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ABSTRACT: CONTEXT Diastrophic dysplasia is a type of osteochondrodysplasia caused by homozygous mutation in the gene DTDST (diastrophic dysplasia sulfate transporter gene). Abnormalities occurring particularly in the skeletal and cartilaginous system are typical of the disease, which has an incidence of 1 in 100,000 live births. CASE REPORT The case of a pregnant woman, without any consanguineous relationship with her husband, whose fetus was diagnosed with skeletal dysplasia based on ultrasound findings and DNA tests, is described. An obstetric ultrasound scan produced in the 16th week of gestation revealed characteristics that guided the clinical diagnosis. Prominent among these characteristics were rhizomelia of the lower and upper limbs (shortening of the proximal portions) and mesomelia (shortening of the intermediate portions). Both upper limbs showed marked curvature, with the first finger of the upper limbs in abduction and clinodactyly of the fifth finger. Molecular analysis using the polymerase chain reaction (PCR) and gene sequencing detected mutations that had already been described in the literature for the gene DTDST, named c.862C > T and c.2147_2148insCT. Therefore, the fetus was a compound heterozygote, carrying two different mutations. CONCLUSIONS Prenatal diagnosis of this condition allowed a more realistic interpretation of the prognosis, and of the couple's reproductive future. This case report shows the contribution of molecular genetics towards the prenatal diagnosis, for which there are few descriptions in the literature.
São Paulo medical journal = Revista paulista de medicina 04/2013; 131(2):127-32. · 0.75 Impact Factor
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ABSTRACT: This study aimed to evaluate the effect that combining multiple ultrasonographic imaging methods has on the proportion of tests with a satisfactory fetal heart assessment at 12-14 weeks of pregnancy using B-mode, color Doppler, and spatiotemporal image correlation software (STIC) via both the abdominal and vaginal routes. This cross-sectional prospective study involved healthy pregnant women at 12-14 weeks of pregnancy with a crown-rump length (CRL) of 84 mm or shorter. The following four cardiac views were assessed: four-chamber, left and right ventricular outflow tract, and aortic arch views. The same examiner sought to identify these four views using B-mode, color Doppler, and STIC via both the vaginal and abdominal routes. The study determined the proportion of cases and the respective 95 % confidence intervals (CIs) in which all four views were identified. The presence of significant differences in comparisons between methods was analyzed using McNemar's test. Although 57 pregnant women at 12-14 weeks of pregnancy agreed to participate in the study, 4 were not included because they presented with a CRL longer than 84 mm. Thus, 53 pregnant women were thoroughly assessed and included in the analysis. The combination of B-mode, color Doppler, and STIC via both the abdominal and vaginal routes enabled the highest proportion of identification of the four views (90.6 %; 95 % CI, 79.8-95.9 %). The lowest proportions were observed when B-mode was used alone via both the vaginal route (30.2 %; 95 % CI, 19.5-43.5 %) and the abdominal route (37.7 %; 95 % CI, 25.9-51.2 %). The abdominal route showed results slightly better than those of the vaginal route with all the methods, but the differences were not statistically significant. In the vast majority of the cases, the fetal hearts were properly assessed at 12-14 weeks of pregnancy when several methods were combined using both the abdominal and vaginal routes. However, only one-third of them would have had adequate heart assessment if the B-mode via either the abdominal or the vaginal route had been used alone.
Pediatric Cardiology 03/2013; · 1.30 Impact Factor
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ABSTRACT: To evaluate changes to the pelvic floor of primiparous women with different delivery modes, using three-dimensional ultrasound.
A prospective cross-sectional study on 35 primiparae divided into groups according to the delivery mode: elective cesarean delivery (n=10), vaginal delivery (n=16), and forceps delivery (n=9). Three-dimensional ultrasound on the pelvic floor was performed on the second postpartum day with the patient in a resting position. A convex volumetric transducer (RAB4-8L) was used, in contact with the large labia, with the patient in the gynecological position. Biometric measurements of the urogenital hiatus were taken in the axial plane on images in the rendering mode, in order to assess the area, anteroposterior and transverse diameters, average thickness, and avulsion of the levator ani muscle. Differences between groups were evaluated by determining the mean differences and their respective 95% confidence intervals. The proportions of levator ani muscle avulsion were compared between elective cesarean section and vaginal birth using Fisher's exact test.
