fetuses between 22 and 38 weeks of gestation. METHODS: a prospective and longitudinal observational study was conducted on 33 fetuses of normal pregnant women evaluated between 22 and 38 weeks of pregnancy. The gestational age was determined on the basis of the date of the last menstruation and/or by ultrasound examination during the first trimester. Doppler ultrasound examination was performed by a single observer using an Image Point 1800 (Hewlett Packard) apparatus equipped with a multiple frequency transducer. For the acquisition of the Doppler tracing of the middle cerebral artery, the sample indicator was calibrated for a sample volume of 1 mm³ and placed on the anterior middle cerebral artery as close as possible to the skullcap. The insonation angle was kept between 5º and 19º and the filter was adjusted to a frequency of 50-100 Hz. The newborn infants were evaluated in order to confirm that the fetuses were vigorous and adequate for gestational age. RESULTS: the results obtained for the resistance and pulsatility indices revealed a 2nd-degree equation, representing a parabola whose values for the resistance index were 0.81 during the 22nd week and 0.75 during the 38th week. The pulsatility index was 1.59 during the 22nd week and 1.45 during the 38th week. Maximum systolic velocity increased progressively along pregnancy, with values of 26.3 cm/s during the 22nd week and 57.7 cm/s during the 38th week. Final diastolic velocity increased progressively from the 26th week (5.21 cm/s) to term (14.6 cm/s). Acceleration time increased significantly only between 26 and 30 weeks, with values of 0.04 s during the 26th week and 0.05 s during the 30th week. CONCLUSION: it was concluded that the evolution of the resistance and pulsatility indices and of maximum systolic velocity were similar to those of most studies described in the literature. Acceleration time presented few modifications during the evaluated gestational weeks.
