RODRIGO RUANO
Projetos de Pesquisa
Unidades Organizacionais
LIM/57 - Laboratório de Fisiologia Obstétrica, Hospital das Clínicas, Faculdade de Medicina
51 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 51
- Expression of angiogenic factors in placenta of stressed rats(2012) CORREA, Isis Paloppi; RUANO, Rodrigo; TAKIUTI, Nilton Hideto; FRANCISCO, Rossana Pulcinelli Vieira; BEVILACQUA, Estela; ZUGAIB, MarceloThe aim of the present study was to analyse the influence of stress on pregnant rats, particularly in terms of maternal, placental and fetal weight, placental morphology and placental gene expression of the angiogenic factors Vegfa and Pgf and their receptors. The parameters were evaluated on gestation Day 20. Maternal, fetal and placental weights were statistically lower in stressed animals than controls, suggesting abnormalities in gestational physiology. Morphologically the placentas of rats subjected to stress were reduced in size and weight, with few glycogen cells and a significant increase in the number of apoptotic cells. Stress caused an increase in placental gene expression of Vegfa (P < 0.05) and a reduction in Pgf, Flt1 and Kdr expression (P < 0.05). It has been suggested that increased VEGF is associated with vasodilatation and hypotension, but in this model persistent hypertension was present. This study suggests that the limited hypotensive Vegfa response to stress-induced hypertension could result from reduced expression of Flt1/Kdr disrupting specific VEGF pathways. These findings may elucidate one of the multiple possible factors underlying how stress modulates placental physiology, and could aid the understanding of stress-induced gestational disorders.
conferenceObject Acute death of the recipient twin after fetoscopic laser surgery for twin-twin transfusion syndrome related to maternal hypotension and type of anesthesia during the procedure(2012) RUANO, Rodrigo; Kim Nguyen; DOTY, Morgen; JOHNSON, Anthony; BELFORT, Michael; MOISE JR., KennethOBJECTIVE: To evaluate the relationship between acute recipient fetal demise following fetoscopic placental laser ablation and maternal hypotension associated with maternal anesthesia in twin-twin transfusion syndrome (TTTS). STUDY DESIGN: Between November 2006 and March 2011, all cases with TTTS that had recipient fetal demise within 24 hours of placental laser ablation were reviewed. For comparison, each case was matched for gestational age at procedure, Quintero staging of the disease and pre-operative Doppler studies with two cases that did not have acute recipient demise. The presence of maternal hypotension (defined as a decline in blood pressure of 20% from pre-operative values) and the duration of the hypotension were evaluated as possible links to acute recipient demise. RESULTS: Acute recipient demise occurred in 5.6% cases (15/267) following laser ablation. Recipient demise was associated with maternal hypotension (OR: 4.9, 95%CI: 1.3-18.7; p 0.02) and the duration of hypotension (OR: 3.33, 95% CI: 1.8-13.6; p 0.02). ROC curve analysis showed the threshold for maternal hypotension and duration of hypotension associated with recipient demise to be 20% and 35 minutes, respectively. General anesthesia was related with maternal hypotension (OR: 19.1, 95% CI: 3.9-94.1; p 0.01). The duration of surgery and anesthesia were not associated with maternal hypotension or acute recipient demise (p 0.23 and p 0.90, respectively). CONCLUSION: Acute recipient demise following fetos copic placental laser ablation for treatment of severe TTTS is associated with maternal hypotension and general anesthesia during the procedure.- Association between magnesium status, oxidative stress and inflammation in preeclampsia: A case-control study(2015) ROCHA, Vivianne de Sousa; ROSA, Fernanda Brunacci Della; RUANO, Rodrigo; ZUGAIB, Marcelo; COLLI, CeliaBackground & aims: Preeclampsia is responsible for more than one-third of all maternal deaths in Brazil. The objectives of the present study were to evaluate magnesium status and its association with oxidative stress and inflammation in preeclamptic women, and to identify the predictor variables of the disorder. Methods: The study population consisted of 36 women divided into preeclamptic (n = 18) and control groups (n = 18). The preeclamptic group included women (>= 20 weeks of pregnancy) with arterial pressure >= 140/90 mmHg and proteinuria >03 g/24 h, while the control group comprised pregnant women with no clinical/obstetric complications. Magnesium intake was assessed via a food frequency questionnaire validated for pregnant women in Brazil. Plasma, erythrocyte and urinary magnesium levels were determined by flame atomic absorption spectroscopy, while oxidative stress and inflammatory markers were assessed using standard protocols. Logistic regression analysis was used to identify the predictors of preeclampsia. Results: Preeclamptic and control groups were similar with respect to magnesium intake and urinary excretion, while plasma and erythrocyte magnesium concentrations were higher in the former group. Plasma magnesium was positively correlated with catalase and glutathione peroxidase activities and with concentrations of interleukin-6 and tumor necrosis factor alpha. Regression analysis showed that plasma magnesium and urinary 8-isoprostane were associated with preeclampsia. Conclusion: Magnesium status appears to result from homeostatic imbalance and physiological alterations typical of preeclampsia. Increased plasma magnesium and decreased urinary 8-isoprostane were considered predictors of preeclampsia.
