MARIO HENRIQUE BURLACCHINI DE CARVALHO
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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- Risk factors for shunting at 12 months following open fetal repair of spina bifida by mini-hysterotomy(2023) ROCHA, Luana Sarmento Neves da; BUNDUKI, Victor; CARDEAL, Daniel Dante; AMORIM FILHO, Antonio Gomes de; NANI, Fernando Souza; PERES, Stela Verzinhasse; CARVALHO, Werther Brunow de; FRANCISCO, Rossana Pulcineli Vieira de; CARVALHO, Mario Henrique Burlacchini deObjectives: Open spina bifida (OSB) is the most common neural tube defect. Prenatal repair reduces the need for ventriculoperitoneal shunting (VPS) due to hydrocephalus from 80-90% to 40-50%. We aimed to determine which variables work as risk factors for VPS at 12 months of age in our population. Methods: Thirty-nine patients underwent prenatal repair of OSB by mini-hysterotomy. The main outcome was occurrence of VPS in the first 12 months of life. Logistic regression was used to estimate the odds ratios (OR) between prenatal variables and the need for shunting. Results: VPS at 12 months occurred in 34.2% of the children. Larger ventricle size before surgery (62.5% >= 15 mm; 46.2% between 12 and 15 mm; 11.8% <12 mm; p=0.008), higher lesion level (80% >L2, vs. 17.9% <= L3; p=0.002; OR, 18.4 [2.96-114.30]), and later gestational age at surgery (25.25 +/- 1.18 vs. 24.37 +/- 1.06 weeks; p=0.036; OR, 2.23 [1.05-4.74]) were related to increased need for shunting. In the multivariate analysis, larger ventricle size before surgery (>= 15 mm vs. <12 mm; p=0.046; OR, 1.35 [1.01-1.82]) and higher lesion level (>L2 vs. <= L3; p=0.004; OR, 39.52 [3.25-480.69]) were risk factors for shunting. Conclusions: Larger ventricle size before surgery (>= 15 mm) and higher lesion level (>L2) are independent risk factors for VPS at 12 months of age in fetuses undergoing prenatal repair of OSB by mini-hysterotomy in the studied population.
- Comparison of terbutaline and atosiban as tocolytic agents in intrauterine repair of myelomeningocele: a retrospective cohort study(2024) SANTOS, Shirley Andrade; NANI, Fernando Souza; MOURA, Elaine Imaeda de; CARVALHO, Diogo Lima de; MIGUEL, Guilherme Jorge Mattos; HADDAD, Cristiane Maria Federicci; VIEIRA, Joaquim Edson; BUNDUKI, Victor; CARVALHO, Mario Henrique Burlacchini de; FRANCISCO, Rossana Pulcineli Vieira; CARDEAL, Daniel Dante; FERNANDES, Hermann dos SantosBackground: Myelomeningocele (MMC) is a neural tube defect disease. Antenatal repair of fetal MMC is an alternative to postnatal repair. Many agents can be used as tocolytics during the in utero fetal repair such as b2-agonists and oxytocin receptor antagonists, with possible maternal and fetal repercussions. This study aims to compare maternal arterial blood gas analysis between terbutaline or atosiban, as tocolytic agents, during intrauterine MMC repair. Methods: Retrospective cohort study. Patients were divided into two groups depending on the main tocolytic agent used during intrauterine MMC repair: atosiban (16) or terbutaline (9). Maternal arterial blood gas samples were analyzed on three moments: post induction (baseline, before the start of tocolysis), before extubation, and two hours after the end of the surgery. Results: Twenty- five patients were included and assessed. Before extubation, the terbutaline group showed lower arterial pH (7.347 +/- 0.05 vs. 7.396 +/- 0.02 for atosiban, p = 0.006) and higher arterial lactate (28.33 +/- 12.76 mg.dL - 1 vs. 13.06 +/- 6.35 mg.dL - 1 , for atosiban, p = 0.001) levels. Conclusions: Patients who received terbutaline had more acidosis and higher levels of lactate, compared to those who received atosiban, during intrauterine fetal MMC repair. (c) 2024 Sociedade Brasileira de Anestesiologia.