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Marcelo Zugaib

Publications and source records attributed to Marcelo Zugaib.

36 records · Page 2Linked to original sources
PubMed2004

Glycemia in newborns of hypertensive mothers according to maternal treatment.

PURPOSE: To evaluate the evolution of glycemic levels in newborns of hypertensive mothers according to maternal treatment. METHODS: Prospective randomized study, including 93 newborns of mothers treated with isradipine (n = 39), atenolol (n = 40), or low sodium diet (control group - n=14). Glycemia was determined at birth (mother and newborn by the oxidase glucose method) and in the 1st, 3rd, 6th, 12th, and 24th hours after birth (newborn by a test strip method). The evolution of glycemia was analyzed in each group (Friedman test). The groups were compared regarding glycemia (Kruskall-Wallis test), and linear regression models were constructed for the analyses (independent variable = maternal glycemia; dependent variables = umbilical cord, 3rd, and 6th hour glycemia). RESULTS: There were no statistically significant differences among the mean blood glucose levels of the 3 groups in any of the assessments. There was a correlation between maternal and umbilical cord blood glucose in the isradipine (r = 0.61; P <.05) and control (r = 0.84; P <.05) groups. Regarding glycemia levels of the mothers and newborns in the third and sixth hours postpartum, this correlation was present only in the control group (maternal x third hour: r = 0.65; P <.05; maternal x sixth hour: r = 0.68; P <.05). There were no correlations in the atenolol group. Hypoglycemia was detected in 51.3% of the isradipine group, 60% of the atenolol group, and 35.7% of the control group, and it was more frequent in the first hour postpartum in all groups. CONCLUSIONS: The results suggest a similar effect of the 3 types of treatment upon newborn glycemia. The correlation analysis suggests that isradipine could have effects upon newborn glycemia only after birth (correlation only in umbilical cord blood), whereas atenolol could act earlier (there was no correlation at any moment). The results also point to the need for glycemic control from the first hour postpartum of newborns of hypertensive mothers whether they have or have not undergone treatment with antihypertensive drugs.

Antihypertensive Agents↗
PubMed2004

[Maternal complications associated with type of delivery in a university hospital].

OBJECTIVE: To analyze maternal complications associated to type of delivery, comparing cesarean (c-) section with vaginal delivery. METHODS: Retrospective study of 1,748 deliveries carried out at a university hospital in the city of S o Paulo, Southeastern Brazil, in which the newborn weighed more than 500 g. Maternal complications occurred during delivery as well as those diagnosed during puerperium that required further hospital admission were analyzed. Statistical analyses included Student's t test and Fisher's Exact test. Significance level was set at 0.05. RESULTS: C-sections were performed on 988 patients (56.5%). Hemorrhagic complications occurred in 1.2% of c-sections and in 0.8% of normal deliveries, with no statistically significant difference between both groups. Endometritis was observed in 0.4% of c-sections and in 0.1% of vaginal deliveries, without statistically significant difference. Two cases of puerperal infection evolved to hysterectomies, in the c-section group. There were no maternal deaths related to c-section. CONCLUSIONS: No associations were found between maternal complications and type of delivery in the period analyzed.

Adolescent↗
PubMed2004

Prenatal diagnosis of congenital Chagas' disease (American trypanosomiasis).

The prenatal diagnosis of congenital transmission of Chagas' disease in a pregnant woman with the indeterminate form of the disease is reported. Sonography revealed fetal hydrops at 31 weeks' gestation. Anti-Trypanosoma cruzi IgM and IgG antibodies were negative in the fetal blood sampled by cordocentesis, but T. cruzi trypomastigotes were found in its buffy coat. Owing to anemia, in utero exchange transfusion was undertaken, but fetal demise ensued. Labor was induced and a stillborn infant weighing 2030 g was delivered. The pathological examination revealed placentitis and meningoencephalitis, myocarditis and splenitis in the stillborn fetus. Amastigotes were found in the myocardium, brain and placenta.

Adult↗
PubMed2003

[Management of gestational diabetes].

The authors go review recent advanes in the treatment of gestational diabetes, giving emphasis to the peculiarities of this both clinical and obstetric disease. The covered topics covered include diet, exercise, metabolic control, insulin therapy and new therapeutic approaches, such as the use of oral hipoglycaemic agents.

Blood Glucose↗
PubMed2003

A study of the incidence and recognition of surgical glove perforation during obstetric and gynecological procedures.

