RODRIGO RUANO
Projetos de Pesquisa
Unidades Organizacionais
LIM/57 - Laboratório de Fisiologia Obstétrica, Hospital das Clínicas, Faculdade de Medicina
22 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 22
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.conferenceObject 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.conferenceObject Estimating risk factors for spontaneous preterm delivery in teen pregnancies(2013) BAKER, Arthur; RUANO, Rodrigo; HAERI, Sinaarticle Placental Volumes Measured by 3-Dimensional Ultrasonography in Normal Pregnancies From 12 to 40 Weeks' Gestation Reply(2012) PAULA, Carla Fagundes Silva de; CAMPOS, Juliana Alvares Duarte Bonini; RUANO, RodrigoconferenceObject Pregnant women with type 2 diabetes mellitus (DM) show evidence of altered cerebral blood hemodynamics compared to controls(2013) CHEN, Qian; HAERI, Sina; VEEN, Teelkien Van; RUANO, Rodrigo; GOLABBAKHSH, Hossein; MORALES, Yisel; HALL, Nicole; MASON, Chawla; BELFORT, Michaelarticle 13 Citação(ões) na Scopus Renal Volumes Measured by 3-Dimensional Sonography in Healthy Fetuses From 20 to 40 Weeks(2013) YOSHIZAKI, Carlos Tadashi; FRANCISCO, Rossana P. V.; PINHO, Joao Correia de; RUANO, Rodrigo; ZUGAIB, MarceloObjectives-The purpose of this study was to establish reference values for fetal kidney volumes as a function of gestational age, estimated by 3-dimensional sonography using the Virtual Organ Computer-Aided Analysis (VOCAL) technique (GE Healthcare, Kretztechnik, Zipf, Austria). Methods-Volumes of right and left kidneys were assessed in 213 healthy fetuses by 3-dimensional sonography using the VOCAL technique. Inclusion criteria were healthy women with singleton pregnancies, unremarkable comprehensive fetal sonographic findings, well-known gestational age established by first-trimester sonography, and gestational ages between 20 and 40 weeks. Exclusion criteria were patients lost to follow-up and birth weight abnormalities. Each patient was scanned once during pregnancy. Regression analysis was used to calculate unified formulas. Results-The mathematical models calculated in the study were as follows: expected right kidney volume = exp[-1.01 + (0.12 x gestational age)]; and expected left kidney volume = exp[-0.90 + (0.12 x gestational age)]. No significant intraobserver or inter-observer variability was observed for the determined volumes. Conclusions-Reference values for right and left fetal kidney volumes throughout gestation using the rotational technique (VOCAL) are described. The use of this technique might aid in further definition of gestational age kidney volume standards to help in defining variations from the norm.- Longitudinal assessment of lung area measurements by two-dimensional ultrasound in fetuses with isolated left-sided congenital diaphragmatic hernia(2015) RUANO, R.; BRITTO, I. S. W.; SANGI-HAGHPEYKAR, H.; BUSSAMRA, L. C. S.; SILVA, M. M. Da; BELFORT, M. A.; DETER, R. L.; LEE, W.; TANNURI, U.; ZUGAIB, M.ObjectiveTo evaluate lung growth in healthy fetuses and those with congenital diaphragmatic hernia (CDH) using two-dimensional (2D) ultrasound. MethodsFetal right lung measurements obtained by 2D ultrasound between 19 and 37 weeks' gestation were evaluated longitudinally in 66 healthy fetuses and 52 fetuses with isolated left-sided CDH. Right lung areas were determined by the tracing' and longest-diameters' methods and, subsequently, lung area-to-head circumference ratios (LHRs) were calculated. Functions fitted to these size parameters with respect to gestational age were evaluated for three sets of group-wise comparisons: (1) healthy vs CDH fetuses; (2) different degrees of severity of CDH; and (3) CDH fetuses that survived vs those that died by 6 months postpartum. ResultsThere was a significantly slower increase in right lung areas and LHRs with advancing gestational age in CDH fetuses than in healthy individuals (P < 0.05). Compared to those with milder forms of CDH, lung areas and LHRs of fetuses with more severe forms displayed a smaller increase (P < 0.05) and LHRs of fetuses with severe CDH did not increase during pregnancy (P > 0.05). Individuals who died postpartum did not show any increase in LHR (P > 0.05) throughout gestation. ConclusionsThe right lung area and LHR, calculated using either the longest-diameters or tracing method, display reduced growth rates during gestation in cases of isolated left-sided CDH as compared with healthy fetuses. The growth curve characteristics of fetal lung areas and LHRs may be useful for predicting neonatal mortality.
