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Biomedical subjects

M Zugaib

Publications and source records attributed to M Zugaib.

At least 19 recordsLinked to original sources
PubMed2007

Use of hyaluronidase for cervical ripening: a randomized trial.

OBJECTIVE: To investigate the action of intracervical administration of hyaluronidase (HAase) as an inductor of cervical ripening on an outpatient basis. METHODS: A randomized double-blind trial was conducted with 168 pregnant women at term, Bishop score (BS)<5, normal fetal vitality and no uterine contractions. An evaluation was performed at the first visit, when either 20,000 UI of lyophilized HAase (5 ml) or placebo was administered via cervical injection. After 48 h, if the BS remained<5, a second dose was administered. The primary outcome was the BS after 48 h or 96 h. The outcome was considered positive when BS>/=5. RESULTS: The results indicate that the proportion of positive response for the HAase group (55%) after 48 h is significantly higher (p<0.0001) than the corresponding proportion for the placebo group (7%) with an absolute risk reduction (ARR) of 48%=55-7% (95%CI=40-56%). After 96 h, these proportions are 93% in the Haase group and 22% in the placebo group (p<0.0001, ARR=71%, 95%CI=61-81%). The average duration of labour for the nulliparae in the HAase group (6.5h) is significantly smaller (p<0.0001) than for those under placebo (12.0 h) with an absolute difference of 5.5h (95%CI=4.6-6.4h). For the multiparae, the results are 4.3h for the HAase patients versus 9.5h for the placebo patients (p<0.0001) with an absolute difference of 5.2h (95%CI=4.1-6.3h). The proportion of vaginal deliveries for women who received HAase was 82% versus 51% for the placebo group (p=0.0007, ARR=31%, 95%CI=19-44%). The proportion of vaginal deliveries for patients with prior cesareans in the HAase group (69%) was also significantly higher (p<0.0001) than that corresponding to the placebo group (13%) with ARR=56% (95%CI=26-86%). No uterine hyper stimulation occurred in the study. CONCLUSION: We detected significant associations between intracervical injection of HAase and ripening of the cervix, as well as with shorter duration of labour and larger chance of vaginal delivery, suggesting that this is a simple, effective and safe method even for women with prior cesarean.

Adolescent↗
PubMed2006

Predictive factors of trophoblastic invasion into the ampullary region of the tubal wall in ectopic pregnancy.

BACKGROUND: Predictive factors of damage to the Fallopian tube may guide the treatment for patients with tubal pregnancy. The aim of this study was to assess the predictive value of the following parameters: gestational age, serum beta-hCG concentrations and ultrasound findings. METHODS: A total of 105 patients with ampullary pregnancy undergoing salpingectomy were analysed. Trophoblastic invasion was histologically classified as stage I when limited to the tubal mucosa, stage II when extending to the muscle layer and stage III in the case of complete tubal wall infiltration. We correlated the depth of trophoblastic infiltration into the tubal wall with gestational age, beta-hCG concentration on the day of surgery and the type and size of the ectopic mass upon ultrasound. RESULTS: No association was observed between the depth of trophoblastic invasion and gestational age (P = 0.53) or tubal mass diameter (P = 0.43). Trophoblastic invasion was, however, associated with beta-hCG concentration (P < 0.001) and with the type of ultrasonographic image (P = 0.001). Beta-hCG levels of 2400 mIU/ml showed 82.8% sensitivity and 85.5% specificity for stage I, and levels of 5990 mIU/ml showed 82.6% sensitivity and 74.6% specificity for stage III. CONCLUSIONS: Depth of trophoblastic penetration into the tubal wall of the ampullary region of Fallopian tube is correlated with beta-hCG concentration and the type of ultrasonographic image; serum beta-hCG is the best predictor of the depth of penetration.

Adolescent↗
PubMed2005

Sonographic markers of exencephaly below 10 weeks' gestation.