OBJECTIVES: The purpose of this study was to compare the frequency of surgical glove perforation among obstetric and gynecological surgical procedures, and to evaluate surgeons' perceptions. MATERIALS AND METHODS: A cross-sectional study was conducted in which nursing personnel examined the gloves used in obstetric and gynecological procedures, immediately after the surgery, in order to detect perforations. RESULTS: Surgical glove perforation occurred in 20.8% of 817 obstetrics procedures and 24.4% of 131 gynecology procedures. The observed difference between groups was not statistically significant (p=0.35). Obstetricians perceived the occurrence of perforation in 30.6% of the events, and gynecologists in 37.5%. This difference was not statistically significant (p=0.44).

Brazil↗
PubMed2003

[Cardiotocography in pregnancies with absent or reversed end-diastolic velocity in the umbilical arteries: analisys of perinatal outcome].

OBJECTIVES: To study the correlation between cardiotocography parameters and perinatal outcome in pregnancies with absent or reversed end-diastolic velocity (AERDV) in the umbilical arteries. METHODS: One hundred and twenty-seven cases presenting with AREDV followed between 1993 and 2000 were selected for analysis. The last cardiotocographic tracing performed on the day of delivery was reviewed and the following parameters were considered: magnitude of long-term variability, presence or absence of acceleration, late deceleration, variable deceleration, prolonged deceleration, pseudo sinusoidal pattern and the classification in normal, suspected and abnormal tracing. RESULTS: A significant (p<0.05) association was found between abnormal tracing and acidemia at birth (pH inferior to 7.20) with 71.9%, first minute Apgar score inferior to seven (73.4%), newborn intubation at delivery (64.1%), and early neonatal death (20.3%). The absence of acceleration was associated (p<0.05) to acidemia at birth (58.8%), first minute Apgar score inferior to seven (67.7%), newborn intubation at delivery (51%) and neonatal death (29.4%). Low FHR variability (<5bpm) was associated to (p<0.05): acidemia at birth (88.5%), newborn intubation at delivery (69.2%), early neonatal death (34.6%) and neonatal death (42.3%). Late decelerations were significantly (p<0,05) related to acidemia at birth.(78.2%). The severe variable deceleration was associated to (p<0.05): acidemia at birth (79.3%), newborn intubation at delivery (69%) and early neonatal death (17.2%). Prolonged deceleration was associated to (p<0.05) newborn intubation at delivery (70.6%). Pseudo sinusoidal pattern was associated to (p<0.05) early neonatal death (60%). CONCLUSION: The AREDV represents a severe fetal compromise with high risk to neonatal morbidity and mortality, and correlation between cardiotocography abnormalities and adverse perinatal outcome was demonstrated.

Acidosis↗
PubMed2003

Pregnancy in patients with heart disease: experience with 1,000 cases.

BACKGROUND: Previously, the high maternal mortality in cardiac patients who became pregnant prompted the assertion: Women with an abnormal heart should not become pregnant. This long-standing notion needs to be revised today. HYPOTHESIS: The study was undertaken to ascertain the experience with a large series of pregnant women with cardiac disease cared for in the same referral center. METHODS: From 1989 to 1999, 1,000 pregnant women with heart disease were followed by the same clinical and obstetric team. The cardiac diseases included rheumatic heart disease (55.7%), congenital heart disease (19.1%), Chagas' disease (8.5%), cardiac arrhythmias (5.1%), cardiomyopathies (4.3%), and others (7.3%). RESULTS: Of the pregnant women studied, 765 (76.5%) experienced no cardiovascular events during the study; 235 (23.5%) patients had the following cardiovascular complications: congestive heart failure (12.3%), cardiac arrhythmias (6%), thromboembolism (1.9%), angina (1.4%), hypoxemia (0.7%), infective endocarditis (0.5%), and other complications (0.7%). Clinical treatment allowed adequate management in 161 (68.8%) patients; however, 46 (19.6%) patients underwent interventional procedures because of refractory complications. The general maternal mortality rate was 2.7%. Of the 915 (91.5%) infants who were discharged, 119 (13%) were premature. CONCLUSION: Pregnancy in women with heart disease is still associated with considerable morbidity and mortality rates, which strongly correlate to maternal underlying disease. Strict prenatal care and early risk stratification during gestation are fundamental measures to improve the prognosis of pregnancy in women with heart disease.

Adolescent↗
PubMed2003

Association between prenatal sonographic findings and post-natal outcomes in 30 cases of isolated spina bifida aperta.

