MARIA AUGUSTA BENTO CICARONI GIBELLI
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- 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.
- 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.
- Palliative Care After Prenatal Diagnosis of Life-limiting Malformations: A Model of Care(2018) BERNARDES, Lisandra Stein; GIBELLI, Maria Augusta B. C.; FIGUEIREDO, Fernanda; BERTOLASSI, Nathalia; BARBOSA, Tercilia; BOLIBIO, Renata; GOMES, Ana; JESUS, Roberta; VILHEGAS, Andresa; ROCHA, Luana; ROSA, Gladys; SETUBAL, Maria Silvia; BENUTE, Glaucia; FRANCISCO, Rossana
- Performance of surveillance cultures at different body sites to identify asymptomatic Staphylococcus aureus carriers(2012) CURSINO, Maria A.; GARCIA, Cilmara P.; LOBO, Renata D.; SALOMAO, Matias C.; GOBARA, Satiko; RAYMUNDO, Gabriela F.; KESPERS, Thaisa; SOARES, Robson E.; MOLLACO, Carla H.; KEIL, Kleiste G.; MALIENO, Paula B.; KREBS, Vera L.; GIBELLI, Maria Augusta; KONDO, Mario M.; ZUGAIB, Marcelo; COSTA, Silvia F.; LEVIN, Anna S.The objective was to evaluate the performance of surveillance cultures at various body sites for Staphylococcus aureus colonization in pregnant women and newborns (NB) and the factors associated with nasal colonization. For NB, 4 sites were evaluated: nares, oropharynx, perineum, and umbilical stump (birth, third day, and weekly). For pregnant women, 4 sites during labor: anterior nares, anus, perineum, and oropharynx. Nasally colonized patients were compared with colonized only extranasally. Colonization was 53% of 392 pregnant women (methicillin-resistant S. aureus [MRSA]: 4%) and 47% of 382 NB (MRSA: 9%). For newborn patients, the best body site was the umbilical stump (methicillin-susceptible S. aureus [MSSA]: 64%; MRSA: 68%) and the combination of nares + umbilical (MSSA: 86%; MRSA: 91%). Among pregnant women, the best body site was the anterior nares (MSSA: 59%; MRSA: 67%) and the combination of nares + oropharynx (MSSA: 83%; MRSA: 80%). A smaller number of household members were associated with MRSA carriage in pregnant women (2.2 +/- 0.6 versus 3.6 +/- 1.8; P = 0.04). In conclusion, multiple culture sites are needed. Control programs based on surveillance cultures may be compromised.
- 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 LourdesIntroduction: 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.
- Limits of therapeutic intervention in a tertiary neonatal intensive care unit in patients with major congenital anomalies in Brazil(2021) GIBELLI, Maria A. B. C.; CARVALHO, Werther B. de; KREBS, Vera L. J.Aim Major congenital anomalies are an important cause of death in the neonatal intensive care unit (NICU). Therapeutic interventions and the suspension of those already in place often raise ethical dilemmas in neonatal care. Methods We analysed treatments-such as ventilatory support, vasoactive drugs, antibiotics, sedation/or analgesia, central venous access and other invasive procedures-offered up to 48 h before death to all newborns with major congenital anomalies over a 3-year period in a NICU in Brazil. We also gathered information contained in medical records concerning conversations with the families and decisions to limit therapeutic interventions. Results We enrolled 74 newborns who were hospitalised from 1 January 2015 to 31 December 2017. A total of 81.1% had central venous access, 74.3% were on ventilatory support, 56.8% received antibiotics and 43.2% used some sedative/analgesic drugs in their final moments. Conversations were registered in medical records in 76% of cases, and 46% of the families chose therapeutic intervention limits. Those who chose to limit therapeutic interventions asked for less exposure to vasoactive drugs (P = 0.003) and antibiotics (P = 0.003), as well as fewer invasive procedures (P = 0.046). There was no change in ventilatory support (P = 0.66), and palliative extubation was not performed for any patient. Conclusions The therapeutic intervention was mainly characterised by maintenance of the current treatment when a terminal situation was identified with no introduction of new treatments that could increase suffering. The families' approach proved to be essential for making difficult decisions in the NICU.
