MARIA DE LOURDES BRIZOT
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina - Docente
LIM/57 - Laboratório de Fisiologia Obstétrica, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/57 - Laboratório de Fisiologia Obstétrica, Hospital das Clínicas, Faculdade de Medicina - Líder
6 resultados
Resultados de Busca
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- Fetal Growth Pattern and Prediction of Low Birth Weight in Gastroschisis(2015) CENTOFANTI, Sandra F.; BRIZOT, Maria de Lourdes; LIAO, Adolfo W.; FRANCISCO, Rossana P. V.; ZUGAIB, MarceloObjectives: To examine growth patterns and predictions of low birth weight in gastroschisis fetuses. Methods: This is a retrospective study of isolated fetal gastroschisis before week 24. Ultrasound fetal biometric parameters - head circumference (HC), abdominal circumference (AC), femur length, HC/AC ratio and estimated fetal weight (EFW) - were plotted against normal growth charts. The percentage difference in mean values between normal and gastroschisis fetuses was determined. The growth deficit for each ultrasound parameter was calculated for the fetuses with 1 examination in each designated period (period I: weeks 20-25(+6); period II: weeks 26-31(+6); period III: from week 32 until term). For low birth weight prediction, measurements below the 10th percentile in periods I and II were tested. Results: Seventy pregnancies were examined. For all fetal parameters, the mean measurements were lower in fetuses with gastroschisis (p < 0.005). The EFW revealed an increased growth deficit between the periods (p = 0.030). HC was predictive of low birth weight in period II (OR = 6.07; sensitivity = 70.8%; specificity = 71.4%). Conclusions: Fetuses with gastroschisis present a reduced growth pattern, and it appears that no growth recovery occurs after the growth restriction has been established. Between week 26 and week 31(+6), an HC measurement below the 10th percentile is associated with an increased risk of low birth weight. (C) 2015 S. Karger AG, Basel
- Placental Transfer of IgG Antibodies Specific to Klebsiella and Pseudomonas LPS and to Group B Streptococcus in Twin Pregnancies(2015) STACH, S. C. L.; BRIZOT, M. L.; LIAO, A. W.; PALMEIRA, P.; FRANCISCO, R. P. V.; CARNEIRO-SAMPAIO, M. M. S.; ZUGAIB, M.Group B Streptococcus (GBS), Klebsiella spp. and Pseudomonas spp. are important aetiological agents of neonatal infections in Brazil. There is a lack of data in the literature regarding the specific transport of immunoglobulin G (IgG) against these pathogens in multiple pregnancies. Maternal (n=55) and umbilical cord (n=110) blood samples were prospectively collected at birth from 55 twin pregnancies. The factors associated with cord levels and transfer ratios of IgG against GBS, Klebsiella and Pseudomonas were examined. The IgG umbilical cord serum levels specific to GBS, Klebsiella LPS and Pseudomonas LPS were significantly associated with maternal-specific IgG concentrations and the presence of diabetes. The anti-Klebsiella IgG cord serum concentrations were also related to birthweight and the presence of hypertension. The transfer ratios against GBS and Pseudomonas LPS were associated with maternal-specific IgG concentrations. The transfer ratios for GBS and Pseudomonas LPS were associated with gestational age at delivery and the presence of diabetes, respectively. None of the examined parameters were related to Klebsiella LPS transfer ratios. We conclude that in twin pregnancies, specific maternal IgG serum concentrations and diabetes were the parameters associated with umbilical cord serum IgG concentrations reactive with the three pathogens investigated. All the other parameters investigated showed different associations with neonatal-specific IgG levels according to the antigen studied. There was no uniformity of the investigated parameters regarding association with placental IgG transfer ratios against the GBS, Pseudomonas LPS and Klebsiella LPS.
