New Definition of Fetal Growth Restriction: Consensus Regarding a Major Obstetric Complication

Univ Fed Sao Paulo, Escola Paulista Med, Dept Obstet, Rua Belchior de Azevedo 156,Apto 111, BR-05089030 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Obstet, Rua Belchior de Azevedo 156,Apto 111, BR-05089030 Sao Paulo, SP, BrazilWeb of Scienc

Histomorphometry and detection of glycosaminoglycans in the endocervical epithelium of pregnant rats after local administration of hyaluronidase

Objective: The aim of the study was to detect the presence of glycosaminoglycans and to investigate histomorphometric aspects of the endocervical epithelium in pregnant rats after local administration of hyaluronidase. Materials and methods: Ten pregnant rats were randomly distributed into two groups. On day 18 of pregnancy, 1mL of distilled water and 0.02 mL of hyaluronidase were administered to the control group (CG) and the study group (SG), respectively. On day 20 the rats were sacrificed, followed by dissection and removal of the uterine cervix, which was prepared for histomorphometry (endocervical epithelium thickness and leucocyte infiltration) and for immunohistochemistry with alcian blue reaction and its respective blockers. The paired Student t test was used to compare the groups. Results: The SG was characterized by reduced epithelial thickness (mean: 291.01±71.1 vs. 764.30±50.94;

Distensibility and Strength of the Pelvic Floor Muscles of Women in the Third Trimester of Pregnancy

Objective. the objective of this study was to compare the role of the pelvic floor muscles between nulliparous and multiparous women in the third trimester of pregnancy, by analyzing the relationship between electrical activity (surface electromyography-EMG), vaginal palpation (modified Oxford scale), and perineal distensibility (Epi-no). Methods. This was an observational cross-sectional study on a sample of 60 healthy pregnant women with no cervical dilation, single fetus, gestational age between 35 and 40 weeks, and maternal age ranging from 15 to 40 years. the methods used were bidigital palpation (modified Oxford scale, graded 05), surface EMG(electrical activity during maximal voluntary contraction), and perineal distensibility (Epi-no device). the Pearson correlation coefficient (r) was used to analyze the Epi-no values and the surface EMG findings. the Kruskal-Wallis test was used to compare the median values from surface EMG and Epi-no, using the modified Oxford scale scores. Results. Among the 60 patients included in this study, 30 were nulliparous and 30 multiparous. the average maternal age and gestational age were 26.06 (+/- 5.58) and 36.56 (+/- 1.23), respectively. It was observed that nulliparous women had both higher perineal muscle strength (2.53 +/- 0.57 versus 2.06 +/- 0.64;P = 0.005) and higher electrical activity (45.35 +/- 12.24.. V versus 35.79 +/- 11.66 mu V;P = 0.003), while among the multiparous women, distensibility was higher (19.39 +/- 1.92 versus 18.05 +/- 2.14;P = 0.013). We observed that there was no correlation between perineal distensibility and electrical activity during maximal voluntary contraction(r = -0.193;p - 0.140). However, we found a positive relationship between vaginal palpation and surface electromyography (P = 0.008), but none between Epi-no values (P = 0.785). Conclusion. the electrical activity and muscle strength of the pelvic floor muscles of the multiparous women were damaged, in relation to the nulliparous women, while the perineal distensibility was lower in the latter group. There was a positive relationship between surface EMG and the modified Oxford scale.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Fed Univ São Paulo UNIFESP, Dept Obstet, BR-05303000 Vila Leopoldina, SP, BrazilUniv Fed Uberlandia, Fac Phys Educ & Physiotherapy, BR-38400 Uberlandia, MG, BrazilFed Univ São Paulo UNIFESP, Dept Obstet, BR-05303000 Vila Leopoldina, SP, BrazilFAPESP: 2011/18731-6Web of Scienc

Assessing the Impact of Twin Pregnancies on the Pelvic Floor Using 3-Dimensional Sonography A Pilot Study

