[show abstract][hide abstract] ABSTRACT: Objective. To identify the risk factors to the development of Burnout Syndrome in Ob/Gyn Brazilian physicians in four dimensions: emotional exhaustion (EE), professional repression (PR), dehumanization (De), and emotional distancing (EmD). Methods. A prospective cross-sectional study was realized with 48 Ob/Gyn physicians (12 lecturers, 12 attending physicians, 12 medical residents, and 12 graduate students) from Department of Obstetrics, São Paulo Federal University (UNIFESP). We used a sociodemographic questionnaire focusing on the activities (administrative, educational, healthcare, and research). We applied a Burnout Syndrome Inventory (BSI) composed of two parts: triggering factors (ISB1) and the Burnout Syndrome (ISB2). The ISB1 is composed of two scales: positive organizational conditions (POC) and negative organizational conditions (NOC). The ISB2 is composed of four scales: EE, PR, De, and EmD. Results. We observed a rate below and above average to POC and NOC, respectively. The dimensions recorded a level above average to EE, an index at the upper limit of the average to De, a median index to EmD, and a median index to PR. Conclusions. The Ob/Gyn physicians are in an area of vulnerability for the development of Burnout Syndrome due to the high level of EE and De, associated with a median index of PR. The high rate of NOC contributes to the triggering of this scenery.
ISRN obstetrics and gynecology 01/2012; 2012:593876.
[show abstract][hide abstract] ABSTRACT: The objective of this study was to evaluate cervix length and the presence of cervical gland area (CGA) in ultrasounds performed before and after the administration of vaginal isosorbide mononitrate (IMN) for cervical ripening.
We performed an observational, descriptive, and longitudinal study of pregnant patients indicated for labor induction and with a Modified Bishop Score (MBS) lower than six. For cervical ripening, 40 mg of vaginal IMN was administered at 0, 16, and 24 hours after the initiation of cervix preparation.
After enrolling 11 patients, the study had to be discontinued due to adverse effects. Three patients requested that they be withdrawn. Headaches were reported by all patients. Nausea, dizziness, dyspnea, and vomiting were also reported. The average cervical lengths at 0, 16, 24 and 36 hours were 27.6, 27.7, 25.9, and 23.0 mm, respectively. CGA disappeared in one of seven patients.
The use of IMN appears to increase the MBS, slightly reducing cervical length without altering the appearance of CGA. Considering the importance of maternal wellbeing during labor, the routine use of IMN cannot be recommended for cervical ripening in the third trimester due to the frequency and intensity of side-effects.
[show abstract][hide abstract] ABSTRACT: Choriocarcinoma is a highly malignant disease of trophoblastic cells, which affects young women in the reproductive years. The main sites of metastasis from choriocarcinoma are lung, vagina, liver, gastrointestinal tract and kidneys, and the involvement of the ovaries is extremely rare. The diagnosis of ovarian metastasis is made mainly by two-dimensional ultrasonography (2DUS) with color Doppler, which shows a large vessel in the center of the mass. The three-dimensional power Doppler ultrasound (3D power Doppler) and dynamic contrast-enhanced magnetic resonance imaging (MRI) are new diagnostic modalities not yet published in literature. We report a case of metastatic choriocarcinoma with left ovary involvement in a 48-year-old woman with history of molar pregnancy and irregular follow-up of this disease. We emphasize the main findings by 2DUS with color Doppler, 3D power Doppler and dynamic contrast-enhanced MRI. 3D power Doppler is able to improve the assessment of anatomical relationships of vessels with the ovarian mass, while the resonance angiography allows us to evaluate the anatomic relations of the mass and adjacent structures, as well as the iliac vessels. The 3D power Doppler and dynamic contrast-enhanced MRI are promising methods in the evaluation of metastasis arising from gestational trophoblastic tumors.
