RODRIGO RUANO
Projetos de Pesquisa
Unidades Organizacionais
LIM/57 - Laboratório de Fisiologia Obstétrica, Hospital das Clínicas, Faculdade de Medicina
10 resultados
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conferenceObject Acute death of the recipient twin after fetoscopic laser surgery for twin-twin transfusion syndrome related to maternal hypotension and type of anesthesia during the procedure(2012) RUANO, Rodrigo; Kim Nguyen; DOTY, Morgen; JOHNSON, Anthony; BELFORT, Michael; MOISE JR., KennethOBJECTIVE: To evaluate the relationship between acute recipient fetal demise following fetoscopic placental laser ablation and maternal hypotension associated with maternal anesthesia in twin-twin transfusion syndrome (TTTS). STUDY DESIGN: Between November 2006 and March 2011, all cases with TTTS that had recipient fetal demise within 24 hours of placental laser ablation were reviewed. For comparison, each case was matched for gestational age at procedure, Quintero staging of the disease and pre-operative Doppler studies with two cases that did not have acute recipient demise. The presence of maternal hypotension (defined as a decline in blood pressure of 20% from pre-operative values) and the duration of the hypotension were evaluated as possible links to acute recipient demise. RESULTS: Acute recipient demise occurred in 5.6% cases (15/267) following laser ablation. Recipient demise was associated with maternal hypotension (OR: 4.9, 95%CI: 1.3-18.7; p 0.02) and the duration of hypotension (OR: 3.33, 95% CI: 1.8-13.6; p 0.02). ROC curve analysis showed the threshold for maternal hypotension and duration of hypotension associated with recipient demise to be 20% and 35 minutes, respectively. General anesthesia was related with maternal hypotension (OR: 19.1, 95% CI: 3.9-94.1; p 0.01). The duration of surgery and anesthesia were not associated with maternal hypotension or acute recipient demise (p 0.23 and p 0.90, respectively). CONCLUSION: Acute recipient demise following fetos copic placental laser ablation for treatment of severe TTTS is associated with maternal hypotension and general anesthesia during the procedure.conferenceObject Three-dimensional power Doppler study of fetal cerebral vascularity in twin-twin transfusion syndrome after fetoscopic laser photocoagulation(2012) RUANO, Rodrigo; JOHNSON, Anthony; BELFORT, Michael; MOISE JR., KennethOBJECTIVE: To evaluate the fetal cerebral vascularity in pregnancies complicated by twin-twin syndrome transfusion syndrome (TTTS) after laser coagulation of the placental anastomoses. STUDY DESIGN: Between July 2010 and May 2011, 36 monochorionic, diamniotic pregnancies with TTTS underwent 3D-power Doppler ultrasonography in order to evaluate the cerebral vascularization index (VI) in both donor and recipient fetuses before and one day after fetoscopic photocoagulation. RESULTS: Mean gestational age at the fetoscopic procedure was 20.5 2.8 weeks. Before the laser procedure, the mean VI in the recipients was higher than in the donors (12.7 6.8% vs 9.5 5.4%, respectively; p < 0.01). After laser procedure, the mean VI in the recipients and donors was similar (12.4 6.6% and 13.9 6.7%, respectively; p = 0.36) (Figure 1). This change represented a significant increase in the donor VIpost-laser(p < 0.01).WhenQuinterostagingwasconsidered,these differences between recipient and donor VI before and after laser procedure were only observed in stages III/IV (p < 0.01 and p < 0.01, respectively), but not in stages I/II (p = 0.28 and p = 0.36, respectively). CONCLUSION: After fetoscopic laser surgery for TTTS, there is an increase in the cerebral blood flow of the donor fetus so that it becomes more similar to its recipient sibling. This occurs predominantly in TTTS Quintero stages III/IV.conferenceObject Estimating risk factors for spontaneous preterm delivery in teen pregnancies(2013) BAKER, Arthur; RUANO, Rodrigo; HAERI, Sina- 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.
