Kleber Cursino de Andrade

Levonorgestrel-releasing intrauterine system (Mirena ® ) as a therapy for endometrial hyperplasia and carcinoma

Adenocarcinoma of the endometrium usually occurs in postmenopausal women. The diagnosis is habitually made during early stages of the disease. Hysterectomy, bilateral salpingo-oophorectomy and staging of the abdomen are the standard therapies. However, these surgical therapies are not feasible in all women because some of them do not present clinical conditions to undergo a surgical procedure. There are several case reports in which women with endometrial carcinoma or hyperplasia have been successfully treated with progestin alone as the primary therapy (1–5). Most cases were treated with medroxyprogesterone acetate (MPA) (1–5), and there were some reports in which a complete clinical remission of the disease was obtained and some women became pregnant after the therapy (1–5). Although MPA was used in exceptional cases, some authors are against this kind of therapy because of the associated risks, such as metastatic disease (6). The report aims to present two women with endometrial carcinoma and one with endometrial hyperplasia treated with the 20-mg/day levonorgestrel-releasing intrauterine system (LNG-IUS, Mirena, Leiras Oy, Turku, Finland).

Congenital hydrocephalus: gestational and neonatal outcomes

PurposeTo evaluate gestational and neonatal outcomes in pregnancies complicated by fetal hydrocephalus.MethodsRetrospective analysis of 287 cases of fetal hydrocephalus followed at the Fetal Medicine Unit of the University of Campinas in the period of 1996 to 2006.ResultsMean maternal age was 25 years, mean gestational age at diagnosis was 27 weeks. There were 50 cases of isolated ventriculomegaly, 95 cases of Chiari II malformation and 142 cases of ventriculomegaly associated with other malformations. Preterm delivery and vaginal delivery were more frequent in the group of ventriculomegaly associated with other malformations. Cardiac, skeletal and renal malformations were the most common associated malformations. Cesarean section was common (95%) in the Chiari II group. Fetal and neonatal death occurred more frequently (29 and 68%, respectively) in the group of ventriculomegaly associated with other malformations. Chromosomal anomalies were present in 15% of 165 investigated cases.ConclusionsFetal and neonatal prognosis and outcome are associated with the presence of associated anomalies and aneuploidy.

Non‐immune hydrops fetalis: A prospective study of 53 cases

Non‐immune hydrops fetalis (NIHF) is a symptom caused by a heterogeneous group of conditions. Diagnostic investigations may constitute a real challenge. This study aimed to evaluate prospectively and systematically a series of NIHF cases using a research protocol expanded for studying inborn errors of metabolism (IEM) during 2 years—2010 and 2011. We also reviewed the frequency of IEM among the NIHF reported in literature. A clinical or etiopathogenic diagnosis was reached in 46 (86.8%) of the 53 studied cases. The main diagnostic groups were chromosomal anomalies (28.3%), syndromic (18.9%), isolated cardiovascular anomaly (7.5%) and congenital infection (7.5%). Metabolic causes were found in 5.7%, all lysosomal storage disorders (LSD). In seven (13.2%), no diagnosis was found in part because of incomplete evaluation. The hydrops was identified prenatally in 90.5% of cases. In 5.7% a spontaneous and complete resolution of the hydrops occurred during pregnancy. Overall mortality was 75.5%. The IEM frequency in the present study (5.7%) was higher than that usually reported. We suggest performing studies directed to IEMs if the more common causes are excluded.

Body stalk anomaly: adverse maternal outcomes in a series of 21 cases

To evaluate the demographic characteristics of cases with body stalk anomaly (BSA) and describe the obstetric outcome.

Prenatal Genomic Profiling of Abdominal Wall Defects through Comparative Genomic Hybridization: Perspectives for a New Diagnostic Tool

Objectives: To describe the molecular analysis through comparative genomic hybridization (CGH) of fetuses with gastroschisis, and to observe if this technique could improve the resolution of the conventional cytogenetic techniques. Methods: Amniotic analysis of fetuses with gastroschisis, using both conventional (G-banding) and molecular (CGH) cytogenetics assays. Results: All of the seven fetuses studied displayed a normal G-band karyotype. Six fetuses displayed a normal disomic profile through CGH and one sample has displayed ish cgh enh 3q26→qter result (ICSN). The fetus with this imbalance of chromosome 3 was re-classified as a ruptured omphalocele, instead of gastroschisis, after birth. Conclusions: The molecular investigation through CGH technique can improve the resolution of the conventional karyotye analysis in cases of abdominal wall defects.

Prenatal diagnosis of isolated fetal cerebellar hemorrhage associated with maternal septic shock.

Fetal cerebellar hemorrhage is a rare prenatal event and is associated mainly with supratentorial hemorrhage. As an isolated event, it is even more infrequent and only 13 cases are reported in literature. Several etiologies have been described, and include vascular malformations and neoplasms, congenital infections, alloimmune thrombocytopenia and blood clotting abnormalities. Interestingly, three of the thirteen cases reported occurred in anemic fetuses that underwent intrauterine transfusions. A 19 year-old woman, gravida 1, was referred to our intensive care unit at 26 weeks’ gestation after a diagnosis of pyelonephritis and severe sepsis. She subsequently developed circulatory failure and needed high doses of noradrenaline to maintain blood pressure. She also developed respiratory distress syndrome and was maintained in mechanical ventilation for 6 days. On admission, a fetal ultrasound scan showed no abnormalities. At 32 weeks, a new scan showed cerebral ventriculomegaly (lateral atrium width of 18 mm) with no other detectable anomalies. A magnetic resonance imaging (MRI) was scheduled and showed an hypersignal on T2-weighted images in the left cerebellar hemisphere with water restriction on diffusion imaging. An ultrasound next showed a hyperchogenic lesion in the left hemisphere. Five weeks later, a new MRI was performed and showed hyposignaling in T2-weighted and volumetric decrease in the left cerebellar hemisphere, which could correspond to previous hemorrhagic infarct (Figure 1). In both MRI scans ventriculomegaly remained stable (lateral atrium width of 20 mm). There was no serological evidence for cytomegalovirus, rubella or toxoplasmosis. After full maternal recovery from sepsis, pregnancy evolved without any other complications. Vaginal delivery occurred at 39 weeks after normal labor. A newborn was delivered in good condition without any clinical signs of neurological impairment with 1 and 5 min Apgar scores of 8 and 9, respectively. Transfontanelar ultrasound confirmed ventriculomegaly

