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 0 Citação(ões) na Scopus
    Association between maternal exposure to air pollution before conception and sex determination in the city of Sao Paulo
    (2020) CARVALHO, Mariana Azevedo; HETTFLEISCH, Karen; RODRIGUES, Agatha S.; BENACHI, Alexandra; VIEIRA, Sandra Elisabete; SALDIVA, Silvia R. D. M.; SALDIVA, Paulo Hilario N.; FRANCISCO, Rossana Pulcineli Vieira; BERNARDES, Lisandra Stein
    It has been widely demonstrated that air pollution can affect human health and that some pollutant gases can have negative impacts on female fertility rates and cause adverse obstetric outcomes, such as premature birth and low birth weight. Few studies have evaluated the impact of maternal exposure to urban air pollution on the number of female births. To evaluate the association between maternal exposure to air pollution during the year before conception and sex determination. This was a prospective study using low-risk pregnant women living in Sao Paulo, Brazil. The pollutants were measured by a fixed station during a 1-year period before conception. Sex was confirmed after birth. We used multiple logistic regression models to evaluate the association between the pollutants and the sex determination and to estimate the odds ratio (OR) and the 95% confidence interval (CI) of being female based on a quantitative increase in pollutant concentration. We evaluated 371 patients. Elevated exposure to nitrogen dioxide (NO2) and particulate matter lower than 10 mu m (PM10) prior to conception were associated with increased odds of being female. Each unit increase of NO(2)exposure increased the odds of being female by 8% (OR = 1.08, 95% CI = 1.02, 1.15,p = 0.008), and each unit increase of PM(10)increased the odds of being female by 14% (OR = 1.14, 95% CI 1.02 to 1.28,p = 0.021). In Sao Paulo, maternal exposure to pollutants was significantly associated with the odds of being female.
  • article 31 Citação(ões) na Scopus
    Associations of maternal personal exposure to air pollution on fetal weight and fetoplacental Doppler: A prospective cohort study
    (2016) CARVALHO, Mariana A.; BERNARDES, Lisandra S.; HETTFLEISCH, Karen; PASTRO, Luciana D. M.; VIEIRA, Sandra E.; SALDIVA, Silvia R. D. M.; SALDIVA, Paulo H. N.; FRANCISCO, Rossana P. V.
    We determined the influence of maternal air pollution exposure during each trimester of pregnancy on fetal and birth weight and fetoplacental hemodynamics. In total, 366 women with singleton pregnancies were prospectively followed in the city of Sao Paulo, Brazil. Nitrogen dioxide (NO2) and ozone (O-3) were measured during each trimester using passive personal samplers. We evaluated fetal weight and Doppler velocimetry data from the umbilical, middle cerebral, and uterine arteries in the 3rd trimester, and birth weight. Multivariate analysis was performed, controlling for known determinants of fetal weight. Exposure to higher levels of O-3 during the 2nd trimester was associated with higher umbilical artery pulsatility indices (PIs) [p = 0.013; beta = 0.017: standard error (SE) = 0.007]. Exposure to higher levels of O-3 during the 3rd trimester was associated with lower umbilical artery PIs (p = 0.011; beta = 0.021; SE = 0.008). Our results suggest that in the environment of Sao Paulo, 03 may affects placental vascular resistance.
  • article 0 Citação(ões) na Scopus
    Expression of matrix metalloproteinases and their inhibitors at the implantation site in ampullary ectopic pregnancies
    (2021) GOMEZ, Ursula Trovato; BRIZOT, Maria de Lourdes; PEREIRA, Pedro Paulo; RODRIGUES, Agatha Sacramento; SCHULTZ, Regina; HOSHIDA, Mara Sandra; FRANCISCO, Rossana Pulcineli Vieira; CABAR, Fabio Roberto
    Objective: This study investigated the qualitative and semi-quantitative expression of metalloproteinases (MMP) and their tissue inhibitors (TIMP) in trophoblastic tissue during ampullary ectopic pregnancies and correlated that expression with the degree of tubal invasion. Study design: It is a prospective study that included 34 patients diagnosed with ampullary tubal pregnancy who underwent salpingectomy. A histological evaluation of the depth of trophoblastic invasion in the tubes obtained was performed. Subsequently, the expression of the MMP-2, MMP-9, MMP-14, TIMP-1, TIMP-2 and TIMP-3 markers was qualitatively and semi-quantitatively evaluated by indirect immunohistochemistry. In addition, the degree of trophoblastic invasion was correlated with the expression of each marker and with the metalloproteinase/inhibitor ratios. Results: MMP-2 (11.2 %; 3.6-17.9) was the marker with greater expression at the implantation site, both in the qualitative and semi-quantitative assessment, while MMP-9 (2.23 %; 0.2-5.4) and TIMP-3 (2.53 %; 0.1-15.3) were only weakly expressed. Conclusion: There was wide variation in expression among the markers and metalloproteinase/inhibitor ratios studied compared to the degrees of invasion.
