ADOLFO WENJAW LIAO
Projetos de Pesquisa
Unidades Organizacionais
LIM/57 - Laboratório de Fisiologia Obstétrica, Hospital das Clínicas, Faculdade de Medicina
27 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 27
- Fetal Growth Pattern and Prediction of Low Birth Weight in Gastroschisis(2015) CENTOFANTI, Sandra F.; BRIZOT, Maria de Lourdes; LIAO, Adolfo W.; FRANCISCO, Rossana P. V.; ZUGAIB, MarceloObjectives: To examine growth patterns and predictions of low birth weight in gastroschisis fetuses. Methods: This is a retrospective study of isolated fetal gastroschisis before week 24. Ultrasound fetal biometric parameters - head circumference (HC), abdominal circumference (AC), femur length, HC/AC ratio and estimated fetal weight (EFW) - were plotted against normal growth charts. The percentage difference in mean values between normal and gastroschisis fetuses was determined. The growth deficit for each ultrasound parameter was calculated for the fetuses with 1 examination in each designated period (period I: weeks 20-25(+6); period II: weeks 26-31(+6); period III: from week 32 until term). For low birth weight prediction, measurements below the 10th percentile in periods I and II were tested. Results: Seventy pregnancies were examined. For all fetal parameters, the mean measurements were lower in fetuses with gastroschisis (p < 0.005). The EFW revealed an increased growth deficit between the periods (p = 0.030). HC was predictive of low birth weight in period II (OR = 6.07; sensitivity = 70.8%; specificity = 71.4%). Conclusions: Fetuses with gastroschisis present a reduced growth pattern, and it appears that no growth recovery occurs after the growth restriction has been established. Between week 26 and week 31(+6), an HC measurement below the 10th percentile is associated with an increased risk of low birth weight. (C) 2015 S. Karger AG, Basel
- 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.
- Maternal postpartum complications according to delivery mode in twin pregnancies(2014) STACH, Sonia Leme; LIAO, Adolfo Wenjaw; BRIZOT, Maria de Lourdes; FRANCISCO, Rossana Pulcineli Vieira; ZUGAIB, MarceloOBJECTIVE: We aimed to examine maternal postpartum complications of twin deliveries according to mode of delivery and investigate the associated risk factors. METHODS: This was a retrospective cohort review of twin pregnancies with delivery after 26 weeks at a tertiary teaching hospital (1993-2008). The rates of maternal postpartum complications were compared among vaginal, elective cesarean and emergency cesarean deliveries. Significant predictors of complications were investigated with stepwise regression analysis and relative risks were calculated. RESULTS: A total of 90 complications were observed in 56/817 (6.9%) deliveries: 7/131 (5.3%) vaginal, 10/251 (4.0%) elective cesarean and 39/435 (9.0%) emergency cesarean deliveries. Significant predictors included high risk pregnancy, gestational age at birth and delivery mode. The occurrence of complications was significantly increased in emergency compared to elective cesarean deliveries (RR = 2.34). CONCLUSIONS: Maternal postpartum complications in twin pregnancies are higher in emergency compared to elective cesarean deliveries and are also related to preexisting complications and earlier gestational age at delivery.
- Twin Pregnancies: Evaluation of Major Depression, Stress, and Social Support(2013) BENUTE, Glaucia R. G.; NOZZELLA, Debora C. R.; PROHASKA, Cecilia; LIAO, Adolfo; LUCIA, Mara C. S. de; ZUGAIB, MarceloBackground: Twin pregnancies are at increased physiological and psychosocial risks. Objective: To investigate the prevalence of major depression in twin pregnancies and correlate with stress and social support. Method: The study included 51 pregnant women under specialized prenatal care who were evaluated by a Portuguese version of the semi-structured questionnaire Primary Care Evaluation of Mental Disorders (PRIME-MD) for Major Depression, and the Prenatal Psychosocial Profile (PPP) for evaluation of stress and social support. Results: Major depression was found in 33.3% of pregnant women, and prevailing symptoms were fatigue or loss of energy (100%), insomnia or hypersomnia (82.4%), changes in appetite (82.4%), decreased interest in daily activities (82.4%), and psychomotor agitation or retardation (82.4%). Among pregnant women who were diagnosed depressive, 76.5% also had a high level of stress and 47.1% complained about lack of social support. Statistical significance was found when correlating depression with perception of negative aspects of having twins and belief in significant body changes during pregnancy (p = .005 and .03, respectively). Marital status, occupation, and pregnancy planning were not significantly associated with the diagnosis of depression. Conclusion: Major depression occurs in one-third of pregnant women expecting twins and is associated with higher levels of stress and lack of social support. A multidisciplinary approach in these cases is fundamental to minimize further risks and complications.
