RODRIGO RUANO
Projetos de Pesquisa
Unidades Organizacionais
LIM/57 - Laboratório de Fisiologia Obstétrica, Hospital das Clínicas, Faculdade de Medicina
29 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 29
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.- Effectiveness of fetal cystoscopy as a diagnostic and therapeutic intervention for lower urinary tract obstruction: a systematic review(2011) MORRIS, R. K.; RUANO, R.; KILBY, M. D.Objective To determine the effectiveness of fetal cystoscopy in the prenatal diagnosis of and intervention for congenital lower urinary tract obstruction. Methods This study was a literature search using MEDLINE, Embase, Cochrane Library, MEDION, Web of Science reference lists and contact with experts. All studies reporting on fetal cystoscopy in lower urinary tract obstruction with data for a 2 x 2 table were selected for review. No language restrictions were applied. There was independent selection of studies, data extraction and quality assessment by two reviewers. Peto odds ratios were calculated as a summary measure of effect. Results A total of 2071 citations were identified and 66 papers selected for detailed evaluation, from which four papers with a total of 63 patients were selected for inclusion. Two papers had results for the use of cystoscopy in diagnosis, showing that fetal cystoscopy altered the ultrasound diagnosis of the underlying pathology in 36.4 and 25.0% of fetuses, respectively. Compared to no treatment, fetal cystoscopic intervention demonstrated an odds ratio for improved perinatal survival of 20.51 (95% CI, 3.87-108.69). However, comparing vesicoamniotic shunt (VAS) with fetal cystoscopy there appeared to be no significant improvement in the perinatal survival odds ratio of 1.49 (95% CI, 0.13-16.97). These results had wide CIs and for cystoscopy vs. VAS, all results crossed the line of no effect. Conclusion There is little published evidence for the effectiveness of therapeutic fetal cystoscopy as an intervention for congenital lower urinary tract obstruction and the quality of this evidence is poor. It should thus be considered to be an 'experimental intervention' and subjected to further investigation.
conferenceObject Estimating risk factors for spontaneous preterm delivery in teen pregnancies(2013) BAKER, Arthur; RUANO, Rodrigo; HAERI, Sina- Reference Range for Fetal Interventricular Septum Area by Means of Four-Dimensional Ultrasonography Using Spatiotemporal Image Correlation(2013) NARDOZZA, Luciano Marcondes Machado; ROLO, Liliam Cristine; ARAUJO JUNIOR, Edward; HATANAKA, Alan Roberto; ROCHA, Luciane Alves; SIMIONI, Christiane; RUANO, Rodrigo; MORON, Antonio FernandesObjective: To determine reference range for fetal interventricular septum area by means of 3-dimensional ultrasonography (3DUS) using the spatiotemporal image correlation (STIC) method. Methods: A prospective, cross-sectional study was conducted on 328 normal pregnant women between the 18th and 33rd gestational weeks. To obtain the interventricular septum area, a virtual plane was used, with the green line (region of interest) adjacent to the external margin of the septum, which was manually delimited. To evaluate the correlation of the septum area with the gestational age, different regression modes were evaluated. The intraclass correlation coefficient was used to evaluate the interobserver reproducibility. Results: The interventricular septum area showed correlation with the gestational age (r = 0.81). The mean increased from 0.47 +/- 0.10 cm(2) in the 18th week to 2.42 +/- 1.13 cm(2) in the 33rd week of gestation. The mathematical equation that best represented this correlation was provided by linear regression: interventricular septum area = 0.0511 x gestational age (R-2 = 0.095). The interobserver reproducibility was good, with bias of 0.01 cm(2), precision of 0.07 cm(2) and absolute limits of agreement of -0.14 and +0.15 cm(2). Conclusions: Reference range for fetal interventricular septum area were determined by means of 3DUS using STIC in the rendering mode and were shown to be reproducible:
- 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, Michael- Early fetal cystoscopy for first-trimester severe megacystis(2011) RUANO, R.; YOSHISAKI, C. T.; SALUSTIANO, E. M. A.; GIRON, A. M.; SROUGI, M.; ZUGAIB, M.Objectives To report the feasibility of early fetal cystoscopy for the prenatal diagnosis and therapy of severe first-trimester megacystis. Methods Between January 2008 and February 2010, early fetal cystoscopy at 16 weeks of gestation was offered to 15 patients whose fetuses presented with severe first-trimester megacystis. All infants were followed up for 6-12 months after birth. Autopsy was always performed whenever fetal or neonatal deaths occurred. Results Seven patients decided to undergo fetal therapy, and eight elected to continue with expectant observation. One fetus died before early fetal cystoscopy was performed. Therefore, six fetuses underwent early fetal cystoscopy. Urethral atresia was diagnosed in three fetuses during fetal cystoscopy and confirmed at autopsy following termination of pregnancy at 19-20 weeks in all cases. Posterior urethral valves were diagnosed and successfully fulgurated by laser during early cystoscopy in three fetuses, two of which survived with normal renal and bladder function after birth; the remaining fetus had a postnatal diagnosis of megacystis-microcolon intestinal hypoperistalsis syndrome and died neonatally. In the expectantly managed group, no survivals were observed, even among cases with 'isolated' posterior urethral valves. Conclusions Percutaneous early fetal cystoscopy is feasible for prenatal diagnosis and therapy of severe megacystis.
