ROSSANA PULCINELI VIEIRA FRANCISCO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/57 - Laboratório de Fisiologia Obstétrica, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/57 - Laboratório de Fisiologia Obstétrica, Hospital das Clínicas, Faculdade de Medicina - Líder
16 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 16
- When One Knows a Fetus Is Expected to Die: Palliative Care in the Context of Prenatal Diagnosis of Fetal Malformations(2017) CATANIA, Taisa Rocha; BERNARDES, Lisandra Stein; BENUTE, Glaucia Rosana Guerra; GIBELI, Maria Augusta Bento Cicaroni; NASCIMENTO, Nathalia Bertolassi do; BARBOSA, Tercilia Virginia Aparecida; KREBS, Vera Lucia Jornada; FRANCISCO, Rossana P. V.Background: Fetal malformations occur in 2% of gestations and are the fifth most common cause of neonatal death in the world. In many cases, fetal malformations result in neonatal death or long stay in intensive care facilities. Families that continue the pregnancy in such a situation need to make choices and cope with an overwhelming number of potential issues. Palliative care starting at the prenatal period is a growing field that allows the entire family to prepare for this difficult situation. Objective: To perform a systematic review of published data on palliative care in the prenatal period. Design: PubMed and the Cochrane Library were searched using the keywords (""perinatal"" OR ""prenatal"" OR ""fetal"") AND ""palliative care"" and also (""perinatal"" OR ""prenatal"" OR ""fetal"") AND ""hospice."" Setting/Subjects: Studies focusing on the long-term impact of prenatal palliative care published up to December 2015 were used. Measurements: Quantitative and qualitative studies. Results: In total, 541 studies were retrieved; 29 articles met the inclusion criteria. Studies were organized into different categories according to the design or main focus. The majority of studies retrieved were reflexives or presented a narrative proposal on palliative care started in the prenatal period (45%). Clinical studies comprised 17% of all articles found. No studies were found on the long-term impact of prenatal palliative care. Conclusions: Prenatal palliative care is a growing field and an important supportive care measure that can help grieving parents and families who do not want to or cannot interrupt their pregnancy. More studies should be carried out, specifically concerning long-term impact of prenatal palliative care. Guidelines and training of health professionals must be developed so that more families can benefit from this type of care.
- Is Doppler ultrasound useful for evaluating gestational trophoblastic disease?(2015) LIN, Lawrence H.; BERNARDES, Lisandra S.; HASE, Eliane A.; FUSHIDA, Koji; FRANCISCO, Rossana P. V.Doppler ultrasound is a non-invasive method for evaluating vascularization and is widely used in clinical practice. Gestational trophoblastic neoplasia includes a group of highly vascularized malignancies derived from placental cells. This review summarizes data found in the literature regarding the applications of Doppler ultrasound in managing patients with gestational trophoblastic neoplasia. The PubMed/Medline, Web of Science, Cochrane and LILACS databases were searched for articles published in English until 2014 using the following keywords: ""Gestational trophoblastic disease AND Ultrasonography, Doppler."" Twenty-eight articles met the inclusion criteria and were separated into the 4 following groups according to the aim of the study. (1) Doppler ultrasound does not seem to be capable of differentiating partial from complete moles, but it might be useful when evaluating pregnancies in which a complete mole coexists with a normal fetus. (2) There is controversy in the role of uterine artery Doppler velocimetry in the prediction of development of gestational trophoblastic neoplasia. (3) Doppler ultrasound is a useful tool in the diagnosis of gestational trophoblastic neoplasia because abnormal myometrial vascularization and lower uterine artery Doppler indices seem to be correlated with invasive disease. (4) Lower uterine artery Doppler indices in the diagnosis of gestational trophoblastic neoplasia are associated with methotrexate resistance and might play a role in prognosis. CONCLUSION: Several studies support the importance of Doppler ultrasound in the management of patients with gestational trophoblastic neoplasia, particularly the role of Doppler velocimetry in the prediction of trophoblastic neoplasia and the chemoresistance of trophoblastic tumors. Doppler findings should be used as ancillary tools, along with human chorionic gonadotropin assessment, in the diagnosis of gestational trophoblastic neoplasia.
