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Nathalie Jeanne Bravo-Valenzuela,Alberto Borges Peixoto,Rosiane Mattar,Edward Araujo Júnior 한국심초음파학회 2022 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.30 No.2
BACKGROUND: To assess the interventricular septum (IVS) volume of fetuses from pre-gestational diabetes mellitus (DM) pregnant women by 3-dimensional ultrasound using spatiotemporal image correlation (STIC) and virtual organ computer-aided analysis (VOCAL) methods. METHODS: This was a prospective cross-sectional study of 45 fetuses from pre-gestational DM and 45 fetuses from healthy pregnant women (controls). Only singleton pregnancies between 20 and 34 + 6 weeks of gestation were included. The fetal IVS volumes were obtained off-line using STIC and VOCAL methods. To analyze differences among variables, the Student’s t-test and Mann-Whitney U test were used. The correlation among continuous variables was determine using Spearman’s correlation test (r). RESULTS: The median of fetal IVS volume was significantly higher in pre-gestational DM than in healthy pregnant women (0.3 cm3 vs. 0.2 cm3, p = 0.032). A strong positive correlation was observed between fetal IVS volume and gestational age at the time of ultrasound examination (r = 0.75, R2 = 0.48, p < 0.0001) and between fetal IVS volume and estimated fetal weight (r = 0.63, R2 = 0.37, p < 0.0001). No significant correlation was noted between fetal IVS volume and glycated hemoglobin levels (r = −0.16, R2 = 0.01, p = 0.540) in the pre-gestational DM pregnant women. CONCLUSIONS: Significant differences were observed in fetal IVS volumes between pre-gestational and healthy mothers, with higher values in the fetuses of pre-gestational DM pregnant women.
The impact of first-trimester intrauterine hematoma on adverse perinatal outcomes
Alberto Borges Peixoto,Edward Araujo Júnior,Taciana Mara Rodrigues da Cunha Caldas,Caetano Galvão Petrini,Ana Cecília Palma Romero,Luciano Eliziário Borges Júnior,Wellington P. Martins 대한초음파의학회 2018 ULTRASONOGRAPHY Vol.37 No.4
Purpose: The aim of this study was to evaluate whether the presence of an intrauterinehematoma (IUH) on an early pregnancy ultrasound scan showing a live fetus was related toadverse perinatal outcomes. Methods: We performed a retrospective cohort study to evaluate pregnant women whounderwent an ultrasound examination in early pregnancy, between 6 weeks 0 days and 10weeks 6 days. We compared the perinatal outcomes between women with and without firsttrimester IUH using the Mann-Whitney and Fisher exact tests. Furthermore, we performed astepwise regression analysis to identify possible predictors of miscarriage among maternalcharacteristics, ultrasound parameters, and IUH. Results: During the study period, data from 783 pregnancies were included, and the incidence ofIUH was 4.5% (35 of 783). We observed a higher proportion of miscarriage following the scan(28.6% vs. 10%, P=0.003) and a larger yolk sac diameter during the scan (4.8 mm vs. 3.8 mm,P<0.001) in the pregnant women with first-trimester IUH. There was no significant differenceregard the prevalence of low birth weight (LBW; P=0.091), very LBW (P=0.370), or extremelyLBW (P=0.600) between cases with IUH and without IUH, the cesarean section rate (68% vs. 81%, P=0.130), preterm delivery (16% vs. 16%, P>0.999), or the incidence of first-trimestervaginal bleeding (31% vs. 20%, P=0.130). Moreover, heart rate (HR) was the only variable thatpredicted miscarriage with statistical significance (P=0.017). Conclusion: Women with first-trimester IUH had a higher risk of miscarriage after the ultrasoundscan. HR was the only variable that predicted miscarriage with statistical significance.
Prenatal diagnosis of transposition of the great arteries: an updated review
Nathalie Jeanne Bravo-Valenzuela,Alberto Borges Peixoto,Edward Araujo Júnior 대한초음파의학회 2020 ULTRASONOGRAPHY Vol.39 No.4
Simple transposition of the great arteries (TGA) is a cyanotic heart disease that accounts for 5% to 7% of all congenital heart diseases. It is commonly underdiagnosed in utero, with prenatal detection rates of less than 50%. Simple TGA is characterized by ventriculoarterial discordance, atrioventricular concordance, and a parallel relationship of TGA. The prenatal diagnosis of TGA influences postnatal outcomes and therefore requires planned delivery and perinatal management. For these reasons, it is important to identify the key ultrasound markers of TGA to improve the prenatal diagnosis and consequently provide perinatal assistance. The presence of two vessels instead of three in the three-vessel tracheal view, a parallel course of TGA, and identification of the origin of each of TGA are the key markers for diagnosing TGA. In addition to the classical ultrasound signs, other two-dimensional ultrasound markers such as an abnormal right convexity of the aorta, an I-shaped aorta, and the "boomerang sign" may also be used to diagnose TGA in the prenatal period. When accessible, an automatic approach using fourdimensional technologies such as spatio-temporal image correlation and sonographically-based volume computer-aided analysis may improve the prenatal diagnosis of TGA. This study aimed to review the ultrasound markers that can be used in the antenatal diagnosis of TGA, with a focus on the tools used by ultrasonographers, the obstetric and fetal medicine team, and perinatal cardiologists to improve the diagnosis of this condition.