- Three-Dimensional Sonographic Assessment of Placental Volume and Vascularization in Pregnancies Complicated by Hypertensive Disorders(2014) PIMENTA, Eduardo Jorge de Almeida; PAULA, Carla Fagundes Silva de; CAMPOS, Juliana Alvares Duarte Bonini; FOX, Karin Anneliese; FRANCISCO, Rossana; RUANO, Rodrigo; ZUGAIB, MarceloObjectives-The purpose of this study was to evaluate the association between placental volumes, placental vascularity, and hypertensive disorders in pregnancy. Methods A prospective case-control study was conducted between April 2011 and July 2012. Placental volumes and vascularity were evaluated by 3-dimensional sonographic, 3-dimensional power Doppler histographic, and 2-dimensional color Doppler studies. Pregnant women were classified as normotensive or hypertensive and stratified by the nature of their hypertensive disorders. The following variables were evaluated: observed-to-expected placental volume ratio, placental volume-to-estimated fetal weight ratio, placental vascular indices, and pulsatility indices of the right and left uterine and umbilical arteries. Results Sixty-six healthy pregnant women and 62 pregnant women with hypertensive disorders were evaluated (matched by maternal age, gestational age at sonography, and parity). Placental volumes were not reduced in pregnancy in women with hypertensive disorders (P > .05). Conversely, reduced placental vascularization indices (vascularization index and vascularization-flow index) were observed in pregnancies complicated by hypertensive disorders (P < .01; P < .01), especially in patients with superimposed preeclampsia (P = .04; P = .02). A weak correlation was observed between placental volumes, placental vascular indices, and Doppler studies of the uterine and umbilical arteries. Conclusions Pregnancies complicated by hypertensive disorders are associated with reduced placental vascularity but not with reduced placental volumes. These findings are independent of changes in uterine artery Doppler studies. Future studies of the prediction of preeclampsia may focus on placental vascularity in combination with results of Doppler studies of the uterine arteries.
- Technical aspects and effectiveness of percutaneous fetal therapies for large sacrococcygeal teratomas: cohort study and literature review(2016) SANANES, N.; JAVADIAN, P.; BRITTO, I. Schwach Werneck; MEYER, N.; KOCH, A.; GAUDINEAU, A.; FAVRE, R.; RUANO, R.Objectives The objectives of this study were to evaluate the efficacy of minimally invasive ablation of high-risk large sacrococcygeal teratomas (SCT) and to compare the efficacy of vascular and interstitial tumor ablation. Methods This was a retrospective multicenter study including a cohort of fetuses with high-risk large SCTs between 2004 and 2010. In addition, we performed a systematic literature review of all cases that underwent tumor ablation in order to compare the survival rates after 'vascular' and 'interstitial' ablation. Statistical analysis was conducted using Bayesian methods. Results In our cohort, a total of 13 fetuses had high-risk large SCT and five of them underwent tumor ablation. The estimated difference in hydrops resolution rate between the fetal intervention and the no fetal intervention groups was 44.6% (95% credibility interval, 1.5 to 81.0%; P-diff>0 = 97.9%). The estimated difference in survival rate between the fetal intervention and the no fetal intervention groups was 31.0% (13.9 to 48.1%; P-diff>0 = 99.9%). We analyzed our five cases together with 28 cases from the literature and estimated the difference in survival rate between the vascular and interstitial ablation groups as 19.8% (-13.1 to 50.1%; P-diff>0 = 88.3%). The estimated difference in hydrops resolution rate between the vascular and the interstitial ablation groups was 36.7% (-5.7 to 72.7%; P-diff>0 = 95.5%). Conclusion Minimally invasive surgery seems to improve perinatal outcome in cases of high-risk large fetal SCT. Our findings suggest that 'vascular' ablation may improve outcome and may be more effective than 'interstitial' tumor ablation, but this hypothesis needs further investigation in a larger multicenter prospective study.
conferenceObject Estimation of maternal cerebrovascular hemodynamics following routine delivery related blood loss(2013) HALL, Nicole; HAERI, Sina; RUANO, Rodrigo; VEEN, Teelkien Van; GOLABBAKHSH, Hossein; CHEN, Qian; MORALES, Yisel; MASON, Chawla; BELFORT, Michael
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