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Published: 1 April 2023

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1

Quadrifoglio, M. "FIRST TRIMESTER SCREENING FOR HYPERTENSIVE DISORDER OF PLACENTAL AND MATERNOGENIC ORIGIN." Doctoral thesis, Università degli Studi di Milano, 2015. http://hdl.handle.net/2434/263870.

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FIRST TRIMESTER SCREENING OF HYPERTENSIVE DISORDERS OF PLACENTAL AND MATERNOGENIC ORIGIN Background: Hypertensive disorders (HD) constitute a heterogeneous group of conditions. They complicate around 10% of pregnancies, and are a major cause of maternal and perinatal morbidity and mortality. The most used classification is based on temporal criteria: diagnosis (or delivery) before/after 34 weeks’ of gestation. Early-onset HD (before 34 weeks) is commonly associated with abnormal uterine artery Doppler, fetal growth restriction, evidence of ischemic lesions on placental examination and adverse maternal and neonatal outcomes. In contrast, late-onset HD (after 34 weeks) is mostly associated with normal or slightly increased uterine resistance index, a low rate of fetal involvement, and more favourable perinatal outcomes. Nevertheless, the phenotypes of HD do not fit entirely into the temporal classification. Thus, it has been hypothesized that phenotypes of HD, rather than temporal classification, reflect the underlying aetiology of HD: 1) HD of placental origin, when the defect in placentation causes an altered remodelling of the spiral arteries leading to reduced placental flow, activation of coagulation cascade, organ damage and intrauterine fetal growth restriction (IUGR); and 2) HD of maternogenic origin, associated with normal feto-placental perfusion and normal fetal growth, probably related to chronic inflammation and insuline resistance, typical aspects of metabolic syndrome. The early identification of pregnancies at risk of HD is a major challenge. Extensive research has identified a series of 1st trimester biophysical and biochemical markers of impaired placentation. The combination of these markers and maternal history have been used by clinicians as a 1st trimester screening for the recognition of pregnancies at risk of early/late onset HD. The aim of the study is to evaluate a new classification of hypertensive disease based on physiopathology, and not on temporary factors and to evaluate the effectiveness of 1st trimester screening for HD of placental and maternal origin by Doppler velocimetry of uterine arteries (UtA). Material and Methods: This is a prospective longitudinal cohort study of pregnant women followed in two hospital: prenatal diagnosis and gynaecologic Unit of the Institute for Maternal and Child Health – IRCCS “Burlo Garofolo” in Trieste and Obstetrics and Gynecologic Unit of Children’s Hospital – ICP “Vittore Buzzi” in Milan, Italy. This study was offered to pregnant women at the time of first trimester ultrasound aneuploidy screening. All women were recruited consecutively from October 2007 to April 2009 in Triest and from October 2009 to December 2012 in Milan. We enrolled singleton pregnancies between 11+0 and 13+6 weeks of gestation. The inclusion criteria were: single pregnancy, gestational age between 11+0 and 13+6 weeks confirmed by scan measurements, and signed informed consent. Multiple pregnancies or pregnancies complicated by fetal malformation or aneuploidy, spontaneous abortion, intrauterine fetal death, maternal neurodevelopment delay or psychiatric disorders were excluded. The following data were collected at the time of the scan: maternal history, previous disease, age, body mass index (BMI), parity, mode of conception (spontaneous or IVF), and gestational age. Doppler velocimetry of both UtA was added to routine ultrasound measurements. Doppler study was performed trans-abdominally, after identifying with the Color Doppler each uterine artery along the side of the cervix and uterus at the level of the internal os. Pulsed wave Doppler was used with the sampling gate set at 2 mm to cover the whole vessel ensuring the angle of insonation <30°. When three similar consecutive waveforms were obtained the pulsatility index (PI) was measured, and the mean PI of the left and right arteries was calculated. The measurements were performed by sonographers qualified by Fetal Medicine Foundation. Once the ultrasound examination was performed and the gestational age confirmed, a blood sample (around 5 cc) was taken from each woman. Maternal serum PAPP-A and B-hCG were measured and converted in multiple of the median (MoM). Definitions: Placental HD was defined as gestational hypertension, with or without proteinuria, associated to IUGR (defined as the AC <5th centile or reduction in AC >40 centiles). Maternal HD was defined as gestational hypertension, with or without proteinuria, associated to appropriate for gestational age fetal growth. Chronic hypertension was defined as history of known hypertension or blood pressure ≥140/90 mmHg in two or more occasions with a distance at least of 4 hours before 20 weeks of gestation. The HD were also distinguished into early-onset, diagnosed <34 weeks’ gestation, and late-onset, with diagnosis ≥ 34 weeks. Intra-uterine growth restriction (IUGR) was defined as ultrasound abdominal circumference below the 10th percentile according to standards references based on gestational age. Other causes of IUGR such as infection, anomalies and abnormal chromosomes were excluded in all cases. Pregnancy outcome data were collected as follows: fetal and maternal outcomes were obtained either directly from the clinical record if the delivery occurred in “Vittore Buzzi” Hospital or in “Burlo Garofolo” hospital or by a telephone questionnaires to the women after delivery. Statistical analysis: The distribution of data was evaluated with Kruskall-Wallis test. In case of non-uniformely distributed data a log transformation was applied. The results are represented as mean value and standard deviation (SD). Logistic regression models were computed to evaluate the significance of the variables considered. The following variables were included: UtA mean PI, BMI, parity, gestational age at time of recruitment and fetal sex. The receiver operating curves (ROC) constructed on regression models were computed and area under the ROC (AUC) calculated to evaluate the performance of the model. We evaluated the 1st trimester model to identify: firstly, women at risk of developing placental or maternogenic HD, and, secondly, the early and late-onset HD. Each disease was evaluated against the whole cohort. The analysis was performed with the program Stata/IC 11.2 for Windows (Stata Corp LP, College Station, USA). Results: 4218 women were enrolled in the study. 712 patients were lost to follow up or excluded because incomplete data acquisition. Overall 34 women were excluded because of: spontaneous abortion, aneuploidies or fetal malformations, and intrauterine fetal death. Among 3472 pregnancies included in the study, 122 women (3,5%) developed some hypertensive gestational disease, 56 fetuses were IUGR (1,6%), 10 women had chronic hypertension (0.3%) and 3284 women were unaffected (94.6%). If we considered classification based on the aetiology, 16 women (0.5%) developed placental HD, 106 (3.0%) presented maternal HD. If we considered classification based on time of delivery, 11 women (0.3%) developed early-HD, 111 women (3.2%) presented late-HD. The mean uterine artery PI was significantly higher in placental HD (2.36 p<0.01) when compared with the unaffected group (1.60). If we consider the early-late group, the mean uterine artery PI was significantly higher in early HD group (2.30, p<0.01) respect control group and in late HD group (1.71, p< 0.05). PAPP-A was significant lower in maternal-HD, late-HD and IUGR group (p< 0.01) and in CH group (p<0.05). There was no significant difference in BhCG levels through study group. Concerning prediction of the logistic regression, the validity of the uterine arteries Doppler velocimetry has been confirmed for early identification of women at risk of developing a hypertensive disease, especially of placental origin. In effect the area under the ROC curve for placental hypertensive diseases was 0.879, whereas for early diseases was 0.858. Conclusions: The main findings of the study are: 1) the UtA mean PI is altered in placental HD, while there were no differences in maternogenic HD; 2) the UtA mean PI is altered in early-onset HD and late-onset HD; 3) the predictive value of UtA mean PI is higher for placental HD than for early-onset HD; and 4) the performance of the model based on UtA PI in the 1st trimester performs best in the prediction of the placental HD compared to all other groups. Our study has some limitations: we acknowledge that the number of cases in the study is too small (the prevalence of HD in our cohort is low) to draw firm conclusions, and confirmation from larger studies will be required. Smoking habit was not considered. Diagnosis of early and late preeclampsia is based on time at delivery and not at time of diagnosis. Despite these limitations, the study shows that the classification based on phenotypes of HD is more appropriate than that based on temporal criteria. Indeed, our findings underline the importance of the “etiology” based classification in order to use, in the most appropriate way, the biophysical or biochemical marker screening tools. Thus, the usefulness of Doppler velocimetry of the uterine arteries to identify HD not associated with IUGR or simply based on temporal criteria appears to be of limited value. This finding is important when evaluating the performance of the screening programs or preventive policies.
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2

Teixidor, i. Viñas Mireia. "Rol de la inserció profilàctica de catèters balons oclusius percutanis a pacients amb anomalia placentària adherent." Doctoral thesis, Universitat Autònoma de Barcelona, 2016. http://hdl.handle.net/10803/399505.

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Objectiu: La malaltia adherent placentària (MAP) és una causa d’hemorràgia postpart severa, amb una pèrdua sanguínia esperada de 3-5L. Ha estat tractada amb cesària i histerectomia peri- part de forma tradicional. S’exposa la nostra experiència amb la inserció profilàctica de catèters balons oclusius percutanis (CBOP) a ambdues artèries ilíaques internes, amb o sense necessitat d’embolització arterial uterina per tal de preservar l’úter de la pacient. Durant el treball de recerca s’ha desenvolupat un nou protocol de tractament conservador multidisciplinar anomenat Triple P procedure. S’avalua els resultats obtinguts des de la implantació d’aquest protocol, així com la necessitat de intervencions futures a dones amb MAP. Material i Mètode: Dos articles han estat publicats a la literatura. El primer va ser publicat al Clinical radiology i inclou vint- i- set pacients diagnosticats perinatalment de MAP amb sospita de placenta percreta que varen ser tractades amb CBOP immediatament abans de realitzar un part per cesària. El segon article és un estudi de cohorts publicat al Ultrasound in Obstetrics and Gynecology on es compara 19 dones amb MAP tractades amb el Triple-P protocol (Grup estudi) i 11 tractades amb CBOP i part per cesària (Grup Control). El nombre i volum de transfusions sanguínies, pèrdua sanguínia estimada, la necessitat d’embolització arterial uterina (EAU) i/o la necessitat d’histerectomia han estat recopilades a ambdós articles. Resultats: Placenta percreta va ser confirmada en 19 pacients [sis (54.5%) pacients del Grup Control i 13 (68.4%) del Grup Estudi]. La pèrdua sanguínia mitja estimada va ser menor al Grup Estudi que en el Grup Control (1.70 L vs 2.17 L, respectivament), però la diferència no va ser estadísticament significativa (P=0.445). El risc d’hemorràgia postpart (HPP) i la necessitat d’histerectomia van disminuir de forma estadísticament significativa en el Grup Estudi (HPP, 54.5% vs 15.8%; P=0.035; histerectomia, 27.3% vs 0.0%; P=0.045). Com a conseqüència, es va observar una disminució estadísticament significativa en l’estada hospitalària de les pacients del Grup estudi (P=0.044). Conclusió: Els CBOP amb o sense EAU contribueixen a la disminució de la pèrdua sanguínia i del risc d’histerectomia peripart a les pacients amb MAP. La introducció del Triple-P procedure disminueix de forma significativa el risc d’histerectomia, HPP i estada hospitalària a aquestes pacients.
Aim: Morbidly adherent placenta (MAP) is a cause of severe postpartum haemorrhage (PPH) with expected blood loss of 3-5L. Traditionally, this has been treated by caesarean hysterectomy. We report our experience of prophylactic occlusion balloon catheters (POBC) in both internal iliac arteries before caesarean section, with or without embolisation to preserve the uterus and reduce haemorrhage. During our research we developed a new multidisciplinary conservative protocol of treatment involving POBC and placental non-separation, myometrial excision and reconstruction of the uterine wall called Triple P procedure. We also evaluate patient outcomes and need for further interventions in women with MAP, before and after introduction of the Triple-P procedure. Methods and Materials: Two articles have published in the literature. The first one was publish at Clinical radiology and includes twenty-seven women diagnosed with MAP and with suspected placenta percreta underwent POBCs before caesarean section. The second article is a cohort study published at Ultrasound in Obstetrics and Gynecology and compares 19 women with MAP treated with the Triple-P protocol (study group) and 11 treated with POBC and caesarean (control group). The quantity of blood replacement products, estimated blood loss, and necessity for uterine arterial embolization and/or hysterectomy were recorded retrospectively in both articles. Results: Placenta percreta was confirmed in 19 patients [six (54.5%) patients in the control group and 13 (68.4%) in the study group]. Estimated mean blood loss during the procedure was lower in the study group than in the control group (1.70 L vs 2.17 L, respectively), but the difference was not statistically significant (P=0.445). The risks of postpartum hemorrhage (PPH) and hysterectomy were statistically significantly lower in the study group (PPH, 54.5% vs 15.8%; P=0.035; hysterectomy, 27.3% vs 0.0%; P=0.045). As a consequence, there was a significant decrease in duration of inpatient stay in the study group (P=0.044). Conclusion: POBC with or without UAE, contributes to reduction in blood loss and preservation of the uterus in women with MAP Introduction of the Triple-P procedure conveyed a significantly reduced rate of hysterectomy, PPH and duration of hospital stay in patients with MAP.
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3

Franco, Glaucimeire Marquez. "Centralização cerebral materna na doença hipertensiva específica da gestação." Universidade Federal de Goiás, 2015. http://repositorio.bc.ufg.br/tede/handle/tede/4729.

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Introduction: Preeclampsia and eclampsia are important causes of maternal and perinatal morbidity and mortality worldwide Objectives: To evaluate the maternal brain centralization in pregnant women with specific gestational hypertension. Produce a systematic review article on the ophthalmic artery Doppler and uterine artery and the flow-mediated dilation. Develop an original article in order to assess the possible occurrence of maternal brain centralization in pregnant women with specific gestational hypertension. Establish normal values of the ratio of uterine artery to the ophthalmic artery (mean and standard deviation). Compare the ratio of uterine with the ophthalmic artery in normal and pathological group. Set the cut-off point, using the ROC curve for specific diagnosis of patients with hypertensive disease of pregnancy. Methods: A systematic literature review involved 260 indexed articles from Medline via PubMed and Virtual Health Library (VHL), published between 1989 and 2014. For the original article, we performed a case-control study of 178 pregnant women divided into two groups: a control group of normal patients (PN), a total of 83 normotensive pregnant women; and one case group of 95 patients with specific gestational hypertension. The analyzed parameters which formed part of the variables studied were: systolic velocity (VS), diastolic velocity (RV), the resistance index, systole-diastole relationship. In addition to these variables were also studied epidemiological variables of pregnancy, parity, abortion, weight, height, BMI, maternal age, gestational age. Results: Through the search strategy, were located 260 articles, of which 33 articles were eligible, with fifteen articles on the ophthalmic artery, eight articles on the brachial artery and eight articles on uterine artery. A total of 178 patients took part in study. The average age of normal pregnant women group of patients was 29.8 ± 4.7 and patients with specific gestational hypertension, of 26.14 ± 6.17. The mean gestational age of normal pregnant patients was 34.3 ± 3.5 weeks and the patients with specific gestational hypertension, of 32.40 ± 3.37. The mean body mass index (BMI) of healthy patients was 26.8 ± 5.6 and patients with specific gestational hypertension, of 30.55 ± 5.12. A normality curve systole-diastole compared with the respective cutoff was performed. A ROC curve was developed, with the cutoff point, considering the systolic velocity, diastolic velocity, systolic-diastolic ratio and the resistance index of the ophthalmic artery, respectively. Conclusion: The Doppler uterine artery and ophthalmic artery flow-mediated dilatation can be useful to identify patients at risk for allowing the monitoring of disease progression and perform effective interventions. It is observed that the possibility of maternal centralization in high-risk pregnancy as the PE is real, whereas in the average normal values and the standard deviation of the Doppler AU / AO-systole-diastole ratio were 0.43 ± 0 16. The cutoff point more sensitive, verified by the ROC curve, which defines maternal brain centralization in patients with hypertensive disorders of pregnancy, is 0.57 for the S / D for UD / AO, with 78% sensitivity and 13 % false positive and 77% specificity.
Introdução: A pré-eclâmpsia é um importante problema em obstetrícia, com altos índices de morbidade perinatal e mortalidade em todo o mundo, principalmente nos países em desenvolvimento. Objetivos: Avaliar a ocorrência de centralização cerebral materna em gestantes portadoras de doença hipertensiva específica da gestação. Produzir um artigo de revisão sistemática sobre Doppler da artéria oftálmica e da artéria uterina e sobre a dilatação fluxo-mediada da artéria braquial. Elaborar um artigo original para avaliar a ocorrência da centralização cerebral materna em gestantes portadoras de doença hipertensiva específica da gestação. Estabelecer a curva de normalidade da relação do Doppler da artéria uterina com o Doppler da artéria oftálmica. Comparar a relação do Doppler da uterina com o Doppler da artéria oftálmica no grupo normal e patológico. Definir o ponto de corte, através da curva ROC, para diagnóstico de pacientes com doença hipertensiva específica da gestação. Métodos: A revisão sistemática da literatura envolveu 260 artigos indexados das bases de dados Medline via PubMed e Biblioteca Virtual em Saúde (BVS), publicados entre 1989 e 2014. Para o artigo original, foi realizado um estudo caso controle com 178 gestantes distribuídas em dois grupos: um grupo-controle de pacientes normais (PN), num total de 83 gestantes normotensas; e um grupo casos de 95 pacientes com doença hipertensiva específica da gestação. As variáveis estudadas foram: a velocidade sistólica (VS), a velocidade diastólica (VD), o índice de resistência, a relação sístole-diástole. Além dessas variáveis foram estudadas paridade, aborto, peso, altura, IMC, idade materna, idade gestacional. Resultados: Por meio da estratégia de busca, localizaram-se 260 artigos, dos quais foram elegíveis 32 artigos, sendo dezesseis artigos sobre a artéria oftálmica, oito artigos sobre a artéria braquial e oito artigos sobre a artéria uterina. Um total de 178 pacientes fez parte do estudo. A média de idade das pacientes do grupo de gestantes normais foi de 29,8±4,7 e das pacientes com doença hipertensiva específica da gestação, de 26,14±6,17. A média da idade gestacional das pacientes gestantes normais foi de 34,3±3,5 semanas e das pacientes com doença hipertensiva específica da gestação, de 32,40±3,37. A média do índice de massa corporal (IMC) das gestantes normais foi de 26,8±5,6 e das pacientes com doença hipertensiva específica da gestação, de 30,55±5,12. Foi realizada uma curva de normalidade da relação sístole-diástole com o respectivo ponto de corte. Desenvolveu-se uma curva ROC com o ponto de corte, considerando a velocidade sistólica, a velocidade diastólica, a relação sístole-diástole e o índice de resistência da artéria oftálmica, respectivamente. Conclusão: O Doppler da artéria oftálmica e da artéria uterina e a dilatação fluxo mediada podem ser úteis para identificar pacientes em risco. Observou-se que a ocorrência de centralização materna em gravidez de alto risco como a pré-eclâmpsia (PE) é real, visto que na curva de normalidade a média e o desvio padrão do Doppler da AU/AO da relação sístole-diástole foram de 0,43 ± 0,16. O ponto de corte mais sensível, verificado por meio da curva ROC, que define centralização cerebral materna nas pacientes com doença hipertensiva específica da gestação, é de 0,57 para a S/D da UD/AO, com 78% de sensibilidade e 13% de falso positivo e 77% de especificidade.
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4

