LIM/57 - Laboratório de Fisiologia Obstétrica
URI Permanente desta comunidade
O Laboratório de Fisiologia Obstétrica é ligado ao Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo (FMUSP).
Linhas de pesquisa: desvios do crescimento fetal: aspectos fisiopatológicos, fatores preditores, exercícios físicos e fisioterapia no ciclo gravídico-puerperal: novas perspectivas e interferências no prognóstico da gestação.
Site oficial: http://limhc.fm.usp.br/portal/lim57-laboratorio-de-fisiologia-obstetrica/
Linhas de pesquisa: desvios do crescimento fetal: aspectos fisiopatológicos, fatores preditores, exercícios físicos e fisioterapia no ciclo gravídico-puerperal: novas perspectivas e interferências no prognóstico da gestação.
Site oficial: http://limhc.fm.usp.br/portal/lim57-laboratorio-de-fisiologia-obstetrica/
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- LIM/57 - Laboratório de Fisiologia Obstétrica
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- LIM/57 - Laboratório de Fisiologia Obstétrica
Submissões Recentes
Data-driven, cross-disciplinary collaboration: lessons learned at the largest academic health center in Latin America during the COVID-19 pandemic
(2024) RITTO, Ana Paula; ARAUJO, Adriana Ladeira de; CARVALHO, Carlos Roberto Ribeiro de; SOUZA, Heraldo Possolo De; FAVARETTO, Patricia Manga e Silva; SABOYA, Vivian Renata Boldrim; GARCIA, Michelle Louvaes; KULIKOWSKI, Leslie Domenici; KALLAS, Esper Georges; PEREIRA, Antonio Jose Rodrigues; COBELLO JUNIOR, Vilson; SILVA, Katia Regina; ABDALLA, Eidi Raquel Franco; SEGURADO, Aluisio Augusto Cotrim; SABINO, Ester Cerdeira; RIBEIRO JUNIOR, Ulysses; FRANCISCO, Rossana Pulcineli Vieira; MIETHKE-MORAIS, Anna; LEVIN, Anna Sara Shafferman; SAWAMURA, Marcio Valente Yamada; FERREIRA, Juliana Carvalho; SILVA, Clovis Artur; MAUAD, Thais; GOUVEIA, Nelson da Cruz; LETAIF, Leila Suemi Harima; BEGO, Marco Antonio; BATTISTELLA, Linamara Rizzo; DUARTE, Alberto Jose da Silva; SEELAENDER, Marilia Cerqueira Leite; MARCHINI, Julio; FORLENZA, Orestes Vicente; ROCHA, Vanderson Geraldo; MENDES-CORREA, Maria Cassia; COSTA, Silvia Figueiredo; CERRI, Giovanni Guido; BONFA, Eloisa Silva Dutra de Oliveira; CHAMMAS, Roger; BARROS FILHO, Tarcisio Eloy Pessoa de; BUSATTO FILHO, Geraldo
Introduction The COVID-19 pandemic has prompted global research efforts to reduce infection impact, highlighting the potential of cross-disciplinary collaboration to enhance research quality and efficiency.Methods At the FMUSP-HC academic health system, we implemented innovative flow management routines for collecting, organizing and analyzing demographic data, COVID-related data and biological materials from over 4,500 patients with confirmed SARS-CoV-2 infection hospitalized from 2020 to 2022. This strategy was mainly planned in three areas: organizing a database with data from the hospitalizations; setting-up a multidisciplinary taskforce to conduct follow-up assessments after discharge; and organizing a biobank. Additionally, a COVID-19 curated collection was created within the institutional digital library of academic papers to map the research output.Results Over the course of the experience, the possible benefits and challenges of this type of research support approach were identified and discussed, leading to a set of recommended strategies to enhance collaboration within the research institution. Demographic and clinical data from COVID-19 hospitalizations were compiled in a database including adults and a minority of children and adolescents with laboratory confirmed COVID-19, covering 2020-2022, with approximately 350 fields per patient. To date, this database has been used in 16 published studies. Additionally, we assessed 700 adults 6 to 11 months after hospitalization through comprehensive, multidisciplinary in-person evaluations; this database, comprising around 2000 fields per subject, was used in 15 publications. Furthermore, thousands of blood samples collected during the acute phase and follow-up assessments remain stored for future investigations. To date, more than 3,700 aliquots have been used in ongoing research investigating various aspects of COVID-19. Lastly, the mapping of the overall research output revealed that between 2020 and 2022 our academic system produced 1,394 scientific articles on COVID-19.Discussion Research is a crucial component of an effective epidemic response, and the preparation process should include a well-defined plan for organizing and sharing resources. The initiatives described in the present paper were successful in our aim to foster large-scale research in our institution. Although a single model may not be appropriate for all contexts, cross-disciplinary collaboration and open data sharing should make health research systems more efficient to generate the best evidence.