This study presents 30 cases of fetal isolated spina bifida aperta (SBA) to identify prenatal ultrasound findings that could predict the prognosis. Comparisons between surviving patients who had normal (group 1) and abnormal (group 2) post-natal neurological outcomes were made for three different prenatal signs, that is, site of vertebral lesion, presence and degree of ventriculomegaly and presence of talipes. The site of the lesion was the most significant outcome predictor, as high spinal dysraphisms were observed in 2 patients (2/7-28.6%) in group 1 and in 15 patients (15/19-79.0%) in group 2 (p = 0.03). The presence of fetal ventriculomegaly was associated with impaired post-natal neurological development, as it occurred in 4 patients (4/7-57.1%) in group 1 and in 18 patients (18/19-94.7%) in group 2 (p = 0.04). The presence of talipes did not significantly differ between the two groups. Patients with abnormal intellectual outcome (8/26-30.8%) had significantly greater (p = 0.018) lateral ventricle/hemisphere ratios (mean = 0.74, standard deviation = 0.13) than those with normal intellectual development (mean = 0.54, standard deviation = 0.18). Mean post-natal follow-up was at 23 months (standard deviation = 15 months).

Abnormalities, Multiple↗
PubMed2003

Prophylactic administration of progesterone by vaginal suppository to reduce the incidence of spontaneous preterm birth in women at increased risk: a randomized placebo-controlled double-blind study.

OBJECTIVE: The purpose of this study was to evaluate the effect of prophylactic vaginal progesterone in decreasing preterm birth rate in a high-risk population. STUDY DESIGN: A randomized, double-blind, placebo-controlled study included 142 high-risk singleton pregnancies. Progesterone (100 mg) or placebo was administered daily by vaginal suppository and all patients underwent uterine contraction monitoring with an external tocodynamometer once a week for 60 minutes, between 24 and 34 weeks of gestation. Progesterone (n = 72) and placebo (n = 70) groups were compared for epidemiologic characteristics, uterine contraction frequency, and incidence of preterm birth. Data were compared by chi(2) analysis and Fisher exact test. RESULTS: The preterm birth rate was 21.1% (30/142). Differences in uterine activity were found between the progesterone and placebo groups (23.6% vs 54.3%, respectively; P <.05) and in preterm birth between progesterone and placebo (13.8% vs 28.5%, respectively; P <.05). More women were delivered before 34 weeks in the placebo group (18.5%) than in the progesterone group (2.7%) (P <.05). CONCLUSION: Prophylactic vaginal progesterone reduced the frequency of uterine contractions and the rate of preterm delivery in women at high risk for prematurity.

Adult↗
PubMed2003

A comparison between middle cerebral artery peak systolic velocity and amniotic fluid optical density at 450 nm in the prediction of fetal anemia.

OBJECTIVE: The purpose of this study was to compare fetal middle cerebral artery peak systolic velocity with amniotic fluid delta optical density at 450 nm in the prediction of fetal anemia. STUDY DESIGN: A prospective study that involved 28 singleton pregnancies that were at-risk for fetal anemia was carried out in a tertiary teaching hospital. Middle cerebral artery peak systolic velocity was measured immediately before the determination of deltaoptical density at 450 nm and fetal hemoglobin concentration. Sensitivities and predictive values for fetal anemia were examined. RESULTS: Fetal hemoglobin concentrations correlated significantly with middle cerebral artery peak systolic velocity (correlation coefficient, -0.77; P <.0001) and deltaoptical density at 450 nm zones (correlation coefficient, -0.56; P =.0025). Middle cerebral artery peak systolic velocity was >1.5 multiples of the median in 15 of 28 cases (54%); for this cutoff value, the sensitivity and positive-predictive values for a hemoglobin deficit of >-3SD were 75% and 60% and for a hemoglobin deficit of >-5SD were 100% and 47%, respectively. The corresponding values for deltaoptical density at 450-nm zone III (6/28 cases, 21%) were 0% (hemoglobin deficit, <-3SD) and 86% and 100% (hemoglobin deficit, <-5SD). CONCLUSION: Middle cerebral artery peak systolic velocity and amniotic fluid optical density at 450 nm are both useful in the prediction of fetal anemia. However, Doppler examination has the advantage of being a noninvasive method that can help reduce the number of invasive procedures in pregnancies that are at-risk for fetal anemia.

Adult↗
PubMed2003

Diffusion imaging may predict reversible brain lesions in eclampsia and severe preeclampsia: initial experience.

