RESUMO
Expanding uterine masses can be the cause of pregnancy loss and add technical difficulties to uterus evacuation due to the intense anatomical distortion of the endocervical canal and uterine cavity. The literature is scarce in the peculiarities of the management of missed abortions in uterus with important distorted anatomies. We report a case of a primigravida patient who presented a rapid and expressive increase of abdominal volume due to a giant uterine mass, evolving to miscarriage. Ultrasound can be a useful tool, allowing visualization of the endocervical path and uterine cavity, helping to perform uterine evacuation in the presence of anatomical distortion without compromising the reproductive future. To the best of our knowledge, no such case has been previously reported.
Assuntos
Aborto Espontâneo , Neoplasias Uterinas , Humanos , Feminino , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/cirurgia , Neoplasias Uterinas/patologia , Gravidez , Adulto , Ultrassonografia , Complicações Neoplásicas na Gravidez/diagnóstico por imagem , Complicações Neoplásicas na Gravidez/patologia , Complicações Neoplásicas na Gravidez/cirurgia , Leiomioma/diagnóstico por imagem , Leiomioma/cirurgia , Leiomioma/patologiaRESUMO
Expanding uterine masses can be the cause of pregnancy loss and add technical difficulties to uterus evacuation due to the intense anatomical distortion of the endocervical canal and uterine cavity. The literature is scarce in the peculiarities of the management of missed abortions in uterus with important distorted anatomies. We report a case of a primigravida patient who presented a rapid and expressive increase of abdominal volume due to a giant uterine mass, evolving to miscarriage. Ultrasound can be a useful tool, allowing visualization of the endocervical path and uterine cavity, helping to perform uterine evacuation in the presence of anatomical distortion without compromising the reproductive future. To the best of our knowledge, no such case has been previously reported.
RESUMO
OBJECTIVE: To evaluate the maternal-fetal outcomes of CAB-induced pregnancies in patients with prolactinoma in a large cohort. METHODS: The prevalence of tumor growth, miscarriage, preterm, low birth weight, congenital malformations and impairment in neuropsychological development in children among women treated with CAB were assessed in a Brazilian multicentre retrospective observational study, RESULTS: We included 194 women with a mean age of 31 (17-45) years, 43.6% presenting microadenomas and 56.4% macroadenomas, at prolactinoma diagnosis. In 233 pregnancies, CAB was withdrawn in 89%, after pregnancy confirmation. Symptoms related to tumor growth occurred in 25 cases, more frequently in macroadenomas. The overall miscarriage rate was 11%, although higher in the subgroup of patients with CAB maintainance after pregnancy confirmation (38% vs. 7.5%). Amongst the live-birth deliveries, preterm occurred in 12%, low birth weight in 6% and congenital malformations in 4.3%. Neuropsychological development impairment was reported in 7% of cases. CONCLUSIONS: Our findings confirm previous results of safety in maternal and fetal outcomes in CAB-induced pregnancies; nevertheless, CAB maintenance after pregnancy confirmation was associated with higher miscarriage rate; result that must be further confirmed.
Assuntos
Cabergolina/uso terapêutico , Agonistas de Dopamina/uso terapêutico , Prolactinoma/patologia , Aborto Espontâneo/patologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Hiperprolactinemia/patologia , Pessoa de Meia-Idade , Gravidez , Complicações Neoplásicas na Gravidez , Estudos Retrospectivos , Adulto JovemRESUMO
OBJECTIVES: The objectives of this study were to establish gestational age-specific reference ranges for cross-sectional area of the umbilical cord, and its components, in twin pregnancies and to compare them with previously reported singleton reference ranges. METHODS: This was a prospective longitudinal study involving uncomplicated dichorionic twin pregnancies. Sonographic measurements of the cross-sectional area of the umbilical cord, umbilical vein and arteries and Wharton's jelly were obtained in a plane adjacent to the fetal abdomen, every 3 weeks, between 18 and 32 weeks of gestations. Multilevel regression analysis was used to determine gestational age-specific reference ranges for each parameter, and these were plotted against singleton pregnancy references. RESULTS: Three hundred and thirty four ultrasound scans were performed in 44 twin pregnancies, between 18 and 32.9 weeks (mean: 3.8 ± 0.7 scans/pregnancy and mean interval between scans: 3.3 ± 0.9 weeks). All umbilical cord cross-sectional areas (total, vein, artery and Wharton's jelly) showed a significant increase with gestational age. Compared with singleton pregnancy ranges, mean values were considerably lower in twin pregnancies and resemble the lower limits observed in singletons. CONCLUSION: In twin pregnancies, cross-sectional area of the umbilical cord, and its components, increases between 18 and 32 weeks, and mean values are substantially lower compared with singleton pregnancies.
