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Background: Pregnancies complicated by placental insufficiency are characterised by increased oxidative stress. It has been suggested that melatonin has antioxidant properties and contributes to the maintenance of placental homeostasis.... more
Background: Pregnancies complicated by placental insufficiency are characterised by increased oxidative stress. It has been suggested that melatonin has antioxidant properties and contributes to the maintenance of placental homeostasis. Objective: To systematically review the available literature about melatonin in pregnancies complicated by placental insufficiency, specifically preeclampsia and fetal growth restriction, exploring three different aspects: 1) maternal melatonin levels; 2) expression and activity of melatonin placental receptors; 3) effects of maternal melatonin administration. Search strategy: PubMed (Medline) and Scopus were searched until December 2020. Selection criteria: Published literature in English language describing the role of melatonin in pregnancies complicated by placental insufficiency, with a specific focus on preeclampsia and fetal growth restriction. Data collection and analysis: Identified studies were screened and assessed independently by two aut...
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Pain following laparoscopic surgery remains a neglected healthcare issue. Virtual reality-mediated therapy’s (VRT) analgesic potential could address this. However, its effect in this setting remains unexplored. We aimed to establish the... more
Pain following laparoscopic surgery remains a neglected healthcare issue. Virtual reality-mediated therapy’s (VRT) analgesic potential could address this. However, its effect in this setting remains unexplored. We aimed to establish the feasibility and safety of VRT as an adjunct analgesic following gynaecological laparoscopy and explore differences between active distraction and passive meditation content. 35 women were enrolled into an open crossover pilot and randomised to either intervention group 1 (active then passive content) or intervention group 2 (passive then active content) following surgery. VRT was administered in two 10-min segments with a 10-min washout period in between. Pain scores, opioid requirements and side effects were recorded before and after each segment whilst questionnaires evaluated acceptability. We observed a significant reduction in pain over time for the entire study population (F = 8.63, p < 0.0005) but no differences between intervention groups,...
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In summary, this dossier presents, transcribed and edited, the fruitful dialogue that has developed between the round table and the public regarding research in the arts. The entire event is available on the YouTube Platform*. These... more
In summary, this dossier presents, transcribed and edited, the fruitful dialogue that has developed between the round table and the public regarding research in the arts. The entire event is available on the YouTube Platform*. These speeches, recorded and transcribed, went through editing and revision until their final configuration, expressed in this document, in a more concise and formal character. Still in relation to its editing process, thanks to Daniel Portioli Rolnik, Technician for Administrative Affairs of the Music Department of FFCLRP-USP, for the excellent transcription that enabled the organizer to present this final text. https://www.youtube.com/watch?v=4UyqFi-UnlU&t=19028s&ab_channel=USPFILARM%C3%94NICARubensRussomannoRicciardi Em síntese, neste dossiê, apresenta-se, transcrito e editado, o profícuo diálogo que se desenvolveu entre a banca e o público a respeito da pesquisa em artes. A íntegra do evento encontra-se disponível na Plataforma YouTube[1]. Essas falas...
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This recommendation document follows the mission of the World Association of Perinatal Medicine in collaboration with the Perinatal Medicine Foundation. We aim to bring together groups and individuals throughout the world for precise... more
This recommendation document follows the mission of the World Association of Perinatal Medicine in collaboration with the Perinatal Medicine Foundation. We aim to bring together groups and individuals throughout the world for precise standardization to implement the ultrasound evaluation of the fetus in the first trimester of pregnancy and improve the early detection of anomalies and the clinical management of the pregnancy. The aim is to present a document that includes statements and recommendations on the standard evaluation of the fetal anatomy in the first trimester, based on quality evidence in the peer-reviewed literature as well as the experience of perinatal experts around the world.
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Background Community lockdowns during the coronavirus disease 2019 (COVID-19) pandemic may influence preterm birth rates, but mechanisms are unclear. Methods We compared neonatal outcomes of preterm infants born to mothers exposed to... more
Background Community lockdowns during the coronavirus disease 2019 (COVID-19) pandemic may influence preterm birth rates, but mechanisms are unclear. Methods We compared neonatal outcomes of preterm infants born to mothers exposed to community lockdowns in 2020 (exposed group) to those born in 2019 (control group). Main outcome studied was composite of significant neonatal morbidity or death. Results Median gestational age was 35 + 4 weeks (295 infants, exposed group) vs. 35 + 0 weeks (347 infants, control group) (p = 0.108). The main outcome occurred in 36/295 (12.2%) infants in exposed group vs. 46/347 (13.3%) in control group (p = 0.69). Continuous positive airway pressure (CPAP) use, jaundice requiring phototherapy, hypoglycaemia requiring treatment, early neonatal white cell and neutrophil counts were significantly reduced in the exposed group. Conclusions COVID-19 community lockdowns did not alter composite neonatal outcomes in preterm infants, but reduced rates of some common...