  • article 6 Citação(ões) na Scopus
    Individual exposure to urban air pollution and its correlation with placental angiogenic markers in the first trimester of pregnancy, in Sao Paulo, Brazil
    (2021) HETTFLEISCH, Karen; CARVALHO, Mariana Azevedo; HOSHIDA, Mara Sandra; PASTRO, Luciana Duzolina Manfre; SALDIVA, Silvia Regina Dias Medici; VIEIRA, Sandra Elisabete; FRANCISCO, Rossana Pulcineli Vieira; SALDIVA, Paulo Hilario Nascimento; BERNARDES, Lisandra Stein
    Pollution of the atmosphere is known that may lead to adverse obstetric outcomes, including fetal growth restriction, gestational hypertension, and preeclampsia. Such disorders are correlated with imbalances in angiogenic factors, which may also be involved in the pathological mechanism as the pollutants impact placental and maternal physiology. In the first trimester of gestation, this study assessed the outcomes of personal maternal short period exposure to air pollution on soluble fms-like tyrosine kinase 1 (sFlt1) and placental growth factor (PLGF) of pregnant women blood concentrations. This was a cross-sectional study, held in the city of Sao Paulo, Brazil, and conducted with low-risk pregnant women, who carried personal passive nitrogen dioxide (NO2) and ozone (O-3) monitors for about a few days preceding the ultrasound evaluation, and on this day, the venous blood sample was collected to measure the angiogenic factors sFlt1 and PLGF and their ratio (sFlt1/PLGF) by enzyme-linked immunosorbent assay (ELISA). By means of multiple regression models, the effect of the studied pollutants on the log-transformed concentrations of the angiogenic factors was evaluated. One hundred thirty-one patients were included. The log of the sFlt1/PLGF ratio increased with rising NO2 levels (p = 0.021 and beta = 0.206), and the log of the PLGF concentration showed a negative correlation with NO2 (p = 0.008 and beta = - 0.234). NO2, an indicator of the levels of primary air pollutants, presented significant positive correlation with an increased sFlt1/PLGF ratio and diminished PLGF levels, which may reflect an antiangiogenic state generated by air pollution exposure.