- Should fetal growth be a matter of concern in isolated single umbilical artery?(2014) CALDAS, Lorena Mesquita; LIA, Adolfo; CARVALH, Mario Henrique; FRANCISCO, Rossana Pulcineli Vieira; ZUGAIB, MarceloObjective: To examine birth weight in pregnancies with isolated single umbilical artery (ISUA). Methods: Case control study with retrospective review of 131 singleton pregnancies with isolated single umbilical artery diagnosed before birth. Control group consisted of 730 singleton pregnancies recruited prospectively, that had histological confirmation of a 3 vessels cord. Pregnancies were classified as uncomplicated or high-risk according to the presence of diseases that increase the risk of placental insufficiency during pregnancy. Mean birth weight and frequency of low birth weight (< 2.500g), very low birth weight (< 1.500g) and fetal growth restriction below the 5th and 10th centiles were compared between groups. Results: Mean birth weight difference between ISUA (n=131, 2840 +/- 701g) and control (n=730, 2.983 +/- 671g) pregnancies was 143g (95% CI= 17-269; p=0.04) and birth weight below the 5th centile was significantly more common in ISUA group [28/131 (21.4%) versus 99/730 (13.6%), p=0.02]. When only uncomplicated pregnancies were considered in both groups, no birth weight differences were observed. Amongst high-risk subgroups, birth weight below the 5th centile remained significantly more common in ISUA compared to control pregnancies [10/35 (28.6%) versus 53/377 (14.1%), p=0.04]. Conclusion: Isolated single umbilical artery does not increase the risk of fetal growth restriction in uncomplicated singleton pregnancies.
- Transplacental Total IgG Transfer in Twin Pregnancies(2014) STACH, Sonia C. L.; BRIZOT, Maria de L.; LIAO, Adolfo W.; FRANCISCO, Rossana P. V.; PALMEIRA, Patricia; CARNEIRO-SAMPAIO, Magda; ZUGAIB, MarceloProblemIn twin pregnancies, factors that influence total umbilical cord IgG concentration and IgG transfer ratio are not well known. MethodBlood samples were prospectively collected from 57 twin pregnancies. Stepwise multivariate regression analysis was used to evaluate the association between total IgG levels in the umbilical cord blood and IgG transfer ratio according to serum IgG concentration, pregnancy chorionicity, the presence of abnormal umbilical artery pulsatility index, intrauterine growth restriction, gestational age at delivery (GAD), birthweight, and placental weight. ResultsUmbilical cord IgG concentration showed a positive correlation with serum IgG concentration and GAD; levels were significantly lower in monochorionic compared with dichorionic pregnancies. IgG transfer ratio also increased with GAD but was inversely correlated with serum IgG concentration levels. ConclusionIn twin pregnancies, besides serum IgG concentration and GAD, chorionicity also influences umbilical cord IgG concentration. Monochorionic twins have lower IgG cord concentration than dichorionic twins.
- Prenatal administration of vaginal progesterone and frequency of uterine contractions in asymptomatic twin pregnancies(2016) OLIVEIRA, Lilia A. M. L. de; BRIZOT, Maria L.; LIAO, Adolfo W.; BITTAR, Roberto E.; FRANCISCO, Rossana P. V.; ZUGAIB, MarceloIntroductionA previous study indicated that progesterone reduces the mean uterine contraction frequency in singleton pregnancy at high risk for preterm birth. The aim of this study was to investigate the effect of vaginal progesterone on the frequency of uterine contractions in twin pregnancies. Material and methodsThis was a secondary analysis of a randomized, double-blind, placebo-controlled trial of twin pregnancies exposed to vaginal progesterone or placebo. Naturally conceived twin pregnancies with no prior history of preterm delivery, asymptomatic regarding preterm labor, who had undergone uterine contraction frequency monitoring from 24 to 34 weeks and 6 days were included in the study. Comparison of the mean frequency of uterine contractions between the treatment groups was performed. We also examined the influence of cervical length and chorionicity on the mean frequency of uterine contractions according to the group. ResultsThe final analysis included 166 women in the progesterone and 170 in the placebo group. The baseline characteristics were similar in the two groups. Overall, no difference in the mean frequency of uterine contractions (p = 0.91) was observed between the progesterone (2.54 3.19) and placebo (2.56 +/- 3.59) groups. Also, no difference in the mean frequency of uterine contractions was observed between the groups in each week between 24 and 34 weeks and 6 days of gestation. Cervical length and chorionicity did not influence the frequency of contractions according to the progesterone or placebo treatment. ConclusionsOverall, progesterone does not influence the frequency of uterine contractions in twin pregnancies.