The mean areas of the urogenital hiatus in the cases of vaginal and forceps deliveries were 17.0 and 20.1 cm², respectively, versus 12.4 cm² in the Control Group (elective cesarean). Avulsion of the levator ani muscle was observed in women who underwent vaginal delivery (3/25), however there was no statistically significant difference between cesarean section and vaginal delivery groups (p=0.5).
Transperineal three-dimensional ultrasound was useful for assessing the pelvic floor of primiparous women, by allowing pelvic morphological changes to be differentiated according to the delivery mode.
Revista brasileira de ginecologia e obstetrićia: revista da Federação Brasileira das Sociedades de Ginecologia e Obstetrícia 03/2013; 35(3):117-22.
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ABSTRACT: Epignathus teratomas are rare tumors that originate in the region of the palate or pharynx and are known as Rathke pouch. They may be associated with other malformations such as a cleft palate and bifid tongue or nose. The prenatal diagnosis can be established by two-dimensional ultrasonography showing a heterogeneous mass protruding through the mouth of the fetus. The three-dimensional ultrasonography in rendering mode permits better understanding of this anomaly by the parents, facilitating the counseling. The importance of prenatal diagnosis lies in the fact that this tumor may obstruct the airways, thus leading to death at birth due to respiratory insufficiency. We report a case of prenatal diagnosis of epignathus teratoma in the 30th week of pregnancy by two-dimensional ultrasonography. We focus on the importance of three-dimensional ultrasonography in rendering mode for demonstrating the spatial relationships of the tumor with the oral cavity and provide correlations between the ultrasound images and the anatomopathological findings.
The Cleft Palate-Craniofacial Journal 02/2013; · 0.82 Impact Factor
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ABSTRACT: BACKGROUND: Preterm delivery is one of the most serious public health problems and is the most important factor relating to neonatal morbidity and mortality. The strategies for preventing it include understanding the risk factors, with specific interventions. Recently, uterine cervix measurements using ultrasonography and vaginal administration of progesterone have gained importance in predicting and secondarily preventing spontaneous preterm delivery. OBJECTIVE: To describe the short cervix syndrome, including its etiology, diagnosis, and possible therapies. METHODS: Research in ISI, Pubmed, and Scielo database using the words short cervix, preterm delivery, sludge, cervical funneling, cervical gland area, progesterone, cerclage, and pessary. RESULTS: We found a lot of articles about this topic, including randomized controlled trials. The etiology is multifactorial, being the diagnosis based in a cervix shortening at 20-24 weeks. The history and measurement of cervix length by transvaginal ultrasound have been shown to be effective to select the high risk pregnancies. The progesterone, cervical cerclage, and cervical pessary showed to be effective to reduce the preterm delivery in pregnant women with short cervix. CONCLUSION: The successful management of pregnant women presenting a short cervix depends on the understanding that cervical shortening is the final common path for several causes of preterm delivery. The best approach should be individualized to each patient.
