Caroline Mombaque dos Santos

Efeito do exercício físico sobre os parâmetros hemodinâmicos fetais

PURPOSE To assess the effects of aerobic physical exercise on the Doppler velocimetry of fetal vessels in pregnant women with no clinical or obstetrical complications. METHODS A cross-sectional study was conducted on 10 healthy low-risk pregnant women at 2 different gestational times: between the 26th and 29th week and 6 days, and at the end of pregnancy, between the 30th and 35th week. The patients were submitted to aerobic physical exercise on a treadmill until reaching fatigue. Ultrasonographic data were obtained at rest and after physical exercise (Doppler velocimetry indices for the umbilical artery, middle cerebral artery, ductus venosus, and uterine arteries). Data were analyzed statistically by the paired and independent Students t-test using the Statistical Package for the Social Sciences (SPSS) package, version 21.0. RESULTS A change in the pulsatility index was observed, with an indication of vasodilatation, with a median value of 1.1±0.1 before exercise and of 1.0±0.1 after exercise; the median value of the resistance index was 0.7±0.04 before exercise and 0.6±0.07 after exercise. The median systole/diastole ratio of the umbilical artery was 3.1±0.4 before exercise and 2.9±0.2 (p=0.03) after exercise at the beginning of pregnancy. No changes in the Doppler velocimetry parameters were observed for the uterine arteries, the middle cerebral artery or the ductus venosus after physical activity at either testing time. Paired analysis of pre- and post-activity data showed a reduction of resistance from the first to the second period (p<0.04). CONCLUSIONS Physical exercise does not lead to changes in systemic blood flow or fetal-placental flow in healthy pregnant women, confirming that exercises of mild to moderate intensity can be prescribed.

Pregnancy in Non-Communicating Unicornuate Uterus: Diagnosis Difficulty and Outcomes – a Case Report

Approximately 1 in every 76,000 pregnancies develops within a unicornuate uterus with a rudimentary horn. Müllerian uterus anomalies are often asymptomatic, thus, the diagnosis is a challenge, and it is usually made during the gestation or due to its complications, such as uterine rupture, pregnancy-induced hypertension, antepartum, postpartum bleeding and intrauterine growth restriction (IUGR). In order to avoid unnecessary cesarean sections and the risks they involve, the physicians should consider the several approaches and for how long it is feasible to perform labor induction in suspected cases of pregnancy in a unicornuate uterus with a rudimentary horn, despite the rarity of the anomaly. This report describes a case of a unicornuate uterus in which a pregnancy developed in the non-communicating rudimentary horn and the consequences of the delayed diagnosis.

Prenatal diagnosis of osteogenesis imperfecta type 2: case report

Objetivos: Descrever um caso de diagnostico pre-natal da forma letal de osteogenese imperfeita. Descricao do caso: Uma gestante de 26 anos, de cor negra, casada, do lar, previamente higida, em sua terceira gestacao, foi encaminhada com idade gestacional de 29 semanas e cinco dias ao Servico de Medicina Fetal do Hospital Universitario de Santa Maria devido a hipotese de crescimento intrauterino restrito. A ultrassonografia obstetrica complementada pela ressonância magnetica permitiu o diagnostico de osteogenese imperfeita tipo 2, com crescimento intrauterino restrito, peso fetal abaixo do percentil 3 e deformidades osseas importantes. A gestante foi submetida a cesariana com 33 semanas de idade gestacional. O recem-nascido, com peso de 1.120 g, foi a obito por insuficiencia respiratoria logo apos o nascimento. Conclusoes: A osteogenese imperfeita e uma doenca do tecido conjuntivo que cursa com formas letais e nao letais, e o diagnostico por imagem no pre-natal possibilita o aconselhamento familiar quanto ao prognostico e a programacao para o parto. O relato deste caso e importante para a comunidade cientifica, visando ao apoio no manejo de casos semelhantes.Objetivos: Descrever um caso de diagnostico pre-natal da forma letal de osteogenese imperfeita. Descricao do caso: Uma gestante de 26 anos, de cor negra, casada, do lar, previamente higida, em sua terceira gestacao, foi encaminhada com idade gestacional de 29 semanas e cinco dias ao Servico de Medicina Fetal do Hospital Universitario de Santa Maria devido a hipotese de crescimento intrauterino restrito. A ultrassonografia obstetrica complementada pela ressonância magnetica permitiu o diagnostico de osteogenese imperfeita tipo 2, com crescimento intrauterino restrito, peso fetal abaixo do percentil 3 e deformidades osseas importantes. A gestante foi submetida a cesariana com 33 semanas de idade gestacional. O recem-nascido, com peso de 1.120 g, foi a obito por insuficiencia respiratoria logo apos o nascimento.Conclusoes: A osteogenese imperfeita e uma doenca do tecido conjuntivo que cursa com formas letais e nao letais, e o diagnostico por imagem no pre-natal possibilita o aconselhamento familiar quanto ao prognostico e a programacao para o parto. O relato deste caso e importante para a comunidade cientifica, visando ao apoio no manejo de casos semelhantes. Aims: To describe a case of prenatal diagnosis of the lethal form of osteogenesis imperfecta.Case description: A 26 year-old pregnant woman, black, married, housewife, previously healthy, in her third pregnancy, was referred with 29 weeks and five days of gestation to the Fetal Medicine Service of the University Hospital of Santa Maria, due to hypothesis of intrauterine growth restriction. Obstetric ultrasound, complemented by magnetic resonance, allowed the diagnosis of osteogenesis imperfecta type 2, with intrauterine growth restriction, fetal weight below the 3rd percentile and major bone deformities. The patient underwent a cesarean section at 33 weeks and four days of gestation. The newborn infant, weighting 1120 g, died due to respiratory failure immediately after birth.Conclusions: Osteogenesis imperfecta is a connective tissue disease that courses with lethal and nonlethal forms, and prenatal diagnostic imaging enables family counseling regarding prognosis and programming the type of delivery. Reporting this case is important to the scientific community, in order to support the management of similar cases.

