Eduardo Félix Martins Santana

Reference charts of fetal biometric parameters in 31,476 Brazilian singleton pregnancies.

The purpose of this study was to establish reference charts of fetal biometric parameters measured by 2‐dimensional sonography in a large Brazilian population.

Prenatally diagnosed fetal tumors of the head and neck: a systematic review with antenatal and postnatal outcomes over the past 20 years.

Abstract Aim: The aim of this study was to review prenatally diagnosed tumors of the head and neck in the fetus and to report antenatal and postnatal outcomes. Methods: PubMed/Medline, EMBASE/SCOPUS, Cochrane database and Google Scholar were reviewed over the last 20 years. No language or article type restriction was used. Results: A total of 1940 record were retrieved. Of the 713 records screened, 566 full-text articles were assessed for eligibility. After 445 articles were excluded for specified reasons, 111 studies met the research criteria and were included for qualitative analysis. Overall, 306 cases of fetal tumors of the head and neck were reviewed. Maternal age was an independent factor. The mean maternal age was 28.2 years and gestational age at prenatal diagnosis was 27.1 weeks. Conventional 2D ultrasound was the standard diagnostic procedure in 27.9% of cases and was implemented in 27.3% of cases by 3D ultrasound and fetal magnetic resonance imaging (MRI). Diagnostic evaluation of intracranial spreading and high-airway obstructions was greatly enhanced by fetal MRI. The more common type of fetal tumor was hemangioma/lymphangioms (42.1%), followed by teratomas (29.7%), tumors of the gingiva (10.1%) and lymphatic venous malformations (9.1%), respectively. Fetal karyotyping was performed only in 9.8% of cases; within fetuses undergoing karyotype, chromosomal abnormalities accounted for 20% of cases. The most common pregnancy complication was polyhydramnios (26.3%). Ex utero intrapartum treatment (EXIT) procedure was performed in 30.1% of cases while surgical excision was used in 22.9% during postnatal life. The survival rate was 35.35%. Conclusion: Fetal tumors of the head and neck are rare congenital malformations. Two-dimensional ultrasound is diagnostic in almost all cases; however, MRI may be an important diagnostic adjunct in targeted cases and help patient selection for immediate intubation at the time of delivery. EXIT procedure and surgical removal of the tumor was associated with good prognosis.

Assessment of embryo/fetus during pregnancy by threedimensional ultrasonography using the HD live software: iconographic essay.

Fetal development is studied since the advent of two-dimensional ultrasonography. However, a detailed assessment of structures and surfaces improved with three-dimensional ultrasonography. Currently, it is possible to identify embryonic components and fetal parts with greater detail, at all pregnancy trimesters, using the HD live software, where the images gain realistic features by means of appropriate control of lighting and shadowing effects. In the present study, the authors utilized this resource to follow-up, by means of images, the development of a normal pregnancy along all trimesters.

Fetal cardiac interventricular septum: volume assessment by 3D/4D ultrasound using spatio-temporal image correlation (STIC) and virtual organ computer-aided analysis (VOCAL)

Abstract Objective: To determine reference values for fetal interventricular septum (IVS) volume by 3D/4D ultrasound using spatio-temporal image correlation (STIC) and virtual organ computer-aided analysis (VOCAL). Methods: A prospective cross-sectional study was conducted on 200 consecutive normal low-risk pregnant women at a gestational age ranging from 18w0d to 33w6d. The volume data sets of the fetal heart were acquired by applying STIC to a four-chamber plane. IVS volume was calculated offline using VOCAL with rotation of 30° (six planes). To assess the correlation of fetal IVS volume as a function of gestational age (GA), Pearson’s correlation coefficient (r) and polynomial regression models with adjustments through the coefficient of determination (R2) were calculated. The intra-class coefficient (ICC) was used to evaluate intra- and inter-observer reproducibility. Results: A good correlation between GA and fetal IVS volume (r = 0.827) was observed. The mean fetal IVS volume ranged from 0.13 ± 0.03 cm3 (0.08–0.18 cm3) at 18wd0 of gestation to 1.33 ± 0.37 cm3 (0.41–1.98 cm3) at 33w6d. The best correlation between fetal IVS volume and GA was exponential: fetal IVS volume = 0.11e0.139×GA (R2 = 0.785). A good intra- and inter-observer reliability were observed, with ICC = 0.999 and 0.991, respectively. Conclusions: Reference values for fetal IVS volume using STIC and VOCAL by 3D/4D ultrasound between 18w0d and 33w6d of gestation were determined and showed to be reliable and concordant.

Simple approach based on maternal characteristics and mean arterial pressure for the prediction of preeclampsia in the first trimester of pregnancy

Abstract Aim: To propose a simple model for predicting preeclampsia (PE) in the 1st trimester of pregnancy on the basis of maternal characteristics (MC) and mean arterial pressure (MAP). Methods: A prospective cohort was performed to predict PE between 11 and 13+6 weeks of gestation. The MC evaluated were maternal age, skin color, parity, previous PE, smoking, family history of PE, hypertension, diabetes mellitus and body mass index (BMI). Mean arterial blood pressure (MAP) was measured at the time of the 1st trimester ultrasound. The outcome measures were the incidences of total PE, preterm PE (delivery <37 weeks) and term PE (delivery ≥37 weeks). We performed logistic regression analysis to determine which factors made significant contributions for the prediction of the three outcomes. Results: We analyzed 733 pregnant women; 55 developed PE, 21 of those developed preterm PE and 34 term PE. For total PE, the best model was MC+MAP, which had an area under the receiver operating characteristic curve (AUC ROC) of 0.79 [95% confidence interval (CI)=0.76–0.82]. For preterm PE, the best model was MC+MAP, with an AUC ROC of 0.84 (95% CI=0.81–0.87). For term PE, the best model was MC, with an AUC ROC of 0.75 (0.72–0.79). The MC+MAP model demonstrated a detection rate of 67% cases of preterm PE, with a false-positive rate of 10%, positive predictive value of 17% and negative predictive value of 99%. Conclusion: The MC+MAP model showed good accuracy in predicting preterm PE in the 1st trimester of gestation.