Assuntos
Idade Gestacional , Gravidez de Gêmeos , Artérias Umbilicais/diagnóstico por imagem , Veias Umbilicais/diagnóstico por imagem , Geleia de Wharton/diagnóstico por imagem , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Análise Multinível , Tamanho do Órgão , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Valores de Referência , Análise de Regressão , Ultrassonografia Pré-Natal , Artérias Umbilicais/anatomia & histologia , Cordão Umbilical/anatomia & histologia , Cordão Umbilical/diagnóstico por imagem , Veias Umbilicais/anatomia & histologia , Geleia de Wharton/anatomia & histologiaRESUMO
Group B Streptococcus (GBS), Klebsiella spp. and Pseudomonas spp. are important aetiological agents of neonatal infections in Brazil. There is a lack of data in the literature regarding the specific transport of immunoglobulin G (IgG) against these pathogens in multiple pregnancies. Maternal (n = 55) and umbilical cord (n = 110) blood samples were prospectively collected at birth from 55 twin pregnancies. The factors associated with cord levels and transfer ratios of IgG against GBS, Klebsiella and Pseudomonas were examined. The IgG umbilical cord serum levels specific to GBS, Klebsiella LPS and Pseudomonas LPS were significantly associated with maternal-specific IgG concentrations and the presence of diabetes. The anti-Klebsiella IgG cord serum concentrations were also related to birthweight and the presence of hypertension. The transfer ratios against GBS and Pseudomonas LPS were associated with maternal-specific IgG concentrations. The transfer ratios for GBS and Pseudomonas LPS were associated with gestational age at delivery and the presence of diabetes, respectively. None of the examined parameters were related to Klebsiella LPS transfer ratios. We conclude that in twin pregnancies, specific maternal IgG serum concentrations and diabetes were the parameters associated with umbilical cord serum IgG concentrations reactive with the three pathogens investigated. All the other parameters investigated showed different associations with neonatal-specific IgG levels according to the antigen studied. There was no uniformity of the investigated parameters regarding association with placental IgG transfer ratios against the GBS, Pseudomonas LPS and Klebsiella LPS.