ALTERAÇÕES HEMODINÂMICAS MATERNAS E REPERCUSSÕES FETAIS APÓS EXERCÍCIO FÍSICO EM GESTANTES – NOTA PRÉVIA

Objetivo: avaliar as alteracoes metabolicas maternas bem como as repercussoes fetais ao estudo Doppler e a cardiotocografia em gestantes de baixo risco submetidas a exercicio fisico aerobico. Metodo: pesquisa longitudinal experimental a ser realizada com gestantes higidas entre a 26 e 34 semanas gestacionais, avaliando parâmetros hemodinâmicos maternos e fetais pre e pos exercicio fisico em esteira. Resultados Esperados: nao evidenciar alteracoes maternas e/ou fetais apos a atividade aerobica, garantindo maior seguranca na prescricao dessa durante o periodo gestacional.

Antenatal diagnosis of unilateral congenital cystic adenomatoid malformation associated with Taussig-Bing syndrome: case report

Aims: To report a rare case of antenatal diagnosis of unilateral congenital cystic adenomatoid malformation associated with Taussig-Bing syndrome. Case description: Patient aged 40 years, four pregnancies with three previous vaginal deliveries, black skin, married, housewife, without prior conditions, was referred to the Fetal Medicine Unit of the University Hospital of Santa Maria due to changes in the thoracic region of the fetus found in routine obstetric ultrasound examination performed at 30 weeks and three days of gestation. At the Doppler ultrasound assessment performed in the reference center, perimembranous ventricular septal defect and transposition of the great vessels were found, characterizing the Taussig-Bing syndrome. Additionally, a unilateral pulmonary congenital cystic adenomatoid malformation type 2 was found. The medical staff decided by a cesarean delivery in a referral center for cardiology, with 37 weeks of gestation. The neonate, weighing 3 kg, presented since the first hours acute respiratory distress with severe cyanosis, and underwent lobectomy. The neonate died within two weeks of life due to respiratory failure during the performance of a surgical procedure to correct the cardiac malformation. Conclusions: There is no description in the literature of association between Taussig-Bing syndrome and congenital cystic adenomatoid malformation. Early ultrasound diagnosis and monitoring in a Fetal Medicine unit is important for planning pre and post-natal interventions and family counseling by a multiprofessional team.

Efeito do exercício físico sobre os parâmetros hemodinâmicos

PURPOSE To assess the effects of aerobic physical exercise on the Doppler velocimetry of fetal vessels in pregnant women with no clinical or obstetrical complications. METHODS A cross-sectional study was conducted on 10 healthy low-risk pregnant women at 2 different gestational times: between the 26th and 29th week and 6 days, and at the end of pregnancy, between the 30th and 35th week. The patients were submitted to aerobic physical exercise on a treadmill until reaching fatigue. Ultrasonographic data were obtained at rest and after physical exercise (Doppler velocimetry indices for the umbilical artery, middle cerebral artery, ductus venosus, and uterine arteries). Data were analyzed statistically by the paired and independent Students t-test using the Statistical Package for the Social Sciences (SPSS) package, version 21.0. RESULTS A change in the pulsatility index was observed, with an indication of vasodilatation, with a median value of 1.1±0.1 before exercise and of 1.0±0.1 after exercise; the median value of the resistance index was 0.7±0.04 before exercise and 0.6±0.07 after exercise. The median systole/diastole ratio of the umbilical artery was 3.1±0.4 before exercise and 2.9±0.2 (p=0.03) after exercise at the beginning of pregnancy. No changes in the Doppler velocimetry parameters were observed for the uterine arteries, the middle cerebral artery or the ductus venosus after physical activity at either testing time. Paired analysis of pre- and post-activity data showed a reduction of resistance from the first to the second period (p<0.04). CONCLUSIONS Physical exercise does not lead to changes in systemic blood flow or fetal-placental flow in healthy pregnant women, confirming that exercises of mild to moderate intensity can be prescribed.