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In this issue of BJOG, Mendoza and colleagues report in an observational study the occurrence of a preeclampsia-like syndrome in six out of eight pregnant patients with novel coronavirus disease (COVID-19) who were admitted to the... more
In this issue of BJOG, Mendoza and colleagues report in an observational study the occurrence of a preeclampsia-like syndrome in six out of eight pregnant patients with novel coronavirus disease (COVID-19) who were admitted to the Intensive Care Unit (ICU) with severe pneumonia (Mendoza M, et al. BJOG 2020). There were no symptoms of preeclampsia amongst the 34 pregnant women who had mild forms of COVID-19. Importantly, the authors recorded not only routine laboratory test results, but also measured biophysical and biochemical markers that are typically altered in women with preeclampsia (uterine artery pulsatility index on Doppler ultrasound, serum soluble fms-like tyrosine kinase-1 [sFLT-1] and placental growth factor [PlGF]). Such markers were normal in five of the six cases, in whom the symptoms of preeclampsia resolved after improvement of the maternal clinical situation.The intriguingly high cumulative incidence of preeclampsia symptoms in women with severe coronavirus disease...
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OBJECTIVE To validate a combined algorithm for early prediction of pre-eclampsia (PE) in the Brazilian population. STUDY DESIGN This is an unplanned secondary analysis of a cohort study. Consecutive singleton pregnancies undergoing... more
OBJECTIVE To validate a combined algorithm for early prediction of pre-eclampsia (PE) in the Brazilian population. STUDY DESIGN This is an unplanned secondary analysis of a cohort study. Consecutive singleton pregnancies undergoing first-trimester screening for PE involving examination of maternal characteristics, medical history, and biophysical markers were considered eligible. Women were classified as low-or high-risk using a cutoff of 1/200, but the individual risk was not used to dictate management, as aspirin prophylaxis was given to women based solely on clinical risk factors. Receiver-operating characteristics (ROC) curves for PE, preterm PE(PE < 37) and early 34(PE < 34) were constructed and detection rates(DR) and false-positive rates(FPR) were calculated, adjusting for the effect of aspirin. Propensity score analysis was utilized to account for possible confounding by indication. MAIN OUTCOME MEASURES Screening performance and PE rates. RESULTS Among 1695 women, 323(19.1%) were classified as high-risk for PE and 1372(80.9%) were considered low-risk. Aspirin use was registered in 62(3.7%) in the high-risk group and 33(1.9%) in the low-risk group. There were 164(9.7%) women who developed PE, including 41(2.4%) with PE < 37 and 18(1.1%) PE < 34.Subgroups with aspirin had higher incidence of PE, suggest confounding by indication. The algorithm had an AUC of 0.87, DR of 72% for PE < 34; an AUC of 0.8, DR of 59% for PE < 37, both with FPR of 18%. Accounting for effect of aspirin, we observed an improvement in DR of PE < 37 to 67%. CONCLUSION Using combined predictive algorithm for preterm PE prediction is feasible in clinical practice in low/middle-income countries. Aspirin use needs to be accounted for when evaluating the performance of screening.
