ROSELI MIEKO YAMAMOTO NOMURA

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Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina - Docente
LIM/57 - Laboratório de Fisiologia Obstétrica, Hospital das Clínicas, Faculdade de Medicina

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Autor e Coautores FMUSP-HC Normalizados: MARCELO ZUGAIB ×

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Agora exibindo 1 - 10 de 24
  • article 14 Citação(ões) na Scopus
    Obesidade materna em gestações de alto risco e complicações infecciosas no puerpério
    (2012) PAIVA, Leticia Vieira de; NOMURA, Roseli Mieko Yamamoto; DIAS, Maria Carolina Goncalves; ZUGAIB, Marcelo
    Objective: To analyze the association between maternal obesity and postnatal infectious complications in high-risk pregnancies. Methods: Prospective study from August 2009 through August 2010 with the following inclusion criteria: women up to the 5th postpartum day; age L 18 years; high-risk pregnancy; singleton pregnancy with live fetus at labor onset; delivery at the institution; maternal weight measured on day of delivery. The nutritional status in late pregnancy was assessed by the body mass index (BMI), with the application of the Atalah et al. curve. Patients were graded as underweight, adequate weight, overweight, or obese. Postpartum complications investigated during the hospital stay and 30 days post-discharge were: surgical wound infection and/or secretion, urinary infection, postpartum infection, fever, hospitalization, antibiotic use, and composite morbidity (at least one of the complications mentioned). Results: 374 puerperal women were included, graded according to the final BMI as: underweight (n = 54, 14.4%); adequate weight (n = 126, 33.7%); overweight (n = 105, 28.1%); and obese (n = 89, 23.8%). Maternal obesity was shown to have a significant association with the following postpartum complications: surgical wound infection (16.7%, p = 0.042), urinary infection (9.0%, p = 0.004), antibiotic use (12.3%, p < 0.001), and composite morbidity (25.6%, p = 0.016). By applying the logistic regression model, obesity in late pregnancy was found to be an independent variable regardless of the composite morbidity predicted (OR: 2.09; 95% CI: 1.15-3.80, p = 0.015). Conclusion: Maternal obesity during late pregnancy in high-risk patients is independently associated with postpartum infectious complications, which demonstrates the need for a closer follow-up of maternal weight gain in these pregnancies.
  • article 2 Citação(ões) na Scopus
    Acute splenic sequestration in a pregnant woman with homozygous sickle-cell anemia
    (2013) MAIA, Carolina Bastos; NOMURA, Roseli Mieko Yamamoto; IGAI, Ana Maria Kondo; FONSECA, Guilherme Hencklain; GUALANDRO, Sandra Menosi; ZUGAIB, Marcelo
    CONTEXT: Homozygous (SS) sickle-cell anemia complicated by acute splenic sequestration in adults is a rare event, and it has never been reported during pregnancy. CASE REPORT: A 25-year-old woman with homozygous (SS) sickle-cell disease was hospitalized at 32 weeks' of gestation presenting weakness, abdominal pain, fever and hemoglobin of 2.4 g/dl. Abnormal fetal heart rate was detected by means of cardiotocography, and 5 units of packed red cells were transfused. Cesarean was performed at 37 weeks. Both mother and baby were discharged in a good general condition. CONCLUSION: This case report demonstrates the importance of immediate blood transfusion for treatment of fetal distress in cases of splenic sequestration during pregnancy. This treatment is essential for avoiding maternal and fetal complications.
  • article 41 Citação(ões) na Scopus
    Anemia During Pregnancy after Silastic Ring Roux-en-Y Gastric Bypass: Influence of Time to Conception
    (2011) NOMURA, Roseli Mieko Yamamoto; DIAS, Maria Carolina Goncalves; IGAI, Ana Maria Kondo; PAIVA, Leticia Vieira; ZUGAIB, Marcelo
    Bariatric surgery before pregnancy may help prevent obesity-related gestational complications. However, maternal malnutrition is not without potential risks during pregnancy. The objective was to evaluate the influence of time to conception after silastic ring Roux-en-Y gastric bypass (SRYGB) on maternal anemia. Patients who underwent SRYGB for morbid obesity and who subsequently became pregnant were followed up at the prenatal. Thirty pregnancies occurred between July 2001 and September 2009. The patients were analyzed according to time to conception after bariatric surgery: 17 patients with time to conception < 4 years (48 months) and 13 patients with a parts per thousand yen4 years. First trimester hemoglobin levels were significantly lower in patients with time to conception a parts per thousand yen4 years (48 months) (median 9.6 g/dL, range 5.8-13.2 g/dL) than in patients with time to conception < 4 years (median 11.1 g/dL, range 9.8-13.6 g/dL; p = 0.047). The need for intravenous iron therapy or packed red cell transfusion was significantly more frequent among women who became pregnant a parts per thousand yen4 years after SRYGB compared to < 4 years (30.8% vs. 0%, p = 0.026). Pregnancy after 4 years of SRYGB is associated with maternal anemia and the need for more strict iron supplementation.
