RESUMEN
PURPOSE: The aim of this study was to investigate the influence of vaginal progesterone on cervical length (CL) in asymptomatic nonselected twin gestations. METHODS: This was a secondary analysis of a randomized, double-blind, placebo-controlled trial of twin pregnancies exposed to vaginal progesterone or placebo. The CL was examined at six different time periods: 18-21+6 weeks (T1), 21-23+6 weeks (T2), 24-26+6 weeks (T3), 27-29+6 weeks (T4), 30-32+6 weeks (T5) and 33-34+6 weeks (T6). The rate of cervical shortening per week and the percent cervical shortening were compared between the groups, with analyses of the entire cohort and of those who delivered spontaneously according to gestational age at birth. RESULTS: The final analysis included 184 women in the progesterone group and 188 women in the placebo group. The baseline characteristics were similar in both groups. No differences in cervical shortening in terms of absolute value or percent shortening were observed between the groups at each time period or throughout gestation. Furthermore, no difference was found in cervical shortening for those who delivered spontaneously. CONCLUSION: Cervical shortening in asymptomatic nonselected twin pregnancies occurred at a similar rate, regardless of vaginal progesterone treatment.
Asunto(s)
Cuello del Útero/efectos de los fármacos , Embarazo Gemelar , Progesterona/administración & dosificación , Progestinas/administración & dosificación , Administración Intravaginal , Adulto , Medición de Longitud Cervical , Cuello del Útero/diagnóstico por imagen , Método Doble Ciego , Femenino , Humanos , Embarazo , Nacimiento Prematuro/prevención & control , Adulto JovenRESUMEN
OBJECTIVES: This study investigated the influence of vaginal progesterone on uterine circulation in asymptomatic twin gestations. STUDY DESIGN: This study was a secondary analysis of a randomized, double-blind, placebo-controlled trial of twin pregnancies exposed to vaginal progesterone or placebo. We included all trial participants who had undergone uterine artery pulsatility index evaluation at the time of randomization. During each ultrasound examination, the uterine artery pulsatility index was evaluated transabdominally. The mean uterine artery pulsatility index between the progesterone and placebo groups were compared for each gestational age, starting between 18 to 34 weeks and 6days and were analyzed at three (Time 1), six (Time 2) and nine (Time 3) weeks after randomization. RESULTS: The final analysis included 128 women in the progesterone group and 122 women in the placebo group. The baseline characteristics were similar in both groups. No difference in the mean uterine artery pulsatility index was observed between the progesterone and placebo groups at each week of gestation or throughout gestation. CONCLUSIONS: In twin pregnancies, the use of vaginal progesterone in the second half of pregnancy does not influence uterine circulation.
Asunto(s)
Progesterona/administración & dosificación , Ultrasonografía Doppler , Arteria Uterina/efectos de los fármacos , Administración Intravaginal , Adulto , Método Doble Ciego , Femenino , Edad Gestacional , Humanos , Embarazo , Resultado del Embarazo , Embarazo Gemelar , Ultrasonografía Prenatal , Arteria Uterina/diagnóstico por imagen , Adulto JovenRESUMEN
OBJECTIVE: The purpose of this study was to evaluate the effect of prophylactic vaginal progesterone in decreasing preterm birth rate in a high-risk population. STUDY DESIGN: A randomized, double-blind, placebo-controlled study included 142 high-risk singleton pregnancies. Progesterone (100 mg) or placebo was administered daily by vaginal suppository and all patients underwent uterine contraction monitoring with an external tocodynamometer once a week for 60 minutes, between 24 and 34 weeks of gestation. Progesterone (n = 72) and placebo (n = 70) groups were compared for epidemiologic characteristics, uterine contraction frequency, and incidence of preterm birth. Data were compared by chi(2) analysis and Fisher exact test. RESULTS: The preterm birth rate was 21.1% (30/142). Differences in uterine activity were found between the progesterone and placebo groups (23.6% vs 54.3%, respectively; P <.05) and in preterm birth between progesterone and placebo (13.8% vs 28.5%, respectively; P <.05). More women were delivered before 34 weeks in the placebo group (18.5%) than in the progesterone group (2.7%) (P <.05). CONCLUSION: Prophylactic vaginal progesterone reduced the frequency of uterine contractions and the rate of preterm delivery in women at high risk for prematurity.