[show abstract][hide abstract] ABSTRACT: Hypospadia is an abnormal development of the corpus spongiosum, that involves cavernosa urethra, as a result of an inadequate fusion of the urethral folds. The incidence ranges from 0.2 to 4.1 per 1,000 live births. Among the markers of hypospadia, isolated ventral or lateral curvature of the penis associated with shortening are the most important markers and, in severe cases, can result in the classic "tulip sign." The diagnosis of hypospadia is uncommon unless there is a routine of detailed analysis of fetal genitalia morphology. The prenatal diagnosis is of great importance for genetic counseling and allows better planning of postnatal treatment. The three-dimensional ultrasonography (3DUS) in rendering mode enables better comprehension of the pathology by parents, facilitating postnatal planning. We report a case of penoscrotal hypospadia diagnosed at 33 weeks of gestation, suspected due to the absence of testicles in the scrotum and difficulty of penis visualization. We emphasize the findings of 3DUS and its importance in the pathology compression by parents.
[show abstract][hide abstract] ABSTRACT: To compare the fetal cerebellum and cisterna magna length measurements by means of two- (2DUS) and three-dimensional (3DUS) ultrasonography using the three-dimensional extended imaging (3D XI), a cross-sectional study with 69 healthy pregnant women between 18 and 24 weeks was performed. For the measurements by 2DUS, the axial planes were used and for the 3DUS a sequence of adjacent axial slices (multislice view). To evaluate the difference between the two techniques, we used the Wilcoxon test. To evaluate the correlation between the cerebellum and cisterna magna length measurements and the gestational age, we used the Spearman correlation coefficient (r). For the calculation of reproducibility, we used the intraclass correlation coefficient (ICC). The mean of the transverse and anterior-posterior diameter of cerebellum and cisterna magna by 3DUS was 9.23 and 6.62 mm, respectively. It was observed that the average of the measurements obtained by 3DUS was significantly higher, 0.76 and 1.02 mm for the length of the cerebellum and cisterna magna, respectively (P < 0.001). There was a high correlation between the length measurement of the cerebellum 3D (r = 0.940, P < 0.001), but low correlation of cisterna magna 3D (r = 0.462, P = 0.080) with the gestational age. There was good intra- and interobserver reproducibility for the cerebellum and cisterna magna 3D with ICC = 0.792 , 0.668, 0.691, and 0.287, respectively. The measurements of the fetal cerebellum and cisterna magna length by 3DUS using the software 3D XI were significantly higher than those obtained by 2DUS.
ISRN obstetrics and gynecology 01/2012; 2012:286141.
[show abstract][hide abstract] ABSTRACT: Purpose. To compare the measurements of fetal nuchal fold (NF) thickness by two-dimensional (2D) and three-dimensional (3D) ultrasonography using the three-dimensional extended imaging (3DXI). Methods. A cross-sectional study was performed with 60 healthy pregnant women with a gestational age between 16 and 20 weeks and 6 days. The 2D-NF measurements were made as the distance from the outer skull bone to the outer skin surface in the transverse axial image in the suboccipital-bregmatic plane of the head. For the 3D we employed the 3DXI multislice view software, in which 3 × 2 tomographic planes was displayed on the screen and the distance between the tomographic slices was 0.5 mm. Maximum, minimum, mean, and standard deviation were calculated for 2D and 3D ultrasonography, as well the maximum and minimum, mean, and standard deviation for the difference between both methods. The Wilcoxon signed-rank test was used to compare the two different techniques. Results. 2D-NF showed a mean of thickness of 3.52 ± 0.95 mm (1.69-7.14). The mean of 3D-NF was 3.90 ± 1.02 mm (2.13-7.72). The mean difference between the methods was 0.38 mm, with a maximum difference of 3.12 mm. Conclusion. The NF thickness measurements obtained by 3D ultrasonography were significantly larger than those detected with 2D ultrasonography.
Obstetrics and Gynecology International 01/2012; 2012:837307.
[show abstract][hide abstract] ABSTRACT: Objective. To verify if the placental thickness allows determining the gestational age, evaluating the correlation between the referred gestational age with the studied one, and the accuracy of the placental thickness measurement (biometry) with fetal morphologic parameters in bitches. Methods. The placental thickness of 336 bitches of diverse breeds was evaluated. Bitches were divided in three groups by body weight: small, medium, and big large size. The gestations pregnancies were evaluated by ultrasound from the third week of gestation. An analysis was performed between the mean values of the gestational age obtained of placental thickness by adjustment of curves and the reported gestational age. Student's t-test was applied to compare the mean of reported and placental thickness gestational age. Significance was defined as P < 0.05. Results. A positive and statistically significant correlation exists between the placental thickness and gestational age. The expression that presents the best correlation coefficient and explanation was thickness of placenta = 0.021x gestational age -0.314. Conclusion. It is possible to determine the gestational age in relation to the placental thickness measured by ultrasound in bitches with a satisfactory accuracy in relation to fetal morphologic parameters as gestational vesicle, ribs, or kidneys.
