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
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- Can thrombophilia worsen maternal and perinatal outcomes in cases of severe preeclampsia?(2018) BAPTISTA, Fernanda Spadotto; BORTOLOTTO, Maria Rita de Figueiredo Lemos; BIANCHINI, Fabiola Roberta Marim; KREBS, Vera Lucia Jornada; ZUGAIB, Marcelo; FRANCISCO, Rossana Pulcinelli VieiraObjective: To evaluate whether thrombophilia worsens maternal and foetal outcomes among patients with severe preeclampsia (PE). Method: From October 2009 to October 2014, an observational retrospective cohort study was performed on pregnant women with severe PE diagnosed before 34 weeks of gestation and their newborns hospitalized at the Clinics Hospital, FMUSP. Patients who had no heart disease, nephropathies, pre-gestational diabetes, gestational trophoblastic disease, foetal malformation, or twin pregnancy and who underwent thrombophilia screening during the postnatal period were included. New pregnancies of the same patient; cases of foetal morphological, genetic, or chromosomal abnormalities after birth; and women who used heparin or acetylsalicylic acid during pregnancy were excluded. Factor V Leiden, G20210A prothrombin mutation, antithrombin, protein C, protein S, homocysteine, lupus anticoagulant, and anticardiolipin IgG and IgM antibodies were analysed. The groups with and without thrombophilia were compared regarding their maternal clinical and laboratory parameters and perinatal outcomes. Results: Of the 127 patients selected, 30 (23.6%) had thrombophilia (hereditary or acquired). We found more white patients in thrombophilia group (p = .036). Analysis of maternal parameters showed a tendency of thrombophilic women to have more thrombocytopenia (p = .056) and showed worsening of composite laboratory abnormalities (aspartate aminotransferase >= 70 mg/dL, alanine aminotransferase >= 70 mg/dL, platelets < 100,000/mm(3), serum creatinine >= 1.1 mg/dL; p = .017). There were no differences in foetal perinatal outcomes. Conclusion: The presence of thrombophilia leads to worsening of maternal laboratory parameters among patients with severe forms of PE but without worsening perinatal outcomes.
- A Prenatal Case of Arrhythmogenic Right Ventricular Dysplasia(2018) LOPES, Lilian Maria; PACHECO, Juliana Torres; SCHULTZ, Regina; FRANCISCO, Rossana Pulcineli Vieira; ZUGAIB, Marcelo
- Risk assessment of venous thromboembolism and thromboprophylaxis in pregnant women hospitalized with cancer: Preliminary results from a risk score(2018) HASE, Eliane Azeka; BARROS, Venina Isabel Poco Viana Leme de; IGAI, Ana Maria Kondo; FRANCISCO, Rossana Pulcinelli Vieira; ZUGAIB, MarceloOBJECTIVES: Hospitalized patients with cancer are at high risk of developing venous thromboembolism, and the risk increases with pregnancy. The aim of this study was to apply a thromboprophylaxis protocol with a venous thromboembolism risk score for hospitalized pregnant women with cancer and to evaluate the effects on maternal morbidity and mortality. METHODS: A longitudinal and prospective study was conducted from December 2014 to July 2016. The venous thromboembolism risk score was modified from the guidelines of the Royal College of Obstetricians and Gynaecologists. Patients were classified as low (score <3) or high risk (score >= 3). The high-risk group received thromboprophylaxis with low-molecular-weight heparin, unless the patient had a contraindication for anticoagulation. One patient could have undergone more than one evaluation. RESULTS: Fifty-two ratings were descriptively analyzed: 34 (65.4%) were classified as high risk, and 28/34 (82.3%) received low-molecular-weight heparin, 1 received unfractionated heparin, and 5 did not receive intervention. Most patients (23/52; 44.2%) had breast cancer. The main risk factors for venous thromboembolism in the high-risk group were chemotherapy (within 6 months; 22/34; 64.7%). No patient exhibited venous thromboembolism, adverse effects of anticoagulation or death up to three months after hospitalization. CONCLUSIONS: Most pregnant women with cancer had a high risk for venous thromboembolism at the time of hospitalization. Breast cancer was the most prevalent cancer, and recent chemotherapy was the main risk factor for anticoagulation. The application of a thromboprophylaxis protocol and determination of a venous thromboembolism risk score for these patients was useful for the prevention of maternal morbidity and mortality due to venous thromboembolism.
