Prenatal Detection of Congenital Heart Diseases: One-Year Survey Performing a Screening Protocol in a Single Reference Center in Brazil

Objective. To describe the experience of a tertiary center in Brazil to which patients are referred whose fetuses are at increased risk for congenital heart diseases (CHDs). Methods. This was a cross-sectional observational study. The data was collected prospectively, during the year 2012, through a screening protocol of the fetal heart adapted from the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guideline. We performed a fetal echocardiogram screening for all pregnant women who were referred to the fetal cardiology outpatient obstetrics clinic of a university hospital. The exams were classified as normal or abnormal. The cases considered abnormal were undergone to a postnatal echocardiogram. We categorized the abnormal fetal heart according to severity in “complex,” “significant,” “minor,” and “others.” Results. We performed 271 fetal heart screening. The incidence of abnormal screenings was 9.96% (27 fetuses). The structural CHD when categorized due to severity showed 48.1% (n=13) of “complex” cases, 18.5% (n=5) “significant” cases, and 7.4% (n=2) “minor” cases. The most common referral reason was by maternal causes (67%) followed by fetal causes (33%). The main referral indication was maternal metabolic disease (30%), but there was just one fetus with CHD in such cases (1.2%). CHDs were found in 19/29 fetuses with suspicion of some cardiac abnormality by obstetrician (65.5%). Conclusion. We observed a high rate of CHD in our population. We also found that there was higher incidence of complex cases

Comparison of Fetal Nuchal Fold Thickness Measurements by Two- and Three-Dimensional Ultrasonography (3DXI Multislice View)

Purpose. To compare the measurements of fetal nuchal fold (NF) thickness by two-dimensional (2D) and three-dimensional (3D) ultrasonography using the three-dimensional extended imaging (3DXI). Methods. A cross-sectional study was performed with 60 healthy pregnant women with a gestational age between 16 and 20 weeks and 6 days. The 2D-NF measurements were made as the distance from the outer skull bone to the outer skin surface in the transverse axial image in the suboccipital-bregmatic plane of the head. For the 3D we employed the 3DXI multislice view software, in which 3 × 2 tomographic planes was displayed on the screen and the distance between the tomographic slices was 0.5 mm. Maximum, minimum, mean, and standard deviation were calculated for 2D and 3D ultrasonography, as well the maximum and minimum, mean, and standard deviation for the difference between both methods. The Wilcoxon signed-rank test was used to compare the two different techniques. Results. 2D-NF showed a mean of thickness of 3.52 ± 0.95 mm (1.69–7.14). The mean of 3D-NF was 3.90 ± 1.02 mm (2.13–7.72). The mean difference between the methods was 0.38 mm, with a maximum difference of 3.12 mm. Conclusion. The NF thickness measurements obtained by 3D ultrasonography were significantly larger than those detected with 2D ultrasonography

Clinical Study Prenatal Detection of Congenital Heart Diseases: One-Year Survey Performing a Screening Protocol in a Single Reference Center in Brazil

Objective. To describe the experience of a tertiary center in Brazil to which patients are referred whose fetuses are at increased risk for congenital heart diseases (CHDs). Methods. This was a cross-sectional observational study. The data was collected prospectively, during the year 2012, through a screening protocol of the fetal heart adapted from the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guideline. We performed a fetal echocardiogram screening for all pregnant women who were referred to the fetal cardiology outpatient obstetrics clinic of a university hospital. The exams were classified as normal or abnormal. The cases considered abnormal were undergone to a postnatal echocardiogram. We categorized the abnormal fetal heart according to severity in "complex, " "significant, " "minor, " and "others. " Results. We performed 271 fetal heart screening. The incidence of abnormal screenings was 9.96% (27 fetuses). The structural CHD when categorized due to severity showed 48.1% ( = 13) of "complex" cases, 18.5% ( = 5) "significant" cases, and 7.4% ( = 2) "minor" cases. The most common referral reason was by maternal causes (67%) followed by fetal causes (33%). The main referral indication was maternal metabolic disease (30%), but there was just one fetus with CHD in such cases (1.2%). CHDs were found in 19/29 fetuses with suspicion of some cardiac abnormality by obstetrician (65.5%). Conclusion. We observed a high rate of CHD in our population. We also found that there was higher incidence of complex cases

Curvas de referências do volume e da área das paredes dos ventrículos cardíacos fetais em diástole entre a 20ª e 33ª semana de gestação por meio da ultrassonografia 3d/4d/