Veterinary medicine international. 01/2012; 2012:850867.
[show abstract][hide abstract] ABSTRACT: THE EEC SYNDROME IS A GENETIC ANOMALY CHARACTERIZED BY THE TRIAD: ectodermal dysplasia (development of anomalies of the structures derived from the embryonic ectodermal layer), ectrodactyly (extremities, hands and feet malformations) and cleft lip and/or palate; these malformations can be seen together or in isolation. The prenatal diagnosis can be made by two-dimensional ultrasonography (2DUS) that identifies the facial and/or limb anomalies, most characteristic being the "lobster-claw" hands. The three-dimensional ultrasonography (3DUS) provides a better analysis of the malformations than the 2DUS. A 25-year-old primigravida, had her first transvaginal ultrasonography that showed an unique fetus with crow-rump length of 47 mm with poorly defined hands and feet,. She was suspected of having sporadic form of EEC syndrome. The 2DUS performed at 19 weeks confirmed the EEC syndrome, showing a fetus with lobster-claw hands (absence of the 2(nd) and 3(rd) fingers), left foot with the absence of the 3rd toe and the right foot with syndactyly, and presence of cleft lip/palate. The 3DUS defined the anomalies much better than 2DUS including the lobster-claw hands.
Journal of clinical imaging science. 01/2012; 2:40.
[show abstract][hide abstract] ABSTRACT: Cancer is the second leading cause of death during the reproductive years, but the incidence during pregnancy is low. The incidence of cancer of the rectum during pregnancy is very rare (1:50,000 to 1:100,000 pregnancies). Usually, the symptoms of this type of cancer are nonspecific and sometimes they are confused with normal changes of pregnancy. The diagnosis of rectal cancer is usually made in the late stage of pregnancy. The treatment of this cancer involves surgery, chemotherapy and radiotherapy, but each type of treatment involves risks to the fetus and the pregnant woman. We present a case of a young primiparous woman who had a quick and bad evolution of an adenocarcinoma of the rectum diagnosed during pregnancy. This patient had extensive involvement of the liver with metastasis and she died two weeks after diagnosis. In this case, we present the clinical, radiological and pathology findings of this disease.
[show abstract][hide abstract] ABSTRACT: Cloacal malformation is an extremely rare fetal pathological condition that presents as a variety of defects. It predominantly affects females, with prevalence of 1 in 50,000 births. Prenatal ultrasonography on a 20-year-old caucasian woman (G4P1A2) at 33 weeks of pregnancy showed the fetus having a large cystic mass in the lower abdomen with a single septum, bilateral hydronephrosis, ambiguous genitalia, and a single umbilical artery. The pregnancy developed accentuated oligohydramnios, and presence of a fetal brain-sparing effect was diagnosed using arterial Doppler velocimetry. The newborn showed abdominal distension, ambiguous genitalia, and rectal atresia, with a single perineal opening. Pelvic ultrasound done on the first day after delivery revealed the presence of a large retrovesical septated cystic mass of dense content in the fetal abdomen, and bilateral hydronephrosis. Hysterotomy was performed, and 70 mL of dense liquid was drained through an abdominal colostomy. The infant died on the 27th day of life as a result of infectious complications. Prenatal diagnosing of female urogenital anomalies is usually difficult because of their rarity, different types of manifestation, and lack of characteristic ultrasound signs. Presence of a septated cyst with dense content in the fetal abdomen confirms the finding of hydrometrocolpos, thus raising clinical suspicion of a cloacal anomaly.