conferenceObject The Impact of Arterial Hypertension in Maternal and Perinatal Outcomes in Pregnancies With Takayasu Arteritis.(2018) BORTOLOTTO, Luiz; BORTOLOTTO, Maria R.; CODARIN, Rodrigo R.; GOMES, Tiago J.; TESTA, Carolina B.; FRANCISCO, Rossana P.; ZUGAIB, Marcelo- Risk Factors for Adverse Fetal Outcome in Hemodialysis Pregnant Women(2018) LUDERS, Claudio; TITAN, Silvia Maria; KAHHALE, Soubhi; FRANCISCO, Rossana Pulcineli; ZUGAIB, MarceloIntroduction: Pregnancy in women on dialysis is associated with a higher risk of adverse events, and the best care for this population remains to be established. Methods: In this series, we aimed to identify factors associated with the risk of adverse fetal outcomes among 93 pregnancies in women on hemodialysis. Dialysis dose was initially assigned according to the presence of residual diuresis, body weight, and years on dialysis. Subsequent adjustments on dialysis dose were performed according to several parameters. Results: The overall successful delivery rate was 89.2%, with a dialysis regimen of 2.6 +/- 0.7 h/d, 15.4 +/- 4.0 h/wk, and mean weekly standard urea Kt/V of 3.3 +/- 0.6. In the logistic models, preeclampsia, lupus, primigravida, and average midweek blood urea nitrogen (BUN) level were positively related to the risk of a composite outcome of perinatal death or extreme prematurity, whereas polyhydramnios was inversely related to it. In multivariable linear regression, preeclampsia, polyhydramnios, primigravida, average midweek BUN, and residual diuresis remained significantly and independently related to fetal weight, which is a surrogate marker of fetal outcome. An average midweek BUN of 35 mg/dl was the best value for discriminating the composite outcome, and BUN >= 3 5 mg/dl was associated with a significant difference in a Kaplan-Meier curve (P = 0.01). Conclusion: Our results showed that a good fetal outcome could be reached and that preeclampsia, lupus, primigravida, residual diuresis, polyhydramnios, and hemodialysis dose were important variables associated with this outcome. In addition, we suggested that a midweek BUN <35 mg/dl might be used as a target for adjusting dialysis dose until hard data were generated.
- Sonographic Markers in the Prediction of Fetal Complex Gastroschisis(2018) ANDRADE, Walkyria S.; BRIZOT, Maria L.; RODRIGUES, Agatha S.; TANNURI, Ana C.; KREBS, Vera L.; NISHIE, Estela N.; FRANCISCO, Rossana P. V.; ZUGAIB, MarceloObjective: To investigate the ultrasound (US) markers predictive of complex gastroschisis (CG), mortality, and morbidity in fetuses with gastroschisis. Materials and Methods: This was a retrospective cohort study of 186 pregnancies with isolated fetal gastroschisis. Eight US markers were analyzed. The predictions and associations of US markers with CG, mortality, and morbidity were assessed. Combinations of US markers predictive of CG were investigated. Results: Extra-abdominal bowel dilatation (EABD), intra-abdominal bowel dilatation (IABD), and polyhydramnios were predictive of CG. EABD between 25 and 28 weeks had a sensitivity of 64%, a specificity of 89%, a positive predictive value (PPV) of 56.2%, and negative predictive value (NPV) of 91.8%. The predictions of IABD were sensitivity = 26.7%, specificity = 96.7%, PPV = 61.5%, and NPV = 86.8%. The odds ratios for CG in the presence of 1 and 2 US markers, compared with the absence of a US marker, were 18.3 (95% CI, 3.83-87.64) and 73.3 (95% CI, 6.14-876), respectively. Conclusion: US markers predictive of CG were established. The combination of these markers increases the probability of CG. (C) 2017 S. Karger AG, Basel
- The role of three-dimensional ultrasound in pregnancies submitted to cerclage(2018) BORGHI, Thais da Fonseca; CARVALHO, Mario Henrique Burlacchini de; AMORIM FILHO, Antonio Gomes de; MARTINELLI, Silvio; ZUGAIB, Marcelo; FRANCISCO, Rossana Pulcineli VieiraOBJECTIVE: Cervical cerclage is the standard treatment for cervical incompetence (CI); however, there is still a high risk of preterm birth for women who undergo this treatment. The aim of this study was to longitudinally evaluate findings on two-dimensional transvaginal ultrasonography (2DTVUS) and three-dimensional transvaginal ultrasonography (3DTVUS) that could be related to gestational age at birth. METHODS: A total of 68 pregnant women who were treated with cerclage were evaluated by 2DTVUS and 3DTVUS in the second and third trimesters of pregnancy. Log-rank tests and Cox regression analyses were used to identify significant findings related to gestational age at delivery. RESULTS: A cervical length lower than 28.1 mm (p=0.0083), a proximal cervical length lower than 10 mm (p=0.0151), a cervical volume lower than 18.17 cm(3) (p=0.0152), a vascularization index (VI) under 2.153 (p=0.0044), and a vascularization-flow index (VFI) under 0.961 (p=0.0059) in the second trimester were all related to earlier delivery. In the third trimester, a cervical length lower than 20.4 mm (p=0.0009), a VI over 0.54 (p=0.0327) and a VFI over 2.275 (p=0.0479) were all related to earlier delivery. Cervical funnelling in the second and third trimesters and proximal cervical length in the third trimester were not related to gestational age at birth. The COX regression analyses showed that cervical volume in the second trimester; FI and VFI in the third trimester were significantly associated with gestational age at birth. CONCLUSION: In women treated with history-indicated cerclage or ultrasound-indicated cerclage, 2nd trimester cervical volume and 3rd trimester FI and VFI are independent significant sonographic findings associated with time to delivery.