Assuntos
Anticorpos Antibacterianos/imunologia , Imunoglobulina G/imunologia , Klebsiella/imunologia , Lipopolissacarídeos/imunologia , Gravidez de Gêmeos/imunologia , Pseudomonas/imunologia , Streptococcus agalactiae/imunologia , Anticorpos Antibacterianos/sangue , Peso ao Nascer/imunologia , Feminino , Sangue Fetal/imunologia , Sangue Fetal/metabolismo , Idade Gestacional , Humanos , Imunidade Materno-Adquirida/imunologia , Imunoglobulina G/sangue , Recém-Nascido , Masculino , Troca Materno-Fetal/imunologia , Análise Multivariada , Placenta/imunologia , Placenta/metabolismo , Gravidez , Gravidez de Gêmeos/sangue , Estudos ProspectivosRESUMO
OBJECTIVES: To investigate fetal venous Doppler measurements in monochorionic twin pregnancies complicated by placental insufficiency and the relationship between fetal venous flow and acidemia at birth or intrauterine fetal death. METHODS: This was a prospective study of 18 monochorionic twin pregnancies with placental insufficiency. Inclusion criteria were monochorionic-diamniotic twin pregnancy, abnormal umbilical artery (UA) Doppler indices, intact membranes and absence of fetal congenital abnormalities. Cases of twin-to-twin transfusion syndrome were excluded. The following Doppler measurements were studied: UA pulsatility index (PI), ductus venosus PI, middle cerebral artery PI and peak systolic velocity, intra-abdominal umbilical vein (UV) time-averaged maximum velocity (TAMXV) and left portal vein (LPV) TAMXV. Doppler parameters were transformed into Z-scores (SD values from the mean) or multiples of the median according to normative references. RESULTS: UA pH < 7.20 occurred in nine (25.0%) neonates, pH < 7.15 in four (11.1%) and intrauterine death in four (11.1%) fetuses. The UV-TAMXV and LPV-TAMXV Z-scores were significantly lower in the group with pH < 7.20 or intrauterine fetal death (-1.79 vs -1.22, P = 0.006 and -2.26 vs -1.13, P = 0.04, respectively). In cases with pH < 7.15 or intrauterine fetal death, UV pulsations were more frequent (50.0% vs 10.7%, P = 0.03) and UV-TAMXV Z-score was significantly lower (-1.89 vs -1.26, P = 0.003). Mixed effects logistic regression analysis, accounting for the paired nature of the outcomes for the two twins in each pregnancy, demonstrated that the UV-TAMXV Z-score significantly predicted UA pH at birth < 7.20 or intrauterine fetal death. The Doppler parameter that independently predicted pH < 7.15 or intrauterine fetal death was presence of pulsation in the UV. CONCLUSION: UV Doppler parameters may predict acidemia at birth or intrauterine fetal death in monochorionic twins complicated by placental insufficiency.
Assuntos
Acidose/fisiopatologia , Morte Fetal , Retardo do Crescimento Fetal/fisiopatologia , Feto/irrigação sanguínea , Artéria Cerebral Média/fisiopatologia , Insuficiência Placentária/fisiopatologia , Veia Porta/fisiopatologia , Artérias Umbilicais/irrigação sanguínea , Acidose/diagnóstico por imagem , Acidose/mortalidade , Velocidade do Fluxo Sanguíneo , Feminino , Retardo do Crescimento Fetal/diagnóstico por imagem , Humanos , Recém-Nascido , Masculino , Artéria Cerebral Média/diagnóstico por imagem , Insuficiência Placentária/diagnóstico por imagem , Insuficiência Placentária/mortalidade , Veia Porta/diagnóstico por imagem , Veia Porta/embriologia , Gravidez , Resultado da Gravidez , Gravidez de Gêmeos , Estudos Prospectivos , Fluxo Pulsátil , Sensibilidade e Especificidade , Ultrassonografia DopplerRESUMO
BACKGROUND: Chronic allograft vasculopathy (CAV) is an important cause of graft loss. Considering the immune inflammatory events involved in the development of CAV, therapeutic approaches to target this process are of relevance. Human amniotic fluid-derived stem cells (hAFSCs), a class of fetal, pluripotent stem cells with intermediate characteristics between embryonic and adult stem cells, display immunomodulatory properties. hAFSCs express mesenchymal and embryonic markers, show high proliferation rates; however, they do not induce tumor formation, and their use does not raise ethical issues. Thus, we sought to investigate the effect of hAFSC on CAV in a model of aorta transplantation. METHODS: Orthotopic aorta transplantation was performed using Fisher (F344) rats as donors and Lewis rats as recipients. Rats were divided into three groups: syngeneic (SYNG), untreated F344 receiving aorta from F344 (n = 8); allogeneic (ALLO), Lewis rats receiving allogeneic aorta from F344 (n = 8); and ALLO + hAFSC, ALLO rats treated with hAFSC (10(6) cells; n = 8). Histological analysis and immunohistochemistry were performed 30 days posttransplantation. RESULTS: The ALLO group developed a robust aortic neointimal formation (208.7 ± 25.4 µm) accompanied by a significant high number of ED1+ (4845 ± 841 cells/mm2) and CD43+ cells (4064 ± 563 cells/mm2), and enhanced expression of α-smooth muscle actin in the neointima (25 ± 6%). Treatment with hAFSC diminished neointimal thickness (180.7 ± 23.7 µm) and induced a significant decrease of ED1+ (1100 ± 276 cells/mm2), CD43+ cells (1080 ± 309 cells/µm2), and α-smooth muscle actin expression 8 ± 3% in the neointima. CONCLUSIONS: These preliminary results showed that hAFSC suppressed inflammation and myofibroblast migration to the intima, which may contribute to ameliorate vascular changes in CAV.
