RESUMO
OBJECTIVES: To examine and compare the reproducibility of measurement of first- and second-trimester uterine artery pulsatility index (UtA-PI) using transabdominal (TAS) and transvaginal (TVS) ultrasound. METHODS: This was an observational study including women ≥ 18 years of age, with a singleton pregnancy, in the first trimester (between 11 + 0 and 13 + 6 weeks' gestation) or second trimester (between 20 and 26 weeks' gestation). UtA-PI and angle of insonation were assessed by two observers (one with 15 and the other with 3 years of experience) using both TAS and TVS. The more experienced observer performed two scans alternated by the other observer. The acquisitions were completely independent and the observers were blinded to each other and to their own measurements. Reproducibility of the measurements by TVS and TAS was assessed using the concordance correlation coefficients (CCCs), intraclass correlation coefficients (ICCs) and limits of agreement (LoA). RESULTS: We analyzed data from 97 women in the first trimester and 96 in the second trimester. The mean ± SD UtA-PI was significantly higher when measured using TVS, compared with TAS, in both the first (1.60 ± 0.49 vs 1.52 ± 0.63, respectively; P = 0.03) and second (1.07 ± 0.33 vs 0.96 ± 0.32, respectively; P < 0.001) trimesters. The median angle of insonation was significantly lower when using TVS, compared with TAS, in both the first (8.0° (interquartile range (IQR), 2.5-16.3°) vs 12.5° (IQR, 2.5-20.0°), respectively; P = 0.04) and second (10.0° (IQR, 4.5-16.5°) vs 17.5° (IQR, 5.0-27.9°), respectively; P < 0.001) trimesters. Both ultrasound techniques had similar reproducibility: the intraobserver CCC ranged from 0.93 to 0.95 and the interobserver CCC ranged from 0.81 to 0.86; and the ICCs of both techniques were highly comparable (the intraobserver LoA was approximately ± 20-30% and the interobserver LoA was approximately ± 30-40%). CONCLUSIONS: When measuring UtA-PI, assessment by TVS provides higher values and better insonation angle compared with TAS. The reproducibility of the ultrasound methods in both first and second trimesters of pregnancy was comparable and should not be considered as good. Future studies examining technical improvements with the aim of increasing the reproducibility of this technique should be encouraged.
Assuntos
Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Fluxo Pulsátil , Ultrassonografia Doppler , Ultrassonografia Pré-Natal , Artéria Uterina/fisiologia , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Idade Gestacional , Humanos , Gravidez , Valores de Referência , Reprodutibilidade dos Testes , Artéria Uterina/diagnóstico por imagemRESUMO
Limited evidence is available regarding antiretroviral (ARV) safety for uninfected infants exposed to these drugs in utero. Our objective was to determine if ARV administered to pregnant women is associated with decreasing umbilical arterial pH and base excess in uninfected infants. A prospective study was conducted on 57 neonates divided into three groups: ZDV group, born to mothers taking zidovudine (N = 20), triple therapy (TT) group, born to mothers taking zidovudine + lamivudine + nelfinavir (N = 25), and control group (N = 12), born to uninfected mothers. Umbilical cord blood was used to determine umbilical artery gases. A test was performed to calculate the sample by comparing means by the unpaired one-tailed t-test, with alpha = 0.05 and beta = 20%, indicating the need for a sample of 18 newborn infants for the study groups to detect differences higher than 20%. The control and ARV groups were similar in gestational age, birth weight, and Apgar scores. Values of pH, pCO2, bicarbonate, and base excess in cord arterial blood obtained at delivery from the newborns exposed to TT were 7.23, 43.2 mmHg, 19.5 mEq/L, and -8.5 nmol/L, respectively, with no significant difference compared to the control and ZDV groups. We conclude that intrauterine exposure to ARV is not associated with a pathological decrease in umbilical arterial pH or base excess. While our data are reassuring, follow-up is still limited and needs to be continued into adulthood because of the possible potential for adverse effects of triple antiretroviral agents.