Archives of Gynecology 02/2013; · 0.91 Impact Factor
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ABSTRACT: Objectives To determine reference ranges for measurements of fetal cerebral fissures by 3-dimensional (3D) sonography in the multiplanar mode and to evaluate the reliability and concordance of these measurements. Methods A cross-sectional study was conducted on 393 women with normal pregnancies at 22 weeks to 33 weeks 6 days. The distances between the internal bone plate of the fetal calvaria and the sylvian, parieto-occipital, hippocampal, and calcarine fissures were assessed. To obtain the distances for the first 3 fissures, a 3D sweep was made in the axial plane, at the level of the lateral ventricles. To obtain the distance for the calcarine fissure, a coronal sweep was used, at the level of the occipital lobes. To evaluate the correlation between the fissures and gestational age, polynomial regression was performed with adjustments using the coefficient of determination (R(2)). Reliability was determined with intraclass correlation coefficients and concordance with concordance limits. Results The mean distances ± SD to the sylvian, parieto-occipital, hippocampal, and calcarine fissures were 10.42 ± 2.28, 22.38 ± 3.23, 24.88 ± 4.67, and 21.19 ± 2.73 mm, respectively. These distances correlated with gestational age such that the best fit with the linear equation produced R(2) values of 0.582, 0.627, 0.860, and 0.458 for the sylvian, parieto-occipital, hippocampal, and calcarine fissures. Reliability analyses showed intraobserver and interobserver intraclass correlation coefficients of 0.90 to 0.95 and 0.85 to 0.97. The concordance limits were-1.33 to 1.30 and -2.38 to 2.28 mm for the intraobserver evaluation and -1.60 to 2.57 and -3.51 to 2.73 mm for the interobserver evaluation. Conclusions Cerebral fissures can be measured by 3D sonography at 22 to 33 weeks of pregnancy with acceptable reliability and concordance. Reference ranges for this gestational period have thus been described.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 02/2013; 32(2):269-77. · 1.25 Impact Factor
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ABSTRACT: Abstract Objective: To evaluate the influence of different races over the measurement of the frontomaxillary facial angle between 11 and 13+6 weeks of pregnancy in a Brazilian population. Methods: A cross-sectional study was conducted with 332 healthy pregnant women, with a crown-rump length (CRL) between 47 and 84 mm. Such measurements were taken abdominally, using the mid-sagittal plane, and the angle was measured by tracing a line over the palate and a line from the anterosuperior maxillary angle all the way to the external part of the forehead. As for the reference intervals, a simple linear regression between the frontomaxillary facial angle and the CRL was used, as well as Pearson's correlation coefficient (r). To evaluate the difference between races, a variance analysis was used (ANOVA). To calculate reproducibility, the intraclass correlation coefficient (ICC) was used. Results: The means for the fetal frontomaxillary facial angle in white, black and mixed races were 81.8±6.6; 82.2±6.1 and 81.4±6.2 mm, respectively. There was no statistical difference between races (p= 0.713). A decreasing correlation between the frontomaxillary facial angle and the CRL was observed for the black (r= -0.450) and mixed (r= -0.212) races. Excellent intraobserver reproducibility was observed, as well as a satisfactory interobserver reproducibility, with ICC of 0.858 and 0.605, respectively. Conclusion: There were no significative statistical differences in the measurement of the fetal frontomaxillary facial angle between 11 and 13+6 weeks of pregnancy in the different races in a Brazilian population.
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 01/2013; · 1.36 Impact Factor
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ABSTRACT: Objective: To determine reference range for fetal interventricular septum area by means of 3-dimensional ultrasonography (3DUS) using the spatiotemporal image correlation (STIC) method. Methods: A prospective, cross-sectional study was conducted on 328 normal pregnant women between the 18th and 33rd gestational weeks. To obtain the interventricular septum area, a virtual plane was used, with the green line (region of interest) adjacent to the external margin of the septum, which was manually delimited. To evaluate the correlation of the septum area with the gestational age, different regression modes were evaluated. The intraclass correlation coefficient was used to evaluate the interobserver reproducibility. Results: The interventricular septum area showed correlation with the gestational age (r = 0.81). The mean increased from 0.47 ± 0.10 cm(2) in the 18th week to 2.42 ± 1.13 cm(2) in the 33rd week of gestation. The mathematical equation that best represented this correlation was provided by linear regression: interventricular septum area = 0.0511 × gestational age (R(2) = 0.095). The interobserver reproducibility was good, with bias of 0.01 cm(2), precision of 0.07 cm(2) and absolute limits of agreement of -0.14 and +0.15 cm(2). Conclusions: Reference range for fetal interventricular septum area were determined by means of 3DUS using STIC in the rendering mode and were shown to be reproducible.
Fetal Diagnosis and Therapy 01/2013; · 1.05 Impact Factor
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ABSTRACT: Treacher-Collins syndrome (TCS) is a rare dominant autosomal anomaly resulting from malformation or disruption of the development of the first and second branchial arches. It is characterized by micrognathia, malar hypoplasia, and malformations of the eyes and ears. The prenatal diagnosis using two-dimensional ultrasonography (2DUS) is characterized by identification of facial malformations together with polyhydramnios. Three-dimensional ultrasonography (3DUS) has the capacity to spatially display these facial malformations, thus making it easy for the parents to understand them. We present a case of TCS diagnosed in the 33rd week using 3DUS, with postnatal confirmation using cranial computed tomography and anatomopathological analysis.