We report two cases of exencephaly diagnosed by transvaginal ultrasonography at 8 weeks 4 days and at 9 weeks 3 days of gestation. Both cases presented an irregular cephalic pole, and, in the case seen at 8 weeks 4 days, brain vesicles were also absent, whereas in the case seen at 9 weeks 3 days, the midline echo was indistinguishable with disorganized choroid plexuses. In both cases, anencephaly was evident at 11 and 12 weeks' gestation and the postmortem confirmed the diagnosis.

Abortion, Eugenic↗
PubMed2004

Ductus venosus blood flow assessment at 11 to 14 weeks of gestation and fetal outcome.

OBJECTIVE: To evaluate the association between abnormal ductus venosus (DV) at 11-14 weeks' gestation and chromosomal abnormalities, structural defects and fetal outcome. METHODS: DV flow-velocity waveform (DV-FVW) and nuchal translucency thickness (NT) were prospectively evaluated in 1217 singleton pregnancies. RESULTS: The DV-FVW was abnormal in 84 fetuses, NT was above the 95th centile in 160 fetuses and both markers were observed in 41 fetuses. Chromosomal defects were diagnosed in 22 fetuses. The sensitivity, specificity and positive and negative predictive values for an abnormal karyotype were 86.4%, 86.9%, 11.9% and 99.7%, respectively, for an increased NT. These values were 68.2%, 96.9%, 31.3% and 99.3%, respectively, for DV-FVW abnormalities and 68.2%, 97.6%, 36.6% and 99.3%, respectively, when both markers were found simultaneously. Regarding structural defects, these values were 43.8%, 92.9%, 8.3% and 99.1% for an abnormal NT, 25.0%, 92.6%, 4.8% and 98.8% for DV-FVW abnormalities and 25.0%, 97.9%, 15.4% and 98.9% for both together. Considering those cases of unexplained fetal demise, the values were 44.4%, 85.9%, 5.0% and 98.9% for NT abnormalities, 22.2%, 92.6%, 4.8% and 98.6% for an abnormal DV-FVW and 22.2%, 98%, 15.4% and 98.7% for both. In cases with increased NT, the percentage of live births with normal karyotype and no major fetal structural defects decreased from 93.8% in normal DV-FVW fetuses to 77.3% in abnormal ones. CONCLUSION: DV assessment at 11-14 weeks' gestation is useful in screening for fetal chromosomal abnormalities and may help to reduce the false-positive rate when combined with NT measurement. Abnormal DV-FVW is also associated with an increase in adverse perinatal outcome in fetuses with enlarged NT. However, the value of DV-FVW assessment in cases with normal NT is unclear.

Abortion, Spontaneous↗
PubMed2003

Postpartum depression: in relation to life events and patterns of coping.

The purpose of this study was to estimate the prevalence of postpartum depression (PPD) and its relationship with life events (LE) and patterns for coping. We performed a cross-sectional study of 113 women, on the 10(th) day of puerperium, at the Obstetric Clinic of the São Paulo University Medical School. The study was based on the following: Pitt (1967) and Stein (1980) Scales, Beck Depression Inventory (1961), Holmes and Rahe Schedule of Recent Events (1967), Folkman and Lazarus Ways of Coping (1985) and questionnaire of social-demographic and obstetric data. Logistic regression was performed to calculate prevalence of PPD and its association with several risk factors. The significance level was defined at 5%. The prevalence of PPD was 15.9% (IC 9.7% to 24.0%). According to the multivariate analyses, the variables of coping with distancing, number of children and ethnic origin were significant. There were no association between PPD and LE. The depressed puerperal women have a low educational level, greater number of children and resort to inadequate coping strategies, such as distancing. This pattern of coping might be an etiological factor of the PPD as well as a reaction to their difficult life environment.

Adaptation, Psychological↗
PubMed2003

Fetal nasal bone length: reference range and clinical application in ultrasound screening for trisomy 21.

