RESUMO
OBJECTIVES: To examine and compare the reproducibility of measurement of first- and second-trimester uterine artery pulsatility index (UtA-PI) using transabdominal (TAS) and transvaginal (TVS) ultrasound. METHODS: This was an observational study including women ≥ 18 years of age, with a singleton pregnancy, in the first trimester (between 11 + 0 and 13 + 6 weeks' gestation) or second trimester (between 20 and 26 weeks' gestation). UtA-PI and angle of insonation were assessed by two observers (one with 15 and the other with 3 years of experience) using both TAS and TVS. The more experienced observer performed two scans alternated by the other observer. The acquisitions were completely independent and the observers were blinded to each other and to their own measurements. Reproducibility of the measurements by TVS and TAS was assessed using the concordance correlation coefficients (CCCs), intraclass correlation coefficients (ICCs) and limits of agreement (LoA). RESULTS: We analyzed data from 97 women in the first trimester and 96 in the second trimester. The mean ± SD UtA-PI was significantly higher when measured using TVS, compared with TAS, in both the first (1.60 ± 0.49 vs 1.52 ± 0.63, respectively; P = 0.03) and second (1.07 ± 0.33 vs 0.96 ± 0.32, respectively; P < 0.001) trimesters. The median angle of insonation was significantly lower when using TVS, compared with TAS, in both the first (8.0° (interquartile range (IQR), 2.5-16.3°) vs 12.5° (IQR, 2.5-20.0°), respectively; P = 0.04) and second (10.0° (IQR, 4.5-16.5°) vs 17.5° (IQR, 5.0-27.9°), respectively; P < 0.001) trimesters. Both ultrasound techniques had similar reproducibility: the intraobserver CCC ranged from 0.93 to 0.95 and the interobserver CCC ranged from 0.81 to 0.86; and the ICCs of both techniques were highly comparable (the intraobserver LoA was approximately ± 20-30% and the interobserver LoA was approximately ± 30-40%). CONCLUSIONS: When measuring UtA-PI, assessment by TVS provides higher values and better insonation angle compared with TAS. The reproducibility of the ultrasound methods in both first and second trimesters of pregnancy was comparable and should not be considered as good. Future studies examining technical improvements with the aim of increasing the reproducibility of this technique should be encouraged.
Assuntos
Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Fluxo Pulsátil , Ultrassonografia Doppler , Ultrassonografia Pré-Natal , Artéria Uterina/fisiologia , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Idade Gestacional , Humanos , Gravidez , Valores de Referência , Reprodutibilidade dos Testes , Artéria Uterina/diagnóstico por imagemRESUMO
PIP: A sample of 16 asymptomatic female HIV carriers (in CDC stages I and II) infected heterosexually and a sample of 26 seronegative women hospitalized in Porto Alegre were studied in order to determine the nervous system manifestations of HIV infection. They answered the computerized version of the Wisconsin Card Sorting Test (WCST) to ascertain how the frontal lobe and the frontotemporal connection were functioning. There was a significant difference between cases and controls (p = 0.0132) with respect to the level of education. The cases performed worse in all measured parameters than the controls (p = 0.0060). The cases made a higher number of total errors (p = 0.00060), a higher percentage of perseverative errors (p = 0.00148) and nonperseverative errors (p = 0.0133). In order to find out whether a possible confounder was at play in the educational level, a stratified analysis was carried out. There was a significant difference between them regarding the total number of errors at the third grade educational level. Differences also appeared at the third grade level with regard to perseverative errors. There was also a significant difference between the two groups in the total number of errors (p 0.05) and perseverative errors (p 0.01) at the level of university education. Multivariate analysis (ANOVA) indicated that age did not alter either the percentage of errors or the number of perseverative responses. The level of education was of importance, but diagnosis was more important to the effect that it was significant in the multivariate equation. With respect to nonperseverative errors, which was altered by the level of education, this factor was isolated as the most important one which maintained significance in this type of analysis. This pilot project should be expanded in the future by applying neuropsychometric tests and depression and anxiety scales in order to confirm the validity of this evaluation.^ieng