How to perform a functional assessment of the fetal heart: a pictorial review
Luciane Alves Rocha,Liliam Cristine Rolo,Edward Araujo Júnior 대한초음파의학회 2019 ULTRASONOGRAPHY Vol.38 No.4
The purpose of this pictorial review was to describe various echocardiographic techniques that can be used for the functional assessment of the fetal heart. The systolic and diastolic assessments of the fetal heart are presented separately, with an emphasis on 2-dimensional Doppler methods and an overview of new technologies. The aim of this summary was to review the tools that can be used by the echocardiographer, and on that basis, to systematize the process of performing a functional assessment.
André Souza Malho,Nathalie Jeanne Bravo-Valenzuela,Renato Ximenes,Alberto Borges Peixoto,Edward Araujo Júnior 대한초음파의학회 2022 ULTRASONOGRAPHY Vol.41 No.3
This pictorial review describes the assessment of a great variety of types of congenital heart disease by three-dimensional ultrasonography with spatiotemporal image correlation using HDlive and the HDlive Flow silhouette rendering mode. These technologies provide fetal heart surface patterns by using a fixed virtual light source that propagates into the tissues, permitting a detailed reconstruction of the heart structures. In this scenario, ultrasound operators can freely select a better light source position to enhance the anatomical details of the fetal heart. HDlive and the HDlive Flow silhouette rendering mode improve depth perception and the resolution of anatomic cardiac details and blood vessel walls compared to standard two-dimensional ultrasonography.
Heron Werner,Taisa Davaus Gasparetto,Pedro Daltro,Emerson Leandro Gasparetto,Edward Araujo Júnior 대한초음파의학회 2018 ULTRASONOGRAPHY Vol.37 No.3
Central nervous system (CNS) malformations play a role in all fetal malformations. Ultrasonography (US) is the best screening method for identifying fetal CNS malformations. A good echographic study depends on several factors, such as positioning, fetal mobility and growth, the volume of amniotic fluid, the position of the placenta, the maternal wall, the quality of the apparatus, and the sonographer’s experience. Although US is the modality of choice for routine prenatal follow-up because of its low cost, wide availability, safety, good sensitivity, and real-time capability, magnetic resonance imaging (MRI) is promising for the morphological evaluation of fetuses that otherwise would not be appropriately evaluated using US. The aim of this article is to present correlations of fetal MRI findings with US findings for the major CNS malformations.
Nathalie Jeanne Magioli Bravo-Valenzuela,Alberto Borges Peixoto,Rosiane Mattar,Edward Araujo Júnior 대한산부인과학회 2021 Obstetrics & Gynecology Science Vol.64 No.3
ObjectiveTo assess the mitral and tricuspid annular plane systolic excursions (MAPSE and TAPSE, respectively) and cardiacoutput (CO) in fetuses of pregnant women with pregestational diabetes mellitus (DM) using spatio-temporal imagecorrelation M-mode (STIC-M) and virtual organ computer-aided analysis (VOCAL). MethodsThis study was prospective and cross-sectional. It included 45 fetuses each from mothers with pregestational DMand healthy mothers, with gestation ages ranging from 20 to 36.6 weeks. The fetal cardiac volumes were obtainedand analyzed by STIC and VOCAL methods. MAPSE and TAPSE were measured by STIC-M in the apical or basal fourchamberview. The values of the right (RV) and left ventricular (LV) CO were calculated by STIC and VOCAL. ResultsThe median values of TAPSE were 6.1 and 6.2 mm in the diabetic and control groups (P<0.001), respectively. The medianvalues of MAPSE were 4.6 mm in the fetuses of mothers with diabetes and 4.8 mm in fetuses of healthy mothers. The fetal LV CO (60.4 L/min vs. 71.1 L/min; P=0.033, respectively) and RV CO (65.2 vs. 70.1 L/min; P=0.026, respectively)were lower in the pregestational DM group than in the control group. A significant effect of pregestational DM wasobserved in all functional parameters after adjusting, with fetal heart rate as covariant. There was moderate significantpositive correlation between MAPSE and LV CO (r=0.53; P=0.0001) and between TAPSE and RV CO (r=0.46; P=0.0001). ConclusionSignificant difference in functional parameters (TAPSE, MAPSE and LV CO) obtained by STIC and VOCAL wereobserved in the fetuses of the pregestational DM group compared to those of the control group.