OBJECTIVES: Fetuses with trisomy 21 typically present with subtle facial abnormalities, including a hypoplastic nasal bone. The aim of this study was to provide a reference range for the length of the fetal nasal bone and to test its value in second-trimester ultrasound screening for trisomy 21. DESIGN: A reference range of fetal nasal bone length was established from cross-sectional data on 1923 consecutive singleton pregnancies scanned at 16-24 weeks' gestation in women older than 35 years. Screening for trisomy 21 was prospectively studied using the measurement of fetal nasal bone lengths smaller than the 5(th) percentile as a cut-off value. RESULTS: Follow-up was possible in 1631 cases (84.8%). Trisomy 21 was found in 22 cases (1.35%). Nasal bone length measurement increased as a function of gestational age (P < 0.05) showing a linear relationship. Screening for trisomy 21 using the 5(th) percentile as a cut-off value resulted in a sensitivity of 59.1% for a 5.1% false-positive rate. The likelihood ratio was 11.6. CONCLUSION: Screening for trisomy 21 using fetal nasal bone length measurements showed a sensitivity comparable to that of maternal biochemistry for a given false-positive rate of 5%. Association of nasal bone lengths with other sonographic markers, taking into account the background risk for maternal and gestational age, may further improve sensitivity and reduce false positives, allowing avoidance of unnecessary invasive diagnostic procedures.

Adult↗
PubMed2003

Cervical length at 11-14 weeks' and 22-24 weeks' gestation evaluated by transvaginal sonography, and gestational age at delivery.

OBJECTIVE: To compare cervical length measurements obtained at 11 to 14 weeks and 22 to 24 weeks of gestation in an unselected group of pregnant women and to correlate the measurements with time of delivery. METHODS: This was a prospective study involving 529 pregnant women attending for routine antenatal care who underwent transvaginal scans at 11-14 weeks and 22-24 weeks for evaluation of cervical length. The mean cervical length was calculated at both stages of gestation and lengths were compared between groups which delivered at term or prematurely, this being defined as delivery before 37 completed weeks of gestation. RESULTS: The mean cervical lengths at 11-14 and 22-24 weeks were, respectively, 42.4 mm and 38.6 mm. Cervical length at 11-14 weeks was not significantly different between the groups which delivered at term (42.7 mm) and preterm (40.6 mm). However, at the 22-24-week evaluation, cervical length was significantly shorter in the group which had a preterm delivery than in that which had a term delivery (26.7 mm and 39.3 mm, respectively; P = 0.0001). In the group of women with a previous history of one or more preterm deliveries, there was a greater shortening in cervical length from the first to the second evaluation than there was in the group of women with no previous history of preterm delivery. This shortening was also more pronounced in the group which delivered prematurely (from 40.6 mm to 26.7 mm) than in that which delivered at term (from 42.7 mm to 39.3 mm). CONCLUSION: There is a spontaneous shortening in the pregnant cervix from the first to the second trimester of pregnancy. The shortening is more rapid in pregnant women who deliver prematurely and who have a history of previous preterm delivery.

Adolescent↗
PubMed2003

Structural and functional cardiac abnormalities identified prior to 16 weeks' gestation in fetuses with increased nuchal translucency.