article 2 Citação(ões) na Scopus Single-Center Experience in Managing Epithelioid Trophoblastic Tumors(2018) LIN, Lawrence H.; FUSHIDA, Koji; OKUMURA, Maria; SCHULTZ, Regina; FRANCISCO, Rossana P. V.; ZUGAIB, MarceloOBJECTIVE: To describe the experience in managing patients with epithelioid trophoblastic tumor (ETT) in a single institution. STUDY DESIGN: This is a retrospective case series of patients diagnosed with ETT at the University of Sao Paulo Trophoblastic Disease Center from January 2001 to December 2016. RESULTS: During the study period, 8 patients with ETT were identified. Patient characteristics were as follows: all patients were of reproductive age, the last gestation in 75% was a hydatidiform mole, the interval from the last pregnancy ranged from 3-48 months, and the median human chorionic gonadotropin (hCG) level was 119 mIU/mL. Six patients presented with stage I disease; 5 of them were treated with hysterectomy and chemotherapy and 1 was treated with hysterectomy alone. One patient presented with a lung nodule and was treated with pulmonary resection and chemotherapy. These 7 patients were followed and had no recurrence. The only patient who died presented with stage IV disease, which did not respond to chemotherapy. CONCLUSION: ETT is a rare form of trophoblastic tumor which presents with low levels of hCG for tumor volume. This case series highlights the importance of surgical management of confined diseases, since ETT is poorly responsive to chemotherapy.- Breastfeeding Twins: Factors Related to Weaning(2018) MIKAMI, Fernanda Cristina Ferreira; FRANCISCO, Rossana Pulcineli Vieira; RODRIGUES, Agatha; HERNANDEZ, Wagner Rodrigues; ZUGAIB, Marcelo; BRIZOT, Maria de LourdesBackground: Many factors may influence a woman's decision to start and maintain breastfeeding. Research aim: This study aimed to investigate the factors associated with breastfeeding cessation in twin infants during the first 6 months after birth and to describe the main reasons for weaning cited by mothers of twins. Methods: This is a secondary data analysis of a prospective randomized trial conducted in Brazil. Data were obtained through longitudinal quantitative and qualitative self-reported interviews. One hundred twenty-eight women pregnant with twins and their 256 infants were followed for up to approximately 6 months, during which time breastfeeding data were obtained through face-to-face interviews at three different points after birth: 30 to 40 days (Time 1), 90 days (Time 2), and 180 days (Time 3). The association between weaning and the investigated factors was examined using survival analysis methodologies. Results: Nonexclusive breastfeeding (p = .004, Cox proportional hazards regression model), a lack of support during the lactation period (p = .001), difficulty breastfeeding (p = .003), a breastfeeding duration shorter than 12 months in a previous pregnancy (p = .001), and infants' birth weight less than 2,300 g (p < .001) were the factors associated with breastfeeding cessation. The main reasons for weaning cited by mothers of twins were insufficient human milk supply, infants' behavior, and returning to work. Conclusion: We have identified the factors associated with weaning in twin infants during the first 180 days of life. This knowledge can help improve strategies to increase breastfeeding rates in twins.
- Resistant Hypertension in Pregnancy: How to Manage?(2018) BORTOLOTTO, Maria Rita; FRANCISCO, Rossana Pulcineli Vieira; ZUGAIB, MarceloThe concept of resistant hypertension may be changed during pregnancy by the physiological hemodynamic changes and the particularities of therapy choices in this period. This review discusses the management of pregnant patients with preexisting resistant hypertension and also of those who develop severe hypertension in gestation and puerperium. The main cause of severe hypertension in pregnancy is preeclampsia, and differential diagnosis must be done with secondary or primary hypertension. Women with preexisting resistant hypertension may need pharmacological therapy adjustment. Several drugs can be used to treat severe hypertension, with exception of angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists. The most used drugs are methyldopa, beta-blockers, and calcium channel antagonists. There is a general agreement that severe hypertension must be treated, but there are still debates over the goals of the treatment. Delivery is indicated in viable pregnancies in which blood pressure control is not achieved with three drugs in full doses. Resistant hypertension may arise in postpartum. The management of resistant hypertension in pregnancy must regard the possible etiology, the fetal well-being, and the mother's risk. Good care is mandatory to reduce maternal mortality risk.