Chaves, Francisco Nogueira. "Technical ligation of ascending branches of the arteries uterna vaginal and its effect in the treatment of symptomatic uterine fibroids." Universidade Federal do CearÃ, 2008. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=4792.

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CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior
A miomatose uterina à um problema de saÃde pÃblica em todo o mundo, sendo responsÃvel por 30 a 40% das indicaÃÃes de histerectomia. Necessita-se de alternativas terapÃuticas eficazes, seguras, minimamente invasivas e de baixo custo. Alguns pesquisadores observaram resultados satisfatÃrios ao promover a diminuiÃÃo do fluxo sanguineo para o Ãtero, atravÃs da oclusÃo dos vasos uterinos por via laparoscÃpica. Neste estudo, com 16 pacientes com volume uterino aumentado, sangramento uterino anormal e dor de origem miomatosa; afastando outras causas concomitantes como cÃncer de colo ou endomÃtrio, adenomiose, e pÃlipos uterinos. Realizou-se uma tÃcnica simplificada de ligadura das artÃrias uterinas ascendentes, por via vaginal (LAUAV), e avaliou-se suas repercussÃes sobre sinais e sintomas mencionados, como tambÃm, sobre as alteraÃÃes do FSH, das imagens uterinas e o grau de satisfaÃÃo geral com o procedimento. A oclusÃo destes vasos foi executada pelo fundo de saco anterior, atravÃs de incisÃo da mucosa vaginal ao nÃvel da prega vÃsico cervical, das 10h Ãs 14h, seguida de secÃÃo dos ligamentos supra-cervical e vÃsico uterino para afastar a bexiga e o ureter. A LAUAV foi realizada sob visÃo direta com material especÃfico para trabalhar neste espaÃo exÃguo. As pacientes foram acompanhadas por 6 meses e reavaliadas em relaÃÃo aos parÃmetros comentados. O sangramento, a dor, o volume uterino, o diÃmetro do maior mioma apresentaram diminuiÃÃo significante e o FSH nÃo apresentou diferenÃas significantes, refletindo preservaÃÃo da funÃÃo ovariana. NÃo ocorreram complicaÃÃes. O grau de satisfaÃÃo das pacientes atingiu 90%. A LAUAV apresentou-se como uma opÃÃo segura, barata e eficaz no tratamento da miomatose sintomÃtica.
Uterine Myomatosis is a worldwide Public Health problem, responsible for 30 to 40% of indications for hysterectomy. Efficient, safe, minimally invasive alternative and low costs therapeutics are needed. Some researchers have observed satisfactory results at promoting the reduction of blood flow to uterus, through the occlusion of uterus blood vessels via laparoscopy. 16 patients who presented uterine increased volume, uterine abnormal bleeding and pain, originated by myomatosis participated in this study. Patients who presented other concurrent causes such as uterine bleeding, pain or uterine volume increase such as cervix cancer or uterus endometrial cancer, adenomyosis and uterine polyps were excluded from this study. It was carried out a ligature technique of ascendant branches of uterine arteries via vaginal (LAUAV) and the repercussion on signals and symptoms above mentioned, as well as alterations of follicle stimulating hormone (FSH), of uterine images, and the level of general satisfaction with such medical proceeding have been evaluated. Occlusion of such vessels was carried out by the bottom of the anterior saccus, through incision of vaginal mucosa, at the level of vesico-cervical plica, from 10a.m. to 2 p.m., followed by section of supra-cervical and vesicouterine ligaments to deviate the bladder and the ureter. LAUAV was carried out under direct vision with specific material to work in such a small space. Patients have been accompanied during 6 months and the re-evaluated in relation to the commented parameters. Bleeding, pain and uterine volume, and the diameter of the dominant myoma has presented significant reduction and FSH has not presented statistically considerable difference, reflecting the preservation of ovarian reserve. No Complications have occurred. Patientsâ satisfaction level attained 90%. LAUAV represents a secure, low-cost and efficient treatment of symptomatic myomatosis.
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5

RABEARIVELO, HAJANIRINA. "Le doppler uterin : interet predictif pour les complications gravidiques sur 45 grossesses suivies au pme du chu de nantes." Nantes, 1993. http://www.theses.fr/1993NANT044M.

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6

García, García Belén. "UTOPIA:Eficacia del Doppler de las arterias uterinas en el segundo trimestre y control exhaustivo de la gestación para la prevención de malos resultados perinatales. Estudio randomizado." Doctoral thesis, Universitat Autònoma de Barcelona, 2015. http://hdl.handle.net/10803/325417.

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La preeclampsia (PE) y el retraso de crecimiento intrauterino (RCIU) afectan a un 4-10% de todas las gestaciones. A pesar de ser las causas principales de parto prematuro yatrogéno y morbilidad materna en países desarrollados, su fisiopatología multifactorial no está del todo aclarada. La única medida terapéutica eficaz continúa siendo la finalización de la gestación. Por lo tanto, predicción y prevención de PE y RCIU siguen siendo objetivos prioritarios en la medicina materno-fetal. Objetivo: Valorar la capacidad del Doppler de arterias uterinas en segundo trimestre para la detección de pacientes con riesgo incrementado de PE y RCIU y, si su seguimiento exhaustivo durante la gestación mejoraría los resultados maternofetales en una población no seleccionada. Métodos: Estudio multicéntrico aleatorizado. Desde junio de 2006 a mayo de 2010, se llevó a cabo este estudio en cuatro centros en España: Hospital Universitario Vall d'Hebron, Hospital Universistario de Sant Joan de Déu, Hospital Universitario de Las Palmas de Gran Canaria y el Hospital de Son Llatzer. En la ecografía morfólogica rutinaria de segundo trimestre, las gestantes fueron asignadas aleatoriamente al grupo de estudio Doppler o no Doppler. Las pacientes que presentaban un aumento de resistencia a nivel de las arterias uterinas eran sometidas a control exhaustivo en la Unidad de Alto Riesgo Obstétrico. El control exhaustivo consistía en visitas mensuales para la toma de constantes , proteinuria cualitativa, analítica sanguínea y control ecográfico de crecimiento fetal y Doppler útero-placentario. Resultados: Se incluyeron los 11667 mujeres. En general, PE se presentó en 350 casos (2,58%), PE de instauración precoz (<34s) en 48 casos (0.41%), retraso del crecimiento intrauterino en 722 casos (6,18%), retraso del crecimiento intrauterino de instauración precoz en 93 casos (0,79) y PE del instauración tardía con retraso del crecimiento intrauterino en 32 casos (0,27%). El aumento de resitencia a nivel de las arterias uterinas, considerado como aquel IP por encima del p90, fue capaz de detectar el 59% de los casos de PE de instauración precoz y el 60% de los casos de RCIU de instauración precoz con una tasa de falsos positivos de 11.1%. Cuando se compararon los resultados perinatales y maternos según grupo al que hubiesen sido asignadas (UT-Doppler vs no - UT Doppler), no se encontraron diferencias estadísticamente significativas. Sin embargo, si se observó un mayor número de intervenciones médicas, tales como inducción al trabajo de parto y tratamiento con corticoesteroides. Conclusión: El estudio ecográfico rutinario de la resistencia a nivel de las arterias uterinas en segundo trimestre, en población no seleccionada identifica a aquellas pacientes con riesgo de complicaciones placentarias, pero la anticipación en el diagnóstico no mejora la morbi-mortalidad materno-fetal.
Pre-eclampsia (PE) and intrauterine growth restriction (IUGR) are estimated to affect 4-10% of all pregnancies. Despite being the leading causes of premature iatrogenic deliveries and maternal morbidity in developed countries, their aetiologies remain elusive and the only definitive therapeutic measure is delivery. Therefore, prediction and prevention of PE and IUGR remain major goals in fetal-maternal medicine. Aims: To ascertain whether uterine artery Doppler screening for PE and IUGR risk in the second trimester and targeted surveillance improve maternal and perinatal outcomes in an unselected population Methods: Multi-center randomised open-label controlled trial. From June 2006 to May 2010, this randomised trial was conducted at four centres in Spain: Vall d’Hebron University Hospital, Sant Joan de Déu University Hospital, Las Palmas de Gran Canaria University Hospital and Son Llatzer Hospital. In the second trimester rutine anomaly scan, women were randomly assigned to the uterine or non-uterine Doppler groups. Women with abnormal uterine artery Doppler were offered intensive surveillance in high-risk clinics of the participating centres with 4-weekly visits that included measurement of maternal blood pressure, proteinuria in dipsticks, blood test, foetal growth and Doppler scan. Results: 11667 women were included. Overall, PE occurred in 350 cases (2,58%), early-onset PE in 48 cases (0,41%), IUGR in 722 cases (6,18%), early-onset IUGR in 93 cases (0,79%) and early-onset PE with IUGR in 32 cases (0,27%). Uterine artery mPI >90th percentile was able to detect 59% of early-onset PE and 60% of early-onset IUGR with a false-positive rate of 11.1%. When perinatal and maternal data according to assigned group (UT-Doppler vs non-UT Doppler) were compared, no differences were found in perinatal or maternal complications. However, screened patients had a increase in medical interventions, such as corticosteroid administration and labour induction. Conclusion: Routine second trimester uterine artery Doppler ultrasound in unselected populations identifies women at risk for placental complications, however anticipation of the diagnosis failed to improve maternal or neonatal morbi-mortality.
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Zlotnik, Eduardo. "Parâmetros de ressonância magnética da pelve como fatores preditivos de resposta de leiomioma uterino à embolização arterial." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/5/5139/tde-11092012-095441/.

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Os métodos minimamente invasivos têm sido cada vez mais utilizados para o tratamento do leiomioma e, a embolização da artéria uterina, tem se destacado como método seguro e efetivo. O objetivo deste estudo foi avaliar, pela ressonância magnética da pelve, os fatores preditores da diminuição dos leiomiomas de pacientes submetidos a embolização da artéria uterina. Métodos: Estudaram-se 50 mulheres sintomáticas com leiomioma uterino, na menacme, que foram submetidas a embolização da artéria uterina. Acompanhou-se, por meio da ressonância magnética o volume do útero e dos leiomiomas. Foram examinados 179 leiomiomas nestas pacientes, um mês antes e seis meses depois do procedimento. Resultados: Seis meses após o tratamento, a redução média do volume uterino foi de 38,91%, enquanto os leiomiomas tiveram redução de 55,23%. Nos leiomiomas submucosos e/ou com a relação nódulo/músculo em T2 mais elevada, a redução do volume foi ainda maior (maior que 50,00%). Conclusões: As pacientes portadoras de leiomiomas e submetidas à embolização da artéria uterina apresentaram redução de volume dos nódulos superior a 50,00%, à ressonância magnética, quando eram submucosos e/ou tinham uma relação nódulo/músculo em T2 mais elevada
Objective : Minimally invasive methods are being an alternative to treat leiomyomas, including the uterine artery embolization that has emerged as a safe and effective method. The aim of this study was to evaluate the magnetic resonance imaging predictors of decrease in leiomyomas of patients who underwent uterine artery embolization. Methods: This study followed 50 symptomatic premenopausal women with uterine leiomyoma who underwent uterine artery embolization. Treatment was accompanied by magnetic resonance imaging of both the volume of the uterus and the leiomyomas. We examined 179 leiomyomas in that 50 patients, one month before and six months after of the procedure. Results: Six months after treatment, the mean reduction in uterine was 38.91%, while leiomyomas decreased by 55.23%. In submucosal leiomyomas and/or with a higher node/muscle ratio in T2, the volume reduction was even higher (greater than 50.00%). Conclusions: The patients with leiomyomas and underwent uterine artery embolization, showed reductions in the volume of nodes greater than 50,00%, on the magnetic resonance imaging, when they were submucosal and / or had a higher node-to-muscle ratio in T2
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Toro, Mayorga Ana G. "UTERINE ARTERY RUPTURE, AN ANGIOPATHY OF THE REPRODUCTIVE SYSTEM OF THE MARE: OCCURRENCE AND POTENTIAL EFFECTS." UKnowledge, 2015. http://uknowledge.uky.edu/gluck_etds/24.

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The intent of this research was to identify if the degenerative changes within arteries in the endometrium (endometrial angiopathies) correlate with degenerative changes in the uterine arteries and can be used as a predictor of increased risk for uterine artery rupture (UAR). With this objective specimens from 20 mares that died from uterine artery rupture and 21 control mares that died from unrelated causes were obtained from cases submitted to the University of Kentucky Veterinary Diagnostic Laboratory (UKVDL) over a two-year period. Postmortem specimens of each mare were collected from the left and right uterine arteries at the origin, bifurcation, and distal to the bifurcation as well as full thickness uterine wall sections at five different sites. An additional sample was taken from the uterine artery at the site of rupture in the affected mares. Tissue samples were immersed in 10% neutral buffered formalin, routinely processed, and stained with hematoxylin and eosin, Masson’s Trichrome, and Verhoeff´s Van Gieson histochemical stains as well as a smooth muscle-actin immunohistochemical marker. Elastosis, fibrosis, and vascular smooth muscle cell degeneration were identified in this study as potential contributors of vascular degeneration and a scoring system was developed to differentiate the degrees of severity of these specific degenerative changes within the intima and media of the vascular wall. Based on the scoring system, sections of uterine arteries and endometrial arterioles were blindly examined and the scored changes recorded for statistical analysis. Although the degenerative changes in endometrial and uterine arteries were similar within each group, the results could not not be used to predict an increased risk for UAR. Furthermore, we determined the major changes in vascular pathology of the affected uterine arteries and show there is a significant difference in degenerative changes between specific layers of the vascular wall.
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Mandia, L. "PLACENTATION IN OOCYTE DONATION PREGNANCIES: EVALUATION OF UTERINE ARTERIES DOPPLER AND PLACENTAL HORMONES." Doctoral thesis, Università degli Studi di Milano, 2015. http://hdl.handle.net/2434/333994.