- A systematic review of instruments measuring grief after perinatal loss and factors associated with grief reactions(2021) SETUBAL, M. S.; BOLIBIO, R.; JESUS, R. C.; BENUTE, G. G.; GIBELLI, M. A.; BERTOLASSI, N.; BARBOSA, T.; GOMES, A.; FIGUEIREDO, F.; FERREIRA, R.; FRANCISCO, R.; BERNARDES, L. SteinObjective Expectant parents who live through perinatal loss experience intense grief, which is not always acknowledged or accepted. A screening tool to detect bereaved parents' grief reactions can guide professionals, including perinatal palliative care teams, to provide follow-up for those in need. This review's goal is to identify and synthesize the international published literature on existent instruments specifically measuring the grieving process after any perinatal loss and to identify factors that could moderate grief reactions. Method Systematic review (PROSPERO # CRD42018092555) with critical synthesis. PUBMED, Cochrane, and PsycINFO databases were searched in English language articles using the keywords ""perinatal"" AND (""grief"" OR ""bereavement"" OR mourning) AND (""scale"" OR ""questionnaire"" OR ""measure"" OR ""assessment"") up to May 2018. Eligibility criteria included every study using a measure to assess perinatal grief after all kinds of perinatal losses, including validations and translations to other languages and interventions designed to alleviate grief symptoms. Results A total of 67 papers met inclusion criteria. Seven instruments measuring perinatal grief published between 1984 and 2002 are described. The Perinatal Grief Scale (PGS) was used in 53 of the selected studies. Of those, 39 analyzed factors associated with grief reactions. Six articles used PGS scores to evaluate pre- and post-bereavement interventions. Studies in English language only might have limited the number of articles. Significance of results The PGS is the most used standardized measures to assess grief after perinatal loss. All parents living through any kind of perinatal loss should be screened.
- Multiple pregnancies with complete mole and coexisting normal fetus in North and South America: A retrospective multicenter cohort and literature review(2017) LIN, Lawrence H.; MAESTA, Izildinha; BRAGA, Antonio; SUN, Sue Y.; FUSHIDA, Koji; FRANCISCO, Rossana P. V.; ELIAS, Kevin M.; HOROWITZ, Neil; GOLDSTEIN, Donald P.; BERKOWITZ, Ross S.Objective. To determine the clinical characteristics of multiple gestation with complete mole and coexisting fetus (CHMCF) in North and South America. Methods. Retrospective non-concurrent cohorts compromised of CHMCF from New England Trophoblastic Disease Center (NETDC) (1966-2015) and four Brazilian Trophoblastic Disease Centers (BTDC) (1990-2015). Results. From a total of 12,455 cases of gestational trophoblastic disease seen, 72 CHMCF were identified. Clinical characteristics were similar between BTDC (n = 46) and NETDC (n = 13) from 1990 to 2015, apart from a much higher frequency of potentially life-threatening conditions in Brazil (p = 0.046). There were no significant changes in the clinical presentation or outcomes over the past 5 decades in NETDC (13 cases in 1966-1989 vs 13 cases in 1990-2015). Ten pregnancies were electively terminated and 35 cases resulted in viable live births (60% of 60 continued pregnancies). The overall rate of gestational trophoblastic neoplasia (GTN) was 46%; the cases which progressed to GTN presented with higher chorionic gonadotropin levels (p = 0.026) and higher frequency of termination of pregnancy due to medical complications (p = 0.006) when compared to those with spontaneous remission. Conclusions. The main regional difference in CHMCF presentation is related to a higher rate of potentially life threatening conditions in South America. Sixty percent of the expectantly managed CHMCF delivered a viable infant, and the overall rate of GTN in this study was 46%. Elective termination of pregnancy did not influence the risk for GTN; however the need for termination due to complications and higher hCG levels were associated with development of GTN in CHMCF.