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Em síntese, neste dossiê, apresenta-se, transcrito e editado, o profícuo diálogo que se desenvolveu entre a banca e o público a respeito da pesquisa em artes. A íntegra do evento encontra-se disponível na Plataforma YouTube[1]. Essas... more
Em síntese, neste dossiê, apresenta-se, transcrito e editado, o profícuo diálogo que se desenvolveu entre a banca e o público a respeito da pesquisa em artes. A íntegra do evento encontra-se disponível na Plataforma YouTube[1]. Essas falas, gravadas e transcritas, passaram por edição e revisão até à sua configuração final, expressa neste documento, em caráter mais conciso e formal. Ainda em relação ao seu processo de edição, agradece a Daniel Portioli Rolnik, Técnico para Assuntos Administrativos do Departamento de Música da FFCLRP-USP, a transcrição exímia que possibilitou ao organizador apresentar este texto final. [1] https://www.youtube.com/watch?v=4UyqFi-UnlU&t=19028s&ab_channel=USPFILARM%C3%94NICARubensRussomannoRicciardi
Research Interests: Humanities and Art
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Are fetal fraction, test failure rate and positive predictive value (PPV) of cell-free fetal DNA (cffDNA) testing different in singleton IVF conceptions compared to spontaneous conceptions? Fetal fraction is significantly lower; test... more
Are fetal fraction, test failure rate and positive predictive value (PPV) of cell-free fetal DNA (cffDNA) testing different in singleton IVF conceptions compared to spontaneous conceptions? Fetal fraction is significantly lower; test failure rate is higher and PPV of cffDNA testing is lower in singleton pregnancies conceived by IVF than those conceived spontaneously. cffDNA testing, which analyses circulating cffDNA in maternal blood, has very high accuracy for detection of trisomy 21 in the general obstetric population. Focused and conclusive evidence regarding the test characteristics of cffDNA testing in IVF conceived pregnancies is lacking. This was a retrospective cohort study including spontaneously and IVF conceived singleton pregnancies collected consecutively between April 2013 and November 2016. A total of 4633 spontaneously conceived and 992 IVF pregnancies were included. The study was performed at an obstetric and gynecological ultrasound clinic in Melbourne, Australia. ...
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To compare the performance of three different screening methods (National Institute for Health and Clinical Excellence (NICE) guidelines, American College of Obstetricians and Gynecologists (ACOG) recommendations and Fetal Medicine... more
To compare the performance of three different screening methods (National Institute for Health and Clinical Excellence (NICE) guidelines, American College of Obstetricians and Gynecologists (ACOG) recommendations and Fetal Medicine Foundation (FMF) algorithm) for second trimester prediction of preeclampsia. This was a prospective non-intervention study in singleton pregnancies, including women attending for second trimester morphologic ultrasound at 19-22 weeks. Maternal characteristics, medical history, mean arterial pressure and mean uterine artery Doppler pulsatility index were recorded and used for risk assessment. Outcomes measured were preeclampsia with delivery before 34, before 37 and after 37 weeks gestation. Detection rates, false positive rates and positive likelihood ratios were calculated, and receiver operating characteristic curves were produced. We screened 543 women during the study. The incidence of preeclampsia before 34, before 37 and after 37 weeks was 0.5, 1.4 ...
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There is a growing movement to encourage reproducibility and transparency practices in the scientific community, including public access to raw data and protocols, the conduct of replication studies, systematic integration of evidence in... more
There is a growing movement to encourage reproducibility and transparency practices in the scientific community, including public access to raw data and protocols, the conduct of replication studies, systematic integration of evidence in systematic reviews, and the documentation of funding and potential conflicts of interest. In this survey, we assessed the current status of reproducibility and transparency addressing these indicators in a random sample of 441 biomedical journal articles published in 2000-2014. Only one study provided a full protocol and none made all raw data directly available. Replication studies were rare (n = 4), and only 16 studies had their data included in a subsequent systematic review or meta-analysis. The majority of studies did not mention anything about funding or conflicts of interest. The percentage of articles with no statement of conflict decreased substantially between 2000 and 2014 (94.4% in 2000 to 34.6% in 2014); the percentage of articles repor...
Research Interests: Science Policy, Documentation, Conflict, Biotechnology, Conflict of Interest, and 15 moreMedicine, Studies, Biological Sciences, Biomedical Research, Systematic review, Publication Bias, Clinical Sciences, Funding, Reproducibility of Results, Journal Articles, Raw Data, Replication Studies, Biomedical Literature, Medical and Health Sciences, and Paediatrics and reproductive medicine
The coumadin-induced skin necrosis is rare and occurs more frequently in the breasts, thighs and buttocks. We describe the first case of coumadin necrosis of the breast in Brazil in a 62-year-old patient.
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Research Interests: Medicine and Gynecology
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ABSTRACTBackgroundThe COVID-19 pandemic has resulted in a range of unprecedented disruptions to the delivery of maternity care globally and has been associated with regional changes in perinatal outcomes such as stillbirth and preterm... more
ABSTRACTBackgroundThe COVID-19 pandemic has resulted in a range of unprecedented disruptions to the delivery of maternity care globally and has been associated with regional changes in perinatal outcomes such as stillbirth and preterm birth. Metropolitan Melbourne endured one of the longest and most stringent lockdowns in 2020. This paper presents the protocol for a collaborative maternity dashboard project to monitor perinatal outcomes in Melbourne, Australia, during the COVID-19 pandemic.MethodsDe-identified maternal and newborn outcomes will be collected monthly from all public maternity services in Melbourne, allowing rapid analysis of a multitude of perinatal indicators. Weekly outcomes will be displayed as run charts according to established methods for detecting non-random ‘signals’ in health care. A pre-pandemic median for all indicators will be calculated for the period of January 2018 to March 2020. A significant shift is defined as ≤ six consecutive weeks, all above or be...