Adverse Perinatal Outcomes among Adolescent Pregnant Women Living with HIV: A Propensity-Score-Matched Study
(2023) OSMUNDO JUNIOR, G. D. S.; CABAR, F. R.; PERES, S. V.; WAISSMAN, A. L.; GALLETTA, M. A. K.; FRANCISCO, R. P. V.
HIV infection and adolescent pregnancy are known to increase the risk of adverse perinatal outcomes. However, data are limited concerning the outcomes of pregnancies among adolescent girls living with HIV. This retrospective propensity-score matched study aimed to compare adverse perinatal outcomes in adolescent pregnant women living with HIV (APW-HIV-positive) with HIV-negative adolescent pregnant women (APW-HIV-negative) and adult pregnant women with HIV (PW-HIV). APW-HIV-positive were propensity-score matched with APW-HIV-negative and PW-HIV. The primary endpoint was a composite endpoint of adverse perinatal outcomes, comprising preterm birth and low birth weight. There were 15 APW-HIV-positive and 45 women in each control group. The APW-HIV-positive were aged 16 (13–17) years and had had HIV for 15.5 (4–17) years, with 86.7% having perinatally acquired HIV. The APW-HIV-positive had higher rates of perinatally acquired HIV infection (86.7 vs. 24.4%, p < 0.001), a longer HIV infection time (p = 0.021), and longer exposure to antiretroviral therapy (p = 0.034) compared with the PW-HIV controls. The APW-HIV-positive had an almost five-fold increased risk of adverse perinatal outcomes compared with healthy controls (42.9% vs. 13.3%, p = 0.026; OR 4.9, 95% CI 1.2–19.1). The APW-HIV-positive and APW-HIV-negative groups had similar perinatal outcomes.
Social Media as Health Education Strategy for Women in The Menopause and Postmenopauseal Transitions and Medical Students
(2022) PORTELLA, Caio Fabio S.; FRANCISQUETTI, Camila C.; MACHADO, Mariana; SANTOS, Nayara S. Sousa; HASHIMOTO, Adriana S.; BURCH, Caroline da Silva; SILVA, Igor de Azevedo da; SIMES, Ricardo dos Santos; NOLL, Priscilla R. E. Silva; BARACAT, Edmund Chada; SOARES JUNIOR, Jose M.; SORPRESO, Isabel C. Esposito
Vaginal progesterone for preventing preterm birth and adverse perinatal outcomes in twin gestations: a systematic review and meta-analysis
(2023) CONDE-AGUDELO, Agustin; ROMERO, Roberto; REHAL, Anoop; BRIZOT, Maria L.; SERRA, Vicente; FONSECA, Eduardo Da; CETINGOZ, Elcin; SYNGELAKI, Argyro; PERALES, Alfredo; HASSAN, Sonia S.; NICOLAIDES, Kypros H.