OBJECTIVE: To determine the accuracy and practicality of fetal echocardiography in the identification of structural and functional cardiac abnormalities prior to 16 weeks' gestation in fetuses with increased nuchal translucency thickness (NT). METHODS: Between January 1996 and June 2002 early fetal echocardiography using the transvaginal route was performed at 12-16 weeks' gestation on 275 fetuses with increased NT. The abnormal cardiac findings were classified as either structural (congenital heart defects) or functional, defined as transient phenomena which might later disappear, such as isolated tricuspid regurgitation and an enlarged ascending aorta. The abnormal findings were related to pregnancy outcome, including autopsy results, karyotyping results, and late fetal and neonatal echocardiography. RESULTS: Cardiac abnormalities were present in 61 fetuses overall (22.2%); including structural cardiac defects in 37 fetuses (13.5%) and functional abnormalities in 24 fetuses (8.7%). Structural cardiac abnormalities were associated with abnormal karyotype in 24 fetuses and normal karyotype in 13 fetuses. Of the 24 fetuses with functional cardiac abnormalities, 2 (8.3%) had isolated tricuspid regurgitation and 22 (91.7%) had enlarged ascending aorta. Abnormal karyotype was present in this group in 4 cases (16.7%). CONCLUSION: Increased NT can be used to define a high-risk group that should receive specialized early fetal echocardiography. This is a reliable technique with great potential for the diagnosis of both structural and functional cardiac abnormalities.

Adolescent↗
PubMed2003

Stress-related preeclampsia: an evolutionary maladaptation in exaggerated stress during pregnancy?

The authors hypothesize that preeclampsia is a stress-related disease and an evolutionary maladaptation of exaggerated stress during human pregnancy. Epidemiologic studies show that relative risk for preeclampsia is increased in many stressful situations. Many risk factors for preeclampsia are stress-related. Low-stress situations, on the contrary, are protective. Stress in pregnancy corroborates all physiopathologic theories for preeclampsia; it does not contradict them. Animals exposed to intense stress show many characteristics of preeclampsia, and some animal models for human preeclampsia have been proposed. The stress-alarm reaction is protective for survival in animals. But the evolutionary maladaptation of this intense stress could lead to preeclampsia in humans.

Animals↗
PubMed2002

Detection of fetal structural abnormalities at the 11-14 week ultrasound scan.

The aim of this study was to evaluate the detection of fetal structural abnormalities by the 11-14 week scan. 2853 pregnant women were submitted to a routine ultrasound scan between the 11th and 14th week and the fetal skull, brain, spine, abdominal wall, limbs, stomach and bladder were examined. Following the scans the patients were examined in the second or third trimester of pregnancy. An isolated increased nuchal translucency was not considered an abnormality. However, these patients had an early echocardiography assessment. Fetal structural abnormalities were classified as major or minor and of early or late onset. A total of 130 (4.6%) defects were identified and 29 (22.3%) of these were diagnosed at the 11-14 week scan, including nine cardiac defects associated with increased nuchal translucency. The antenatal ultrasound detection rate was 71.5%, and 31.2% were detected in the first-trimester assessment. 78.8% of the major defects were diagnosed by the prenatal scan and 37.8% by the 11-14 week scan. Fetal structural abnormalities at the 11-14 week scan were detected in approximately 22.3% of the cases, therefore, a second-trimester anomaly scan is important in routine antenatal care to increase the prenatal detection of fetal defects.

Adult↗
PubMed2002

Effect of maternal position on cervical length measurement in twin pregnancies.

OBJECTIVE: To compare cervical length measurements in twin pregnancies obtained from patients in the recumbent and standing positions. METHODS: Fifty women with uncomplicated twin pregnancies underwent monthly transvaginal ultrasound examinations for cervical length measurement in the recumbent and standing positions. The correlation between cervical length measurements obtained in the recumbent and standing positions, and between these measurements and gestational age, were examined. The significance of the differences between measurements obtained in the recumbent and standing positions was also analyzed. RESULTS: Based on data obtained at the first ultrasound examination, there was a significant correlation between cervical length measurements in the recumbent and standing positions (r = 0.77; t = 8.25; P < 0.0001) and both measurements showed a significant inverse correlation with gestational age (recumbent position: r = -0.60, P < 0.0001; standing position: r = -0.46; P = 0.0008). The mean of the differences (standing - recumbent) was -1.8 mm (95% confidence interval = -3.7-0.04; t = -1.96; P = 0.06) and the mean of percentage differences ((standing - recumbent)/recumbent x 100) was -2.9% (95% confidence interval = -8.6-2.7; t = -1.04; P = 0.3). When the data obtained at all examinations were examined by multiple regression analysis, cervical length measurement in the recumbent position was the only parameter that correlated significantly with the percentage difference between cervical length measurements (P < 0.0001). CONCLUSIONS: Cervical length in twin pregnancies decreases with gestation and there is a good correlation between measurements obtained from women in the recumbent and standing positions. No significant changes in cervical length were observed comparing measurements obtained in the two maternal positions.