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Introduction and objective: The aim of our study was to investigate the hypothesis that placentation in oocyte donation pregnancies (OD) presents differences compared to pregnancies conceived naturally or through in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) technique using autologous oocytes, as a result of alteration in normal placental and fetal-maternal interaction responsible of physiological placentation, due to genetic or hormonal factor and abnormal uterine and placental perfusion. Methods: To verify this issue we performed 2 study concurrently. We first performed a longitudinal study to measure uterine artery doppler pulsatility index (PI) at first (11-13+6 weeks), second (19-21 weeks) and third trimester (30-32 weeks) and maternal serum levels of and 17-β estradiol at 11-13+6 weeks in 55 OD pregnancies, in 48 (IVF/ICSI) pregnancies with autologous oocytes and 122 spontaneous pregnancies. The second was a retrospective study performed in order to analyze free β-human chorionic gonadotropin (hCG), pregnancy-associated plasma protein-A (PAPP-A) and nuchal translucency in 13624 spontaneously conceived pregnancies (Controls), 171 oocyte donation pregnancies (OD IVF/ICSI) and 76 IVF pregnancies with autologous oocytes (Autologous IVF/ICSI). Results: Mean uterine artery PI was significantly lower in OD in all trimester of pregnancy. First trimester: Controls 1,679 (DS 0,456), Autologous IVF/ICSI 1,706 (DS 0,481) and OD IVF/ICSI - oocyte recipients 1,415 (DS 0,486), showing the latter a reduced value [IC95% - p 0.001 (OD vs. Spontaneous conceived pregnancies) and p 0.007 (OD vs. Autologous IVF/ICSI)]; II trimester: Controls 0,96 (0,294), Autologous IVF/ICSI 1,15 (0,407), OD IVF/ICSI - oocyte recipients 0,80 (0,292) (p < 0.05). III trimester, only the analysis between OD and spontaneous conceived pregnancies showed the same trend (p 0.018). Free β-hCG levels were significantly higher both in OD IVF/ICSI pregnancies (1.44 ± 1.06 MoM) and Autologous IVF/ICSI (1.48 ± 1.02 MoM) compared to Controls (1.15 ± 0.84 MoM; p<0.05) and Age-matched Controls (1.18 ± 0.98 MoM; p<0.05). PAPP-A levels did not significantly differ among the four groups. Significantly lower nuchal translucency was detected in Controls (1.41 ± 0.36 mm) compared to OD IVF/ICSI (1.46 ± 0.44 mm; p<0.05), in Autologous IVF/ICSI (1.51 ± 0.34 mm; p<0.05) and Age-matched Controls (1.44 ± 0.42 mm; p<0.05). Conclusion: Oocyte donation has a significant impact either on biophysical and biochemical markers.
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Patel, Trusher. "Uterine Arterial Embolization: Classification of Leiomyomas to Determine Predictors of Response." Yale University, 2006. http://ymtdl.med.yale.edu/theses/available/etd-06282006-134426/.

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The purpose of this study is to determine features of uterine leiomyoma on Magnetic Resonance Imaging (MRI) that identify predictors of response to Uterine Arterial Embolization (UAE). MRI images were obtained before and after UAE in 35 women. These images were analyzed for uterine and fibroid size changes along with fibroid border characteristics and location for a total of 73 fibroids. Fibroids were classified as either smooth or lobulated based on border appearance on MR imaging to determine any differences in mean fibroid volume reduction post-embolization. The mean decrease in fibroid volume from pre-embolization to post-embolization was 48.1% ± 28.6 % (SD) (P < 0.001). No statistical difference was detected in the mean volume reduction between lobulated and smooth fibroids, 40.6% ± 23.1% (SD) and 50.9% ± 30.2% (SD) respectively, with a confidence interval [-25.1, 4.6, SEM 7.5, Df 71], single factor ANOVA (F[1,71]=1.88, Fcrit=3.98, p=0.17). However, some difference was detected in the failure rate of lobulated versus smooth fibroids to embolization, 5% and 9.4% respectively, ANOVA (F [1, 71]= 0.37, Fcrit= 3.98, p > 0.1), albeit at low statistical power. Also no difference was detected in mean fibroid volume reduction between intramural, submucosal, and subserosal fibroids. Thus, we introduced a novel characteristic by which to classify uterine fibroids based upon border appearance on MR imaging.
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11

Alegría, Vera René Augusto. "Caracterización de la función vascular de un modelo de restricción de crecimiento intra-uterino por oclusión progresiva de arterias uterinas en cobayas." Tesis, Universidad de Chile, 2015. http://repositorio.uchile.cl/handle/2250/131855.

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Memoria para optar al Título Profesional de Médico Veterinario
La restricción del crecimiento intrauterino (RCIU) es una causa importante de mortalidad y morbilidad perinatal. Una interacción compleja y dinámica del ambiente materno, la placenta y el feto está involucrado en asegurar el crecimiento normal del feto. Por lo tanto, un desequilibrio en este complejo sistema puede llevar a un retraso del crecimiento intrauterino y condicionar la salud en la vida posnatal del animal que padece esta condición. Esta memoria de título se ha enfocado en describir el crecimiento fetal intrauterino y la función vascular umbilical en un novedoso modelo de RCIU en cobayos. La inducción de RCIU se realizó de manera quirúrgica a través de la implantación de oclusores ameroides que disminuyen progresivamente el flujo uterino durante la segunda mitad de la gestación. El seguimiento del crecimiento fetal y la función umbilical se realizó mediante ultrasonografía Doppler que asociado a estudios post mortem permitieron describir las características de una gestación normal y de una con marcada restricción de crecimiento (46%). Este menor peso de los fetos de término se asoció a una caída de 29% de la eficiencia placentaria. Finalmente, se observaron cambios significativos en la función vascular umbilical, tanto in vivo como ex vivo, lo que deja de manifiesto una menor función vasodilatadora en los animales RCIU. Este estudio demuestra que los fetos que presentan una disminución de la perfusión útero-placentaria tienen una marcada restricción de crecimiento asimétrica y una disfunción endotelial umbilical
Financiamiento: Proyecto Fondecyt No. 1130801
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12

Nocum, Don. "Optimising patient radiation dose for uterine artery embolisation." Thesis, The University of Sydney, 2022. https://hdl.handle.net/2123/29778.

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Uterine artery embolisation (UAE) is a minimally invasive procedure used to treat patients with symptomatic uterine fibroids and/or adenomyosis. UAE involves x-ray imaging with an angiography system that emits ionising radiation. The practices of radiation dose optimisation are critical for UAE patients who are usually in their reproductive-age – to minimise the exposure to reproductive organs. The aims of this thesis were to: conduct a literature review on the factors that contribute to the radiation dose of patients during UAE; establish a regression model to identify the predictors of radiation dose at our centre using baseline UAE prospective data; to introduce a continuous quality improvement (CQI) program for UAE radiation dose optimisation and assess its impact on dose reduction and image quality; and to establish a new regression model to identify new UAE dose predictors on an upgraded angiography system. The first study concluded that the regression model formed from a high volume of baseline data had the potential to improve practice and reduce UAE radiation dose. The second study concluded that the CQI program, which used theoretical and empirical evidence, had optimised UAE radiation dose practices, where dose reduction demonstrated no detrimental effects on image quality. The third study concluded that significant dose reductions between an upgraded and preceding angiography system were achieved, and the resultant multivariable linear regression (MLR) model can be used in future UAE procedures to validate its system-dependent nature. The next logical step in future studies influenced by this thesis is the continual exploration of radiation dosimetry for UAE, with technological advancements and the calculation of effective dose for the ovaries and uterus. Understanding the risks, benefits and outcomes from this procedure, compared to surgery, can contribute to the decision making of patients, doctors and policy makers.
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Karlsson, Caroline. "Direct and endothelium-linked serotonergic control of vascular tone in human uterine and umbilical arteries." Lund : Dept. of Obstetrics and Gynaecology, University of Lund Malmö University Hospital, 1998. http://catalog.hathitrust.org/api/volumes/oclc/40420934.html.

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Bernardo, Andre [UNIFESP]. "Impacto da embolização arterial do leiomioma uterino no volume uterino, diâmetro do mioma dominante e na função ovariana." Universidade Federal de São Paulo (UNIFESP), 2011. http://repositorio.unifesp.br/handle/11600/9708.

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Made available in DSpace on 2015-07-22T20:50:19Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-05-25. Added 1 bitstream(s) on 2015-08-11T03:26:06Z : No. of bitstreams: 1 Publico-12634.pdf: 488476 bytes, checksum: 5e0af058b16520b991d17847c830fc84 (MD5)
INTRODUÇÃO: Para avaliar o impacto da embolização arterial de miomas (EAM) no volume uterino, diâmetro do maior mioma e na função ovariana, foi realizado antes e após 3 meses do procedimento ultrassonografia pélvica pela via transvaginal (USPTV) e dosagens de FSH (hormônio folículo estimulante). CASUÍSTICA E MÉTODO: Participaram do estudo 30 pacientes com leiomioma sintomático que se submeteram à EAM após ciência e assinatura do termo de consentimento livre e esclarecido, obedecendo aos critérios de inclusão do estudo. Foram realizados exames de USPTV pelo mesmo profissional, no mesmo aparelho antes e após três meses da EAM. O volume uterino foi expresso em cm³ e o diâmetro do maior mioma em cm. Foram feitas dosagens de FSH antes e após três meses da EAM no laboratório central do Hospital São Paulo. Os valores foram quantificados em UI/ml, analisados e expressos por média±desvio padrão (DP). Os dados foram então submetidos a análise estatística pelo teste não paramétrico de Mann-Whitney. RESULTADOS: Houve a exclusão de uma paciente por falta de dados pós-EAM. A média do volume do útero pré-EAM foi 402,4±165,9cm³, diâmetro do maior mioma pré-EAM 5,928±2,126cm. O resultado observado foi volume uterino pós-EAM foi 258,9±118,6cm³ e diâmetro do maior mioma pós-EAM 4,607±1,858cm. A média da dosagem de FSH pré-EAM foi 4,997(±3,520)UI/ml e pós-EAM foi 5,500(±4,759)UI/ml com p=0,581*. Das dosagens hormonais foram analisados 29 casos. Uma paciente, que equivale a 3,4% do total, cursou com aumento definitivo de FSH. Houve redução de 35% do volume uterino, de 22% no tamanho do maior leiomioma e a EAM não alterou significativamente os valores de FSH após 3 meses. CONCLUSÃO. O procedimento diminuiu o volume uterino e o diâmetro do maior mioma preservando o órgão e, não provoca alterações na função ovariana.
PURPOSE: To evaluate the impact of the mioma arterial embolization (EAM) by uterine volume, mioma diameter greater and in the ovarian function, was carried through before and after three months of the procedure, pelvic ultrasonography for the transvaginal way (USPTV) and dosages of FSH (follicle-stimulating hormone). METHODS: Thirty patients carrying of symptomatic leiomyomas had participated of the study that they had been submitted to the EAM after science and signature of the term of free and clarified assent, obeying the criteria of inclusion of the study. Examinations of USPTV for the same professional had been carried through, in the same device before and after three months of the EAM. The uterus volume was express in cm³ e mioma diameter greater in cm. Had been made dosages of FSH before and after three months of the EAM in the central laboratory of the Hospital São Paulo. The values had been quantified in UI/ml, analyzed and express for medium+/-shunting line standard. The data then had been submitted the statistics analysis for the test distribution free of Mann-Whitney. RESULTS: It had the exclusion of a patient due to lack of data after EAM. The average before EAM uterine volume was 402,4±165,9cm³, before-EAM mioma diameter greater 5,928±2,126cm. The observed result was after-EAM uterine volume was 258,9±118,6cm³ and after-EAM mioma diameter greater 4,607±1,858cm. The average of the dosage before-EAM FSH was 4,997 (±3,520) UI/ml and after-EAM FSH was 5,500 (±4,759) UI/ml with p=0,581*. In hormone dosages, 29 cases had been evaluated. One case, that is equivalent 3.4% of the total, attended a course with definitive increase of FSH. It had reduction of 35% of the uterus volume, of 22% in the size of the mioma diameter greater and the EAM did not modify the FSH values significantly after 3 months. CONCLUSION: The procedure causes reduction of the uterine volume and leiomyomas preserving the uterus and, does not provoke ovarian function alterations.
TEDE
BV UNIFESP: Teses e dissertações
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Rettig, Christine [Verfasser]. "Expression und Funktion von nikotinischen Azetylcholinrezeptoruntereinheiten in der Arteria uterina der Ratte / Christine Rettig." Gießen : Universitätsbibliothek, 2011. http://d-nb.info/1062972716/34.

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Gonzáles, Alarcón Luis Fernando. "Validez de la velocimetría Doppler de arteria uterina en la predicción de pre-eclampsia." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2003. https://hdl.handle.net/20.500.12672/2033.

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En el Instituto Materno Perinatal durante período comprendido entre el 01 de octubre de 1999 y el 31 de marzo del año 2000 se realizó un estudio prospectivo, longitudinal y comparativo con un diseño de tipo validación de prueba diagnóstica con el objetivo de determinar el valor de la velocimetría Doppler de la arteria uterina entre las 20 y 26 semanas de gestación en la predicción de pre-eclampsia. Un total de 144 gestantes cumplieron los criterios de inclusión. Se registró la presencia o ausencia de la escotadura o incisura protodiastólica ("notch") en la onda de la flujometría de ambas arterias uterinas y el índice de resistencia (IR) de las arterias uterinas si eran _ 95to percentil. El 89,2% de pacientes con presencia de notch protodiastólico a la evaluación ultrasonográfica Doppler de las arterias uterinas presentaron pre-eclampsia al término de la gestación. Ninguna paciente tuvo índice de resistencia (IR) de las arterias uterinas _ 95to percentil. La presencia de notch protodiastólico en las ondas de velocimetría de las arterias uterinas, la nuliparidad y el riesgo social alto se asociaron significativamente con pre-eclampsia. El riesgo relativo de pre-eclampsia para pacientes con presencia de notch protodiastólico en las ondas de flujo de las arterias uterinas fue 26,8 (IC 95% 12,4 – 56,7; P _ 0,0001). Para pre-eclampsia, la presencia del notch protodiastólico en la onda de velocimetría de la arteria uterina por ultrasonografía Doppler tuvo una sensibilidad de 89,1%, especificidad de 80,4%, valor predictivo positivo de 61,1% y un valor predictivo negativo 95,5%. Se concluye que la presencia del notch protodiastólico en la onda de velocimetría de la arteria uterina evaluada por ultrasonografía Doppler transabdominal entre las 20- 26 semanas de gestación fue un importante predictor de pre-eclampsia.
Tesis de segunda especialidad
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Marinelli, Juliana Valente Codato. "Parâmetros ultrassonográficos bi e tridimensionais em gestações únicas com colo uterino curto." Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/5/5139/tde-07112018-092737/.