- Longitudinal reference range for umbilical cord cross-sectional area in twin pregnancies at 18-32 weeks of gestation(2015) FERNANDES, D. B.; LIAO, A. W.; BRIZOT, M. L.; FRANCISCO, R. P. V.; ZUGAIB, M.ObjectivesThe objectives of this study were to establish gestational age-specific reference ranges for cross-sectional area of the umbilical cord, and its components, in twin pregnancies and to compare them with previously reported singleton reference ranges. MethodsThis was a prospective longitudinal study involving uncomplicated dichorionic twin pregnancies. Sonographic measurements of the cross-sectional area of the umbilical cord, umbilical vein and arteries and Wharton's jelly were obtained in a plane adjacent to the fetal abdomen, every 3weeks, between 18 and 32weeks of gestations. Multilevel regression analysis was used to determine gestational age-specific reference ranges for each parameter, and these were plotted against singleton pregnancy references. ResultsThree hundred and thirty four ultrasound scans were performed in 44 twin pregnancies, between 18 and 32.9weeks (mean: 3.80.7 scans/pregnancy and mean interval between scans: 3.30.9weeks). All umbilical cord cross-sectional areas (total, vein, artery and Wharton's jelly) showed a significant increase with gestational age. Compared with singleton pregnancy ranges, mean values were considerably lower in twin pregnancies and resemble the lower limits observed in singletons. ConclusionIn twin pregnancies, cross-sectional area of the umbilical cord, and its components, increases between 18 and 32weeks, and mean values are substantially lower compared with singleton pregnancies. (c) 2015 John Wiley & Sons, Ltd.
- 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.
- Myocardial performance index in fetal anemia(2015) ASSUNCAO, Renata Almeida de; LIAO, Adolfo Wenjaw; BRIZOT, Maria de Lourdes; FRANCISCO, Rossana Pulcineli Vieira; ZUGAIB, MarceloObjectiveThe objective of the study was to examine the correlation between fetal myocardial performance index (MPI) and hemoglobin (Hb) levels. MethodsIt is a prospective study involving singleton pregnancies at risk of fetal anemia as a result of maternal anti-D alloimmune disease. Right and left ventricle (LV) MPIs were evaluated by ultrasound up to 72h before cordocentesis. Zeta-score values for fetal MPI and Hb levels were calculated, and correlation was examined with linear regression analysis. Significance level was set as 0.05. ResultsFourteen singleton pregnancies underwent 31 cordocentesis procedures at a mean gestation of 28.24.1weeks. Zeta-score values for LV MPI, isovolumetric relaxation time (IRT), and ejection time (ET) correlated significantly with fetal Hb zeta-score (LV MPI zeta=3.816+0.336xHb zeta, r=0.59, p<0.001; LV IRT zeta=2.643+0.218xHb zeta, r=0.45, p=0.01; LV ET zeta=-2.474-0.271xHb zeta, r=-0.42, p=0.02). LV isovolumetric contraction time (ICT) zeta-score and right ventricle (RV) MPI did not show significant correlation (LV ICT zeta, r=0.35, p=0.054; RV MPI, r=0.12, p=0.53). ConclusionLV myocardial performance not only remains preserved but also is actually enhanced in cases of moderate/severe fetal anemia. (c) 2014 John Wiley & Sons, Ltd.
- Vaginal progesterone for the prevention of preterm birth in twin gestations: a randomized placebo-controlled double-blind study(2015) BRIZOT, Maria L.; HERNANDEZ, Wagner; LIAO, Adolfo W.; BITTAR, Roberto E.; FRANCISCO, Rossana P. V.; KREBS, Vera L. J.; ZUGAIB, MarceloOBJECTIVE: The purpose of this study was to investigate the use of vaginal progesterone for the prevention of preterm delivery in twin pregnancies. STUDY DESIGN: We conducted a prospective, randomized, doubleblind, placebo-controlled trial that involved 390 naturally conceived twin pregnancies among mothers with no history of preterm delivery who were receiving antenatal care at a single center. Women with twin pregnancies between 18 and 21 weeks and 6 days' gestation were assigned randomly to daily vaginal progesterone (200 mg) or placebo ovules until 34 weeks and 6 days' gestation. The primary outcome was the difference in mean gestational age at delivery; the secondary outcomes were the rate of spontaneous delivery at <34 weeks' gestation and the rate of neonatal composite morbidity and mortality in the treatment and nontreatment groups. RESULTS: The baseline characteristics were similar in both groups. The final analysis included 189 women in the progesterone group and 191 in the placebo group. No difference (P = .095) in the mean gestational age at delivery was observed between progesterone (35.08 +/- 3.19 [SD]) and placebo groups (35.55 +/- 2.85). The incidence of spontaneous delivery at <34 weeks' gestation was 18.5% in the progesterone group and 14.6% in the placebo group (odds ratio, 1.32; 95% confidence interval, 0.24-2.37). No difference in the composite neonatal morbidity and mortality was observed between the progesterone (15.5%) and placebo (15.9%) groups (odds ratio, 1.01; 95% confidence interval, 0.58-1.75). CONCLUSION: In nonselected twin pregnancies, vaginal progesterone administration does not prevent preterm delivery and does not reduce neonatal morbidity and death.