Case reports in obstetrics and gynecology. 01/2013; 2013:203976.
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ABSTRACT: PURPOSE: To compare two-dimensional ultrasonography (2DUS) and magnetic resonance imaging (MRI) for assessing brain and spine parameters in fetuses with spina bifida. METHODS: A cross-sectional study was conducted on 15 fetuses with spina bifida (one with encephalocele, four with rachischisis and 10 with myelomeningocele). The size of the atrium of the lateral ventricle, percentage shortening of the cerebellum, degree of compromising of the first vertebra and total number of vertebras affected by herniation were assessed. The MRI examination was performed not more than 7 days after the 2DUS. To compare and correlate the parameters from the two techniques, the paired Student's t test and intraclass correlation coefficient (ICC) were used. To assess the correlations of atrium measurements from 2DUS and MRI with other parameters, Pearson's correlation coefficient (r) was used. RESULTS: No significant difference was observed in any of the means of the parameters assessed using the two techniques (p > 0.05). Both 2DUS and MRI seemed to present satisfactory reliability in measurements on the size of the atrium of the lateral ventricle and the first vertebra affected (ICC = 0.88 and 0.75, respectively). Measurements on the atrium of the lateral ventricle from 2DUS correlated better with the other parameters than did measurements from MRI. CONCLUSIONS: In fetuses with spina bifida, 2DUS and MRI present similar results, but measurements on the atrium of the lateral ventricle from 2DUS correlated better with the other parameters.
Archives of Gynecology 12/2012; · 0.91 Impact Factor
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ABSTRACT: OBJECTIVE: Primary anophthalmia is a rare congenital malformation that affects 0.6/10,000 liveborn infants. It is usually associated with central nervous system malformations, aneuploidies, cytomegalovirus infection and mental retardation and it can also be part of genetic conditions such as Fraser, Goltz, Goldenhar, Waardenburg and Lenz syndromes. Neonatal prognosis depends on whether anophthalmia is an isolated malformation, or it is associated with other defects or part of a syndrome. CASE REPORT: A healthy 43-year-old woman, G4 P3 with three previous healthy children, was referred to our clinic for a routine obstetric ultrasound at 28 weeks' gestation. The fetal eye globes and lenses could not be seen on two-dimensional (2D) ultrasound, which led to the diagnosis of bilateral congenital anophthalmia. No other fetal malformations were detected. At 30 weeks' gestation, a three-dimensional (3D) ultrasound was performed using the rendering mode and "reverse face" view. Using this technique, the absence of both eye globes could be clearly seen through a "slit". 3D-ultrasound allowed the parents to better understand their child's problem and possible postnatal implications. Fetal magnetic resonance imaging (MRI) was also performed, to study the fetal cortex in more detail. This exam revealed right cerebral hemisphere sulci and gyri hypoplasia. At 41 1/7 weeks, she went into spontaneous labor and delivered vaginally a 3525 g male infant with Apgar scores of 9 and 10. Postnatal exams confirmed bilateral congenital anophthalmia. CONCLUSION: This is the first case report in the literature of prenatal diagnosis of bilateral anophthalmia using 3D "reverse face" view ultrasound and MRI.
Taiwanese journal of obstetrics & gynecology 12/2012; 51(4):616-619.
