Antenatal Ultrasonographic Anteroposterior Renal Pelvis Diameter Measurement: Is It a Reliable Way of Defining Fetal Hydronephrosis?

Purpose. It was to quantify the intraobserver and interobserver variability of the sonographic measurements of renal pelvis and classify hydronephrosis severity. Methods. Two ultrasonographers evaluated 17 fetuses from 23 to 39 weeks of gestation. Renal pelvis APD were taken in 50 renal units. For intraobserver error, one of them performed three sequential measurements. The mean and standard deviation from the absolute and percentage differences between measurements were calculated. Bland-Altman plots were used to visually assess the relationship between the precision of repeated measurements. Hydronephrosis was classified as mild (5.0 to 9.9 mm), moderate (10.0 to 14.9 mm), or severe (≥15.0 mm). Interrater agreement were obtained using the Kappa index. Results. Absolute intraobserver variation in APD measurements was 5.2 ± 3.5%. Interobserver variation of ultrasonographers was 9.3 ± 9.7%. Neither intraobserver or interobserver error increased with increasing APD size. The overall percentage of agreement with the antenatal hydronephrosis diagnosis was 64%. Cohen's Kappa to hydronephrosis severity was 0.51 (95% CI, 0.33 to 0.69). Conclusion. Inter and intraobserver APD measurement errors were low in these group, but the agreement to hydronephrosis diagnosis and classification was fair. We suggest that standard and serial APD measurement can better define and evaluate fetal hydronephrosis

Análise multivariada dos fatores determinantes da mortalidade perinatal de fetos submetidos à transfusão sanguínea intrautero por anemia decorrente da isoimunização materna

Exportado OPUSMade available in DSpace on 2019-08-12T17:40:35Z (GMT). No. of bitstreams: 1 gabriel_costa_osanan.pdf: 383788 bytes, checksum: f0c8f8b8c597f457a5f336560873cee1 (MD5) Previous issue date: 9A isoimunização materna é a principal causa de anemia fetal no Brasil e constitui importante causa de morbi-mortalidade perinatal prevenível. Os fetos gravemente anêmicos necessitam de transfusões intrauterinas para melhorar seu prognóstico perinatal. Objetivo: verificar os fatores determinantes de mortalidade perinatal em fetos transfundidos. Pacientes e métodos: Trata-se de estudo de coorte, no qual foram seguidas 128 gestações complicadas pela isoimunização materna, cujos fetos receberam transfusão intrauterina, no CEMEFE-HC-UFMG, no período 1999-2009. Os fatores prognósticos de mortalidade perinatal estudados foram alocados em três categorias distintas: aqueles relacionados à prematuridade, os relacionados à anemia e os relacionados ao procedimento transfusional. Cada fator foi testadoindividualmente através da análise de regressão logística univariada. A seguir, utilizou-se uma variável significativa de cada uma destas categorias para realizar a análise multivariada. Foram obtidos os seguintes parâmetros para cada fator da equação: coeficiente de regressão, coeficiente de regressão padronizado (Z escore), o valor p, razão de chances e seu respectivo intervalo de confiança de 95%.Resultados: A taxa de mortalidade perinatal neste estudo foi de 18,1% sendo a maioria no período intra-útero. Os fatores escolhidos, após análise univariada, para compor a equação da análise multivariada foram: a idade gestacional ao nascimento (p < 0,0001), a presença de complicações secundárias ao procedimento (p < 0,0001) e o déficit de hemoglobina na última TIU (p = 0,001). À análise multivariada observou-se que todos os três parâmetros escolhidos foram significativos para determinação do óbito perinatal, na seguinte ordem de importância: idade gestacional do parto (coeficiente padrão -3,56; p < 0,0001), presença de complicação transfusional (coeficiente padrão 2,41; p =0,016) e déficit de hemoglobina na última cordocentese (coeficiente padrão 2,13; p = 0,033). Conclusão: O principal fator determinante da mortalidade perinatal em fetos transfundidos foi a prematuridade, representada pela idade gestacional ao nascimento. A presença de complicações transfusionais e a gravidade da anemiaforam também significativas como marcadores deste prognóstico.Isoimmunization is the main cause of fetal anemia in Brazil and it is an important cause of preventable perinatal mortality and morbidity.Objective: To determine prognostic factors of perinatal mortality in transfused fetuses. Patients and methods: It is a cohort study that followed 128 pregnancies complicated by maternal isoimmunization, in which their fetuses had to receive intrauterine transfusion at the CEMEFE-HC-UFMG, during the period of 1999-2009. The prognostic factors of perinatal mortality were allocated into three distinct categories: that related to prematurity, that related to fetal anemia and that related tothe IUT. Each prognostic factor was individually tested by the univariate analysis. Then, one significative variable of each category was selected to compose the multivariate analysis. In this analysis, it was obtained from each prognostic factor: Z score, p value, likelihood ratio and 95% confidence intervals. Results: The mortality rate found in this study was 18, 1%, and most of them occurred during the intrauterine period (17 out of 25). After the univariate analysis, the following factors were chosen to compose the multivariate analysis equation: the gestational age atbirth ( p<0,0001 ), the presence of intrauterine transfusion ( IUT ) complications ( p < 0,0001 ) and the hemoglobin deficit at the last IUT ( p = 0,001 ). The multivariate analysis indicated that all of these three parameters were significant to determine death in following order of importance: gestational age at birth (z score: -3,56; p< 0,0001) , presence IUT complications (z score: 2,41; p = 0,016) , and hemoglobin deficit at the last cordocentese ( z score: 2,13; p = 0,033). Conclusion: Prematurity,represented by gestational age at birth, was the most important factor to determine perinatal mortality in the group of transfused fetuses. IUT complications and the severity of fetal anemia at the last transfusion were also significant as an indicator of perinatal mortality prognosis

