LISANDRA STEIN BERNARDES CIAMPI DE ANDRADE
Projetos de Pesquisa
Unidades Organizacionais
LIM/62 - Laboratório de Fisiopatologia Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
LIM/57 - Laboratório de Fisiologia Obstétrica, Hospital das Clínicas, Faculdade de Medicina
LIM/57 - Laboratório de Fisiologia Obstétrica, Hospital das Clínicas, Faculdade de Medicina
31 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 31
- When One Knows a Fetus Is Expected to Die: Palliative Care in the Context of Prenatal Diagnosis of Fetal Malformations(2017) CATANIA, Taisa Rocha; BERNARDES, Lisandra Stein; BENUTE, Glaucia Rosana Guerra; GIBELI, Maria Augusta Bento Cicaroni; NASCIMENTO, Nathalia Bertolassi do; BARBOSA, Tercilia Virginia Aparecida; KREBS, Vera Lucia Jornada; FRANCISCO, Rossana P. V.Background: Fetal malformations occur in 2% of gestations and are the fifth most common cause of neonatal death in the world. In many cases, fetal malformations result in neonatal death or long stay in intensive care facilities. Families that continue the pregnancy in such a situation need to make choices and cope with an overwhelming number of potential issues. Palliative care starting at the prenatal period is a growing field that allows the entire family to prepare for this difficult situation. Objective: To perform a systematic review of published data on palliative care in the prenatal period. Design: PubMed and the Cochrane Library were searched using the keywords (""perinatal"" OR ""prenatal"" OR ""fetal"") AND ""palliative care"" and also (""perinatal"" OR ""prenatal"" OR ""fetal"") AND ""hospice."" Setting/Subjects: Studies focusing on the long-term impact of prenatal palliative care published up to December 2015 were used. Measurements: Quantitative and qualitative studies. Results: In total, 541 studies were retrieved; 29 articles met the inclusion criteria. Studies were organized into different categories according to the design or main focus. The majority of studies retrieved were reflexives or presented a narrative proposal on palliative care started in the prenatal period (45%). Clinical studies comprised 17% of all articles found. No studies were found on the long-term impact of prenatal palliative care. Conclusions: Prenatal palliative care is a growing field and an important supportive care measure that can help grieving parents and families who do not want to or cannot interrupt their pregnancy. More studies should be carried out, specifically concerning long-term impact of prenatal palliative care. Guidelines and training of health professionals must be developed so that more families can benefit from this type of care.
- Is Doppler ultrasound useful for evaluating gestational trophoblastic disease?(2015) LIN, Lawrence H.; BERNARDES, Lisandra S.; HASE, Eliane A.; FUSHIDA, Koji; FRANCISCO, Rossana P. V.Doppler ultrasound is a non-invasive method for evaluating vascularization and is widely used in clinical practice. Gestational trophoblastic neoplasia includes a group of highly vascularized malignancies derived from placental cells. This review summarizes data found in the literature regarding the applications of Doppler ultrasound in managing patients with gestational trophoblastic neoplasia. The PubMed/Medline, Web of Science, Cochrane and LILACS databases were searched for articles published in English until 2014 using the following keywords: ""Gestational trophoblastic disease AND Ultrasonography, Doppler."" Twenty-eight articles met the inclusion criteria and were separated into the 4 following groups according to the aim of the study. (1) Doppler ultrasound does not seem to be capable of differentiating partial from complete moles, but it might be useful when evaluating pregnancies in which a complete mole coexists with a normal fetus. (2) There is controversy in the role of uterine artery Doppler velocimetry in the prediction of development of gestational trophoblastic neoplasia. (3) Doppler ultrasound is a useful tool in the diagnosis of gestational trophoblastic neoplasia because abnormal myometrial vascularization and lower uterine artery Doppler indices seem to be correlated with invasive disease. (4) Lower uterine artery Doppler indices in the diagnosis of gestational trophoblastic neoplasia are associated with methotrexate resistance and might play a role in prognosis. CONCLUSION: Several studies support the importance of Doppler ultrasound in the management of patients with gestational trophoblastic neoplasia, particularly the role of Doppler velocimetry in the prediction of trophoblastic neoplasia and the chemoresistance of trophoblastic tumors. Doppler findings should be used as ancillary tools, along with human chorionic gonadotropin assessment, in the diagnosis of gestational trophoblastic neoplasia.