OBJECTIVE: To evaluate the efficacy of vaginal progesterone for the prevention of preterm birth and adverse perinatal outcomes in twin gestations.DATA SOURCES: MEDLINE, Embase, LILACS, and CINAHL (from their inception to January 31, 2023), Cochrane databases, Google Scholar, bibliographies, and conference proceedings.STUDY ELIGIBILITY CRITERIA: Randomized controlled trials that compared vaginal progesterone to placebo or no treatment in asymptomatic women with a twin gestation.METHODS: The systematic review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions. The primary outcome was preterm birth <34 weeks of gestation. Secondary outcomes included adverse perinatal outcomes. Pooled relative risks with 95% confidence intervals were calculated. We assessed the risk of bias in each included study, heterogeneity, publication bias, and quality of evidence, and performed subgroup and sensitivity analyses.RESULTS: Eleven studies (3401 women and 6802 fetuses/infants) fulfilled the inclusion criteria. Among all twin gestations, there were no significant differences between the vaginal progesterone and placebo or no treatment groups in the risk of preterm birth <34 weeks (relative risk, 0.99; 95% confidence interval, 0.84-1.17; high-quality evidence), <37 weeks (relative risk, 0.99; 95% confidence interval, 0.92-1.06; high-quality evidence), and <28 weeks (relative risk, 1.00; 95% confidence interval, 0.64-1.55; moderate-quality evidence), and spontaneous preterm birth <34 weeks of gestation (relative risk, 0.97; 95% confidence interval, 0.80-1.18; high-quality evidence). Vaginal progesterone had no significant effect on any of the perinatal outcomes evaluated. Subgroup analyses showed that there was no evidence of a different effect of vaginal progesterone on preterm birth <34 weeks of gestation related to chorionicity, type of conception, history of spontaneous preterm birth, daily dose of vaginal progesterone, and gestational age at initiation of treatment. The frequencies of preterm birth <37, <34, <32, <30, and <28 weeks of gestation and adverse perinatal outcomes did not significantly differ between the vaginal progesterone and placebo or no treatment groups in unselected twin gestations (8 studies; 3274 women and 6548 fetuses/infants). Among twin gestations with a transvaginal sonographic cervical length <30 mm (6 studies; 306 women and 612 fetuses/infants), vaginal progesterone was associated with a significant decrease in the risk of preterm birth occurring at <28 to <32 gestational weeks (relative risks, 0.48-0.65; moderate-to high-quality evidence), neonatal death (relative risk, 0.32; 95% confidence interval, 0.11-0.92; moderate-quality evidence), and birthweight <1500 g (relative risk, 0.60; 95% confidence interval, 0.39-0.88; high-quality evidence). Vaginal progesterone significantly reduced the risk of preterm birth occurring at <28 to <34 gestational weeks (relative risks, 0.41-0.68), composite neonatal morbidity and mortality (relative risk, 0.59; 95% confidence interval, 0.33-0.98), and birthweight <1500 g (relative risk, 0.55; 95% confidence interval, 0.33-0.94) in twin gestations with a transvaginal sonographic cervical length <= 25 mm (6 studies; 95 women and 190 fetuses/infants). The quality of evidence was moderate for all these outcomes. CONCLUSION: Vaginal progesterone does not prevent preterm birth, nor does it improve perinatal outcomes in unselected twin gestations, but it appears to reduce the risk of preterm birth occurring at early gestational ages and of neonatal morbidity and mortality in twin gestations with a sonographic short cervix. However, more evidence is needed before recommending this intervention to this subset of patients.
Three-dimensional Ultrasound Evaluation of Lung Volume in Fetuses with Abdominal Wall Defect
(2023) NISHIE, Estela Naomi; OSMUNDO-JUNIOR, Gilmar de Souza; MOHAMED, Samirah Hosney Mahmoud; TANNURI, Ana Cristina Aoun; GIBELLI, Maria Augusta Bento Cicaroni; CARVALHO, Werther Brunow de; PERES, Stela Verzinhasse; FRANCISCO, Rossana Pulcineli Vieira; BRIZOT, Maria de Lourdes
Introduction: Abdominal wall defects (AWD) interfere with postnatal respiratory parameters. We aimed to evaluate lung volume (LV) in fetuses with AWD using three-dimensional (3D) ultrasound (US) and to correlate AWD with the type (omphalocele and gastroschisis) and size of the defect and neonatal morbidity and mortality.Methods: This prospective study included 72 pregnant women with fetuses with AWD and a gestational age <25 weeks. Abdominal volume, 3D US LV, and herniated volume were acquired every 4 weeks up to 33 weeks. LV was compared with normal reference curves and correlated with abdominal and herniated volumes.Results: Omphalocele (p<0.001) and gastroschisis (p<0.001) fetuses had smaller LV than did normal fetuses. LV was positively correlated with abdominal volume (omphalocele, r=0.86; gastroschisis, r=0.88), whereas LV was negatively correlated with omphalocele-herniated volume/abdominal volume (p<0.001, r= -0.51). LV was smaller in omphalocele fetuses that died (p=0.002), were intubated (p=0.02), or had secondary closure (p<0.001). In gastroschisis, a smaller LV was observed in fetuses discharged using oxygen (p=0.002).Discussion/Conclusion: Fetuses with AWD had smaller 3D LV than normal fetuses. Fetal abdominal volume was inversely correlated with LV. In omphalocele fetuses, a smaller LV was associated with neonatal mortality and morbidity.
