EDUARDO JORGE DE ALMEIDA PIMENTA
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- Three-Dimensional Sonographic Assessment of Placental Volume and Vascularization in Pregnancies Complicated by Hypertensive Disorders(2014) PIMENTA, Eduardo Jorge de Almeida; PAULA, Carla Fagundes Silva de; CAMPOS, Juliana Alvares Duarte Bonini; FOX, Karin Anneliese; FRANCISCO, Rossana; RUANO, Rodrigo; ZUGAIB, MarceloObjectives-The purpose of this study was to evaluate the association between placental volumes, placental vascularity, and hypertensive disorders in pregnancy. Methods A prospective case-control study was conducted between April 2011 and July 2012. Placental volumes and vascularity were evaluated by 3-dimensional sonographic, 3-dimensional power Doppler histographic, and 2-dimensional color Doppler studies. Pregnant women were classified as normotensive or hypertensive and stratified by the nature of their hypertensive disorders. The following variables were evaluated: observed-to-expected placental volume ratio, placental volume-to-estimated fetal weight ratio, placental vascular indices, and pulsatility indices of the right and left uterine and umbilical arteries. Results Sixty-six healthy pregnant women and 62 pregnant women with hypertensive disorders were evaluated (matched by maternal age, gestational age at sonography, and parity). Placental volumes were not reduced in pregnancy in women with hypertensive disorders (P > .05). Conversely, reduced placental vascularization indices (vascularization index and vascularization-flow index) were observed in pregnancies complicated by hypertensive disorders (P < .01; P < .01), especially in patients with superimposed preeclampsia (P = .04; P = .02). A weak correlation was observed between placental volumes, placental vascular indices, and Doppler studies of the uterine and umbilical arteries. Conclusions Pregnancies complicated by hypertensive disorders are associated with reduced placental vascularity but not with reduced placental volumes. These findings are independent of changes in uterine artery Doppler studies. Future studies of the prediction of preeclampsia may focus on placental vascularity in combination with results of Doppler studies of the uterine arteries.
- Comparison between Fetal Endoscopic Tracheal Occlusion Using a 1.0-mm Fetoscope and Prenatal Expectant Management in Severe Congenital Diaphragmatic Hernia(2011) RUANO, Rodrigo; DUARTE, Sergio Aluisio; PIMENTA, Eduardo Jorge de Almeida; TAKASHI, Eduardo; SILVA, Marcos Marques da; TANNURI, Uenis; ZUGAIB, MarceloObjectives: To evaluate if fetal endoscopic tracheal occlusion (FETO) for severe congenital diaphragmatic hernia (CDH) using a 1.0-mm fetoscope improves neonatal outcome. Method: Between January 2006 and December 2008, a controlled study was conducted at a single center in which FETO was proposed for fetuses with severe isolated CDH (lung-to-head ratio <1.0) and liver herniation to the thoracic cavity but no other detectable anomalies at diagnosis (<26 weeks). FETO was performed under maternal epidural and fetal intramuscular anesthesia, guided by ultrasonography and 1.0-mm fetoscope between 26 and 30 weeks. All cases submitted to FETO were delivered by ex utero intrapartum therapy procedure. Postnatal therapy was the same for both treated fetuses and controls. The primary outcome was neonatal survival (up to 28 days after birth). Results: A total of 35 women met the inclusion criteria, and in 17 of them, fetal intervention was intended. However, in 1 case, it was not possible to insert the balloon inside the fetal trachea because of placental bleeding. FETO was therefore successfully performed in 16 fetuses with severe CDH. Eighteen cases received no prenatal intervention and served as the control group. Mean gestational age at diagnosis was similar in both groups (p > 0.05). Delivery occurred at 35.6 (range: 28-38) weeks in the FETO group and at 37.5 (range: 31-40) weeks (p = 0.18) among controls. Nine of 17 (52.9%) infants in the FETO group and 1 of 18 (5.6%) in the control group survived (p < 0.01). Severe pulmonary arterial hypertension was present in 8/17 (47.1%) infants from the FETO group and in 16/18 (88.9%) controls (p = 0.01). Conclusion: The present study shows that FETO using a 1.0-mm fetoscope is feasible and may improve neonatal outcome in severe CDH.
conferenceObject 3D-power Doppler quantification of placental vascularity in pregnancy complicated with hypertensive disorders(2013) PIMENTA, Eduardo; RUANO, Rodrigo; FRANCISCO, Rossana; ZUGAIB, MarceloOBJECTIVE: To evaluate if pregnancies complicated with hypertensive disorders have reduced placental vascularity than healthy pregnancies. STUDY DESIGN: Between April 2011 and July 2012, a prospective case-control study was conducted in one center. Sixty-one pregnant women with hypertensive disorder (19 with pure preeclampsia, 23 with chronic hypertension and 20 with superimposed preeclampsia) and 66 healthy pregnant women underwent 3DUS examination once during the pregnancy. Case and controls were a match according to maternal age, gestational age at ultrasound examination and parity. Placental vascularity was calculated using the 3D-power Doppler histogram using pre-established power Doppler settings. Comparison among groups and subgroups were analyzed using t-student and ANOVA tests. RESULTS: The population demographics and characteristics were similar in both groups. Mean gestational age at evaluation was 32.6±3.4 weeks. The placental vascularity index was significantly reduced in cases with hypertension (11.1±0.8%) in comparison with healthy pregnancies (15.2±1.1%; p<0.01); but with similar reduction in those with pure preeclampsia (10.7±1.1%), chronic hypertension (11.5±1.3%)and superimposed pre eclampsia (11.2±1.2%; p=0.89). CONCLUSION: Pregnancies complicated with hypertensive disorders have reduced placental vascularity than healthy pregnancies, independently of the classification of the disorder.