  • article 11 Citação(ões) na Scopus
    Pregnancy in Women with Complex Congenital Heart Disease. A Constant Challenge
    (2019) AVILA, Walkiria Samuel; RIBEIRO, Veronica Martins; ROSSI, Eduardo Giusti; BINOTTO, Maria Angelica; BORTOLOTTO, Maria Rita; TESTA, Carolina; FRANCISCO, Rossana; HAJJAR, Ludhmilla Abraao; MIURA, Nana
    Background: The improvement in surgical techniques has contributed to an increasing number of childbearing women with complex congenital heart disease (CCC). However, adequate counseling about pregnancy in this situation is uncertain, due to a wide variety of residual cardiac lesions. Objectives: To evaluate fetal and maternal outcomes in pregnant women with CCC and to analyze the predictive variables of prognosis. Methods: During 10 years we followed 435 consecutive pregnancies in patients (pts) with congenital heart disease. Among of them, we selected 42 pregnancies in 40 (mean age of 25.5 +/- 4.5 years) pts with CCC, who had been advised against pregnancy. The distribution of underlying cardiac lesions were: D-Transposition of the great arteries, pulmonary atresia, tricuspid atresia, single ventricle, double-outlet ventricle and truncus arteriosus. The surgical procedures performed before gestation were: Fontan, Jatene, Rastelli, Senning, Mustard and other surgical techniques, including Blalock, Taussing, and Glenn. Eight (20,0%) pts did not have previous surgery. Nineteen 19 (47.5%) pts had hypoxemia. The clinical follow-up protocol included oxygen saturation recording, hemoglobin and hematocrit values; medication adjustment to pregnancy, anticoagulation use, when necessary, and hospitalization from 28 weeks, in severe cases. The statistical significance level considered was p < 0.05. Results: Only seventeen (40.5%) pregnancies had maternal and fetal uneventful courses. There were 13 (30.9%) maternal complications, two (4.7%) maternal deaths due to hemorrhage pos-partum and severe pre-eclampsia, both of them in women with hypoxemia. There were 7 (16.6%) stillbirths and 17 (40.5%) premature babies. Congenital heart disease was identified in two (4.1%) infants. Maternal and fetal complications were higher (p < 0.05) in women with hypoxemia. Conclusions: Pregnancy in women with CCC was associated to high maternal and offspring risks. Hypoxemia was a predictive variable of poor maternal and fetal outcomes. Women with CCC should be advised against pregnancy, even when treated in specialized care centers.
  • article 1 Citação(ões) na Scopus
    A Prenatal Case of Arrhythmogenic Right Ventricular Dysplasia
    (2018) LOPES, Lilian Maria; PACHECO, Juliana Torres; SCHULTZ, Regina; FRANCISCO, Rossana Pulcineli Vieira; ZUGAIB, Marcelo
  • article 13 Citação(ões) na Scopus
    Risk assessment of venous thromboembolism and thromboprophylaxis in pregnant women hospitalized with cancer: Preliminary results from a risk score
    (2018) HASE, Eliane Azeka; BARROS, Venina Isabel Poco Viana Leme de; IGAI, Ana Maria Kondo; FRANCISCO, Rossana Pulcinelli Vieira; ZUGAIB, Marcelo
    OBJECTIVES: Hospitalized patients with cancer are at high risk of developing venous thromboembolism, and the risk increases with pregnancy. The aim of this study was to apply a thromboprophylaxis protocol with a venous thromboembolism risk score for hospitalized pregnant women with cancer and to evaluate the effects on maternal morbidity and mortality. METHODS: A longitudinal and prospective study was conducted from December 2014 to July 2016. The venous thromboembolism risk score was modified from the guidelines of the Royal College of Obstetricians and Gynaecologists. Patients were classified as low (score <3) or high risk (score >= 3). The high-risk group received thromboprophylaxis with low-molecular-weight heparin, unless the patient had a contraindication for anticoagulation. One patient could have undergone more than one evaluation. RESULTS: Fifty-two ratings were descriptively analyzed: 34 (65.4%) were classified as high risk, and 28/34 (82.3%) received low-molecular-weight heparin, 1 received unfractionated heparin, and 5 did not receive intervention. Most patients (23/52; 44.2%) had breast cancer. The main risk factors for venous thromboembolism in the high-risk group were chemotherapy (within 6 months; 22/34; 64.7%). No patient exhibited venous thromboembolism, adverse effects of anticoagulation or death up to three months after hospitalization. CONCLUSIONS: Most pregnant women with cancer had a high risk for venous thromboembolism at the time of hospitalization. Breast cancer was the most prevalent cancer, and recent chemotherapy was the main risk factor for anticoagulation. The application of a thromboprophylaxis protocol and determination of a venous thromboembolism risk score for these patients was useful for the prevention of maternal morbidity and mortality due to venous thromboembolism.
  • 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.
  • conferenceObject
    Preconception women's dietary intake of nutrients from one-carbon metabolism pathway: has it effects on birth weight?
    (2015) TEIXEIRA, Juliana Araujo; CASTRO, Ana Lucia da Silva; FRANCISCO, Rossana Pulcineli Vieira; VIEIRA, Sandra Elisabete; SALDIVA, Silvia Regina Dias Medici; MARCHIONI, Dirce
  • article 5 Citação(ões) na Scopus
    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.