Obstetrícia
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- Severe hereditary spherocytosis and distal renal tubular acidosis associated with the total absence of band 3Publication . Ribeiro, ML; Alliosio, N; Almeida, H; Gomes, C; Texier, P; Lemos, C; Mimoso, G; Morlé, L; Bey-Cabet, F; Rudigoz, RC; Delaunay, J; Tamagnini, GAbsence of band 3, associated with the mutation Coimbra (V488M) in the homozygous state, caused severe hereditary spherocytosis in a young child. Although prenatal testing was made available to the parents, it was declined. Because the fetus stopped moving near term, an emergency cesarean section was performed and a severely anemic, hydropic female baby was delivered. She was resuscitated and initially kept alive with respiratory assistance and hypertransfusion therapy. Cord blood smears revealed erythroblastosis, poikilocytosis, and red cells with stalk-like elongations. Band 3 and protein 4.2 were absent; spectrin, ankyrin, and glycophorin A were significantly reduced. Renal tubular acidosis was detected by the age of 3 months. Nephrocalcinosis appeared soon thereafter. After 3 years of follow-up the child is doing reasonably well on a regimen that includes regular blood transfusions and daily bicarbonate supplements. The long-term prognosis remains uncertain given the potential for hematologic and renal complications.
- Immunocytochemical localization of endothelin-1 in human placenta from normal and preeclamptic pregnanciesPublication . Barros, JS; Bairos, VA; Baptista, MG; Fagulha, JOBJECTIVE: The aim of this study was to examine the distribution of endothelin-1 (ET-1) in the human placenta at different gestational ages and to determine whether differences in ET-1 immunoreactivity occurred in preeclamptic compared with uncomplicated pregnancies. METHODS: Localization of ET-1 was investigated by the immunoperoxidase technique in first-trimester, second-trimester, and term human placentas from normal pregnancies and in placentas from preeclamptic pregnancies. RESULTS: In normal placentas from all gestational ages studied, endothelin-1 immunoreactivity (ET-1 IR) was specifically detected in the endothelium of the fetal vessels and in the syncytiotrophoblast. ET-1 IR was also expressed by the villous cytotrophoblast of first- and second-trimester normal placentas. The extravillous cytotrophoblast of the basal and chorionic plates also exhibited ET-1 IR, but with varying degrees of intensity. In preeclamptic placentas, the expression of ET-1 IR was uneven with a negative staining in all placentas from pregnancies between the 29th and 32nd weeks of gestation. The expression of ET-1 IR was most intense in some syncytiotrophoblast tissue in the terminal villi after the 33rd week of gestation. In placentas from preeclamptic pregnancies between the 35th and the 36th weeks of gestation, strong ET-1 IR expression was evident in the endothelium of fetal vessels and in the syncytiotrophoblast. Regardless of gestational age, ET-1 IR was also observed in the extravillous cytotrophoblast of the basal and chorionic plates of preeclamptic placentas. CONCLUSION: This study demonstrates that ET-1 IR is widely distributed in the human placenta and provides further evidence to support the concept that ET-1 plays an important role as a modulator of vascular tone in the uteroplacental and fetoplacental units and may participate in the pathogenesis of preeclampsia.
- Diabetes e gravidez: passado, presente e futuroPublication . Fagulha, IAfter the discovery of insulin and during almost an half of a century, physicians and researchers apply their efforts in a better knowledge to reduce the perinatal mortality of the offspring of the diabetic mother. The optimisation of glucose control--the main key of the management of diabetic pregnancy--and the new methods of fetal and neonatal surveillance allowed that in the end of XX century the perinatal mortality were close to the general population. Nevertheless the perinatal morbidity is still elevated. Several studies suggest that fetal hyperinsulinism, consequence major of the abnormal intra uterine milieu of the diabetic mother, could be the cause of such morbidity at short and long term. In this paper, gestational diabetes is specially analysed. In spite of a large amount of studies, there is until know no diagnostic test that allows us to identify the pregnant women with a higher risk for a bad outcome namely, macrosomia and their consequences like caesarean section, traumatic delivery and neonatal complications. The ideal test should give that kind of information. Thus some methods of fetal surveillance had been proposed complementary. At this moment the health care professionals that are working in the field of diabetes and pregnancy are waiting for the results of the prospective multicentric study (HAPO study), hoping that a consensus could be reached about such a test.
- Hipertiroidismo e antitiroideus de síntese na gravidezPublication . Oliveira, V; Correia, P; Marques, JP; Marta, E; Paiva, S; Ruas, L
- Crescimento fetal e controlo glicémico em grávidas diabéticas tipo 1Publication . Campos, MV; Ruas, L; Paiva, S; Leitão, P; Lobo, C; Marta, E; Sobral, E; Cravo, AINTRODUCTION: Conflicting results have been reported with respect to the relationship between direct or indirect measures of glycemic control in mothers with type 1 diabetes and macrosomia. OBJECTIVE: To evaluate the frequency of LGA babies in type 1 diabetic pregnancies and analyse the influence of some maternal characteristics and glucose control in oversized babies. MATERIAL AND METHODS: A retrospective study of 18 pregnant women with type 1 diabetes mellitus was performed. It was divided in two groups: group 1 (G1- n=9)--pregnant women with LGA babies and group 2 (G2- n=9)--pregnant women with AGA (Appropriate weight for gestational age) babies. We evaluate the follow parameters: HbA1c in the third trimester of pregnancy, fasting and 1 h postprandial capillary glucose levels, pregestational BMI, maternal age, duration of Diabetes mellitus, weight gain during pregnancy, microvascular diabetes complications (retinopathy and nefropathy), and type of delivery. We defined LGA birth weight over the 90 centile. RESULTS: LGA babies occurred in 50% of gestations. We did not find any statistical differences in maternal age, diabetes mellitus duration, pregestational BMI, weight gain during pregnancy, microvascular diabetes complications, HbA1c levels (medium value in the two groups 6,5%). The glucose fasting values were higher in G1: 95,7 +/- 31.7 mg/ dl, vs G2: 83.3 +/- 17.1 mg/dl without, however, reaching statistically significant differences. There was statically differences in postprandial glucose values G1: 160.3 +/- 60.2 mg/dl vs G2: 111.9 +/- 27.1 mg/dl -- p= 0.043. CONCLUSIONS: The frequency of LGA babies was elevated 50% in type 1 diabetic pregnancies, although normal HbA1c values. Thus we conclude that the 1 h postprandial glucose levels should be considered a strong predictor of fetal growth.
