ROSELI MIEKO YAMAMOTO NOMURA
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
16 resultados
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- Increase in cesarean sections in Brazil - a call to reflection(2023) BRAGA, Antonio; SUN, Sue Yazaki; ZACONETA, Alberto Carlos Moreno; JUNIOR, Alberto Trapani; LUZ, Adriana Gomes; OSANAN, Gabriel; DUARTE, Geraldo; RAMOS, Jose Geraldo Lopes; WENDER, Maria Celeste Osorio; NOMURA, Roseli Mieko Yamamoto; FRANCISCO, Rossana Pulcineli Vieira; BORGES, Vera Therezinha Medeiros; MATTAR, Rosiane
- 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, MarceloObjective: 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.
- Abortion: a review of women's perception in relation to their partner's reactions in two Brazilians cities(2014) NONNENMACHER, Daniele; BENUTE, Glaucia Rosana Guerra; NOMURA, Roseli Mieko Yamamoto; AZEVEDO, George Dantas de; DUTRA, Elza Maria do Socorro; REBOUAS, Melina Sefora Souza; LUCI, Mara Cristina Souza de; FRANCISCO, Rossana Pulcineli VieiraObjective: to analyze women's perception in relation to their partner's reaction and behavior during the abortion process in two Brazilian capitals, associating the variables from women who suffered a spontaneous abortion with those from women who induced it. Methods: semi-structured, questionnaire-based interviews were conducted with 285 women who underwent spontaneous abortion and 31 who reported having induced it. The data were analyzed using the thematic analysis technique, and, subsequently, by the IBM SPSS Statistics Standard Edition software program. The significance level was set at p < 0.05. Results: in both capitals, the women who induced an abortion referred to the partner as the person who could not find out about the abortion (p<0.01 in Natal; p = 0.02 in Sao Paulo-SP) and, simultaneously, as the one who could have avoided it (p < 0.01 in Natal; p = 0.03 in Sao Paulo). In Natal-RN, induced abortion was associated with the partner's absence at the time pregnancy was confirmed (p = 0.02) and, in Sao Paulo-SP, with their negative reaction to news of the pregnancy (p = 0.04) and lack of participation in the abortion process (p < 0.01). Conclusion: despite having achieved independence, women still regard male participation in the abortion process as an important factor. The specifics of each capital denote the influence of the geographic and cultural dimension, indicating the need to take into account the particulars of each region in Brazil while considering a holistic approach to women's health.
- 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.
- Pica and Eating Attitudes: A Study of High-Risk Pregnancies(2016) SANTOS, Amanda M.; BENUTE, Glaucia R. G.; NOMURA, Roseli M. Y.; SANTOS, Niraldo O.; LUCIA, Mara C. S. De; FRANCISCO, Rossana P. V.Objective To describe and determine the association between the occurrence of pica and eating attitudes in women with high-risk pregnancies and to determine the prevalence of pica during pregnancy. Methods A cross-sectional and prospective 24-month study was conducted with 913 women with high-risk pregnancies. Structured interviews were carried out and the Eating Attitudes Test was applied. Results Pica was diagnosed in 5.7 % of the pregnant women, and its most commonly practiced type was geophagia (57.7 %). The association between pica and signs related to the eating attitudes: ""to be considered too thin by others'' (p < 0.02), and ""to spend too much time thinking about food'' (p = 0.05); and the association between pica and the risk of both anorexia nervosa and bulimia nervosa (p < 0.01) were statistically significant. Conclusions The absence of validated instruments in the literature for assessing pica reinforces the difficulty of investigating this practice and the need for further studies. Moreover, additional efforts need to focus in the improvement of screening for other eating disorders with obstetric consequences associated with pica and be incorporated into the routine of healthcare professionals.
- 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.
- 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, MarceloObjective: 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.
- Transient accelerations of fetal heart rate analyzed by computerized cardiotocography in the third trimester of pregnancy(2014) LAULETTA, Ana Luisa Fernandes; NOMURA, Roseli Mieko Yamamoto; MIYADAHIRA, Seizo; FRANCISCO, Rossana Pulcineli Vieira; ZUGAIB, MarceloObjective: the aim of this study was to investigate the patterns of transient FHR accelerations (10 bpm and 15 bpm) in the third trimester of pregnancy, comparing the occurrence of this event before and after the 32nd gestational week. Methods: This is a prospective study comparing the results of the computerized cardiotocography of 46 low-risk women with singleton pregnancies, maternal age between 18 and 40 years, gestational age between 28 and 40 weeks, absence of maternal morbidity and adequate fetal growth according to ultrasound. Computed Cardiotocography (8002 Sonicaid System and Fetal Care System) was performed for 30 minutes to analyze the variables of FHR. Results: twenty-three pregnant women underwent cardiotocography before 32 weeks (mean = 29.9 weeks, SD = 1.4 weeks) and were compared with 23 pregnant women who were examined after 32 weeks (mean = 36.3 weeks, SD = 2.5 weeks). Regarding the characteristics of FHR, fetuses evaluated between 32 1/7 weeks and 40 weeks showed a significantly greater number of accelerations above 15 bpm (median = 5, variation 0-18) than the group of pregnant women from 28 to 32 weeks (median = 4, variation 0 to 10; P = 0.048). There was a significant positive correlation between the number of accelerations above 15 bpm and the gestational age at examination (rho = 0.33; P = 0.026). Conclusion: computerized cardiotocography showed an association regarding the number of transient accelerations greater than 15 bpm in the assessment of both periods before and after 32 weeks of gestational age, suggesting the influence of the maturation of the fetal autonomic nervous system with pregnancy progression.
- 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.
- Influence of fetal acidemia on fetal heart rate analyzed by computerized cardiotocography in pregnancies with placental insufficiency(2013) MAEDA, Mariane de Fatima Y.; NOMURA, Roseli M. Y.; NIIGAKI, Juliana I.; FRANCISCO, Rossana P. V.; ZUGAIB, MarceloObjective: To determine the influence of fetal acidemia on fetal heart rate (FHR) parameters analyzed by computerized cardiotocography (cCTG) in pregnancies with placental insufficiency. Methods: This was a cross-sectional study of 46 pregnancies with placental insufficiency between 26 and 34 weeks gestation by abnormal umbilical artery Doppler [pulsatility index (PI)>95th percentile]. Results: Twenty fetuses had acidemia at birth, pH<7.20 (43.5%) and 26 had normal pH (56.5%). In the analysis of FHR parameters, fetal movements (FM) per hour was significantly lower in the group with acidemia (median = 2) when compared with the group with normal pH (median = 15, p = 0.019). The values of pH correlated positively with FM (rho = 0.35; p = 0.019, 95% CI: 0.061 to 0.577) and basal FHR (rho = 0.37, p = 0,011, 95% CI: 0.090 to 0.597) and negatively with the ductus venosus (DV) PI for veins (PIV) z-score (rho = -0.31, p = 0,036, 95% CI: -0.550 to -0.021). Logistic regression showed that the DV PIV z-score (p = 0.0232) and basal FHR (p = 0.0401) were independent variables associated with acidemia at birth. Conclusions: The present results suggest that cCTG parameters may be useful in the management of cases with early onset placental insufficiency in association with Doppler velocimetry assessment, and that basal FHR and DV-PIV are most clearly in association with acidemia at birth.