Maternal malnutrition during pregnancy among women with sickle cell disease
(2023) PAIVA, Leticia Vieira; IGAI, Ana Maria Kondo; NOMURA, Roseli Mieko Yamamoto
OBJECTIVE: The objective of this study was to compare the nutritional status and dietary intake of pregnant women with sickle cell disease (SS hemoglobinopathy and SC hemoglobinopathy) to healthy controls and report the maternal and perinatal outcomes.METHODS: This is a prospective, longitudinal cohort study. Pregnant women with a diagnosis of sickle cell disease and control group were recruited in an outpatient clinic of a tertiary care hospital in Sao Paulo, Brazil. Maternal anthropometric data and dietary intake data were collected at the second and third trimesters.RESULTS: A total of 49 pregnancies complicated by sickle cell disease were included. Prepregnancy body mass index was significantly lower in the SS hemoglobinopathy group (n=26, median 20.3 kg/m(2)) than the SC hemoglobinopathy group (n=23, 22.7 kg/m(2)) or control group (n=33, 23.2 kg/ m(2), p<0.05). The prepregnancy nutritional status revealed significantly more women classified as underweight in the SS hemoglobinopathy group (15.4%) than in the SC hemoglobinopathy group (4.4%) and control group (1.6%, p=0.009). In the second trimester, maternal protein intake was significantly lower in SS hemoglobinopathy (73.2 g/day) and SC hemoglobinopathy (68.8 g/day) than in the control group (95.7 g/day, p=0.004). In the third trimester, only SS hemoglobinopathy mothers showed dietary intake of protein significantly lower than that of the controls (67.5 g/day vs. 92.8 g/day, p=0.02). Vitamin A and E consumption was also reduced in the third trimester in the SS hemoglobinopathy group (p<0.05).CONCLUSION: The nutritional status of pregnant women with SS hemoglobinopathy is characterized by a state of undernutrition. The lower protein intake in the second and third trimesters of pregnant women with SS hemoglobinopathy may contribute to this condition. Undernourishment is a serious complication of sickle cell disease, primarily during pregnancy, and it should be addressed during the prenatal period.
Bacterial profile and prevalence of urinary tract infections in pregnant women in Latin America: a systematic review and meta-analysis
(2023) SOUZA, Henrique Diorio de; DIORIO, Giselle Rodrigues Mota; PERES, Stela Verzinhasse; FRANCISCO, Rossana Pulcineli Vieira; GALLETTA, Marco Aurelio Knippel
BackgroundGiven the physiological changes during pregnancy, pregnant women are likely to develop recurrent urinary tract infections (UTIs) and pyelonephritis, which may result in adverse obstetric outcomes, including prematurity and low birth weight preeclampsia. However, data on UTI prevalence and bacterial profile in Latin American pregnant women remain scarce, necessitating the present systematic review to address this issue.MethodsTo identify eligible observational studies published up to September 2022, keywords were systematically searched in Medline/PubMed, Cochrane Library, Embase, Web of Science, and Bireme/Lilacs electronic databases and Google Scholar. The systematic review with meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the quality of studies was classified according to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. The meta-analysis employed a random-effects method with double-arcsine transformation in the R software.ResultsDatabase and manual searches identified 253,550 citations published until September 2022. Among the identified citations, 67 met the inclusion criteria and were included in the systematic review, corresponding to a sample of 111,249 pregnant women from nine Latin American countries. Among Latin American pregnant women, the prevalence rates of asymptomatic bacteriuria, lower UTI, and pyelonephritis were estimated at 18.45% (95% confidence interval [CI]: 15.45-21.53), 7.54% (95% CI: 4.76-10.87), and 2.34% (95% CI: 0.68-4.85), respectively. Some regional differences were also detected. Among the included studies, Escherichia coli (70%) was identified as the most frequently isolated bacterial species, followed by Klebsiella sp. (6.8%).ConclusionPregnant women in Latin America exhibit a higher prevalence of bacteriuria, UTI, and pyelonephritis than pregnant women globally. This scenario reinforces the importance of universal screening with urine culture during early prenatal care to ensure improved outcomes. Future investigations should assess the microbial susceptibility profiles of uropathogens isolated from pregnant women in Latin America.Trial registrationThis research was registered at PROSPERO (No. CRD42020212601).