Evolução das Características Ecográficas da Placenta, da Posição e da Apresentação Fetal em Gestações Normais.

Purpose: to evaluate the ultrasound characteristics of normal pregnancies, according to the placental maturity, local of insertion and thickness, fetal presentation and position during the second half of pregnancy. Methods: a descriptive study was perfomed, including at least 120 measures in each gestational age, in 2,868 normal pregnant women from Campinas, Brazil, studied through routine obstetric ultrasound examinations, with fetal biometry and placental evaluation, applying Grannum, Berkowitz, Hobbins (1979) criteria for placental maturity. Placental thickness was measured at the cord insertion site. Results: grade 0 placentas were more frequent up to 31 weeks and grade I after 32 weeks. Grade II did not appear until 32 weeks and grade III was more frequent after 36 weeks. The placental thickness significantly increased with gestational age and the most frequent placental locations were anterior and posterior. The cephalic presentation was the most frequent all gestational ages, with only 1% of breech presentation at term. The most frequent fetal position was fetal spine left side, followed by right side. Conclusions: the studied factors showed a similar distribution to that expected for normal populations and could be used as a standard for the Brazilian population.

Effect of android fat distribution on thrombin‐activatable fibrinolysis inhibitor levels in women with polycystic ovary syndrome

Women with polycystic ovary syndrome (PCOS) often present with thromboembolic risk factors, such as obesity, hyperandrogenism, and insulin resistance [1]. Furthermore, some PCOS-related metabolic abnormalities represent cardiovascular risk factors. We aimed to assess the association between hemostatic parameters and clinical and dual-energy X-ray absorptiometry (DXA) measurements of fat distribution in these women. This article is protected by copyright. All rights reserved.

Micromass cultures are effective for differentiation of human amniotic fluid stem cells into chondrocytes

OBJECTIVES: Articular cartilage is vulnerable to injuries and undergoes an irreversible degenerative process. The use of amniotic fluid mesenchymal stromal stem cells for the reconstruction of articular cartilage is a promising therapeutic alternative. The aim of this study was to investigate the chondrogenic potential of amniotic fluid mesenchymal stromal stem cells from human amniotic fluid from second trimester pregnant women in a micromass system (high-density cell culture) with TGF-β3 for 21 days. METHODS: Micromass was performed using amniotic fluid mesenchymal stromal stem cells previously cultured in a monolayer. Chondrocytes from adult human normal cartilage were used as controls. After 21 days, chondrogenic potential was determined by measuring the expression of genes, such as SOX-9, type II collagen and aggrecan, in newly differentiated cells by real-time PCR (qRT-PCR). The production of type II collagen protein was observed by western blotting. Immunohistochemistry analysis was also performed to detect collagen type II and aggrecan. This study was approved by the local ethics committee. RESULTS: SOX-9, aggrecan and type II collagen were expressed in newly differentiated chondrocytes. The expression of SOX-9 was significantly higher in newly differentiated chondrocytes than in adult cartilage. Collagen type II protein was also detected. CONCLUSION: We demonstrate that stem cells from human amniotic fluid are a suitable source for chondrogenesis when cultured in a micromass system. amniotic fluid mesenchymal stromal stem cells are an extremely viable source for clinical applications, and our results suggest the possibility of using human amniotic fluid as a source of mesenchymal stem cells.

Reference Ranges for Ultrasonographic Measurements of the Uterine Cervix in Low-Risk Pregnant Women

Objective To define transvaginal ultrasound reference ranges for uterine cervix measurements according to gestational age (GA) in low-risk pregnancies. Methods Cohort of low-risk pregnant women undergoing transvaginal ultrasound exams every 4 weeks, comprising measurements of the cervical length and volume, the transverse and anteroposterior diameters of the cervix, and distance from the entrance of the uterine artery into the cervix until the internal os. The inter- and intraobserver variabilities were assessed with the linear correlation coefficient and the Student t-test. Within each period of GA, 2.5, 10, 50, 90 and 97.5 percentiles were estimated, and the variation by GA was assessed with analysis of variance for dependent samples. Mean values and Student t-test were used to compare the values stratified by control variables. Results After confirming the high reproducibility of the method, 172 women followed in this cohort presented a reduction in cervical length, with an increase in volume and in the anteroposterior and transverse diameters during pregnancy. Smaller cervical lengths were associated with younger age, lower parity, and absence of previous cesarean section (C-section). Conclusion In the studied population, we observed cervical length shortening throughout pregnancy, suggesting a physiological reduction mainly in the vaginal portion of the cervix. In order to better predict preterm birth, cervical insufficiency and premature rupture of membranes, reference curves and specific cut-off values need to be validated.