- Sorting pain out of salience: assessment of pain facial expressions in the human fetus(2021) BERNARDES, Lisandra S.; CARVALHO, Mariana A.; HARNIK, Simone B.; TEIXEIRA, Manoel J.; OTTOLIA, Juliana; CASTRO, Daniella; VELLOSO, Adriano; FRANCISCO, Rossana; LISTIK, Clarice; GALHARDONI, Ricardo; SILVA, Valquiria Aparecida da; MOREIRA, Larissa I.; FILHO, Antonio G. de Amorim; FERNANDES, Ana M.; ANDRADE, Daniel Ciampi deIntroduction:The question of whether the human fetus experiences pain has received substantial attention in recent times. With the advent of high-definition 4-dimensional ultrasound (4D-US), it is possible to record fetal body and facial expressions.Objective:To determine whether human fetuses demonstrate discriminative acute behavioral responses to nociceptive input.Methods:This cross-sectional study included 5 fetuses with diaphragmatic hernia with indication of intrauterine surgery (fetoscopic endoluminal tracheal occlusion) and 8 healthy fetuses, who were scanned with 4D-US in 1 of 3 conditions: (1) acute pain group: Fetuses undergoing intrauterine surgery were assessed in the preoperative period during the anesthetic injection into the thigh; (2) control group at rest: Facial expressions at rest were recorded during scheduled ultrasound examinations; and (3) control group acoustic startle: Fetal facial expressions were recorded during acoustic stimulus (500-4000 Hz; 60-115 dB).Results:Raters blinded to the fetuses' groups scored 65 pictures of fetal facial expressions based on the presence of 12 items (facial movements). Analyses of redundancy and usefulness excluded 5 items for being of low discrimination capacity (P>0.2). The final version of the pain assessment tool consisted of a total of 7 items: brow lowering/eyes squeezed shut/deepening of the nasolabial furrow/open lips/horizontal mouth stretch/vertical mouth stretch/neck deflection. Odd ratios for a facial expression to be detected in acute pain compared with control conditions ranged from 11 (neck deflection) to 1,400 (horizontal mouth stretch). Using the seven-item final tool, we showed that 5 is the cutoff value discriminating pain from nonpainful startle and rest.Conclusions:This study inaugurates the possibility to study pain responses during the intrauterine life, which may have implications for the postoperative management of pain after intrauterine surgical interventions
- Association between maternal exposure to air pollution before conception and sex determination in the city of Sao Paulo(2020) CARVALHO, Mariana Azevedo; HETTFLEISCH, Karen; RODRIGUES, Agatha S.; BENACHI, Alexandra; VIEIRA, Sandra Elisabete; SALDIVA, Silvia R. D. M.; SALDIVA, Paulo Hilario N.; FRANCISCO, Rossana Pulcineli Vieira; BERNARDES, Lisandra SteinIt has been widely demonstrated that air pollution can affect human health and that some pollutant gases can have negative impacts on female fertility rates and cause adverse obstetric outcomes, such as premature birth and low birth weight. Few studies have evaluated the impact of maternal exposure to urban air pollution on the number of female births. To evaluate the association between maternal exposure to air pollution during the year before conception and sex determination. This was a prospective study using low-risk pregnant women living in Sao Paulo, Brazil. The pollutants were measured by a fixed station during a 1-year period before conception. Sex was confirmed after birth. We used multiple logistic regression models to evaluate the association between the pollutants and the sex determination and to estimate the odds ratio (OR) and the 95% confidence interval (CI) of being female based on a quantitative increase in pollutant concentration. We evaluated 371 patients. Elevated exposure to nitrogen dioxide (NO2) and particulate matter lower than 10 mu m (PM10) prior to conception were associated with increased odds of being female. Each unit increase of NO(2)exposure increased the odds of being female by 8% (OR = 1.08, 95% CI = 1.02, 1.15,p = 0.008), and each unit increase of PM(10)increased the odds of being female by 14% (OR = 1.14, 95% CI 1.02 to 1.28,p = 0.021). In Sao Paulo, maternal exposure to pollutants was significantly associated with the odds of being female.
