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
39 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 39
- 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.
- Variant rs17619600 in the gene encoding serotonin receptor 2B (HTR2B) increases the risk of gestational diabetes mellitus: a case-control study(2023) PENNO, Juliana Regina Chamlian Zucare; SANTOS-BEZERRA, Daniele Pereira; CAVALEIRO, Ana Mercedes; SOUSA, Ana Maria da Silva; ZACCARA, Tatiana Assuncao; COSTA, Rafaela Alkmin da; FRANCISCO, Rossana Pulcineli Vieira; CORREA-GIANNELLA, Maria LuciaBackgroundDuring pregnancy, the increase in maternal insulin resistance is compensated by hyperplasia and increased function of maternal pancreatic beta cells; the failure of this compensatory mechanism is associated with gestational diabetes mellitus (GDM). Serotonin participates in beta cell adaptation, acting downstream of the prolactin pathway; the blocking of serotonin receptor B (HTR2B) signaling in pregnant mice impaired beta cell expansion and caused glucose intolerance. Thus, given the importance of the serotoninergic system for the adaptation of beta cells to the increased insulin demand during pregnancy, we hypothesized that genetic variants (single nucleotide polymorphisms [SNPs]) in the gene encoding HTR2B could influence the risk of developing GDM.MethodsThis was a case-control study. Five SNPs (rs4973377, rs765458, rs10187149, rs10194776, and s17619600) in HTR2B were genotyped by real-time polymerase chain reaction in 453 women with GDM and in 443 pregnant women without GDM.ResultsOnly the minor allele C of SNP rs17619600 conferred an increased risk for GDM in the codominant model (odds ratio [OR] 2.15; 95% confidence interval [CI] 1.53-3.09; P < 0.0001) and in the rare dominant model (OR 2.32; CI 1.61-3.37; P < 0.0001). No associations were found between the SNPs and insulin use, maternal weight gain, newborn weight, or the result of postpartum oral glucose tolerance test (OGTT). In the overall population, carriers of the XC genotype (rare dominant model) presented a higher area under the curve (AUC) of plasma glucose during the OGTT, performed for diagnostic purposes, compared with carriers of the TT genotype of rs17619600.ConclusionsSNP rs17619600 in the HTR2B gene influences glucose homeostasis, probably affecting insulin release, and the presence of the minor allele C was associated with a higher risk of GDM.
conferenceObject Placental abruption and thrombophilia(2013) ARISSA, K.; BARROS, V. V.; BAPTISTA, F. S.; BORTOLOTTO, M. R. D. F. L.; V, R. P. Francisco; ZUGAIB, M.- COL1A1, COL4A3, TIMP2 and TGFB1 polymorphisms in cervical insufficiency(2021) ALVES, Ana Paula V. D.; FREITAS, Amanda B.; LEVI, Jose Eduardo; AMORIM FILHO, Antonio G.; FRANCO, Lucas A. M.; HOSHIDA, Mara Sandra; PATINO, Elizabeth G.; V, Rossana P. Francisco; CARVALHO, Mario Henrique B.Objectives: To investigate the association between selected single nucleotide polymorphisms (SNPs) with cervical insufficiency and its relationship with obstetric history. Methods: Twenty-eight women with cervical insufficiency (case group) and 29 non-pregnant women (control group) were included. The SNPs sequenced included rs2586490 in collagen type I alpha 1 chain (COL1A1), rs1882435 in collagen type IV alpha 3 chain (COL4A3), rs2277698 in metallopeptidase inhibitor 2 (TIMP2), and rs1800468 in transforming growth factor beta 1 (TGFB1). Results: We found a higher frequency of the normal allele in the control group (65.5%) and the homozygous mutated genotype in the case group (64.3%) for rs2586490 in COL1A1 (p=0.023). An unplanned finding in the cervical insufficiency group was a higher gestational age of delivery (median >= 38 weeks) in the mutated allele than in the wildtype genotype (median of 28.2 weeks) for rs2857396, which is also in the COL1A1 gene (p=0.011). Conclusions: The findings of the present study corroborate the hypothesis that cervical insufficiency has a genetic component and probably involves genes encoding proteins in the extracellular matrix, in addition to inflammatory processes.
