Adilson Cunha Ferreira

Evolução do comprimento cervical uterino na gestação, avaliado pela ultra-sonografia transvaginal

PURPOSE: to establish a normality curve of cervical length during pregnancy measured by transvaginal ultrasonography. METHODS: we conducted a prospective, longitudinal study on 82 healthy pregnant women who were followed up from the beginning of pregnancy to delivery at four-week intervals, of whom 49 concluded the study. Patients were divided according to parity into nulliparous women and women with one or more previous deliveries. Cervical length was measured in a sagittal view by transvaginal ultrasonography, as the linear distance between internal and external cervical os. RESULTS: no significant difference was observed in mean cervical length or the 5th, 25, 50th, 75th, or 95th percentile according to gestational age between groups (p>0.05). Between the 20th and 24th gestacional week, the 5th, 50th and 95th percentiles of cervical length were 28, 35 and 47.2 mm, respectively. Cervical length decreased progressively during normal pregnancy, with a significant shortening observed after 20 weeks of gestation and being more marked after 28 weeks (p<0.05). CONCLUSION: the pattern of cervical length behavior does not seem to differ between nulliparous women and women with one or more previous deliveries. The numerical values of the normality curve of cervical length according to gestational age reflect the variability in the peculiar characteristics of the studied sample, thus emphasizing the value of the parameters established for different populations.

Contribuição da ultra-sonografia abdominal no seguimento de pacientes pós-tratamento de câncer mamário

O objetivo deste estudo e avaliar a contribuicao da ultra-sonografia abdominal em um grupo de pacientes em seguimento pos-tratamento de câncer primario da mama. Foram analisados, retrospectivamente, os resultados dos exames ecograficos abdominais em cem prontuarios de pacientes tratadas de câncer primario de mama, realizados de janeiro a dezembro de 1997, no setor de ultra-sonografia da Divisao de Radiologia do Departamento de Clinica Medica da Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo. Informacoes como idade, tipo histologico, estadiamento, numero e resultados dos exames ultra-sonograficos foram tabeladas e analisadas. Em 70% dos casos, os laudos ecograficos abdominais eram normais. O diagnostico de metastase hepatica foi de 3%. O maior percentual de alteracoes encontradas nao estava relacionado diretamente com complicacao do câncer mamario. The objective of this study is to evaluate the contribution of the abdominal ultrasound in a group of patients in the follow-up after breast cancer treatment. The results of the abdominal ultrasound was retrospectively evaluated in one hundred patients treated of primary cancer from January to December, 1997, in the ultrasound sector - Division of Radiology - Department of Clinical Medicine - Ribeirao Preto, University of Sao Paulo. Information such as age, histological type, stage, number and results of the ultrasound were rated and analyzed. In 70% of the cases the result of the abdominal ultrasound was normal. The diagnosis of hepatic metastasis was 3%. The largest percentage of the alterations was not directly related as complication of the breast cancer.

Tumor placentário diagnosticado durante a gravidez: relato de caso

The most frequently nontrophoblastic tumor of the placenta found is chorioangioma, with an incidence of about 1%. When they are small, they do not significantly affect the fetus, but the large ones can cause intrauterine growth restriction, polyhydramnios, premature delivery, congestive heart failure and fetal death. The authors report a case of chorioangioma in a 28-year-old woman, second gestation, whose diagnosis was established at the 32nd week by ultrasound and confirmed by the anatomopathological examination. Ultrasonography evaluations showed chronic fetal distress and the delivery was performed at 36 weeks. The newborn results were satisfactory with Apgar 9-10 and fetal weight 2.460 g.

Evolução dos índices dopplervelocimétricos da artéria cerebral média em fetos de gestantes normais