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INTRODUÇÃO: Pouco se sabe sobre parâmetros ultrassonográficos transvaginais possíveis de serem avaliados durante a gestação além do comprimento do colo uterino. A escassa literatura sugere que o volume calculado através da ultrassonografia tridimensional, a quantificação de sinal power Doppler em todo o órgão e o Doppler das artérias uterinas possam sofrer alterações de acordo com o comprimento cervical, e até mesmo anteceder seu encurtamento no processo que leva ao parto. OBJETIVOS: agregar novos parâmetros bi e tridimensionais ultrassonográficos à avaliação do colo uterino em gestações únicas. MÉTODO: Estudo transversal desenvolvido com dados de 2014 a janeiro de 2018 do projeto PROPE, no qual foi realizada ultrassonografia transvaginal em pacientes entre 20 e 23 semanas e 6 dias de gestação. Foram compilados e submetidos à análise secundária os dados de 162 gestantes com comprimento do colo uterino >= 25 mm (grupo Controle), 68 gestantes com comprimento do colo >= 15 mm e < 25 mm (grupo Colo Curto) e 18 gestantes com comprimento do colo < 15 mm (grupo Colo Muito Curto). Foram analisadas as características demográficas e antecedentes obstétricos das gestantes, e foram comparados entre os grupos os parâmetros cervicais de comprimento, volume e vascularização, além do Doppler de artérias uterinas bilateralmente. RESULTADOS: O comprimento médio (± DP) dos colos uterinos de cada grupo foi 35,28 ± 5,12 mm para o grupo Controle, 20,51 ± 2,47 mm para o grupo Colo Curto, e 10,72 ± 2,51 mm para o grupo Colo Muito Curto. Houve diferença entre os grupos quanto à idade materna, cor (etnia) e idade gestacional de inclusão. Quanto aos antecedentes obstétricos, houve associação somente entre a presença de colo curto na gestação atual e pelo menos um parto prematuro anterior em gestantes não nulíparas (p = 0,021). Em relação aos parâmetros ultrassonográficos, verificou-se correlação linear positiva moderada entre volume e comprimento do colo (coeficiente de Pearson=0.587, valor p < 0.0001). Os grupos Controle, Colo Curto e Colo Muito Curto foram estatisticamente diferentes em relação às médias (± DP) de volume (46,38 ± 13,60 cm vs. 32,15 ± 13,14 cm vs. 22,08 ± 11,10 cm, respectivamente)(p <= 0,001), e em relação às médias (± DP) de índice de fluxo (IF) (39,81 ± 6,42 cm vs. 38,73 ± 4,99 cm vs. 36,02 ± 5,34 cm, respectivamente) (p = 0,027), em que a diferença estatística ocorre entre os grupos Controle e Colo Muito Curto. Porém, na presença da informação do volume, após regressão linear, a associação entre os grupos e IF deixa de ser significativa. Também não houve relação entre os grupos estudados e o Doppler de artérias uterinas. CONCLUSÃO: Existe correlação linear positiva entre o volume e o comprimento do colo uterino. Na ausência de informações sobre o volume, comprimento cervical e índices de vascularização não se correlacionam. O comprimento cervical também não está relacionado a alterações no Doppler de artérias uterinas. Apesar das limitações de uma amostra pequena e escassez de dados comparativos na literatura, este estudo foi realizado com uma amostra homogênea da população e abre caminho para maiores pesquisas sobre o assunto
INTRODUCTION: Little is known about transvaginal ultrasound parameters other than cervical length that can be assessed during gestation. The literature suggests that changes in volume on three-dimensional ultrasound, quantification of power Doppler signal in the entire organ, and Doppler sonography of uterine arteries may be related to cervical length, and even precede its shortening during spontaneous delivery. OBJECTIVES: To include new two- and three-dimensional ultrasonographic parameters for evaluation of the uterine cervix in single pregnancies. METHODS: A crosssectional study of data from Project PROPE on transvaginal ultrasonography performed in patients between 20 and 23 weeks and 6 days of gestation from May 2014 to January 2018 was conducted. Secondary analysis of data from 162 pregnant women with uterine cervical length >= 25 mm (Control group), 68 pregnant women with cervical length >= 15 mm and < 25 mm (Short Cervix group), and 18 pregnant women with cervical length < 15 mm (Very Short Cervix group) was performed. The demographic characteristics and obstetric history of the pregnant women were analyzed, and the cervical length, volume, and vascularization were compared between the groups. In addition, Doppler velocimetry of the uterine arteries was performed bilaterally. RESULTS: The mean cervical length (± SD) was 35.28 ± 5.12 mm for the Control group, 20.51 ± 2.47 mm for the Short Cervix group, and 10.72 ± 2, 51 mm for the Very Short Cervix group. The groups differed in maternal age, ethnicity, and gestational age. When analyzing the obstetric history of only non-nulliparous patients we observed a significant association between the presence of a short cervix in the current pregnancy and at least one previous preterm birth (p = 0.021). With regard to the ultrasonographic parameters, we observed a moderate positive linear correlation between the volume and length of the cervix (Pearson coefficient = 0.587, p < 0.0001). The Control, Short Cervix, and Very Short Cervix groups showed differences in the mean (± SD) volume (46.38 ± 13.60 cm vs. 32.15 ± 13.14 cm vs. 22.08 ± 11.10 cm, respectively) (p <= 0.001) and mean (± SD) flow index (FI) parameter of cervical vascularization (39.81 ± 6.42 cm vs. 38.73 ± 4.99 cm vs. 36.02 ± 5.34 cm, respectively) (p = 0.027), and the difference between the Control and Very Short Cervix groups was statistically significant. However, after linear regression, in the presence of volume information, we found no association between the groups and FI. CONCLUSION: Cervical length and volume are positively correlated. When information about the volume is not provided, there\'s no association between cervical length and vascularization. Uterine artery Doppler is not related to cervical length. Despite the limitations of a small sample size and less comparative data in the literature, this study was performed with a homogeneous sample population and paves the way toward further research on the subject
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18

Martins, Mauricio de Sena. "Embolização das arterias uterinas como tratamento de miomas sintomaticos." [s.n.], 2001. http://repositorio.unicamp.br/jspui/handle/REPOSIP/313235.

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Orientadores: Gustavo Antonio de Souza, Cecilia Maria Roteli Martins
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Doutorado
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19

Pinto, Ricardo Augusto de Paula. "Tratamento das pacientes sintomáticas portadoras de miomas uterinos através da associação das técnicas de embolização dos miomas e ligadura endovascular das artérias uterinas." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/5/5151/tde-06062007-110430/.

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Os miomas uterinos são os tumores benignos mais comuns do trato genital feminino, sendo que nas mulheres portadoras, 30% são sintomáticos e exigem alguma forma de tratamento. No presente estudo, foram tratadas 35 pacientes sintomáticas com diagnóstico clínico e ultra-sonográfico de mioma uterino, por meio da embolização dos miomas com partículas de polivinil-álcool associadas à obstrução das artérias uterinas com micromolas fibradas. A avaliação clínica e ecográfica foram inicialmente feitas e o acompanhamento realizado após um, três, seis e doze meses do procedimento. O sucesso técnico foi de 94,3%. O volume uterino médio era de 404,53 cm3 antes do tratamento endovascular percutâneo e o sintoma mais freqüente, em 82,9%, a menorragia. A redução média dos volumes uterinos foi de 21,4%, 39,7%, 53,8% e 59,8% respectivamente em um, três, seis e 12 meses (p < 0,01). Houve, também, a redução do volume do nódulo miomatoso dominante em 5%, 18,5%, 26,8% e 32,9% em um, três, seis e 12 meses, respectivamente (p < 0,01). A melhora e o controle da menorragia foram obtidos em 100% das pacientes tratadas. Houve necessidade de histerectomia em uma paciente por insucesso no controle da dor após seis meses do procedimento. A embolização dos miomas uterinos com partículas de polivinil-álcool associada à oclusão endovascular das artérias uterinas com micromolas fibradas é uma alternativa de tratamento minimamente invasivo para as pacientes sintomáticas portadoras de miomas uterinos que proporciona controle e melhora dos sintomas e redução do tamanho dos miomas e do volume uterino.
Uterine fibroids are the most frequent benign tumors of the female genital tract. The tumors are symptomatic in about 30% of the cases, requiring medical treatment. In the present study, a total of 35 clinically symptomatic patients with ultrasonographic diagnosis of fibroids underwent endovascular treatment, which consisted of embolization of the uterine arteries with 355-500 micras PVA particles associated to metallic coils. Clinical and ultrasonographic evaluations were performed at baseline, 1, 3, 6 and 12 months post-intervention. Technical success was obtained in 94.3% of the cases. Mean uterine volume before the procedure was 404.53 cm³ and menorrhagia was the most frequent symptom (82.9%). Mean reduction of the uterine volumes was 21.4%, 39.7%, 53.8% and 59.8% respectively at 1, 3, 6 and 12 months post-intervention. Dominant fibroid size was also significantly reduced after the procedure (5%, 18.5%, 26.8% and 32.9% reductions at 1, 3, 6 and 12 months, respectively; p < 0.01). Vaginal bleeding was abolished in all cases after the 12-month follow up. One patient needed to undergo hysterectomy 6 months after the procedure due to uncontrolled pain. Our results demonstrate uterine arteries embolization is minimally invasive and provides clinical control of the fibroids associated to significant reduction of the uterine volume. Moreover, the technique preserves the uterus and should be considered a therapeutic alternative to standard surgical treatment.
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20

Reho, John Joseph. "The Impact of Reductions in Uterine Perfusion Pressure on Uterine Arterial Reactivity in Gravid Rats II and L-tyrosine Polyphosphate Nanoparticles as a Potential In Vivo Gene Delivery Device." University of Akron / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=akron1333899328.

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21

Heihoff-Klose, Anne. "Prädiktive Wertigkeit von Parametern des oxidativen Status bei Präeklampsie und intrauteriner Wachstumsretardierung." Doctoral thesis, Universitätsbibliothek Leipzig, 2012. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-84053.

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Eine Dysbalance zwischen Sauerstoffradikalen und der plasmatischen antioxidativen Kapazität sowie eine gesteigerte Aktivität der neutrophilen Granulozyten werden als mögliche pathophysiologische Faktoren der Schwangerschaftserkrankungen Präeklampsie (PE) und intrauterine Wachstumsretardierung (IUGR) diskutiert. Das Ziel der Studie war, zu prüfen, ob der plasmatische antioxidative Status und die Plasmaspiegel der neutrophilen Granulozyten Myeloperoxidase und PMN Elastase bei Schwangerschaften mit uteriner Perfusionsstörung, die ein Hochrisikokollektiv für die oben genannten Schwangerschaftskomplikationen darstellen, verändert sind. Die Messungen mit dem immundiagnostischen ELISA zur Bestimmung der antioxidativen Kapazität (ImAnOx) ergaben, dass eine signifikante Erniedrigung der Totalen Antioxidativen Kapazität im Hochrisikokollektiv vorlag. Eine Verbesserung der Risikobeurteilung war durch den ImAnOx-Test nicht möglich. Die Berechnung des Antioxidativen Quotienten durch die zusätzliche Bestimmung des Harnsäurespiegels konnte die Voraussage nicht verbessern. Zur inflammatorischen Komponente mit Hilfe der Enzymspiegelmessungen zeigten die Ergebnisse weder einen Zusammenhang mit der uterinen Perfusionsstörung noch verbesserten sie die Einschätzung des Risikos. Anhand der Ergebnisse wird deutlich, dass mit der uterinen Dopplersonographie insbesondere für das fetale Geburtsgewicht eine Kalkulation möglich ist.
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22

Niehoff, Manuela [Verfasser]. "Vaskuläre Funktion uteriner Arterien und intrauterine Wachstumsretardierun der Feten von Ratten mit präeklamptischem Phänotyp / Manuela Niehoff." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2012. http://d-nb.info/1030057036/34.

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23

Biermann, Jana [Verfasser]. "Dopplersonografische Untersuchungen zur Durchblutung des Corpus luteum, der Arteria ovarica und der Arteria uterina der Stute unter Einfluss einer postovulatorischen hCG-Behandlung / Jana Biermann." Hannover : Bibliothek der Tierärztlichen Hochschule Hannover, 2013. http://d-nb.info/1037792580/34.

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24

Ruijtenbeek, Karin. "Consequences of prenatal growth retardation on arterial properties." [Maastricht : Maastricht : Universiteit Maastricht] ; University Library, Maastricht University [Host], 2002. http://arno.unimaas.nl/show.cgi?fid=7218.

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25

Limay, Ríos Oscar Antonio. "Eco Doppler de las arterias uterinas en predicción de macrosomía fetal." Doctoral thesis, Universidad Nacional Mayor de San Marcos, 2016. https://hdl.handle.net/20.500.12672/6088.

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Determina la relación entre el índice de pulsatilidad promedio de las arterias uterinas tomadas por ecografía en gestantes entre las 11 a 14 y 20 a 26 semanas de gestación con la macrosomía neonatal. Estudio prospectivo, longitudinal, analítico. Se incluyen a 3,279 gestantes atendidas en el Instituto Nacional Materno Perinatal entre el periodo 2011 a 2014, de los cuales 952 son pacientes captadas entre las 11 a 14 semanas y 2327 entre las 20 a 26 semanas, se forma dos grupos: 11 a 14 y 20 a 26 semanas; los pesos considerados para la comparación son: 3,600, 3,800, 4,000, 4,200 y 4,400 gramos, se realiza una correlación por el método de Pearson, la significación estadística se realiza por medio de la prueba de Chi cuadrado para ambos grupos, para calcular la probabilidad de ocurrencia de los eventos se calcula el odss ratio y para evaluar la precisión se utiliza intervalos de confianza, posteriormente se construye una curva ROC para precisar la sensibilidad y la tasa de falsos positivos. La tesis concluye que existe correlación entre el Doppler de las arterias uterinas tomado entre las 11 a 14 semanas y entre las 20 a 26 semanas con la macrosomía neonatal, pero su sensibilidad es baja y su tasa de falsos positivos es alta, siendo mejor la toma de la ecografía entre las 11 a 14 semanas.
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26

Tessier, Daniel. "Maternal Obesity Induces a Pro-Inflammatory Uterine Immune Response Associated with Altered Utero-Placental Development and Adverse Fetal Outcomes." Thesis, Université d'Ottawa / University of Ottawa, 2015. http://hdl.handle.net/10393/32451.

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Obese pregnant women have increased risk of a number of pregnancy complications, including poor maternal health, fetal growth restriction (FGR) and fetal demise. The success of pregnancy is dependent on precise regulation of the immune response within the utero-placental environment. Rats as a model for human related pregnancy complications are beginning to be widely used because of the similarities between these species in terms of trophoblast invasion and spiral artery remodeling. However our knowledge of immune cells and cytokine localization in the rat utero-placental tissue relating to these processes is limited. Therefore our first aim was to characterize the immune cell populations, such as uterine natural killer (uNK) cells, neutrophils and macrophages in the rat utero-placental unit at two crucial gestational ages relevant to trophoblast invasion and spiral artery remodeling, gestational day (GD) 15 and GD18. In addition, we characterized the cytokine distribution of TNFα, IFNγ and IL-10 in the utero-placental tissue at both above mentioned gestational ages. Our study has demonstrated co-localization of TNFα and IFNγ with uNK cells in the perivascular region of the spiral arteries in the rat mesometrial triangle. Neutrophils were localized at the maternal fetal interface and in the spiral artery lumen of the rat mesometrial triangle at both gestational ages. TNFα and IL-10 demonstrated a temporal change in the localization from GD15 to GD18 which coincides with the leading edge of trophoblast invasion into the mesometrial triangle. The results of the current study furthers our knowledge of the localization and temporal expression of uterine immune cells and relevant cytokines, and provides a base to research the function of these immune cells and cytokines during rat pregnancy as a model to study human pregnancy and complications related to immune functions. Since obesity is associated with a peripheral and systemic pro-inflammatory state in humans, our second objective was to investigate whether maternal obesity could alter the utero-placental and systemic immune response in the rats. To characterize maternal obesity induced changes in uterine immune state we used pregnant rats fed a control diet (normal weight; CD) or a high fat diet (obese; HFD) at GD15 and GD18. We performed immunohistochemistry to localize TNFα and IL-10, and quantified the levels of TNFα, IL-1β and IL-10 in the uterine tissue by immunoassay. To assess the systemic immune state, circulating levels of pro-inflammatory cytokine MCP-1 were assessed by immunoassay. We demonstrated an increased concentration of the pro-inflammatory marker TNFα and a reduced anti-inflammatory IL-10-positive cell distribution in the rat mesometrial triangle in response to a HFD. In addition increased circulating MCP-1 was observed in the HFD-fed dams at both gestation ages. HFD induced obesity in our rat model leads to an increase in uterine and systemic pro-inflammatory markers. These markers have demonstrated the potential to alter utero-placental development. Pregnancy complications such as FGR and fetal demise have been shown to be associated with impaired placental development as a result of altered trophoblast invasion and aberrant maternal spiral artery remodeling. Therefore, our third aim was to compare these parameters between the CD-fed rats and HFD-fed rats at GD15 and GD18. Early trophoblast invasion was increased by approximately 2-fold in HFD-fed dams with a concomitant increase in the expression of matrix metalloproteinase-9 protein, a mediator of tissue remodeling and invasion. By late gestation reduced trophoblast invasion was observed in HFD-fed dams. Furthermore, we also observed in late gestation significantly higher levels of smooth muscle actin surrounding the uterine spiral arteries of HFD-fed dams, suggesting impaired spiral artery remodeling. We also determined the impact of human serum from obese mothers on trophoblast invasion. We compared the invasion of HTR-8/SVneo cells treated with pooled first-trimester serum from obese women with or without fetal growth restriction vs. cells treated with serum from normal-weight women with or without fetal growth restriction. First-trimester serum from obese pregnant women reduced invasion of the trophoblast cell line HTR8/SVneo compared to serum from normal-weight pregnant women. Taken together, the results of this study suggest that maternal obesity can negatively influence crucial utero-placental development processes resulting in the poor pregnancy outcomes and increased fetal demise. To summarize, the HFD increased the pro-inflammatory marker TNFα which was associated with altered trophoblast invasion profiles and impaired vascular remodeling. These disturbances in utero-placental development were also associated with decreased birth weights (indication of FGR) and increased rates of stillbirths in our obese rat model. In conclusion, we have made progress in defining the influence of maternal obesity (HFD) on utero-placental development. The importance of these studies is evident since FGR represents a leading cause of perinatal morbidity and mortality. Furthermore, FGR fetuses have an increased risk of becoming obese in their lifetime as a result of fetal programming, therefore resulting in the propagation of a transgenerational obesity cycle. Therefore by understanding the mechanisms by which maternal obesity influences utero-placental development leading to FGR, we may be able to impact short term morbidity and prevent the programming of obesity in future generations. In addition, characterization of maternal obesity’s influence on utero-placental development will also help in the search for therapeutics or intervention strategies to help optimize fetal growth and improve pregnancy outcomes in obese women.
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27

Carrión, Villasana Raúl. "Índice de pulsatilidad de la arteria uterina como predictor de preeclampsia en el Hospital Nacional Daniel Alcides Carrión." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2013. https://hdl.handle.net/20.500.12672/9742.