To determine the reference ranges of the area and volume of the fetal ventricular walls between 20 and 33+6 weeks of gestation in rendering mode and virtual organ computer-aided analysis (VOCAL), respectively, by three-and four-dimensional ultrasound using the spatio-temporal image correlation (STIC) and perform data volumetric was aplicated in fetuses with confirmed moderate and/or complex congenital heart disease (CHD). METHODS: We conducted a prospective cross-sectional study of 371 fetuses between 20 and 33+6 weeks of gestation and 21 fetuses with moderate and/or complex CHD. The fetal heart was scanned using STIC modality, starting with the classic four-chamber view plane. We determined the area and volume of the cardiac ventricular walls by the rendering and Virtual Organ Computed-aided Analysis (VOCAL) modes, respectively. For the construction of reference intervals, we used linear regression model, adjusted by the determination coefficient (R²). For calculation of intra- and interobserver repeatability of both area and volume of the ventricular walls, we used Bland-Altman plots and intraclass correlation coefficient (ICC). RESULTS: There was a strong correlation between gestational age and ventricular wall area (R² = 0.66 for the right and R² = 0.66 for the left). The mean of the right and left ventricular wall area ranged from 0.86 ± 0.23 cm2 (0.50 ? 1.37 cm2) and 0.82 ± 0.20 cm2 (0.49 ? 1.30 cm2) at 20 weeks to 2.75 ± 0.69 cm2 (1.38 ? 4.18 cm2) and 2.49 ± 0.59 cm2 (1.33 ? 4.02 cm2) at 33 weeks, respectively. There was a strong correlation between gestational age and ventricular wall volume (R² = 0.62 for the right and R² = 0.64 for the left). The mean of the right and left ventricular wall area ranged from 0.92 ± 0.34 cm3 (0.37 ? 1.78 cm3) and 0.73 ± 0.22 cm3 (0.40 ? 1.18 cm2) at 20 weeks to 5.28 ± 1.91 cm3 (1.35 ? 9.89 cm3) and 4.37 ± 1.79 cm2 (1.97 ? 8.28 cm2) at 33 weeks, respectively. The inter- and intraobserver repeatability for the right and left ventricular wall area was excellent: ICC = 0.85 (confidence interval - CI95% 0.75 ? 0.91); 0.93 (CI95% 0.88 ? 0.96); 0.94 (CI95% 0.90 ? 0.97) and 0.95 (CI95% 0.90 ? 0.97), respectively. The inter-observer repeatability was excellent for the left ventricular wall volume with ICC = 0.91 (CI95% 0.85 ? 0.95) and the intra-observer repeatability was also excellent for the right and left volume of the ventricular wall with ICC= 0.90 (CI95% 0.81 ? 0.94) and 0.97 (CI95% 0.95 ? 0.98), respectively. We observed that the volumes of the right and left walls were altered (95th percentile) in 8 of the 21 fetuses (38.0%) with moderate and/or complex CHD. CONCLUSIONS: Reference ranges for the area and volume of the fetal ventricular walls were determined and showed good repeatability for the area. The volumetric repeatability of the ventricular wall was good for the intra-observer (right and left) and intra-observer for the left ventricle. The volumetric reference range was validated in fetuses with confirmed moderate and/or complex CHD and can be applied to different types of CHD.Dados abertos - Sucupira - Teses e dissertações (2013 a 2016

Periodontal Health Status and Associated Factors: Findings of a Prenatal Oral Health Program in South Brazil

Objective. The aims of this study were to evaluate the periodontal health of pregnant women and to investigate the association of periodontal status with demographic and socioeconomic characteristics, as well as medical and dental history. Materials and Methods. A total of 311 pregnant women were interviewed to obtain sociodemographic data along with medical and dental histories. Clinical examinations were performed to record the presence of visible plaque, gingival bleeding, and caries activity. The periodontal condition was evaluated by Community Periodontal Index of Treatment Needs (CPITN) in one tooth of each sextant (16, 11, 26, 36, 31, and 46). Results. After the adjustment analysis, the presence of visible plaque remained the main determinant of gingival bleeding (OR = 2.91, CI = 1.91–4.48). First-trimester pregnancy status was also a predictor, with a lower prevalence of gingival bleeding observed in the second (OR = 0.87, CI = 0.77–0.99) and third (OR = 0.82, CI = 0.73–0.93) trimesters. Conclusion. In pregnant women, the presence of dental plaque and first-trimester pregnancy status were the main implicated factors predicting gingival bleeding