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ABSTRACT: OBJECTIVE: This study aims to determine reference curves for fetal atrioventricular valve areas by means of three-dimensional ultrasound using the spatiotemporal image correlation (STIC) software. METHODS: This was a cross-sectional prospective study on 328 normal fetuses between the 18th and the 33rd weeks of pregnancy. In order to obtain valve areas, the four heart chambers plane was used with the fetus in a dorsal posterior position. To construct reference ranges, a linear regression model was used, adjusted according to the coefficient of determination (R(2) ). To calculate the reproducibility of the tricuspid valve area, the intraclass coefficient correlation (ICC) was used. RESULTS: The mean areas of the tricuspid and mitral valves ranged from 0.19 ± 0.08 and 0.20 ± 0.10 cm(2) in the 18th week to 0.93 ± 0.31 and 1.06 ± 0.39 cm(2) in the 33rd week, respectively. The intra-observer and interobserver reproducibility was excellent with ICC = 0.997 and 0.933, respectively. CONCLUSIONS: Reference curves for fetal atrioventricular valve areas were determined and presented good reproducibility. © 2012 John Wiley & Sons, Ltd.
Prenatal Diagnosis 11/2012; · 2.11 Impact Factor
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ABSTRACT: Objectives- The purpose of this study was to establish reference ranges for vertebral body areas of the fetal lumbosacral spine in the coronal plane on 3-dimensional sonography using volume contrast imaging with OmniView (GE Healthcare, Zipf, Austria). Methods- An observational cross-sectional study was conducted on 576 healthy pregnant women at gestational ages of 20 weeks to 34 weeks 6 days. Volume contrast imaging with OmniView was used to measure the vertebral body areas (L1-L5, S1, and S2) by positioning a curved line along the fetal lumbosacral spine. To create reference ranges, first- and second-degree linear regression models adjusted using residual analysis and the coefficient of determination (R(2)) were created. To assess reproducibility, two examiners evaluated 40 random volumes using the intraclass correlation coefficient. Results- The mean areas of the vertebral bodies were 102.72 (range, 25-254), 107.29 (range, 30-245), 105.10 (range, 31-231), 99.09 (range, 31-211), 87.74 (range, 11-178), 65.80 (range, 18-161), and 46.54 (range, 12-129) mm(2) for L1, L2, L3, L4, L5, S1, and S2, respectively. In the intraobserver and interobserver reproducibility assessments, intraclass correlation coefficients of greater than 0.80 were found for all fetal vertebral body areas. Conclusions- Reference values for fetal lumbosacral spine vertebral body areas were determined by 3-dimensional sonography using volume contrast imaging with OmniView, and they were shown to be reproducible.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 11/2012; 31(11):1743-52. · 1.25 Impact Factor
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ABSTRACT: INTRODUCTION: The Rh system is the most polymorphic and immunogenic of all systems of blood groups. Currently more than 49 antigens were identified with five major antigens D, C, c, E, e. Knowledge of the molecular basis of the Rh system permitted the understanding of both the mechanism of Rh phenotype on the antigen variants of RHD and RHCE In Caucasians the primary mechanism of D-negative phenotype is the complete deletion of RHD gene, while the black Africans is the presence of pseudogene and gene hybrid RHD-CE (3-7)-D. OBJECTIVE: To determine the prevalence gene pseudogene and hybrid gene and standardization of molecular techniques in method of Taqman on real-time PCR for RHD genotyping. PATIENTS AND METHODS: 203 samples of D-negative donor were used to establish and validate the effectiveness of RHD genotyping in real-time PCR using Taqman technology. The extraction was performed using a commercial kit QIAmp DNA mini kit. Samples exon 10 and 7 positive were submitted to amplification of exon 5, confirming the pseudogene RHDΨ, whereas exon 10+exon 7 - for the hybrid gene (C) cdes and mutation C733G (Leu245Val) of the RHCE gene. RESULTS: Twenty-five (12.3%) samples were positive, 14 amplified for both exons 10 and 7 while in 11 only for the exon 10. When extended the screening using exon 10, 7 and 5, only 06 amplified. The pseudogene was present in 07 samples (3.5%) and the hybrid RHD-CE (3-7) in 04 (1.97%), while in 177 (87.2%) of Rh negative donors were RHD gene deletion. In 07 samples not amplified for exon 3 had mutated and the mutation C733G antigen. CONCLUSION: The prevalence of pseudogene was 3.5% and the gene hybrid RHD-CE of 1.9%. This approach for real-time PCR as a complementary tool is technically feasible and the results of this study helped develop a new strategy for RHD genotyping.