bookPart Diagnóstico de gravidez(2013) CHAU, Juang Horng; RUANO, Rodrigo; ZUGAIB, MarceloconferenceObject Three-dimensional power Doppler study of fetal cerebral vascularity in twin-twin transfusion syndrome after fetoscopic laser photocoagulation(2012) RUANO, Rodrigo; JOHNSON, Anthony; BELFORT, Michael; MOISE JR., KennethOBJECTIVE: To evaluate the fetal cerebral vascularity in pregnancies complicated by twin-twin syndrome transfusion syndrome (TTTS) after laser coagulation of the placental anastomoses. STUDY DESIGN: Between July 2010 and May 2011, 36 monochorionic, diamniotic pregnancies with TTTS underwent 3D-power Doppler ultrasonography in order to evaluate the cerebral vascularization index (VI) in both donor and recipient fetuses before and one day after fetoscopic photocoagulation. RESULTS: Mean gestational age at the fetoscopic procedure was 20.5 2.8 weeks. Before the laser procedure, the mean VI in the recipients was higher than in the donors (12.7 6.8% vs 9.5 5.4%, respectively; p < 0.01). After laser procedure, the mean VI in the recipients and donors was similar (12.4 6.6% and 13.9 6.7%, respectively; p = 0.36) (Figure 1). This change represented a significant increase in the donor VIpost-laser(p < 0.01).WhenQuinterostagingwasconsidered,these differences between recipient and donor VI before and after laser procedure were only observed in stages III/IV (p < 0.01 and p < 0.01, respectively), but not in stages I/II (p = 0.28 and p = 0.36, respectively). CONCLUSION: After fetoscopic laser surgery for TTTS, there is an increase in the cerebral blood flow of the donor fetus so that it becomes more similar to its recipient sibling. This occurs predominantly in TTTS Quintero stages III/IV.- Effectiveness of fetal cystoscopy as a diagnostic and therapeutic intervention for lower urinary tract obstruction: a systematic review(2011) MORRIS, R. K.; RUANO, R.; KILBY, M. D.Objective To determine the effectiveness of fetal cystoscopy in the prenatal diagnosis of and intervention for congenital lower urinary tract obstruction. Methods This study was a literature search using MEDLINE, Embase, Cochrane Library, MEDION, Web of Science reference lists and contact with experts. All studies reporting on fetal cystoscopy in lower urinary tract obstruction with data for a 2 x 2 table were selected for review. No language restrictions were applied. There was independent selection of studies, data extraction and quality assessment by two reviewers. Peto odds ratios were calculated as a summary measure of effect. Results A total of 2071 citations were identified and 66 papers selected for detailed evaluation, from which four papers with a total of 63 patients were selected for inclusion. Two papers had results for the use of cystoscopy in diagnosis, showing that fetal cystoscopy altered the ultrasound diagnosis of the underlying pathology in 36.4 and 25.0% of fetuses, respectively. Compared to no treatment, fetal cystoscopic intervention demonstrated an odds ratio for improved perinatal survival of 20.51 (95% CI, 3.87-108.69). However, comparing vesicoamniotic shunt (VAS) with fetal cystoscopy there appeared to be no significant improvement in the perinatal survival odds ratio of 1.49 (95% CI, 0.13-16.97). These results had wide CIs and for cystoscopy vs. VAS, all results crossed the line of no effect. Conclusion There is little published evidence for the effectiveness of therapeutic fetal cystoscopy as an intervention for congenital lower urinary tract obstruction and the quality of this evidence is poor. It should thus be considered to be an 'experimental intervention' and subjected to further investigation.
- Low Apgar scores at 5 minutes in a low risk population: maternal and obstetrical factors and postnatal outcome(2012) SALUTIANO, Eugenia Maria Assuncao; CAMPOS, Juliana Alvares Duarte Bonini; IBIDI, Silvia Maria; RUANO, Rodrigo; ZUGAIB, MarceloObjective: To evaluate the association between Apgar scores of less than seven at five minutes (AS(5min) < 7) and antenatal factors and postnatal outcomes. Methods: A retrospective cohort and case-control study of 27,252 consecutive term newborns in a low risk obstetrical population between January 2003 and December 2010. Maternal and infant databases were reviewed from all cases with AS(5min) < 7 (n = 121; 0.4%) and 363 cases with AS(5min) >= 7 at 5 minutes who were randomly selected by a computer program. The main outcomes were neonatal death, newborn respiratory distress, need for orotracheal intubation and neonatal intensive care unit (NICU), and hypoxic-ischemic-encephalopathy. Results: After multiple regression analysis, repeated late decelerations on cardiotocography (OR: 2.4; 95% CI: 1.4-4.1) and prolonged second stage of labor (OR: 3.3; 95% CI: 1.3-8.3) were associated with AS(5min) < 7, as well as neonatal respiratory distress (OR: 3.0; 95% CI: 1.3-6.9), orotracheal intubation (OR: 2.5; 95% CI: 1.2-4.8), need for NICU (OR: 9.5; 95% CI: 6.7-16.8), and hypoxic-ischemic-encephalopathy (OR: 14.1; 95% CI: 3.6-54.7). No other antenatal factors were associated with AS(5min) < 7 (p > 0.05). Conclusion: Repeated late decelerations and prolonged second stage of labor in the low-risk population are predictors of AS(5min) < 7, a situation associated with increased risk of neonatal respiratory distress, need for mechanical ventilatory support and NICU, and hypoxic-ischemic-encephalopathy.
conferenceObject Estimating risk factors for spontaneous preterm delivery in teen pregnancies(2013) BAKER, Arthur; RUANO, Rodrigo; HAERI, Sina- Reference Range for Fetal Interventricular Septum Area by Means of Four-Dimensional Ultrasonography Using Spatiotemporal Image Correlation(2013) NARDOZZA, Luciano Marcondes Machado; ROLO, Liliam Cristine; ARAUJO JUNIOR, Edward; HATANAKA, Alan Roberto; ROCHA, Luciane Alves; SIMIONI, Christiane; RUANO, Rodrigo; MORON, Antonio FernandesObjective: 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 x 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: