ROSSANA PULCINELI VIEIRA FRANCISCO

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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

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  • article 23 Citação(ões) na Scopus
    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.
  • article 6 Citação(ões) na Scopus
    Effect of vaginal progesterone in tocolytic therapy during preterm labor in twin pregnancies: Secondary analysis of a placebo-controlled randomized trial
    (2017) HERNANDEZ, Wagner R.; FRANCISCO, Rossana P. V.; BITTAR, Roberto E.; GOMEZ, Ursula T.; ZUGAIB, Marcelo; BRIZOT, Maria L.
    Aim: Our aim was to investigate the effect of the prophylactic use of vaginal progesterone on the latency period from the initiation of tocolytic therapy to delivery in twin pregnancies with preterm labor. Methods: This study was a secondary analysis of a randomized, double-blind, placebo-controlled trial of twin pregnancies in mothers who were exposed to a 200mg vaginal progesterone ovule or a placebo ovule daily from 18 to 34weeks gestation. Patients who were administered tocolysis with Atosiban because of preterm labor were included. The latency from tocolysis to delivery, mean gestational age at delivery and the rates of delivery within 48h and within seven days were compared between progesterone and placebo groups. Results: The analysis included 27 women in the progesterone group and 30 in the placebo group. The baseline characteristics were similar between the groups. Overall, there were no differences in the latency period to delivery (17.5413.54days and 21.58 +/- 13.52days; P=0.289), rates of delivery within 48h (14.8% and 6.7%; P=0.40) or within seven days (29.64% and 23.3%; P=0.76) or mean gestational age at delivery (32.53 +/- 3.33 and 34.13 +/- 2.87; P=0.08) between the progesterone and placebo groups, respectively. Conclusions: Prophylactic use of 200mg of vaginal progesterone does not influence the latency to delivery in women with twin pregnancies treated with tocolysis because of preterm labor.
  • conferenceObject
    EFFECT OF THE MICROENVIRONMENT ON THE PLACENTAL BEHAVIOUR: RESPONSE OF THE CHORIONIC VILLI TO NORMAL AND PREECLAMPTIC PREGNANT SERUM
    (2017) PRADO, Karen; CASTRO, Karla; LORENZON-OJEA, Aline; CARDOSO, Elaine; HOSHIDA, Mara; ALVES, Eliane; FRANCISCO, Rossana P. Vieira; ZUGAIB, Marcelo; BEVILACQUAL, Estela
  • article 2 Citação(ões) na Scopus
    Feeding and nutritional profiles of children at 12 months of age living in the western region of the city of Sao Paulo: The Procriar Project
    (2017) SALDIVA, Silvia Regina Dias Medici; BONINI, Patricia Gama; VENANCIO, Sonia Isoyama; FRANCISCO, Rossana Pulcineli Vieira; VIEIRA, Sandra Elisabete
    Objective To analyze the feeding profiles, nutritional statuses and influences of maternal characteristics on food consumption of infants at the end of the first year of life. Methods This is a cross-sectional study nested within a cohort of pregnant women that evaluated children with a mean age of 12.1 months. The weights and lengths were measured, and the body mass index was calculated. Food consumption was obtained through 24-hour recall and was assessed qualitatively. The outcomes studied dichotomously (yes/no) were overweight (body mass index >=+2 Z-scores), consumption of foods considered unhealthy (i.e., sugar, petit suisse cheese, sandwich crackers, and soft drinks), consumption of fruits, legumes and vegetables and a minimum acceptable diet composed of minimum dietary diversity and minimum meal frequency. Logistic regression models were constructed to evaluate the association between maternal variables and the outcomes studied. Results A total of 254 infants were evaluated, of whom 10.7% were overweight. The majority of the infants did not receive a minimum acceptable diet (58.7%), 28.0% consumed petit suisse cheese and 42.0% received added sugar in their preparations. Mothers less than 20 years old or with more schooling were more likely to offer unhealthy foods to their children (p=0.03). Fruits, legumes and vegetables (consumption was higher among children of mothers over 20 years old (p=0.04). Conclusion The study revealed a high prevalence of overweight and an inadequacy of food consumption among children. The finding that adolescent mothers and/or mothers with more schooling tend to offer inadequate food to children may favor the definition of specific educational strategies.
  • article 69 Citação(ões) na Scopus
    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.
  • article
    Successful Pregnancies After Adequate Hormonal Replacement in Patients With Combined Pituitary Hormone Deficiencies
    (2017) CORREA, Fernanda A.; BIANCHI, Paulo H. M.; FRANCA, Marcela M.; OTTO, Aline P.; RODRIGUES, Rodrigo J. M.; EJZENBERG, Dani; SERAFINI, Paulo C.; BARACAT, Edmundo Chada; FRANCISCO, Rossana P. V.; BRITO, Vinicius N.; ARNHOLD, Ivo J. P.; MENDONCA, Berenice B.; CARVALHO, Luciani R.
    Context: Women with hypopituitarism have lower pregnancy rates after ovulation induction. Associated pituitary hormone deficiencies might play a role in this poorer outcome. Objective: We evaluated fertility treatment and pregnancy outcomes in five women with childhoodonset combined pituitary hormone deficiencies (CPHD). Patients and Methods: Five women with CPHD were referred for fertility treatment after adequacy of hormone replacement was determined. Patients were subjected to controlled ovarian stimulation (COS) for timed intercourse, intrauterine insemination, or in vitro fertilization, according to the presence or absence of other infertility factors (male or tubal). Results: All women became pregnant. The number of COS attempts until pregnancy was achieved varied between 1 and 5. The duration of COS resulting in at least one dominant follicle varied between 9 and 28 days, and total gonadotropin consumed varied between 1200 and 3450 IU. Two patients with severely suppressed basal gonadotropin levels since an early age had a cancelled COS cycle. All pregnancies were singleton except one (monochorionic twin gestation). The gestational ages at birth ranged from 35 weeks to 39 weeks and 4 days; three patients underwent cesarean section, and two had vaginal deliveries. Only one newborn was small for gestational age (delivered at 35 weeks). Conclusion: Adequate hormonal replacement prior to ovarian stimulation resulted in successful pregnancies in patients with childhood-onset CPHD, indicating that hormone replacement, including growth hormone, is an important step prior to fertility treatments in these patients.
  • article 14 Citação(ões) na Scopus
    Placental weight and birth weight to placental weight ratio in monochorionic and dichorionic growth-restricted and non-growth-restricted twins
    (2017) SOUZA, Mariangela Alves; BRIZOT, Maria de Lourdes; BIANCOLIN, Sckarlet Ernandes; SCHULTZ, Regina; CARVALHO, Mario Henrique Burlacchini de; FRANCISCO, Rossana Pulcineli Vieira; ZUGAIB, Marcelo
    OBJECTIVE: The aim of the present study was to compare the placental weight and birth weight/placental weight ratio for intrauterine growth-restricted and non-intrauterine growth-restricted monochorionic and dichorionic twins. METHODS: This was a retrospective analysis of placentas from twin pregnancies. Placental weight and the birth weight/placental weight ratio were compared in intrauterine growth-restricted and non-intrauterine growth-restricted monochorionic and dichorionic twins. The association between cord insertion type and placental lesions in intrauterine growth-restricted and non-intrauterine growth-restricted monochorionic and dichorionic twins was also investigated. RESULTS: A total of 105 monochorionic (intrauterine growth restriction=40; non-intrauterine growth restriction=65) and 219 dichorionic (intrauterine growth restriction=57; non-intrauterine growth restriction=162) placentas were analyzed. A significantly lower placental weight was observed in intrauterine growth-restricted monochorionic (p=0.022) and dichorionic (p < 0.001) twins compared to non-intrauterine growth-restricted twins. There was no difference in the birth weight/placental weight ratio between the intrauterine growth restriction and non-intrauterine growth restriction groups for either monochorionic (p=0.36) or dichorionic (p=0.68) twins. Placental weight and the birth weight/placental weight ratio were not associated with cord insertion type or with placental lesions. CONCLUSION: Low placental weight, and consequently reduced functional mass, appears to be involved in fetal growth restriction in monochorionic and dichorionic twins. The mechanism by which low placental weight influences the birth weight/placental weight ratio in intrauterine growth-restricted monochorionic and dichorionic twins needs to be determined in larger prospective studies.
  • conferenceObject
    OBSTETRIC AND PERINATAL OUTCOMES IN PREGNANT WOMEN WITH PERINATALLY ACQUIRED HIV-INFECTION-PRELIMINARY RESULTS
    (2017) OSMUNDO JUNIOR, Gilmar de Souza; RODRIGUES, Agatha Sacramento; KREBS, Vera Lucia Jornada; ZUGAIB, Marcelo; FRANCISCO, Rossana Pulcineli Vieira
  • bookPart
    A ultrossonografia no segundo e terceiro trimestres
    (2017) BUNDUKI, Victor; NUNES, Clarissa Moraes; FRANCISCO, Rossana Pulcineli Vieira
  • article 44 Citação(ões) na Scopus
    Short-Term Exposure to Urban Air Pollution and Influences on Placental Vascularization Indexes
    (2017) HETTFLEISCH, Karen; BERNARDES, Lisandra Stein; CARVALHO, Mariana Azevedo; PASTRO, Luciana Duzolina Manfre; VIEIRA, Sandra Elisabete; SALDIVA, Silvia R. D. M.; SALDIVA, Paulo; FRANCISCO, Rossana Pulcineli Vieira
    Background: It has been widely demonstrated that air pollution can affect human health and that certain pollutant gases lead to adverse obstetric outcomes, such as preeclampsia and fetal growth restriction. Objectives: We evaluated the influence of individual maternal exposure to air pollution on placental volume and vascularization evaluated in the first trimester of pregnancy. Methods: This was a cross-sectional study on low-risk pregnant women living in Sao Paulo, Brazil. The women carried passive personal NO2 and O-3 monitors in the week preceding evaluation. We employed the virtual organ computer-aided analysis (VOCAL) technique using three-dimensional power Doppler ultrasound to evaluate placental volume and placental vascular indexes [vascularization index (VI), flow index (FI), and vascularization flow index (VFI)]. We analyzed the influence of pollutant levels on log-transformed placental vascularization and volume using multiple regression models. Results: We evaluated 229 patients. Increased NO2 levels had a significant negative association with log of VI (p = 0.020 and beta = -0.153) and VFI (p = 0.024 and beta = -0.151). NO2 and O-3 had no influence on the log of placental volume or FI. Conclusions: NO2, an estimator of primary air pollutants, was significantly associated with diminished VI and VFI in the first trimester of pregnancy.