  • article 7 Citação(ões) na Scopus
    Manejo clínico e obstétrico em gestantes portadoras de hepatite autoimune complicada pela plaquetopenia moderada ou grave
    (2013) NOMURA, Roseli Mieko Yamamoto; KLEINE, Roololpho Truffa; IGAI, Ana Maria Kondo; FRANCISCO, Rossana Pulcineli Vieira; ZUGAIB, Marcelo
    Objective: To describe the management of prenatal care and delivery in patients bearing autoimmune hepatitis associated with moderate or severe thrombocytopenia. Methods: This study was performed in a tertiary level university hospital. Thirteen pregnancies in ten patients diagnosed with autoimmune hepatitis, complicated by thrombocytopenia, were retrospectively analyzed. The inclusion criteria were as follows: clinical diagnosis of autoimmune hepatitis, moderate or severe thrombocytopenia (platelet count < 100 x 103/mm(3)), gestational age at birth over 22 weeks, and patient followed-up by a specialized team at the institution. The variables studied were: maternal age, parity, treatment regimen, platelet count, examinations for investigation of hepatic function, type of delivery, weight at birth, and gestational age at the time of delivery. Results: The average maternal age was 24.5 years (SD = 5.3) and six (50%) occurred in nulliparous women. During pregnancy, monotherapy with prednisone was adopted in 11 cases (92%). According to the autoantibody profiles, seven pregnancies (58%) had the autoimmune hepatitis type I diagnosis, two pregnancies had type II (17%), and three pregnancies (25%) had cryptogenic chronic hepatitis (undetectable titers of autoantibodies). Portal hypertension was featured in 11 pregnancies (92%). The average gestational age at delivery was 36.9 weeks (SD = 1.5 weeks), with an average weight at birth of 2,446 g (SD = 655 g). Eight infants (67%) were small for gestational age. At the time of delivery, severe thrombocytopenia was featured in four cases (33%) and cesarean surgery was performed in seven cases (58%). Complications at delivery occurred in three cases (25%), one patient presented uterine atony, and two patients presented perineal bruising. There was no perinatal or maternal death. Conclusion: The complication's of thrombocytopenic patients with autoimmune hepatitis are elevated; nevertheless, with appropriate attention and care, they can be resolved. The association between two severe pathologies appears to increase the risk of prematurity and fetal growth restriction, demanding specialized prenatal care, as well as surveillance of newborn well-being.