- Fetal thrombotic vasculopathy: A case report and literature review(2016) PELEJA, Ana Berquo; MARTINELLI, Silvio; RIBEIRO, Renata Lopes; BITTAR, Roberto Eduardo; SCHULTZ, Regina; FRANCISCO, Rossana Pulcineli VieiraIntroduction: Fetal thrombotic vasculopathy is a recently described placental alteration with varying degrees of involvement and often associated with adverse perinatal outcomes. The diagnosis is made histologically and therefore is postnatal, which makes it a challenge in clinical practice. Method: Case report and review of literature on the subject. Results: The present case refers to a pregnant woman presenting fetal growth restriction, with poor obstetrical past, and sent late to our service. Even with weekly assessments of fetal vitality (fetal biophysical profile and Doppler velocimetry) and prenatal care, the patient progressed with fetal death at 36 weeks and 1 day. There was no association with inherited and acquired thrombophilia. Pathological examination of the placenta revealed fetal thrombotic vasculopathy. Conclusion: The fetal thrombotic vasculopathy may be associated with adverse perinatal outcomes including fetal death, but much remains to be studied regarding its pathogenesis. Diagnosis during pregnancy is not possible and there is still no proven treatment for this condition. Future studies are needed so that strategies can be developed to minimize the impact of fetal thrombotic vasculopathy.
- 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.
- Cancer During Pregnancy: The Oncologist Overview(2019) HEPNER, Adriana; NEGRINI, Daniel; HASE, Eliane Azeka; EXMAN, Pedro; TESTA, Laura; TRINCONI, Angela F.; FILASSI, Jose Roberto; FRANCISCO, Rossana Pulcineli Vieira; ZUGAIB, Marcelo; O'CONNOR, Tracey L.; MARTIN, Michael GaryAlthough a rare and challenging condition, cancer during pregnancy should promptly be identified and treated. Not only standards of care guidelines for the underlying disease are taken into account, but also fetal safety might be weighted for clinical decisions. Frequent lack of experience and knowledge about this condition could lead to late diagnosis, imprecise management, suboptimal treatment and fetal and maternal harm. Therefore, this review aims to summarize the current evidence regarding the epidemiology, clinical presentation, diagnostic workup, staging and treatment, including novel treatment modalities for patients diagnosed with cancer during pregnancy.
- Fetal growth according to different reference ranges in twin pregnancies with placental insufficiency(2015) NAKANO, Julianny Cavalheiro Nery; LIAO, Adolfo Wenjaw; BRIZOT, Maria de Lourdes; MIYADAHIRA, Mariana; FRANCISCO, Rossana Pulcineli Vieira; ZUGAIB, MarceloThe aim of this study was to compare different fetal growth curves in twin pregnancies with severe placental insufficiency. A retrospective cross-sectional analysis of 47 twin pregnancies with absent or reverse end diastolic flow in the umbilical artery of one fetus was performed. Pregnancies with major fetal abnormalities, twin-twin transfusion or three or more fetuses were not included. The estimated fetal weight zeta-scores were calculated for both fetuses (abnormal Doppler and co-twin) according to the following criteria: Hadlock, Liao and Araujo. The abdominal circumference zeta-scores were calculated according to Hadlock, Liao, Araujo, Ong and Stirrup. The mean estimates of the zeta-score values were calculated using generalized estimating equation regression analysis. The mean gestational age at inclusion was 27.4 +/- 4.7 weeks. The fetal sex and the interaction Doppler findings x criteria correlated significantly with the zeta-score values (p<0.001 for both variables). The estimated fetal weight mean zeta-scores (standard error) according to each criteria were as follows: Hadlock - abnormal Doppler: -2.98 (0.18), co-twin: -1.16 (0.15); Liao -abnormal Doppler: -2.89 (0.24), co-twin: -0.58 (0.19); and Araujo - abnormal Doppler: -3.05 (0.29), co-twin: -0.75 (0.18). Values for abdominal circumference were as follows: Hadlock -abnormal Doppler: -3.14 (0.26), co-twin: -1.13 (0.19); Liao -abnormal Doppler: -2.63 (0.27), co-twin: -0.42 (0.19); Araujo abnormal Doppler: -2.44 (0.22), co-twin: -0.71 (0.14); Ong -abnormal Doppler: -3.36 (0.34), co-twin: -1.48 (0.23); and Stirrup AD - -2.36 (0.14), co-twin: -1.18 (0.10). Sex-and plurality-specific charts should be used in the evaluation of fetal growth in twin pregnancies with placental insufficiency.