- The Impact of Immunosuppressive Drugs on Human Placental Explants(2019) GOMES, Sara Z.; ARAUJO, Franciele; BANDEIRA, Carla L.; OLIVEIRA, Leandro G.; HOSHIDA, Mara S.; ZUGAIB, Marcelo; FRANCISCO, Rossana P. V.; BEVILACQUA, EstelaThe use of immunosuppressive drugs guarantees the vitality of the graft and allows gestation in spite of intercurrences such as prematurity and intrauterine growth restriction. However, little is known about the direct effects of immunosuppressive drugs on placental cells. We investigated the effects of immunosuppressive drugs in the chorionic villous explants from human term placentas of healthy gestations. Human placental explants from term gestations (37-39 week gestational age, n = 12) were exposed to cyclosporine A (CSA, 0, 62.5, 125, 1250 ng/mL) or azathioprine (AZA, 0, 5, 10, 100 ng/mL) separately or, in combination for up to 48 hours. 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assays showed a significant decrease in the explant metabolic activity between AZA and the control group (24 hours, 100 ng/mL, 48 hours, all concentrations, P < .005). Cyclosporin A (CsA) reduced cell activity when associated with AZA (48 hours, P < .005). Fibrinoid deposits increased in AZA-treated explants alone (5 ng/mL, 48 hours; 10 ng/mL, 24-48 hours; P < .005) or when associated with CsA (10 AZA/125 CsA, P < .05), whereas in CsA treatment alone, there was an augment in syncytial knots (24-48 hours, P < .005). The sFLT1 gene (24 hours, P < .05) and protein (P < .005) expression increased in AZA and CsA-treatments separately or in combination (P < .05). Placental growth factor increased in AZA (24 hours, 10 ng/mL) and CsA (125 ng/mL; P < .05). In conclusion, our data indicate that AZA primarily acts on the villous metabolism, perturbing placental homeostasis. Since these drugs may alter the balance of angiogenic factors in its selection for clinical application, their impact on the behavior of placental villous should be considered.
- Livebirth after uterus transplantation from a deceased donor in a recipient with uterine infertility(2018) EJZENBERG, Dani; ANDRAUS, Wellington; MENDES, Luana Regina Baratelli Carelli; DUCATTI, Liliana; SONG, Alice; TANIGAWA, Ryan; ROCHA-SANTOS, Vinicius; ARANTES, Rubens Macedo; SOARES JR., Jose Maria; SERAFINI, Paulo Cesar; HADDAD, Luciana Bertocco de Paiva; FRANCISCO, Rossana Pulcinelli; D'ALBUQUERQUE, Luiz Augusto Carneiro; BARACAT, Edmund ChadaBackground Uterus transplantation from live donors became a reality to treat infertility following a successful Swedish 2014 series, inspiring uterus transplantation centres and programmes worldwide. However, no case of livebirth via deceased donor uterus has, to our knowledge, been successfully achieved, raising doubts about its feasibility and viability, including whether the womb remains viable after prolonged ischaemia. Methods In September, 2016, a 32-year-old woman with congenital uterine absence (Mayer-Rokitansky-KusterHauser [MRKH] syndrome) underwent uterine transplantation in Hospital das Clinicas, University of Sao Paulo, Brazil, from a donor who died of subarachnoid haemorrhage. The donor was 45 years old and had three previous vaginal deliveries. The recipient had one in-vitro fertilisation cycle 4 months before transplant, which yielded eight cryopreserved blastocysts. Findings The recipient showed satisfactory postoperative recovery and was discharged after 8 days' observation in hospital. Immunosuppression was induced with prednisolone and thymoglobulin and continued via tacrolimus and mycophenalate mofetil (MMF), until 5 months post-transplantation, at which time azathioprine replaced MMF. First menstruation occurred 37 days post-transplantation, and regularly (every 26-32 days) thereafter. Pregnancy occurred after the first single embryo transfer 7 months post-transplantation. No blood flow velocity waveform abnormalities were detected by Doppler ultrasound of uterine arteries, fetal umbilical, or middle cerebral arteries, nor any fetal growth impairments during pregnancy. No rejection episodes occurred after transplantation or during gestation. Caesarean delivery occurred on Dec 15, 2017, near gestational week 36. The female baby weighed 2550 g at birth, appropriate for gestational age, with Apgar scores of 9 at 1 min, 10 at 5 min, and 10 at 10 min, and along with the mother remains healthy and developing normally 7 months post partum. The uterus was removed in the same surgical procedure as the livebirth and immunosuppressive therapy was suspended. Interpretation We describe, to our knowledge, the first case worldwide of livebirth following uterine transplantation from a deceased donor in a patient with MRKH syndrome. The results establish proof-of-concept for treating uterine infertility by transplantation from a deceased donor, opening a path to healthy pregnancy for all women with uterine factor infertility, without need of living donors or live donor surgery.