- Pictures as mementos after perinatal death: a case study(2022) JESUS, Roberta Carolina de Almeida; BENUTE, Glaucia; BERTOLASSI, Nathalia; BARBOSA, Tercilia; BOLIBIO, Renata; FIGUEIREDO, Fernanda; SETUBAL, Maria Silvia; GIBELLI, Maria Augusta; GOMES, Ana; FERREIRA, Raquel; FRANCISCO, Rossana; BERNARDES, LisandraBackground: The grieving process following perinatal loss caused by life-limiting conditions presents some particularities associated with the family's culture and the symbolic relationship with the deceased. Objective: To reflect on the symbolic meaning attributed to mementos, particularly pictures taken immediately after birth. Method: Case study-a qualitative analysis of the data collected through semidirected interviews. Results: Of the three women that took part in the study, one woman chose not to take a picture but opted to take home the hat with her son's name on it that was provided as a regular procedure for every birth at the maternity centre. During the interview, she questioned her decision. The two other women took pictures and still look at them affectionate. One of the women keeps the picture of her child in a shrine at home, thus attributing a symbolic religious meaning to the whole experience that alleviates her pain. Conclusion: The symbolic meaning attributed to pictures of the deceased can help parents process grief.
- Reduced placental volume and flow in severe growth restricted fetuses(2016) ABULE, Renata Montes Dourado; BERNARDES, Lisandra Stein; DORO, Giovana Farina; MIYADAHIRA, Seizo; FRANCISCO, Rossana Pulcinelli VieiraOBJECTIVES: To evaluate placental volume and vascular indices in pregnancies with severe fetal growth restriction and determine their correlations to normal reference ranges and Doppler velocimetry results of uterine and umbilical arteries. METHODS: Twenty-seven fetuses with estimated weights below the 3rd percentile for gestational age were evaluated. Placental volume and vascular indices, including vascularization, flow, and vascularization flow indices, were measured by three-dimensional ultrasound using a rotational technique and compared to a previously described nomogram. The observed-to-expected placental volume ratio for gestational age and observed-to-expected placental volume ratio for fetal weight were calculated. Placental parameters correlated with the Doppler velocimetry results of uterine and umbilical arteries. RESULTS: The mean uterine artery pulsatility index was negatively correlated with the observed-to-expected placental volume ratio for gestational age, vascularization index and vascularization flow index. The observed-to-expected placental volume ratio for gestational age and observed-to-expected placental volume ratio for fetal weight and vascularization index were significantly lower in the group with a bilateral protodiastolic notch. No placental parameter correlated with the umbilical artery pulsatility index. CONCLUSIONS: Pregnancies complicated by severe fetal growth restriction are associated with reduced placental volume and vascularization. These findings are related to changes in uterine artery Doppler velocimetry. Future studies on managing severe fetal growth restriction should focus on combined results of placental three-dimensional ultrasound and Doppler studies of uterine arteries.
- A systematic review of instruments measuring grief after perinatal loss and factors associated with grief reactions(2021) SETUBAL, M. S.; BOLIBIO, R.; JESUS, R. C.; BENUTE, G. G.; GIBELLI, M. A.; BERTOLASSI, N.; BARBOSA, T.; GOMES, A.; FIGUEIREDO, F.; FERREIRA, R.; FRANCISCO, R.; BERNARDES, L. SteinObjective Expectant parents who live through perinatal loss experience intense grief, which is not always acknowledged or accepted. A screening tool to detect bereaved parents' grief reactions can guide professionals, including perinatal palliative care teams, to provide follow-up for those in need. This review's goal is to identify and synthesize the international published literature on existent instruments specifically measuring the grieving process after any perinatal loss and to identify factors that could moderate grief reactions. Method Systematic review (PROSPERO # CRD42018092555) with critical synthesis. PUBMED, Cochrane, and PsycINFO databases were searched in English language articles using the keywords ""perinatal"" AND (""grief"" OR ""bereavement"" OR mourning) AND (""scale"" OR ""questionnaire"" OR ""measure"" OR ""assessment"") up to May 2018. Eligibility criteria included every study using a measure to assess perinatal grief after all kinds of perinatal losses, including validations and translations to other languages and interventions designed to alleviate grief symptoms. Results A total of 67 papers met inclusion criteria. Seven instruments measuring perinatal grief published between 1984 and 2002 are described. The Perinatal Grief Scale (PGS) was used in 53 of the selected studies. Of those, 39 analyzed factors associated with grief reactions. Six articles used PGS scores to evaluate pre- and post-bereavement interventions. Studies in English language only might have limited the number of articles. Significance of results The PGS is the most used standardized measures to assess grief after perinatal loss. All parents living through any kind of perinatal loss should be screened.
