Assessment of ultrasound and Doppler parameters in the third trimester of pregnancy as predictors of adverse perinatal outcome in unselected pregnancies

Objectives: The aim of the study was to investigate ultrasound and Doppler parameters in the third trimester of pregnancy as possible predictors of adverse perinatal outcome in unselected pregnancies. Material and methods: We performed a retrospective cross-sectional study including unselected pregnant women be­tween 27 and 36 + 6 weeks of gestation. The following ultrasound and Doppler parameters were assessed: estimated fetal weight (EFW) [g], EFW percentile, placental maturity grade (Grannum classification), single vertical deepest pocket (SVDP) of amniotic fluid [cm], amniotic fluid index (AFI) [cm], mean uterine artery (UtA) pulsatility index (PI), umbilical artery (UA) PI, middle cerebral artery (MCA) PI, MCA peak systolic velocity (PSV) [cm/s], and cerebroplacental ratio (CPR). Adverse perinatal outcome was defined as Apgar score of < 7 at 1 min, birth weight of < 2500 g at delivery, and gestational age of < 37 weeks at delivery. The unpaired t test was used to compare the groups. Results: AFI (p = 0.01), mean UtA PI (p = 0.04) and mean UA PI (p = 0.03) were significantly different with regard to the Apgar score at 1 min. EFW, EFW percentile, SVDP of amniotic fluid, AFI, mean UtA PI, UA PI, and MCA PI were significantly different (p < 0.001) in terms of birth weight. Placental maturity grade (p = 0.02), SVDP of the amniotic fluid (p < 0.001), AFI (p < 0.001), mean UtA PI (p < 0.001), UA PI (p = 0.001), and MCA PI (p < 0.001) were significantly different as far as gestational age at delivery is concerned. Conclusion: Ultrasound and Doppler parameters may predict adverse perinatal outcomes in unselected pregnancies in the third trimester of pregnancy

Study protocol for the multicentre cohorts of Zika virus infection in pregnant women, infants, and acute clinical cases in Latin America and the Caribbean: The ZIKAlliance consortium

Background: The European Commission (EC) Horizon 2020 (H2020)-funded ZIKAlliance Consortium designed a multicentre study including pregnant women (PW), children (CH) and natural history (NH) cohorts. Clinical sites were selected over a wide geographic range within Latin America and the Caribbean, taking into account the dynamic course of the ZIKV epidemic. Methods: Recruitment to the PW cohort will take place in antenatal care clinics. PW will be enrolled regardless of symptoms and followed over the course of pregnancy, approximately every 4 weeks. PW will be revisited at delivery (or after miscarriage/abortion) to assess birth outcomes, including microcephaly and other congenital abnormalities according to the evolving definition of congenital Zika syndrome (CZS). After birth, children will be followed for 2 years in the CH cohort. Follow-up visits are scheduled at ages 1-3, 4-6, 12, and 24 months to assess neurocognitive and developmental milestones. In addition, a NH cohort for the characterization of symptomatic rash/fever illness was designed, including follow-up to capture persisting health problems. Blood, urine, and other biological materials will be collected, and tested for ZIKV and other relevant arboviral diseases (dengue, chikungunya, yellow fever) using RT-PCR or serological methods. A virtual, decentralized biobank will be created. Reciprocal clinical monitoring has been established between partner sites. Substudies of ZIKV seroprevalence, transmissio

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Análise Do Índice De Performance Miocárdica Modificado Do Ventrículo Esquerdo Fetal Durante A Realização De Cirurgia Fetal A Céu Aberto Para Correção De Mielomeningocele Nível

Objective: To Access Left Ventricle Modified Myocardial Performance Index (Mpi) During Open Fetal Surgery. Methods: Open Myelomeningocele Repair Was Performed In 37 Fetuses Between The 24th And 27th Week Of Gestation. Mpi-Mod Was Claculated At Specific Periods: Pre-Anesthesia (1), Post-Anesthesia (2), Neurosurgery (3a-Early Skin Manipulation, 3b- Spinal Cord Releasing And 3c- Sintesis), And End Of Surgery (4). Mean±Standard Deviation (Sd) Of Mpi And Its Related Times- Isovolumetric Contraction Time (Ict), Isovolumetric Relaxation Time (Irt) And Ejection Time (Et), Was Determined For Each Period. Anova With Repeated Measures Was Used To Assess Differences Among These Periods. Tukey Multiple Comparation Test Compared Global Surgery Stages. Results: The Mean±Sd Of Mpi In The Specific Time Points Were 0.32 (±0.06); 0.32 (±0.05); 0.34 (±0.05); 0.48 (±0.10); 0.36 (±0.06) E 0.32 (±0.05), Respectively (P<0.001). In The Two-Tailed Time Comparisons, Neurosurgery Stage Presents Mpi Highest Levels, Especially On Stage 3bObjetivo: Avaliar O Comportamento Do Índice De Performance Miocárdica (Ipm) Modificado Do Ventrículo Esquerdo Durante A Correção De Mielomeningocele (Mmc) A Céu Aberto. Métodos: Foi Realizado Estudo Com 37 Fetos Submetidos À Correção De Mielomeningocele A Céu Aberto Entre A Semana 24ª E 27ª De Gestação. O Ipm-Mod Foi Avaliado Em Períodos Específicos: Pré-Anestesia Materna (1), Pós-Anestesia Materna (2), Neurocirurgia (3a- Início Da Manipulação Da Pele; 3b- Liberação Das Raízes Nervosas E Da Medula Espinhal; 3c: Final) E Término Da Cirurgia (4). A Média ± Desvio Padrão (Dp) Do Ipm E Dos Tempos Relacionados Ao Seu Cálculo-Tempo De Contração Isovolumétrica (Tci), Tempo De Relaxamento Isovolumétrico (Tri) E Tempo De Ejeção (Te), Foram Determinados Para Cada Período. A Análise De Variância (Anova) Com Medidas Repetidas Foi Utilizada Para Avaliar Diferenças Entre Estes Estágios. A Fim De Comparar Diferentes Períodos Foi Utilizado O Teste De Comparações Múltiplas De Tukey. Resultados: A Média ± Dp Da Ipm Nos TemposDados abertos - Sucupira - Teses e dissertações (2018