- Association of spontaneous labor onset with neonatal outcomes in pregnancies with fetal gastroschisis: A retrospective cohort analysis(2019) OSMUNDO JUNIOR, Gilmar de Souza; MOHAMED, Samirah Hosney Mahmoud; NISHIE, Estela Naomi; TANNURI, Ana Cristina Aoun; GIBELLI, Maria Augusta Bento Cicaroni; FRANCISCO, Rossana Pulcineli Vieira; BRIZOT, Maria de LourdesIntroduction The present study aims to investigate the association of spontaneous labor onset with neonatal outcomes in pregnancies with fetal gastroschisis. The secondary goal was to evaluate the association between ultrasound markers and labor onset in pregnancies with fetal gastroschisis. Material and methods A retrospective analysis was performed for 207 pregnancies with fetal gastroschisis between 2005 and 2017. Patients were followed according to a strict protocol involving ultrasound scans and routine evaluations of fetal biophysical profile parameters and intra- and extra-abdominal bowel diameters. Labor, delivery and neonatal records were reviewed. The neonatal outcomes were complex gastroschisis, staged surgical closure of the abdominal defect, short bowel syndrome, time on mechanical ventilation, time to full enteral feeding and necrotizing enterocolitis. Results Spontaneous labor onset was associated with complex gastroschisis (30.7% vs 6.8%, P = 0.002) and short bowel syndrome (13.2% vs none, P = 0.013) in cases with spontaneous preterm delivery compared with the indicated preterm deliveries. Spontaneous labor onset was associated with a longer time on mechanical ventilation for term and preterm newborns. Associations were not observed between ultrasound markers and spontaneous labor onset. Conclusions Spontaneous labor onset in pregnancies with fetal gastroschisis was associated with adverse neonatal outcomes, particularly in those born preterm.
- Non-Multidrug-Resistant, Methicillin-Resistant Staphylococcus aureus in a Neonatal Unit(2014) GARCIA, Cilmara P.; ROSA, Juliana F.; CURSINO, Maria A.; LOBO, Renata D.; MOLLACO, Carla H.; GOBARA, Satiko; MALIENO, Paula B.; RAYMUNDO, Gabriela F.; SOARES, Robson E.; KEIL, Kleiste G.; TOMA, Edi; SALOMAO, Matias C.; MATTE, M. Helena; KREBS, Vera L.; GIBELLI, M. Augusta; KONDO, Mario M.; ZUGAIB, Marcelo; COSTA, Silvia F.; LEVIN, Anna S.Background: In the last decade, non-multiresistant methicillin-resistant Staphylococcus aureus (NM-MRSA) has been described as an important agent in bloodstream infections in our hospital. Methods: This prospective cohort study, conducted from February 2009 through January 2010 in the neonatal unit, evaluated 403 newborns (NB), their 382 mothers and 148 health care workers (HCW). Results: Approximately 217 NB (54%), 187 mothers (48%) and 87 HCW (59%) were colonized by S. aureus (SA). MRSA colonization was greater among NB (15%) than mothers (4.7%) and HCW (3.4%). Although mother-to-NB transmission occurred, in most cases mothers were not responsible for NB colonization. There were 2 predominant PFGE patterns among the NB and some mothers and HCW became colonized by them. Factors significantly associated with MRSA carriage by NB were lower level of maternal schooling (risk factor: odds ratio: 2.99; 95% confidence interval: 1.10-8.07) and maternal rhinosinusitis (protective factor: odds ratio: 0.33; 95% confidence interval: 0.12-0.88). Among NB who remained hospitalized for more than 72 hours, breast feeding was protective (odds ratio: 0.22; 95% confidence interval: 0.05-0.98). All the isolates were NM-MRSA, carried few virulence factors and SCCmec types IVa and type IVd predominated. Conclusions: Although there were no cases of infection, nosocomial transmission of MRSA clearly occurred in the neonatal unit, and this highlights the need for infection control practices such as hand hygiene to prevent cross-dissemination. Other healthcare practices, which are very basic but also ample in scope, may play a role, such as general education of women and breast feeding.