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Determina si el índice de pulsatilidad de la arteria uterina >2.2 entre las 11 y 14 semanas es un método predictor del desarrollo de preeclampsia en gestantes que se atienden en el Hospital Nacional Daniel Alcides Carrión en el periodo comprendido del 01 de de junio del 2010 a julio del 2013. La investigación está orientada a describir los índices de pulsatilidad de la arteria uterina entre las 11 y 14 semanas en gestantes con riesgo de preeclampsia, para ello se realiza un estudio, descriptivo, retrospectivo, de casos. La muestra seleccionada está comprendida por 74 pacientes en quienes se realiza el índice de pulsatilidad de la arteria uterina entre las 11 y 14 semanas. Los instrumentos empleados están conformados por una ficha de recolección de datos convenientemente elaborada para los fines de estudio. El índice de pulsatilidad de las pacientes que desarrollan preeclampsia leve es de 2.49 frente a 1.51 de las pacientes que no desarrollan preeclampsia (P<0.05). El índice de pulsatilidad de las pacientes que desarrollan preeclampsia severa es de 2.09 frente a 1.5 de las pacientes que no desarrollan preeclampsia (P<0.05). El 8.1% de las pacientes desarrollan preeclampsia leve y el 1.4% de las pacientes desarrollan preeclampsia severa. Concluye que el índice de pulsatilidad de la arteria uterina >2.2 entre las 11 y 14 semanas es un buen método predictor del desarrollo de preeclampsia en gestantes.
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28

García, Cañadilla Patricia. "Multiscale cardiovascular analysis and simulations for the understanding of intra-uterine cardiovascular remodelling." Doctoral thesis, Universitat Pompeu Fabra, 2015. http://hdl.handle.net/10803/310949.

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Cardiovascular diseases are nowadays one of the major causes of death in developed countries. Besides the already known risk factors such as lifestyle and genetics, there is a growing evidence that adverse remodelling during prenatal life presents a risk factor for some cardiovascular diseases at later life. Recent studies have demonstrated that fetuses with intra-uterine growth restriction show cardiovascular remodelling at organ, vascular and also cellular and subcellular level, and moreover these changes persist postnatally. However this is a complex mechanism that needs to be further investigated. Currently, Doppler ultrasonography is one of the techniques most used to assess the fetal cardiovascular status and to study the heart and vascular remodelling in clinical practice. However, some of underlying hemodynamic and vascular changes cannot be assessed clinically and more sophisticated techniques are needed. Computational modelling of biological systems arises as a powerful tool to overcome this challenge, to support clinicians and to improve the understanding of different pathologies. In this thesis we proposed the use of computational models of fetal circulation, of cardiac cells and also image-processing tools, to improve the understanding of intra-uterine cardiac remodelling that takes place at different scales of the fetal cardiovascular system, and also to estimate the patient-specific hemodynamic properties that cannot be directly assessed from clinical measurements. The results arising from this thesis demonstrate that computational models are able to improve the understanding and detection of the intra-uterine cardiovascular remodelling by means of patient-specific simulations.
Les malalties cardiovasculars són avui en dia una de les principals causes de mortalitat en països desenvolupats. Deixant de banda els factors de risc relacionats amb l'estil de vida i la genètica, existeix una creixent evidència de què la remodelació adversa durant la vida prenatal esdevé un factor de risc per a algunes malalties cardiovasculars en l'edat adulta. S'ha demostrat que els fetus amb restricció de creixement intrauterina mostren signes de remodelació cardiovascular tant a nivell d'òrgan, vascular com a nivell cel•lular i subcel•lular, i molts cops aquests canvis persisteixen postnatalment. No obstant, és tracta d'un mecanisme complex que necessita ser investigat en profunditat. Actualment, l'ecografia Doppler és una de les tècniques més empradres per avaluar l'estat cardiovascular fetal i per estudiar la remodelació tant cardiaca com vascular durant la pràctica clínica. No obstant, alguns dels canvis hemodinàmics i vasculars subjacents no es poden avaluar clínicament, requerint de tècniques més sofisticades. El modelatge computacional de sistemes biològics es presenta com un potent instrument per superar aquest repte, per donar suport als metges i millorar la comprensió de les diferents patologies. En aquesta tesi es presenta per una banda l'ús de models computacionals tant de la circulació fetal com també de la cèl•lula cardíaca i la utilització d'eines de processat d'imatge amb la finalitat de millorar la comprensió de la remodelació cardiovascular intrauterina que té lloc a diferents escales del sistema cardiovascular fetal, i estimar les propietats hemodinàmiques específiques de cada pacient, les quals no es poden extreure directament a partir de mesures clíniques. Els resultats derivats d'aquesta tesi demostren que els models computacionals són capaços de millorar la comprensió i la detecció de la remodelació cardiovascular intrauterina mitjançant simulacions específiques del pacient.
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29

Pimenta, Eduardo Jorge de Almeida. "Estimativa do volume placentário e da vascularização placentária por meio da ultrassonografia tridimensional em gestação com síndromes hipertensivas." Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/5/5139/tde-18092013-163004/.

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Objetivo: Estimar o volume placentário e os índices de vascularização placentária em gestantes com síndromes hipertensivas, no segundo e terceiro trimestres gestacionais, e compará-los com os de gestantes sem morbidades (grupo controle). Métodos: Durante o período compreendido entre Abril de 2011 a Julho de 2012, foi realizado estudo clínico, prospectivo caso-controle envolvendo 62 gestantes hipertensas com idades gestacionais compreendidas entre 27 a 38 semanas e 66 gestantes hígidas na mesma faixa de idade gestacional. As gestantes foram submetidas à ultrassonografia para avaliação do volume placentário tridimensional calculado pelo método VOCAL, analisado mediante dois índices placentários, ou seja, volume placentário observado sobre esperado (VP o/e) e relação entre volume placentário sobre peso fetal (VP/PF), e também com quantificação da vascularização placentária por meio dos índices vasculares: índice de vascularização (IV), índice de vascularização e fluxo (IVF) e índice de fluxo (IF), utilizando ultrassom 3D power Doppler. Os critérios de inclusão foram gestações únicas com idade gestacional confirmada à ultrassonografia, sem malformações fetais e com diagnóstico do tipo de hipertensão, realizado segundo os critérios seguidos pelo protocolo assistencial da Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo ou gestações sem complicações clínicas e/ou obstétricas. Foram assim criados dois índices placentários: de volume placentário observado (calculado no exame) sobre a média esperada (percentil 50 da curva de normalidade publicada por de Paula et al.),definido pela sigla VP o/e; e um índice relacionando o volume placentário estimado sobre o peso fetal, definido pela sigla VP/PF; este último com o objetivo de eliminar a influência da variável Idade gestacional. Resultados: Foram incluídas no estudo 62 gestantes hipertensas (grupo estudo) e 66 gestantes hígidas (grupo controle). Do total de pacientes examinadas, 7 ( 5,4 %) foram excluídas: 6 por apresentarem intercorrências clínicas maternas e 1 por óbito fetal. Não houve diferenças estatisticamente significativas entre os índices de volumes placentários (O/E VP e VP/PF) das pacientes do grupo estudo quando comparadas com o grupo controle (p=0,793 e 0,152, respectivamente). Em relação aos índices vasculares placentários, houve redução significativa do IV (p < 0,001) e do IVF (p=0,002), não tendo havido redução nos valores do IF.Em relação a esse índice houve aumento do valor do fluxo, com p=0,006. Conclusão: Os volumes placentários não apresentaram diferenças estatisticamente significativas quando comparados com os de pacientes do grupo controle. Os índices de vascularização placentária (IV, IF e IVF) apresentaram os seguintes resultados: o IV e o IVF se mostraram significativamente menores nas pacientes hipertensas, enquanto o IF não mostrou redução no grupo estudo quando comparados com os do controle
Objectives: Our aim was to estimate placental volumes and vascular indexes in pregnant women with hypertensive syndromes during second and third gestational trimesters, and to compare them with those of healthy pregnant women (control group). Methods: From April 2011 to July 2012 a clinical, prospective, case-control study has been performed with 62 hypertensive pregnant women at gestational age of 27 to 38 weeks and 66 healthy pregnant women at the same gestational age. All pregnant women underwent three-dimensional power Doppler ultrasound examination to assess the placental volumes and vascular indexes: VI (vascularization Index), Vascularization Flow Index (VFI) and Flow Index (FI). The inclusion criteria were single gestation with gestational age confirmed by first trimester ultrasound, without fetal malformations and established diagnosis of hypertension according to criteria used at Obstetrics Department from Hospital das Clinicas of Faculdade de Medicina da Universidade de São Paulo or pregnant women without clinical diseases or obstetrical complications. Two placental volume ratios were created: observed-toexpected placental volume (o/e-PV) and placental volume-to-estimated fetal weight (PV/EFW) aiming to exclude any influence of the gestational age over results. For expected placental volume we used the 50th percentile from placental volume normograms as published by de Paula et al. Results Sixtysix healthy pregnant women and 62 pregnant women with hypertensive disorders were evaluated (matched by maternal age, gestational age at ultrasound exam and parity). Placental volumes were not reduced in pregnancy with hypertensive disorders (p>0.05). Reduced placental VI and VFI were observed in pregnancy complicated with hypertensive disorder (p<0.01 and p<0.01), specially in patients with superimposed preeclampsia (p=0.02 and 0.04). Week correlation was observed between placental volumes, placental vascular indices and Doppler studies of the uterine and umbilical arteries. Conclusion: Placental volumes showed no statistically significant differences when comparing study group with control group. Vascularization indices (VI, FI and VFI) have showed the following results: VI and VFI were significantly lower in hypertensive patients, whilst FI showed no decrease when compared to control group
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30

Vollert, Hans-Walter. "Diagnostic and clinical value of Doppler sonography of the uterine arteries at 20 - 23 weeks of gestation in a low risk population." [S.l.] : [s.n.], 2001. http://www.diss.fu-berlin.de/2001/247/index.html.

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31

Hirakawa, Humberto Sadanobu [UNESP]. "Comparação entre a dopplervelocimetria das artérias uterinas e a impedância bioelétrica na predição de hipertensao na gestação e restrição de crescimento intrauterino." Universidade Estadual Paulista (UNESP), 2009. http://hdl.handle.net/11449/106387.

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Financiadora de Estudos e Projetos (FINEP)
Avaliar as possíveis associações entre os valores diretos, resistência e reactância, obtidos pela BIA, no segundo e terceiro trimestres da gestação, e a ocorrência de hipertensão arterial e RCIU e comparar, para os parâmetros com associação positiva, o desempenho preditivo dos dois métodos - BIA e Dopplervelocimetria das artérias uterinas, realizados nos mesmos períodos da gestação. Desenho do estudo: Coorte prospectiva. Local do estudo: Hospital das Clinicas da Faculdade de Medicina de Botucatu / UNESP. População: 200 gestantes acompanhadas no Ambulatório de Pré-natal. As gestantes realizaram BIA e estudo Dopplervelocimétrico das artérias uterinas entre 22 e 26 semanas e entre 30 e 34 semanas de gestação. Desfechos: Foi considerado como desfecho materno o desenvolvimento de hipertensão arterial após a 20ª semana de gestação, sendo que à presença de proteinúria igual ou superior a 300 mg em urina de 24 horas confirmou o diagnóstico de PE e os casos de hipertensão arterial isolada, livre de proteinúria, foram considerados como Hipertensão Gestacional (HG). Para o recém-nascido, considerou- Resumo 13 se a relação do peso com a idade gestacional ao nascimento. Análise estatística: Foram analisadas as associações entre a ocorrência das complicações perinatais consideradas e os valores médios de resistência e reactância, entre 22 e 24 semanas e entre 30 e 34 semanas de gestação. O índice de massa corporal (IMC) pré-gestacional foi testado como variável de confusão, por análise de covariância; a comparação entre os resultados foi realizada pelo teste de Tukey, considerando p <0,05. Gráficos de dispersão e Curvas ROC foram elaboradas para o parâmetro de impedância bioelétrica que mostrou associação mais precoce e para os índices de pulsatilidade médio das artérias uterinas, obtido pela Dopplervelocimetria, na predição...
To evaluate the possible associations between the direct values, resistance and reactance, obtained by BIA in the second and third trimesters of pregnancy and the occurrence of arterial hypertension and IUGR and compare, for the parameters with positive association, the predictive performance by two methods  BIA and Uterine Arteries Dopplervelocimetry (pulsatility indices average), performed in the same periods of pregnancy. Study Design: Prospective cohort study. Setting: Clinic Hospital of Botucatu Medicine College. Population: 229 women followed in the Prenatal Clinic. The women underwent BIA and Uterine Arteries Dopplervelocimetry between 22 and 26 weeks and between 30 and 34 weeks of gestation. Outcomes: maternal outcomes were considered as the development of hypertension after the 20th. week of gestation, whereas the presence of proteinuria greater than or equal to 300 mg in 24 hours of urine confirmed the diagnosis of PE and the cases of hypertension alone, free of proteinuria, were considered as gestational hypertension (GH). For newborns, the ratio of weight to gestational age at birth was considered. Statistical analysis: We examined the associations between the occurrences of perinatal complications and considered the average values of resistance and reactance, between 22 and 24 weeks and between 30 and 34 weeks of gestation. Prepregnancy body mass index (BMI) was tested as a variable of confusion, by analysis of covariance, the comparison between the results was performed by Tukey test, considering p <0.05. Graphs of dispersion and ROC curves were developed for the parameter of bioelectric impedance showed early association and the average pulsatility indices of uterine arteries, obtained by Dopplervelocimetry in the prediction of complications. The areas on the curves were calculated and determined reference value for the parameters considered. These values were used... (Complete abstract click electronic access below)
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Lazar, Junior Felipe. "Terapia de reposição hormonal e indices de pulsatilidade das arterias uterina e carotida interna na pos-menopausa." [s.n.], 2001. http://repositorio.unicamp.br/jspui/handle/REPOSIP/313356.