- Pregnancy of unknown location(2019) PEREIRA, Pedro Paulo; CABAR, Fabio Roberto; GOMEZ, Ursula Trovato; FRANCISCO, Rossana Pulcineli VieiraPregnancy of unknown location is a situation in which a positive pregnancy test occurs, but a transvaginal ultrasound does not show intrauterine or ectopic gestation. One great concern of pregnancy of unknown location is that they are cases of ectopic pregnancy whose diagnosis might be postponed. Transvaginal ultrasound is able to identify an ectopic pregnancy with a sensitivity ranging from 87% to 94% and a specificity ranging from 94% to 99%. A patient with pregnancy of unknown location should be followed up until an outcome is obtained. The only valid biomarkers with clinical application and validation are serum levels of the beta fraction of hCG and progesterone. A single serum dosage of hCG is used only to determine whether the value obtained is above or below the discriminatory zone, that means the value of serum hCG above which an intrauterine gestational sac should be visible on ultrasound. Serum progesterone levels are a satisfactory marker of pregnancy viability, but they are unable to predict the location of a pregnancy of unknown location: levels below 5 ng/mL are associated with nonviable gestations, whereas levels above 20 ng/mL are correlated with viable intrauterine pregnancies. Most cases are low risk and can be monitored by expectant management with transvaginal ultrasound and serial serum hCG levels, in addition to the serum progesterone levels. To minimize diagnostic error and intervene during progressive intrauterine gestation, protocol indicates active treatment only in situations when progressive intrauterine pregnancy is excluded and a high possibility of ectopic pregnancy exists.
- Zika Virus Infection in Pregnant Women and Microcephaly(2017) DUARTE, Geraldo; MORON, Antonio Fernandes; TIMERMAN, Artur; FERNANDES, César Eduardo; MARIANI NETO, Corintio; ALMEIDA FILHO, Gutemberg Leão de; WERNER JUNIOR, Heron; SANTO, Hilka Flavia Barra do Espírito; STEIBEL, João Alfredo Piffero; BORTOLETTI FILHO, João; ANDRADE, Juvenal Barreto Borriello de; BURLÁ, Marcelo; SÁ, Marcos Felipe Silva de; BUSSO, Newton Eduardo; GIRALDO, Paulo César; SÁ, Renato Augusto Moreira de; PASSINI JUNIOR, Renato; MATTAR, Rosiane; FRANCISCO, Rossana Pulcineli VieiraAbstract From the discovery of the Zika virus (ZIKV) in 1947 in Uganda (Africa), until its arrival in South America, it was not known that it would affect human reproductive life so severely. Today, damagetothe central nervous system is known to be multiple, and microcephaly is considered the tip of the iceberg. Microcephaly actually represents the epilogue of this infection’s devastating process on the central nervous system of embryos and fetuses. As a result of central nervous system aggression by the ZIKV, this infection brings the possibility of arthrogryposis, dysphagia, deafness and visual impairment. All of these changes of varying severity directly or indirectly compromise the future life of these children, and are already considered a congenital syndrome linked to the ZIKV. Diagnosis is one of the main difficulties in the approach of this infection. Considering the clinical part, it has manifestations common to infections by the dengue virus and the chikungunya fever, varying only in subjective intensities. The most frequent clinical variables are rash, febrile state, non-purulent conjunctivitis and arthralgia, among others. In terms of laboratory resources, there are also limitations to the subsidiary diagnosis. Molecular biology tests are based on polymerase chain reaction (PCR)with reverse transcriptase (RT) action, since the ZIKV is a ribonucleic acid (RNA) virus. The RT-PCR shows serum or plasma positivity for a short period of time, no more than five days after the onset of the signs and symptoms. The ZIKVurine test is positive for a longer period, up to 14 days. There are still no reliable techniques for the serological diagnosis of this infection. If there are no complications (meningoencephalitis or Guillain-Barré syndrome), further examination is unnecessary to assess systemic impairment. However, evidence is needed to rule out other infections that also cause rashes, such as dengue, chikungunya, syphilis, toxoplasmosis, cytomegalovirus, rubella, and herpes. There is no specific antiviral therapy against ZIKV, and the therapeutic approach to infected pregnant women is limited to the use of antipyretics and analgesics. Anti-inflammatory drugs should be avoided until the diagnosis of dengue is discarded. There is no need to modify the schedule of prenatal visits for pregnant women infected by ZIKV, but it is necessary to guarantee three ultrasound examinations during pregnancy for low-risk pregnancies, and monthly for pregnant women with confirmed ZIKV infection. Vaginal delivery and natural breastfeeding are advised.