MARCELO ZUGAIB
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina - Docente
LIM/57 - Laboratório de Fisiologia Obstétrica, Hospital das Clínicas, Faculdade de Medicina
LIM/57 - Laboratório de Fisiologia Obstétrica, Hospital das Clínicas, Faculdade de Medicina
8 resultados
Resultados de Busca
Agora exibindo 1 - 8 de 8
- Prediction of the rate of decline in fetal hemoglobin levels between first and second transfusions in red cell alloimmune disease(2012) NISHIE, Estela Naomi; LIAO, Adolfo Wenjaw; BRIZOT, Maria de Loudes; ASSUNCAO, Renata A.; ZUGAIB, MarceloObjective To determine variables that predict the rate of decline in fetal hemoglobin levels in alloimmune disease. Method Retrospective review of singleton pregnancies that underwent first and second intrauterine transfusions for treatment of fetal anemia because of maternal Rh alloimmunization in a tertiary referral center. Results Forty-one first intrauterine transfusions were performed at 26.1?weeks (standard deviation, SD, 4.6), mean volume of blood transfused was 44.4?mL (SD 23.5) and estimated feto-placental volume expansion was 51.3% (SD 14.5%). Between first and second transfusion, hemoglobin levels reduced on average 0.40?g/dl/day (SD 0.25). Stepwise multiple regression analysis demonstrated that this rate significantly correlated with hemoglobin levels after the first transfusion, the interval between both procedures, and middle cerebral artery systolic velocity before the second transfusion. Conclusion The rate of decline in fetal hemoglobin levels between first and second transfusions in alloimmune disease can be predicted by a combination of hemoglobin levels after the first transfusion, interval between both procedures, and middle cerebral artery systolic velocity before the second transfusion. (C) 2012 John Wiley & Sons, Ltd.
- Longitudinal reference range for umbilical cord cross-sectional area in twin pregnancies at 18-32 weeks of gestation(2015) FERNANDES, D. B.; LIAO, A. W.; BRIZOT, M. L.; FRANCISCO, R. P. V.; ZUGAIB, M.ObjectivesThe objectives of this study were to establish gestational age-specific reference ranges for cross-sectional area of the umbilical cord, and its components, in twin pregnancies and to compare them with previously reported singleton reference ranges. MethodsThis was a prospective longitudinal study involving uncomplicated dichorionic twin pregnancies. Sonographic measurements of the cross-sectional area of the umbilical cord, umbilical vein and arteries and Wharton's jelly were obtained in a plane adjacent to the fetal abdomen, every 3weeks, between 18 and 32weeks of gestations. Multilevel regression analysis was used to determine gestational age-specific reference ranges for each parameter, and these were plotted against singleton pregnancy references. ResultsThree hundred and thirty four ultrasound scans were performed in 44 twin pregnancies, between 18 and 32.9weeks (mean: 3.80.7 scans/pregnancy and mean interval between scans: 3.30.9weeks). All umbilical cord cross-sectional areas (total, vein, artery and Wharton's jelly) showed a significant increase with gestational age. Compared with singleton pregnancy ranges, mean values were considerably lower in twin pregnancies and resemble the lower limits observed in singletons. ConclusionIn twin pregnancies, cross-sectional area of the umbilical cord, and its components, increases between 18 and 32weeks, and mean values are substantially lower compared with singleton pregnancies. (c) 2015 John Wiley & Sons, Ltd.