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Pregnancy is a physiological stress test that is reliant on adequate adaptation of the maternal cardiovascular system. Alterations to blood volume, cardiac output and total vascular resistance are keys to meeting the metabolic demands of... more
Pregnancy is a physiological stress test that is reliant on adequate adaptation of the maternal cardiovascular system. Alterations to blood volume, cardiac output and total vascular resistance are keys to meeting the metabolic demands of the mother and fetus and allowing for adequate perfusion of the uteroplacental unit. Failure of these haemodynamic adaptations can contribute to various disorders of pregnancy, including pre-eclampsia (PE) and fetal growth restriction (FGR). This chapter will explore the methods used to measure maternal cardiac function. We will focus on how they can be used to assess both physiological cardiovascular adaptations during pregnancy and maladaptations that may contribute to pathological processes such as fetal growth restriction.
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BackgroundCommunity lockdowns during the COVID-19 pandemic may influence preterm birth rates, but mechanisms are unclear.MethodsWe compared neonatal outcomes of preterm infants born to mothers exposed to community lockdowns in 2020... more
BackgroundCommunity lockdowns during the COVID-19 pandemic may influence preterm birth rates, but mechanisms are unclear.MethodsWe compared neonatal outcomes of preterm infants born to mothers exposed to community lockdowns in 2020 (exposed group) to those born in 2019 (control group). Main outcome studied was composite of significant neonatal morbidity or death.ResultsMedian gestational age was 35+4 weeks (295 infants, exposed group) vs. 35+0 weeks (347 infants, control group) (p = 0.108). The main outcome occurred in 36/295 (12.2%) infants in exposed group vs. 46/347 (13.3%) in control group (p = 0.69). Continuous positive airway pressure (CPAP) use, jaundice requiring phototherapy, hypoglycaemia requiring treatment, early neonatal white cell and neutrophil counts were significantly reduced in the exposed group.ConclusionsCOVID-19 community lockdowns did not alter composite neonatal outcomes in preterm infants, but reduced rates of some common outcomes, and early white cell and ne...
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Women in the pregnancy-puerperal cycle or those who are lactating have been deliberately excluded from participating in COVID-19 vaccine clinical trials that aimed to evaluate either the efficacy in inducing the formation of neutralizing... more
Women in the pregnancy-puerperal cycle or those who are lactating have been deliberately excluded from participating in COVID-19 vaccine clinical trials that aimed to evaluate either the efficacy in inducing the formation of neutralizing antibodies or the investigational products’ safety profile. Exclusion of pregnant and lactating women from such studies still certainly inequitably deny these women access to COVID-19 vaccines since these products’ availability became increasingly available to non-pregnant people and even during pregnancy in high-income settings. In this clinical opinion article, we discuss aspects of the prolonged pandemic, the emergence of viral variants, the risks of severe complications of COVID-19 in pregnant women, and the disproportionate impact on low- and middle-income countries. We argue that the decision to receive the COVID-19 vaccine should be a joint decision between the pregnant or lactating women and the healthcare providers while considering the available data on vaccine efficacy, safety, the risks of SARS-CoV-2 infection in pregnant women, and the woman's individual risk for infection and serious illness. The various types of vaccines already in use and their safety and effectiveness, and the potential risks and benefits of their administration to pregnant or lactating women are reviewed.
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Objective To identify the most effective procedures recommended for the prevention of preeclampsia. Data Sources A systematic review was performed in the following databases: Pubmed/MEDLINE, CINAHL, Web of Science, Cochrane and LILACS via... more
Objective To identify the most effective procedures recommended for the prevention of preeclampsia. Data Sources A systematic review was performed in the following databases: Pubmed/MEDLINE, CINAHL, Web of Science, Cochrane and LILACS via the Virtual Health Library (VHL). A manual search was also performed to find additional references. The risk of bias, the quality of the evidence, and the classification of the strength of the recommendations were evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Selection of Studies In the initial search in the databases, the total number of articles retrieved was 351, and 2 were retrieved through the manual search; after duplicate articles were removed, 333 citations remained. After a thorough review of the titles and abstracts, 315 references were excluded. Accordingly, 18 articles were maintained for selection of the complete text (phase 2). This process led to the exclusion of 6 studies. ...