conferenceObject Pregnant women with type 2 diabetes mellitus (DM) show evidence of altered cerebral blood hemodynamics compared to controls(2013) CHEN, Qian; HAERI, Sina; VEEN, Teelkien Van; RUANO, Rodrigo; GOLABBAKHSH, Hossein; MORALES, Yisel; HALL, Nicole; MASON, Chawla; BELFORT, MichaelconferenceObject Estimation of maternal cerebrovascular hemodynamics following routine delivery related blood loss(2013) HALL, Nicole; HAERI, Sina; RUANO, Rodrigo; VEEN, Teelkien Van; GOLABBAKHSH, Hossein; CHEN, Qian; MORALES, Yisel; MASON, Chawla; BELFORT, MichaelconferenceObject Maternal obesity is associated with increased cerebral perfusion pressure in pregnancy(2013) HAERI, Sina; RUANO, Rodrigo; GOLABBAKHSH, Hossein; CHEN, Qian; VEEN, Teelkien Van; MORALES, Yisel; HALL, Nicole; MASON, Chawla; BELFORT, MichaelconferenceObject Prenatal magnetic resonance imaging parameters predict mortality and the need for extracorporeal membrane oxygenation in isolated congenital diaphragmatic hernia(2012) RUANO, Rodrigo; LAZER, David; LEE, Timothy; MOISE JR., Kenneth; JOHNSON, Anthony; CASSADY, Christopher; BELFORT, Michael; CASS, Darrell L.; OLUTOYE, OluyinkaObjective To determine the association between MRI findings and mortality or need for extracorporeal membrane oxygenation (ECMO) in cases of isolated congenital diaphragmatic hernia (CDH). Study Design Retrospective cohort study of all fetuses with isolated CDH followed in between January 2004 and July 2011. The following MRI parameters were evaluated between 20 and 32 weeks: i) the observed/expected total fetal lung volume (o/e-TLV); ii) the predicted pulmonary volume (PPV) calculated by the lung/thoracic volume ratio; iii) the percentage of liver herniated into fetal thorax (%LH), calculated by the herniated liver/total liver volume ratio; iv) the liver/thoracic volume ratio (LiTh). The predictability of MRI parameters for mortality and need for ECMO was evaluated by univariate, multiple regression, factor analysis and ROC curves. Results 71 fetuses with isolated (61 left and 10 right) CDH were evaluated. Overall mortality was 17/71 (23.9%). One fetus died in utero, and one died a few hours after birth. ECMO was indicated in 26/69 (37.7%) newborns with survival rate of 50.0%. The side of the diaphragmatic defect was not associated with mortality (p=0.55) or the need for ECMO (p=0.49). Good correlation was observed between o/e-TLV and PPV (r=0.47; p0.05). All four MRI parameters were statistically associated with mortality or need for ECMO (Table 1). The best combination to predict mortality using MRI − o/e-TLV+%LH with probability of death=exp(−0.35+(0.87x(1−o/eTLV))+(0.01x%LH))/(1+(exp(−0.35+(0.87x(1−o/eTLV))+(0.01x%LH))). ECMO was used in cases with higher probability of death (>60%) when compared to those that did not need ECMO (probability of death less than 40%; p<0.01). Full-size table Table options Conclusion Mortality and need for ECMO in neonates with isolated CDH can be accurately predicted during prenatal life using MRI through the combination of fetal lung volume measurements and the amount of liver herniated into the fetal thorax.conferenceObject Indications for preterm birth in a cohort of patients with severe twin-twin transfusion after fetoscopic laser surgery(2012) PAPANNA, Ramesha; BLOCK-ABRAHAM, Dana; RUANO, Rodrigo; MANN, Lovepreet; PEREZ, Coral; RUPP, Courtney; MOISE, Kenneth; JOHNSON, AnthonyconferenceObject Predictors for acute fetal demise immediately after fetoscopic laser coagulation in twin-twin transfusion syndrome(2012) PAPANNA, Ramesha; RUANO, Rodrigo; JOHNSON, Anthony; MOISE, Karen; BELFORT, Michael; MOISE, Kenneth