- Influência do estado nutricional materno, ganho de peso e consumo energético sobre o crescimento fetal, em gestações de alto risco(2012) NOMURA, Roseli Mieko Yamamoto; PAIVA, Letícia Vieira; COSTA, Verbênia Nunes; LIAO, Adolfo Wenjaw; ZUGAIB, MarceloPURPOSE: To analyze the influence of maternal nutritional status, weight gain and energy consumption on fetal growth in high-risk pregnancies. METHODS: A prospective study from August 2009 to August 2010 with the following inclusion criteria: puerperae up to the 5th postpartum day; high-risk singleton pregnancies (characterized by medical or obstetrical complications during pregnancy); live fetus at labor onset; delivery at the institution; maternal weight measured on the day of delivery, and presence of medical and/or obstetrical complications characterizing pregnancy as high-risk. Nutritional status was assessed by pregestational body mass index and body mass index in late pregnancy, and the patients were classified as: underweight, adequate, overweight and obese. A food frequency questionnaire was applied to evaluate energy consumption. We investigated maternal weight gain, delivery data and perinatal outcomes, as well as fetal growth based on the occurrence of small for gestational age and large for gestational age neonates. RESULTS: We included 374 women who were divided into three study groups according to newborn birth weight: adequate for gestational age (270 cases, 72.2%), small for gestational age (91 cases, 24.3%), and large for gestational age (13 cases, 3.5%). Univaried analysis showed that women with small for gestational age neonates had a significantly lower mean pregestational body mass index (23.5 kg/m², p<0.001), mean index during late pregnancy (27.7 kg/m², p<0.001), and a higher proportion of maternal underweight at the end of pregnancy (25.3%, p<0.001). Women with large for gestational age neonates had a significantly higher mean pregestational body mass index (29.1 kg/m², p<0.001), mean index during late pregnancy (34.3 kg/m², p<0.001), and a higher proportion of overweight (30.8%, p=0.02) and obesity (38.5%, p=0.02) according to pregestational body mass index, and obesity at the end of pregnancy (53.8%, p<0.001). Multivariate analysis revealed the index value during late pregnancy (OR=0.9; CI95% 0.8-0.9, p<0.001) and the presence of hypertension (OR=2.6; 95%CI 1.5-4.5, p<0.001) as independent factors for small for gestational age. Independent predictors of large for gestational age infant were the presence of diabetes mellitus (OR=20.2; 95%CI 5.3-76.8, p<0.001) and obesity according to body mass index during late pregnancy (OR=3.6; 95%CI 1.1-11.7, p=0.04). CONCLUSION: The maternal nutritional status at the end of pregnancy in high-risk pregnancies is independently associated with fetal growth, the body mass index during late pregnancy is a protective factor against small for gestational age neonates, and maternal obesity is a risk factor for large for gestational age neonates.
- Should We Measure Fetal Omphalocele Diameter for Prediction of Perinatal Outcome?(2014) KIYOHARA, Marina Y.; BRIZOT, Maria L.; LIAO, Adolfo W.; FRANCISCO, Rossana P. V.; TANNURI, Ana C. A.; KREBS, Vera L. J.; ZUGAIB, MarceloObjective: To evaluate the fetal omphalocele diameter/abdominal circumference ratio (OD/AC) as a predictor of adverse perinatal outcome. Methods: Analysis involving 47 singleton pregnancies with fetal omphalocele, normal karyotype and absence of other major abnormalities. The OD/AC ratio was determined antenatally by ultrasound and the best cutoff for the prediction of neonatal death was determined by receiver operating characteristic curve analysis. Additional secondary outcomes included need for oral intubation in the first 24 h of life, two-step surgery or use of synthetic mesh, reoperation, parenteral feeding and need for respiratory assistance >21 days, time to first oral feed, and time to hospital discharge. Results: Fetal OD/AC did not change significantly with gestational age. Postnatal death occurred in 10 (21.3%) cases and the best cutoff for prediction was an OD/AC ratio >= 0.26 In pregnancies with the first ultrasound evaluation performed before 31 weeks' gestation and an OD/AC >= 0.26, the likelihood ratio for needing intubation in the first 24 h of life was 2.6 (95% CI: 1.2-5.7), needing two-step surgery or use of mesh was 4.9 (95% Cl: 1.9-14.4), and postnatal death was 4 (95% Cl: 1.9-7.5). Conclusion: A fetal ultrasound OD/AC ratio >= 0.26 is associated with increased postnatal morbidity and mortality. (C) 2013 S. Karger AG, Basel
article 3 Citação(ões) na Scopus Unusual Presentation of a Sacral Parasitic Conjoined Twin(2011) OKUMURA, Maria; LIAO, Adolfo Wenjaw; BRIZOT, Maria de Lourdes; ZUGAIB, Marcelo; SCHULTZ, Regina
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