  • article 25 Citação(ões) na Scopus
    Influência do estado nutricional materno, ganho de peso e consumo energético sobre o crescimento fetal, em gestações de alto risco
    (2012) NOMURA, Roseli Mieko Yamamoto; PAIVA, Letícia Vieira; COSTA, Verbênia Nunes; LIAO, Adolfo Wenjaw; ZUGAIB, Marcelo
    PURPOSE: To analyze the influence of maternal nutritional status, weight gain and energy consumption on fetal growth in high-risk pregnancies. METHODS: A prospective study from August 2009 to August 2010 with the following inclusion criteria: puerperae up to the 5th postpartum day; high-risk singleton pregnancies (characterized by medical or obstetrical complications during pregnancy); live fetus at labor onset; delivery at the institution; maternal weight measured on the day of delivery, and presence of medical and/or obstetrical complications characterizing pregnancy as high-risk. Nutritional status was assessed by pregestational body mass index and body mass index in late pregnancy, and the patients were classified as: underweight, adequate, overweight and obese. A food frequency questionnaire was applied to evaluate energy consumption. We investigated maternal weight gain, delivery data and perinatal outcomes, as well as fetal growth based on the occurrence of small for gestational age and large for gestational age neonates. RESULTS: We included 374 women who were divided into three study groups according to newborn birth weight: adequate for gestational age (270 cases, 72.2%), small for gestational age (91 cases, 24.3%), and large for gestational age (13 cases, 3.5%). Univaried analysis showed that women with small for gestational age neonates had a significantly lower mean pregestational body mass index (23.5 kg/m², p<0.001), mean index during late pregnancy (27.7 kg/m², p<0.001), and a higher proportion of maternal underweight at the end of pregnancy (25.3%, p<0.001). Women with large for gestational age neonates had a significantly higher mean pregestational body mass index (29.1 kg/m², p<0.001), mean index during late pregnancy (34.3 kg/m², p<0.001), and a higher proportion of overweight (30.8%, p=0.02) and obesity (38.5%, p=0.02) according to pregestational body mass index, and obesity at the end of pregnancy (53.8%, p<0.001). Multivariate analysis revealed the index value during late pregnancy (OR=0.9; CI95% 0.8-0.9, p<0.001) and the presence of hypertension (OR=2.6; 95%CI 1.5-4.5, p<0.001) as independent factors for small for gestational age. Independent predictors of large for gestational age infant were the presence of diabetes mellitus (OR=20.2; 95%CI 5.3-76.8, p<0.001) and obesity according to body mass index during late pregnancy (OR=3.6; 95%CI 1.1-11.7, p=0.04). CONCLUSION: The maternal nutritional status at the end of pregnancy in high-risk pregnancies is independently associated with fetal growth, the body mass index during late pregnancy is a protective factor against small for gestational age neonates, and maternal obesity is a risk factor for large for gestational age neonates.
  • article 2 Citação(ões) na Scopus
    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, Marcelo
    Objective: 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.
  • article 3 Citação(ões) na Scopus
    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, Marcelo
    Objective: 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.
  • article 5 Citação(ões) na Scopus
    Fetal venous circulation in monochorionic twin pregnancies with placental insufficiency: prediction of acidemia at birth or intrauterine fetal death
    (2014) LIAO, T. B.; NOMURA, R. M. Y.; LIAO, A. W.; FRANCISCO, R. P. V.; ZUGAIB, M.
    Objectives To investigate fetal venous Doppler measurements in monochorionic twin pregnancies complicated by placental insufficiency and the relationship between fetal venous flow and acidemia at birth or intrauterine fetal death. Methods This was a prospective study of 18 monochorionic twin pregnancies with placental insufficiency. Inclusion criteria were monochorionic-diamniotic twin pregnancy, abnormal umbilical artery (UA) Doppler indices, intact membranes and absence of fetal congenital abnormalities. Cases of twin-to-twin transfusion syndrome were excluded. The following Doppler measurements were studied: UA pulsatility index (PI), ductus venosus PI, middle cerebral artery PI and peak systolic velocity, intra-abdominal umbilical vein (UV) time-averaged maximum velocity (TAMXV) and left portal vein (LPV) TAMXV. Doppler parameters were transformed into Z-scores (SD values from the mean) or multiples of the median according to normative references. Results UA pH<7.20 occurred in nine (25.0%) neonates, pH<7.15 in four (11.1%) and intrauterine death in four (11.1%) fetuses. The UV-TAMXV and LPV-TAMXV Z-scores were significantly lower in the group with pH<7.20 or intrauterine fetal death (-1.79 vs -1.22, P=0.006 and -2.26 vs -1.13, P=0.04, respectively). In cases with pH<7.15 or intrauterine fetal death, UV pulsations were more frequent (50.0% vs 10.7%, P=0.03) and UV-TAMXV Z-score was significantly lower (-1.89 vs -1.26, P=0.003). Mixed effects logistic regression analysis, accounting for the paired nature of the outcomes for the two twins in each pregnancy, demonstrated that the UV-TAMXV Z-score significantly predicted UA pH at birth<7.20 or intrauterine fetal death. TheDoppler parameter that independently predicted pH<7.15 or intrauterine fetal death was presence of pulsation in the UV. Conclusion UV Doppler parameters may predict acidemia at birth or intrauterine fetal death in monochorionic twins complicated by placental insufficiency.