[show abstract][hide abstract] ABSTRACT: Lethal multiple pterygium (LMP) is a series of disorders of fetal formation with a heterogeneous range of manifestations that generally include cystic hygroma, pulmonary hypoplasia, cleft palate, cryptorchidism, joint contractures, fetal akinesia, heart defects, growth restriction, and intestinal malrotation. The prenatal diagnosis of this syndrome is suspected when two-dimensional ultrasound (2DUS) scan shows several malformations.. The three-dimensional ultrasound (3DUS) in rendering mode permits the spatial visualization of these malformations, allowing better understanding of this anomaly by parents. We report a case of a fetus in the second trimester with multiple abnormalities suggestive of LMP that were identified using 2DUS, and emphasize the importance of 3DUS in counseling the parents.
Journal of clinical imaging science. 01/2012; 2:65.
[show abstract][hide abstract] ABSTRACT: Conjoined twins are rare variants of monozygotic twins, which result from an incomplete division of the embryonic disk. Cephalothoracopagus is a rare twin pregnancy described as imperfect fusion of the head and chest, but separated columns, limbs, and pelvis. They occur with incidence rates that range from 1 per 50,000 to 1 per 100,000 births; however, the incidence of the cephalothoracopagus variety is 1 per 58 conjoined twins. In the case of identical and symmetric faces caused by the orientations of the 2 notochordal axes that are perfectly ventroventral, they are called janiceps disymmetros. We present a prenatal diagnosis of a typical case of cephalothoracopagus janiceps disymmetros and the diagnostic confirmation by image and pathology exams.
[show abstract][hide abstract] ABSTRACT: Aneurism of the vein of Galen is a complex arteriovenous malformation which is of multiply communications between of the vein of Galen and the cerebral arteries. It represents less than 1% of the cerebral arteriovenous malformations. Few cases using three-dimensional (3D) power and color Doppler ultrasound have been reported in the literature. We present a case of an aneurysm of the vein of Galen diagnosed at 25th week of pregnancy. We demonstrate the main findings of 3D power and color Doppler ultrasonography in this anomaly. A 36-year-old pregnant woman, gravida 3, para 2 was referred to our institution because of a midline cystic mass diagnosed in a previous ultrasonography undertaken at 24 weeks' gestation. The ultrasonographic finding consisted of a male fetus with a midline cystic mass, with positive flow detection by color Doppler and ventriculomegaly due to the compressive effects of the malformation. The 3D color and power Doppler ultrasonography allowed us to reconstruct the architecture of the vascular malformation, and it showed the spatial relationships of aneurysm of the vein of Galen with the other structures of the brain. Pregnancy was interrupted at 29 weeks' gestation because of presence of cardiomegaly. A male newborn survived for 36 hours only. The 3D ultrasound can be used as advent image technique in prenatal diagnosis of aneurysm of the vein of Galen.
Clinical medicine insights. Case reports. 01/2012; 5:77-80.
[show abstract][hide abstract] ABSTRACT: Present the outcomes of six cases submitted to intrauterine myelomeningocele (MMC) repair.
Descriptive observational study of six children submitted to antenatal surgical repair of MMC between 26 and 27 weeks gestation. All deliveries were through cesarean section. The following neonatal variables were assessed: gestational age at delivery, birth weight, Apgar scores, need for intubation, duration of hospital stay and need for postnatal shunt procedures. After 3.5 years, the children were evaluated using the Columbia Mental Maturity Scale or Denver II tests and the Hoffer Ambulation Scale.
All deliveries were preterm at a mean gestational age of 32 + 4 weeks and mean birth weight was 1,942 g. Two infants had Apgar scores <7 at 1 min and 1 at 5 min. Ventricular-peritoneal shunts were placed in two cases. All six children are alive: five have normal cognitive development and one has a neuropsychomotor developmental delay. Two children had normal leg movements, a sacral functional level and are community ambulators. Three children had upper lumbar anatomical level lesions and one had a lower thoracic level lesion at the time of fetal surgery. One child, with an L1-L2 anatomical level lesion, in noambulatory and fully dependent on a wheelchair for mobility.
Antenatal surgical repair of MMC reduced the need for postnatal shunt placements. Despite preterm delivery, the cognitive development of most children at 3.5 years was normal. Antenatal surgery seemed to improve lower limb motor function in these cases.