Análise do comportamento da frequência cardaca fetal durante a realização de cirurgia a céu aberto para correção de mielomeningocele

Objective: To analyze fetal heart rate (FHR) monitoring during intrauterine myelomeningocele repair. Methods: A study was performed with 57 fetuses submitted to intrauterine myelomeningocele repair between 24th and 27th week of gestation. Evaluations of FHR were made at specific periods: pre-anesthesia (1); post-anesthesia (2); beginning of laparotomy (3); uterus abdominal withdrawal (4); hysterotomy / neurosurgery pre-incision (5a); early skin manipulation (5b); spinal cord releasing (5c) and neurosurgery end (5d); abdominal cavity reintroduction of the uterus (6); abdominal closure (7) and in the end of surgery (8). Mean±standard deviation (SD) of FHR were determinated for each period, and variance analysis (ANOVA) was used with repeated measures to assess differences among these stages. In order to compare different periods of fetal surgery, mean difference was assessed with confidence interval (CI) 95% and differences were analyzed by Tukey multiple comparison test. Results: Mean of FHR in the specific time points were 140.2 (1); 140 (2); 139.2 (3); 138.8 (4); 135.1 (5a); 133.9 (5b); 123.1 (5c); 134.0 (5d); 134.5 (6); 137.9 (7); 139.9 (8) bpm, respectively (p<0.0001). Comparing periods, the highest frequencies were observed in initial and final moments. Neurosurgery stage presents lower frequencies specially during release of spinal cord. Conclusion: FHR monitoring allows immediate diagnosis and action against hemodynamic disturbances, especially to fetal low frequencies observed during the neurosurgical correction of myelomeningocele, which was the most critical periodObjetivo: Avaliar o comportamento da frequência cardíaca fetal (FCF) durante a correção de mielomeningocele a céu aberto. Métodos: Foi realizado estudo com 57 fetos submetidos à correção de mielomeningocele a céu aberto entre a semana 24ª e 27ª de gestação. As avaliações de FCF foram feitas em períodos específicos: pré-anestesia (1); pós-anestesia (2); início da laparotomia (3); retirada do útero da cavidade abdominal (4); histerotomia / neurocirurgia pré-incisão (5a); início da manipulação da pele (5b); liberação da medula espinhal (5c) e final da neurocirurgia (5d); reintrodução uterina à cavidade abdominal (6); laparorrafia (7) e final da cirurgia (8). A média ± desvio padrão (DP) da FCF foram determinados para cada período, e a análise de variância (ANOVA) com medidas repetidas foi utilizada para avaliar diferenças entre esses estágios. A fim de comparar diferentes períodos da cirurgia fetal, foi avaliada a diferença média, com intervalo de confiança (IC) de 95% e utilizado o teste de comparações múltiplas de Tukey. Resultados: A média da FCF nos tempos específicos foram 140,2 (1); 140 (2); 139,2 (3); 138,8 (4); 135,1 (5a); 133,9 (5b); 123,1 (5c); 134,0 (5d); 134,5 (6); 137,9 (7); 139,9 (8) bpm, respectivamente (p<0,0001). Comparando os períodos, as maiores frequências foram observadas nos momentos iniciais e finais. O período neurocirúrgico apresentou as frequências mais baixas, especialmente durante a liberação da medula espinhal. Conclusão: O monitoramento contínuo da FCF permite a identificação e atuação imediata frente aos distúrbios hemodinâmicos, especialmente para a redução dos batimentos cardíacos fetais durante a correção neurocirúrgica da mielomeningocele, período este, considerado o mais crítico do procedimento.Dados abertos - Sucupira - Teses e dissertações (2013 a 2016