Adult↗
PubMed2002

Transvaginal ultrasonography in predicting placenta previa at delivery: a longitudinal study.

OBJECTIVES: To determine the extent of overlapping of the internal cervical os by the lower placental edge at 11-14 weeks' gestation which best predicts placenta previa at term. PATIENTS AND METHODS: This was a prospective study initially involving 381 singleton pregnancies with a live fetus at 11-14 weeks attending for routine antenatal care. The distance between the lower placental edge and the internal cervical os was longitudinally evaluated by transvaginal ultrasound examination at 11-14 weeks', 20-24 weeks', and 30-34 weeks' gestation. The first 203 cases were selected at random (first phase) and after this period only cases with the lower placental edge reaching and/or overlapping the internal cervical os were followed up (n = 170, second phase). Thus a total of 373 cases were analyzed, 351 of whom were examined in all three trimesters. Multiple regression analysis was used to estimate the probability of predicting placenta previa at term using the overlap of the lower placental edge over the internal cervical os in the first trimester of pregnancy. RESULTS: A change in the relative position of the placenta (placental migration) was observed in all 351 cases examined in the three trimesters of pregnancy. In the general population, represented by the 203 cases (first phase), the incidence of placenta previa at 11-14 weeks' gestation was 42.3% (86/203), at 20-24 weeks' 3.9% (8/203) and at term 1.9% (4/203). A total of 18 cases of placenta previa and 17 cases of marginal placenta were observed at term. It was estimated that when the lower placental edge overlaps the internal cervical os by 23 mm at 11-14 weeks the probability of placenta previa at term is 8% with a sensitivity of 83.3% and specificity of 86.1%. CONCLUSION: The present study establishes the probability of placenta previa at term depending on the relationship of the lower placental edge to the internal cervical os at 11-14 weeks.

Adolescent↗
PubMed2002

Adeno-associated virus DNA in human gestational trophoblastic disease.

Previous studies had shown a correlation between infection with the human adeno-associated virus (AAV) and spontaneous abortion in early pregnancy. Furthermore, AAV DNA had been detected in cells of the human trophoblast lines, Jeg-3, JAr, and BeWo, in cells of the human amnion line, FL, and in trophoblasts from amnion fluids. Infectious AAV virions could be isolated from amnion fluids. To further analyse AAV infection during pregnancy, we tested material from Gestational Trophoblastic Disease for the presence of AAV DNA. With 63 tissue samples from patients from Brazil, including 49 hydatiform moles and 14 choriocarcinomas, nested PCR was performed to detect the presence of AAV DNA. In addition, 15 samples from spontaneous abortions were analysed. AAV DNA was found in 43 samples (28/49 hydatiform moles, 4/14 choriocarcinomas, 11/15 miscarriage material). These findings confirm AAV infection of embryo-derived tissue in humans and further suggest a role of AAV in miscarriage and trophoblastic disease.

Abortion, Spontaneous↗
PubMed2002

Phenotypic modulation of fibroblastic cells in the mucous layer of the human uterine cervix at term.