PURPOSE: to study the evolution of the resistance and pulsatility indices, maximum velocity, final diastolic velocity and time of acceleration of the middle cerebral artery of fetuses between 22 and 38 weeks of gestation. METHODS: a prospective and longitudinal observational study was conducted on 33 fetuses of normal pregnant women evaluated between 22 and 38 weeks of pregnancy. The gestational age was determined on the basis of the date of the last menstruation and/or by ultrasound examination during the first trimester. Doppler ultrasound examination was performed by a single observer using an Image Point 1800 (Hewlett Packard) apparatus equipped with a multiple frequency transducer. For the acquisition of the Doppler tracing of the middle cerebral artery, the sample indicator was calibrated for a sample volume of 1 mm3 and placed on the anterior middle cerebral artery as close as possible to the skullcap. The insonation angle was kept between 5o and 19o and the filter was adjusted to a frequency of 50-100 Hz. The newborn infants were evaluated in order to confirm that the fetuses were vigorous and adequate for gestational age. RESULTS: the results obtained for the resistance and pulsatility indices revealed a 2nd-degree equation, representing a parabola whose values for the resistance index were 0.81 during the 22nd week and 0.75 during the 38th week. The pulsatility index was 1.59 during the 22nd week and 1.45 during the 38th week. Maximum systolic velocity increased progressively along pregnancy, with values of 26.3 cm/s during the 22nd week and 57.7 cm/s during the 38th week. Final diastolic velocity increased progressively from the 26th week (5.21 cm/s) to term (14.6 cm/s). Acceleration time increased significantly only between 26 and 30 weeks, with values of 0.04 s during the 26th week and 0.05 s during the 30th week. CONCLUSION: it was concluded that the evolution of the resistance and pulsatility indices and of maximum systolic velocity were similar to those of most studies described in the literature. Acceleration time presented few modifications during the evaluated gestational weeks.

Índice de líquido amniótico: variabilidade inter e intra-observador

Objetivo: demonstrar a variacao interobservador da medida ultra-sonografica do indice de liquido amniotico (ILA) e da medida da area dos bolsoes, bem como realizar uma comparacao entre estes dois parâmetros. Alem disto, procurou-se estabelecer a variacao intra-observador existente na medicao deste indice. Metodos: foram estudados os valores do ILA, como descrito por Phelan et al.18 , de um grupo de oitenta gestantes, consideradas clinicamente normais, atendidas na Escola de Ultra-sonografia e Reciclagem Medica Ribeirao Preto e no Departamento de Ginecologia e Obstetricia da Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo (FMRP - USP). Todas as gestantes apresentavam idade gestacional acima de 24 semanas. Deste grupo, cinquenta pacientes submeteram-se a avaliacao do ILA por cinco ultra-sonografistas diferentes, com o uso do mesmo equipamento e no mesmo periodo de tempo, procurando-se estabelecer a variacao interobservador deste indice. Alem disto, foi realizada a medida planimetrica da area por parte de dois destes cinco ultra-sonografistas escolhidos aleatoriamente, na tentativa de verificar a variacao interobservador na medida da area. Outro grupo composto por trinta gestantes foi avaliado por um mesmo observador ultra-sonografista na tentativa de se realizar a avaliacao da variacao intra-observador na medicao do ILA. Resultados: observamos uma variacao interobservador significante na medicao do ILA e significante na medicao da area. Nao obstante, a variacao intra-observador na medida do ILA foi considerada nao-significante. Houve uma correlacao entre as medidas do ILA e da area. Conclusoes: o ILA apresenta maior aplicabilidade em relacao a medida da area, alem da maior facilidade de obtencao.

Quantificação do líquido amniótico pela ultra-sonografia tridimensional e bidimensional no primeiro trimestre da gestação

PURPOSE: To determine the values of amniotic fluid in normal fetuses during the first trimester of pregnancy by three- and bi-dimensional ultrasonography. METHODS: In a prospective longitudinal study, 25 normal fetuses were evaluated from the 8th to the 11th week of gestation. Amniotic fluid volume was measured by endovaginal ultrasonography with the three- and two-dimensional modes. The two-dimensional study consisted of volumetric determination by mathematical calculation based on an ellipsoidal shape (constant 0.52) to obtain the amniotic sac and embryo volumes. In the three-dimensional study, the amniotic fluid volume was determined by the VOCAL technique using 6, 9, 15, and 30 degrees of rotation. The amniotic fluid volume obtained by 6-degree rotations was considered to be the final result. In both modes, amniotic fluid volume was obtained by subtracting the volume of the embryo from the volume of the amniotic sac. Data were analyzed statistically for variance (ANOVA), correlation and regression analysis. The level of significance was set at p < 0.05. RESULTS: The amniotic fluid volume as measured by two-dimensional ultrasonography increased from 5.45 to 39.52 cm3 in the range from the 8th to the 11th week (ANOVA - p < 0.05). There was a correlation between gestational age and amniotic fluid volume (p < 0.001, r2 = 88.3%). In the three-dimensional study, the amniotic fluid volume increased from 5.7 to 42.9 cm3 in the range from the 8th to the 11th week (ANOVA - p < 0.05), and again a correlation between gestational age and amniotic fluid volume (p < 0.001, r2 = 98.1%) was observed. CONCLUSION: an increase in amniotic fluid volume occurs during the first trimester of pregnancy, as determined by the two- and three-dimensional modes. In addition, we have demonstrated that the higher the gestational age, the larger the amniotic fluid volume.