- Longitudinal assessment of lung area measurements by two-dimensional ultrasound in fetuses with isolated left-sided congenital diaphragmatic hernia(2015) RUANO, R.; BRITTO, I. S. W.; SANGI-HAGHPEYKAR, H.; BUSSAMRA, L. C. S.; SILVA, M. M. Da; BELFORT, M. A.; DETER, R. L.; LEE, W.; TANNURI, U.; ZUGAIB, M.ObjectiveTo evaluate lung growth in healthy fetuses and those with congenital diaphragmatic hernia (CDH) using two-dimensional (2D) ultrasound. MethodsFetal right lung measurements obtained by 2D ultrasound between 19 and 37 weeks' gestation were evaluated longitudinally in 66 healthy fetuses and 52 fetuses with isolated left-sided CDH. Right lung areas were determined by the tracing' and longest-diameters' methods and, subsequently, lung area-to-head circumference ratios (LHRs) were calculated. Functions fitted to these size parameters with respect to gestational age were evaluated for three sets of group-wise comparisons: (1) healthy vs CDH fetuses; (2) different degrees of severity of CDH; and (3) CDH fetuses that survived vs those that died by 6 months postpartum. ResultsThere was a significantly slower increase in right lung areas and LHRs with advancing gestational age in CDH fetuses than in healthy individuals (P < 0.05). Compared to those with milder forms of CDH, lung areas and LHRs of fetuses with more severe forms displayed a smaller increase (P < 0.05) and LHRs of fetuses with severe CDH did not increase during pregnancy (P > 0.05). Individuals who died postpartum did not show any increase in LHR (P > 0.05) throughout gestation. ConclusionsThe right lung area and LHR, calculated using either the longest-diameters or tracing method, display reduced growth rates during gestation in cases of isolated left-sided CDH as compared with healthy fetuses. The growth curve characteristics of fetal lung areas and LHRs may be useful for predicting neonatal mortality.
- Technical aspects and effectiveness of percutaneous fetal therapies for large sacrococcygeal teratomas: cohort study and literature review(2016) SANANES, N.; JAVADIAN, P.; BRITTO, I. Schwach Werneck; MEYER, N.; KOCH, A.; GAUDINEAU, A.; FAVRE, R.; RUANO, R.Objectives The objectives of this study were to evaluate the efficacy of minimally invasive ablation of high-risk large sacrococcygeal teratomas (SCT) and to compare the efficacy of vascular and interstitial tumor ablation. Methods This was a retrospective multicenter study including a cohort of fetuses with high-risk large SCTs between 2004 and 2010. In addition, we performed a systematic literature review of all cases that underwent tumor ablation in order to compare the survival rates after 'vascular' and 'interstitial' ablation. Statistical analysis was conducted using Bayesian methods. Results In our cohort, a total of 13 fetuses had high-risk large SCT and five of them underwent tumor ablation. The estimated difference in hydrops resolution rate between the fetal intervention and the no fetal intervention groups was 44.6% (95% credibility interval, 1.5 to 81.0%; P-diff>0 = 97.9%). The estimated difference in survival rate between the fetal intervention and the no fetal intervention groups was 31.0% (13.9 to 48.1%; P-diff>0 = 99.9%). We analyzed our five cases together with 28 cases from the literature and estimated the difference in survival rate between the vascular and interstitial ablation groups as 19.8% (-13.1 to 50.1%; P-diff>0 = 88.3%). The estimated difference in hydrops resolution rate between the vascular and the interstitial ablation groups was 36.7% (-5.7 to 72.7%; P-diff>0 = 95.5%). Conclusion Minimally invasive surgery seems to improve perinatal outcome in cases of high-risk large fetal SCT. Our findings suggest that 'vascular' ablation may improve outcome and may be more effective than 'interstitial' tumor ablation, but this hypothesis needs further investigation in a larger multicenter prospective study.
- «
- 1 (current)
- 2
- 3
- »