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Orientador : Lucia Helena Simões da Costa Paiva
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: Objetivo ¿ Avaliar os efeitos da terapia de reposição hormonal sobre os índices de pulsatilidade das artérias uterinas e carótidas internas em mulheres na pósmenopausa. Sujeitos e Método ¿ Realizou-se um ensaio clínico prospectivo, controlado, aleatorizado e duplo cego. Oitenta mulheres foram alocadas e acompanhadas por 12 semanas em dois grupos de tratamento: 40 pacientes receberam 2mg de estradiol associados a 1mg de acetato de noretisterona de forma contínua, comparadas com 40 pacientes que receberam placebo. Setenta e seis mulheres concluíram o estudo, 38 em cada grupo. Foram realizadas medidas dos índices de pulsatilidade das artérias uterinas e carótidas internas através de ultra-sonografia bidimensional com Doppler em cores utilizando equipamento Aloka SSD 2000 com transdutor linear de 7,5MHz para as artérias carótidas e de 5,0MHz para as artérias uterinas. As aferições foram realizadas antes do início, com quatro e 12 semanas de tratamento. Análise dos dados ¿ Foi utilizado o teste t de student para amostras independentes na comparação das médias entre os grupos. A comparação das médias entre grupos ao longo do tempo foi feita com análise de variância para medidas repetidas (ANOVA). O coeficiente de correlação de Pearson foi utilizado para testar a correlação entre as diversas variáveis. Resultados ¿ A comparação das características das mulheres nos dois grupos mostrou que foram semelhantes em relação à idade, tempo de menopausa, índice de massa corporal, pressão arterial, colesterol total e frações e estradiol plasmático pré-tratamento. Nas artérias uterinas houve queda significativa no índice de pulsatilidade ao redor de 32%, atingindo o máximo na 12ª semana do estudo no grupo de usuárias de TRH. Nas artérias carótidas internas, os resultados mostraram que não houve diminuição significativa do índice de pulsatilidade nos grupos estudados. Observou-se através do coeficiente de correlação linear, que as variáveis idade e índice de massa corporal mostraram-se diretamente associadas ao índice de pulsatilidade da artéria carótida interna. No grupo que utilizou placebo, não houve alterações significativas entre quatro e 12 semanas de tratamento quando comparadas aos valores pré-tratamento. Conclusão ¿ A Terapia de Reposição Hormonal contínua foi efetiva em reduzir o índice de pulsatilidade da artéria uterina, sendo que este mesmo efeito não foi observado nas artérias carótidas internas. O efeito observado neste estudo sugere que a terapia de reposição hormonal combinada com estrogênios atua de forma diversa e individual sobre os vasos, dependendo do território estudado
Abstract: Objective: To compare the short-term effects of oral hormone replacement therapy (HRT) and placebo on carotid and uterine vascular impedance. Methods: Eighty postmenopausal women were randomized to 3 months treatment with oral continuous combined HRT or placebo. Carotid and uterine arteries pulsatility indices (PIs) were assessed by color Doppler at baseline, and after 4 and 12 weeks of treatment. Seventy-six women completed the trial, 38 in the TRH group and 38 in the placebo group. The study had a 90% power to detect a difference between treatment groups of 0.05 in the carotid artery and of 0.25 in uterine artery PI at the 5% significance level. Results: The carotid PI did not decrease significantly in both groups. In the uterine arteries, the drop in PI was steeper and greater and reached its maximum at 3 months (32%). Drops in carotid PI correlated positively with baseline PI values, but were affected positively by age, time since menopause and BMI. Drops occurred at despite of the supposed counteract effect of norethisterone acetate. In the placebo group, there was no significantly difference between 4, and 12 weeks of treatment with the baseline. Conclusion: Oral continuous HRT are effective at 12 weeks in reducing impedance to flow in uterine circulation. This effect did not occur in the carotid circulation. This short-term vascular effect suggests that the vascular effect of HRT is not the same when comparing different territories
Mestrado
Tocoginecologia
Mestre em Tocoginecologia
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33

Schumacher, Christina [Verfasser], and Kerstin [Akademischer Betreuer] Amann. "Veränderungen der Nierenmorphologie bei Ratten mit intrauteriner Wachstumsrestriktion (IUGR) im Modell der Arteria uterina Ligatur / Christina Schumacher. Betreuer: Kerstin Amann." Erlangen : Universitätsbibliothek der Universität Erlangen-Nürnberg, 2011. http://d-nb.info/1015782787/34.

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34

Hilário, Sandro Garcia. "Avaliação da expressão gênica relacionada à receptividade endometrial em pacientes submetidos à embolização do mioma uterino." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/5/5139/tde-09082012-164244/.

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OBJETIVO: Avaliar a receptividade endometrial de pacientes submetidas à embolização do mioma uterino, analisando a expressão gênica de LIF, IL-11, IL-6, claudina-4, HoxA-10, HoxA-11, receptor de estrogênio e receptor de progesterona antes e após este procedimento. CASUÍSTICA E MÉTODOS: Foram colhidas biópsias aspirativas de endométrio de 30 pacientes previamente à embolização do mioma uterino e repetida a coleta 3 a 4 meses após este procedimento. A média etária do grupo estudado foi de 36,2 anos. O volume uterino médio pré-embolização foi de 662,1 cc e o pós-embolização foi de 338,2 cc, medidos através de ressonância nuclear magnética. INTERVENÇÃO: As amostras de endométrio foram analisadas pela técnica de RT-PCR para os genes LIF, IL-11, IL-6, claudina-4, HoxA-10, HoxA-11, receptor de estrogênio e receptor de progesterona. RESULTADOS: Dentre os genes estudados, LIF (p=0,005), IL-11 (p=0,001) e HoxA-11 (p=0,021) apresentaram redução estatisticamente significante da expressão no endométrio após a embolização. Os demais genes não apresentaram alteração da expressão estatisticamente significante. CONCLUSÃO: Houve alteração da expressão de genes relacionados à receptividade endometrial, no endométrio de pacientes tratadas pela técnica da embolização do mioma uterino
OBJECTIVE: Assessing endometrial receptivity in patients undergoing uterine fibroid embolization by analyzing the gene expression of LIF, IL-11, IL-6, claudin-4, Hoxa-10, Hoxa-11, estrogen receptor and progesterone receptor before and after this procedure. METHODS: Endometrial aspiration biopsies were collected from 30 patients prior to embolization of uterine myoma, and the collections were repeated 3 to 4 months after this procedure. The average age of the study group was 36.2 years old. The mean uterine volume pre-embolization was 662. 1 cc and post-embolization was 338.2cc as measured by Magnectic Resonance Imaging (MRI). INTERVENTION: Endometrial samples were analyzed by RT-PCR for genes LIF, IL-11, IL-6, claudin-4, Hoxa-10, Hoxa-11, estrogen receptor and progesterone receptor. RESULTS: Among the studied genes, LIF (p=0.005), IL-11 (p=0.001) and Hoxa-11 (p=0.021) showed statistically significant reduction of expression in the endometrium after embolization. The remaining genes showed no statistically significant change in expression. CONCLUSION: There was altered expression of genes related to endometrial receptivity in the endometrium of patients treated by the technique of embolization of uterine myoma
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35

Carbajal, Jaimes Carmen Susana. "Índice de pulsatilidad de la arteria uterina como predictor de preeclampsia en el Instituto Nacional Materno Perinatal : setiembre 2009-mayo 2010." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2010. https://hdl.handle.net/20.500.12672/13054.

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Describe los índices de pulsatilidad de la arteria uterina entre las 11 y 14 semanas en gestantes con riesgo de preeclampsia. Se realiza un estudio de tipo descriptivo, retrospectivo y de casos. La muestra seleccionada estuvo comprendida por 142 pacientes en quienes se realizó el índice de pulsatilidad de la arteria uterina entre las 11 y 14 semanas en el Instituto Nacional Materno Perinatal en el periodo de septiembre de 2009 a mayo de 2010. Se concluye que el índice de pulsatilidad de las pacientes que desarrollaron preeclampsia leve fue de 2.29 frente a 1.5 de las pacientes que no desarrollaron preeclampsia. Siendo esta diferencia estadísticamente significativa (P<0.05). El índice de pulsatilidad de las pacientes que desarrollaron preeclampsia severa fue de 2.27 frente a 1.5 de las pacientes que no desarrollaron preeclampsia. Siendo esta diferencia estadísticamente significativa (P<0.05). El 14.1% de las pacientes desarrollaron preeclampsia leve y el 11.3% de las pacientes desarrollaron preeclampsia severa. El índice de pulsatilidad de la arteria uterina >2.2 entre las 11 y 14 semanas es un buen método predictor del desarrollo de Preeclampsia en gestantes. Las limitaciones que se pudieron encontrar están referidas al escaso financiamiento y a la dificultad para acceder a la recolección de los datos.
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36

Carbajal, Jaimes Carmen Susana. "Indice de pulsatilidad de la arteria uterina como predictor de preeclampsia en el Instituto Nacional Materno Perinatal : setiembre 2009-mayo 2010." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2010. https://hdl.handle.net/20.500.12672/12966.

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El presente trabajo de investigación estuvo orientada a determinar los factores asociados a sepsis nosocomial en los recién nacidos en el servicio de neonatología de Hospital Militar Central, para ello se realizó un estudio, descriptivo, retrospectivo, de casos y controles. La muestra seleccionada estuvo comprendida por 136 neonatos que desarrollaron sepsis intrahospitalaria clínica atendidos en el periodo que corresponde al estudio. Los instrumentos empleados estuvieron conformados por una ficha de recolección de datos convenientemente elaborados para los fines de estudio.
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37

BETOUX, FREDERIC. "Embolisation arterielle et hemorragies graves par cancer uterin : a propos de trois cas ; place de cette technique en gynecologie-obstetrique." Reims, 1993. http://www.theses.fr/1993REIMM090.

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38

Gaynor, Louise Michelle. "Immunogenetic regulation of Natural Killer cell function in pregnancy." Thesis, University of Cambridge, 2017. https://www.repository.cam.ac.uk/handle/1810/270329.

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Uterine NK (uNK) cells are a distinct subset of NK cells in the decidua of humans and rodents during pregnancy, which are essential for remodelling of the spiral arteries supplying the feto-placental unit. Similarly to peripheral NK cells, uNK cells express Natural Killer receptors (NKRs) that engage MHC class I molecules. Evidence from human genetic association studies suggests that, in the presence of allogeneic cognate paternal MHC class I ligands, inhibitory uterine NKRs are associated with disorders of pregnancy arising from impaired decidual vascular remodelling. Conversely, enhancement of human uNK cell activity through activating NKRs is associated with high birth weight. Evidence from mouse models corroborates that uNK cell activity is modulated by interactions between NKRs and MHC class I, but has largely focussed on the effect of paternal MHC. In this study, the contribution of maternal immunogenetic regulation of NK cell function to reproductive outcome was assessed independently of parental MHC disparity in mice. To evaluate the role of NKR genes in isolation, I used congenic B6.BALB-TC1 (TC1) mice that differ from C57BL/6 (B6) mice only within the region of chromosome six encoding NKRs that recognise MHC class I. Absence of a major inhibitory NKR for self-MHC, Ly49I, in TC1 mice causes a compensatory shift in the NKR repertoire expressed and preserves a majority subpopulation of educated NK cells. B6 and TC1 splenic and uterine NK cells are similarly functionally reactive and mature, and no significant differences could be detected in spiral arterial remodelling or fetal growth between these strains in MHC-syngeneic matings. This supports data from human immunogenetic studies showing that maternal uterine NKRs are not associated with differences in pregnancy outcome in the absence of novel paternal MHC class I ligands, and highlights the importance of maternal and paternal co-regulation of uNK cell activity during pregnancy. No mouse models of uNK cell activation are currently available with which to corroborate human immunogenetic associations between activating uterine NKRs and high birth weight. Male m157-transgenic (m157-Tg) mice, which ubiquitously express viral m157 glycoprotein ligands for the activating NKR Ly49H, were mated with B6 females. Exclusive expression of m157 glycoprotein by trophoblast improved placental efficiency, but did not enhance fetal growth. Some fertility clinics surmise that uNK cell activation initiates the pathogenesis of spontaneous abortion. It has been suggested that this may occur due to reduced expression by human uNK cells of miR-483-3p, which stimulates endogenous insulin-like growth factor (IGF)-1 production and uNK cell cytotoxicity in vitro. It is demonstrated here that neither miR-483-3p nor IGF-1 regulate murine NK cell development, maturation or function. No discernible reproductive phenotype is evident in miR-483 deficient females. It can be inferred that post-transcriptional control by miR-483 is not biologically relevant to murine NK cell function. Although m157-Tg mice may provide an interesting model to further study uNK cell-mediated placental adaptations, it remains important to identify a murine model of enhanced uNK cell function to corroborate human immunogenetic associations with high birth weight and to challenge the supposition that uNK cell activation is harmful to pregnancy.
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Franco, Maria do Carmo Pinho. "Efeitos da Desnutrição Intra-Uterina na Reatividade Vascular de Ratos Espontaneamente Hipertensos (SHR) e Wistar." Universidade de São Paulo, 2000. http://www.teses.usp.br/teses/disponiveis/42/42136/tde-23032001-091851/.

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Evidências epidemiológicas tem sugerido que a desnutrição intra-uterina pode ter papel importante no desenvolvimento de hipertensão arterial na fase adulta. No presente trabalho, foi estudada a influência da desnutrição intra-uterina na reatividade vascular e na pressão arterial de animais Wistar e SHR (ambos os sexos). Para tanto, ratas prenhes foram submetidas à restrição alimentar equivalente a 50% da dieta normal, durante toda a gestação. Curvas concentração-efeito à noradrenalina (NA), acetilcolina (ACh) e ao nitroprussiato de sódio (NPS) foram realizadas em anéis de aorta de ratos Wistar e SHR nutridos e desnutridos (ambos os sexos). A desnutrição intra-uterina elevou a pressão arterial em animais Wistar, machos e fêmeas, até níveis considerados de hipertensão. Além disso, acarretou alterações da reatividade à NA e à ACh, mas não ao NPS. Em animais SHR, de ambos os sexos, os efeitos deletérios da desnutrição intra-uterina foram capazes de exacerbar a hipertensão e a disfunção endotelial já existentes nesses animais.
Epidemiological studies suggest that intrauterine undernutrition can play an important role in the development of arterial hypertension in adulthood (FERRARI et al., 2000). Furthermore, maternal malnutrition during organ developmental stage impairs fetal growth and is believed to alter permanently the metabolism and physiology of the developing tissues. The aim of the present study was to examine the effects of intrauterine undernutrition in the arterial blood and vascular reactivity pressure of male and female normotensive (Wistar) and spontaneously hypertensive (SHR) rats offspring. Female pregnant rats (Wistar and SHR) were fed either normal or 50% of the normal intake diets, during the whole gestational period. Arterial blood pressure and the norepinephrine (NE), acetylcholine (ACh) and sodium nitroprusside (SNP) dose-response curves in isolated aortic rings of their offspring (male and female – when they reached adulthood) were determined. In Wistar rats, the intrauterine undernutrition induced an increase in the arterial blood pressure, leading to hypertension. Dietary restriction during pregnancy of Wistar rats altered the vascular reactivity to NE and ACh, whereas the response to SNP remained unaltered in the offspring. In the SHR offspring (male and female) the intrauterine undernutrition exacerbates the already existing hypertension and endothelial dysfunction. In summary, this study has shown that intrauterine undernutrition increased the arterial blood pressure and altered the vascular reactivity of male and female normotensive and SHR offspring.
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Hirakawa, Humberto Sadanobu. "Comparação entre a dopplervelocimetria das artérias uterinas e a impedância bioelétrica na predição de hipertensao na gestação e restrição de crescimento intrauterino /." Botucatu : [s.n.], 2009. http://hdl.handle.net/11449/106387.