Avaliar a correlação entre a concentração da hemoglobina e a medida ecográfica do diâmetro biventricular externo em fetos anêmicos de gestantes isoimunizadas

OBJETIVO: Verificar se existe correlação significativa entre a medida ecográfica do diâmetro biventricular externo e a concentração sérica da hemoglobina fetal pré-transfusional e se essa medida ecográfica poderá vir a ser utilizada como marcador não invasivo da anemia fetal. MÉTODOS: Estudo transversal prospectivo, no qual foram selecionadas 65 cordocenteses realizadas em 36 fetos anêmicos de mães portadoras de isoimunização pelo fator Rh. Obteve-se a medida do diâmetro biventricular externo (DBVE), por meio do modo M, utilizando-se aparelho de ultra-som convencional. Anterior à transfusão foi obtida amostra de 0,5ml de sangue fetal, para dosagem da hemoglobina, sendo a medida imediatamente realizada através de espectrofotometria, no equipamento Hemocue®. Como análise estatística foi utilizada a regressão dos mínimos quadrados, aceitando-se p<0,05 e análise multivariada. RESULTADOS: Foram observadas correlação inversa entre a concentração da hemoglobina no sangue fetal no momento prévio à transfusão e a medida do DBVE e correlação direta entre a medida do DBVE e a idade gestacional, e, também, através da análise multivariada que, à medida que a concentração de hemoglobina fetal cai, o DBVE aumenta, independentemente da influência da idade gestacional nesse parâmetro. CONCLUSÃO: Existe correlação inversa entre a concentração da hemoglobina no sangue fetal e a medida do DBVE, independente da idade gestacional. Os achados sugerem que o DBVE poderá vir a ser um marcador ecográfico de predição do nível de hemoglobina de fetos de gestantes isoimunizadas

Diagnosis of Severe Fetal Anemia Based on Perinatal Outcomes: A Comparative Analysis of the Current Reference Values

Objectives. To compare current criteria for severe fetal anemia diagnosis. Methodology. A cohort study analyzed 105 alloimmunized fetuses that underwent cordocentesis due to risk of anemia. Concordance among the diagnostic criteria for severe fetal anemia, hemoglobin deficit >7 g/dL, hemoglobin deficit ≥5 g/dL, and hemoglobin concentration 7.0 g/dL and hemoglobin concentration 7.0 g/dL reference, and 0.77 (Kappa index, IC 95%: 0.64 to 0.90) when comparing hemoglobin deficit≥5.0 g/dL and hemoglobin concentration <0.55 MoM standards. Eighteen cases were classified differently depending on the criteria used. The cut-off point of hemoglobin deficit ≥5 g/dL was the best criterion to discriminate fetuses with poor perinatal outcome in our study. Conclusions. Relevant discordances in classification of severe fetal anemia were pointed out. Some criteria may underestimate the real gravity of fetal anemia

Uromodulin: a new biomarker of fetal renal function?

Abstract Introduction: Obstructive uropathies are main diseases affecting the fetus. Early diagnosis allows to establish the appropriate therapy to minimize the risk of damage to kidney function at birth. Biochemical markers have been used to predict the prognosis of renal function in fetuses. Uromodulin, also known by Tamm-Horsfall protein (THP) is exclusively produced in the kidneys and in normal conditions is the protein excreted in larger amounts in human urine. It plays important roles in kidneys and urinary tract. Also it participates in ion transport processes, interact with various components of the immune system and has a role in defense against urinary tract infections. Moreover, this protein was proved to be a good marker of renal function in adult patients with several renal diseases. Objective: To evaluate if uromodulin is produced and eliminated by the kidneys during fetal life by analyzing fetal urine and amniotic fluid and to establish correlation with biochemical parameter of renal function already used in Fetal Medicine Center at the Clinic Hospital of UFMG (CEMEFE/HC). Methods: Between 2013 and 2015, were selected 29 fetuses with indication of invasive tests for fetal diagnosis in monitoring at the CEMEFE/HC. Results: The determination of uromodulin was possible and measurable in all samples and showed statistically significant correlation with the osmolarity. Conclusion: There was a tendency of lower levels of Uromodulin values in fetuses with severe renal impairment prenatally. Thus, high levels of this protein in fetal amniotic fluid or fetal urine dosages possibly mean kidney function preserved