Perinatal outcomes from the use of antiepileptic drugs during pregnancy: a case-control study

Abstract Objective: To evaluate the perinatal results from epileptic women using antiepileptic drugs during prenatal care. Methods: This was a retrospective longitudinal study assessing the perinatal results of women exposed to antiepileptic drugs during pregnancy, and we compared these results with those of pregnant women who were not exposed. The development of pregnancy, gestational age at delivery, Apgar scores, biometric data, morbidity, stillbirths and neonatal mortality were analyzed. The chi-square test and Fisher’s exact test were used for the categorical variables, while Student’s t-test was used for independent numerical variables. Results: Over a 10-year period, 12 790 singleton gestations were analyzed, among which 104 (0.8%) consisted of epileptic pregnant women. From this total, 82 evolved to childbirth and their neonatal data were compared with those of 316 newborns from non-epileptic women. The most-used antiepileptic drug was phenobarbital in 70% of the cases. There was greater neonatal mortality (p = 0.006), occurrence of neonatal hemorrhagic disorders (p = 0.005), and occurrence of minor congenital anomalies (p = 0.03) among the children of women exposed to antiepileptic drugs. Conclusion: The antenatal exposure to antiepileptic drugs is associated mainly with occurrences of hemorrhagic complications during the neonatal period; furthermore, great prevalence of newborns presenting minor congenital anomalies and elevated risk of neonatal mortality.

Prenatal Diagnosis of Arthrogryposis as a Phenotype of Pena-Shokeir Syndrome using Two- and Three-dimensional Ultrasonography

Pena-Shokeir syndrome is a rare autosomal recessive disease, characterized by facial anomalies, arthrogryposis, polyhydramnios, fetal growth restriction, and pulmonary hypoplasia. This report describes the findings of this anomaly with two and three-dimensional ultrasound in a female in her 28th week of pregnancy, who was referred to us because the fetus presented arthrogryposis of unknown cause. These imaging methods allowed adequate evaluation of the fetal malformations and also enabled appropriate counseling of the couple.

Perinatal outcomes after open fetal surgery for myelomeningocele repair: a retrospective cohort study

Describe outcomes of open fetal surgery for myelomeningocele (MMC) repair in two Brazilian hospitals and the impact of surgical experience on outcome.

Fetal nuchal fold thickness measurement between 18 and 24 weeks of pregnancy: reference intervals for a Brazilian population

Abstract Objective: To determine reference intervals of fetal nuchal fold (NF) thickness measurement in the second trimester of pregnancy in a Brazilian population. Methods: This was a retrospective cross-sectional study with 2559 normal singleton pregnancies between 18 and 24 weeks of pregnancy. The fetal NF was obtained in the axial plane of fetal head at level of lateral ventricles including the cavum septum pellucidum, third ventricle, thalamus and transverse cerebellar diameter. The NF was measured posterior to the occipital bone, from the bone surface to the skin, including only soft tissue. To assess the correlation between fetal NF and gestational age (GA), polynomial equations were calculated and adjusted to determination coefficient (R2). Results: The mean fetal NF ranged from 3.98 ± 1.14 mm at 18 − 18 + 6 to 4.83 ± 0.93 mm at 24 − 24 + 6 weeks of gestation. A good correlation was observed between fetal NF and GA, which is better represented by a linear equation: NF = 1.055 + 0.158*GA (R2 = 0.06). Conclusion: Reference intervals of fetal NF thickness measurement in the second trimester of pregnancy were determined for a Brazilian population.

Association of Progesterone, Pessary, and Antibiotic for Treating Pregnant Woman with Short Cervix Syndrome: Importance of Magnetic Resonance Imaging in the Assessment of Pessary Position

Preterm delivery (PD) is the most important cause of neonatal mortality, particularly before the 32nd week of pregnancy. A short cervix is the most important quantitative marker for predicting PD. However, there are other qualitative markers such as cervical gland area, cervical funneling, and sludge. We present the case of a pregnant woman who was diagnosed with a short cervix at 14-weeks and demonstrate the use of triple therapy, which helped to achieve a good perinatal result. A 37-year-old pregnant woman (G3P0) was referred to our service at 14-weeks of pregnancy presenting with a short cervix (20 mm) and a positive sludge sign. She was hospitalized; a pessary was inserted, and started on antibiotic therapy (clindamycin and cefalotin for 10 days). At 20 weeks, she was again admitted to the hospital, and this time presented with a further shortened cervix (9 mm), cervical funneling, and a positive sludge sign, with the pessary in position. The following procedures were performed: Amniocentesis on the sludge (negative bacterioscopy), another cycle of antibiotics, administration of oral progesterone, and imaging to determine retention of pessary position. The patient was placed in the Trendelenburg position and remained hospitalized for 82 days. At 32 + 1 weeks, the fetus presented distress (tachycardia). C-section was performed, producing a live female newborn weighing 2,180 g and presenting Apgar indexes of 8/8. This case report demonstrates the importance of magnetic resonance imaging to assess the position of pessary in a pregnant woman with short cervix.