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
19 resultados
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conferenceObject Descriptive analysis of pregnant women with recurrent fetal death and thrombophilia(2014) ANDRES, M. D. P.; IGAI, A. M. K.; BARROS, V; FRANCISCO, R. P.; ZUGAIB, M.- Maternal postpartum complications according to delivery mode in twin pregnancies(2014) STACH, Sonia Leme; LIAO, Adolfo Wenjaw; BRIZOT, Maria de Lourdes; FRANCISCO, Rossana Pulcineli Vieira; ZUGAIB, MarceloOBJECTIVE: We aimed to examine maternal postpartum complications of twin deliveries according to mode of delivery and investigate the associated risk factors. METHODS: This was a retrospective cohort review of twin pregnancies with delivery after 26 weeks at a tertiary teaching hospital (1993-2008). The rates of maternal postpartum complications were compared among vaginal, elective cesarean and emergency cesarean deliveries. Significant predictors of complications were investigated with stepwise regression analysis and relative risks were calculated. RESULTS: A total of 90 complications were observed in 56/817 (6.9%) deliveries: 7/131 (5.3%) vaginal, 10/251 (4.0%) elective cesarean and 39/435 (9.0%) emergency cesarean deliveries. Significant predictors included high risk pregnancy, gestational age at birth and delivery mode. The occurrence of complications was significantly increased in emergency compared to elective cesarean deliveries (RR = 2.34). CONCLUSIONS: Maternal postpartum complications in twin pregnancies are higher in emergency compared to elective cesarean deliveries and are also related to preexisting complications and earlier gestational age at delivery.
- Should fetal growth be a matter of concern in isolated single umbilical artery?(2014) CALDAS, Lorena Mesquita; LIA, Adolfo; CARVALH, Mario Henrique; FRANCISCO, Rossana Pulcineli Vieira; ZUGAIB, MarceloObjective: To examine birth weight in pregnancies with isolated single umbilical artery (ISUA). Methods: Case control study with retrospective review of 131 singleton pregnancies with isolated single umbilical artery diagnosed before birth. Control group consisted of 730 singleton pregnancies recruited prospectively, that had histological confirmation of a 3 vessels cord. Pregnancies were classified as uncomplicated or high-risk according to the presence of diseases that increase the risk of placental insufficiency during pregnancy. Mean birth weight and frequency of low birth weight (< 2.500g), very low birth weight (< 1.500g) and fetal growth restriction below the 5th and 10th centiles were compared between groups. Results: Mean birth weight difference between ISUA (n=131, 2840 +/- 701g) and control (n=730, 2.983 +/- 671g) pregnancies was 143g (95% CI= 17-269; p=0.04) and birth weight below the 5th centile was significantly more common in ISUA group [28/131 (21.4%) versus 99/730 (13.6%), p=0.02]. When only uncomplicated pregnancies were considered in both groups, no birth weight differences were observed. Amongst high-risk subgroups, birth weight below the 5th centile remained significantly more common in ISUA compared to control pregnancies [10/35 (28.6%) versus 53/377 (14.1%), p=0.04]. Conclusion: Isolated single umbilical artery does not increase the risk of fetal growth restriction in uncomplicated singleton pregnancies.
- Transplacental Total IgG Transfer in Twin Pregnancies(2014) STACH, Sonia C. L.; BRIZOT, Maria de L.; LIAO, Adolfo W.; FRANCISCO, Rossana P. V.; PALMEIRA, Patricia; CARNEIRO-SAMPAIO, Magda; ZUGAIB, MarceloProblemIn twin pregnancies, factors that influence total umbilical cord IgG concentration and IgG transfer ratio are not well known. MethodBlood samples were prospectively collected from 57 twin pregnancies. Stepwise multivariate regression analysis was used to evaluate the association between total IgG levels in the umbilical cord blood and IgG transfer ratio according to serum IgG concentration, pregnancy chorionicity, the presence of abnormal umbilical artery pulsatility index, intrauterine growth restriction, gestational age at delivery (GAD), birthweight, and placental weight. ResultsUmbilical cord IgG concentration showed a positive correlation with serum IgG concentration and GAD; levels were significantly lower in monochorionic compared with dichorionic pregnancies. IgG transfer ratio also increased with GAD but was inversely correlated with serum IgG concentration levels. ConclusionIn twin pregnancies, besides serum IgG concentration and GAD, chorionicity also influences umbilical cord IgG concentration. Monochorionic twins have lower IgG cord concentration than dichorionic twins.
- 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.