- Associations of maternal personal exposure to air pollution on fetal weight and fetoplacental Doppler: A prospective cohort study(2016) CARVALHO, Mariana A.; BERNARDES, Lisandra S.; HETTFLEISCH, Karen; PASTRO, Luciana D. M.; VIEIRA, Sandra E.; SALDIVA, Silvia R. D. M.; SALDIVA, Paulo H. N.; FRANCISCO, Rossana P. V.We determined the influence of maternal air pollution exposure during each trimester of pregnancy on fetal and birth weight and fetoplacental hemodynamics. In total, 366 women with singleton pregnancies were prospectively followed in the city of Sao Paulo, Brazil. Nitrogen dioxide (NO2) and ozone (O-3) were measured during each trimester using passive personal samplers. We evaluated fetal weight and Doppler velocimetry data from the umbilical, middle cerebral, and uterine arteries in the 3rd trimester, and birth weight. Multivariate analysis was performed, controlling for known determinants of fetal weight. Exposure to higher levels of O-3 during the 2nd trimester was associated with higher umbilical artery pulsatility indices (PIs) [p = 0.013; beta = 0.017: standard error (SE) = 0.007]. Exposure to higher levels of O-3 during the 3rd trimester was associated with lower umbilical artery PIs (p = 0.011; beta = 0.021; SE = 0.008). Our results suggest that in the environment of Sao Paulo, 03 may affects placental vascular resistance.
- Quantitative analysis of renal vascularization in fetuses with urinary tract obstruction by three-dimensional power-Doppler(2011) BERNARDES, Lisandra Stein; FRANCISCO, Rossana P. V.; SAADA, Julien; SALOMON, Remi; RUANO, Rodrigo; LORTAD-JACOB, Stephen; ZUGAIB, Marcelo; BENACHI, AlexandraOBJECTIVE: To evaluate the applicability of 3-dimensional evaluation of renal vascularization for predicting postnatal renal function in fetuses with suspected urinary obstruction. STUDY DESIGN: Fetuses were evaluated by 3-dimensional power-Doppler histogram, and vascular indices were estimated. Depth between the probe and the renal cortex was also evaluated. Postnatal follow-up was obtained in all cases and the main outcome was renal impairment. RESULTS: Twenty-three fetuses with urinary dilatation (cases) and 73 with normal renal morphology (controls) were included in the current study. Five (21.7%) cases developed renal impairment. Vascularization index and vascularization and flow index were significantly lower in fetuses that developed renal impairment compared with those with normal renal function (P = .009 and P = .036, respectively). The 3 vascular indexes correlated with depth. Percentage of depth-corrected vascularization index and vascularization flow index were lower in fetuses developing postnatal renal failure. CONCLUSION: Fetal renal vascularity (vascularization index and vascularization and flow index) was significantly lower in fetuses that developed renal impairment.
- Individual exposure to urban air pollution and its correlation with placental angiogenic markers in the first trimester of pregnancy, in Sao Paulo, Brazil(2021) HETTFLEISCH, Karen; CARVALHO, Mariana Azevedo; HOSHIDA, Mara Sandra; PASTRO, Luciana Duzolina Manfre; SALDIVA, Silvia Regina Dias Medici; VIEIRA, Sandra Elisabete; FRANCISCO, Rossana Pulcineli Vieira; SALDIVA, Paulo Hilario Nascimento; BERNARDES, Lisandra SteinPollution of the atmosphere is known that may lead to adverse obstetric outcomes, including fetal growth restriction, gestational hypertension, and preeclampsia. Such disorders are correlated with imbalances in angiogenic factors, which may also be involved in the pathological mechanism as the pollutants impact placental and maternal physiology. In the first trimester of gestation, this study assessed the outcomes of personal maternal short period exposure to air pollution on soluble fms-like tyrosine kinase 1 (sFlt1) and placental growth factor (PLGF) of pregnant women blood concentrations. This was a cross-sectional study, held in the city of Sao Paulo, Brazil, and conducted with low-risk pregnant women, who carried personal passive nitrogen dioxide (NO2) and ozone (O-3) monitors for about a few days preceding the ultrasound evaluation, and on this day, the venous blood sample was collected to measure the angiogenic factors sFlt1 and PLGF and their ratio (sFlt1/PLGF) by enzyme-linked immunosorbent assay (ELISA). By means of multiple regression models, the effect of the studied pollutants on the log-transformed concentrations of the angiogenic factors was evaluated. One hundred thirty-one patients were included. The log of the sFlt1/PLGF ratio increased with rising NO2 levels (p = 0.021 and beta = 0.206), and the log of the PLGF concentration showed a negative correlation with NO2 (p = 0.008 and beta = - 0.234). NO2, an indicator of the levels of primary air pollutants, presented significant positive correlation with an increased sFlt1/PLGF ratio and diminished PLGF levels, which may reflect an antiangiogenic state generated by air pollution exposure.