OBJECTIVE: The purpose of this study was to validate diffusion-weighted magnetic resonance imaging in the prediction of the evolutive course of brain edema and to establish its pathophysiologic presence in patients with eclampsia/severe preeclampsia. STUDY DESIGN: Seventeen patients with a clinical diagnosis of severe eclampsia/preeclampsia and T2 hyperintense brain lesions on routine magnetic resonance imaging were evaluated at hospital admission and 8 weeks later. RESULTS: Brain edema was reversible in 13 patients and irreversible in 4 patients, as indicated on follow-up magnetic resonance imaging. Sixteen of 17 patients were differentiated accurately into reversible and irreversible groups on the basis of diffusion imaging on hospital admission. Diffusion-weighted magnetic resonance imaging demonstrated a significant increase in water mobility in abnormal regions compared with normal-appearing brains in patients in the reversible group (1.34+/-0.10 mm(2) vs 0.79+/-0.08 mm(2)/s x 10(-3), P<.001). In the irreversible group, restricted water diffusion was present, which was consistent with cytotoxic edema and early brain infarction in 3 of 4 patients. CONCLUSION: Diffusion-weighted magnetic resonance imaging can predict successfully the evolutive course of brain edema in an acute setting in these patients. Our findings indicate that brain edema is vasogenic, although ischemic/cytotoxic edema was observed less commonly.

Adolescent↗
PubMed2002

Reference range for cervical length in twin pregnancies.

BACKGROUND: Twin pregnancies are at increased risk of preterm delivery, and cervical length measurement by transvaginal ultrasound examination has been shown to be an effective method of screening for this complication. The aim of the present study is to establish a reference range for cervical length measurement throughout gestation in twin pregnancies. METHODS: Prospective study involving 144 nonselected twin pregnancies that delivered after 34 weeks and underwent ultrasound examination every 4 weeks for transvaginal measurement of cervical length. Mean cervical length measurements, 95% confidence intervals for the estimate and 95% prediction intervals were established throughout gestation by linear regression analysis. RESULTS: There was a significant correlation between cervical length measurements and gestational age [cervical length (mm) = - 0.758 * gestation age (weeks) + 56.69, r=- 0.43, p < 0.0001], and mean cervical length shortened by approximately 0.8 mm per week, from 47 mm at 13 weeks to 32 mm at 32 weeks. The corresponding lower limits for the 95% prediction intervals were 29 and 15 mm, respectively. CONCLUSION: Cervical length shortens gradually throughout gestation in twin pregnancies.

Cervix Uteri↗
PubMed2002

Stress in pregnancy: a new Wistar rat model for human preeclampsia.

OBJECTIVE: Our study evaluated the effects of chronic and/or acute stress on pregnant and nonpregnant female rats. STUDY DESIGN: The rats were exposed to the sonic stimulus associated with overpopulation between days 7 and 14 of pregnancy. The rats were immobilized 2 days before the vascular reactivity experiments. RESULTS: In 14-day pregnant rats, chronic stress led to lower weight, increased adrenal weight, lower endothelium-derived relaxing factor release, and lower fetal weight. In 20-day pregnant rats, chronic stress caused decreased weight gain, higher blood pressure, increased vasomotility and proteinuria, lower endothelium-derived relaxing factor release, and lower fetal weight. In the 20-day pregnant group, the higher adrenal weight resulted in higher blood pressure, lower vascular relaxation, and lower average fetal weight. A greater number of fetuses had higher adrenal weight, higher blood pressure, and lower vascular relaxation. CONCLUSION: The alterations found in the rats were similar to those that occur in human preeclampsia. Therefore, we propose a new animal model for human preeclampsia.

Acute Disease↗
PubMedDate not supplied

[Comparative study of manual vacuum aspiration and uterine curettage for treatment of abortion].

OBJECTIVES: To compare manual vacuum aspiration (MVA) and uterine curettage (D and C) for first trimester abortions, in terms of the efficiency of eliminating ovular remnants, frequency of complications, duration of the procedure, and duration of patients' hospitalization. METHODS: In a prospective study, 50 patients in the MVA group and 50 in the D&C group were randomly included. Inclusion criteria were: spontaneous abortion, gestational age less than 13 weeks, patent cervix, endometrial thickness >15 mm, afebrile state, and hemoglobin >10 g/dl. Blood samples were collected before and after surgical procedures for control of hemoglobin levels. Anesthesia was performed in all cases. The time required for each surgical procedure was recorded. RESULTS: Groups were similar regarding gestational age (9.93 +/- 2.40 vs 9.73 +/- 2.58 weeks; p = 0.71) and endometrial thickness before surgery (22.14 +/- 4.80 vs 22.68 +/- 5.68 mm; p = 0.65). There were no surgical or anesthetic complications in either group. Durations of the procedure and of hospitalization were significantly shorter in the MVA group (3.71 vs 10.18 min, p < 0.001, and 14.18 vs 23.06 h, p = 0.03, respectively). Decrease of hemoglobin levels was greater after the surgical procedure in the D and C group (p = 0.02). CONCLUSION: MVA caused less blood loss, was less time consuming, and resulted in shorter hospitalization. However, both surgical procedures were found to be efficient for treatment of incomplete abortions during the first trimester of pregnancy, with no complications after both treatments.

Abortion, Incomplete↗