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
15 resultados
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- 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.
- Predicting pH at birth in pregnancies with abnormal pulsatility index and positive end-diastolic velocity in the umbilical artery(2012) RIBEIRO, Renata Lopes; FRANCISCO, Rossana Pulcineli Vieira; MIYADAHIRA, Seizo; ZUGAIB, MarceloObjectives: To identify potential associations between fetal surveillance tests and acidosis at birth in pregnancies with abnormal but positive end-diastolic velocity in the umbilical artery. Methods: A prospective case-control study [group 1: pH < 7.2; group 2: pH >= 7.2] including 46 fetuses with abnormal but positive end-diastolic velocity in the umbilical artery was conducted between February 2007 and March 2009. Outcome variables were evaluated by univariate analysis and compared between the two groups. Clinically relevant and statistically significant variables were analyzed by logistic regression. Results: Abnormal nonstress test, presence of deceleration, and absent fetal breathing movements were statistically significant. Logistic regression analysis revealed that fetal heart rate (FHR) deceleration in the nonstress test is the only predictor of fetal acidosis at birth (p = 0.024; OR = 8.2; 95% CI: 1.2-52). Conclusions: In fetuses with positive end-diastolic flow velocity, acute variables of the antenatal surveillance tests are correlated with acidosis at birth and FHR deceleration in the nonstress test is the only predictor of fetal acidosis.
- Computerized fetal heart rate analysis in the prediction of myocardial damage in pregnancies with placental insufficiency(2015) MAEDA, Mariane de Fatima Y.; NOMURA, Roseli M. Y.; NIIGAKI, Juliana I.; FRANCISCO, Rossana P. V.; ZUGAIB, MarceloObjective: To evaluate the reliability of fetal heart rate (FHR) parameters analyzed by computerized cardiotocography (cCTG) in predicting myocardial damage in pregnancies with placental insufficiency. Study design: We evaluated 38 patients with placental insufficiency detected before 34 weeks of gestation. All patients underwent 30 min of cCTG (Sonicaid Fetal Care, version 2.2) and Doppler of umbilical artery, middle cerebral artery, and ductus venosus. Umbilical vein blood samples were collected at birth to determine fetal cardiac Troponin T, and a >= 0.09 ng/ml value was deemed a sign of myocardial damage. Results: The fetuses with myocardial damage (39%) showed significantly increased values of umbilical artery pulsatility index z-score (P = 0.003), ductus venosus pulsatility index z-score (P = 0.007), basal FHR (P = 0.033) and periods of low episodes (P = 0.038). The number of small accelerations and the short-term variation (STV) were significantly reduced in the group with myocardial damage (P = 0.013 and P = 0.003, respectively). Logistic regression analysis identified SW and gestational age at delivery as independent predictors for fetal myocardial damage, with area under ROC curve of 0.91. Conclusions: Computerized cardiotocography parameters may be useful in the management of early onset placental insufficiency, and the association of SW with gestational age could play a role in detecting myocardial injury in pregnancies with placental insufficiency.
- 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.
- The effect of fetal anemia on fetal cardiac troponin T in pregnancies complicated by RhD alloimmunization(2013) NOMURA, Roseli Mieko Yamamoto; BRIZOT, Maria de Lourdes; LIAO, Adolfo Wenjaw; NISHIE, Estela Naomi; ZUGAIB, MarceloObjective: To study the effect of fetal anemia on fetal cardiac troponin T (cTnT) in pregnancies complicated by RhD alloimmunization. Method: Twenty pregnant women complicated by RhD alloimmunization who underwent intrauterine transfusion (IUT) for treatment of fetal anemia were studied. Immediately before IUT, fetal blood was obtained for hemoglobin and cTnT measurements. Results: Complete measurements of hemoglobin and cTnT before IUT were obtained in 49 procedures, of which 20 were first-time. The regression analysis between hemoglobin z-score and cTnT values in 49 procedures showed significant negative correlation (r = -0.43, p = 0.002, Regression equation Log(cTnT) = -1.5057 + -0.07563 Hb z-score). Cardiac TnT values before first IUT were significantly associated with perinatal death. In the group with elevated cTnT (n = 7), fetal or neonatal death was more frequent (2 IUD and 2 NND) when compared to normal cTnT group (n = 13, 1 IUD) (57.1 vs. 7.7%, p = 0.031, Fisher's exact test). Conclusion: Fetal blood concentration of cTnT before IUT was negatively correlated to hemoglobin z-score, and levels of cTnT help to manage the pregnancies complicated by RhD alloimmunization.
- Fetal gastroschisis: antepartum fetal heart rate analysis by computerized cardiotocography(2017) ANDRADE, Walkyria S.; BRIZOT, Maria de L.; MIYADAHIRA, Seizo; OSMUNDO JUNIOR, Gilmar de Souza; FRANCISCO, Rossana P. V.; ZUGAIB, MarceloObjectives: To describe the antenatal fetal heart rate (FHR) parameters analyzed by computerizedcardiotocography (cCTG) in fetuses with gastroschisis and compare the FHR parameters with ultrasound gastrointestinal markers.Methods: A retrospective analysis of antepartum cCTG records were conducted in 87 pregnant cases with fetal gastroschisis between 28and 36 weeks (plus 6 days). A comparative analysis of the median distribution of the following FHR parameters was performed: basal FHR, short-term variation (STV), FHR accelerations and decelerations, episodes of high and low variations, and variations in low and high episodes. FHR parameters and ultrasound gastrointestinal markers were also compared.Results: The majority of FHR parameters did not present significant changes throughout gestation. An increased number of records with episodes of low variation (p=0.019) and an increased number of accelerations >15 bpm (p=0.001) were the only observed changes throughout gestation. Stomach herniation was significantly associated with a lower STV (p=0.018) and a higher frequency of records with low episodes (p=0.049).Conclusions: The cCTG analysis indicated that the FHR parameters in fetuses with gastroschisis presented different patterns from those observed in normal fetuses. Stomach herniation was associated with altered FHR patterns.