The uterine cervix is a dynamic structure with a high capacity to adapt to different, even opposing, roles during the sequence of physiological events of gestation (for example, acting as a barrier to retain the fetus during pregnancy and dilating to allow delivery at term). Histoarchitectural changes of the uterine cervix allow its successful adaptation. The aim of this study was to investigate whether fibroblastic cell plasticity, described in the lamina propria of the rat uterine cervix at term, could be observed in women too. Biopsy specimens of non-pregnant and intrapartum human cervices were studied under the transmission electron microscope, and cytoskeletal differentiation markers were identified by immunohistochemistry under the light microscope. Desmin-positive cells were present in the mucous layer of the cervix during labour. These cells displayed cytoplasmic processes (typical of myofibroblasts) that also stained positively for vimentin. The main ultrastructural features for defining the myofibroblast under the electron microscope were also observed in these cells. However, cervices of non-pregnant women contained resident fibroblasts at the same location. Examination of the differentiation repertoire of fibroblastic cells in the mucous layer of the uterine cervix resulted in the characterization of myofibroblasts at term. The implications of the plasticity of fibroblastic-myofibroblastic cells in the physiological changes displayed in the uterine cervix during pregnancy, labour and postpartum involution require further investigation.

Biomarkers↗
PubMed2001

Prenatal sonographic diagnosis of adrenal neuroblastoma.

Neuroblastoma is the most frequent extracranial solid tumor in childhood, but it is seldom diagnosed prenatally. We report a case of adrenal neuroblastoma identified at 39 weeks' menstrual age and successfully treated by postnatal surgery and chemotherapy. Sonography revealed a hyperechoic mass in the right upper quadrant of the fetal abdomen associated with hydramnios and hydronephrosis. Two days after delivery, the tumor was resected. No metastasis was identified. The infant received 6 cycles of chemotherapy, and at 2 years of age she was well, with no signs of recurrence.

Adrenal Gland Neoplasms↗
PubMed2001

Trisomy 10: ultrasound features and natural history after first trimester diagnosis.

We report on the ultrasound features and natural history of trisomy 10. At 12 weeks' gestation in a routine scan examination, the fetus presented with increased nuchal translucency thickness, mild skin oedema, bilateral pleural effusion, marked micrognathia, cardiomegaly, unilateral talipes and reversed A-wave in the ductus venosus blood flow. Karyotyping on chorionic villus sampling (CVS) led to the diagnosis of trisomy 10, which was confirmed by fetal blood sampling at 22 weeks' gestation. As the parents opted to continue with the pregnancy, the natural history and following ultrasound features are described. This is the third case of trisomy 10 in the literature reporting on the physical features. The most frequent ultrasound findings presented in trisomy 10 are increased nuchal translucency, micrognathia, renal agenesis, facial cleft, limbabnormalities, cardiac defects and early severe growth retardation.

Adolescent↗
PubMed2001

First-trimester screening for chromosomal abnormalities by fetal nuchal translucency in a Brazilian population.

OBJECTIVES: To examine the detection rate of chromosomal abnormalities using nuchal translucency (NT) thickness in a Brazilian population. METHODS: This was a prospective study of 2996 singleton pregnancies with a live fetus at 10-14 weeks of gestation attending for routine antenatal care in a teaching hospital in Brazil. Fetal crown-rump length (CRL) and NT thickness were measured and the risks for trisomy 21 were calculated by a combination of maternal age and fetal NT with the use of software provided by The Fetal Medicine Foundation. Sensitivity and positive predictive values for different risk cut-offs were calculated. RESULTS: Chromosomal defects were diagnosed in 22 cases, including 10 cases of trisomy 21. The estimated risk based on maternal age and fetal NT was 1 in 300 or greater in 222 (7.4%) cases and these included nine of 10 (90.0%) pregnancies with trisomy 21 and nine of 12 (75.0%) pregnancies with other chromosomal defects. The NT was above the 95th centile in 5.8% of cases and this group included 70% of the trisomy 21 cases. CONCLUSION: A combination of maternal age and fetal NT provides an effective method of screening for chromosomal defects. The performance of the test in a Brazilian population is similar to that in Britain.

Brazil↗