- Epidemiologia da gestação múltipla: casuística de 15 anosPublication . Rodrigues, CT; Branco, MR; Ferreira, ID; Nordeste, A; Fonseca, M; Taborda, A; Santos-Silva, I; Almeida, MCBetween January of 1987 and December of 2001 were born 1243 twins related to 609 multiple pregnancies, in Maternidade Bissaya-Barreto. Data were grouped in periods of three years and several parameters were studied. The rate of multiple gestation has increased probably due to the contribution of the assisted conception techniques, and to the increase of the number of multiple fetal pregnancies (two or more) and to the increase of the mother age. These more frequent obstetric problems were preterm birth, gestational hypertension and abnormal sonographic data of fetal growth. The average age of delivery was 34 weeks and the birth weight has decreased. The most important factors for neonatal morbidity were hyaline membranous disease, intraventricular haemorrhage and the twin-twin transfusion syndrome. The neonatal mortality decreased in the last studied period.
- História natural da dilatação pielocalicial pré-natalPublication . Franco, S; Carvalho, G; Antunes, A; Brito, M; Morais, C; Barros, JSINTRODUCTION: It is estimated that genitourinary anomalies comprise 20% of all antenatally detected fetal anomalies, and pyelocaliectasia is the most common one. Detection of antenatal dilatation of the urinary tract does not always indicate postnatal urinary tract obstruction or even a significant genitourinary anomaly. Most cases will improve spontaneously, representing a temporary physiologic impedence and do not require surgery. MATERIALS AND METHODS: In a two-year period we studied 197 newborns, with prenatal pyelocaliectasia, without concomitant anomaly, delivered at Maternidade Dr. Daniel de Matos. In the postnatal follow-up period, the infants were followed at Pediatrics Department, at our Center. RESULTS: A male predilection was found. Ultrasonic follow-up of the 197 infants showed that pyelocaliectasia resolved in 97%, while 3% still presented it in the postnatal ultrasound. Complementary renal evaluation, with voiding cystourethrography and radionuclide imaging, was realised in 29 (15%) infants to further characterize the abnormality detected in postnatal ultrasound. Surgery was performed in four (2%) children. CONCLUSION: Prenatally diagnosed pyelocaliectasia may be safely observed, and surgical correction should be performed only if renal compromise occurs.
- Crise hipercalcémia secundária a hiperparatiroidismo primário durante a gravidezPublication . Branco, MR; Rodrigues, CT; Campos, A; Figueiredo, A; Coucelo, J; Magalhães, C; Santos-Silva, I; Taborda, A; Almeida, MCPrimary hyperparathyroidism is a rare occurrence in pregnancy with significant risks to the mother and the foetus, witch is related to the level of serum calcium. A 41-year-old women, gravida 2, para 1, presented at 22 weeks gestation with nausea, vomiting and mild cognitive dysfunction associated with hypercalcemic crisis. The hypercalcemia was observed to be related to parathyroid hyperplasia that was surgically removed. Complete resolution of her symptomatology and hypercalcemia occurred postoperatively. The pregnancy was complicated with transient hypertension. A small for gestational age healthy male infant was delivered at term with no neonatal complications related with this pathology.
- Epilepsia e gravidez: que conduta? A propósito de um caso clínicoPublication . Rodrigues, CT; Branco, M; Ferreira, I; Estanqueiro, P; Vicente, T; Santos-Silva, I; Couceiro, A; Ramos, C
- Drenagem pleuro-amnióticaPublication . Rodrigues, CT; Maciel, P; Ribeiro, SC; Carvalho, CL; Correia, JP; Matos, LF; Mesquita, JB; Couceiro, AB; Jardim, FRFetal hydrothorax refers to a collection of fluid within the fetal thorax that may be the result of chylous leak from the thoracic duct (primary hydrothorax) or generalized fluid retention associated with immune or no immune fetal hydrops (secondary hydrothorax). The authors' presents a case report occurred in 2002, of a pregnant woman that at 25 weeks' gestation that was referred to Maternidade Bissaya-Barreto-Coimbra because of a fetal hydrothorax at left, under tension and with cardiac decompensation signs. A fetal thoracocentesis was performed and the diagnosis was chylothorax. Because of a rapid reaccumulation of fluid a pleuroamniotic shunt was placed. The effusion and the cardiac decompensation signs regressed. The delivery was at 38 weeks' gestation. The newborn had been stable. Actually he has 10 months, is healthy and has a normal grow and development.