  • article 4 Citação(ões) na Scopus
    Asma na gestação: efeitos na vitalidade fetal, complicações maternas e perinatais
    (2013) MENDES, Renata Franco Pimentel; NOMURA, Roseli Mieko Yamamoto; ORTIGOSA, Cristiane; FRANCISCO, Rossana Pulcineli Vieira; ZUGAIB, Marcelo
    Objective: To assess the effects of maternal asthma on pregnancy, analyzing the consequences of the severity of the disease in the impairment of fetal well-being, as well as the related maternal and perinatal complications. Methods: A retrospective study with 117 pregnancies complicated by maternal asthma and with no other comorbidities, in the period from January, 2005 to December, 2010. Inclusion criteria were as follows: singleton pregnancy; pregnant women diagnosed with asthma prior to pregnancy; initiation of prenatal care before the 28th week of pregnancy; birth at this institution; newborn weighing over 500 g and gestational age at delivery of 22 weeks or more; absence of fetal malformations or chromosomal abnormalities; absence of maternal comorbidities. Asthma was classified as intermittent, mild persistent, moderate persistent, or severe persistent. The results of fetal biophysical profile and of Doppler velocimetry of the umbilical artery performed 14 days prior to birth were analyzed. Results: Of the total of 117 pregnant women with asthma, 41 (35.0%) had intermittent, 33 (28.2%) mild persistent, 21 (17.9%) moderate persistent, and 22 (18.8%) severe persistent asthma. There was no significant difference among the groups as to the type of birth: cesarean section was performed in 65.8% of the cases, maternal corticosteroid therapy was used at the moment of birth in 20.5%, the gestational age at birth averaged 38.6 weeks (SD 1.9 weeks), and birth weight averaged 3,056 g (SD 581 g). The fetal biophysical profile performed during the antepartum period (n = 90, 76.9%) showed a normal result (8 or 10) in 99% of the cases. Doppler velocimetry of the umbilical artery was assessed in 23.9% (n = 28) of the pregnant women, and delivered normal results in 100% of the cases. The use of systemic corticosteroid therapy was significantly (p < 0.001) different among the intermittent (4.9%), mild persistent (9.1%), moderate persistent (28.6%), and severe persistent (45.5%) groups. Regarding the beginning of birth, there was a higher proportion of elective cesarean section in the groups with moderate persistent asthma (52.5%) and severe persistent (54.6%) when compared to the intermittent (21.9%) and mild persistent (24.2%) groups (p = 0.039). Conclusion: The severity of maternal asthma does not appear to have any direct influence on perinatal outcomes, and does not compromise fetal well-being. Active conduct to enable a better maternal clinical condition provides a favorable prognosis for pregnancy complicated by asthma.
  • article 10 Citação(ões) na Scopus
    Influência da percepção dos profissionais quanto ao aborto provocado na atenção à saúde da mulher
    (2012) BENUTE, Gláucia Rosana Guerra; NONNENMACHER, Daniele; NOMURA, Roseli Mieko Yamamoto; LUCIA, Mara Cristina Souza de; ZUGAIB, Marcelo
    PURPOSE: To identify the knowledge and awareness of health professionals regarding the Brazilian legislation on induced abortion. METHODS: Unidentified sealed envelopes containing the questionnaires were sent to all professionals (n=149) working in the Obstetrics Department of a university hospital and public hospital at the periphery of São Paulo (SP), Brazil. A total of 119 professionals responded to the questionnaire. The 0.05 confidence interval and the Fisher exact test and χ² test were used for data analysis. RESULTS: Of the respondents, 48.7% were physicians, 33.6% were nursing professionals and 17.6% were professionals from other fields (psychologists, nutritionists, physiotherapists, laboratory technicians and administrators). There was a significant difference (p=0.01) in the proportion of professionals who believe that abortion for non-lethal fetal malformation and due to unplanned pregnancies should be included in the Brazilian legislation. It was observed that the knowledge about the law and the description of the circumstances allowed by law on abortion was significantly different when comparing health professionals (p=0.01). When asked about the situations in which Brazilian law allows abortion, 32.7% of physicians, 97.5% of nursing professionals and 90.5% of other professionals were unaware of the law. CONCLUSION: This study demonstrated the lack of of knowledge of Brazilian law among health professionals, to a lesser extent among obstetricians and a to a greater extent among nursing professionals. Attitudes of discrimination and prejudice were observed regarding the care provided to women who induce an abortion.