- Cord blood B-type natriuretic peptide levels in placental insufficiency: correlation with fetal Doppler and pH at birth(2013) COSTA, Verbenia N.; NOMURA, Rosen M. Y.; MIYADAHIRA, Seizo; FRANCISCO, Rossana P. Vieira; ZUGAIB, MarceloObjective: To examine the correlation of cardiac B-type natriuretic peptide (BNP) concentrations in umbilical cord blood at birth with fetal Doppler parameters and pH at birth. Study design: Prospective cross-sectional study with the following inclusion criteria: women with a singleton pregnancy, placental insufficiency characterized by increased pulsatility index (PI) of the umbilical artery (UA), intact membranes, and absence of fetal abnormalities. The exclusion criteria kept out cases of newborns with postnatal diagnosis of abnormality and cases in which the blood analysis was not performed. The Doppler parameters used were the UA PI, middle cerebral artery (MCA) PI, cerebroplacental ratio (CPR), and ductus venosus (DV) PI for veins (Ply), all converted into zeta scores. Blood samples were obtained from the umbilical cord immediately after delivery to measure the pH of the UA and the BNP. Results: Thirty-two pregnancies with placental insufficiency were included, 21 (65%) with positive diastolic flow and 11 (35%) with absent or reversed end diastolic flow in the UA. The concentration of BNP correlated significantly with the UA PI z-score (rho = 0.43, P = 0.016), the CPR z-score (rho = -0.35, P= 0.048), the DV PIV z-score (rho = 0.61, P < 0.001), pH at birth (rho = -0.39, P = 0.031), and gestational age (rho = -0.51, P = 0.003). In the multiple regression analysis, antenatal parameters were included; the DV PIV z-score (P = 0.008) was found to be an independent parameter correlating with BNP at birth. Correlation between BNP and the DV PIV z-score was borne out by the regression equation Log[BNP] = 2.34 + 0.13*DV (F = 18.8, P < 0.001). Correlation between BNP and pH at birth was confirmed by the regression equation Log[BNP] = 21.36-2.62*pH (F = 7.69, P = 0.01). Conclusion: The results suggest that fetal cardiac dysfunction identified by BNP concentrations at birth correlated independently with changes in DV PIV and correlated negatively with pH values at birth.
- 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.
article 3 Citação(ões) na Scopus Three-Dimensional Ultrasonographic Assessment of Fetal Total Lung Volume as a Prognostic Factor in Primary Pleural Effusion(2012) RUANO, Rodrigo; RAMALHO, Alan Saito; FREITAS, Rogerio Caixeta Moraes de; CAMPOS, Juliana Alvares Duarte Bonini; LEE, Wesley; ZUGAIB, MarceloObjectives-The purpose of this study was to predict perinatal outcomes using fetal total lung volumes assessed by 3-dimensional ultrasonography (3DUS) in primary pleural effusion. Methods-Between July 2005 and July 2010, total lung volumes were prospectively estimated in fetuses with primary pleural effusion by 3DUS using virtual organ computer-aided analysis software. The first and last US examinations were considered in the analysis. The observed/expected total lung volumes were calculated. Main outcomes were perinatal death (up to 28 days of life) and respiratory morbidity (orotracheal intubation with mechanical respiratory support >48 hours). Results-Twelve of 19 fetuses (63.2%) survived. Among the survivors, 7 (58.3%) had severe respiratory morbidity. The observed/expected total lung volume at the last US examination before birth was significantly associated with perinatal death (P < .01) and respiratory morbidity (P < .01) as well as fetal hydrops (P < .01) and bilateral effusion (P = .01). Conclusions-Fetal total lung volumes may be useful for the prediction of perinatal outcomes in primary pleural effusion.- Changes in fetal myocardial performance index following intravascular transfusion: preliminary report(2016) ASSUNCAO, Renata Almeida de; LIAO, Adolfo Wenjaw; BRIZOT, Maria de Lourdes; FRANCISCO, Rossana Pulcineli Vieira; ZUGAIB, MarceloObjective: To investigate the changes in fetal left ventricle myocardial performance index (MPI) following intrauterine intravascular transfusion (IUT). Methods: Prospective study, including 25 IUT performed in 13 singleton pregnancies with maternal Rh D alloimmune disease. Left ventricle MPI was evaluated prior to transfusion and repeated 24h after each procedure. Delta MPI was calculated as the difference between post- and pre-transfusion MPI z-scores. Multilevel regression analysis was used to examine the association between delta MPI and gestational age at procedure, fetal middle cerebral artery peak velocity MoM, pre- and post-MPI and hemoglobin z-score values, the volume of blood transfused and feto-placental volume percentage expansion. Adjustments were made for repeated measurements within the same fetus, and across different time points. The significance level was set as 0.05. Results: MPI z-score values increased significantly following transfusion (delta MPI = 1.10 +/- 2.47, p = 0.036). Delta MPI showed a significant correlation with gestational age at transfusion (r = -0.47, p = 0.018), pre-transfusion MPI z-score (r = -0.50, p = 0.012) and feto-placental volume percentage expansion (r = -0.41, p = 0.044). Conclusion: Left ventricle MPI increases significantly after intrauterine blood transfusion and greater changes are associated with procedures at an earlier gestational age, lower pre-transfusion MPI z-scores and smaller feto-placental volume expansion.