- Placental pathological findings in coronavirus disease 2019: Perinatal outcomes(2022) ARCOS JUNIOR, Gelson Farias; FRANCISCO, Rossana Pulcineli Vieira; KILL, Beatriz; PERES, Stela Verzinhasse; GIBELLI, Maria Augusta B. C.; IBIDI, Silvia Maria; CARVALHO, Werther Brunow de; SIMOES, Angelica Braz; BRIZOT, Maria de Lourdes; SCHULTZ, Regina; CARVALHO, Mariana AzevedoIntroduction: Placental alterations caused by severe acute respiratory coronavirus-2 (SARS-CoV-2) infection have already been described, but most studies used small sample groups and the difference according to the severity of the disease has not been verified. Our objective was to describe placental alterations in patients with coronavirus disease 2019 (COVID-19) and analyze the association of pathological placental findings with the clinical pa-rameters of COVID-19 and perinatal results.Methods: This was a nested study within a prospective cohort study involving 109 symptomatic pregnant women with COVID-19. The prevalence of observed placental alterations was described, and the associations of path-ological findings with the clinical parameters of COVID-19 severity and with perinatal outcomes were assessed.Results: The frequency of types of placental features was poor maternal vascular perfusion in 45% of cases, poor fetal vascular perfusion in 33.9%, hematogenous origin infection in 32.1%, and morphological changes corre-sponding to ascending infection in 21.1%. Hematogenous infection differed significantly according to COVID-19 severity (p = 0.008), with a prevalence ratio (PR) of 1.74 (95% confidence interval, 1.02-2.98) in the moderate COVID-19 group compared to the mild COVID-19 group. Among the perinatal outcomes, there was an unex-pected inverse association between prematurity and placental infection of hematogenous origin, with lower rates of prematurity among cases with inflammation of hematogenous origin (p = 0.029).Discussion: Moderate SARS-Cov-2 infection presented a higher prevalence of placental pathological findings. There was no association of placental findings with adverse perinatal outcomes.
- Vertical transmission of SARS-CoV2 during pregnancy: A high-risk cohort(2021) MAEDA, Mariane de Fatima Yukie; BRIZOT, Maria de Lourdes; GIBELLI, Maria Augusta Bento Cicaroni; IBIDI, Silvia Maria; CARVALHO, Werther Brunow de; HOSHIDA, Mara Sandra; MACHADO, Clarisse Martins; SABINO, Ester Cerdeira; SILVA, Lea Campos de Oliveira da; JAENISCH, Thomas; MENDES-CORREA, Maria Cassia Jacintho; MAYAUD, Philippe; FRANCISCO, Rossana Pulcinelli VieiraObjective Identify the potential for and risk factors of SARS-CoV-2 vertical transmission. Methods Symptomatic pregnant women with COVID-19 diagnosis in whom PCR for SARS-CoV-2 was performed at delivery using maternal serum and at least one of the biological samples: cord blood (CB), amniotic fluid (AF), colostrum and/or oropharyngeal swab (OPS) of the neonate. The association of parameters with maternal, AF and/or CB positivity and the influence of SARS-CoV-2 positivity in AF and/or CB on neonatal outcomes were investigated. Results Overall 73.4% (80/109) were admitted in hospital due to COVID-19, 22.9% needed intensive care and there were four maternal deaths. Positive RT-PCR for SARS-CoV-2 was observed in 14.7% of maternal blood, 13.9% of AF, 6.7% of CB, 2.1% of colostrum and 3.7% of OPS samples. The interval between COVID-19 symptoms and delivery was inversely associated with SARS-CoV-2 positivity in the maternal blood (p = 0.002) and in the AF and/or CB (p = 0.049). Maternal viremia was associated with positivity for SARS-CoV-2 in AF and/or CB (p = 0.001). SARS-CoV-2 positivity in the compartments was not associated with neonatal outcomes. Conclusion Vertical transmission is possible in pregnant women with COVID-19 and a shorter interval between maternal symptoms and delivery is an influencing factor.