Transfusion and Apheresis Science 09/2012; · 1.25 Impact Factor
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ABSTRACT: To compare the agreement of multiplanar and rendering modes in the assessment fetal atrioventricular valves (mitral and tricuspid) areas by three-dimensional (3D) ultrasonography using the software spatio-temporal image correlation (STIC).
We conducted a prospective cross-sectional study with normal pregnant women, with single fetuses, between 18-33 weeks. To measure the areas, we used the plan of four-chamber view. In the case of multiplanar, the plane was rotated on the axis "Z" form the heart to position at 9h. For rendering, the green line (region of interest - ROI) was placed from the atria of the heart perpendicular to the crux. The agreement was assessed by a Bland-Altman (limits of agreement) using the relative difference between the measures: ((rendering mode) - (multiplanar mode)) / (average).
328 fetuses were evaluated. We have not identified the occurrence of systematic error between methods: the average relative difference was 1.62% (-2.07% to 5.32%, confidence interval 95%) in the mitral and 1.77% (- 1.08% to 4.62%) in the tricuspid valve. The limits of agreement between methods were -65.26% to 68.51% for the mitral and -49.91% to 53.45% for the tricuspid.
There was no systematic error between modes and thus the observed values for the area of fetal atrioventricular valves can be used for comparisons needs to be corrected. However, relatively large variations may be observed when repeating the measurement area by different modes.
Brazilian Journal of Cardiovascular Surgery 09/2012; 27(3):472-6.
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ABSTRACT: To assess and to compare the renal volume evolution in bitches during pregnancy by two-dimensional (2D) ultrasonography using the ellipsoid technique (volume = length x width x depth x 0.523) and three-dimensional (3D) ultrasonography using the Virtual Organ Computer-aided AnaLysis (VOCAL) method. A longitudinal prospective study was performed with 17 normal Golden Retrievers bitches during pregnancy from heat to the last third of gestation. The ultrasound scans were performed by two veterinarians. The left and right kidneys were assessed in three moments (day 0 = non-pregnant bitches; days 1st to 20th of pregnancy and days 21st to 40th of pregnancy) by three techniques (ellipsoid; VOCAL 12° and VOCAL 30°). For reproducibility calculations, we used the intraclass correlation coefficient (ICC).
The inferential result of the volumes in ANOVA revealed the interaction effect between side and moment (p = 0.009). The 3D techniques showed, in average, the same renal volumes (p = 0.137) regardless of the side and moment. Considering the right side, the renal volume in the day 0 was smaller than the day 21st to 40th (p = 0.029). Considering the left side, the renal volume at day 0 was smaller than the day 1st to 20th (p = 0.020) and day 21st to 40th (p = 0.007). It was found good intra observer reproducibility (ICC > 0.9) and none of the three techniques showed a good inter observer reproducibility (ICC < 0.7).
The renal volume bitches by 3D ultrasonography using the VOCAL method (12° and 30°) had good correlation with the volume obtained by 2D ultrasonography method.
BMC Veterinary Research 07/2012; 8:102. · 2.00 Impact Factor
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ABSTRACT: to evaluate the relationship between ductus venous (DV) and Doppler velocimetry in neonatal outcome in severe compromised preterm fetuses.
the study was designed as an observational and cross-sectional study with 52 premature neonates with brain sparing effect. The criteria of neonatal severe morbidity were: severe intraventricular hemorrhage (grades 3 or 4), retinopathy of prematurity (grade 3 or 4), cystic periventricular leukomalatia, bronchopneumo dysplasia and neonatal mortality. The fetuses were divided in two groups: group 0 - all the fetuses with ventricular systole/atrial contraction (S/A) in DV ratio values less them 3.4; group 1 - fetuses with values of S/A ratio greater than 3.4.
42% of fetuses showed abnormal S/A ratio in DV and 48% showed birth weight below percentile 3 for gestational age. There was no statistical significance comparing the 02 groups according to bronchopneumo dysplasia, retinopathy of prematurity (grade 3 or 4) and intraventricular hemorrhage (grade 3 or 4). Only one fetus presented cystic periventricular leukomalatia. We found statistically significant association between abnormal DV S/A ratio and neonatal mortality (CI 95%, 1.28 -38.22, p< 0.002).
our results suggest that abnormal DV blood flow detected by Doppler examination isn't associated with severe neonatal morbidity but with neonatal mortality.