Asunto(s)
Trabajo de Parto Prematuro/prevención & control , Progesterona/administración & dosificación , Adulto , Tasa de Natalidad , Método Doble Ciego , Femenino , Humanos , Placebos/uso terapéutico , Embarazo , Factores de Riesgo , Supositorios , Contracción Uterina/efectos de los fármacosRESUMEN
OBJECTIVE: The purpose of this study was to compare fetal middle cerebral artery peak systolic velocity with amniotic fluid delta optical density at 450 nm in the prediction of fetal anemia. STUDY DESIGN: A prospective study that involved 28 singleton pregnancies that were at-risk for fetal anemia was carried out in a tertiary teaching hospital. Middle cerebral artery peak systolic velocity was measured immediately before the determination of deltaoptical density at 450 nm and fetal hemoglobin concentration. Sensitivities and predictive values for fetal anemia were examined. RESULTS: Fetal hemoglobin concentrations correlated significantly with middle cerebral artery peak systolic velocity (correlation coefficient, -0.77; P <.0001) and deltaoptical density at 450 nm zones (correlation coefficient, -0.56; P =.0025). Middle cerebral artery peak systolic velocity was >1.5 multiples of the median in 15 of 28 cases (54%); for this cutoff value, the sensitivity and positive-predictive values for a hemoglobin deficit of >-3SD were 75% and 60% and for a hemoglobin deficit of >-5SD were 100% and 47%, respectively. The corresponding values for deltaoptical density at 450-nm zone III (6/28 cases, 21%) were 0% (hemoglobin deficit, <-3SD) and 86% and 100% (hemoglobin deficit, <-5SD). CONCLUSION: Middle cerebral artery peak systolic velocity and amniotic fluid optical density at 450 nm are both useful in the prediction of fetal anemia. However, Doppler examination has the advantage of being a noninvasive method that can help reduce the number of invasive procedures in pregnancies that are at-risk for fetal anemia.
Asunto(s)
Líquido Amniótico/química , Anemia/diagnóstico , Enfermedades Fetales/diagnóstico , Arteria Cerebral Media/fisiopatología , Diagnóstico Prenatal , Adulto , Amniocentesis , Velocidad del Flujo Sanguíneo , Cordocentesis , Femenino , Sangre Fetal/química , Edad Gestacional , Hemoglobinas/análisis , Humanos , Embarazo , Estudios Prospectivos , Sensibilidad y Especificidad , Espectrofotometría , Sístole , Ultrasonografía Doppler de Pulso , Ultrasonografía PrenatalRESUMEN
Objetivo: avaliar a evolução de 24 casos de gastrosquise, em relação aos fatores prognósticos pré-natais que interferiram na sobrevida pós-natal. Pacientes e Métodos: foram avaliados 24 casos de gastrosquise diagnosticados no Setor de Medicina Fetal do Hospital das Clínicas da FMUSP, durante um período de 8 anos. Foram classificados em gastrosquise associada, quando presentes outras malformações, e isolada. Nos dois grupos foram analisados parâmetros referentes às alças intestinais dilatadas na avaliação ultra-sonográfica (dilatação > ou igual 18 mm), complicações obstétricas e resultados pós-natal. Resultados: foram observados 9 casos de gastrosquise associada (37,5 por cento) e 15 casos de gastrosquise isolada (62,5 por cento). Todos os casos de gastrosquise associada foram de prognóstico letal, levando a uma alta taxa de mortalidade geral de 60,8 por cento. Do grupo de gastrosquises isoladas, todos nasceram vivos e foram submetidos a cirurgia, com taxa de sobrevida de 60 por cento e mortalidade pós-natal de 40 por cento. A mediana da idade gestacional foi de 35 semanas e o peso no nascimento de 2.365 gramas no grupo geral. Nas gastrosquises isoladas, o parto prematuro ocorreu em 10 casos, principalmente decorrente de complicações obstétricas. Dois recém-nascidos foram considerados pequenos para a idade gestacional e apenas 3 apresentaram peso no nascimento > ou igual 2.500 gramas. O oligoidrâmnio foi um achado comum (46,6 por cento), sendo mais freqüente no grupo que evoluiu para óbito neonatal (66,7 por cento). A avaliação ultra-sonográflca das alças intestinais demonstrou que em 13 de 15 casos (86,6 por cento) as alças eram dilatadas, mas sem relação significativa com o prognóstico e achados pós-natais. Não houve diferença significativa em relação a idade gestacional e peso no nascimento, comparando os grupos de vivos e óbitos neonatais. Conclusões: as gastrosquises isoladas apresentam um melhor prognóstico quando comparadas às associadas, sendo de suma importância a sua diferenciação pré-natal. As gastrosquises isoladas estão associadas a complicações obstétricas (60 por cento), prematuridade e baixo peso ao nascimento. O diagnóstico pré-natal permite uma melhor monitorização das condições fetais. O parto destas gestações deve ser no termo, a menos que complicações obstétricas se apresentem.