- Comparative analysis of Insulin-like growth factor binding protein-1, placental alpha-microglobulin-1, phenol and pH for the diagnosis of preterm premature rupture of membranes between 20 and 36 weeks(2019) GALLETTA, Marco A. K.; BITTAR, Roberto E.; RODRIGUES, Agatha S.; FRANCISCO, Rossana P. V.; ZUGAIB, MarceloAim Preterm premature rupture of membranes (PPROM) is responsible for approximately one-third of premature births worldwide, and although the diagnosis is often straightforward, this condition can still present difficulties. The purpose of this research was to compare the accuracy of several PPROM diagnostic tests. Methods A total of 94 pregnant women with clinical suspicion of PPROM who were between 20 and 36 weeks of pregnancy were examined by vaginal speculum, and tests were performed for phenol, pH, insulin-like growth factor binding protein-1 (IGFBP-1) and placental alpha-microglobulin-1 (PAMG-1). All patients were followed up until the diagnosis was fully defined, and a diagnosis of PROM was confirmed by a definitive evolution of the clinical symptoms (visualization of vaginal amniotic fluid or persistence of oligohydramnios). Results After excluding the cases that could not be definitively diagnosed, a good diagnostic performance of the immunochromatographic tests was observed that was superior to that of the clinical tests. Similar accuracies were observed for IGFBP-1 (98.7%) and PAMG-1 (93.9%). However, while the IGFBP-1 test differed from a vaginal pH >= 7 (88.9%) and the phenol test (85.7%), this did not occur for the PAMG-1 test. The performance of the tests was modified only by the presence of bleeding (with lower specificity rates for pH and phenol), without interference of gestational age or maternal morbidities. Conclusion Immunochromatographic tests are good tools but should be used sparingly in resource-poor settings because they are expensive, and there is no significant difference between PAMG-1 and traditional tests.
- 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.
- Dietary Pattern Influences Gestational Weight Gain: Results from the ProcriAr Cohort Study-Sao Paulo, Brazil(2022) SALDIVA, Silvia Regina Dias Medici; NETA, Adelia da Costa Pereira De Arruda; TEIXEIRA, Juliana Araujo; PERES, Stela Verzinhasse; MARCHIONI, Dirce Maria Lobo; CARVALHO, Mariana Azevedo; VIEIRA, Sandra Elisabete; FRANCISCO, Rossana Pulcineli VieiraThe maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) influence maternal and infant outcomes. This study identified patterns of habitual dietary intake in 385 pregnant women in Sao Paulo and explored their associations with excessive weight gain (EGWG). Weight at the first visit (<14 weeks) was used as a proxy for pre-pregnancy weight. Food consumption was assessed using the 24HR method, administered twice at each gestational trimester, and dietary patterns were identified by principal component analysis. Three dietary patterns were identified: ""Vegetables and Fruits,"" ""Western,"" and ""Brazilian Traditional."" Descriptive data analysis was performed using absolute and relative frequencies for each independent variable and multilevel mixed-effects logistic regression was used to analyze excessive gestational gain weight (EGWG) and dietary patterns (DP). The Brazilian Traditional dietary pattern showed a protective effect on EGWG (p = 0.04) and age > 35 years (p = 0.03), while subjects overweight at baseline had a higher probability of EGWG (p = 0.02), suggesting that the identification of dietary and weight inadequacies should be observed from the beginning of pregnancy, accompanied by nutritional intervention and weight monitoring throughout the gestational period to reduce risks to the mother and child's health.
- Adverse Perinatal Outcomes among Adolescent Pregnant Women Living with HIV: A Propensity-Score-Matched Study(2023) OSMUNDO JUNIOR, G. D. S.; CABAR, F. R.; PERES, S. V.; WAISSMAN, A. L.; GALLETTA, M. A. K.; FRANCISCO, R. P. V.HIV infection and adolescent pregnancy are known to increase the risk of adverse perinatal outcomes. However, data are limited concerning the outcomes of pregnancies among adolescent girls living with HIV. This retrospective propensity-score matched study aimed to compare adverse perinatal outcomes in adolescent pregnant women living with HIV (APW-HIV-positive) with HIV-negative adolescent pregnant women (APW-HIV-negative) and adult pregnant women with HIV (PW-HIV). APW-HIV-positive were propensity-score matched with APW-HIV-negative and PW-HIV. The primary endpoint was a composite endpoint of adverse perinatal outcomes, comprising preterm birth and low birth weight. There were 15 APW-HIV-positive and 45 women in each control group. The APW-HIV-positive were aged 16 (13–17) years and had had HIV for 15.5 (4–17) years, with 86.7% having perinatally acquired HIV. The APW-HIV-positive had higher rates of perinatally acquired HIV infection (86.7 vs. 24.4%, p < 0.001), a longer HIV infection time (p = 0.021), and longer exposure to antiretroviral therapy (p = 0.034) compared with the PW-HIV controls. The APW-HIV-positive had an almost five-fold increased risk of adverse perinatal outcomes compared with healthy controls (42.9% vs. 13.3%, p = 0.026; OR 4.9, 95% CI 1.2–19.1). The APW-HIV-positive and APW-HIV-negative groups had similar perinatal outcomes.