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Orientador: Iracema de Mattos Paranhos Calderon
Banca: José Carlos Peraçoli
Banca: Joelcio Francisco Abade
Banca: Nelson Lourenço Maia Filho
Banca: Nilton Hideto Takiuti
Resumo: Avaliar as possíveis associações entre os valores diretos, resistência e reactância, obtidos pela BIA, no segundo e terceiro trimestres da gestação, e a ocorrência de hipertensão arterial e RCIU e comparar, para os parâmetros com associação positiva, o desempenho preditivo dos dois métodos - BIA e Dopplervelocimetria das artérias uterinas, realizados nos mesmos períodos da gestação. Desenho do estudo: Coorte prospectiva. Local do estudo: Hospital das Clinicas da Faculdade de Medicina de Botucatu / UNESP. População: 200 gestantes acompanhadas no Ambulatório de Pré-natal. As gestantes realizaram BIA e estudo Dopplervelocimétrico das artérias uterinas entre 22 e 26 semanas e entre 30 e 34 semanas de gestação. Desfechos: Foi considerado como desfecho materno o desenvolvimento de hipertensão arterial após a 20ª semana de gestação, sendo que à presença de proteinúria igual ou superior a 300 mg em urina de 24 horas confirmou o diagnóstico de PE e os casos de hipertensão arterial isolada, livre de proteinúria, foram considerados como Hipertensão Gestacional (HG). Para o recém-nascido, considerou- Resumo 13 se a relação do peso com a idade gestacional ao nascimento. Análise estatística: Foram analisadas as associações entre a ocorrência das complicações perinatais consideradas e os valores médios de resistência e reactância, entre 22 e 24 semanas e entre 30 e 34 semanas de gestação. O índice de massa corporal (IMC) pré-gestacional foi testado como variável de confusão, por análise de covariância; a comparação entre os resultados foi realizada pelo teste de Tukey, considerando p <0,05. Gráficos de dispersão e Curvas ROC foram elaboradas para o parâmetro de impedância bioelétrica que mostrou associação mais precoce e para os índices de pulsatilidade médio das artérias uterinas, obtido pela Dopplervelocimetria, na predição... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: To evaluate the possible associations between the direct values, resistance and reactance, obtained by BIA in the second and third trimesters of pregnancy and the occurrence of arterial hypertension and IUGR and compare, for the parameters with positive association, the predictive performance by two methods  BIA and Uterine Arteries Dopplervelocimetry (pulsatility indices average), performed in the same periods of pregnancy. Study Design: Prospective cohort study. Setting: Clinic Hospital of Botucatu Medicine College. Population: 229 women followed in the Prenatal Clinic. The women underwent BIA and Uterine Arteries Dopplervelocimetry between 22 and 26 weeks and between 30 and 34 weeks of gestation. Outcomes: maternal outcomes were considered as the development of hypertension after the 20th. week of gestation, whereas the presence of proteinuria greater than or equal to 300 mg in 24 hours of urine confirmed the diagnosis of PE and the cases of hypertension alone, free of proteinuria, were considered as gestational hypertension (GH). For newborns, the ratio of weight to gestational age at birth was considered. Statistical analysis: We examined the associations between the occurrences of perinatal complications and considered the average values of resistance and reactance, between 22 and 24 weeks and between 30 and 34 weeks of gestation. Prepregnancy body mass index (BMI) was tested as a variable of confusion, by analysis of covariance, the comparison between the results was performed by Tukey test, considering p <0.05. Graphs of dispersion and ROC curves were developed for the parameter of bioelectric impedance showed early association and the average pulsatility indices of uterine arteries, obtained by Dopplervelocimetry in the prediction of complications. The areas on the curves were calculated and determined reference value for the parameters considered. These values were used... (Complete abstract click electronic access below)
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41

Marrufo, Avellaneda Carlos Alberto. "Formas de onda de velocimetría Doppler de la arteria uterina en el segundo trimestre para la predicción de preeclampsia : Instituto Nacional Materno Perinatal, abril - junio, 2009." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2011. https://hdl.handle.net/20.500.12672/12799.

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Objetivo: Determinar la utilidad de la velocimetría doppler (presencia de la incisura protodiástólica e índice de pulsatilidad por encima del percentil 95) de la arteria uterina entre las 20 – 26 semanas de gestación en el Instituto Nacional Materno Perinatal durante el período comprendido entre el 01 de abril y el 30 de junio de 2009. Material y métodos: Estudio observacional analítico, prospectivo, longitudinal, de tipo cohorte. Se registró la presencia de la incisura protodiastólica ("notch") en la onda de la flujometría de ambas arterias uterinas y el índice de pulsatilidad por encima del percentil 95. Resultados: Un total de 170 gestantes cumplieron los criterios de inclusión y consintieron participar en el estudio. De ellas, 76 (44,7%) desarrollaron preeclampsia, lo que dio una incidencia de 1,6% (76 / 4811). El 89,2% de pacientes con presencia de notch protodiastólico y el 87,65 de gestantes con índice de pulsatilidad por encima del percentil 95 a la evaluación ultrasonográfica doppler de las arterias uterinas presentaron preeclampsia. La presencia de notch protodiastólico en las ondas de velocimetría de las arterias uterinas (RR 2.5; IC al 95%: 1,8 – 3,4; p  0,001), índice de pulsatilidad por encima del percentil 95 (RR 2.7; IC al 95%: 1,9 – 3,6; p  0,001) fueron factores de riesgo independientes y significativos para preeclampsia. Conclusiones: La presencia del notch protodiastólico en la onda de velocimetría de la arteria uterina y el índice de pulsatilidad por encima del percentil 95 evaluados por ultrasonografía doppler transabdominal entre las 20- 26 semanas de gestación son importantes predictores de preeclampsia.
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42

Salazar, Pumahuacre Alberto, and Flores Paul Glicerio Arcos. "Curvas de flujometría Doppler de arterias uterinas en gestantes de bajo riesgo en el Instituto Materno Perinatal año 2002." Universidad Nacional Mayor de San Marcos. Programa Cybertesis PERÚ, 2004. http://www.cybertesis.edu.pe/sisbib/2004/arcos_fp/html/index-frames.html.

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En el Instituto Especializado Materno Perinatal entre el 01 de febrero y el 30 de noviembre del 2002 a las gestantes que acudieron al control prenatal entre las 14 y 42 semanas de gestación se les ofreció la evaluación ecográfica con velocimetría Doppler de las arterias uterinas para realizar un estudio prospectivo descriptivo para determinar los valores normales de flujometría Doppler de las arterias uterinas entre las 11 - 42 semanas en gestantes de bajo riesgo obstétrico. Se determinó el índice de resistencia (IR) de ambas arterias, la reproducción de las mediciones y las variaciones intra e interobservador. 178 gestantes cumplieron los criterios de inclusión. La velocimetría Doppler de las arterias uterinas se realizó entre las 14 y 39 semanas de gestación. No hubo gestantes entre las 40 y 42 semanas. La onda de la arteria uterina izquierda se obtuvo en todas las pacientes pero la onda de la arteria uterina derecha solo en 163 (91,6%) gestantes. El IR media de la arteria uterina izquierda y derecha fue 0,58 y 0,55; respectivamente. El índice de resistencia de la arteria uterina derecha fue menor que el de la izquierda desde las 12 semanas de gestación. En el 95% de ocasiones, las variaciones intra e interobservador fueron menores de 0,12 y 0,15; respectivamente. Concluimos que el índice de resistencia de la arteria uterina derecha es menor que el de la arteria uterina izquierda, la medición del IR es altamente reproducible y las mediciones intra e interobservador del IR no difieren significativamente.
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43

Sarno, Manoel Alfredo Curvelo. "Associação entre antecedentes morbidos, dopplervelocimetria de arterias uterinas, anticorpos antifosfolipideos e resultados perinatais adversos em um grupo de gestantes." [s.n.], 2009. http://repositorio.unicamp.br/jspui/handle/REPOSIP/311741.

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Orientador: Ricardo Barini
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: Introdução: A presença de anticorpos antifosfolipídeos freqüentemente está associada a complicações obstétricas como aborto de repetição, óbito fetal, descolamento prematuro da placenta e pré-eclâmpsia grave e precoce. Objetivo: avaliar associação dos antecedentes mórbidos, da Dopplervelocimetria de artérias uterinas, dos anticorpos antifosfolipídeos (AAF) e resultados obstétricos/perinatais em um grupo de gestantes. Sujeitos e Métodos: foi conduzido um estudo de coorte e corte transversal, onde foram analisadas gestantes atendidas nos Ambulatórios de Pré-Natal da Unicamp que aceitaram participar do estudo. Foi aplicado um questionário sobre os antecedentes mórbidos, realização de dosagem dos AAF, realizada Dopplervelocimetria de artérias uterinas e analisada correlação com resultados obstétricos/perinatais. Resultado: foram avaliadas 385 gestantes com média de idade de 26,6 (±6,3) anos. A anticardiolipina (aCL) e o anti-ß2 glicoproteína I (anti-ß2-gpI) foram avaliados em 382 gestantes, dos quais 4,4% apresentaram o anti-ß2gpI IgM positivo, 4,7% IgG, 6,2% aCL IgG e 6,7% IgM. O anticoagulante lúpico (AL) foi avaliado em 137 gestantes com positividade em 2,3%. 33,4% das gestantes tinham, pelo menos, um antecedente obstétrico desfavorável (aborto recorrente, óbito fetal, pré-eclâmpsia, parto prematuro, filho anterior nascido com peso menor que 2.500g ou descolamento prematuro de placenta) e 2,6% tinham eventos trombóticos (infarto, acidente vascular cerebral, tromboembolismo pulmonar ou trombose venosa profunda). 16,5% tinham pelo menos um antecedente e um AAF positivo, contra 13,3% sem antecedente (p=0,44). 10% apresentavam antecedente trombótico e AAF positivo contra 14,4% sem história de evento trombótico e AAF negativo (p=0,88). As complicações obstétricas/perinatais foram avaliadas em 305 gestantes sendo que no grupo com antecedentes 31,7% evoluíram para alguma complicação obstétrica na gestação em curso contra 28,4% do grupo sem antecedente (p=0,59). Analisando o desfecho pré-eclâmpsia com pelo menos um antecedente, 7,7% x 4,5% (p=0,29), índice Apgar no 5º minuto menor ou igual a 7, 4,9% x 5,6% (p=0,57), peso abaixo de 2.500g, 15,5% x 12% (p=0,47). Quando separados os grupos com e sem antecedentes e comparados ao Doppler de artérias uterinas as mulheres que relataram peso inferior a 2.500g tiveram 4,0 [IC95: 1,16-13,7] vezes mais chance de apresentar índice de pulsatilidade acima do percentil 95 (IP>P95) e 4,68 [IC95: 1,37-15,9] quando apresentavam antecedente de elevação da pressão arterial antes das 34 semanas em gestação anterior. Não foram encontradas correlações dos outros antecedentes com o Doppler. Quando o IP>P95 houve um risco relativo (RR) de 2,77 [IC95: 1,87-4,11] para pelo menos uma complicação obstétrica/perinatal, 5,19 [IC95: 1,41-19,1] para Apgar do 5º minuto menor que 7 e 6,94 [IC95: 4,31-11,1] de peso abaixo de 2.500g. Quando associado IP>P95 e pelo menos um antecedente o RR para peso abaixo de 2.500g foi de 6,06 [IC95: 3,19-11,5] e 6,61 [IC95: 3,46-12,6] para parto antes das 37 semanas. Quando comparados os dois grupos não foi encontrada significância estatística no desfecho de pré-eclâmpsia com RR de 4.70 [IC95: 0,80-27,4]. Na avaliação do IP>P95 e AAF, 11,1% tinham o IP>P95 e pelo menos um AAF, contra 14,4% no grupo sem essas características, com Razão de Prevalência (RP)=0,77 [IC95: 0,11-4,96]. A RP para o grupo com IP>P95 e pelo menos um antecedente para a presença de pelo menos um AAF, foi de 1,75 [IC95: 0,31-9,75]. Conclusão: os antecedentes obstétricos desfavoráveis, assim como o Doppler de artérias uterinas não se correlacionaram com os AAF. O aumento da resistência ao Doppler nas artérias uterinas, isoladamente ou em associação aos antecedentes mórbidos, apresentou maior chance de complicações obstétricas/perinatais. Não foram encontradas diferenças estatísticas quando avaliado o Doppler associado com antecedentes e AAF
Abstract: The presence of antiphospholipid antibodies is often associated with obstetrical complications such as recurrent miscarriage, fetal death, placental abruption and severe early preeclampsia. Objective: To evaluate the association between a history of morbidity, uterine artery Doppler flow, serum antiphospholipid antibodies (APA) and perinatal/obstetric outcomes in a group of pregnant women. Subjects and methods: A cross-sectional cohort study evaluated pregnant women receiving care at Unicamp's prenatal clinic, who agreed to participate in the study. A questionnaire was applied to obtain data on the patient's history of morbidity, serum antiphospholipid antibodies were measured and a Doppler scan of the uterine arteries was performed. Results were correlated with obstetrical/perinatal outcome. Results: A total of 385 pregnant women with a mean age of 26.6 ± 6.3 years were evaluated. Anticardiolipin (aCL) and anti-ß2 glycoprotein I (anti-ß2-gpI) were evaluated in a group of 382 pregnant women, 4.4% of whom tested positive for anti-ß2-gpI IgM, 4.7% for IgG, 6.2% for ACL IgG and 6.7% for IgM. Lupus anticoagulant (LA) was evaluated in 137 pregnant women, 2.3% of whom tested positive. Overall, 33.4% of patients had a medical history that included recurrent miscarriage, fetal death, preeclampsia, prematurity, previous pregnancy resulting in an infant with birthweight of <2.500g or placental abruption. In addition, 2.6% had experienced a thrombotic event such as myocardial infarction, stroke, pulmonary thromboembolism or deep vein thrombosis. Overall, 16.5% of patients had at least one of the above-mentioned conditions and tested positive for APA compared to 13.3% of those with no medical history of any of these conditions (p=0.44). Ten percent of the women had experienced a thrombotic event and tested positive for APA while 14.4% had never had a thrombotic event and tested negative for APA (p=0.88). Obstetric and perinatal outcomes were analyzed in 305 women, and results showed that 31.7% of the women with a medical history of morbidities suffered at least one obstetrical complication in the current pregnancy compared to 28.4% in the group of women who had no medical history of morbidity (p=0.59). When each outcome was correlated with a history of at least one medical condition, preeclampsia was found in 7.7% of cases versus 4.5% in the group with no medical history (p=0.29), 5th minute Apgar score = 7 in 4.9% compared to 5.6% (p=0.57) and birthweight <2.500g in 15.5% compared to 12% (p=0.47). When the groups of women with and without a medical history of complication were analyzed separately and correlated with uterine artery Doppler, the women who reported having had an infant with a birthweight <2.500 grams were four times more likely (95%CI: 1.16-13.7) to have a pulsatility index (PI) above the 95th percentile and 4.68 times more likely (95%CI: 1.37-15.9) if they had a history of increased blood pressure prior to 34 weeks in their previous pregnancy. No significant correlations were found between other medical conditions and PI above the 95th percentile. When the PI was above the 95th percentile, there was a relative risk (RR) of 2.77 (95%CI: 1.87-4.11) of developing at least one obstetrical/perinatal complication, a RR of 5.19 (95%CI: 1.41-19.1) of 5th minute Apgar score being = 7 and a RR of 6.94 (95%CI: 4.31-11.1) of birthweight <2.500 grams. When PI above the 95th percentile was associated with at least one prior complication, the RR for birthweight <2.500 grams was 6.06 (95%CI: 3.19 - 11.5) and 6.61 (95%CI: 3.46 - 12.6) for delivery prior to 37 weeks. When the two groups were compared, no statistically significant correlation was found with respect to eclampsia (RR 4.70; 95%CI: 0.80 - 27.4). In the evaluation of PI above the 95th percentile and APA, 11.1% of patients had PI above the 95th percentile and at least one APA compared to 14.4% in the group without these characteristics (prevalence ratio [PR] 0.77; 95%CI: 0.11-4.96). The PR for the group with PI above the 95th percentile and at least one previous medical condition was 1.75 (95%CI: 0.31-9.75). Conclusion: Neither history of morbidity nor uterine artery Doppler was found to be associated with antiphospholipid antibodies. A significant correlation was found between increased uterine artery Doppler resistance, both when analyzed alone or in association with medical history, and obstetric/perinatal complications. No statistically significant differences were found between uterine artery Doppler associated with medical history and antiphospholipid antibodies
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Tocoginecologia
Doutor em Tocoginecologia
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44

Fang, Marino Alfredo Renato. "Características de la ultrasonografía Doppler de arterias uterinas entre 11-14 semanas de gestación y el desarrollo de preeclampsia." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2009. https://hdl.handle.net/20.500.12672/14630.