Assuntos
Equilíbrio Ácido-Base/efeitos dos fármacos , Fármacos Anti-HIV/uso terapêutico , Sangue Fetal/química , Infecções por HIV/tratamento farmacológico , Adulto , Fármacos Anti-HIV/efeitos adversos , Estudos de Casos e Controles , Quimioterapia Combinada , Feminino , Infecções por HIV/sangue , Humanos , Concentração de Íons de Hidrogênio/efeitos dos fármacos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Lamivudina/efeitos adversos , Lamivudina/uso terapêutico , Nelfinavir/efeitos adversos , Nelfinavir/uso terapêutico , Gravidez , Resultado da Gravidez , Estudos Prospectivos , Zidovudina/efeitos adversos , Zidovudina/uso terapêuticoRESUMO
Limited evidence is available regarding antiretroviral (ARV) safety for uninfected infants exposed to these drugs in utero. Our objective was to determine if ARV administered to pregnant women is associated with decreasing umbilical arterial pH and base excess in uninfected infants. A prospective study was conducted on 57 neonates divided into three groups: ZDV group, born to mothers taking zidovudine (N = 20), triple therapy (TT) group, born to mothers taking zidovudine + lamivudine + nelfinavir (N = 25), and control group (N = 12), born to uninfected mothers. Umbilical cord blood was used to determine umbilical artery gases. A test was performed to calculate the sample by comparing means by the unpaired one-tailed t-test, with a = 0.05 and ß = 20 percent, indicating the need for a sample of 18 newborn infants for the study groups to detect differences higher than 20 percent. The control and ARV groups were similar in gestational age, birth weight, and Apgar scores. Values of pH, pCO2, bicarbonate, and base excess in cord arterial blood obtained at delivery from the newborns exposed to TT were 7.23, 43.2 mmHg, 19.5 mEq/L, and -8.5 nmol/L, respectively, with no significant difference compared to the control and ZDV groups. We conclude that intrauterine exposure to ARV is not associated with a pathological decrease in umbilical arterial pH or base excess. While our data are reassuring, follow-up is still limited and needs to be continued into adulthood because of the possible potential for adverse effects of triple antiretroviral agents.
Assuntos
Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Equilíbrio Ácido-Base/efeitos dos fármacos , Fármacos Anti-HIV/uso terapêutico , Sangue Fetal/química , Infecções por HIV/tratamento farmacológico , Fármacos Anti-HIV/efeitos adversos , Estudos de Casos e Controles , Quimioterapia Combinada , Infecções por HIV/sangue , Concentração de Íons de Hidrogênio/efeitos dos fármacos , Transmissão Vertical de Doenças Infecciosas , Lamivudina/efeitos adversos , Lamivudina/uso terapêutico , Nelfinavir/efeitos adversos , Nelfinavir/uso terapêutico , Resultado da Gravidez , Estudos Prospectivos , Zidovudina/efeitos adversos , Zidovudina/uso terapêuticoRESUMO
OBJECTIVE: To assess peak systolic velocity values in middle cerebral artery (PSMCA) of normal fetuses from 22nd to 38th week of gestation. MATERIAL AND METHODS: We made a prospective study of 33 healthy fetuses from 22nd to 38th to determine peak systolic velocity by Doppler velocimetry. Doppler ultrasound was performed by a single observer, always using the same apparatus. The Doppler tracing was obtained with a sample volume of 1 mm; placement was on the anterior middle cerebral artery, as close as possible to the skullcap. The insonation angle was kept below 20 degrees and the wall filter was adjusted to a frequency of 50-100 Hz. The PSMCA increases from 26.3 cm/s to 57.7 cm/s in middle cerebral artery from 22nd to 38th week of gestation (p < 0.05). There was a significant positive correlation between PSMCA and the gestational values (p < 0.001, r2 = 60.5%). CONCLUSION: In normal fetuses, the PSMCA increases from 22nd to 38th week of gestation. The Doppler velocimetry values for normal fetuses could be compared with those obtained during fetal anemia.
Assuntos
Feto/irrigação sanguínea , Artéria Cerebral Média/fisiologia , Análise de Variância , Velocidade do Fluxo Sanguíneo/fisiologia , Idade Gestacional , Humanos , Fluxometria por Laser-Doppler , Artéria Cerebral Média/diagnóstico por imagem , Variações Dependentes do Observador , Estudos Prospectivos , Reologia/métodos , Sístole , Ultrassonografia Doppler de PulsoRESUMO
Os autores abordam os diversos parametros ecograficos utilizados no diagnostico do retardo de crescimento intra-uterino, salientando a medida seriada do diametro biparietal e a determinacao do peso fetal.Finalmente, ressaltam o importante papel da ecografia no diagnostico e na orientacao terapeutica desta sindrome clinica