Comprimento do colo uterino de gestantes com rotura prematura pré-termo de membranas avaliado pela ultra-sonografia transvaginal

OBJETIVO: avaliar o comprimento do colo uterino, por meio da ultra-sonografia transvaginal, em gestantes com rotura prematura pre-termo de membranas. PACIENTES E METODOS: o grupo de estudo (Ge) foi constituido por 26 gravidas entre a 24a e a 36a semana de gestacao e o grupo controle (Gc) por 49 pacientes clinicamente normais, na mesma idade gestacional. As pacientes foram avaliadas entre a 24a e 28a, 28a e 32a, 32a e 36a semana de gestacao, sendo subdivididas nos subgrupos Ge24-28, Ge28-32, Ge32-36 e Gc24-28, Gc28-32, Gc32-36, conforme pertencessem ao grupo de estudo e controle, respectivamente. O comprimento do colo uterino foi obtido por meio da ultra-sonografia transvaginal, em vista sagital, realizando-se a medida linear da distância entre os orificios cervicais interno e externo. RESULTADOS: observamos diferencas significantes das medidas do comprimento do colo uterino entre Ge24-28 e Gc24-28, cujos valores foram 24,3 e 33,0 mm, respectivamente (p=0,04), como tambem entre Ge32-36 e Gc32-36, cujos valores foram, respectivamente, 20,1 e 28,0 mm (p=0,005). Os periodos de latencia dos grupos Ge24-28, Ge28-32 e Ge32-36 foram, respectivamente, sete, cinco e tres dias, apresentando correlacao positiva com o comprimento do colo uterino (r=0,66) e negativa com a idade gestacional (r=-0,27). CONCLUSAO: o comprimento do colo uterino variou de acordo com a idade gestacional em que a rotura prematura pre-termo das membranas foi detectada, sendo menor no grupo de estudo que no grupo controle entre a 24a e a 28a e entre a 32a e a 36a semana. Alem disso, demonstrou-se que quanto menor o comprimento do colo, menor e o tempo de latencia, e que houve diminuicao no periodo de latencia a medida que aumentou a idade gestacional em que se deu a rotura.

Volume uterino em adolescentes avaliado pela ultra-sonografia

PURPOSE: to evaluate the uterine volume in women between 10 and 40 years in order to observe if the uterine volume in adolescents is smaller than the uterine volume in women between 20 and 40 years. We intend to emphasize the differences between the uterine volume of adolescents and that of adult women and to correlate with the immaturity of the genital tract of adolescents regarding gestation and delivery. METHOD: a cross-sectional study, which included 828 patients between 10 and 40 years old divided into two groups and examined using abdominal ultrasound to obtain the uterine volume measure. The first group consisted of 477 (57.7%) adolescents, and the second group of 351 (42.3%) adult women between 20 and 40 years old. In the adolescent group, ultrasound examination was performed by a single observer and in the group of adult women ultrasound examination was performed by a group of observers who used the same methodology as that of group 1. Image Point HX (Hewlett Packard) and Hitachi 525 ultrasound equipment were used with a multiple frequency probe. For the calculation of the uterine volume we used the longitudinal diameter (LD), anteroposterior diameter (APD) and transverse diameter (TD) with the (LD x APD x TD) x 0.45 formula. RESULTS: adolescents aged 10 to 17 years had a smaller uterine volume than women aged 20 to 40 years (p 0.05). CONCLUSION: adolescents less than 18 years old or primiparous have a smaller uterine volume than women between 20 to 40 years old. However, adolescents aged 18 years or older, or secundipara, have a uterine volume similar to that of women aged 20 to 40 years.