Misoprostol use in obstetrics
(2023) NOMURA, Roseli Mieko Yamamoto; NAKAMURA-PEREIRA, Marcos; BRIZOT, Maria de Lourdes; JR, Alberto Trapani; PARO, Helena Borges Martins da Silva; ROSAS, Cristiao Fernando; MEDEIROS, Robinson Dias de; SURITA, Fernanda Garanhani; LUZ, Adriana Gomes; MATTAR, Rosiane; FERREIRA, Elton Carlos; ALVES, Alvaro Luiz Lage; CORDIOLI, Eduardo; DAMASIO, Lia Cruz Vaz da Costa; WENDER, Maria Celeste Osuerio; BRAGA, Antonio
A Study of the Current Scenario of the Obstetrics and Gynecology Residency during the COVID-1 9 Pandemic
(2023) SONNENFELD, Marina Martinelli; NOZAKI, Alexandre Massao; GENOVA, Anelise Silva de; RISTOW, Jose Ricardo Weitz; MOURA, Tamiris Ferreira de; CABRAL, Rayanne Pereira; GARCIA, Joao Victor Almeida; GUIMARAES, Camila Abdias; OLIVEIRA, Andre Luiz Malavasi Longo de; FRANCISCO, Rossana Pulcineli Vieira
Objective To analyze the impact of the COVID-19 pandemic on the residency of gynecology and obstetrics in Sao Paulo. Methods Cross-sectional study developed by representatives of residents of the Association of Gynecology and Obstetrics of the State of Sao Paulo ( SOGESP, in the Portuguese acronym). Data were collected from questionnaires applied to gynecology and obstetrics residents registered on the SOGESP website in February 2022. The interviewees answered about the repercussions of the pandemic on medical residency and whether they had technical and psychological support during the period. Results A total of 247 questionnaires were collected from residents of gynecology and obstetrics. The residents had an age of 28.3 +/- 3 years old, and most of them were female (88.4%). The displacement to COVID care was reported by 62.34% of the students, but only 35.6% reported completely adequate personal protective equipment and only 7.7% reported complete theoretical and technical instruction to support these patients. Almost all of the interviewees stated that the gynecology sector was the most affected. The majority of the interviewees considered that the second- year residents had the greatest loss, and more than half of the residents in the 1st and 2nd year said they wished to give up their residency during the pandemic. More than 80% of the residents reported online theoretical classes and/or presentation of articles, reinforcing the fact that virtual activities gained a greater space within the medical residency. Conclusion The pandemic impacted the residency in greater proportion in outpatient clinics and gynecological surgeries, also interfering with the physician ' s desire to continue with the program.
Pre-eclampsia (vol 9, 8, 2023)
(2023) DIMITRIADIS, Evdokia; ROLNIK, Daniel L.; ZHOU, Wei; ESTRADA-GUTIERREZ, Guadalupe; KOGA, Kaori; FRANCISCO, Rossana P. V.; WHITEHEAD, Clare; HYETT, Jon; COSTA, Fabricio da Silva; NICOLAIDES, Kypros; MENKHORST, Ellen