- Conjoined twins pregnancies: experience with 36 cases from a single center(2011) BRIZOT, M. L.; LIAO, A. W.; LOPES, L. M.; OKUMURA, M.; MARQUES, M. S.; KREBS, V.; SCHULTZ, R.; ZUGAIB, M.Objective To review a single center's experience in the management of twin pregnancies with conjoined fetuses. Methods Retrospective study describing prenatal findings, delivery details, surgical treatment and perinatal outcome. Results The study included 36 twin pregnancies with conjoined twins seen over a period of 12 years in a single tertiary hospital: 69.4% were thoracopagus, 13.9% parapagus, 8.3% omphaloischiopagus 5.6% omphalopagus and 2.8% cephalopagus. Cardiac defects were present in 91.6% of twin pairs and associated malformations were present in 61.8% of the cases: limb abnormalities in 36.1%, abdominal wall defects in 25.0%, cleft lip and/ or palate in 13.9% and congenital diaphragmatic hernia in 5.5%. Surgical separation was considered not feasible and prognosis lethal in 30 (83.3%) cases. Termination of pregnancy was performed in 12 pregnancies of poor prognosis. Cesarean section was performed in all remaining cases. Five sets of twins underwent surgical separation and six children survived. Overall survival in our series was 8.3% and, among the livebirths, 13.6%. Conclusion Conjoined twin pregnancies should be referred to tertiary centers for detailed fetal anomaly and echocardiographic assessment to evaluate prognosis and determine the possibility of postnatal surgical separation.
- Ultrasound detection rate of single umbilical artery in the first trimester of pregnancy(2011) LAMBERTY, Clarissa O.; CARVALHO, Mario Henrique Burlacchini de; MIGUELEZ, Javier; LIAO, Adolfo Wenjaw; ZUGAIB, MarceloObjective To determine accuracy of first trimester detection of single umbilical artery (SUA). Methods The number of vessels in the umbilical cord was examined in a prospective cohort of 779 singleton, low-risk, unselected pregnancies, in the first (11-13 weeks) and second (17-24 weeks) trimesters, using both power and color Doppler and after delivery, by placental histopathologic exam. Concordance between first and second trimester findings to postnatal diagnoses was compared by calculating kappa coefficients. Results There was medium concordance between the findings in the first trimester and the postnatal diagnoses (kappa = 0.52) and high concordance (kappa = 0.89) for the second trimester scan. Sensitivity, specificity, positive and negative predictive values for the findings in the first trimester were 57.1, 98.9, 50.0 and 99.2% and for the second trimester were 86.6, 99.9, 92.9 and 99.7%. Conclusion Sensitivity and positive predictive value of first trimester scan to identify an isolated SUA in a prospective unselected population was poor. Diagnosis of isolated SUA as well as a definitive judgment about the presence of associated anomalies would still require a scan in the second trimester.
- Prenatal diagnosis and natural history of fetuses presenting with pleural effusion(2011) RUANO, Rodrigo; RAMALHO, Alan Saito; CARDOSO, Ana Karina Silva; MOISE JR., Kenneth; ZUGAIB, MarceloObjective To describe the natural history of fetuses presenting with pleural effusion. Methods Between January 2005 and December 2009 all fetuses diagnosed with pleural effusion were followed up. Fetuses were divided into three groups: I, isolated pleural effusion; II, associated structural anomalies but normal karyotype; and III, chromosomal anomalies. Univariate and multivariate analyses were performed to determine the association between prenatal ultrasound findings and perinatal death. Results Fifty-six fetuses were included in the study. Associated structural or chromosomal anomalies occurred in 75.0% (42/56) of cases. Bilateral pleural effusion and fetal hydrops were associated with each other (p < 0.01) and with perinatal death (p < 0.05). Multivariate analysis indicated that only the presence of associated abnormalities was a statistical determinant of perinatal death (OR, 3.56; 95% CI, 1.48-5.64; p < 0.01). Conclusion Fetal pleural effusion is often associated with other abnormalities, and this association has poor perinatal outcome.