Journal of prenatal medicine. 07/2012; 6(3):40-6.
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ABSTRACT: To determine a predictive model for supporting decisions relating to the prognosis for women presenting with preterm labor and intact membranes.
We conducted a prospective observational cohort study on 70 pregnant women at between 22 and 34 weeks of gestation. Transvaginal sonographic evaluation on the cervix was performed once on women who had completed a course of parenteral tocolysis. The sonographic parameters of cervical length measurement and presence of cervical glandular area were obtained. The outcome variable was occurrences of preterm delivery (<35 weeks). Using a univariate logistic regression model, the coefficients of each independent variable were first estimated. To construct the predictive model, multivariate logistic regression containing all the selected variables that might be related to preterm delivery was used as the starting point. Accuracy, sensitivity, specificity and predictive values were used to measure associations of predicted probabilities and to check the ability of the model to predict outcomes. The predictive analyses were based on logistic regression models, with calculation of odds ratios and 95 % confidence intervals.
The incidence of preterm delivery was 32.80 % (23/70). After validation, the predictive model proposed showed accuracy of 87.88 %, sensitivity of 78.26 % and specificity of 93.02 %.
The model presented good accuracy with correspondence between predictions and observations, and has the capacity to become a useful tool for management of pregnant women with preterm labor and intact amniotic membranes.
Archives of Gynecology 06/2012; 286(4):893-900. · 0.91 Impact Factor
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ABSTRACT: OBJECTIVE: To compare the cardiac output (CO) and ejection fraction (EF) of the heart of male and female fetuses obtained by 3D-ultrasonography using spatio-temporal image correlation (STIC). METHODS: We conducted a cross-sectional study with 216 normal fetuses, between 20 and 34 weeks of gestation, 108 male and 108 female. Ventricular volumes at the end of systole and diastole were obtained by STIC, and the volumetric assessments performed by the virtual organ computer-aided analysis (VOCAL) rotated 30º. To calculate the DC used the formula: DC = stroke volume / fetal heart rate, while for the FE used the formula: EF = stroke volume / end-diastolic volume. The DC (combined male and female) and EF (male and female) were compared using the unpaired t test and ANCOVA. Scatter plots were created with the percentiles 5, 50 and 95. RESULTS: The average of DC combined, DC left, DC right, FE right and FE left, male and female were 240.07 mL/min, 122.67 mL/min, 123.40 mL/min, 72.84%, 67.22%, 270.56 mL/ min, 139.22 mL/min, 131.34 mL/min, 70.73% and 64.76% respectively, without statistical difference (P> 0.05). CONCLUSIONS: The fetal CO and EF obtained by 3Dultrasonography (STIC) showed no significant difference in relation to gender.
Brazilian Journal of Cardiovascular Surgery 06/2012; 27(2):275-282.
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ABSTRACT: Objective: The purpose of this study was to estimate what measurements and planes are being assessed during second-trimester scan in Brazil, some characteristics from performing physicians and whether informed consent is being asked. Methods: Invitational e-mails were sent for all physicians registered in the database from three institutions. Participants who agreed to participate were directed to an online survey consisting 21 questions. All participants who agreed to participate and sent the online survey were included. We excluded participants who sent an incomplete survey; those who perform ≤10 second-trimester scans per month and those who do not work in Brazil. Results: A total of 41,847 invitational e-mails were submitted, and 467 participants were included in the final analysis. We observed a relatively low proportion of participants examining some important planes from fetal heart: only approximately 80% usually examine the five-chamber and three-vessel views and only 44.3% examine the tracheal view. Regarding the expertise of examiners, we observed that 10.7% of participants do not have any certificate acknowledged by our official institutions. Additionally, only 7.9% of the participants ask for signed informed consent before examination. Conclusions: Specific guidelines are still missing. A relatively high proportion of second-trimester scan do not evaluate even what is suggested to be performed in a routine second-trimester scan.
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 05/2012; 25(11):2242-7. · 1.36 Impact Factor