Child s Nervous System 12/2011; 28(3):461-7. · 1.24 Impact Factor
[show abstract][hide abstract] ABSTRACT: To provide reference values for fetal thigh volume using three-dimensional (3D) ultrasound and the eXtended Imaging Virtual Organ Computer-aided AnaLysis (XI VOCAL) method.
This is a cross-sectional study that enrolled 425 healthy pregnant women between the 20(th) and 40(th) weeks of gestation. The XI VOCAL was performed along the axial cross-section in ten sequential areas for the volumetric calculations, having the proximal and distal echogenic diaphysis as references. Second-degree polynomial regression models, with the determination of percentiles, were created to evaluate the relation between the fetal thigh volume and gestational age (GA). Intraoperator and interoperator reproducibility was evaluated using intraclass correlation coefficient.
The mean fetal thigh volume varied from 8.00 (3.90-11.90 cm(3) ) to 122.14 cm(3) (105.0-153.50 cm(3) ) at 20 and 40 weeks of gestation, respectively. Fetal thigh volume was strongly correlated with gestational age, and the reference values can be obtained by the following mathematical equation: fetal thigh volume (cm(3) ) = 68.70-7.63 × GA + 0.23 × GA(2) (R(2) = 0.946). The intraoperator and interoperator reproducibility were excellent, with an intraclass correlation coefficient = 1.000 and 0.999, respectively.
The reference range of fetal thigh volume was determined by 3D-ultrasound using the XI VOCAL method.
[show abstract][hide abstract] ABSTRACT: To assess the fetal lumbosacral spine by three-dimensional (3D) ultrasonography using volume contrast imaging (VCI) omni view method and compare reproducibility and agreement between three different measurement techniques: standard mouse, high definition mouse and pen-tablet.
A comparative and prospective study with 40 pregnant women between 20 and 34 + 6 weeks was realized. 3D volume datasets of the fetal spine were acquired using a convex transabdominal transducer. Starting scan plane was the coronal section of fetal lumbosacral spine by VCI-C function. Omni view manual trace was selected and a parallel plane of fetal spine was drawn including interest region. Intraclass correlation coefficient (ICC) was used for reproducibility analysis. The relative difference between three used techniques was compared by chi-square test and Fischer test.
Pen-tablet showed better reliability (ICC=0.987). In the relative proportion of differences, this was significantly higher for the pen-tablet (82.14%; p<0.01). In paired comparison, the relative difference was significantly greater for the pen-tablet (p<0.01).
The pen-tablet showed to be the most reproductive and concordant method in the measurement of body vertebral area of fetal lumbosacral spine by 3D ultrasonography using the VCI.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 11/2011; 25(9):1818-21. · 1.36 Impact Factor
[show abstract][hide abstract] ABSTRACT: The purpose of this study was to establish reference intervals for fetal ear length using 3-dimensional sonography in the rendering mode.
A cross-sectional study was conducted on 114 women from 19 weeks to 23 weeks 6 days of normal pregnancy. Fetal ear length measurement was performed in the rendering mode, obtained from 2-dimensional mode reconstruction. To determine the correlation between ear length and gestational age, scatterplots were constructed, and the Pearson correlation coefficient was calculated. Mean, median, SD, maximum, and minimum values and percentiles for each gestational age were calculated. To calculate the intraobserver reproducibility, we used the intraclass correlation coefficient.
The mean ear length ± SD increased from 14.43 ± 1.28 mm (range, 12.80-16.50 mm) in the 19th week of pregnancy to 19.72 ± 1.87 mm (range, 17.20-22.40 mm) in the 23rd week. Three-dimensional sonographic ear length measurements were correlated with gestational age, with the best adjustment represented by the following exponential equation: ear length = exp(1.215 × gestational age - 8.692) (R(2) = 0.423). The intraobserver reproducibility was excellent, resulting in an intraclass correlation coefficient of 0.967 (95% confidence interval, 0.939-0.982).
Reference intervals for fetal ear length using 3-dimensional sonography in the rendering mode from 19 weeks to 23 weeks 6 days of pregnancy were determined and proved reproducible.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 09/2011; 30(9):1185-90. · 1.40 Impact Factor