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Da a conocer las características de la ultrasonografía doppler de las arterias uterinas entre 11 – 14 semanas de gestación en relación al desarrollo de preeclampsia. La ultrasonografía doppler de las arterias uterinas entre 11 – 14 semanas de gestación predice el desarrollo de preeclampsia. Se realizó un estudio descriptivo, prospectivo de corte transversal en el servicio de obstetricia del Hospital Nacional Arzobispo Loayza entre el 01 junio 2008 y el 31 de mayo 2009. Se incluyeron todas las gestantes entre las 11 a 14 semanas que ingresaron durante el periodo de estudio con consentimiento informado. Se excluyeron las gestantes con edad gestacional menor de 11 o mayor de 14 semanas; con ecografía que sugirió malformaciones congénitas o que sufrieron aborto. Se les realizó la ecografía doppler y fueron seguidas hasta el parto; se revisaron las historias clínicas y los datos necesarios se anotaron en la ficha de recolección de datos. El Análisis estadístico se realizó con los paquetes SPSS 17 y MS Excel 2003, con intervalo de confianza de 95%, se usó Test Chi cuadrado o Fisher y regresión logística multivariada. Se trabajó con 140 gestantes de las cuales 24 (17.1%) desarrollaron preeclampsia, los antecedentes que presentaron asociación significativa con la enfermedad fueron: el antecedente de hipertensión arterial y antecedente de preeclampsia (p<0.01). Entre las características de la ecografía doppler se encontró que el índice de resistencia (IR) promedio fue 0.75 ± 0.11 y el índice de pulsatilidad (IP) promedio fue 1.76 ± 0.52; 72 gestantes (51.4%) presentaron notch bilateral y el IP > 2.35 se presentó en 20 gestantes (14%) de las que 16 presentaron preeclampsia (66.7% de ellas) y 4 no presentaron (3.4% de ellas) (p<0.0001), por lo que se considera como predictor de preeclampsia con sensibilidad de 66.7%, especificidad de 96.5%, VPP de 80% y VPN de 93.3%. El IP promedio entre 11 – 14 semanas de gestación fue 1.76 ± 0.52, el IR promedio fue 0.75 ± 0.11, El notch bilateral se presentó en 51.4% de las gestantes. El IP > 2.35 entre 11 – 14 semanas predice el desarrollo de preeclampsia. Palabras Claves: Doppler, primer trimestre, preeclampsia.
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45

Arcos, Flores Paul Glicerio, and Pumahuacre Alberto Salazar. "Curvas de flujometría Doppler de arterias uterinas en gestantes de bajo riesgo en el Instituto Materno Perinatal año 2002." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2004. https://hdl.handle.net/20.500.12672/1788.

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En el Instituto Especializado Materno Perinatal entre el 01 de febrero y el 30 de noviembre del 2002 a las gestantes que acudieron al control prenatal entre las 14 y 42 semanas de gestación se les ofreció la evaluación ecográfica con velocimetría Doppler de las arterias uterinas para realizar un estudio prospectivo descriptivo para determinar los valores normales de flujometría Doppler de las arterias uterinas entre las 11 - 42 semanas en gestantes de bajo riesgo obstétrico. Se determinó el índice de resistencia (IR) de ambas arterias, la reproducción de las mediciones y las variaciones intra e interobservador. 178 gestantes cumplieron los criterios de inclusión. La velocimetría Doppler de las arterias uterinas se realizó entre las 14 y 39 semanas de gestación. No hubo gestantes entre las 40 y 42 semanas. La onda de la arteria uterina izquierda se obtuvo en todas las pacientes pero la onda de la arteria uterina derecha solo en 163 (91,6%) gestantes. El IR media de la arteria uterina izquierda y derecha fue 0,58 y 0,55; respectivamente. El índice de resistencia de la arteria uterina derecha fue menor que el de la izquierda desde las 12 semanas de gestación. En el 95% de ocasiones, las variaciones intra e interobservador fueron menores de 0,12 y 0,15; respectivamente. Concluimos que el índice de resistencia de la arteria uterina derecha es menor que el de la arteria uterina izquierda, la medición del IR es altamente reproducible y las mediciones intra e interobservador del IR no difieren significativamente.
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46

Gadonski, Giovani. "Aspectos da fisiopatologia da pré-eclâmpsia: efeito da N-iminoetil-L-ornitina nas alterações hemodinâmicas renais durante a gestação e o papel da interleucina 6 na hipertensão produzida por redução na perfusão uterina em ratas prenhes." Pontifícia Universidade Católica do Rio Grande do Sul, 2006. http://hdl.handle.net/10923/4517.

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The present thesis evaluates different aspects of the physiopathology of preeclampsia in two studies. The role of endothelial nitric oxide sinthase (eNOS) in renal and systemic hemodynamic changes during pregnancy was the aim of the first experiment. To achieve this goal, N-iminoethyl-L-ornithine (L-NIO), the most potent eNOS inhibitor, was used. Acute L-NIO infusion in pregnant rats decreased glomerular filtration rate (GFR) and renal plasma flow (RPF), as well as increased renal vascular resistance (RVR). In contrast, L-NIO did not induce significant hemodynamic effects in virgin rats. These findings suggest that eNOS may play a role in mediating renal hemodynamic changes during normal pregnancy. A possible mechanism of PE is related to excessive intravascular inflammatory response. Chronic reductions in uterine perfusion pressure (RUPP) in pregnant rats are associated with increased arterial pressure (AP) and proteinuria. The purpose of the second study was to determine the role of interleukin-6 (IL-6) in mediating the increase in AP in response to RUPP in pregnant rats. Increased AP in pregnant RUPP rat was associated with increased IL-6 serum levels. Furthermore, chronic elevation in IL-6 serum level in pregnant rats, reaching levels similar to those observed in RUPP rats, was related to significant increment in AP and RVR as well as reduction in RPF and GFR compared to controls. Interleukin-6 increased plasma renin activity but did not change endothelin levels in pregnant rats treated with IL-6. Interleukin-6 had no effect on AP or renal hemodynamics in virgin rats. These data indicate that plasma IL-6 is elevated in response to chronic reductions in uterine perfusion in pregnant rats and that a comparable elevation in plasma IL-6 increases AP and reduces renal function in pregnant rats.
O presente trabalho aborda aspectos da fisiopatologia da pré-eclâmpsia (PE) em dois estudos. A avaliação da participação da isoforma endotelial da óxido nítrico sintase (eNOS) no processo de adaptação hemodinâmica renal e sistêmica observadas na gestação foi o objetivo do primeiro estudo. Para isso, foi utilizado o inibidor mais potente da eNOS, N-iminoetil-L-ornitina: L-NIO. A administração aguda de L-NIO em ratas prenhes diminuiu a taxa de filtração glomerular (TFG) e o fluxo plasmático renal (FPR), bem como aumentou a resistência vascular renal (RVR). Em contraste, L-NIO não apresentou efeitos hemodinâmicos significativos em ratas virgens. Esses achados sugerem que a eNOS possa ter um papel importante como mediador das alterações hemodinâmicas renais ocorridas durante a gestação. Um dos possíveis mecanismos ligados à gênese da PE ocorre devido à resposta inflamatória intravascular excessiva. O modelo de redução da pressão de perfusão uterina (RUPP) em ratas prenhes está associado ao aumento dos níveis de pressão arterial e proteinúria. O objetivo do segundo estudo foi investigar a participação da interleucina-6 (IL-6) no aumento da pressão arterial (PA) no modelo RUPP. A elevação na pressão arterial em ratas do modelo RUPP está associada ao aumento dos níveis de IL-6. A elevação dos níveis de IL-6 em ratas prenhes, atingindo níveis comparáveis àqueles encontrados em ratas do modelo RUPP, resultou em aumento significativo da PA e da RVR, além de redução do FPR renal e da TFG em relação ao grupo controle. A IL-6 induziu aumento na atividade plasmática da renina, mas não alterou significativamente os níveis de endotelina nas ratas tratadas com IL-6. A IL-6 não induziu efeitos significativos sobre os parâmetros hemodinâmicos renais em ratas virgens. Esses resultados indicam que os níveis de IL-6 estão aumentados no modelo RUPP e que o aumento dos níveis de IL-6 está associado à elevação da PA e diminuição dos parâmetros hemodinâmicos renais em ratas prenhes.
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47

Minaya, Ramírez Leonila. "Validez de la velocimetría Doppler de las arterias uterinas en la predicción de restricción de crecimiento intrauterino : Instituto Nacional Materno Perinatal, año 2011." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2012. https://hdl.handle.net/20.500.12672/12801.

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Objetivo: Determinar la utilidad de la velocimetría doppler de la arteria uterina entre las 20 – 26 semanas de gestación por medio de la determinación de la presencia de la incisura protodiástólica y la media de los índices de resistencia y pulsatilidad por encima del percentil 95 para la predicción de restricción de crecimiento intrauterino en el Instituto Nacional Materno Perinatal durante el período comprendido entre el 01 de abril y el 31 de diciembre de 2011. Material y métodos: Descriptivo retrospectivo, transversal de tipo validación de prueba diagnóstica. Resultados: Un total de 103 pacientes cumplieron los criterios de inclusión y en todas se obtuvo las ondas de flujometría satisfactoriamente. La prevalencia de restricción de crecimiento intrauterino fue 3,9. Diecisiete pacientes (16,5%) presentaron incisura protodiastólica de la onda de la flujometría de ambas arterias uterinas, mientras que en dos (1,9%) y 20 (19,4%) la media los índices de resistencia y pulsatilidad; respectivamente, fue > del percentil 95. El percentil 95 de la media del índice de pulsatilidad (IP) de la arteria uterina fue 1,84. Existió asociación entre la presencia de la incisura protodiastólica en la velocimetría doppler y la presencia de RCIU (60,0% vs 14,3%; p  0,05), y entre los índices de pulsatilidad (60,0% vs 17,3%; p  0,05) y resistencia (20,0% vs 1,0%; p  0,05) por encima del percentil 95 con RCIU. Las gestantes que presentaron la incisura protodiastólica de las arterias uterinas tuvieron 2,4 más riesgo de desarrollar RCIU (IC al 95%: 1,7 – 6,1; p  0,05), aquellas con el índice de pulsatilidad por encima del percentil 95 tuvieron 1,7 más riesgo de desarrollar RCIU (IC al 95%: 1,2 – 7,4; p  0,001) y en aquellas con el índice de resistencia por encima del percentil 95 el riesgo de desarrollar RCIU fue 3,2 (IC al 95%: 2,3 – 5,8; p  0,05) veces mayor. El análisis de regresión logística demostró que la presencia de la incisura protodiastólica de la onda de flujometría de las arterias uterinas y el índice de pulsatilidad por encima del percentil 95 se asociaron con RCIU. La curva ROC y los índices diagnósticos confirmaron la utilidad de la velocimetría doppler para predecir RCIU. Conclusiones: La valoración doppler de las arterias uterinas entre las 20 – 26 semanas de gestación identifica una proporción importante de mujeres que desarrollarán restricción de crecimiento intrauterino.
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48

Andía, Ruiz Víctor Martín. "Curvas de flujometría Doppler de arterias uterinas, umbilical y cerebral media en gestaciones de bajo riesgo en el Instituto Nacional Materno Perinatal, 2007." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2009. https://hdl.handle.net/20.500.12672/14479.

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En el Instituto Nacional Materno Perinatal se realizó un estudio descriptivo, observacional y prospectivo con el total de gestantes de bajo riesgo obstétrico a quienes se les realizo estudio mediante flujometría Doppler de las arterias uterinas, umbilical y cerebral media entre las 11 - 42 semanas, con control prenatal y parto en el Instituto Nacional Materno Perinatal entre el 1º de enero y el 31 de diciembre del 2007 con el objetivo de elaborar las curvas de los valores correspondientes al Índice de Resistencia y al Índice de Pulsatilidad de las arterias umbilical y cerebral media y el Índice de Resistencia promedio de las arterias uterinas. Un total de 1746 gestantes cumplieron los criterios de inclusión. El estudio mediante flujometría Doppler se realizó entre las 11 y 41 semanas de gestación. No hubo gestantes con 42 semanas. Las curvas de los Índices de Resistencia y Pulsatilidad de la arteria cerebral media mostraron aumento inicial hasta la semana de gestación 30 y disminuyeron posteriormente; mientras que estos mismos índices para la arteria umbilical disminuyen en relación inversa con la edad gestacional, al igual que el promedio del Índice de Resistencia de las arterias uterinas. Se concluyó que los valores de referencia actualizados del Índice de Resistencia y Pulsatilidad permiten optimizar la capacidad diagnóstica de la evaluación Doppler de las arterias uterinas, umbilical y cerebral media fetales contribuyendo a mejorar la vigilancia del embarazo normal y complicado.
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49

Sánchez, Cabrera Moisés Luis. "Uso de flujometría Doppler de arterias uterinas como predictor de pre – eclampsia en gestantes de alto riesgo, Hospital Nacional Dos de Mayo, 2010 - 2012." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2013. https://hdl.handle.net/20.500.12672/14420.

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Pretende encontrar una mayor asociación al analizar los parámetros simultáneamente. Este estudio descriptivo, transversal se realizó en el Hospital Nacional Dos de Mayo, durante el periodo de julio 2010 a julio 2012, con una muestra de 280 gestantes con alto riesgo para preeclampsia, a las cuales se les tomó una flujometría doppler de arterias uterinas durante la semanas 11 y 14 de gestación y posteriormente se identificó según la Historia clínica el diagnóstico de preeclampsia. Para el análisis de las variables categóricas, se empleó el test de chi cuadrado y análisis de regresión logística multivariado, se consideró significativo si p< 0.05. Se calculó la sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo. Los resultados encontrados de los parámetros flujométricos analizados con relación a la pre eclampsia, son para el Notch Bilateral: resultados no estadísticamente significativos; el IP promedio > 2.35: sensibilidad fue 66.7%, la especificidad 96.5%, el VPP fue 80% y VPN 93.3%, estadísticamente significativo (p<0.0001); Y la presencia de ambos Notch Bilateral y el IP promedio >2.35: la sensibilidad fue 62.5%, la especificidad 99.1%, el VPP fue 99.1% y VPN 92.7%, estadísticamente significativo (p<0.0001) y de mayor VPP que cuando sólo el IP es tomado en cuenta. En conclusión existe una mayor asociación cuando los dos parámetros están alterdos en una paciente con respecto al desarrollo de pre eclampsia que tomando solo un parámetro. La recomendación por tanto es realizar estudio de cohortes para hallar el riesgo relativo de estos parámetros y confirmar la asociación encontrada y tener un método predictivo confiable. De esta manera se encontraran con mayor certeza las pacientes que desarrollaran pre eclampsia y darle el tratamiento preventivo para disminuir el riesgo.
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50

Zumaeta, Rodríguez Miguel Augusto. "Índice de pulsatilidad medio de las arterias uterinas y su relación con preeclampsia y complicaciones perinatales. Instituto Nacional Materno Perinatal, octubre 2010 - mayo 2011." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2013. https://hdl.handle.net/20.500.12672/12371.

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Determina la utilidad del índice de pulsatilidad medio de las arterias uterinas mayor del percentil 95 como predictor de preeclampsia y complicaciones perinatales en gestantes durante el período comprendido entre octubre del 2010 a mayo del 2011. En el Instituto Nacional Materno Perinatal de Lima – Perú se realizó un estudio observacional, transversal, analítico y prospectivo comparando 24 gestantes con índice de pulsatilidad medio mayor del percentil 95 con otras 40 que no lo tuvieron. El análisis estadístico se realizó con el programa IBM Statistics SPSS 19. La media del índice de pulsatilidad fue 1,31 +/- 0,31 (rango: 0,53 – 2,08) y su distribución siguió una distribución bimodal. El riesgo de preeclampsia y de complicaciones perinatales en pacientes con índice de pulsatilidad medio de las arterias uterinas mayor del percentil 95 fue 5,23 (IC al 95%: 3,84 – 9,82) y 4,42 (IC al 95%: 2,98 – 6,34); respectivamente, en comparación con pacientes con índice de pulsatilidad medio de las arterias uterinas menor del percentil 95. El análisis multivariado demostró que las complicaciones materno perinatales independientes y significativas en gestantes con índice de pulsatilidad de las arterias uterinas mayor del percentil 95 fueron: morbilidad materna (OR 4,39; 95% IC 2,02 – 9,55), restricción de crecimiento intrauterino (OR 7,25; 95% IC 4,42 – 15,08), pequeño para la edad gestacional (OR 7,16; 95% IC 4,42 – 15,08), Apgar < 7 (OR 5,01; 95% IC 2,87 – 8,70), óbito fetal (OR 2,91; 95% IC 2,01 – 4,11) e ingreso a UCI (OR 3,39; 95% IC 2,19 – 4,30). Se concluyó que el índice de pulsatilidad medio de las arterias uterinas mayor del percentil 95 predice en forma significativa la presencia de preeclampsia y complicaciones materno-perinatales asociadas independientemente de la edad gestacional.
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