Association between decreased ovarian reserve and poor oocyte quality
( Viviane Margareth Scantamburlo ),( Renate Von Linsingen ),( Lidio Jair Ribas Centa ),( Kahisa Fontana Dal Toso ),( Debora Scaraboto ),( Edward Araujo Júnior ),( Jaime Kulak Junior ) 대한산부인과학회 2021 Obstetrics & Gynecology Science Vol.64 No.6
Objective To analyze the association between oocyte quality and decreased ovarian reserve (DOR) markers in young women undergoing controlled ovarian stimulation (COS). Methods This retrospective study included 49 patients classified as having DOR based on anti-Mullerian hormone (AMH) levels, follicle-stimulating hormone (FSH) levels, or antral follicle counts (AFCs; <10). Images of all obtained oocytes were analyzed, and oocyte quality was classified according to maturity and morphology. The COS protocol utilized gonadotropin (FSH and/or human menopausal gonadotropin [hMG]) doses ranging from 150 to 300 IU/day. The Student’s t test or Mann-Whitney test was used to compare the groups. Spearman’s coefficients were estimated to verify the correlation between the administered dose of FSH/hMG and the number of mature oocytes. To evaluate the association between patient- and oocyte-related variables, logistic regression models were adjusted. Results Women with DOR classified according to FSH level had more immature oocytes (P<0.001). Women with DOR according to AMH had fewer mature oocytes and increased basal FSH levels (P<0.001). Women with DOR according to AFC had an increased risk of abnormally shaped oocytes (P=0.035). Conclusion This study showed that DOR based on AMH levels, FSH levels, and AFC was associated with poorer quality oocytes in young women who underwent COS.
Juliana de Freitas Leite,Guilherme Antonio Rago Lobo,Paulo Martin Nowak,Irene Reali Antunes,Edward Araujo Júnior,David Baptista da Silva Pares 대한산부인과학회 2019 Obstetrics & Gynecology Science Vol.62 No.6
ObjectiveTo evaluate the performance of the preeclampsia (PE) screening algorithm of the Fetal Medicine Foundation (FMF)during the first trimester in a Brazilian population using maternal characteristics, mean arterial pressure (MAP), anduterine artery Doppler data. MethodsThis is a prospective cohort study that evaluated 701 pregnant women during the first trimester ultrasound screeningfor chromosomal abnormalities (11–13+6 weeks). All patients provided information regarding clinical and obstetrichistory, MAP, and mean uterine artery pulsatility index (mean PI). Patients were assigned to four groups based on thepresence of PE and gestational age at delivery: group 1 (control), patients without hypertensive disorders (n=571);group 2, PE and delivery before 34 weeks of gestation (n=7); group 3, PE and delivery before 37 weeks of gestation,including patients from group 2 and patients that presented PE with delivery between 34 and 37 weeks (n=17); andgroup 4, PE and delivery before 42 weeks of gestation, including patients from both groups 2 and 3 and patients thatpresented PE with delivery between 37 and 42 weeks of gestation (n=34). ResultsAfter the exclusion of 96 patients, we evaluated the data of 605 patients. By combining maternal characteristics, MAP,and the mean uterine artery PI for the detection of PE, we found a sensitivity of 71.4% in group 2, 50% in group 3,and 41.2% in group 4 (false positive rate=10%). ConclusionUsing maternal characteristics, MAP, and uterine artery Doppler data, we were able to identify a significantproportion of patients who developed preterm PE.
Maurício Mendes Barbosa,Eduardo Félix Martins Santana,Hérbene José Figuinha Milani1,Julio Elito Júnior,Edward Araujo Júnior,Antônio Fernandes Moron,Luciano Marcondes Machado Nardozza 대한산부인과학회 2018 Obstetrics & Gynecology Science Vol.61 No.4
ObjectiveTo evaluate the initial maternal and perinatal outcomes of fetoscopic laser photocoagulation for the treatment oftwin-to-twin transfusion syndrome (TTTS) in a referral center in Brazil. MethodsThis prospective observational study analyzed 24 fetoscopic laser photocoagulation procedures at 18.26 weeks ofgestation. TTTS severity was determined using the Quintero classification. Blood vessels that crossed the interamnioticmembrane were nonselectively photocoagulated. The χ2 test and Mann-Whitney U test were used for the statisticalanalysis. ResultsThe mean (±standard deviation) age of pregnant women, gestational age at surgery, surgical time, gestational age atbirth, and newborn weight were 32.2±4.1 years, 20.7±2.9 weeks, 51.8±16.7 minutes, 30.5±4.1 weeks, and 1,531.0±773.1g, respectively. Using the Quintero classification, there was a higher percentage of cases in stage III (54.2%), followedby stages IV (20.8%), II (16.7%), and I (8.3%). Ten (41.7%) donor fetuses died and 14 (58.3%) donor fetuses surviveduntil the end of gestation. Placental insertion location (anterior vs. posterior) did not affect the incidence of iatrogenicseptostomy, surface bleeding, and premature rupture of membranes until the end of gestation. The death rate ofdonor and recipient fetuses before 24th gestational week increased with severity of TTTS. ConclusionThe maternal and perinatal outcomes resulting from the implementation of a new minimally invasive surgicaltechnique are in line with those obtained in major centers worldwide, considering the learning curves andinfrastructures.