Objectives-The purpose of this study was to compare the morphologic characteristics of the pelvic floor musculature between women with twin and singleton pregnancies.Methods-We conducted a cross-sectional case-control study of 40 nulliparous women aged 20 to 38 years to compare women with singleton pregnancies (n = 23) to women with twin pregnancies (n = 17). Biometric measurements of the levator hiatus and the sagittal and coronal diameters were made by transperineal 3-dimensional sonography between the 28th and 38th gestational weeks. Comparisons were statistically assessed by the unpaired Student t test and Mann-Whitney U test.Results-For the women with singleton pregnancies, the mean sagittal diameters at rest, during the Valsalva maneuver, and during pelvic floor contraction were 5.3, 5.7, and 4.5 cm, respectively, and the mean coronal diameters under these conditions were 3.8, 4.1, and 3.6 cm. for the women with twin pregnancies, the corresponding values were as follows: mean sagittal diameters, 5.3, 5.8, and 4.6 cm; and mean coronal diameters, 4.3, 4.3, and 3.8 cm. the differences in coronal diameters were statistically significant at rest (P < .01) and during contraction (P = .04). the mean levator hiatal areas for the women with singleton pregnancies were 14.6, 16.9, and 11.7 cm(2) at rest, during Valsalva, and during contraction, respectively; for the women with twin pregnancies, these values were 16.0, 18.6, and 12.6 cm(2).Conclusions-Hiatal measurements were higher in twin than in singleton pregnancies, with coronal diameters reaching significance at rest and during contraction, suggesting that pelvic support undergoes greater changes during twin pregnancy.Universidade Federal de São Paulo, Dept Obstet, Pelv Floor Sect, BR-05303000 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Obstet, Pelv Floor Sect, BR-05303000 São Paulo, BrazilWeb of Scienc

Assessment of fetal malformations in the first trimester of pregnancy by three-dimensional ultrasonography in the rendering mode. Pictorial essay.

We present our experience in the contribution of three-dimensional ultrasonography, using the rendering mode, to the prenatal diagnosis of congenital anomalies including neurological defects (acrania/anencephaly, encephalocele, holoprosencephaly), facial anomalies (cyclopia and facial clefts), abdominal wall defects (omphalocele and gastroschisis) and defects of extremities (fetal muscle-skeletal dysplasias). Three-dimensional ultrasonography may contribute to improve the prenatal diagnosis with further revision of the fetal images, allowing a better prenatal counsel to the parents

Prenatal Diagnosis of Galen Vein Aneurysm Using Ultrasonography and Magnetic Resonance Imaging and Perinatal and Long-Term Neurological Outcomes: A Case Series

Objective To describe the prenatal diagnosis of Galen vein aneurysm (GVA) based on ultrasonography and magnetic resonance imaging (MRI) in a series of cases, as well as its postnatal outcomes and follow-up until 4 years of age. Methods A retrospective longitudinal study was performed, analyzing a database comprising seven cases of prenatal diagnosis of GVA at two Brazilian institutions from February of 2000 to May of 2012. The following data were evaluated: gestational age at diagnosis, GVA dimensions on ultrasonography, associated fetal changes, findings on fetal echocardiography, gestational age at delivery, type of delivery, birth weight, Apgar score at the 1st and 5th minutes, neonatal outcomes, and survival with follow-up until 4 years of age. Results The mean gestational age +/- standard deviation on the prenatal diagnosis of GVA based on ultrasonography was 25 +/- 4.9 weeks. The mean length of GVA was 3.2 +/- 0.4 cm. The mean gestational age at birth was 37.5 +/- 0.7 weeks, and a cesarean section was per of age and only one showed serious neurological sequelae. Ultrasonography and MRI showed similar findings for all seven cases. Conclusions Galen Vein Aneurysm is associated with a high neonatal death rate. Therefore, its prenatal diagnosis is essential for parent counseling and follow-up at tertiary care institutions.formed in 85.7% of the cases (6/7). The mean birth weight was 3,070 +/- 240.4 g. The total survival rate was 42.8% (4/7), with three neonatal deaths. Of the four survivors, three presented with normal neuropsychomotor development until 4 yearsUniv Pernambuco, Dept Obstet & Gynecol, Recife, PE, BrazilReal Hosp Portugues Beneficencia Pernambuco, Recife, PE, BrazilClin Diagnost Imagem, Rio De Janeiro, RJ, BrazilFac Med Sao Jose do Rio Preto, Sao Jose Do Rio Preto, SP, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Obstet, Rua Belchior de Azevedo 156,Apto 111, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Obstet, Rua Belchior de Azevedo 156,Apto 111, Sao Paulo, SP, BrazilWeb of Scienc