- Myocardial performance index in fetal anemia(2015) ASSUNCAO, Renata Almeida de; LIAO, Adolfo Wenjaw; BRIZOT, Maria de Lourdes; FRANCISCO, Rossana Pulcineli Vieira; ZUGAIB, MarceloObjectiveThe objective of the study was to examine the correlation between fetal myocardial performance index (MPI) and hemoglobin (Hb) levels. MethodsIt is a prospective study involving singleton pregnancies at risk of fetal anemia as a result of maternal anti-D alloimmune disease. Right and left ventricle (LV) MPIs were evaluated by ultrasound up to 72h before cordocentesis. Zeta-score values for fetal MPI and Hb levels were calculated, and correlation was examined with linear regression analysis. Significance level was set as 0.05. ResultsFourteen singleton pregnancies underwent 31 cordocentesis procedures at a mean gestation of 28.24.1weeks. Zeta-score values for LV MPI, isovolumetric relaxation time (IRT), and ejection time (ET) correlated significantly with fetal Hb zeta-score (LV MPI zeta=3.816+0.336xHb zeta, r=0.59, p<0.001; LV IRT zeta=2.643+0.218xHb zeta, r=0.45, p=0.01; LV ET zeta=-2.474-0.271xHb zeta, r=-0.42, p=0.02). LV isovolumetric contraction time (ICT) zeta-score and right ventricle (RV) MPI did not show significant correlation (LV ICT zeta, r=0.35, p=0.054; RV MPI, r=0.12, p=0.53). ConclusionLV myocardial performance not only remains preserved but also is actually enhanced in cases of moderate/severe fetal anemia. (c) 2014 John Wiley & Sons, Ltd.
- Kidney impairment in fetal growth restriction: three-dimensional evaluation of volume and vascularization(2020) SENRA, Janaina Campos; YOSHIZAKI, Carlos Tadashi; DORO, Giovana Farina; RUANO, Rodrigo; GIBELLI, Maria Augusta Bento Cicaroni; RODRIGUES, Agatha Sacramento; KOCH, Vera Hermina Kalika; KREBS, Vera Lucia Jornada; ZUGAIB, Marcelo; FRANCISCO, Rossana Pulcineli Vieira; BERNARDES, Lisandra SteinObjectives Renal development is impaired in fetal growth restriction (FGR). Renal size can be considered a surrogate of renal function in childhood, and could be impaired in that condition. Our aim was to evaluate the ratio of total renal volume, measured by three-dimensional ultrasound, to estimated fetal weight (TRV/EFW) among fetuses with and without growth restriction. Furthermore, we correlated TRV/EFW with fetal Doppler velocimetry and renal vascularization indexes and evaluated the association of renal volume and vascular parameters with adverse neonatal events in growth-restricted fetuses. Methods In a retrospective cohort, TRV and renal vascularization of growth-restricted and normal fetuses were evaluated by three-dimensional ultrasonography and VOCAL technique. Independent samples t-tests and Mann-Whitney test were used for comparisons between groups. Logistic regression model was applied to evaluate the association between renal characteristics and adverse neonatal events. Results Seventy-one growth-restricted fetuses were compared to 194 controls. The TRV/EFW was lower in the growth-restricted group (P < .001). In our sample, this ratio did not correlate with Doppler velocimetry parameters, renal vascular indexes or any adverse neonatal events. Conclusion The TRV/EFW ratio is decreased in FGR. Further studies are needed to investigate the association of this ratio with long-term renal outcomes.
- Percutaneous laser ablation under ultrasound guidance for fetal hyperechogenic microcystic lung lesions with hydrops: a single center cohort and a literature review(2012) RUANO, Rodrigo; SILVA, Marcos Marques da; SALUSTIANO, Eugenia Maria Assuncao; KILBY, Mark David; TANNURI, Uenis; ZUGAIB, MarceloObjective To evaluate the perinatal outcomes in hydropic fetuses with congenital microcystic pulmonary lesions that underwent percutaneous, invasive, laser therapy. Method This retrospective study reviews the literature and our experience between 2004 and 2010. Characteristics of the cystic lung lesions, liquor volume (presence of polyhydramnios or not), localization of ablation (vascular vs interstitial) and gestational age at which the procedure was performed were related to outcome (survival). Results In total, 16 fetuses with congenital lung lesions underwent invasive percutaneous laser ablation, seven performed in our center and nine published cases. Survival rate was higher in fetuses with a subsequent postnatal diagnosis of bronchopulmonary sequestration (87.5%) compared with congenital adenomatoid malformation (28.6%; p?=?0.04). The technique of vascular ablation was more successful (100%) than interstitial ablation (25.0%, p?