- Tumorigenic Factor CRIPTO-1 Is Immunolocalized in Extravillous Cytotrophoblast in Placenta Creta(2014) BANDEIRA, Carla Leticia; BORBELY, Alexandre Urban; FRANCISCO, Rossana Pulcineli Vieira; SCHULTZ, Regina; ZUGAIB, Marcelo; BEVILACQUA, EstelaCRIPTO-(CR)1 is a protein associated with tumorigenesis and metastasis. Here we demonstrate that CR-1 expression in normal and creta placentas is associated with various degrees of uterine invasion. Cytokeratin (CK) and CR-1 protein expression was visualized by immunohistochemical staining of formalin-fixed, paraffin-embedded placental specimens (control placentas, n = 9; accreta, n = 6; increta, n = 10; percreta, n = 15). The pattern of extravillous trophoblast (EVT) cell morphology was distinctive in creta placentas: densely-compacted cell columns and large star-shaped cells with a typically migratory phenotype, not common among third trimester control placentas. Quantification revealed higher CR-1 immunoreactivities in accreta (P = 0.001), increta (P = 0.0002), and percreta placentas (P = 0.001) than in controls. In contrast to controls, there was a significant positive relationship between CR-1 and CK reactivity in all creta placentas (accreta, P = 0.02; increta, P = 0.0001, and percreta, P = 0.025). This study demonstrated CR-1 expression in the placental bed, its increased expression in creta placentas, and EVT cells as the main CR-1-producing cell type. Morphological examination revealed an immature and invasive trophoblast profile in creta placentas, suggesting impairment of the trophoblast differentiation pathway. These findings provide important new insights into the pathophysiology of abnormal creta placentation and its gestational consequences.
- 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.
- Should We Measure Fetal Omphalocele Diameter for Prediction of Perinatal Outcome?(2014) KIYOHARA, Marina Y.; BRIZOT, Maria L.; LIAO, Adolfo W.; FRANCISCO, Rossana P. V.; TANNURI, Ana C. A.; KREBS, Vera L. J.; ZUGAIB, MarceloObjective: To evaluate the fetal omphalocele diameter/abdominal circumference ratio (OD/AC) as a predictor of adverse perinatal outcome. Methods: Analysis involving 47 singleton pregnancies with fetal omphalocele, normal karyotype and absence of other major abnormalities. The OD/AC ratio was determined antenatally by ultrasound and the best cutoff for the prediction of neonatal death was determined by receiver operating characteristic curve analysis. Additional secondary outcomes included need for oral intubation in the first 24 h of life, two-step surgery or use of synthetic mesh, reoperation, parenteral feeding and need for respiratory assistance >21 days, time to first oral feed, and time to hospital discharge. Results: Fetal OD/AC did not change significantly with gestational age. Postnatal death occurred in 10 (21.3%) cases and the best cutoff for prediction was an OD/AC ratio >= 0.26 In pregnancies with the first ultrasound evaluation performed before 31 weeks' gestation and an OD/AC >= 0.26, the likelihood ratio for needing intubation in the first 24 h of life was 2.6 (95% CI: 1.2-5.7), needing two-step surgery or use of mesh was 4.9 (95% Cl: 1.9-14.4), and postnatal death was 4 (95% Cl: 1.9-7.5). Conclusion: A fetal ultrasound OD/AC ratio >= 0.26 is associated with increased postnatal morbidity and mortality. (C) 2013 S. Karger AG, Basel
- Major depression in high-risk obstetric inpatients and outpatients(2014) JUHAS, Thiago Robles; BENUTE, Gláucia Rosana Guerra; LUCIA, Mara Cristina Souza de; FRANCISCO, Rossana Pulcineli VieiraOBJECTIVE: To evaluate and compare the presence of major depression in high-risk obstetric patients among ward and ambulatory patients. METHOD: An exploratory, descriptive, and cross-sectional study was carried out among 542 high-risk pregnant women divided into two groups: 278 were outpatients receiving ambulatory care, and 264 were ward patients. Both attended a public university hospital in the State of São Paulo, Brazil. Major depressive disorder was evaluated using the Brazilian version of the Primary Care Evaluation of Mental Disorders. The Χ2 test was used in the statistical analysis with a level of significance of 5% (p<0.05). RESULTS: Sixty women (11.0%) were diagnosed with major depression, twenty-five (9%) were outpatients and thirty-five (13%) were ward patients. There was no statistically significant difference between groups with respect to the major depression (p = 0.11). Statistically significant differences were found between outpatients and ward patients as follows: insomnia or hypersomnia (p<0.01); fatigue or loss of energy (p = 0.02); diminished concentration (p<0.01); and restlessness or psychomotor retardation (p<0.01). CONCLUSIONS: Hospitalization may intensify some depressive symptoms. The high proportion of women with major depression demonstrates the need for access to psychosocial support during the pregnancy period, especially in pregnant women at high-risk.
- 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.