Assuntos
Líquido Amniótico/citologia , Aorta Abdominal/transplante , Doenças da Aorta/prevenção & controle , Células-Tronco Fetais/transplante , Transplante de Órgãos/efeitos adversos , Células-Tronco Pluripotentes/transplante , Actinas/metabolismo , Animais , Aorta Abdominal/imunologia , Aorta Abdominal/metabolismo , Aorta Abdominal/patologia , Doenças da Aorta/etiologia , Doenças da Aorta/imunologia , Doenças da Aorta/metabolismo , Doenças da Aorta/patologia , Biomarcadores/metabolismo , Movimento Celular , Células Cultivadas , Células-Tronco Fetais/imunologia , Células-Tronco Fetais/metabolismo , Humanos , Imuno-Histoquímica , Masculino , Miofibroblastos/metabolismo , Miofibroblastos/patologia , Neointima , Células-Tronco Pluripotentes/imunologia , Células-Tronco Pluripotentes/metabolismo , Ratos , Ratos Endogâmicos F344 , Ratos Endogâmicos Lew , Fatores de TempoRESUMO
OBJETIVO: Estudar a avaliaçäo da maturidade fetal em gestaçöes de alto risco e analisar os resultados neonatais. MÉTODOS: Entre julho de 1998 e agosto de 1999 foram realizadas, no Setor de Vitalidade Fetal da Clínica Obstétrica do HC-FMUSP, 180 amniocenteses para avaliaçäo da maturidade fetal, sendo realizados os testes de Clements em três tubos e a contagem de células orangiófilas coradas com Azul de Nilo a 0,1 por cento. Os resultados perinatais foram correlacionados com a maturidade fetal em 75 casos cujo parto ocorreu até sete dias após a punçäo. RESULTADOS: Na macroscopia, 91 por cento das amostras apresentavam líquido amniótico claro, 3,3 por cento meconial e 5,6 por cento hemorrágico. A maturidade foi observada em 28 por cento dos exames realizados. Na avaliaçäo dos resultados perinatais, quando a maturidade estava ausente, a necessidade de intubaçäo do recém-nascido ocorreu em três casos (13 por cento) e nos fetos maduros isto ocorreu em um caso (2,5 por cento) (p<0,05). A necessidade de internaçäo em UTI neonatal ocorreu em 65 por cento dos recém-nascidos que apresentavam líquido imaturo e em apenas 10 por cento dos maduros (p<0,0001). CONCLUSÖES: Os recém-nascidos das gestantes com maturidade fetal presente apresentaram com menor freqüência necessidade de intubaçäo na sala de parto e de internaçäo em UTI neonatal, demonstrando menor morbidade perinatal. Entre a 29ª e a 32ª semana de gestaçäo, foram observados cerca de 10 por cento de fetos maduros, demonstrando que, quando necessário, a avaliaçäo da maturidade pode ser realizada neste período da gravidez. Näo observamos casos com maturidade fetal abaixo de 29 semanas, limitando a realizaçäo deste exame neste período